Objectives: The aim of this study is to explore the efficacy and safety of flexible ureteroscopy (fURS) with prestenting (PS) for patients and a newly starting department. Method: The data of patients who underwent fURS for calculi with nonprestenting (NPS) after a clinical practice change was compared with PS patients before. Result: In all, 199 patients met the inclusion criteria. There was no significant difference for both groups in basic demography except that the NPS group included more proximal ureteral stone. Subgroup analysis was then used by a different site. There was no significance in sheath success (4/100 vs. 1/99, p = 0.369). Stone free rate (SFR) and success rate between PS and NPS group showed significant difference in total (96.94 vs. 89.58%, p = 0.048, 96.97 vs. 85.00%, p = 0.005 respectively). Better SFR and success rate were found only for the renal stones in subgroup analysis (97.67 vs. 80.49%, p = 0.014, 97.67 vs. 74.42%, p = 0.003 respectively). Operative time was significantly longer based on stenting status (45.969 ± 19.4732 vs. 30.553 ± 8.9645 min, p = 0.01) and there was no difference in subgroup analysis. More complications were found in the NPS group, but no severe complications were encountered. Conclusion: Intentional PS is a feasible try for an amateur fURS surgeon or a newly started department in order to gain a better outcome and lower complications in the whole time. It improves the outcomes when additional small surgery is not the trouble.
This study aimed to prospectively evaluate the safety and efficacy of a new developed method that uses percutaneous ultrasound-guided hematoma aspiration followed by targeted localized manual compression for treatment of femoral artery pseudoaneurysm after cardiac catheterization, which obviates thrombin use, surgery, and long-time compression.From January 2007 to July 2014, 32 patients (17 women; mean age, 55.3 ± 11.5 years) out of 8,725 consecutive cases undergoing cardiac catheterization via femoral access developed one pseudoaneurysm each ranging in size from 21 × 11 mm to 72 × 39 mm. Under ultrasound guidance, blood within the pseudoaneurysm was aspirated percutaneously using an 18-gauge needle, while the pseudoaneurysm neck and a nearby site over the pseudoaneurysm were manually compressed for 15 min. All patients underwent repeat ultrasound examination 24 hours later.Of the 32 pseudoaneurysms, 31 were successfully occluded, and 1 recurred in a patient with coexisting arteriovenous fistula, yielding an overall success rate of 96.9% (31/32). No further recurrence or procedure related complications were observed. The treatment approach is unlike open surgical repair with hematoma evacuation and arterial defect suturing, in that it entails hematoma aspiration and feeding flow blockage at the pseudoaneurismal neck.In this preliminary experience, combining percutaneous ultrasound-guided hematoma aspiration and manual compression appears safe and effective in treating femoral artery pseudoaneurysms after catheterization and avoids thrombin use, long-time compression, and surgery.
Purpose: To compare perioperative outcomes and long-term renal function changes between prior stenting (PS) and not prior stenting (NPS) before flexible ureteroscopy lithotripsy (f-URS) for solitary kidney patients. Methods: Solitary kidney patients with 10-30 mm renal stones were enrolled in this historical control study. Perioperative parameters and complications were compared. Stone-free was defined as the absence of any residual stones on a CT scan. Renal function changes were evaluated by estimated glomerular filtration rate (eGFR) and adjusted for body surface area. A decrease in the eGFR over 20% was identified as 'deterioration' in renal function. The follow-up period was at least 6 months. Logistic regression was used to identify risk factors of renal function deterioration. Results: Of the 76 patients included, 40 cases experienced prior stenting before f-URS. The average stone diameter was 16.8 ± 4.7 mm, ranging from 10.0 to 28.4 mm. Initial SFR was 85.0 and 83.3% in the PS and NPS groups, respectively (p ¼ 0.842), while SFR after the second procedure was 97.5 and 94.4% (p ¼ 0.926). Seven PS and 5 NPS patients developed complications (p ¼ 0.666). At the postoperative 6 months, seven patients showed a deteriorated renal function. Surgical time in minutes was identified as a risk factor for renal function deterioration after the operation (OR ¼ 1.061, 95% CI: 1.015-1.109, p ¼ 0.009, per minute). Conclusion: It appears that one-stage f-URS without PS could be feasible for 10-30 mm renal stones in solitary kidney patients, and less surgical time might be beneficial to protect renal function.
Background
Accessory renal artery (ARA) is the most common site for anatomical variation of renal supply artery. Rare studies reported interventional embolization for the management of massive hemorrhage caused by ARA injury after percutaneous kidney biopsy (PKB).
Case presentation
We describe a 35-year-old man who developed massive hemorrhage after PKB leading to shock. Digital subtraction angiography (DSA) showed hemorrhage in the ARA at the inferior pole of the right kidney and hemostasis was noticed after renal artery embolization.
Conclusions
We proposed that much attention should be paid to the presence of ARA before PKB. In addition, digital subtraction angiography combined with superselective embolization is the best choice for the treatment of renal artery injury.
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