CU专题推送（六）| Advances in Urinary Calculi Management 文章合集

Abstract 

Background: The management of suspected kidney stone disease in pregnancy is challenging. In cases of persistent flank pain and where investigations may have rendered equivocal results, ureteroscopy (URS) is a recognized diagnostic and therapeutic intervention. This study aimed to investigate the safety and outcomes associated with performing URS during pregnancy, as the technique has evolved over the past 4 decades at our center. 

Materials and Methods: We performed a retrospective analysis of pregnant patients who underwent URS at our tertiary center between 1984 and 2022. Outcomes of interest included anesthetic approach, operative time, hospital stay, and complications. 

Results: Eighty-seven pregnant patients underwent 96 URS procedures, and 60% (n = 57) of these procedures were performed during the third trimester. Overall, 58% (n = 56) of the procedures were achieved with local anesthesia and light sedation. During the most recent decade, the latter was successfully carried out in 97% of the procedures, with the remainder occurring under spinal anesthesia as per patient choice. Overall, 57% (n = 50) of the whole study group had ureteral calculi found at the time of surgery and in 88% (n = 44) of these cases, fragmentation/extraction was performed. The remainder had insertion of ureteral stent with definitive clearance deferred until postpartum. Mean operative time and postprocedure hospital stay was 33 minutes (range, 7–100 minutes) and 2.2 days (range, 0–16 days), respectively. The overall intraoperative and postoperative complication rates were 2% and 11%, respectively. During the final decade, the latter improved to 6% and all adverse events were minor (Clavien I/II), with the exception of a single case. Regarding exit strategy, ureteral stent was placed in 42% (n = 40) of the procedures, 23% (n = 22) had ureteral catheter inserted, and the remainder (35%, n = 34) had none. 

Conclusions: Ureteroscopy can be safely performed during pregnancy using anesthetic approach with local anesthesia and light sedation. Development of a local protocol and multidisciplinary management algorithm are instrumental in enabling the delivery of such a service.

【引用格式】

Juliebø-Jones P, Beisland C, Gjengstø P, Baug S, Ulvik Ø. Ureteroscopy during pregnancy: Outcomes and lessons learned over 4 decades at a tertiary center in norway. Curr Urol 2023;17(1):7–12. doi: 10.1097/CU9.0000000000000157

【扫描二维码阅读原文】

Abstract 

Objectives: To retrospectively determine which objective measurements had an increased likelihood of requiring immediate surgical intervention in patients presenting to the emergency department (ED) with acute ureteral calculi. 

Materials and methods: Employing our institution’s electronic medical record system, we conducted a retrospective cohort study of 4366 patients who presented to the ED with an acute ureteral calculus over an 8-year period. Data consisting of relevant demographic information, vital signs, laboratory parameters, and interventional history was obtained and analyzed. 

Results: This study consisted of 4366 patients presenting to the ED with acute ureteral calculi, of whom 312 (7%) required a procedure prior to being discharged. Of these 312 patients, 290 (6.6%) underwent cystoscopy with ureteral stent placement and 22 (0.5%) were sent to interventional radiology for percutaneous nephrostomy tube placement. Patients who tested positive for nitrites in their urine had a relative risk of 3.48 of receiving intervention when compared to the nitrite negative group. 

Conclusions: Through this retrospective cohort study, we were able to fifind what objective measurements were associated with an increased need for immediate surgical intervention in patients who presented to the ED with acute ureteral calculi. With this data, urologists can be better equipped to identify the patients that present in the emergency setting that will require urgent intervention. 

【引用格式】

Kranz Z, Peifer G, Rohloff M, Maatman T, Shockley K. Which objective emergency department parameters leads to expedited intervention in patients with acute urinary tract calculi. Curr Urol 2022;16(1):1–4. doi: 10.1097/CU9.0000000000000070

【扫描二维码阅读原文】

Abstract 

Objectives: The aim of our study was to compare the effects on quality of life (QoL) and stone-free rate (SFR) of percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS) in patients with renal stones 2–4 cm. 

Materials and methods: A total of 102 patients with renal pelvis stones were enrolled in this prospective controlled study, of which 52 were performed RIRS and 50 with PNL. The QoL was evaluated by using Short From-36 pre- and post-operatively. Also, the surgical data of all patients during and after the operations were compared between the 2 groups. 

Results: The mean age, body mass index, stone size and density of the patients in the 2 groups were statistically similar (p>0.05). The SFR of PNL and RIRS were found 94% (47/50) and 73% (38/52), respectively (p<0.01). There were no statistically differences between operation times, minor complication rates and Short From-36 scores of the 2 groups. Hospitalization times were 1.13± 0.34 days for RIRS and 2.9±5.7 days for PNL (p<0.05). While the blood transfusion rate of PNL group was 8% (4/50), none patient was made blood transfusion in RIRS. 

Conclusions: The results of our study show that the blood transfusion rates and hospitalization times of RIRS group are signifificantly lower than PNL for management of renal pelvis stone 2–4 cm. Despite these advantages of RIRS, the SFR is signifificantly lower than PNL for these stones. The effects on QoL of the both interventions before and after surgery were similar.

【引用格式】

Ucer O, Erbatu O, Albaz AC, Temeltas G, Gumus B, Muezzinoglu T. Comparison stone-free rate and effects on quality of life of percutaneous nephrolithotomy and retrograde intrarenal surgery for treatment of renal pelvis stone (2–4 cm): A prospective controlled study. Curr Urol 2022;16(1):5–8. doi: 10.1097/ CU9.0000000000000071

【扫描二维码阅读原文】

Abstract 

Objectives: This study is aimed to investigate the outcome of one-stage ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) for simultaneous ureteral and renal stones over 10 years at a tertiary urology institute. 

Materials and methods: We retrospectively analyzed the data of patients who were operated on for simultaneous ureteral and renal stones from January 2011 to December 2020. Patients were divided into 2 groups: group A, who underwent one-stage URS and prone PCNL, and group B, who underwent staged procedures. The overall success, complications, operative time, and hospital stays were compared between the 2 groups. 

Results: Data for 190 patients were reviewed; mean age was 50±13 years old, and 146 (77%) were male. The one-stage (A) and staged (B) groups included 102 and 88 patients, respectively. Group A included older patients, with a high The American Society of Anesthesiologists score, while group B included more patients with multiple or staghorn stones. The one-stage group recorded shorter operative time (120±12min vs. 140±16min, p=0.02) and shorter hospital stays (3 days [2–6] vs. 4 days [3–9], p=0.06). Otherwise, both groups had equal outcomes in terms of success rates and complications. 

Conclusions: PCNL and URS can be performed in one-session for simultaneous ureteral and renal stones, except for multiple renal and staghorn stones. The results are comparable to those of the staged procedure in terms of success rate and complications, with the advantage of a shorter operative time and hospital stay.

【引用格式】

Atwa AM, Elawdy MM, Taha DE, Abouelkheir RT, Abouelenein EE, El-Halwagy S, El-Hefnawy AS, El-Tabey N, ELNahas AR, Shoma AM. One-stage versus staged ureteroscopy and percutaneous nephrolithotomy for simultaneous ureteral and renal stones. Curr Urol 2022;16(1):15–19. doi: 10.1097/CU9.0000000000 000087

【扫描二维码阅读原文】

Abstract 

Background: Proximal ureteral stones (PUS) have relatively low rates of spontaneous expulsion. However, some patients do well on expectant management. Our aim was to compare risk factors for surgical intervention in patients with PUS who underwent primary intervention to those subjected to expectant management. 

Materials and methods: We retrospectively reviewed the medical charts of patients presented to the emergency room with symptoms of renal colic and underwent computerized tomography between August 2016 and August 2017. A total of 97 consecutive patients were identifified with up to 10mm PUS. We collected patient demographics, clinical, and imaging data, and performed binary regression analysis for risk of intervention. 

Results: The average age was 49 years (range 17–97) and average stone size was 7.1mm (range 3–10). Forty-one patients underwent immediate intervention while the remaining 56 patients were treated conservatively. Of the 56 patients treated conservatively, 26 underwent delayed intervention while 30 reported spontaneous stone expulsion. On univariate analysis of all 97 patients, statistically signifificant risk factors for intervention were found based on stone size, age, serum lymphocyte, platelet counts, and stone density. Of these risk factors, stone size ≥ 7mm (p=0.012, odds ratio=5.4) and platelet count 230K/mL (p=0.027, odds ratio=4.9) remained statistically signifificant on multivariate analysis. 

Conclusions: Stone size and platelet count were found to be risk factors for surgical intervention in patients with up to 10mm PUS. These fifindings may assist in identifying patients who are more suitable for conservative approach.

【引用格式】

Shpunt I, Elbaz E, Avda Y, Modai J, Leibovici D, Berkowitz B, Shilo Y. When should we give up on expectant management for patients with proximal ureteral stones? Curr Urol 2022;16(1):9–14. doi: 10.1097/CU9.0000000000000074

【扫描二维码阅读原文】

Abstract 

Objectives: To compare operative times, safety, and effectiveness of percutaneous nephrolithotomy in the supine versus the prone position. 

Materials and methods: An observational study of 100 patients was conducted in our institution for 2 years from 2018 to 2020 divided into 2 groups: 50 patients underwent modifified supine percutaneous nephrolithotomy (PCNL) and 50 patients underwent standard prone PCNL. The inclusion criteria included a renal calculus (calyx or pelvis) of any size for which PCNL was indicated and exclusion criteria were patients having contraindications for PCNL such as bleeding disorders, pregnancy, high risk, and co-morbid conditions. The measured data included operative time, number of punctures, stone-free rate, length of hospital stays, and rate of complications. 

Results: The 2 groups were comparable in mean age, male to female ratio, calculus size, number of punctures, residual calculi, and postoperative fever and pain. The mean difference of hemoglobin in the supine PCNL group was 0.37 g/dL whereas in the prone PCNL group it was 0.61 g/dL. The p value was signifificant at 0.043. The mean time to fifinish from initial postion was 72.24 minutes in supine PCNL and 88.12 minutes in prone PCNL. The p value was signifificant (p<0.001). The mean time before puncture was 20.92 minutes in the supine position and 31.84 minutes in the prone position. The p value was signifificant (p<0.001). The mean time from puncture to fifinish was 51.32 minutes in the supine position and 56.28 minutes in the prone position. The p value was signifificant (p< 0.001). 

Conclusions: As observed from this study, supine PCNL is associated with a signifificantly reduced operating time when compared to conventional prone position PCNL procedures. The postoperative complications such as pain and fever were not signifificantly different. Hence, the supine PCNL is an equally effective modality for treatment of a renal calculus with benefifits of simultaneous retrograde access and less operative time compared to the prone PCNL.

【引用格式】

Mulay A, Mane D, Mhaske S, Shah AS, Krishnappa D, Sabale V. Supine versus prone percutaneous nephrolithotomy for renal calculi: Our experience. Curr Urol 2022;16 (1):25–29. doi: 10.1097/CU9.0000000000000076

【扫描二维码阅读原文】

Abstract 

Objectives: This study is aimed to determine the impact of liver disease severity on the outcome of patients undergoing endourological procedures for urolithiasis, and to understand the factors that are helpful in improving the outcome. 

Materials and methods: We retrospectively analyzed the records of patients with chronic liver disease who underwent endourological procedures between January 2014 and February 2020. Inpatient records and charts were assessed for age, sex, height, weight, body mass index, model for end-stage liver disease (MELD) score, Child–Turcotte–Pugh score, type of procedure and anesthesia, intensive care unit (ICU) stay, duration of hospitalization, number, size, and position of stones, and postoperative complications such as hematuria, sepsis, and secondary procedures. Data are presented as mean±standard deviation or frequency. The chi-square test was applied to determine the exact association between categorical data and Student t-test or Mann–Whitney U test as appropriate for continuous data. Statistical signifificance was set at p<0.05. 

Results: Hospital and ICU stay as well as administration of different blood products were signifificantly longer in the Child C than in the Child A and B categories (p<0.001). Two patients in the Child C category died, while 3 left the hospital against medical advice. The duration of ICU stay and blood products administered increased with augmenting MELD scores. The durations of hospitalization and blood product administration were signifificantly higher in patients with an MELD score ≥20 than in the group with MELD score <20. 

Conclusions: Hospital and ICU stay and blood product administration were signifificantly higher in Child C than in Child A and B class patients. Hospitalization duration and blood product administration were signifificantly higher in patients with an MELD score ≥20.

【引用格式】

Sharma A, Sindwani G, Arora V, Bhardwaj A. Impact of liver disease severity on outcomes of patients undergoing endourological procedures for urolithiasis. Curr Urol 2022;16(1):20–24. doi: 10.1097/CU9.0000000000000088

【扫描二维码阅读原文】

Abstract 

Background: We aimed to determine if the ratio of the upper to the lower diameter of the ureter could have any predictive value for ureteral stone impaction. 

Materials and methods: Patients who had a solitary unilateral ureteric stone, determined by noncontrast computerized tomography, were assessed if they had undergone ureteroscopic lithotripsy. A total of 111 patients, 84 males (76%), and 27 females (24%), were recruited to the study. Demographic data of the patients and preoperative radiological parameters based on noncontrast computerized tomography were recorded. The impaction status was also assessed during the operation. 

Results: Of the 111 patients, ureteral stones in 63 (57%) patients were determined to be impacted, and ureteral stones in 48 (43%) were nonimpacted. Impacted stones were more common in older patients, female patients, and patients with an American Society of Anesthesiologists score of 2. 

Conclusions: Signifificant relationships were found between the impaction status and transverse stone length, longest stone length, upper diameter of the ureter, ratio (upper diameter of the ureter/lower diameter of the ureter), and anteroposterior diameter of the pelvis. These parameters were higher in patients with impacted stones.

【引用格式】

Abat D, Börekoglu A, Altunkol A, Köse IÇ, Boga MS. Is there any predictive value of the ratio of the upper to the lower diameter of the ureter for ureteral stone impaction? Curr Urol 2021;15 (3):161–166. doi: 10.1097/CU9.0000000000000019

【扫描二维码阅读原文】

【引用格式】

Li F, Chi C, Chen Q. Endoscopic combined intrarenal surgery in prone split-leg and inclined supine positions to treat renal cast and multiple calyx stones: An invited commentary. Curr Urol 2022;16(1):30–31. doi: 10.1097/CU9.0000000000000096

【扫描二维码阅读原文】