Ureteroscopia flexible sin vaina de acceso ureteral / Flexible ureteroscopy without ureteral access sheath

Introducción: La vaina de acceso ureteral (VAU) se utiliza ampliamente en la ureteroscopia flexible con litotricia con láser (URSF) por sus mejores tasas de estado libre de cálculos, menor presión intrarrenal y menos complicaciones. Sin embargo, también aumenta los costes quirúrgicos y puede lesionar la pared ureteral. El objetivo principal de nuestro estudio es comparar la seguridad y la eficacia de la URSF con y sin VAU para evaluar la justificación de su uso en todos los casos.Materiales y métodos: Hemos llevado a cabo un estudio analítico observacional retrospectivo con una base de datos prospectiva. Se incluyeron para el análisis un total de 241 pacientes consecutivos que se sometieron a URSF para el tratamiento de cálculos renales y de uréter superior entre enero de 2018 y mayo de 2020 y se dividieron en dos grupos según el uso dela VAU. Se compararon los datos demográficos, las características de los cálculos, la presentación, el tiempo operatorio, la necesidad de catéter ureteral, la infección urinaria posoperatoria, el cólico renal y la necesidad de procedimientos adicionales.Resultados: Un total de 198 pacientes (82,2%) conformaron el grupo sin VAU. El tiempo operatorio fue significativamente menor en el grupo de pacientes sin VAU que en los tratados con VAU (64,6 minutos ± 29,5 vs. 89,9 minutos ±2,8, respectivamente; p 0,010). Ambos grupos presentaron tasas similares de dolor renal e infección del tracto urinario. Los procedimientos auxiliares fueron más frecuentes en el grupo con VAU (37,2 vs. 21,2%; p 0,026), pero no hubo significación en el análisis multivariante.Conclusión: La URSF sin VAU parece ser tan segura como la URSF con VAU, pero requiere menos procedimientos adicionales. Otra de las ventajas es un menor tiempo operatorio (AU)

Introduction: Ureteral access sheath (UAS) is widely used in flexible ureteroscopy and laser lithotripsy (FURS) based on better stone-free rates, lower intrarenal pressure and fewer complications. However, it also rises surgical costs and may injure the ureteral wall. The main objective of our study is to compare safety and efficacy of FURS with and without UAS to evaluate whether its use is justified in all cases.Materials and methods: We performed a retrospective observational analytic study based on a prospective database. A total of 241 consecutive patients who underwent FURS for upper ureter and renal stones between January 2018 and May 2020 were included for analysis and divided into two groups upon UAS use. We compared demographic data, stone characteristics, prestenting, operative time, need for ureteral stent, postoperative urinary tract infection, renal colic and need for ancillary procedures.Results: A total of 198 patients (82.2%) were included in the group without UAS. Operative time was significantly shorter in the group of patients without UAS than those with UAS (64.6 minutes ± 29.5 vs. 89.9 minutes ± 2.8 respectively; p 0.010). Both groups had similar rates of colic pain and urinary tract infection. Ancillary procedures were more frequent in the UAS group (37.2 vs. 21.2%; p 0.026), but significance was lost in multivariate assessment.Conclusion: FURS without UAS seems to be as safe as FURS with UAS but requires less ancillary procedures. An additional advantage is shorter operative time (AU)

Flexible ureteroscopy without ureteral access sheath.

INTRODUCTION: Ureteral access sheath (UAS) is widely used in flexible ureteroscopy and laser lithotripsy (FURS) based on better stone-free rates, lower intrarenal pressure and fewer complications. However, it also rises surgical costs and may injure the ureteral wall. The main objective of our study is to compare safety and efficacy of FURS with and without UAS to evaluate whether its use is justified in all cases. MATERIALS AND METHODS: We performed a retrospective observational analytic study based on a prospective database. A total of 241 consecutive patients who underwent FURS for upper ureter and renal stones between January 2018 and May 2020 were included for analysis and divided into two groups upon UAS use. We compared demographic data, stone characteristics, prestenting, operative time, need for ureteral stent, postoperative urinary tract infection, renal colic and need for ancillary procedures. RESULTS: A total of 198 patients (82.2%) were included in the group without UAS. Operative time was significantly shorter in the group of patients without UAS than those with UAS (64.6 minutes ± 29.5 vs. 89.9 minutes ± 2.8 respectively; p 0.010). Both groups had similar rates of colic pain and urinary tract infection. Ancillary procedures were more frequent in the UAS group (37.2 vs. 21.2%; p 0.026), but significance was lost in multivariate assessment. CONCLUSION: FURS without UAS seems to be as safe as FURS with UAS but requires less ancillary procedures. An additional advantage is shorter operative time.

[Management of malignant ureteral obstruction.] / Manejo de la obstrucción ureteral maligna.

OBJECTIVE: To describe the different therapeutic alternatives in malignant ureteral obstruction (MUO), and to analyze short and long-term results. METHODS: We conducted a bibliographic search about MUO in Spanish and English languages in PubMed and Google Scholar. We examined the most relevant reviews, original manuscripts and their respective citations. Last search was on April 2016. RESULTS: Polymeric double J stent is the cheapest and most accessible internal urinary diversion, but has also the shortest duration. Early and late failure rates were 0-35% and 14-49% respectively. Mean time to late failure was 3-12 months. Percutaneous nephrostomy is the safest alternative in terms of failure rates, though it has frequent complications such as tube dislodgement, and may have a negative effect on quality of life. The only metallic double J stent with enough bibliographic background is the Resonance® stent. Early failure was 0-15% and late failure 4-41%, with a mean time to late failure of 2.6-13 months. Regarding metallic stents, Memokath 051® has obtained the best results, with 0-5% early failure rates, 19-49% late failures and mean time to late failure of 7-11 months. In patients with polymeric double J stent failure, patients benefited from tandem double J stents, metallic double J catheters or metallic stents, avoiding the need of a percutaneous nephrostomy. The evidence level was low in all cases. CONCLUSIONS: Results in MUO are very heterogeneous and have a low evidence level. Factors that influence results include stent characteristics, status and prognosis of the obstructive condition and probably patient and physician's preferences. Polymeric double J stents seem to have higher early and late failure rates than metallic double J catheters and metallic stents. Even though, the difference is not clearly evident. Prospective, multicenter, multidisciplinary trials are necessary to elucidate convenience and adequate selection of each type of stent.