Contemporary Trends of Inpatient Surgical Management of Stone Disease: National Analysis in an Economic Growth Scenario

Marchini, Giovanni Scala; Mello, Marcos Figueiredo; Levy, Renata Bertazzi; Vicentini, Fábio Carvalho; Torricelli, Fábio César Miranda; Eluf-Neto, José; Mazzucchi, Eduardo; Srougi, Miguel

doi:10.1089/end.2015.0021

Cited by 34 publications

(34 citation statements)

References 17 publications

(24 reference statements)

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“…22 Endourological developments have widespread gained for last two decades; in parallel to the developments in medicine, technology and lifestyle changes, the prevalence of urinary stone and treatment expenses has risen. 23 Because of the enormous economic burden; urological societies established methods as efficient, safe, and low cost for kidney stone treatments. For instance; treatment recommendations related to the size of the stone.…”

Section: Discussionmentioning

confidence: 99%

Threshold Point of the Total Stone Volume Matter on Decision of Flexible Ureteroscopy

İlgi¹,

Dalkilinc²,

Kutsal³

et al. 2017

J Reconstr Urol

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A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : To determine optimal patients who appropriate for flexible ureteroscopy (FURS) treatment of kidney stones, and the precise cut-off volume value to regard success of FURS. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : We retrospectively analysed; 164 FURS procedures for kidney stone treatment between December 2012-October 2016 at our centre. Stone Free Rates (SFR) of the procedure was controlled with Non-Contrast CT (NCCT) at the end of the first month. The success rate was determined as the absence of stone fragments or clinical insignificant residual fragments <4 mm. Demographic features, clinical findings and outcomes were recorded. Multivariate analyses were performed to find independent factors and ROC curve was plotted to mark threshold points. Patients are classified according to volume as group 1 (under the cut-off value) and group 2 (beyond the cut-off volume). Area Under Curve (AUC) was used to define a relation between Total Stone Volume (TSV) and operative outcomes. R Re es su ul lt ts s: : The mean TSV was 364.6±295.9 mm 3 , and the overall SFR was 124 (75.6%). We identified that TSV beyond the 330 mm 3 volume SFR significantly decrease, operative time and fluoroscopy time remarkably increase as well. The AUC for the TSV and outcomes were 0.743, 0.754, 0.731 respectively. Patients whose TSV smaller than 330 mm 3 were 93 (56.7%) and the rest of patients 51(43.3%) have larger stone volume. SFR is significantly lower and fluoroscopy, the operative time longer in group two patients. C Co on nc cl lu us si io on n: : TSV is the strongest influential factor for the SFR. FURS should be kept in mind firstly for the renal stones TSV <330mm 3 , for larger stones other treatment modalities could be thought. K Ke ey yw wo or rd ds s: : Threshold limit values; kidney calculi; ureteroscopy Ö ÖZ ZE ET T A Am ma aç ç: : Böbrek taşı tedavisinde fleksibl üreterorenoskopi (FURS) tedavisine uygun hastaların belirlenmesi ve FURS tedavisinin başarısını değerlendirmesinde net bir eşik değerinin hesaplanması. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Kliniğimizde Aralık 2012 Ekim 2016 tarihleri arasında böbrek taşı tedavisi için FURS tedavisi uygulanmış 164 vaka geriye dönük tarandı. Yapılan işlemin taşsızlık oranı birinci ayın sonunda çekilen kontrastsız bilgisayarlı tomografi (BT) ile değerlen-dirildi. Başarı oranını belirlerken; BT'de kalkül görülmemesi ya da klinik olarak anlamsız kabul edilen (<4 mm) kalküllerin görülmesi başarı olarak kabul edildi. Demografik özellikler, klinik bulgular ve sonuçlar kayıt altına alındı. Bağımsız faktörleri ve ROC eğrisini belirlemek için çok değişkenli analizler yapıldı. Hastalar taş hacimlerinin eşik değerlerinin üstünde ve altında olmalarına göre iki gruba ayrıldılar. Eğri altında kalan alan, toplam taş hacmi (TTH) ile operasyon sonuçları arasındaki ilişkiyi tanımlamak için kullanıldı. B Bu ul lg gu ul la ar r: : Ortalama TTH 364,6±295,9 mm 3 ve toplam taşsızlık oranı 124 (%75,6) idi. Total taş hacmi 3...

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Section: Discussionmentioning

confidence: 99%

Threshold Point of the Total Stone Volume Matter on Decision of Flexible Ureteroscopy

İlgi¹,

Dalkilinc²,

Kutsal³

et al. 2017

J Reconstr Urol

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“…Houve uma elevação de 15,7% no período, com aproximadamente 58 mil internações em 1998 e mais de 67 mil hospitalizações em 2012 [4,5] . Apesar do aumento no número absoluto, ao ajustá-lo para a população, a prevalência de internações por litíase manteve-se estável em torno de 0,035% ao longo dos quinze anos analisados [7] (Figura 3).…”

Section: Litíase Urinária -Contexto Epidemiológicounclassified

“…Figura 3 -Evolução do número absoluto (amarelo) e da prevalência (azul) de internação por litíase no Brasil (SUS) entre 1998 e 2012 [7] Esse achado difere dos dados mundiais, em parte pelo fato da estatística brasileira não fazer referência aos números ambulatoriais nem aos de saúde suplementar, utilizado por significativa parcela da população. Desde 1998, o número de internações pelo sexo feminino é maior que no sexo masculino.…”

Section: Litíase Urinária -Contexto Epidemiológicounclassified

“…Desde 1998, o número de internações pelo sexo feminino é maior que no sexo masculino. Ao se ajustar tais números para a população no período estudado, observamos que enquanto no sexo masculino houve redução no número de internações, no feminino ela se apresenta estável [7] . Portanto, a tendência mundial de igualdade na proporção homem:mulher parece se confirmar no Brasil, com participação crescente do sexo feminino nas internações por litíase…”

Section: Litíase Urinária -Contexto Epidemiológicounclassified

“…Figura 4 -Evolução do número absoluto (escala da esquerda -linhas) e relativo (direita -barras) de internações por litíase no Brasil (SUS) entre 1998 e 2012 para o sexo masculino (azul) e feminino (roxo) [7] …”

Section: Urinária (Figura 4)unclassified

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Influência do cálculo ureteral silencioso sobre a função renal antes e após o tratamento

Marchini¹

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Comparison of minimally invasive percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of intermediate proximal ureteral and renal stones in the elderly

et al. 2015

Urolithiasis

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The aim of this study is to compare the outcomes of flexible ureteroscopy (fURS) and minimally invasive percutaneous nephrolithotomy (mPNL) for the treatment of renal and/or proximal ureteral stones sized 1-2 cm in the elderly (≥60 years). Between January 2010 and March 2015, 184 consecutive mPNL and fURS were performed to treat intermediate renal and/or proximal ureteral stones in geriatric patients. The records were retrospectively reviewed and outcomes were compared. Although no significant difference was found in the complication rate between two groups, a statistical trend (p = 0.059) in favor of fURS was observed. In addition, multivariate analysis demonstrated that mPNL, preoperative positive urine culture and lower hemoglobin were independent risk factors for postoperative complication (p = 0.016, p = 0.021, p = 0.001, respectively). And fURS was significantly associated with less hemoglobin drop, red blood cell transfusion, analgesics requirement, postoperative hospital duration, and charges of laboratory tests, medical examinations and medications (p = 0.019, p = 0.037, p = 0.006, p = 0.000 and p = 0.007, p = 0.000, p = 0.000, p = 0.001, respectively), while higher costs of operations (p = 0.008). Receiver operating characteristic curve suggested a preoperative hemoglobin of 106.5 g/L as the threshold for predicting red blood cell transfusion after mPNL. The overall one-session stone-free rate of fURS at 1 month was lower (p = 0.006), while it was similar for solitary stone between two groups. Comorbidity and previous stone surgery did not affect postoperative complication and stone-free rate. This study shows that mPNL is more effective for multiple stones, but fURS is associated with potentially less complications and postoperative hospital stay. Furthermore, preoperative hemoglobin level and urine culture can be used to predict postoperative complication risk and they may be helpful in choosing treatment methods for the elderly.

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Contemporary Trends of Inpatient Surgical Management of Stone Disease: National Analysis in an Economic Growth Scenario

Abstract: Trends of stone disease surgical management in the public health system of Brazil follow worldwide tendencies toward less invasive treatment modalities.

Cited by 34 publications

References 17 publications

Threshold Point of the Total Stone Volume Matter on Decision of Flexible Ureteroscopy

Threshold Point of the Total Stone Volume Matter on Decision of Flexible Ureteroscopy

Influência do cálculo ureteral silencioso sobre a função renal antes e após o tratamento

Comparison of minimally invasive percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of intermediate proximal ureteral and renal stones in the elderly

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