Objectives To present our single‐centre experience of urolithiasis management in anomalous kidneys, highlighting the need for an algorithm‐based approach in deciding the appropriate treatment method for each type. Patients and Methods We retrospectively reviewed the data of all the patients who presented to our renal unit with urolithiasis in an anomalous kidney between January 1990 and July 2014. The peri‐operative characteristics of all the patients, along with management approach, were studied. Results Percutaneous nephrolithotomy (PCNL) was the most common surgical technique used, followed by flexible ureterorenoscopy (URS). Pain was the most common presentation in these patients. The overall stone clearance rate associated with PCNL and flexible URS was 85.8% in cases of anomalous kidneys in this series. The stone clearance rates in ectopic kidneys, horseshoe kidneys, malrotated kidneys and autosomal dominant polycystic kidneys associated with PCNL and flexible URS were similar: 86%, 88%, 76% and 83%, respectively, and 81.2%, 80%, 92% and 100%, respectively . Based on our results, we developed a stone management algorithm. Conclusion The management of renal calculi in patients with renal anomalies may vary based on the stone size, location, density, pelvicalyceal system anatomy and drainage. An algorithm‐based approach could help surgeons decide the appropriate treatment in this population.
SummaryIn this study, we compared the manoeuvrability and ease of use of the single-use Ambu aScope and Olympus re-usable fibrescope in a manikin set to simulate difficult fibrescope placement. A total of 75 anaesthetists took part in this randomised crossover non-inferiority study. We recorded the time to task completion, tip surface collision count and participants' impression of ease of use. For the Ambu aScope and Olympus fibrescope, the mean (SD) first attempt time to task completion was 63 (31) s and 53 (23) s, respectively (95% CI of the difference 3-17 s), p = 0.008. This rejected the null hypothesis of a difference of > 30 s. The mean (SD) number of tip surface collisions was 2.7 (1.9) and 2.5 (1.8), respectively, (95% CI of the difference )0.4 to 0.7) p = 0.56. However, the participants found the Olympus easier to use (p < 0.001). Mean (SD) visual analogue scores for the perceived ease of use (0 mm = extremely difficult and 100 mm = extremely easy) were 65 (18) mm and 77 (14) mm for the Ambu aScope and Olympus scopes, respectively. This study found that the single-use Ambu aScope is as easy to manoeuvre as the Olympus re-usable fibrescope. This single-use device appears to be an acceptable alternative to the re-usable fibrescope.
IntroductionImaging is a vital cog in the wheel of diagnosis and management of patients suspected with renal and ureteric calculi, and it is imperative to choose the appropriate investigation that is accurate as well as safe for the patient. At present, computed tomography (CT) is the gold standard for a patient suspected to have stone disease. However, CT scan is associated with the hazards of radiation and high cost. Ultrasonography (US) is cheap and also devoid of any radiation hazard to the patient. But, at the same time, its usage is limited by decreased sensitivity and specificity, inaccuracy in measuring stone size, and observer dependency. In this article, we review the techniques to improve the accuracy of US in measuring stone size.Accuracy of USAccording to a review, the sensitivity and specificity for renal calculi are 45% and 88%, respectively, and for ureteric calculi, they are 45% and 94%, respectively. The sensitivity of US decreased when the size of the stone is <3 mm and also in a nondilated system, and the sensitivity increased as the size of the stone increased.Tools to improve accuracyThere are factors that can be adjusted to increase the accuracy of stone measurement. The main factors are changes in gain and depth and alternate modes such as flash angle imaging, harmonic mode, and S mode. Also measures such as use of shadow for size measurement can help in improving the accuracy of stone size measurement. A new automated computerized stone-sizing program improves the accuracy of stone size calculation and reduces user variability.ConclusionUS is an ideal first-line imaging modality for nephrolithiasis due to its advantages such as low cost, absence of radiation, and easy availability. However, the only limitation is its reduced sensitivity and specificity when compared with CT. The addition of newer modes can improve the accuracy in stone size measurement.
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