A retrospective study on retrograde Intra-renal Surgery with versus without the use of Ureteral Access Sheaths in patients with Nephrolithiasis

INTRODUCTION@#Placement of ureteral access sheath (UAS) prior to retrograde intra-renal surgery (RIRS) is done to provide easier re- entries, shorter operation time and better vision. However, some studies have associated the placement of UAS to increased morbidity and complications.@*OBJECTIVE@#The study aimed to compare outcomes of patients with nephrolithiasis who underwent RIRS with versus without placement of UAS.@*METHODS@#This is a retrospective cohort study among patients with nephrolithiasis who underwent RIRS with or without placement of UAS. The authors analyzed a total of 52 patients who underwent RIRS, 22 without, and 30 with UAS. Comparison of patients’ clinical profile, duration of post-operative hospital stay and the difference of their frequency were determined using Independent Sample T-test, Mann-Whitney U test and Fisher’s Exact test, respectively. STATA 15.0 was used for data analysis.@*RESULTS@#The two groups were similar in terms of clinical profile and operative outcomes. In terms of complications, there was one patient who had a failed surgery in the UAS group. Bleeding was reported in both groups. One-fourth of the patients had abdominal/bladder cramps and 13% had fever. Stone-free rate was 94% at 1 month and 92% at 3 months post-op. Readmission within 3 months was seen in four patients (8%) and retreatment was done on three patients (6%).@*CONCLUSION@#There is no significant difference in placing UAS or not prior to RIRS in terms of clinical profile and operative outcomes. Safety measures should be observed to prevent any bleeding and ureteral injuries during placement of UAS intra-operatively.

Design and Validation of a Non-biological 3D Printed Pelvocalyceal System (RIRS Box) for Simulation-based Training of Flexible Ureteroscopy: A Stage 2A Surgical Innovation Study

@#In the field of Urology, flexible ureterorenoscopy (fURS) remains a challenging skill for junior residents to develop due to its steep learning curve. Hence, training models were incorporated into simulation-based training to allow for novice trainees to overcome the learning curve without potentially compromising patient outcomes and minimize complications. OBJECTIVE: To describe the design and test the validity of a non-biological three-dimensional (3D) model of the pelvocalyceal system as a tool for simulation-based training for flexible ureterorenoscopy METHODS: This was a prospective, quasi-experimental, surgical innovation research stage 2a study conducted in a tertiary government hospital. The retrograde intrarenal surgery (RIRS) box was composed of four siliconized pelvocalyceal systems which were 3D printed using computed tomography urograms of actual patients. Thirty-two urologists were asked to perform flexible ureteroscopy using the RIRS box and were given a questionnaire to assess face and content validity using the Likert scale. RESULTS: The RIRS Box training model showed good face and content validity. The 3D printed pelvocalyceal system was judged to have a close anatomical resemblance to an actual calyceal system. While performing fURS, the RIRS box provided similar pelvocalyceal visualization and instrument handling as in an actual procedure. Majority of participants considered the training model useful for training (75%) and believed that it may improve the RIRS technique (46.8%). CONCLUSION: The RIRS Box training model may help urologists improve the manner in which they acquire technical knowledge and skills necessary in performing fURS.

Design and validation of a non-biological 3D printed pelvocalyceal system (RIRS BOX) for simulation-based training of flexible ureteroscopy: A stage 2A surgical innovation study

@#In the field of Urology, flexible ureterorenoscopy (fURS) remains a challenging skill for junior residents to develop due to its steep learning curve. Hence, training models were incorporated into simulation-based training to allow for novice trainees to overcome the learning curve without potentially compromising patient outcomes and minimize complications.@*OBJECTIVE@#To describe the design and test the validity of a non-biological three-dimensional (3D) model of the pelvocalyceal system as a tool for simulation-based training for flexible ureterorenoscopy.@*METHODS@#This was a prospective, quasi-experimental, surgical innovation research stage 2a study conducted in a tertiary government hospital. The retrograde intrarenal surgery (RIRS) box was composed of four siliconized pelvocalyceal systems which were 3D printed using computed tomography urograms of actual patients. Thirty-two urologists were asked to perform flexible ureteroscopy using the RIRS box and were given a questionnaire to assess face and content validity using the Likert scale.@*RESULTS@#The RIRS Box training model showed good face and content validity. The 3D printed pelvocalyceal system was judged to have a close anatomical resemblance to an actual calyceal system. While performing fURS, the RIRS box provided similar pelvocalyceal visualization and instrument handling as in an actual procedure. Majority of participants considered the training model useful for training (75%) and believed that it may improve the RIRS technique (46.8%).@*CONCLUSION@#The RIRS Box training model may help urologists improve the manner in which they acquire technical knowledge and skills necessary in performing fURS.

Correlation of monitoring the renal pelvic pressure in RIRS and the morbidity of postoperative fever / 局解手术学杂志

Objective To investigate the clinical significance of monitoring the renal pelvic pressure( RPP) and regulating the manual perfusion pressure in flexible ureteroscope holmium laser lithotripsy. Methods A total of 189 patients with upper urinary tract calculi treated by RIRS in our hospital were retrospectively analyzed from August 2014 to August 2017. The renal pelvic pressure was monitored during RIRS in 136 cases( monitored group) whereas no monitoring occurred in the rest 53 cases( unmonitored group) . The monitored group was divided into two sub-groups of 49 cases named high-pressure group(the cumulative time of renal pelvis pressure upon 40 cmH2O≥1 min) and 87 ca-ses named low-pressure group respectively. The morbidity of postoperative fever ( T≥38. 5℃) was evaluated statistically between monitored group and unmonitored group,meanwhile between high-pressure group and low-pressure group. Results Postoperative fever did not correlate to age,sex,involved kidney,and postoperative urinary tract infection. Whether renal pelvic pressure was monitored or not,infection calculi, duration of operation and whether the cumulative time of renal pelvis pressure upon 40cmH2O≥1 min contributed to postoperative fever. The rate of postoperative fever in unmonitored group was higher than monitored group while the same between high-pressure group and low-pres-sure group,with statistically significant difference(P<0. 05). Conclusion Monitoring the intraoperative RRP and regulating the manual perfusion pressure during RIRS has positive significance in postoperative recovery and contribute to reducing postoperative fever.

Intraparenchymal hematoma as a late complication of retrograde intrarenal surgery

ABSTRACT A 34 year-old woman was admitted to our hospital with left flank pain. A non-contrast enhanced computerized tomography (NCCT) revealed a 1.5x2cm left proximal ureter stone. Patient was scheduled for ureterorenoscopy (URS) and stone removal. She was submitted to retrograde intrarenal surgery (RIRS). At the postoperative 1st day, the patient began to suffer from left flank pain. A NCCT was taken, which revealed a subcapsular hematoma and perirenal fluid. The patient was managed conservatively with intravenous fluid, antibiotic and non-steroidal anti-inflammatory drug therapy and was discharged at the postoperative 6th day. Two weeks after the discharge the patient was admitted to emergency department with severe left flank pain, palpitation and malaise. KUB (kidney-ureter-bladder) radiography showed double-J stent (DJS) to be repositioned to the proximal ureter. Patient was evaluated with contrast enhanced CT which revealed an 8cm intraparenchymal hematoma/abscess in the middle part of the kidney. A percutaneous drainage catheter was inserted into the collection. The percutaneous drainage catheter and the DJS were removed at the 10th day of second hospitalization. RIRS surgery is an effective and feasible choice for renal stones with high success and acceptable complication rates. However, clinician should be alert to possible complications.