The glue-clot technique: a new technique description for small calyceal stone fragments removal.

During the last 20 years, the technology advancement of small flexible ureterorenoscopes has dramatically changed the management of renal calculi. Retrograde intrarenal surgery (RIRS) has currently a high impact on active stone treatment, and it is increasingly used worldwide. Nevertheless, kidney stone fragmentation and direct removal of fragments require many passages of the ureteroscope, is often time-consuming, and may be very difficult through anatomical and technical factors. We describe a simple, feasible and efficient technique for small stone fragments retrieval, which are often difficult to remove during RIRS.

Laparoscopic cryotherapy for small renal masses: Current State.

OBJECTIVES: To provide an up-to-date review of the available literature on laparoscopic cryotherapy for small renal masses (SRMs) including technique description, indications and outcomes. METHODS: A systematic literature search was conducted in March 2012, using MEDLINE and EMBASE via Ovid databases, to identify studies on laparoscopic cryotherapy for SRMs published during the last 10 years. Only English-language and human-based full manuscripts reporting case series studies with >20 participants, patient characteristics, efficacy and safety data were included. RESULTS: No randomised controlled trials (RCTs)were identified. In total, 27 full reports addressing laparoscopic cryoablation (LCA) for SRMs were selected. The number of patients per study ranged from 20 to 144. Mean age of treated patients across the series ranged from 62 to 73 years. Mean size of renal tumors ranged from 2.7 to 4 cm, being in most cases <3 cm. The number of cryoprobes used for cryoablation ranged from 1 to 6, and only 10 series described the use of 17-gauge (1.47 mm) third-generation needles. Overall, more than 55% of all ablated lesions were pathologically confirmed RCC. Mean follow-up ranged from 9 to 93 months. Only 7 series presented a long-term follow-up of more than 36 months. Most studies were limited by a relatively short follow-up. At least four urologic groups reported intermediate- and long-term outcomes. Persistence rates ranged from 0% to 17% and recurrence rates ranged from 0% to 14%. Overall complication rates ranged from 0% to 40%. CONCLUSIONS: Retrospective observational data and a few prospective series on LCA of SRMs show acceptable oncological 3- to 5-year outcomes with a low recurrence rate. It has proven to be a safe procedure with an overall low complication rate. It is mainly indicated for SRMs in elderly patients affected by co-morbidity and high surgical risk bearing tumours in the anterior valve of the kidney or in contact with the ureter or neighbouring organs.

Crioablacion laparoscopica de pequeñas masas renales: Estado actual / Laparoscopic cryotherapy for small renal masses: current state

OBJETIVO: Presentar una revisión actualizada de la literatura disponible sobre crioablación laparoscópica de pequeñas masas renales (SRMs), incluyendo descripción de la técnica, indicaciones y resultados. MÉTODOS: Se realizó una revisión de la literatura hasta marzo de 2012, utilizando las bases de datos MEDLINE y EMBASE vía Ovid, para identificar estudios sobre crioablación laparoscópica de SRMs publicados durante los últimos 10 años. Sólo se incluyeron manuscritos en inglés y estudios basados en humanos, que reportaron series con más de 20 participantes, características de los pacientes, eficacia y seguridad del procedimiento. RESULTADOS: No se identificaron ensayos clínicos aleatorizados (RCTs). En total, se seleccionaron 27 trabajos originales sobre crioablación laparoscópica (LCA) de SRMs. El número de pacientes por estudio osciló entre 20 y 144. La edad media de los mismos a lo largo de las series osciló entre 62 y 73 años. El tamaño medio de los tumores renales osciló entre 2,7 y 4 cm, siendo en la mayoría de los casos ≤3 cm. El número de crioagujas utilizadas para crioablación osciló entre 1 y 6, mientras que sólo en 10 series se describió la utilización de crioagujas de tercera generación de 17 gauge (1,47 mm).En total, más del 55% de las lesiones tratadas resultaron carcinoma de células renales (RCC) confirmado por el análisis anatomopatológico. El seguimiento medio de los pacientes osciló entre 9 y 93 meses. Sólo 7 series presentaron un seguimiento a largo plazo superior a 36 meses. La mayoría de los estudios resultaron limitados por un seguimiento relativamente corto. Al menos cuatro grupos de investigación reportaron resultados a intermedio y a largo plazo. Las tasas de persistencia tumoral oscilaron entre 0% y 17%, mientras que las tasas de recidiva oscilaron entre 0% y 14%. La tasa global de complicaciones osciló entre 0% y 40%(AU)

CONCLUSIONES: Los datos de estudios observacionales y retrospectivos así como los de algunas series prospectivas, demostraron aceptables resultados oncológicos a 3 y 5 años y una baja tasa de recidiva. La LCA demostró ser un procedimiento seguro con una baja tasa global de complicaciones. Está indicada principalmente en el tratamiento de SRMs en pacientes añosos con alta comorbilidad y elevado riesgo quirúrgico, albergando tumores en la valva anterior del riñón o en contacto con el uréter u órganos vecinos(AU)

OBJECTIVES: To provide an up-to-date review of the available literature on laparoscopic cryotherapy for small renal masses (SRMs) including technique description, indications and outcomes. METHODS: A systematic literature search was conducted in March 2012, using MEDLINE and EMBASE via Ovid databases, to identify studies on laparoscopic cryotherapy for SRMs published during the last 10 years. Only English-language and human-based full manuscripts reporting case series studies with >20 participants, patient characteristics, efficacy and safety data were included. RESULTS: No randomised controlled trials (RCTs) were identified. In total, 27 full reports addressing laparoscopic cryoablation (LCA) for SRMs were selected. The number of patients per study ranged from 20 to 144. Mean age of treated patients across the series ranged from 62 to 73 years. Mean size of renal tumors ranged from 2.7 to 4 cm, being in most cases <3 cm. The number of cryoprobes used for cryoablation ranged from 1 to 6, and only 10 series described the use of 17-gauge (1.47 mm) third-generation needles. Overall, more than 55% of all ablated lesions were pathologically confirmed RCC.Mean follow-up ranged from 9 to 93 months. Only 7 series presented a long-term follow-up of more than 36 months. Most studies were limited by a relatively short follow-up. At least four urologic groups reported intermediate- and long-term outcomes. Persistence rates ranged from 0% to 17% and recurrence rates ranged from 0% to 14%. Overall complication rates ranged from 0% to 40%(AU)

CONCLUSIONS: Retrospective observational data and a few prospective series on LCA of SRMs show acceptable oncological 3- to 5-year outcomes with a low recurrence rate. It has proven to be a safe procedure with an overall low complication rate. It is mainly indicated for SRMs in elderly patients affected by co-morbidity and high surgical risk bearing tumours in the anterior valve of the kidney or in contact with the ureter or neighbouring organs(AU)