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Moretto S, Saita A, Scoffone CM, Talso M, Somani BK, Traxer O, Angerri O, Knoll T, Liatsikos E, Herrmann TRW, Ulvik Ø, Skolarikos A, Cracco CM, Keller EX, Paciotti M, Piccolini A, Uleri A, Tailly T, Carmignani L, Pietropaolo A, Corrales M, Lughezzani G, Lazzeri M, Fasulo V, De Coninck V, Arena P, Nagele U, Ferretti S, Kronenberg P, Perez-Fentes D, Osther PJ, Goumas IK, Acquati P, Ajayi L, Diana P, Casale P, Buffi NM. Ureteral stricture rate after endoscopic treatments for urolithiasis and related risk factors: systematic review and meta-analysis. World J Urol 2024; 42:234. [PMID: 38613692 DOI: 10.1007/s00345-024-04933-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/15/2024] [Indexed: 04/15/2024] Open
Abstract
PURPOSE We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors. METHODS We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design). RESULTS A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years' studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 (P = 0.05), 2.6 (P = 0.009), 7.1 (P < 0.001), and 7.47 (P = 0.003), respectively. CONCLUSIONS The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment.
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Affiliation(s)
- S Moretto
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy.
| | - A Saita
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - C M Scoffone
- Department of Urology, Cottolengo Hospital, Turin, Italy
| | - M Talso
- Department of Urology, Luigi Sacco University Hospital, Milan, Italy
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - O Traxer
- Department of Urology, Sorbonne Université, Paris, France
| | - O Angerri
- Department of Urology, Fundació Puigvert Univ. Autonoma de Barcelona, Barcelona, Spain
| | - T Knoll
- Department of Urology, Sindelfingen Medical Center, University of Tübingen, Tübingen, Germany
| | - E Liatsikos
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - T R W Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland
- Hannover Medical School, Hannover, Germany
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, South Africa
| | - Ø Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - A Skolarikos
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athen, Athens, Greece
| | - C M Cracco
- Department of Urology, Cottolengo Hospital, Turin, Italy
| | - E X Keller
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - M Paciotti
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - A Piccolini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - A Uleri
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - T Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - L Carmignani
- Department of Urology, University of Milan, Milan, Italy
| | - A Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - M Corrales
- Department of Urology, Sorbonne Université, Paris, France
| | - G Lughezzani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - M Lazzeri
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - V Fasulo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - V De Coninck
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - P Arena
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - U Nagele
- Department of Urology, General Hospital Hall in Tirol, Hall in Tirol, Austria
| | - S Ferretti
- Department of Urology, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Italy
| | - P Kronenberg
- Department of Urology, Hospital CUF Descobertas, Lisbon, Portugal
| | - D Perez-Fentes
- Department of Urology, University Hospital Complex of Santiago de Compostela, Santiago, Spain
| | - P J Osther
- Department of Urology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - I K Goumas
- Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - P Acquati
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
| | - L Ajayi
- Department of Urology, Royal Free London NHS Foundation Trust, London, UK
| | - P Diana
- Department of Urology, Fundació Puigvert Univ. Autonoma de Barcelona, Barcelona, Spain
| | - P Casale
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - N M Buffi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
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Öğreden E, Oğuz U, Demirelli E, Benli E, Sancak EB, Gülpinar MT, Akbaş A, Reşorlu B, Ayyildiz A, Yalçin O. Categorization of ureteroscopy complications and investigation of associated factors by using the modified Clavien classification system. Turk J Med Sci 2016; 46:686-94. [PMID: 27513242 DOI: 10.3906/sag-1503-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/15/2015] [Indexed: 11/03/2022] Open
Affiliation(s)
- Ercan Öğreden
- Department of Urology, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Ural Oğuz
- Department of Urology, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Erhan Demirelli
- Department of Urology, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Erdal Benli
- Department of Urology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Eyüp Burak Sancak
- Department of Urology, Faculty of Medicine, Çanakkale 18 Mart University, Çanakkale, Turkey
| | - Murat Tolga Gülpinar
- Department of Urology, Faculty of Medicine, Çanakkale 18 Mart University, Çanakkale, Turkey
| | - Alpaslan Akbaş
- Department of Urology, Faculty of Medicine, Çanakkale 18 Mart University, Çanakkale, Turkey
| | - Berkan Reşorlu
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Ali Ayyildiz
- Department of Urology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Orhan Yalçin
- Department of Urology, Faculty of Medicine, Giresun University, Giresun, Turkey
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Sterling M, Ziemba J, Mucksavage P. Acute management of symptomatic nephrolithiasis. World J Clin Urol 2014; 3:161-167. [DOI: 10.5410/wjcu.v3.i3.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 05/23/2014] [Accepted: 08/29/2014] [Indexed: 02/06/2023] Open
Abstract
Over half a million patients present to emergency departments and nearly 3 million patients visit healthcare providers annually due to problems associated with urolithiasis. Despite updated guidelines from the American Urological Association and European Association of Urology for the evaluation and management of nephrolithiasis, considerable variability still exists regarding treatment for acute symptomatic upper urinary tract stones. Therefore, this article will review the current evaluation and management of acute symptomatic nephrolithiasis. Initial management includes analgesia and antiemetics. Additionally, a urinalysis and creatinine are required laboratory evaluations. Acute imaging with a non-contrast computed tomography (CT) scan is the diagnostic imaging modality of choice. However, concerns over radiation exposure have led towards low-dose and even ultra-low-dose protocols for the detection of urinary calculi. Low-dose non-contrast CT scans are now standard of care for the initial diagnosis of renal colic in patients with a body mass index ≤ 30. Medical expulsive therapy is recommended for patients with a ureteral calculus < 10 mm and no signs of infection. Emergency urinary decompression is mandatory for a specific subset of patients, especially those with infection. Although limited data exists, emergency ureteroscopy or even shock wave lithotripsy may also be therapeutic options.
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Abstract
Although ureteric injury is relatively uncommon, it is a serious event that can result in intra-abdominal sepsis, renal failure, and loss of the ipsilateral renal unit. Most injuries are iatrogenic and remain undiagnosed until the patient presents with symptoms postoperatively. In addition to compromising patient safety, missed ureteric injuries frequently result in litigation. Over the past 20 years, there has been a rapid uptake of laparoscopic and robotic techniques within urology and other surgical specialties. This trend, coupled with increased use of ureteroscopy, has increased the risk of injury to the ureter. The key to diagnosing and managing a ureteric injury is to have a low threshold for suspecting its presence. Diagnosis can be achieved using retrograde pyelography, ureteroscopy, CT, or intravenous urography. Initial management should involve ureteric stent placement or percutaneous nephrostomy drainage. In selected patients, surgical reconstruction might be the optimal approach. Decisions regarding surgical technique (open, laparoscopic, or robotic) are guided by the clinical situation and surgical expertise available.
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Youn JH, Kim SS, Yu JH, Sung LH, Noh CH, Chung JY. Efficacy and safety of emergency ureteroscopic management of ureteral calculi. Korean J Urol 2012; 53:632-5. [PMID: 23061001 PMCID: PMC3460006 DOI: 10.4111/kju.2012.53.9.632] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 07/20/2012] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of the ureteroscopic management of ureteral stones immediately after a first colic attack. Materials and Methods We retrospectively analyzed the data of 226 patients with obstructive ureteral stones who underwent ureteroscopy with stone retrieval. The 67 patients in group A underwent ureteroscopy within 48 hours of admission to our emergency department, whereas the 159 patients in group B underwent ureteroscopy more than 48 hours after admission. The chi-square test was used to evaluate and compare stone-free status, auxiliary procedures, and complications and the Kruskal-Wallis and Fisher's exact tests were used to analyze qualitative data. Results Mean stone sizes in groups A and B were 2.41±1.62 mm and 4.11±2.64 mm, respectively. No patient experienced a major complication during or after the procedure. Stone-free rates were 89.55% and 89.93%, respectively. Conclusions Emergency ureteroscopy in cases of obstructive ureteral stones is both safe and effective and offers the advantages of immediate stone fragmentation and the relief of acute-onset colic pain.
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Affiliation(s)
- Jun Ho Youn
- Department of Urology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Purpurowicz Z, Sosnowski M. Endoscopic holmium laser treatment for ureterolithiasis. Cent European J Urol 2012; 65:24-7. [PMID: 24578918 PMCID: PMC3921759 DOI: 10.5173/ceju.2012.01.art7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 12/01/2011] [Accepted: 12/06/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The rapid development and invention of ever more technologically advanced ureterorenoscopes as well as other instruments used in fragmenting ureteral stones have made the traditional surgical treatment of ureterolithiasis very rare. MATERIAL AND METHODS We investigated 727 patients treated for ureterolithiasis. 769 ureteroscopic lithotripsies (URSL) with the holmium laser were performed. We evaluated the relation of the stone size, the section of the ureter involved, length of time of the stone within the ureter and the condition of the urinary tract to the results of the ureterolithiasis treatment. RESULTS A good result of breaking up the stone and passing its fragments out of the ureter within 3 months following the first URSL was observed in 642 (90.9%) out of 706 patients. The remaining 64 (9.1%) patients required additional procedures: ESWL was performed on 44 patients; URSL was repeated for 20 patients. The most serious early post-URSL complications involved: urinary tract infection with symptoms of urosepsis in 10 patients, leading to death in 1 case, ureteral perforation in 3 patients, including 1 case presenting a periureteral leak that necessitated a surgical intervention. CONCLUSIONS URSL with the holmium laser is an effective and safe method for treating ureterolithiasis.
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Abstract
Retrograde exploration of the ureter and kidneys is currently a widely used and well-established procedure to deal with problems of a diagnostic and therapeutic nature with reduced invasiveness. The process of miniaturizing the instruments combined with the steady improvement in video quality has continuously amplified its potential applications, maintaining the procedure safe and rapid. During an operation, however, unexpected events may condition a change to the programme or determine the onset of even more serious complications. Our aim is to analyze such events and complications and recommend potential solutions to prevent and/or deal with such happenings.
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Affiliation(s)
- Alessandro D'Addessi
- Urology Department, Catholic University School of Medicine, Rome, Italy. adaddessi @ rm.unicatt.it
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Sarica K, Tanriverdi O, Aydin M, Koyuncu H, Miroglu C. Emergency ureteroscopic removal of ureteral calculi after first colic attack: is there any advantage? Urology 2011; 78:516-20. [PMID: 21601257 DOI: 10.1016/j.urology.2011.01.070] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 12/07/2010] [Accepted: 01/24/2011] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To comparatively evaluate the efficacy of ureteroscopic stone treatment immediately after the first colic attack and in an electively planned manner. METHODS A total of 145 patients underwent semirigid ureteroscopic removal of obstructive ureteral calculi using 2 different approaches (group 1, 69 patients, and group 2, 76 patients). The 69 patients in group 1 were treated with appropriate medical therapy for a period of ≥7 days for colic pain and subsequently underwent either semirigid ureteroscopy or pneumatic lithotripsy in a planned manner. The 76 patients in group 2 underwent semirigid ureteroscopy after the first colic attack. The stone-free status, auxiliary procedures, and complications were evaluated between the 2 groups using the Mann-Whitney U test; for qualitative data, Fisher's exact test was used. RESULTS Of the 145 patients who underwent semirigid ureteroscopy, the mean stone size was 11.80±3.95 mm and 8.32±2.08 mm in the 2 groups. No patient experienced a major complication during or after the procedure. The stone-free rate was 87% and 90.7% in groups 1 and 2, respectively. The mean readmission rate to the emergency department for the management of a colic attack was 3.03±2.84 in group 1; no patient in group 2 required readmission. CONCLUSION Ureteroscopic stone removal immediately after the first colic attack in the cases of obstructive ureteral stones proved to be safe and effective. It has the main advantage of offering both immediate stone fragmentation and the relief of acute onset colic pain causing extreme discomfort.
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Affiliation(s)
- Kemal Sarica
- Department of Urology, Yeditepe University Medical School, and 2nd Urology Department, Sisli Etfal Training Research Hospital, Istanbul, Turkey
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Al-Ghazo MA, Ghalayini IF, Al-Azab RS, Bani Hani O, Bani-Hani I, Abuharfil M, Haddad Y. Emergency ureteroscopic lithotripsy in acute renal colic caused by ureteral calculi: a retrospective study. ACTA ACUST UNITED AC 2011; 39:497-501. [PMID: 21499919 DOI: 10.1007/s00240-011-0381-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 04/07/2011] [Indexed: 12/12/2022]
Abstract
This work was conducted to evaluate the safety and efficacy of emergency ureteroscopic lithotripsy in patients with ureteral stones. From May 2003 to December 2010, 244 patients (184 men and 60 women, mean age 45.6 ± 12.7 years (range 22-73 years) were treated with emergency ureteroscopic lithotripsy for ureteral calculi. All patients were divided into three groups according to the stone location in the ureter. Intracorporeal lithotripsy when necessary was performed with the Swiss lithoclast. The overall stone-free status was defined as the complete absence of stone fragments at 4 weeks, postoperatively. A double J stent was inserted in selected patients if there was significant ureteral wall trauma, edema at the stone impaction site, suspected or proved ureteral perforation, and if the stone migrated to the kidney. The overall success rate was 90.6%. The success rates were different according to the stone site. The success rate of groups A, B and C was 69.4, 94.8 and 96.6%, respectively. The overall rate of ureteral stent insertion at the end of the procedure was 177/244 (72.5%). The rate of stent insertion was 41/49 (83.7%), 32/46 (69.6%) and 104/149 (69.8%) in groups A, B and C, respectively. The overall complication, failure, and stricture rate was 32/244 (13.1%), 23/244 (9.4%) and 0.8%, respectively. With the recent advances in ureteroscopic technology, intracorporeal probes and stone extraction devices, emergency ureteroscopy is found to be a safe and effective procedure with immediate relief from ureteral colic and ureteral stone fragmentation.
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Affiliation(s)
- Mohammed A Al-Ghazo
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid 22110, Jordan.
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Adiyat KT, Meuleners R, Monga M. Selective Postoperative Imaging After Ureteroscopy. Urology 2009; 73:490-3; discussion 493. [DOI: 10.1016/j.urology.2008.09.064] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 07/06/2008] [Accepted: 09/02/2008] [Indexed: 10/21/2022]
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Traxer O, Lechevallier E, Saussine C. [Distal ureteral stone: therapeutic management]. Prog Urol 2008; 18:981-5. [PMID: 19033066 DOI: 10.1016/j.purol.2008.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 09/02/2008] [Indexed: 10/21/2022]
Affiliation(s)
- O Traxer
- Service d'urologie, hôpital Tenon, 4, rue de la Chine, 75970 Paris cedex 20, France.
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Elashry OM, Elgamasy AK, Sabaa MA, Abo-Elenien M, Omar MA, Eltatawy HH, El-Abd SA. Ureteroscopic management of lower ureteric calculi: a 15-year single-centre experience. BJU Int 2008; 102:1010-7. [PMID: 18485033 DOI: 10.1111/j.1464-410x.2008.07747.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review our 15-year experience with ureteroscopic treatment of distal ureteric calculi and to determine the impact of improved technology and techniques on the efficacy, success and complications of the procedure. PATIENTS AND METHODS We retrospectively reviewed the medical records of 4512 patients who underwent 5133 ureteroscopic procedures for the treatment of distal ureteric calculi at our institution from January 1991 to December 2005. The patient and stone characteristics, treatment variables and clinical outcomes were assessed. Factors such as type of ureteroscope, procedure duration, procedure success, complication rate and hospital stay were evaluated. Data obtained from a cohort of patients that underwent the procedure from 1991 to 1995 (group 1) were statistical compared with those obtained from a cohort of patients from 1996 to 2005 (group 2). Logistic regression analysis was used to identify associated factors with the major complications of ureteroscopy. RESULTS Overall, the stone-free rate after the procedure was 94.6%, the mean (sd; range) operative duration was 43 (15.0; 25-120) min, the intraoperative complication rate was 6.67%, the postoperative complication rate was 9.9%, and the mean (sd) hospital stay was 1.7 (1.1) days. The clinical and radiological follow-up (mean 36.8 months) for 71.3% of eligible patients detected only 12 ureteric strictures (0.23%). On comparing group 1 with group 2, the overall success of ureteroscopic stone extraction improved from 85.7% to 97.3% (P < 0.001), significant ureteric perforation decreased from 3.3% to 0.5% (P = 0.05), ureteric avulsion decreased from 1.3 to 0.1% (P < 0.05), ureteric stricture decreased from 0.7% to 0.1% (P < 0.007), the mean (sd) procedure time significantly decreased from 75 (42.9) min to 36.5 (12.5) min (P < 0.001), and the mean hospital stay significantly decreased from 2.5 (1.6) days to 0.5 (1.2) days, with a trend toward outpatient treatment. Logistic regression analysis showed a significant association of the major ureteroscopic complications with increased operative duration, type of ureteroscope used, stone impaction, stone size and surgeon experience. CONCLUSION The present series shows the high success rate, with minor complications, that can be achieved with ureteroscopic treatment of distal ureteric calculi. Improvements in ureteroscope design, accessories, technique and experience have led to a significant increase in the success rate and decrease in the complication rate.
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Editorial comment on: endoluminal isoproterenol irrigation decreases renal pelvic pressure during flexible ureterorenoscopy: a clinical randomized, controlled study. Eur Urol 2008; 54:1410-1. [PMID: 18403101 DOI: 10.1016/j.eururo.2008.03.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Karadag MA, Tefekli A, Altunrende F, Tepeler A, Baykal M, Muslumanoglu AY. Is Routine Radiological Surveillance Mandatory After Uncomplicated Ureteroscopic Stone Removal? J Endourol 2008; 22:261-6. [DOI: 10.1089/end.2006.0445] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mert Ali Karadag
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey
| | - Ahmet Tefekli
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey
| | - Fatih Altunrende
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey
| | - Abdulkadir Tepeler
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey
| | - Murat Baykal
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey
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Gunlusoy B, Degirmenci T, Arslan M, Kozacioglu Z, Nergiz N, Minareci S, Ayder AR. Ureteroscopic Pneumatic Lithotripsy: Is the Location of the Stone Important in Decision Making? Analysis of 1296 Patients. J Endourol 2008; 22:291-4. [DOI: 10.1089/end.2007.0160] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bulent Gunlusoy
- Department of Urology, Izmir Education and Teaching Hospital, Izmir, Turkey
| | - Tansu Degirmenci
- Department of Urology, Izmir Education and Teaching Hospital, Izmir, Turkey
| | - Murat Arslan
- Department of Urology, Izmir Education and Teaching Hospital, Izmir, Turkey
| | - Zafer Kozacioglu
- Department of Urology, Izmir Education and Teaching Hospital, Izmir, Turkey
| | - Nihat Nergiz
- Department of Urology, Izmir Education and Teaching Hospital, Izmir, Turkey
| | - Suleyman Minareci
- Department of Urology, Izmir Education and Teaching Hospital, Izmir, Turkey
| | - Ali Riza Ayder
- Department of Urology, Izmir Education and Teaching Hospital, Izmir, Turkey
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Osorio L, Lima E, Soares J, Autorino R, Versos R, Lhamas A, Marcelo F. Emergency ureteroscopic management of ureteral stones: why not? Urology 2007; 69:27-31; discussion 31-3. [PMID: 17270606 DOI: 10.1016/j.urology.2006.08.1116] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Revised: 05/19/2006] [Accepted: 08/22/2006] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To describe a single-center experience in the emergency ureteroscopic management of ureteral stones. METHODS We retrospectively considered the data from 144 patients (mean age 49.6 years, range 23 to 82) who had had obstructive ureteral stones and had undergone emergency ureteroscopy with stone retrieval. Intracorporeal pneumatic lithotripsy was performed when necessary. At the end of the procedure, a ureteral catheter was systematically left in place in 100 patients (69.4%) and removed within 24 hours. In the remaining 44 patients, a double-J stent was preferred and was removed within 30 days, depending on the clinical course. Stone-free status was defined as the complete absence of fragments at 1 month of follow-up. RESULTS The calculi were more frequently localized in the distal ureter than in the proximal one (90.3% versus 9.7%, respectively). The overall mean stone diameter was 9.1 mm (range 5 to 20). The overall stone-free rate was 92.4%. A greater stone-free rate was obtained in those with stones less than 10 mm (95.8%) than in those with stones larger than 10 mm (89%, P = 0.002). Similarly, a significantly better outcome occurred for those with stones located in the distal ureter (94.6%) than for those with stones in the proximal one (71.4%, P = 0.004). The overall complication rate was 4.2%. The mean hospital stay was 2.5 days (range 1 to 7). CONCLUSIONS In our experience, emergency ureteroscopy in cases of obstructive ureteral stones proved to be safe and effective. It has the main advantage of offering both immediate relief from pain and stone fragmentation. Additional extensive studies are warranted to corroborate these findings.
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Affiliation(s)
- Luis Osorio
- Department of Urology, Santo Antonio General Hospital, Oporto, Portugal.
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17
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Abstract
The management of urolithiasis has radically changed over the last two decades. Open surgery has been almost completely replaced by minimally invasive procedures, mainly extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS). Although these treatment modalities have been proven to be very safe and effective, serious complications can occur. Prompt diagnosis is often essential and may even be lifesaving. Radiologists play an important role in this setting, since many of these complications can be readily diagnosed by imaging. Awareness of the wide spectrum of complications may be crucial in interpreting imaging studies of patients who have undergone one of these procedures. This article reviews the contemporary management of ureteric stones with ESWL and URS and illustrates the radiological findings of complications of these procedures.
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Affiliation(s)
- G Gayer
- Department of Diagnostic Imaging, Assaf Harofeh Medical Center, Zrifin 70300, Israel.
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de la Rosette JJMCH, Skrekas T, Segura JW. Handling and prevention of complications in stone basketing. Eur Urol 2006; 50:991-8; discussion 998-9. [PMID: 16530928 DOI: 10.1016/j.eururo.2006.02.033] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Accepted: 02/10/2006] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To review the incidence, risk factors, and treatment options of intraoperative and postoperative complications of stone basketing in urology with emphasis on certain principles that must be upheld to prevent those complications. METHODS A literature search was performed using the MEDLINE database on stone basketing between 1970 and 2005. RESULTS Iatrogenic trauma due to retrieval of a stone is well known but the exact incidence is difficult to ascertain. Rarely, stone basketing can cause major trauma to the ureter, such as avulsion or intussusception, requiring open or laparoscopic intervention for ureteral continuity restoration. Mucosal abrasion, ureteral perforation, and stricture formation have also been described as complications of stone basketing. Occasionally, the engaged or broken basket can provoke anxiety even for experienced urologists. Factors that increase the risk of complications, strategies for repair, and techniques for prevention are discussed extensively. CONCLUSION Infrequent, surgical misadventures during stone basketing can occur and must be treated appropriately. Careful attention to instrument selection and surgical techniques and awareness of risk factors and type and site of potential injury are essential to reduce these complications.
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Kalafatis P, Zougkas K, Petas A. Primary ureteroscopic treatment for obstructive ureteral stone-causing fornix rupture. Int J Urol 2005; 11:1058-64. [PMID: 15663675 DOI: 10.1111/j.1442-2042.2004.00949.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Management of fornix rupture (FR) by obstructive stone is comprised of extravasation control and the elimination of the obstruction. For all patients, management initially remains conservative under close follow up. Endoscopic management of FR involved with an obstructive stone of the ureter or the pelvi-ureteric junction (UPJ) consists mainly of stenting the ureter. Our endoscopic approach to this pathological entity comprises of the sole stenting of the ureter, as well as primary ureteroscopic lithotripsy followed by ureter stenting. PATIENTS AND METHODS In the Department of Urology at the General Hospital of Rhodos Island, Rhodos, Greece, over the last 15 years, 51 of 86 patients with FR due to an obstructive stone, were treated endoscopically. Twenty-two patients underwent sole stenting of the ureter (option A) and 29 patients underwent primary ureteroscopic lithotripsy and stenting (option B). RESULTS The overall primary 'successful outcome' was achieved in nine of the 22 patients (40.9%) in the group treated with sole stenting, while the remaining 59.1% required secondary interventions. However, 27 of the 29 patients (93.1%) treated with primary ureteroscopic lithotripsy and stenting required no auxiliary treatment. The primary successful outcome results for obstructive middle and lower ureteral stones with FR were eight out of 12 (66.6%) and 26 out of 27 (96.3%) for therapeutic options A and B, respectively. Upper obstructive ureteral stones with FR required secondary intervention in most cases, regardless of the therapeutic option chosen. (In nine out of 10 and one out of two cases for options A and B, respectively). The mean duration of hospitalization for options A and B were 7.6 and 5.3 days, respectively. The mean duration that the ureter stent remained in situ for A and B treatment options was 30.9 and 10.2 days, respectively. CONCLUSIONS Sole stenting of the ureter is reserved for infected FR or for stones of the upper ureter or the UPJ. Ureteroscopic lithotripsy followed by double-J stenting of the ureter may offer a quick and safe therapeutic alternative for distal and middle obstructive ureteral stones with FR.
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Demirci D, Gülmez I, Ekmekçioğlu O, Karacagil M. Retroperitoneoscopic ureterolithotomy for the treatment of ureteral calculi. Urol Int 2005; 73:234-7. [PMID: 15539842 DOI: 10.1159/000080833] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2003] [Accepted: 03/17/2004] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Most upper or middle ureteral stones are treated with shock wave lithotripsy or endoscopic techniques. In rare cases the ureteral stones are treated with open surgery after failure of first-line treatments. Retroperitoneoscopy is a minimally invasive alternative to open surgery. PATIENTS AND METHODS Between May 1995 and January 2001, twenty-one patients underwent retroperitoneoscopic ureterolithotomy. The stones in upper and middle ureter were large and impacted (5 patients) or not fragmented after shock wave lithotripsy (16 patients). A balloon dissector was placed and infiltrated with 800 ml air in the retroperitoneal space. Three 10-mm trocars were used. The pressure was kept at 15 mm Hg by carbon dioxide insufflation. The stones were extracted from the ureter using a laparoscopic stylet. RESULTS The stones in 17 patients were successfully removed in a median operating time of 105 (min-max 45-190) min. Urine extravasation in all cases and pnomoscrotum in 2 cases were observed as postoperative complications. The median hospital stay was 6 (min-max 3-22) days with minimal analgesic requirement. CONCLUSION Retroperitoneoscopic ureterolithotomy is a useful and effective alternative treatment technique to open surgery when first-line treatments have failed or are unlikely to be effective.
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Affiliation(s)
- Deniz Demirci
- Erciyes University, Medical Faculty Department of Urology, Kayseri, Turkey.
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Butler MR, Power RE, Thornhill JA, Ahmad I, McLornan I, McDermott T, Grainger R. An audit of 2273 ureteroscopies--a focus on intra-operative complications to justify proactive management of ureteric calculi. Surgeon 2005; 2:42-6. [PMID: 15570806 DOI: 10.1016/s1479-666x(04)80137-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND At the national Stone Centre we have adopted a proactive management approach involving early ureteroscopy for ureteric calculi. As the efficacy of ureteroscopy is known this study focuses on the low intra-operative complication rate as justification for a proactive management protocol. PATIENTS AND METHODS A retrospective study (1987-1997) identified 1936 patients undergoing 2273 ureteroscopies. A database was created from inpatient hospital records. The male to female ratio was 3 to 1, age range was 25 to 84 years. RESULTS Twenty-three patients (1%) had an intra-operative complication during ureteroscopy. Immediate ureteric JJ stenting was performed in 16 cases with ureteric injury. Two cases underwent percutaneous drainage and delayed antegrade ureteric stenting, ureteroscopy was terminated because of poor visibility. Five patients (0.22%) underwent open surgery for: ureteric perforation (n = 2); Dormia basket ureteric avulsion (n = 1); impacted Dormia basket and stone (n = 1); and impacted balloon dilator and stone (n = l). Ureteroscopic complications were not related to the level of ureteric calculus. CONCLUSION A protocol of proactive management of ureteric calculi facilitates rapid turnover of large patient numbers. This approach is supported by the low intra-operative complication rate, most of which can be managed by further endoscopic procedures. In the event of corrective open surgery a favourable outcome has resulted.
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Affiliation(s)
- M R Butler
- Department of Urology, The Adelaide and Meath Hospital Dublin, incorporating The National Children's Hospital, Tallaght, Dublin 24, Ireland.
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Hautmann S, Friedrich MG, Fernandez S, Steuber T, Hammerer P, Braun PM, Jünemann KP, Huland H. Extracorporeal Shockwave Lithotripsy Compared with Ureteroscopy for the Removal of Small Distal Ureteral Stones. Urol Int 2004; 73:238-43. [PMID: 15539843 DOI: 10.1159/000080834] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The treatment of small distal ureteral stones smaller or equal to 5 mm in size is still highly controversial. In distal ureteral stones larger than 5 mm in size, ureteroscopy (URS) has been shown in many studies to be superior to shockwave lithotripsy (SWL). The objective was to analyze the stone-free rate after treatment of distal ureteral stones with in situ SWL or URS. MATERIALS AND METHODS A total of 3,857 SWL treatments were performed at our institution between 1996 and 2001. During this period 45 in situ SWL procedures were performed with the Dornier MFL 5000 lithotripter on distal ureteral stones regardless of the stone size. A total of 262 URS treatments were performed on distal ureteral stones. URS for small (5 mm or less) distal ureteral stones was performed in 110 cases. RESULTS Distal ureteral stones smaller or equal to 5 mm in size were treated successfully stone free in 78% in one SWL session. Patients required a second SWL in 14% of the cases and 8% of the patients required a third SWL session. URS patients were successfully stone free after the procedure in 97% of the cases. Failed URS that needed an additional URS were performed in 2 and 1% of the patients had one SWL in situ treatment. CONCLUSIONS URS treatment has shown to be the therapy of choice for distal ureteral stones. It is more effective than SWL treatment in this stone location. In experienced hands URS is a safe though even more invasive procedure than SWL. This can be expected as urologists perform more than 40 URS procedures per year.
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Affiliation(s)
- Stefan Hautmann
- Department of Urology, University Hospital Hamburg, Eppendorf, Hamburg, Germany.
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23
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Abstract
Ureteroscopy has undergone a dramatic evolution over the last two decades. Although ureteroscopic injury is the most common cause of ureteral trauma because of the large number of ureteroscopic procedures performed, improvements in instrumentation and technique have resulted in a reduced incidence of serious complications. Despite significant technologic advances, however, surgical misadventures still occur, some of which have lasting consequences. Careful attention to instrument selection and surgical technique are critical to reduce untoward events related to ureteroscopy. As such, adverse sequelae associated with ureteroscopy should be related to the underlying pathology itself rather than to the treatment.
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Affiliation(s)
- D Brooke Johnson
- Division of Urology, University of Utah Health Sciences Center, 50 North Medical Drive, Salt Lake City, UT 84132, USA
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Unsal A, Cimentepe E, Balbay MD. Routine ureteral dilatation is not necessary for ureteroscopy. Int Urol Nephrol 2004; 36:503-6. [PMID: 15787325 DOI: 10.1007/s11255-004-0860-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To present our experience in ureteroscopic lithotripsy and stone extraction without ureteral dilatation. PATIENTS AND METHODS A total of 134 consecutive patients (80 male and 54 female), with a mean age of 36.4 (18-65) years underwent ureteroscopic stone removal. The stones were located in the lower, middle, and upper parts of the ureter in 92, 18 and 24 patients and the mean stone diameters were 9.2 (6-15) mm, 10.5 (8-15) mm and 8.8 (8-10) mm, respectively. A semirigid ureteroscope 8 F in size was used without any ureteral dilatation. The stones were fragmented by a pneumatic lithotripter in the ureter and the fragments were removed by a basket catheter or stone forceps. All patients were re-evaluated with a plain film on postoperative first day and with intravenous urography (IVU) at 3 months. Residual fragments bigger than 3 mm were accepted as treatment failure. RESULTS The mean operation time was 44 (20-120) minutes. After the operation, the stone-free rate was 89/92 (97%) for lower, 15/18 (83%) middle and 18/24 (75%) upper ureteral stones, respectively. Double J catheter replacement was needed in 13 patients due to impacted stone and/or failed procedure. Ureteral perforation did not occur in any patient. Patients were discharched from hospital within 6-24 hours. No ureteral stricture was encountered during the follow-up period. CONCLUSION Our experience suggests that ureteroscopic interventions could be easily performed for all parts of ureter without previous dilatation of the ureter.
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Affiliation(s)
- Ali Unsal
- Department of Urology, Fatih University, School of Medicine, Ankara, Turkey.
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Noninvasive Anesthesia, Analgesia And Radiation-Free Extracorporeal Shock Wave Lithotripsy For Stones In The Most Distal Ureter:. J Urol 2002. [DOI: 10.1097/00005392-200208000-00009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Noninvasive Anesthesia, Analgesia And Radiation-Free Extracorporeal Shock Wave Lithotripsy For Stones In The Most Distal Ureter: Experience With 165 Patients. J Urol 2002. [DOI: 10.1016/s0022-5347(05)64655-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bugg CE, El-Galley R, Kenney PJ, Burns JR. Follow-up functional radiographic studies are not mandatory for all patients after ureteroscopy. Urology 2002; 59:662-7. [PMID: 11992836 DOI: 10.1016/s0090-4295(02)01508-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To evaluate the usefulness of follow-up radiographic studies after ureteroscopy by retrospective chart review. METHODS We reviewed the charts of 118 patients who underwent 134 ureteroscopic procedures from January 1998 to November 1999. RESULTS Follow-up was obtained at our institution for 87 patients. The follow-up period ranged from 3 to 34 weeks (mean 7, SE +/- 0.75). Of 10 patients who underwent ureteroscopy for diagnostic purposes, none had postoperative pain or obstruction on follow-up radiographic studies. Of 77 patients who underwent ureteroscopy for calculi, 12 (16%) had postoperative obstruction. One third of patients with residual obstruction (4 of 12) complained of persistent pain versus 6% of patients without evidence of obstruction (4 of 65) (P = 0.02). Twelve patients had residual stone fragments on their follow-up radiographic studies; 5 (42%) of these patients complained of pain versus 3 (5%) of 65 patients who were stone free after surgery (P = 0.002). The use of pain to predict either obstruction or residual fragments had a negative and positive predictive value of 83% and 75%, respectively. Preoperative obstruction and postoperative pain were combined as one indicator for the presence of residual fragments and postoperative obstruction. Patients who had preoperative obstruction and presented with postoperative pain had a 67% chance of having residual fragments and a 50% chance of residual obstruction, and 96% of patients without preoperative obstruction and no postoperative pain had no persistent obstruction or residual fragments (P = 0.001). CONCLUSIONS For patients who present for ureteroscopy with no obstruction and report no pain at follow-up, a plain radiograph may be sufficient. For patients who present with obstruction and report pain during follow-up, functional imaging studies are recommended.
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Affiliation(s)
- Charles E Bugg
- Division of Urology, University of Alabama at Birmingham, Birmingham, Alabama 35294-3296, USA
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Abstract
OBJECTIVES Endourological procedures as ureteroscopy require an advanced level of skills. To facilitate the training of the proper technique, simulators are helpful. Nonbiological models, useful to learn the basic steps, do not represent the clinical situation in an ideal way. We therefore looked for a biological but nevertheless easily available model. METHODS The complete urinary tract is dissected off the retroperitoneal organ package of freshly slaughtered pigs. RESULTS The porcine urinary tract model allows for training all aspects of diagnostic and therapeutic ureteroscopy including lithotripsy and stenting in a way which is almost identical to the clinical situation in humans. CONCLUSIONS The porcine urinary tract model is an ideal ex vivo model. Concerning 'tissue feeling' and anatomic relations, it is superior to nonbiological simulators. Nevertheless, it is quite easily available and inexpensive. In training courses, we have used it with great success.
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