Obstructive struvite ureterolithiasis in 4-month-old intact male Bernese mountain dog.

A 4-month-old, 7 kg, intact male, Bernese mountain dog was presented for obstructive struvite ureterolithiasis. Multiple urethroliths, ureteroliths, and urocystoliths were present. Based on an abdominal ultrasound, there was severe left hydronephrosis and hydroureter from distal ureterolith obstruction, just proximal to the vesicoureteral junction. The dog was not azotemic. Successful treatment was accomplished via ventral cystotomy. Bladder wall culture revealed a methicillin-resistant Staphylococcus spp. No predisposing cause was identified. There are no known genetic predispositions in Bernese mountain dogs for struvite urolithiasis. The urinary tract infection resolved with surgical retrieval of the uroliths and antibiotic treatment. The dog remained clinically normal after the cystotomy but developed a subclinical urinary tract infection 4 mo post-operatively. Key clinical message: Urolithiasis is rare in pediatric veterinary patients. To the authors' knowledge, this is the first report of obstructive ureterolithiasis in a puppy. There is no known genetic predisposition for urolithiasis in Bernese mountain dogs.

Urétérolithiase obstructive à struvite chez un bouvier bernois mâle intact de 4 mois. Un bouvier bernois mâle intact de 4 mois, pesant 7 kg, a été présenté pour une urétérolithiase obstructive à struvite. De multiples urétrolithes, urétérolithes et urocystolithes étaient présents. Sur la base d'une échographie abdominale, il y avait une hydronéphrose gauche sévêre et un hydro-uretêre dû à une obstruction distale de l'urétérolithe, juste en amont de la jonction vésico-urétérale. Le chien n'était pas azotémique. Le succês du traitement a été obtenu par cystotomie ventrale. La culture de la paroi vésicale a révélé un Staphylococcus spp. résistant à la méticilline. Aucune cause prédisposante n'a été identifiée. Il n'y a pas de prédisposition génétique connue chez les bouviers bernois pour la lithiase urinaire à struvite. L'infection des voies urinaires s'est résolue avec l'extraction chirurgicale des urolithes et un traitement antibiotique. Le chien est resté cliniquement normal aprês la cystotomie mais a développé une infection subclinique des voies urinaires 4 mois aprês l'opération.Message clinique clé:La lithiase urinaire est rare chez les patients vétérinaires pédiatriques. À la connaissance des auteurs, il s'agit du premier rapport d'urétérolithiase obstructive chez un chiot. Il n'y a pas de prédisposition génétique connue pour la lithiase urinaire chez les bouviers bernois.(Traduit par Dr Serge Messier).

Comparison of the effects of retroperitoneoscopic ureterolithotomy and ureteroscopic lithotripsy in the treatment of upper ureteral calculi.

ABSTRACT: This study compares the efficacy of retroperitoneoscopic ureterolithotomy (RPUL) and ureteroscopic lithotripsy (URL) in the treatment of upper ureteral calculi.The clinical data of 150 patients with upper ureteral calculi who underwent RPUL and 136 patients who underwent URL between January 2014 and October 2019 were retrospectively analyzed. The operation time, postoperative hospital stay, operation success rate, stone clearance rate, and surgical complications were evaluated between the two groups.For the RPUL and URL groups, respectively, the average operation time was 74.5 ±â€Š24.6 minutes and 54.5 ±â€Š13.2 minutes; the postoperative hospital stay was 5.8 ±â€Š1.4 days and 3.2 ±â€Š1.2 days; the operation success rate was 96.0% (144/150) and 85.3% (116/136); the incidence rate of complications was 3.5% (5/144) and 17.5% (18/103); and the stone clearance rate was 100% (144/144) and 88.8% (103/116), which were all statistically significant (P < .05).Both RPUL and URL had the advantages of low trauma and fast recovery rate for patients with upper ureteral calculi. However, patients who underwent RPUL showed higher success and fewer complication rate. RPUL might be a safe and effective laparoscopic method for the treatment of patients with upper ureteral calculi.

Risk factors and clinical relevance of positive urine cultures in cats with subcutaneous ureteral bypass.

BACKGROUND: The objective of the study was to report the incidence and risk factors associated with positive urine bacterial cultures as well as long-term outcome in cats with subcutaneous ureteral bypass (SUB) devices. RESULTS: Medical records of cats that underwent SUB device placement were retrospectively reviewed. Signalment of the cat, laterality of the ureteral obstruction, surgery, anesthesia and hospitalization duration, bacterial culture results and follow-up data were retrieved. Thirty-two cats met the inclusion criteria. Four cats (12.5%) had a positive intraoperative culture, with two of them being treated successfully. Ten cats out of 28 (35.7%) were documented with a positive urine culture during follow-up period, with a median time between discharge and identification of the first positive urine culture of 159 days (range 8-703 days). Bacteriuria resolved in 60% of cats (6/10). Escherichia coli was the most common organism, isolated in 4 out of 10 postoperative urine cultures. Overall, subclinical bacteriura was documented for 6 of 32 (18.8%) cats and 5 of 32 (15.6%) cats displayed clinicals signs suggestive of persistent UTI. One cat had subclinical bacteriuria. Three cats died during the follow-up period. There was a significant difference between negative and positive urine bacterial culture groups in median hospitalization duration (5 days versus 6 days, P = 0.022) and in median body condition score (5/9 versus 4/9, P = 0.03). Cats with a longer hospital stay and with a lower body condition score were more likely to have a positive urine culture during follow-up period. CONCLUSIONS: SUB device placement surgery is associated with complications such as chronic bacteriuria. Bacteriuria in our study resolved with appropriate antibiotic treatment in more than half of cats. Risk factors identified for positive urine culture were a longer hospitalization duration and a decreased body condition score.

Renal pelvic rupture, intrapelvic haematoma and retroperitoneal haemorrhage associated with obstructive ureterolithiasis in a cat.

A neutered female cat presented with a 9-day history of hyporexia and depression. The referring veterinarian had identified moderate non-regenerative anaemia, haematuria and suspected unilateral obstructive ureterolithiasis. Subsequent ultrasonography revealed moderate distension of the left renal pelvis with echogenic material, ureteral distension and ureterolithiasis. A partial ureteral obstruction was suspected. After 4 days of medical management, there was further distension of the renal pelvis with well-delineated echogenic material and an accumulation of perinephric fluid. A left nephroureterectomy was performed. Renal pelvic rupture with intrapelvic haematoma and retroperitoneal haemorrhage was confirmed by histopathology. Eighteen months following surgery, the cat remained clinically well with normal renal values.

Placement of ureteral stents in three rabbits for the treatment of obstructive ureterolithiasis.

Management of ureteral obstruction with stenting is often associated with a lower rate of complications than ureterotomy in domestic carnivores, but this treatment has not been previously evaluated in rabbits. Three rabbits (7, 6 and 10 years old) were diagnosed with unilateral obstructive ureterolithiasis associated with hydronephrosis and hydroureter on abdominal ultrasound. Decreased overall renal function was confirmed in all three cases. Ureteral stents were placed retrogradely via cystotomy without complication in two cases and anterogradely via nephrostomy in the third case. Survival after stent placement was 30, 3 and 8 months, with encrustation of the stent and re-obstruction occurring 18, 1 and 6 months after stent placement in successive cases. Ureteral stenting can be considered for short-term management of ureterolithiasis in rabbits to improve renal function and maintain quality of life. Ultrasound or radiographic monitoring is recommended to detect encrustation of the stent. Studies comparing ureteral stenting to ureterotomy in rabbits are needed to determine the effectiveness of these techniques.

Sepsis urinaria tras tratamiento endourológico de la litiasis por ureterorrenoscopia / Urinary sepsis after endourological ureterorenoscopy for the treatment of lithiasis

Objetivo: Evaluar la incidencia, presentación clínica y factores asociados al desarrollo de sepsis urinaria tras la realización de una ureterorrenoscopia. Material y métodos: Estudio retrospectivo de los pacientes intervenidos mediante ureterorrenoscopia para el tratamiento de la litiasis entre julio de 2015 y octubre de 2017. Se identificaron aquellos pacientes que desarrollaron sepsis urinaria en los primeros 30 días tras la intervención. Se recogieron antecedentes personales, clínicos, quirúrgicos y microbiológicos. Se realizó análisis estadístico mediante chi2 (o test exacto de Fisher), t de Student (o U de Mann-Whitney) o regresión logística según procediese. Resultados: Se realizaron 246 ureterorrenoscopias, 184 (74,8%) sobre litiasis ureterales y 62 (25,2%) sobre litiasis renales, con una edad media de 52 (44,5-59,5) años. Tras el procedimiento, 18 (7,3%) pacientes desarrollaron sepsis urinaria, 10 de ellos (55,5%) en las primeras 24h. El urocultivo mostró enterobacterias (61,1%) y enterococos (38,9%). El antibiograma mostró mayor sensibilidad a nitrofurantoínas (100%) y a quinolonas (72%). El análisis estadístico mostró que el sexo femenino, el inicio clínico de la litiasis en forma de sepsis urinaria, haber recibido antibiótico o haber precisado derivación urinaria mediante doble J en el inicio, el urocultivo prequirúrgico positivo y la persistencia de restos litiásicos tras la cirugía se asociaron de forma significativa (p<0,05) al desarrollo de sepsis urinaria tras la ureterorrenoscopia. Conclusión: La sepsis urinaria es una complicación que aparece tras la realización de una ureterorrenoscopia, especialmente en pacientes de sexo femenino, con antecedente de sepsis urinaria, antibioterapia, doble J, urocultivo previo positivo o presencia de restos litiásicos tras el procedimiento

Objective: To evaluate the incidence, clinical presentation and factors associated with the development of urinary sepsis after performing ureterorenoscopy. Material and methods: Retrospective study of patients undergoing ureterorenoscopy for the treatment of lithiasis between July 2015 and October 2017. Patients who developed urinary sepsis during the 30 days following the intervention were identified. Personal, clinical, surgical and microbiological backgrounds were collected. Statistical analysis was performed with the Chi squared test (or Fisher's exact test), Student's t (or U Mann-Whitney) or logistic regression as appropriate. Results: 246 ureterorenoscopies were performed, 184 (74.8%) on ureteral stones and 62 (25.2%) on kidney stones, with a mean age of 52 (44.5-59.5) years. After procedure, 18 (7.3%) patients developed urinary sepsis, 10 of them (55.5%) occurred in the first 24h. The urine culture showed enterobacteria (61.1%) and enterococci (38.9%). The antibiogram showed greater sensitivity to nitrofurantoins (100%) and quinolones (72%). The statistical analysis showed that female sex, the clinical debut of urolithiasis as urinary sepsis, having received antibiotic or having required urinary diversion by a double J during debut, positive presurgical uroculture and the persistence of residual lithiasis after surgery were significantly associated (p < 0.05) with the development of urinary sepsis after ureterorenoscopy. Conclusion: Urinary sepsis is a complication that appears after performing ureterorenoscopy, especially in female patients with a history of urinary sepsis, antibiotic therapy, double J, previous positive urine culture or residual lithiasis after the procedure

The Impact of Stone Multiplicity on Surgical Decisions for Patients with Large Stone Burden: Results from ReSKU.

Introduction: American Urological Association (AUA) guidelines recommend percutaneous nephrolithotomy (PCNL) for total stone burden greater than 20 mm, yet it is unclear if the number of stones affects adherence to this guideline. We aim to assess the impact of stone multiplicity on the choice of ureteroscopy (URS) vs PCNL as a first-line therapy for patients with high burden (>20 mm), and examine whether the AUA guideline-discordant care impacts patient outcomes. Materials and Methods: Data were collected from the Registry for Stones of the Kidney and Ureter (ReSKU) database, a prospectively collected registry of patients with stone disease. Multivariate logistic regression (MLR) was used to estimate the association between stone multiplicity and the decision to perform URS for high stone burden (>20 mm) patients. MLR was further used to estimate the association between performing URS and the following outcomes: stone-free rate, need for a second operation, and complications. Postoperative hospital stay was compared between patients receiving URS vs PCNL using Student's t-test. Results: One hundred twenty-five patients were included in this analysis. For patients with total stone burden exceeding 20 mm, those with more than three stones had roughly nine times the likelihood of undergoing URS over PCNL compared with patients with a single stone (adjusted odds ratio 9.21, confidence interval [95% CI] 2.55-40.58, p = 0.001). Stone-free rates, Clavien-Dindo scores, and frequency of second-look operations did not differ significantly between URS and PCNL patients. URS patients were discharged an average of 1.26 days earlier than patients who received PCNL (95% CI 0.72-1.81, p < 0.001). Discussion: Stone multiplicity strongly predicts which patients with stone burden >20 mm will undergo URS and who will undergo PCNL. These deviations from AUA guidelines do not appear to worsen patient outcomes. These results suggest that careful consideration of each patient may warrant deviation from guidelines.

Neumatosis intestinal en la enfermedad de Crohn / Pneumatosis intestinalis in Crohn's disease

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Ureterolitotripsia para a remoção de cálculos ureterais / Ureterolithotripsy for removal of ureteral stones

CONTEXTO: Ureterolitotripsia, ULT, é o tratamento de escolha para o cálculo ureteral e vem sendo realizada há mais de 20 anos no Brasil em serviços privados e em alguns hospitais-escola. Entretanto, ainda não está incorporada ao SUS. TECNOLOGIA: Ureterolitotripsia. PERGUNTAS: A ULT é segura, efetiva e custo-efetiva em comparação ao procedimento disponível em primeira linha, a litotripsia extracorpórea por ondas de choque, LECO, para a remoção de cálculos ureterais? EVIDÊNCIAS CIENTÍFICAS: Pela revisão sistemática da literatura foi possível selecionar e reanalisar os estudos de 03 metanálises recentes, relevantes e com baixo risco de vieses. Nestas, concluiuse que a ULT está relacionada a um efeito 10% maior quando se avalia a liberação dos cálculos, com taxa de complicações similar à litotripsia extracorpórea por ondas de choque, LECO. Na literatura internacional a ULT é considerada o procedimento de primeira escolha para o tratamento de cálculos ureterais proximais e distais por estar relacionada a alta eficiência e baixa morbidade quando comparada aos demais procedimentos para a remoção de cálculos ureterais. AVALIAÇÃO ECONÔMICA: A avaliação econômica em nosso meio mostra que a ULT é menos custoefetiva que a litotripsia extracorpórea por ondas de choque, LECO. As comparações internacionais mostram relações de custo-efetividade mais favoráveis ao procedimento por ULT em relação aos demais para a remoção de cálculos ureterais incluindo a LECO. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: A partir da movimentação das autorizações de internação hospitalar, AIH, atribuíveis à litíase ureteral proximal grave, estima-se que entre 10.000 e 15.000 pacientes poderiam ser beneficiados pela incorporação da ULT (de 9% até 13,6% dos 110.000 pacientes tratados com LECO ambulatoriamente). Considerando-se o custo adicional de R$ 3.475,39 encontrado em hospital de São Paulo (microcusteio), a verba orçamentária local investida variou entre R$ 34.753.900,00 e R$ 52.130.850,00. Considerando uma média global (do valor na Tabela do SUS ponderado pela proporção de cirurgias) de ressarcimento de R$ 754,17, os 10.000 a 15.000 procedimentos de ULT, que já estão sendo realizados, teriam um impacto orçamentário adicional de R$ 568.644,42 até R$ 4.339.495,99. As principais limitaçõesincluem a heterogeneidade nos estudos, o estudo local foi retrospectivo, houve avaliação parcial das taxas e custos dos eventos adversos e complicações da LECO, os custos pagos no pregão público do Estado de São Paulo são menores que nas outras fontes de dados (por exemplo, materiais e medicamentos no Banco de Preços em Saúde (BPS) do Ministério da Saúde). CONCLUSÃO: A evidência atualmente disponível sobre eficácia e segurança da ULT para tratamento de cálculos ureterais proximais está baseada em dezenas de estudos randomizados e prospectivos, com nível de evidência 1B e grau forte de recomendação. Os resultados apresentados pelos estudos meta-analíticos mostram resolutividade da ULT 10% maior que o método de LECO (sucesso de mais pacientes livres de cálculos ureterais dentre os tratados) e taxa de complicações similares às da litotripsia extracorpórea por ondas de choque, LECO. O modelo para estimar a relação de custo-efetividade com base nos dados empíricos observados em nosso meio mostrou custo adicional da ULT, embora as publicações internacionais recentes, em que se revisaram as relações de custo-efetividade, apontem para um favorecimento da ULT como mais eficiente em comparação com a LECO. RECOMENDAÇÃO PRELIMINAR DA CONITEC: Os membros do Plenário presentes em sua 72ª reunião ordinária, no dia 08 de novembro de 2018, indicaram que o tema seja submetido à Consulta Pública com recomendação preliminar favorável à incorporação no SUS da ureterolitotripsia condicionada à não ocorrência de custos incrementais em relação aos procedimentos comparados. Considerou-se que a técnica tem maior resolutividade e possui taxa de complicações similares ao procedimento disponível no SUS. CONSULTA PÚBLICA: A consulta pública n° 01 de 2019 foi realizada entre os dias 12/01/2019 e 31/01/2019. Foram recebidas 78 contribuições sendo 21 pelo formulário para contribuições técnico-científicas e 57 pelo formulário para contribuições sobre experiência ou opinião. No conjunto das contribuições, 92,3% do total foram enviadas por profissionais de saúde. Em 90% das contribuições enviadas afirma-se concordância total com a recomendação preliminar. Entre as discordâncias parciais alegou-se que a ressalva de equiparação de valores entre os procedimentos utilizados em litíase do trato urinário pode prejudicar a disponibilização dessa tecnologia no SUS e que seria necessário formalizar um algoritmo para otimizar o uso dos recursos mais complexos para os estratos de maior complexidade do tratamento dessa doença. Entre os documentos técnicos recebidos, 2 artigos e 1 citação foram encaminhados, todos 3 já incluídos nas revisões sistemáticas e Diretrizes utilizadas para estruturar e descrever as evidências científicas que embasaram o presente relatório técnico da CONITEC. Entendeu-se que as contribuições submetidas não trouxeram argumentação suficiente para modificar a recomendação preliminar. RECOMENDAÇÃO FINAL: Após a apresentação no dia 07 de fevereiro de 2019 do consolidado das 78 contribuições recebidas na consulta pública n° 1 de 2019, os membros da CONITEC presentes na 74ª reunião ordinária deliberaram, por unanimidade, que fosse ratificada a recomendação inicial favorável à incorporação da ureterolitotripsia transureteroscópica para litíase do trato urinário, condicionada à não ocorrência de custos incrementais aos procedimentos comparados. Nesta data, assinou-se o registro de deliberação nº. 422/2019 pela incorporação da tecnologia. DECISÃO: Incorporar a ureterolitotripsia transureteroscópica para litíase do trato urinário, no âmbito do Sistema Único de Saúde - SUS. Dada pela Portaria nº 15, publicada no Diário Ofical da União nº 54, seção 1, página 66, em 22 de março de 2019.

Perioperative Occlusion of a Subcutaneous Ureteral Bypass Secondary to a Severe Pyonephrosis in a Birman Cat.

A subcutaneous ureteral bypass (SUB) was placed in a 10-year-old Birman cat for management of unilateral ureterolithiasis. Perioperative occlusion of the nephrostomy tube of the SUB device happened secondary to a severe pyonephrosis. Flushing of the system throught the subcutaneous shunting port was made with saline solution after clamping the urinary bladder catheter. Repetitive flushing of the device was performed daily for 3 days to be sure of the remanent patency of the catheter. Repetitive flushing of the SUB device is a successful renal-sparing treatment for pyonephrosis in a cat and may be considered as an effective treatment option for this condition.

Comparison between double-pigtail ureteral stents and ureteral bypass devices for treatment of ureterolithiasis in cats.

OBJECTIVE To compare the complication rates and outcomes in cats with ureteral obstruction treated by placement of double-pigtail ureteral stents or ureteral bypass (UB) devices. DESIGN Retrospective cohort study. ANIMALS Cats with unilateral or bilateral ureterolithiasis that received double-pigtail ureteral stents (30 stents in 27 cats; stent group) or UB devices (30 devices in 23 cats; UB group). PROCEDURES Medical records were reviewed to collect data on signalment, clinical signs, serum biochemical data, surgical procedure, duration of hospitalization, complications, and follow-up (≥ 6 months after placement) information. Outcomes were compared between device types. RESULTS Median durations of surgery and hospitalization were significantly longer in the stent versus UB group. Perioperative mortality rate was 18% (5/27) in the stent group and 13% (3/23) in the UB group. Median survival time was shorter in the stent versus UB group. Stent placement was associated with a greater risk of lower urinary tract-related signs, such as hematuria (52% [14/27]) and pollakiuria or stranguria (48% [13/27]). The risk of device occlusion was also greater in the stent (26% [7/27]) versus UB (4% [1/23]) group. The percentage of cats requiring additional procedures to treat complications was greater in the stent (44%; complications included uroabdomen, stent occlusion, and refractory cystitis) versus UB (9%; complications included UB occlusion and urethral obstruction) group. CONCLUSIONS AND CLINICAL RELEVANCE Although the benefits of stent placement in the treatment of ureteral obstruction in cats have been established, results suggested that cats treated with UB devices had a lower risk of complications and a longer survival time than those treated with double-pigtail ureteral stents.

[Comparison of results of open simple nephrectomy secondary to lithiasis in patients with and without nephrostomy]. / Comparación de los resultados de la nefrectomía simple abierta secundaria a litiasis en pacientes con y sin nefrostomía.

BACKGROUND: Simple nephrectomy is the procedure of choice in the treatment of excluded kidneys. The purpose of this study was to describe and compare surgical results in open simple retroperitoneal nephrectomies in patients with and without nephrostomy. METHODOLOGY: 58 patients were analyzed. The demographic parameters of patients with nephrostomy were compared to patients without nephrostomy (age, gender, weight, lithium localization, transoperative variables (surgical time, transoperative bleeding) and postoperative variables (need for intensive care, need for transfusion, surgical wound infection and hospital stay days) RESULTS: Statistically significant differences were found for the variables of operative bleeding (p=0.0442), surgical time (p=0.0093), hospital stay days (p=0.0040), and transfusion requirements (p=0.0170). There were no differences in the need for intensive care (p=0.6314), transoperative complications (p=0.7414) and surgical wound infection (p=0.2762). CONCLUSIONS: The presence of a nephrostomy catheter in patients undergoing open simple nephrectomy leads to an increased risk of morbidity, with increased bleeding, surgical time, need for transfusion, and hospital stay days.

The "old" 15 mm renal stone size limit for RIRS remains a clinically significant threshold size.

PURPOSE: To investigate the performance of retrograde intrarenal surgery (RIRS) for the 1-2 cm renal stone size range in comparison to smaller stones. MATERIALS AND METHODS: From a data base of 3000 ureteroscopies between 2004 and 2014, 635 consecutive patients underwent RIRS for renal stones. Patients were divided to three groups according to their renal stone size (<10, 10-15, 15-20 mm). Preoperative, operative, stone free rate (SFR) and follow-up data were analyzed and compared. RESULTS: The SFR for the three groups was 94.1, 90.1 and 85%, respectively. Patients with renal stone size above 15 mm had a statistically significantly lower SFR. The efficiency quotient calculated for stones larger and smaller than 15 mm was 83.9 vs. 91.8%, respectively (p < 0.01). The mean operative time and hospital stay were longer for patients with renal stones larger than 15 mm (73.6 ± 29.9 vs. 53 ± 19.4 min, p < 0.01 and 2.2 ± 2 vs. 1.8 ± 1.8 days, p = 0.031, respectively). Moreover, the complication rate was almost two times higher (10 vs 5.4%, p = 0.08). Concomitant ureteral stones and older age were independent predictors of failure in the large stone group. CONCLUSIONS: While the overall SFR following RIRS for renal stones up to 2 cm is generally high, the SFR for 15-20 mm stones is significantly lower, with a longer operating time and hospital stay, and a higher complication rate.

Stented Versus Stentless Laparoscopic Ureterolithotomy: A Systematic Review and Meta-Analysis.

INTRODUCTION: This systematic review and meta-analysis were designed to evaluated the efficacy and safety of stented versus stentless laparoscopic ureterolithotomy (LU). METHODS: We conducted a systematic review and meta-analysis that included six trials that investigated the outcomes, including the rate of prolonged urine leakage, operative time, time to drain removal, and estimated blood loss, between stented versus stentless LU. RESULTS: Four studies with 289 participants were included in the study. There was no significant difference between two groups in rate of prolonged urine leakage (odds ratios [OR] 0.35, 95% confidence intervals [CI] 0.09-1.46, p = 0.15). Significant longer operative time was detected in patients who underwent stented LU compared with stentless group (mean difference 11.36, 95% CI 7.53-15.20, P < .00001). There was no significant difference between two groups in day of drain removal (mean difference -1.09, 95% CI -2.33-0.15, P = .08). No significant difference in blood loss in patients who underwent stented LU compared with stentless group was detected (mean difference 7.67, 95% CI -0.29-15.64, P = .06). CONCLUSION: Our study demonstrated that the rate of prolonged urine leakage, time to drain removal, and estimated blood loss were not significantly different between stented and stentless LU.

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.

[Update in the management of ureteral lithiasis: Semirigid and flexible ureterorenoscopy.] / Actualización en el tratamiento de la litiasis ureteral: URS semirrígida y flexible.

OBJECTIVE: The contribution of therapeutic ureteroscopy done by Perez Castro in 1980 varied the management algorithm for ureteral lithiasis worldwide. The techniques of Retrograde Ureteroscopy and transrenal antegrade ureteroscopy led to the abandonment of open surgery for the treatment of ureteral lithiasis. Only Shock wave lithotripsy has maintained similar success rates in selected cases. METHODS: Descriptive analysis of the semirigid and flexible ureteroscopy techniques performed in our department over the last 10 years giving detail on the technique and safety tips to increase the efficacy and efficiency of ureteroscopy. 4,533 semirigid ureterorenoscopies and 980 flexible ureterorenoscopies were performed between January 2005 and July 2016. RESULTS: We registered 82% lithiasis elimination on a single operation with a 1,8% overall complication rate for complications higher than Clavien III. We registered 108 urinary sepsis episodes with 2 deaths secondary to massive shock. One patient required supra-selective renal embolization due to renal rupture and hemorrhage after URS. Four patients have required open or laparoscopic surgical repair Five patients required nephrectomy due to absent function of the renal unit after URS and 2 for complete ureteral avulsion on ureteroscope extraction. CONCLUSIONS: Semirigid ureterorenoscopy enables the elimination of ureteral lithiasis on a major ambulatory surgery regimen with an acceptable complication rate and a low rate of ancillary measures. Flexible ureteroscopy has resolved intrarenal lithiasis of up to 2 cm, being a substitute for percutaneous nephrolithotomy for these cases.

Actualización en el tratamiento de la litiasis ureteral: URS semirrígida y flexible / Update in the management of ureteral lithiasis: Semirigid and flexible ureterorenoscopy

INTRODUCCIÓN: La aportación de la ureterorrenoscopia terapéutica por Perez-Castro en 1980 ha variado el algoritmo de tratamiento de la litiasis ureteral en todo el mundo. Las técnicas de ureteroscopia retrógrada o anterógrada transrenal han hecho abandonar totalmente las técnicas de cirugía abierta para la resolución de la litiasis ureteral. Solo la Litotricia por ondas de choque ha mantenido tasas de éxito similares en casos seleccionados. MÉTODOS: Análisis descriptivo de las técnicas de ureterorrenoscopia semirrigida y flexible realizadas en nuestro Centro en los últimos 10 años detallando la técnica quirúrgica y los trucos de seguridad para aumentar la eficacia y eficiencia de la ureteroscopia. Se han realizado, entre enero de 2005 y julio de 2016, 4523 ureteroscopias semirrígidas y 980 ureterorrenoscopias flexibles. RESULTADOS: Se ha registrado un 82% de resolución de la litiasis en un solo acto quirúrgico con una tasa global de complicaciones superiores al Clavien III del 1,8%. Se han registrado 107 episodios de sepsis urinaria con dos éxitus por shock masivo.Un paciente requirió embolización renal supraselectiva por rotura renal y hemorragia post URS. Cuatro pacientes han requerido reparación cirugía abierta/laparoscópica por estenosis ureteral compleja. Cinco pacientes requirieron nefrectomía por anulación renal post URS y dos por avulsión completa del uréter al extraer el Ureteroscopio. CONCLUSIONES: La ureterorrenoscopia semirrígida permite la resolución de la litiasis ureteral en régimen de cirugía mayor ambulatoria con un porcentaje de complicaciones asumible y una baja tasa de medidas auxiliares. La ureteroscopia flexible ha permitido la resolución de litiasis intrarrenales hasta 2 cm. Sustituyendo la nefrolitotomía percutánea para la resolución de éstos casos

INTRODUCTION: The contribution of therapeutic ureteroscopy done by Perez Castro in 1980 varied the management algorithm for ureteral lithiasis worldwide. The techniques of Retrograde Ureteroscopy and transrenal antegrade ureteroscopy led to the abandonment of open surgery for the treatment of ureteral lithiasis. Only Shock wave lithotripsy has maintained similar success rates in selected cases methods: descriptive analysis of the semirigid and flexible ureteroscopy techniques performed in our department over the last 10 years giving detail on the technique and safety tips to increase the efficacy and efficiency of ureteroscopy. 4,533 semirigid ureterorenoscopies and 980 flexible ureterorenoscopies were performed between January 2005 and July 2016. RESULTS: We registered 82% lithiasis elimination on a single operation with a 1,8% overall complication rate for complications higher than Clavien III. We registered 108 urinary sepsis episodes with 2 deaths secondary to massive shock. One patient required supra-selective renal embolization due to renal rupture and hemorrhage after URS. Four patients have required open or laparoscopic surgical repair Five patients required nephrectomy due to absent function of the renal unit after URS and 2 for complete ureteral avulsion on ureteroscope extraction conclusions: Semirigid ureterorenoscopy enables the elimination of ureteral lithiasis on a major ambulatory surgery regimen with an acceptable complication rate and a low rate of ancillary measures. Flexible ureteroscopy has resolved intrarenal lithiasis of up to 2 cm, being a substitute for percutaneous nephrolithotomy for these cases

Paediatric ureterolithotripsy: Tips and tricks - Experience at a single center.

BACKGROUND: Paediatric stone disease is very common in certain regions of India. Traditionally, the endourology for the stones even in paediatric age group is managed by adult urologist and paediatric surgeons tend to do open surgeries. The nonavailability of paediatric size equipments and lack of training at the teaching and tertiary care paediatric surgical centers in India are factors due to which there is continued apathy of paediatric surgeons to endourology. The aim of this study was to discuss the feasibility of paediatric ureterolithotripsy for successful procedure. We introduced the paediatric ureterolithotripsy as per the predecided indications of stone size up to 15 mm in paediatric ureterolithiasis at a tertiary care center in rural set up. SUBJECTS AND METHODS:: Patients up to 18 years of age presenting with ureterolithiasis and not responding to conservative treatment or who needed endourological intervention were included in the study. RESULTS:: Thirty-one patients underwent uretero lithotripsy (URSL) for ureteric calculus with more than 95% clearance rate. CONCLUSIONS:: Single-stage paediatric ureterolithotripsy is quite feasible and effective in achieving the stone clearance in paediatric ureterolithiasis.

Intraparenchymal hematoma as a late complication of retrograde intrarenal surgery.

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.