EAU Guidelines on Interventional Treatment for Urolithiasis

Türk, Christian; Petřík, Aleš; Sarıca, Kemal; Seitz, Christian; Skolarikos, Andreas; Straub, Michael; Knoll, Thomas

doi:10.1016/j.eururo.2015.07.041

Cited by 1,602 publications

(1,632 citation statements)

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“…Three patients were noted to have discontinued alkalinization medication, because they found potassium citrate unpalatable. Overall, there was evidence that 54 of 76 (71%) patients received medical therapy that followed international guidelines (24,25). Despite this, 27 (50%) of 54 patients continued to form kidney stones.…”

Section: Clinical Featuresmentioning

confidence: 99%

Clinical and Genetic Analysis of Patients with Cystinuria in the United Kingdom

Rhodes

Yarram-Smith²,

Rice

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Cystinuria is a rare inherited renal stone disease. Mutations in the amino acid exchanger System b 0,+ , the two subunits of which are encoded by SLC3A1 and SLC7A9, predominantly underlie this disease. The work analyzed the epidemiology of cystinuria and the influence of mutations in these two genes on disease severity in a United Kingdom cohort.Design, setting, participants, & measurements Prevalent patients were studied from 2012 to 2014 in the northeast and southwest of the United Kingdom. Clinical phenotypes were defined, and genetic analysis of SLC3A1 and SLC7A9 combining Sanger sequencing and multiplex ligation probe-dependent amplification was performed.Results In total, 76 patients (42 men and 34 women) were studied. All subjects had proven cystine stones. Median age of presentation (first stone episode) was 24 years old, but 21% of patients presented after 40 years old. Patients had varied clinical courses, with 37% of patients having $10 stone episodes; 70% had evidence of CKD, and 9% had reached ESRD as a result of cystinuria and its complications. Patients with cystinuria received a variety of different therapies, with no obvious treatment consensus. Notably, 20% of patients had staghorn calculi, with associated impaired renal function in 80% of these patients. Genetic analysis revealed that biallelic mutations were present in either SLC3A1 (n=27) or SLC7A9 (n=20); 22 patients had only one mutated allele detected (SLC3A1 in five patients and SLC7A9 in 17 patients). In total, 37 different mutant variant alleles were identified, including 12 novel mutations; 22% of mutations were caused by large gene rearrangements. No genotypephenotype association was detected in this cohort.Conclusions Patients with cystinuria in the United Kingdom often present atypically with staghorn calculi at $40 years old and commonly develop significant renal impairment. There is no association of clinical course with genotype. Treatments directed toward reducing stone burden need to be rationalized and developed to optimize patient care.

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Section: Clinical Featuresmentioning

confidence: 99%

Clinical and Genetic Analysis of Patients with Cystinuria in the United Kingdom

Rhodes

Yarram-Smith²,

Rice

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…Ureteroscopy is a safe effective modality to access the upper urinary tract. 1,2 The designs of traditional reusable ureteroscopes, however, result in progressive deterioration of scope performance. Sterilization requires dedicated equipment, staff, and time.…”

Section: Introductionmentioning

confidence: 99%

A Prospective Case–Control Study Comparing LithoVue, a Single-Use, Flexible Disposable Ureteroscope, with Flexible, Reusable Fiber-Optic Ureteroscopes

Usawachintachit

Isaacson

Taguchi

et al. 2017

Journal of Endourology

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Objective: LithoVueÔ is a novel, single-use, digital flexible ureteroscope that was released to the US market in January 2016. There are scant data regarding its performance in humans. Procedural outcomes comparing LithoVue with reusable ureteroscopes are presented in patients undergoing ureteroscopy for upper urinary tract pathology. Patients and Methods: Clinical outcomes between two groups of patients undergoing flexible ureteroscopy for upper urinary tract pathology were analyzed. The first group underwent surgery utilizing LithoVue, and the second group used reusable fiber-optic flexible ureteroscopes. Differences in procedural outcomes, operative times, and time spent in hospital were analyzed using two-tailed t-tests and chi-squared and Fisher's exact tests. Results: One hundred fifteen cases utilizing LithoVue and 65 cases utilizing reusable ureteroscopes were included in this study. Demographics, surgical indications, stone size, location, total stone burden, composition, procedural outcomes, and complications were comparable between groups. For all cases, LithoVue procedures lasted 54.1 -25.7 minutes compared with 64.5 -37.0 minutes for reusable scope procedures ( p < 0.05) and for stone removal cases, 57.3 -25.1 vs 70.3 -36.9 minutes, respectively ( p < 0.05). Scope failure occurred in 4.4% of LithoVue cases and 7.7% of reusable cases ( p = 0.27). Conclusions: LithoVue represents a feasible alternative to reusable ureteroscopes with a low rate of scope failure comparable with reusable ureteroscopes. Its use shortens procedure duration, a finding that warrants further investigation.

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“…Fluid analysis showed pleural fluid to serum creatinine ratio of 1.1, proving that the fluid was urine. We highly suspected the composition of the stone to be xanthine due to the decreased level of serum uric acid as stated in the European Association of Urology: Guidelines on Urolithiasis 2015 [9]. The urinothorax was drained with a thoracostomy tube, and the obstructive uropathy was relieved with a double J stent.…”

Section: Discussionmentioning

confidence: 99%