ABSTRACT
PURPOSE: To prospectively evaluate the rate and associated risk factors of early infectious complications after ureterorenoscopy for urolithiasis. METHODS: After ethical committee approval, 400 therapeutic retrograde ureterorenoscopy procedures between August 3, 2020 and November 24, 2021 were included for analysis in a single-center study. Postoperative infection was defined as an afebrile urinary tract infection, fever (≥ 38 °C) with pyuria (≥ 300 WBC/µL) or proven urinary pathogen, and urosepsis. The primary outcome was the rate of infectious complications after ureterorenoscopy. Secondary outcomes were the perioperative factors that increased the risk of infectious complications within 30 days of surgery using univariate and multivariate logistic regression analysis. RESULTS: Twenty-nine of four hundred (7.3%) patients developed an infectious complication within 30 days after ureterorenoscopy. Ten (2.5%) patients developed an afebrile urinary tract infection, eight (2.0%) developed fever with pyuria, five (1.3%) febrile urinary tract infection, and six (1.5%) urosepsis. On univariate analysis, preoperative stent-type JFil® pigtail suture stent was significantly associated with the dependent variable (p < 0.001). On multivariate logistic regression analysis, older age (OR 1.035; 95% CI 1.006-1.070; p = 0.02) was found to be significantly associated with developing a postoperative infectious complication. CONCLUSIONS: A 7.3% rate of postoperative infectious complications and 1.5% urosepsis rate were observed after therapeutic ureterorenoscopy, without the need of intensive care admission. The only significant risk factors were preoperative stent type (JFil® pigtail suture stent) on univariate analysis, and older age on multivariate logistic regression analysis. Further multicentric prospective observational data are needed in this field.
Subject(s)
Postoperative Complications , Ureteroscopy , Urinary Tract Infections , Humans , Male , Female , Prospective Studies , Risk Factors , Ureteroscopy/adverse effects , Middle Aged , Urinary Tract Infections/epidemiology , Urinary Tract Infections/etiology , Adult , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Aged , Time Factors , Sepsis/etiology , Sepsis/epidemiology , Urolithiasis/surgeryABSTRACT
Introduction: Collecting duct, or Bellini duct, renal cell carcinoma (CDRCC) is a rare tumour, comprising only 0.4-2% of all renal cell carcinoma. The goal of this study was to evaluate the cases in our institution and look at current available literature. Material and methods: We searched all data on renal cell tumours in our institution between 2011 and 2021 and identified four cases with confirmed CDRCC pathology. Important features were listed and analysed. We also reviewed current available literature and compared it to our case series. Results: All cases were men with a median age of 63.5 years. All were symptomatic at presentation. Two patients presented with flank pain and two with gross haematuria. Three patients had stage IV disease at time of presentation and one stage III disease. All cases had clear Bellini duct renal cell carcinoma appearance on microscopy with infiltrative tubular architecture and high-grade nuclear features. Immunohistochemic (IHC) staining was performed for diagnostic confirmation. Three patients underwent radical nephrectomy and received adjuvant chemotherapy. One case had kidney biopsy for diagnostic confirmation and received first line chemotherapy. Immunotherapy or tyrosine kinase inhibitor (TKI) were started for second, third or fourth line of treatment. Median overall survival after diagnosis was 11 months. Conclusions: CDRCC is a rare subtype of renal cell carcinoma with poor prognosis, typically presenting in a more advanced or metastatic stage. Diagnosis can be challenging. Multimodality treatment should be considered using radical surgery and systemic treatment.
ABSTRACT
There is currently insufficient in vivo evidence that high-power Ho:YAG lasers improve retrograde intrarenal surgery or the ablation efficacy. While prospective trials are awaited, a low-cost, silent, low-power Ho:YAG laser that requires only a standard electrical outlet is more than sufficient for retrograde intrarenal surgery.
