Differences in Ureteroscopic Stone Treatment and Outcomes for Distal, Mid-, Proximal, or Multiple Ureteral Locations: The Clinical Research Office of the Endourological Society Ureteroscopy Global Study

Castro, Enrique Perez; Osther, Palle Jørn Sloth; Jinga, Viorel; Razvi, Hassan; Stravodimos, Konstantinos; Parikh, Kandarp Priyakant; Kural, Ali Rıza; Rosette, Jean de la

doi:10.1016/j.eururo.2014.01.011

Cited by 191 publications

(87 citation statements)

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“…The total CR in this series was 14.3%, which is in line with the current URS literature demonstrating a CR of up to 25% [7,8,9,10,11,12,13,22]. Most of our complications (91.7%) were minor (Clavien I-II) and did not require any surgical interventions.…”

Section: Discussionsupporting

confidence: 75%

“…However, ureteroscopy, especially when combined with laser lithotripsy, may cause severe complications (e.g. septic shock or ureteral avulsion), fortunately only in rare cases [5,15,22]. Various risk factors associated with the occurrence of complications after URS have been identified: stone size, stone location, stone width in ureteral stones, ureteral stone impaction, long operative duration and surgeon's or department's experience [8,9,10,11,12,13].…”

Section: Discussionmentioning

confidence: 99%

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Is Prolonged Operation Time a Predictor for the Occurrence of Complications in Ureteroscopy?

et al. 2015

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Objective: To determine the impact of duration of ureteroscopy for urolithiasis on complication rates (CRs) of the procedure. Methods: A retrospective analysis of 2,010 patients, treated between 2006 and 2011, was done. The operation time (OT) and the occurrence of complications were compared. Results: The overall CR was 14.3% [298 complications, minor complications (Clavien I-II) 91.7%]. The median OT was 35 min [interquartile range (IQR) 20-61]. The OT differed significantly between those without complications [34 min (IQR 20-60)] and those with complications [45 min (IQR 25-76)] (p < 0.0001). The correlation between the OT and the occurrence of complications (r = -0.009648, p < 0.0001) was very weak and passed the level of significance (r = 0.2). The effect size was of minor relevance (Cohen's d = 0.27972). Conclusions: Longer OT correlates significantly with a higher CR. The effect is however shown to be minor and the overall rate of complications, especially severe ones, is low.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Is Prolonged Operation Time a Predictor for the Occurrence of Complications in Ureteroscopy?

et al. 2015

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“…A recently published analysis of a prospective global database demonstrated an overall complication rate of 3.8% and a less than three-month hospital admission rate of 6.7% for 4477 patients undergoing semirigid or flexible ureteroscopy for distal ureteric calculi. 1 Further, our study demonstrated that the majority of patients had stones >5 mm and no significant differences were noted in procedure time, tolerance, analgesic/sedation requirements, complications, admissions, and success rates ( Table 3).…”

Section: Discussionmentioning

confidence: 90%

“…1,2 Ureteroscopy under local anesthesia was first described by Rittenberg et al in 1987. 3 Since January 1993, distal ureteroscopy under conscious sedation has been offered at our centre for the removal of distal ureteric stones.…”

Section: Introductionmentioning

confidence: 99%

Ureteroscopy with conscious sedation for distal ureteric calculi: 10-year experience

Kroczak

Kaler

Patel

et al. 2016

CUAJ

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Introduction: Distal ureteroscopy for stone extraction is a common procedure that is generally performed with spinal or general anesthesia. We retrospectively reviewed all distal ureteroscopy performed for ureteric stone extraction with conscious sedation at our institution over a 10-year period to determine its efficacy and safety. Methods: A retrospective chart review was performed of all distal ureteroscopy performed for calculus removal from 2004 to 2014. Patient characteristics, analgesic requirement, tolerability, procedure time, stone size and composition, method of stone extraction, success rate, and complications were collected. Results: Between 2004 and 2014, 314 procedures were performed. Mean age was 53.74 years, with 160 males and 154 females. A success rate of 97% and 10 (3.2%) complications were reported. Mean analgesic requirement was 189 μg of fentanyl (range: 50-400) and 2.79 mg of midazolam (range: 0-8). A total of 263 patients (83.7%) tolerated the procedure well, with only seven (2.2%) having poor tolerability. When comparing females to males, females were found to require less fentanyl (p=0.0001) and midazolam (p=0.0001). When calculi >5 mm were compared to those <5 mm, there was no statistically significant difference in success rate, procedure time, analgesic requirement, tolerability, or complications. Conclusion: Distal ureteroscopy with conscious sedation is safe and efficacious. To our knowledge, this is the first report demonstrating stones >5 mm can be safely and effectively treated with conscious sedation during this procedure. The context of our findings must be understood within the limitations of our retrospective analysis. IntroductionDistal ureteric stones are often treated with observation and/or medical expulsive therapies, extracorporeal shockwave lithotripsy (ESWL) or distal ureteroscopy under spinal or general anesthesia. ESWL and distal ureteroscopy have both been shown to be safe and effective treatments.Stone removal via ureteroscopy usually requires an operating theatre and general anesthetic, in contrast to ESWL, which is typically performed under conscious sedation. 1,2Ureteroscopy under local anesthesia was first described by Rittenberg et al in 1987. 3 Since January 1993, distal ureteroscopy under conscious sedation has been offered at our centre for the removal of distal ureteric stones. A proof of principle analysis at our centre demonstrated the feasibility and safety of this procedure. 4 Subsequent to this analysis in 2003, our centre compared ESWL and distal ureteroscopy for distal ureteric stones and found treatment success in 72% and 95% of patients, respectively.5 These results also showed men were less likely to tolerate ureteroscopy under conscious sedation compared to women.In this study, we report an updated analysis of all distal ureteroscopies under conscious sedation performed for distal ureteric stone extraction at our institution over a 10-year period to evaluate its safety and efficacy over the long term. MethodsSince 1993 our instit...

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“…Lopes et al reported that SWL has lower stone-free rates and a higher number of procedures for large proximal and mid-ureter stones [6]. Although URS is the first option for ureteral stones, its success rate is decreased in large mid- or upper-ureter stones [7]. Ureteroscopic treatment was conducted in proximal ureter stones that were prone to more failure; moreover, ureteral perforation was observed more in mid-ureter stones, especially in impacted ones [7].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Ureteroscopic Laser Lithotripsy with Laparoscopic Ureterolithotomy for Large Proximal and Mid-Ureter Stones

Kaygısız¹,

Çoşkun²,

Kılıçarslan³

et al. 2015

Urol Int

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Objectives: To compare the effectiveness and complications of ureteroscopic laser lithotripsy with laparoscopic ureter laparoscopic ureterolithotomy in mid- or proximal portion of large ureteral stones. Material and Methods: We reviewed patients with large (>15 mm) ureteral stone and those who underwent ureteroscopic laser lithotripsy (URS group) or laparoscopic ureterolithotomy (LU group). The first attempt was considered successful in patients who had residual fragments smaller than 2 mm and no conversion of the primary procedure to another. Results: Sixty patients (URS group 29, LU group 31) met inclusion criteria. FURS was used as an adjunctive procedure in one patient for URS group and in two patients for LU group in the same season. LU had a higher success rate and the first-day stone-free rate when compared with URS. Number of procedures was also significantly higher in URS group. There was no difference in stone-free rates at the first and third months, and length of hospitalization and operation were higher in the LU group. Only two patients in the LU group and one patient in the URS group had major complications. Conclusions: Laparoscopy is an effective option of large proximal and mid-ureter stone treatment; however, URS provides similar stone-free rates at three months as a minimal invasive procedure.

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Differences in Ureteroscopic Stone Treatment and Outcomes for Distal, Mid-, Proximal, or Multiple Ureteral Locations: The Clinical Research Office of the Endourological Society Ureteroscopy Global Study

Cited by 191 publications

References 15 publications

Is Prolonged Operation Time a Predictor for the Occurrence of Complications in Ureteroscopy?

Is Prolonged Operation Time a Predictor for the Occurrence of Complications in Ureteroscopy?

Ureteroscopy with conscious sedation for distal ureteric calculi: 10-year experience

Comparison of Ureteroscopic Laser Lithotripsy with Laparoscopic Ureterolithotomy for Large Proximal and Mid-Ureter Stones

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