Aplicaciones clínicas, experimentales y resultados del uso de diferentes dispositivos de aspiración en la cirugía intrarrenal retrógrada. Revisión sistemática / Experimental and clinical applications and outcomes of using different forms of suction in retrograde intrarenal surgery. Results from a systematic review

Objetivo Identificar los últimos avances en los dispositivos de aspiración para la cirugía retrógrada intrarrenal (CRIR) y la ureteroscopia en el tratamiento de la litiasis, y evaluar los resultados de su aplicación. Procedimiento El 4 de enero de 2023 se realizó una búsqueda bibliográfica sistemática en Scopus, PubMed y EMBASE. Solo se incluyeron artículos en inglés; se aceptaron estudios en la población pediátrica y estudios en adultos. Se excluyeron los estudios duplicados, los informes de casos, las cartas al editor y los resúmenes de congresos. Hallazgos principales Se seleccionaron 21 trabajos. Se han propuesto varios sistemas de aspiración para la CRIR: a través de la vaina de acceso ureteral o directamente por el endoscopio. La inteligencia artificial también puede desempeñar un papel, monitorizando los valores de la presión y del flujo de irrigación. Todas las técnicas propuestas mostraron resultados perioperatorios satisfactorios en cuanto a tiempo quirúrgico, tasa libre de cálculos (TLC) y fragmentos residuales. Además, la reducción de la presión intrarrenal (mediante la aspiración) también se asoció a una tasa de infección menor. Incluso los estudios que incluyen cálculos renales con un diámetro de 20mm o superior informan de una mayor TLC y una reducción de las complicaciones postoperatorias. Sin embargo, la falta de parámetros bien establecidos para la presión de la aspiración y el flujo de líquido impide la estandarización del procedimiento. Conclusión Como ha sido demostrado en los estudios incluidos, el uso de dispositivos de aspiración en el tratamiento quirúrgico de los cálculos urinarios favorece la obtención de una TLC mayor y reduce las complicaciones infecciosas. La CRIR con sistema de aspiración podría sustituir a la técnica tradicional, gracias a sus ventajas asociadas al control de la presión intrarrenal y aspiración del polvo fino. (AU)

Objective To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones. Basic procedures A systematic literature search was performed on 4th January 2023 using Scopus, PubMed, and EMBASE. Only English papers were included; both pediatric and adult studies were accepted. Duplicate studies, case reports, letters to the editor, and meeting abstracts were excluded. Main findings Twenty-one papers were selected. Several methods have been proposed for suction use in RIRS, such as through the ureteral access sheath or directly to the scope. Artificial intelligence can also regulate this system, monitoring pressure and perfusion flow values. All the proposed techniques showed satisfactory perioperative results for operative time, stone-free rate (SFR), and residual fragments. Moreover, the reduction of intrarenal pressure (induced by aspiration) was also associated with a lower infection rate. Even the studies that considered kidney stones with a diameter of 20mm or higher reported higher SFR and reduced postoperative complications. However, the lack of well-defined settings for suction pressure and fluid flow prevents the standardization of the procedure. Conclusion Aspiration device in the surgical treatment of urinary stones favours a higher SFR, reducing infectious complications, as supported by the included studies. RIRS with a suction system provided to be a natural successor to the traditional technique, regulating intrarenal pressure and aspirating fine dust. (AU)

Experimental and clinical applications and outcomes of using different forms of suction in retrograde intrarenal surgery. Results from a systematic review.

OBJECTIVE: To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones. BASIC PROCEDURES: A systematic literature search was performed on 4th January 2023 using Scopus, PubMed, and EMBASE. Only English papers were included; both pediatric and adult studies were accepted. Duplicate studies, case reports, letters to the editor, and meeting abstracts were excluded. MAIN FINDINGS: Twenty-one papers were selected. Several methods have been proposed for suction use in RIRS, such as through the ureteral access sheath or directly to the scope. Artificial intelligence can also regulate this system, monitoring pressure and perfusion flow values. All the proposed techniques showed satisfactory perioperative results for operative time, stone-free rate (SFR), and residual fragments. Moreover, the reduction of intrarenal pressure (induced by aspiration) was also associated with a lower infection rate. Even the studies that considered kidney stones with a diameter of 20 mm or higher reported higher SFR and reduced postoperative complications. However, the lack of well-defined settings for suction pressure and fluid flow prevents the standardization of the procedure. CONCLUSION: Aspiration device in the surgical treatment of urinary stones favours a higher SFR, reducing infectious complications, as supported by the included studies. RIRS with a suction system provided to be a natural successor to the traditional technique, regulating intrarenal pressure and aspirating fine dust.

Safety and Efficacy of Live Retrograde Intrarenal Surgery in Patients with Kindey Stone: Outcomes from a Boutique Course Series Which Complies with the Live Surgery Event Policies

Background: Live surgery events (LSEs) are frequently organized for sharing the surgical experiences with surgeons at the beginning of their learning curves. The aim of this study was to investigate whether the outcomes and complication rates of patients underwent retrograde intrarenal surgery (RIRS) at LSEs are comparable with regular cases. Methods: Ten courses were organized during 2017–2022. Data of 32 patients who operated in the LSEs were 1:3 matched (for stone burden and surgeon) with the data of patients who underwent regular RIRS within the course periods at the same centers (n = 96). All courses took place in concordance with the latest LSE policies. The primary outcomes were stone-free and complication rates. Fluoroscopy and operation times were the secondary outcomes. Results: Stone-free rates of the groups were similar (84% in LSE and 79% in control group; p = 0.520). Similarly, there were no differences in complication rates (p = 0.428) and fluoroscopy time (p = 0.477). Duration of the LSE cases (82.24 ± 31.12 min) was slightly but insignificantly longer than regular cases (73.77 ± 20.89 min, p = 0.092). Moreover, guest surgeons tend to have longer operation time with statistically insignificant prolongation (74.92 ± 30.43 min for host, 89.52 ± 28.34 min for guest surgeons, p = 0.064). Conclusions: RIRS can be performed without jeopardizing operation efficiency and patient safety in LSEs. If surgeon is not familiar with operating room set-up or staff, live surgery must be performed by host surgeon to avoid extended operating time (AU)

Effects of platelet-rich plasma against experimental ischemia/reperfusion injury in rat testis.

BACKGROUND: Testicular torsion is a common problem and, to date, there is no agent to preserve testicular function following detorsion. Platelet-rich plasma (PRP), with its rich growth factor composition, has proven beneficial in regenerative therapy. It is believed that PRP has not been studied in testis for ischemia/reperfusion (I/R) injury. OBJECTIVE: This study investigated the effect of PRP in an I/R rat model 1 month after detorsion. STUDY DESIGN: Of 24 adult male Sprague-Dawley rats, 18 were randomly assigned into three groups, with six in each: control, I/R and I/R + PRP. The PRP was prepared from the remaining six. Each group underwent right orchiectomy. Ischemia was performed by rotating the left testis 720° and fixing with a nylon suture for 4 h. Reperfusion occurred 4 h later by removing the suture, and PRP was administered at a dose of 10 µl (2000 × 109/l) into the left testis via the intraparenchymal route. Animals were sacrificed at the fourth week, and testes were taken for malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD), myeloperoxidase (MPO), transforming growth factor ß (TGF-ß), and caspase-3 measurements. RESULTS: Ischemia/reperfusion caused a significant increase in MDA, MPO and caspase-3 activity, and significant decrease in GSH levels and SOD activity. The PRP treatment helped correct the alterations in SOD, caspase-3, and MPO activities and MDA levels. However, the mean MDA level and MPO activity were not totally restored compared with the controls. Serum testosterone levels of the I/R group were significantly lower compared with the control and I/R + PRP groups. TGF-ß and caspase-3 protein expressions were significantly higher in the I/R group compared with the control group and were low with PRP administration compared with I/R groups (summary Table). DISCUSSION: The findings of the present study suggest that PRP, by inhibiting neutrophil infiltration and oxidative stress and increasing antioxidant defense, exerts protective effects on testicular tissues against I/R. This study had some limitations: a scoring system was not used in the assessment of spermatogenesis in the histopathological findings and specific testis cell types were not histologically assessed. CONCLUSIONS: In light of the biochemical, histological and, especially, hormonal findings, intraparenchymal PRP injection may have a protective effect in testicular tissue against I/R injury.

A retroperitoneal bronchogenic cyst mimicking adrenal tumour in an adult: is differential diagnosis truly possible?

Bronchogenic cysts are developmental abnormalities of the primitive foregut resulting from aberrant budding from the ventral diverticulum. A retroperitoneal position for a bronchial cyst is extremely unusual and should be differentiated from other neoplastic lesions. Although histologically they can be differentiated from other lesions, bronchial cysts may show various pathological patterns of differentiation that may cause confusion in differentiating them from cystic teratomas. This is a case of a retroperitoneal bronchogenic cyst featuring uncommon histological findings, which raises the question whether these benign lesions can always be accurately differentiated from teratomatoid cystic neoplasms.

A giant adrenal pseudocyst: case report and review of the literature.

A 45-year-old woman whose MR images revealed a lobulated, complicated cyst with septations on the superior pole of left kidney underwent retroperitoneoscopic cyst marsupialization. In pathologic examination beneath the atrophic adrenal gland, hyalinized, calcification foci cyst wall without any surrounding epithelium was seen microscopically. It was reported to be "adrenal pseudocyst".