Evaluation of a Diuresis Enhanced Non-Contrast Computed Tomography for Kidney Stones Protocol to Maximize Collecting System Distention

Sung, John; Jefferson, Francis; Tapiero, Shlomi; Owyong, Michael; Xie, Lillian; Karani, Rajiv; Ghamarian, Peter; Lall, Chandana; Clayman, Ralph V.; Landman, Jaime

doi:10.1089/end.2019.0719

Cited by 6 publications

(4 citation statements)

References 19 publications

(24 reference statements)

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“…Various studies claim ESWL success rate up to 90% in adult population [15], but the aforementioned factors influence the treatment outcome and trajectory and determine whether re-treatment is necessitated [7].…”

Section: Discussionmentioning

confidence: 99%

Renal Stone Density: Determinant of ESWL Success

Mahar

Fawad

Jawaid

et al. 2022

J. Pharm. Res. Int.

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Background: The worldwide prevalence of developing renal stones is as high as 15% with an estimated 1 in every 5 persons being affected with the condition in Pakistan. Among the many treatment options available for renal calculi, extracorporeal shockwave lithotripsy (ESWL) is among the commonest owing to its non-invasive nature, however, it has its drawbacks; one being limitation against dense stones. Objective: To assess association between stone density (detected on CT KUB) and ESWL outcome among patients with renal calculi. Methodology: This clinical trial was conducted upon a sample of 150 patients (of either gender, aged 16 to 70 years) presenting to the Urology out-patient, emergency and lithotripsy department of Ziauddin University Hospital with renal calculi from 30th August 2017 to 30th September 2019. After taking written informed consent, data was recorded onto a prestructured questionnaire containing inquiries pertaining to basic biodata, sociodemographic details, and disease history, inferences obtained from C.T KUB, operative notes and the eventual treatment outcome. The data obtained was analyzed using SPSS v. 21.0. Results: The mean age of the sample stood at 36.7 (SD ± 3.1). 104 (69.3%) patients had multiple calculi and 46(30.7%) have single calculi with mean density of 812 (SD ± 219) HU. A (having stone density <500-HU) group B (having stone density 501 to 1000-HU) and group C (having stone density >1000-HU). The success of group A was 95.34% group B was 88.5% and group C was 80.3%. Major proportion of the sample (39.3%) required up to 3 ESWL sessions. The stone density was observed to be inversely proportional to the success of ESWL. Conclusion: After careful consideration, it can be concluded that higher stone density is associated with a poor ESWL outcome and thus other treatment modalities may be considered among patients with a stone density of more than 900 HU.

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Section: Discussionmentioning

confidence: 99%

Renal Stone Density: Determinant of ESWL Success

Mahar

Fawad

Jawaid

et al. 2022

J. Pharm. Res. Int.

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“…Наше мнение разделяется в единственной работе по описанию 3D-реконструкции ЧЛС по снимкам бесконтрастной КТ, выполненной J.M. Sung et al [5], где авторы предлагают протокол внутривенной инфузии с диуретической нагрузкой для искусственного расширения ЧЛС перед выполнением КТ. Согласно результатам, данный подход приводит к значимому увеличению объёма реконструкции полостной системы по сравнению с реконструкцией снимков, сделанных в контрольной группе.…”

Section: Discussionunclassified

The three-dimensional reconstruction of the dilated renal pelvicalyceal system by non-enhanced computed tomography

Гулиев¹,

Комяков

Talyshinskii

2021

Vestn. urol.

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Introduction. The three-dimensional reconstruction of the renal pelvicalyceal system (PCS) is possible when performing enhanced computed tomography (CT). However, the use of a contrast agent has its limitations associated with the presence of allergy and chronic kidney disease.Purpose of the study. To describe the method of semi-autonomous three-dimensional (3D) reconstruction of the PCS based on non-enhanced CT images of patients with upper urinary tract obstruction.Materials and methods. Five patients diagnosed with renal colic were recruited from April-May 2021. All patients underwent CT-urography after informed consent. Medical Imaging Interaction Toolkit program (MITK) expanded with explainable update were used for 3D-reconstruction of PCS via excretory and native phases. To assess the accuracy of the latter, both contrast and non-contrast models were compared regarding their surface area. Also, the PCS of one patient was used to reconstruct virtual endoscopic views based on enhanced and non-enhanced models. Five urologists estimated their similarity and potential use of non-enhanced models for the interventional planning via a Likert scale questionnaire. The resulting models were also analyzed by programmer-engineers to test their suitability for 3D-printing.Results. The average surface area of enhanced and non-enhanced models was 3291 mm2 and 2879 mm2, respectively. Obtained models were suitable for their intraluminal reconstruction and potential 3D-printing. Analyzed properties of non-enhanced models were estimated at 4.5 out of 5.0.Conclusion. The described semi-autonomous reconstruction of the renal PCS based on non-enhanced CT images allows for a short time to reconstruct its 3D-view in patients with the upper urinary tract obstruction.

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“…[11][12][13][14][15][16][17][18][19][20][21][22] An IDS as low as possible is desirable in such situations since the mean intrarenal volume is estimated to range between 3 and 5 ml in non-hydronephrotic human kidneys. 5 Considering this, the IDS of the evaluated flexible ureteroscopes represents 22% to 77% of the intrarenal volume. In summary, the lower the scope IDS, the better the scope performance in such clinical scenarios (Table 3).…”

Section: Therapeutic Advances In Urologymentioning

confidence: 98%

“… 3 , 4 IDS may become a problem during ureteroscopy considering the low volumes available in the upper urinary tract, with mean collecting system volumes of 2.9 ml in non-hydronephrotic kidneys, and 5.1 ml with diuretic distension based on computed tomography pyelocaliceal system measurements in a recent study. 5 Upon overinjection of fluid in a dilated pyelocaliceal system, there is a risk for overpressure and potential consecutive damage or complications such as forniceal rupture, infection, sepsis, urinoma, and hematoma. 6 – 9 On the other hand, aspiration over the working channel can potentially cause damage to the mucosa if the surface is inadvertently aspirated at the tip of the scope in a collapsed pyelocaliceal system, with subsequent impairment of visibility due to bleeding.…”

Section: Introductionmentioning

confidence: 99%

Instrumental dead space and proximal working channel connector design in flexible ureteroscopy: a new concept

Kwok

Coninck

Pietropaolo

et al. 2023

Therapeutic Advances in Urology

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Objective: The objective of this study was to evaluate a new concept in flexible ureteroscopy: instrumental dead space (IDS). For this purpose, various proximal working channel connector designs, as well as the impact of ancillary devices occupying the working channel were evaluated in currently available flexible ureteroscopes. Design and methods: IDS was defined as the volume of saline irrigation needed to inject at the proximal connector for delivery at the distal working channel tip. Because IDS is related to working channel diameter and length, proximal connector design, as well as occupation of working channel by ancillary devices, these parameters were also reviewed. Results: IDS significantly varied between flexible ureteroscope models, ranging from 1.1 ml for the Pusen bare scopes, to 2.3 ml for Olympus scopes with their 4-way connector ( p < 0.001). Proximal connector designs showed a high degree of variability in the number of available Luer locks, valves, seals, angles, and rotative characteristics. The measured length of the working channel of bare scopes ranged between 739 and 854 mm and significantly correlated with measured IDS ( R2 = 0.82, p < 0.001). The coupling of scopes with an alternative ancillary proximal connector and the insertion of ancillary devices into the working channel significantly reduced IDS (mean IDS reduction of 0.1 to 0.5 ml; p < 0.001). Conclusions: IDS appears as a new parameter that should be considered for future applications of flexible ureteroscopes. A low IDS seems desirable for several clinical applications. The main factors impacting IDS are working channel and proximal connector design, as well as ancillary devices inserted into the working channel. Future studies should clarify how reducing IDS may affect irrigation flow, intrarenal pressure, and direct in-scope suction, as well as evaluate the most desirable proximal connector design properties.

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Evaluation of a Diuresis Enhanced Non-Contrast Computed Tomography for Kidney Stones Protocol to Maximize Collecting System Distention

Cited by 6 publications

References 19 publications

Renal Stone Density: Determinant of ESWL Success

Renal Stone Density: Determinant of ESWL Success

The three-dimensional reconstruction of the dilated renal pelvicalyceal system by non-enhanced computed tomography

Instrumental dead space and proximal working channel connector design in flexible ureteroscopy: a new concept

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