Feasibility of minimally invasive management in patients with forgotten double J stent: a single centre experience

Background: aim of the study was to present the experience in managing forgotten/encrusted Double J (DJ) ureteral stents and to review the literature on the subject.Methods: Author retrospectively studied patients presenting to the Outpatient Department from January 2016 to January 2019 with forgotten DJ stent(s) (six or more than six months after the insertion). Data was collected for age, gender, indication for DJ stenting, clinical features at presentation, radiological imaging and surgical procedure performed to extract the DJ stents. The post-operative stay, complications of the procedures and morbidity was also studied.Results: During the study period, a total 32 patients reported to the department with history of forgotten DJ stents. Most common age group involved was 41-60 years. Most common presenting symptoms were lower urinary tract symptoms (LUTS) or dysuria.  Duration of stent in-situ ranged from 6 month to 15 years. Most common sites of encrustations along the forgotten DJ stent were ureter and kidney followed by urinary blabber. Fluoroscopic guided DJ stent removal was done in 8 patients. A combination of Cystolithotripsy, URSL and PCNL was needed to clear the stone and extract the DJ stent in remaining patients.Conclusions: Forgotten/encrusted DJ stent may lead to complications ranging from urinary tract infections to loss of renal function. They can be safely and successfully removed, and the renal function can be preserved. Endo-urological management of forgotten encrusted stents is highly successful and often avoids the need for open surgical techniques.

Flexible ureterorenoscopy vs extracorporeal shock wave lithotripsy for inferior calyceal calculi of 10 ~ 20 mm / 中国内镜杂志

Objective To compare the subjective and objective outcomes of flexible ureterorenoscopy (F-URS) and extracorporeal shock wave lithotripsy (ESWL) for the treatment of inferior calyceal calculi between 10 to 20 mm. Method A retrospective analysis was performed for inferior calyceal calculi between 10 to 20 mm at our institution on a total of 112 patients treated with holmium laser lithotripsy or ESWL from September 2013 to September 2016. Retreatment rate, complications, stone clearance rate and subjective patient-reported outcomes were compared. Result Stone clearance rate was significantly higher in F-URS group compared with ESWL group (86.1% vs 61.8%, P < 0.05). Retreatment rate (44.7% vs 8.3%, P < 0.05) was higher in ESWL. There was no significant difference in complication (11.1% vs 7.9%, P > 0.05). Overall satisfaction score [(2.92 ± 1.24) vs (2.07 ± 1.35), P < 0.05] and voiding symptom score [(3.87 ± 0.64) vs (2.23 ± 0.73), P < 0.05)] were significantly higher in F-URS than ESWL. More patients in F-URS were willing to undergo the procedure again (83.3% vs 55.3%, P<0.05). Conclusion For the treatment of intermediate size inferior calyceal calculi,F-URS is superior to ESWL in terms of stone clearance rate, retreatment rate and subjective satisfaction.

Cirugía intrarrenal retrógrada para el tratamiento de litiasis renal. Experiencia de 63 casos en un centro ambulatorio / Retrograde Intrarenal Surgery for the Treatment of Renal Lithiasis. An Experience in 63 Cases in an Ambulatory Center

Objetivos: El objetivo del estudio fue evaluar nuestra experiencia inicial en cirugía intrarrenal retrógrada para el tratamiento de litiasis renales y determinar si es una cirugía eficaz y segura para realizarse en un centro ambulatorio. Materiales y métodos: Se evaluó a todos los pacientes sometidos a ureterorrenoscopia flexible con láser Holmium en la Clínica Andina de Urología luego de un año de procedimientos. Se determinaron datos demográficos, características de las litiasis operadas, porcentaje libre de litiasis y complicaciones según escala modificada de Clavien. Resultados: Un total de 63 pacientes fueron intervenidos desde marzo de 2017 a marzo de 2018. El tamaño medio de las litiasis urinarias fue de 11,6 mm. En un 93,6% de los pacientes la cirugía se pudo completar sin inconvenientes con un tiempo medio de 44 minutos. El porcentaje global libre de litiasis fue del 76,19%. Un 17,4% tuvo complicaciones generales, sin embargo, solo 2 pacientes requirieron reinternación. Conclusiones: La ureterorrenoscopia flexible es una cirugía mínimamente invasiva, eficaz y segura, con un bajo índice de complicaciones (AU)

Objectives: The aim of this study was to evaluate our initial experience in retrograde intrarenal surgery for the treatment of renal lithiasis and determinate if the surgery is effective and safe to be practice in an ambulatory center. Materials and methods: We recorded all patients who underwent flexible ureterorenoscopy and laser Holmium at Clínica Andina de Urología after one year of surgeries. Demographic information, stones characteristics, stone free rate and complication using Clavien system were gathered. Results: A total of 63 patients underwent flexible ureterorenoscopy from March 2017 to March 2018. Mean stone diameter was 11.6 mm. Surgery was complete in 93.6% of patients with a mean operative time of 44 minutes. Stone free rate was 76.19%. The overall complication rate was 17.4%, nevertheless, only 2 patients were readmitted. Conclusions: IFlexible ureterorenoscopy is a minimally invasive procedure, effective and safe, with a low rate of complications. (AU)

Tratamiento de la litiasis urinaria: ¿hay algún espacio actualmente para la laparoscopía? / Treatment of urolithiasis: currently is there any space for laparoscopy?

Resumen: Introducción: el desarrollo de técnicas de mínimo acceso en el tratamiento de litiasis urinaria ha modificado el manejo de esta patología en la actualidad; sin embargo, el desafío terapéutico continúa siendo grande en pacientes con cálculos complejos del uréter proximal y pelvis renal, donde una buena opción es la cirugía laparoscópica. Materiales y métodos: fueron tratados mediante cirugía laparoscópica 10 pacientes durante el primer semestre del año 2016, portadores de litiasis piélica compleja y de uréter proximal (> 15 mm); edad: 38 años (±11.66). Localización de los cálculos: 8 en el uréter proximal y 2 en la pelvis renal. Resultados: tiempo operatorio: 65 a 270 minutos; pérdida de sangre media: 31.25 ml (± 6.29), producción del dren en el primer día: 36 a 45 ml. Dolor postoperatorio en el primer día postquirúrgico: 3.5 (EVA) (± 2.22). El resultado cosmético fue muy satisfactorio para todos (media: 9.5 ± 0.05). Tasa libre de litiasis: 100%. Discusión: el manejo de los cálculos ubicados en el uréter proximal, cuando son voluminosos o piélicos complejos, son un desafío debido a su menor tasa libre cálculos ya sea con ureterorrenoscopia o litotripcia extracorpórea; una opción para el tratamiento de este tipo de litiasis es la cirugía laparoscópica (tasa libre de cálculos hasta 100% en una sola sesión) y mejoría de los parámetros como estancia hospitalaria, requerimiento de tratamiento analgésico adicional, recuperación y resultados cosméticos. Conclusiones: los cálculos de volumen considerable o situados en una parte del aparato urinario de difícil acceso se tratan con éxito a través del abordaje laparoscópico, que es una opción ideal que sustituye el abordaje abierto y métodos endourológicos en casos seleccionados. Palabras claves: ureterolitotomía laparoscópica, cálculo ureteral, cálculo piélico, ureterorrenoscopia, litotripcia extracorpórea

Introduction: The development of minimal access techniques in the treatment of urolithiasis has changed the management of this condition today; however the therapeutic challenge remains in patients with complex stones in proximal ureter and renal pelvis in which laparoscopic surgery is a good option. Materials and Methods: 10 patients were treated during the first half of 2016, whith diagnosis of complex pelvic lithiasis and proximal ureteral stones (> 15 mm); laparoscopic surgery was indicated. The mean age was 38 years (± 11.66). The location of these lithiasis was 8 proximal ureter and 2 in the renal pelvis. Results: Operative time ranged from 65 minutes to 270 minutes; the mean blood loss was 31.25 cc (± 6.29), drain production on the first day was between 36 ml - 45 ml. Postoperative pain on the first day after surgery was 3.5 (VAS) (± 2.22). The cosmetic result was very satisfactory for all, with an average of 9.5 (± 0.05). stone-free rate was 100%. Discussion: The management of bulky proximal ureteral stones or complex pyelic stones are a challenge because of its low stone-free rate either with ureterorenoscopy or external shock wave lithotripsy; an option for treating this type of stones is laparoscopic surgery, with a stone-free rate up to 100% in a single session and improving parameters such as hospital stay, requirement for additional analgesic treatment, early recovery, and cosmetic results. Conclusions: In complex situations ureteral or pyelic stones are successfully treated through laparoscopic approach, being an ideal choice to replace the open approach and endoruologic methods in selected cases. Key words: laparoscopic ureterolithotomy, ureteral stones, pyelic stones, ureterorenoscopy, shock wave lithotripsy.

Comparison of retrograde intrarenal surgery versus a single-session percutaneous nephrolithotomy for lower-pole stones with a diameter of 15 to 30 mm: A propensity score-matching study

PURPOSE: To investigate surgical outcomes between retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) groups for a main stone sized 15 to 30 mm and located in the lower-pole calyx. MATERIALS AND METHODS: Patients who underwent PNL or RIRS for a main stone sized 15 to 30 mm and located in the lower-pole calyx were retrospectively reviewed. Each patient in the RIRS group was matched to one in the PNL group on the basis of calculated propensity scores by use of age, sex, body mass index, previous treatment history, stone site, maximum stone size, and stone volume. We compared perioperative outcomes between the unmatched and matched groups. RESULTS: Patients underwent PNL (n=87, 66.4%) or RIRS (n=44, 33.6%). After matching, 44 patients in each group were included. Mean patient age was 54.4+/-13.7 years. Perioperative hemoglobin drop was significantly higher and the hospital stay was longer in the PNL group than in the RIRS group. The operative time was significantly longer in the RIRS group than in the PNL group. Stone-free rates were higher and complications rates were lower in the RIRS group than in the PNL group without statistical significance. The presence of a stone located in the lower-anterior minor calyx was a predictor of stone-free status. CONCLUSIONS: RIRS and single-session PNL for patients with a main stone of 15 to 30 mm located in the lower-pole calyx showed comparable surgical results. However, RIRS can be performed more safely than PNL with less bleeding. Stones in the lower-anterior minor calyx should be carefully removed during these procedures.

Flexible ureterorenoscopy for upper urinary tract treatment using new 7.5 F 270 degree deflectable ureteroscope: Siriraj Hospital early experience.

Objective: To evaluate the efficacy and report our experience of using a flexible ureterorenoscopy in the diagnosis and therapy for upper urinary tract disease. Methods: Between September 2005 and June 2008, 21 upper urinary tract procedures were performed with 7.5 F actively deflectable, flexible ureteroscope. Of these 13 were for diagnostic reasons and eight for therapeutic purposes. A retrospective data of these procedures was collected. The indication, diagnostic or therapeutic procedure, operative time, success rate and postoperative course were analyzed. Results: The procedures were performed in 21 patients (mean age 66.71 years; range, 47-85 years; 11 procedures in males and 10 procedures in females). The indications were lateralizing essential hematuria (2), hematuria with upper tract radiolucent lesions (11), upper tract lesions without hematuria (3) and stones (5). In the diagnostic group, the mean operative time was 50 min (range 15-120). The procedure was completed successfully in all patients. The most common endoscopic finding was urothelial carcinoma in hematuria with upper tract lesions (9/11). In the therapeutic group (stone removal five, tumor fulguration three), the mean operative time was 83.12 min (range 30-160). The success rate of these therapeutic procedures was 62.5% (5/8). There was no intra and postoperative major complication. With an average follow up of 14 months (range 1-33), no patient had a late complication, such as ureteral stricture. The flexible ureteroscope did not need repair during this study. Conclusion: Flexible ureterorenoscopy is an effective and minimally invasive diagnostic and therapeutic tool for upper urinary tract disease.

The Experience of Ureterorenoscopic Lithotripsy with Insertion of Ureterorenoscope between Two Safety Guide Wires Serving as an Access Port / 대한비뇨기과학회지

PURPOSE: Although ureterorenoscopic lithotripsy (URSL) is highly successful in urinary calculous disease, there are still several problems associated with the procedure, such as the difficulty in learning the procedure and the relatively high risk of ureteral injury. We performed an URSL, with the insertion of an ureterorenoscope between two safety guide wires, which served as an access port, without the need for ureteral dilatation (new URSL), and evaluated the usefulness and efficacy of this method by a comparison of our results with those of a series of conventional URSL. MATERIALS AND METHODS: Sixty-six ureteral stones (63 cases) were treated by a new URSL procedure. At the beginning of the procedure, two safety guide wires were inserted into the ureter. The ureterorenoscope was then inserted into the ureter between the safety guide wires. The outcomes were assessed, and compared to 140 cases of conventional URSL performed by the same operator. RESULTS: The overall success rate of the new URSL procedure was 98%. The mean operation time and postoperative hospital stay were 33 minutes (10-70min) and 1.4 days (1-6 day), respectively. Complications were observed in 5 cases (7.5%), and included, an ureteral perforation in 1 case, mild to moderate ureteral injury in 2, a gross hematuria in 1 (>48 hr) and flank pain in another. CONCLUSIONS: Based on our experience, the new URSL has several merits compared to the conventional procedure, such as no need for ureteral dilatation, easiness of the insertion of the ureterorenoscope into the ureter, prevention of upward migration of the stone during the procedure, and the better visual operation field. The new URSL procedure is relatively easy to perform, with few complications, and would, therefore, be an alternative to conventional URSL.

The management of upper urinary tract hematuria by ureterorenoscopy / 中华泌尿外科杂志

Objective To improve the diagnosis and treatment of upper urinary tract hematuria. Methods A total of 121 patients with hematuria who had undergone B-utrasonography,KUB plus IVU,CT and cystoscopy were suspected of hematuria from upper urinary tract.For these cases ureterorenoscopy was performed to establish the diagnosis and to conduct specific therapies. Results The diagnostic accordance rate was 92%(111/121).Among these cases,ureteral small stones in middle and lower segments were found in 45 cases;renal pelvis and ureteral tumors in 32 cases;renal hemorrhagic diseases in 19 cases and ureteral polyps in 15 cases.19 cases who had renal hemorrhagic diseases and 10 who had no definite lesions received specific therapies were followed up for 6 to 8 months.The long-term successful rate was 79%(23/29). Conclusions The application of ureterorenoscopy for the management of upper urinary tract hematuria is quite effective and worthy of widespread application.

Ureterorenoscopy in the Evaluation of Upper Urinary Tract Disease / 대한비뇨기과학회지

A prospective study of our first 76 cases of ureterorenoscopy using extended length rigid and flexible endoscopes was performed. 63 stone manipulation were attempted in 61 patients by 2 endoscopists 46(73.0% ). Analyzed sequentially, removal was successful in 21 of 32 attempts(65. 6%) among the initial 40 cases and in 25 of 31 (80.6% ) among the subsequent 36 cases. Of 12 calculi larger than 5mm and of 12 positioned above the iliac vessels 6(46.2%). 7(58.3%), respectively, were removed successfully. Diagnostic and therapeutic uses of the ureteroscope in and delineation of ureteral filling defect(5 cases). In 4 cases information was obtained endoscopically that was not possible by standard diagnostic techniques. The direct visual approach to the ureter has distinct advantages over blind ureteral instrumentation.

Clear visual field ureterorenoscopy by using ureteral catheter / 대한비뇨기과학회지

Uereterorenoscopy has become a useful diagnostic tool for the evaluation and treatment of the ureteral diseases such as the filling defect upper tract hematuria and abnormal cytology. Keeping a clear visual field in ureterorenoscopy is an essential for the reducing of complication such as ureteral perforation. We used alternative suction with 4 Fr. ureteral catheter through side hole of ureterorenoscopic sheath in 32 cases without serious complications. We believe that this method may help not only keeping clear visual field but also doing ureterorenoscopy safely, while use ureteral catheter as a safety guide wire.