Gap between UAS and ureteroscope predicts renal stone-free rate after flexible ureteroscopy with the fragmentation technique.
Kidney calculi
Postoperative complications
Stone-free rate
Ureteral access sheath
Ureteroscopy
Journal
World journal of urology
ISSN: 1433-8726
Titre abrégé: World J Urol
Pays: Germany
ID NLM: 8307716
Informations de publication
Date de publication:
Jul 2021
Jul 2021
Historique:
received:
08
05
2020
accepted:
10
09
2020
pubmed:
29
9
2020
medline:
12
1
2022
entrez:
28
9
2020
Statut:
ppublish
Résumé
To assess the effect of our new classification on surgical outcomes after flexible ureteroscopy (fURS) for kidney stones. We retrospectively examined 128 patients after single renal fURS procedures performed using ureteral access sheaths (UASs) with the fragmentation technique. Based on the gap (calculated by subtracting the ureteroscope diameter from the UAS diameter), enrolled patients were divided into three groups: small (< 0.6 mm), medium (0.6 to < 1.2 mm), and large space groups (≥ 1.2 mm). Stone-free (SF) status was defined as either complete absence of stones (SF) or the presence of stones < 4 mm in diameter on non-contrast computed tomography (NCCT). The SF rate was significantly lower in the small space group (50% in small, 97.9% in medium, 89.2% in large; p = 0.001). Perioperative complications over Clavien-Dindo Grade I were observed in 16.7%, 4.2%, and 8.1% of patients, respectively (p = 0.452). The ratio of stone volume and operative time (efficiency of stone removal) was significantly higher in the large space group compared to the small and medium space groups (0.009 ± 0.003 ml/min, 0.013 ± 0.005 ml/min, 0.027 ± 0.012 ml/min, respectively; p < 0.001). Our findings that gaps > 0.6 mm (1.8 Fr), including the combination of a 9.5-Fr UAS and a small caliber ureteroscope, improve SF rates, and larger gaps facilitate stone removal efficiency providing the basis for future development of clinical protocols aimed at improving outcomes.
Identifiants
pubmed: 32986134
doi: 10.1007/s00345-020-03459-7
pii: 10.1007/s00345-020-03459-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2733-2739Informations de copyright
© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Breda A, Ogunyemi O, Leppert JT, Schulam PG (2009) Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones. Eur Urol 55:1190–1197. https://doi.org/10.1016/j.eururo.2008.06.019
doi: 10.1016/j.eururo.2008.06.019
pubmed: 18571315
El-Nahas AR, Ibrahim HM, Youssef RF, Sheir KZ (2012) Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for treatment of lower pole stones of 10–20 mm. BJU Int 110:898–902. https://doi.org/10.1111/j.1464-410X.2012.10961.x
doi: 10.1111/j.1464-410X.2012.10961.x
pubmed: 22372915
Cohen J, Cohen S, Grasso M (2013) Ureteropyeloscopic treatment of large, complex intrarenal and proximal ureteral calculi. BJU Int. https://doi.org/10.1111/j.1464-410X.2012.11352.x
doi: 10.1111/j.1464-410X.2012.11352.x
pubmed: 23714649
Breda A, Ogunyemi O, Leppert JT et al (2008) Flexible ureteroscopy and laser lithotripsy for single intrarenal stones 2 cm or greater-is this the new frontier? J Urol 179:981–984. https://doi.org/10.1016/j.juro.2007.10.083
doi: 10.1016/j.juro.2007.10.083
pubmed: 18207179
Pearle MS, Lingeman JE, Leveillee R et al (2008) Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less. J Urol 179:2005–2009. https://doi.org/10.1016/j.juro.2008.03.140
doi: 10.1016/j.juro.2008.03.140
Komeya M, Usui K, Asai T et al (2018) Outcome of flexible ureteroscopy for renal stone with overnight ureteral catheterization: a propensity score-matching analysis. World J Urol. https://doi.org/10.1007/s00345-018-2328-1
doi: 10.1007/s00345-018-2328-1
pubmed: 29761227
Komeya M, Odaka H, Asano J et al (2019) Development and internal validation of a nomogram to predict perioperative complications after flexible ureteroscopy for renal stones in overnight ureteral catheterization cases. World J Urol. https://doi.org/10.1007/s00345-019-03023-y
doi: 10.1007/s00345-019-03023-y
pubmed: 31784774
Raheem OA, Khandwala YS, Sur RL et al (2017) Burden of urolithiasis: trends in prevalence, treatments, and costs. Eur Urol Focus 3:18–26. https://doi.org/10.1016/j.euf.2017.04.001
doi: 10.1016/j.euf.2017.04.001
pubmed: 28720363
Giusti G, Proietti S, Villa L et al (2016) Current standard technique for modern flexible ureteroscopy: tips and tricks. Eur Urol 70:188–194. https://doi.org/10.1016/j.eururo.2016.03.035
doi: 10.1016/j.eururo.2016.03.035
pubmed: 27086502
Vanlangendonck R, Landman J (2004) Ureteral access strategies: Pro-access sheath. Urol Clin North Am 31:71–81
doi: 10.1016/S0094-0143(03)00095-8
Breda A, Territo A, López-Martínez JM (2016) Benefits and risks of ureteral access sheaths for retrograde renal access. Curr Opin Urol 26:70–75. https://doi.org/10.1097/MOU.0000000000000233
doi: 10.1097/MOU.0000000000000233
pubmed: 26555688
Rehman J, Monga M, Landman J et al (2003) Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology 61:713–718
doi: 10.1016/S0090-4295(02)02440-8
Aboumarzouk OM, Monga M, Kata SG et al (2012) Flexible ureteroscopy and laser lithotripsy for stones >2cm: a systematic review and meta-analysis. J Endourol 26:1257–1263
doi: 10.1089/end.2012.0217
Traxer O, Wendt-Nordahl G, Sodha H et al (2015) Differences in renal stone treatment and outcomes for patients treated either with or without the support of a ureteral access sheath: the clinical research office of the endourological society ureteroscopy global study. World J Urol 33:2137–2144. https://doi.org/10.1007/s00345-015-1582-8
doi: 10.1007/s00345-015-1582-8
pubmed: 25971204
pmcid: 4655002
Noureldin YA, Kallidonis P, Ntasiotis P et al (2019) The effect of irrigation power and ureteral access sheath diameter on the maximal intra-pelvic pressure during ureteroscopy: in vivo experimental study in a live anesthetized pig. J Endourol 33:725–729
doi: 10.1089/end.2019.0317
Tracy CR, Ghareeb GM, Paul CJ, Brooks NA (2018) Increasing the size of ureteral access sheath during retrograde intrarenal surgery improves surgical efficiency without increasing complications. World J Urol 36:971–978. https://doi.org/10.1007/s00345-018-2204-z
doi: 10.1007/s00345-018-2204-z
pubmed: 29380131
Ito H, Kawahara T, Terao H et al (2012) The most reliable preoperative assessment of renal stone burden as a predictor of stone-free status after flexible ureteroscopy with holmium laser lithotripsy: a single-center experience. Urology 80:524–528. https://doi.org/10.1016/j.urology.2012.04.001
doi: 10.1016/j.urology.2012.04.001
pubmed: 22658621
Yallappa S, Metcalfe J, Subramonian K (2018) The natural history of asymptomatic calyceal stones. BJU Int 122:263–269. https://doi.org/10.1111/bju.14354
doi: 10.1111/bju.14354
pubmed: 29675983
Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48:452–458. https://doi.org/10.1038/bmt.2012.244
doi: 10.1038/bmt.2012.244
pubmed: 23208313