ABSTRACT
BACKGROUNDS/AIMS: Operation room (OR) time is of great value affecting surgical outcome, complications and the daily surgical program with financial implications. METHODS: We retrospectively evaluated 570 consecutive patients submitted to ureteroscopy or ureterorenoscopy for the treatment of ureteral or renal stones. Demographic parameters, patient's stones characteristics, type of ureteroscope, surgeon experience and surgical theater characteristics were analyzed. OR time was calculated from the initiation of anesthesia to patient extubation. Multivariate analysis was conducted using a linear regression test with multiple parameters to identify predictors of OR time. RESULTS: Eight factors were identified as significant. These include total stones volume, ureteroscope used, stone number, nurses experience, radio-opacity of the stone on kidney-ureter-bladder X-ray, main surgeon experience, operating room type, and having a nephrostomy tube prior to surgery. CONCLUSIONS: The surgical team experience and familiarity with endourological procedure, and the surgical room characteristics has a crucial impact on OR time and effectiveness.
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INTRODUCTION: We evaluated the efficacy and safety of single lower calyceal tract combined with flexible nephroscopy for the management of staghorn renal stones by percutaneous nephrolithotomy. METHODS: The medical records of patients who underwent percutaneous nephrolithotomy for the management of staghorn stones were analyzed. We included patients aged >18 years, while patients with incomplete data and renal anatomical anomalies were excluded from the study. Stone-free rate, postoperative complications, procedure duration, fluoroscopy time, and length of hospitalization were recorded. Postoperative outcomes were evaluated by non-contrast computed tomography scan 4-6 weeks after the operation. Stone-free status was defined as the absence of residual stones >4 mm. RESULTS: The study cohort consisted of 103 consecutive patients. Stone-free rate was 65.0%. No complications were observed in 69.9% of the cases; most postoperative complications were Grade 1 (13.6%) and 2 (10.7%). Five patients (4.9%) suffered a Grade 3a complication and another patient (1.0%) suffered a Grade 3b complication. CONCLUSIONS: Percutaneous nephrolithotomy through a single lower calyceal tract combined with flexible nephroscopy can be a valuable treatment option for the treatment of staghorn calculi, providing efficacy and safety. Nevertheless, the present study is limited by both its retrospective nature and being conducted at a single centre and, thus, proper prospective studies with head-on comparisons are needed to prove or disprove the advantages and disadvantages of either approach.
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Objective. To evaluate and compare the efficacy and safety of retrograde versus antegrade ureteroscopic lithotripsy for the treatment of large proximal ureteral stones. Patients and Methods. We retrospectively analyzed the medical records of patients with proximal ureteral stones >15 mm, treated in our institution from January 2011 to January 2016. Intraoperative parameters, postoperative outcomes, and complications were recorded and compared between the two techniques. Results. Our analysis included 57 patients. Thirty-four patients (59.6%) underwent retrograde and 23 patients (40.4%) underwent antegrade ureteroscopy. There was no significant difference in patients' demographics and stone characteristics between the groups. Stone-free rate was significantly higher (p = 0.033) in the antegrade group (100%) compared to retrograde one (82.4%). Fluoroscopy time, procedure duration, and length of hospitalization were significantly (p < 0.001) lower in retrograde approach. On the other hand, the need for postoperative stenting was significantly lower in the antegrade group (p < 0.001). No difference was found between the groups (p = 0.745) regarding postoperative complications. Conclusions. Antegrade ureteroscopy is an efficient and safe option for the management of large proximal ureteral stones. It may achieve high stone-free rates compared to retrograde ureteroscopy with the drawback of longer operative time, fluoroscopy time, and length of hospitalization.
Subject(s)
Lithotripsy/methods , Ureteral Diseases/surgery , Ureteroscopy/methods , Urinary Calculi/surgery , Adult , Aged , Female , Humans , Male , Middle Aged , Ureter/pathology , Ureter/surgery , Ureteral Diseases/pathology , Urinary Calculi/pathologyABSTRACT
OBJECTIVE: To assess interobserver reliability and reproducibility of the Clinical Research Office of the Endourological Society (CROES) nephrolithometric nomogram. PATIENTS AND METHODS: Preoperative data and postoperative outcomes of 100 consecutive patients who underwent percutaneous nephrolithotomy were obtained. Patients' data were reviewed separately by 4 independent urologists of different academic level: an experienced attending endourologist, a graduated fellow, a young fellow, and a resident. Each rater adjusted a CROES score in all 100 patients. Interobserver reliability was analyzed by assessing intraclass correlation (ICC) and kappa coefficient among and between all different raters. RESULTS: Assessment of interobserver reliability showed good or excellent agreement among all raters. Moderate agreement was only found between the raters for the "presence of staghorn" score. ICCs among all raters expressed excellent levels for each independent CROES parameter and reached great statistical significance. The highest correlation was noticed for "stone burden" in contrast to "presence of staghorn" parameter that showed the lowest. ICC for the final CROES score revealed good to excellent agreement among all raters and all pairs of raters. CONCLUSION: CROES nephrolithometry is a reproducible nomogram. Reproducible results were obtained within a single institution by multiple reviewers of varying experience within a short period of time after undergoing standardized training.
