Flexible Ureterorenoscopy for Renal and Proximal Ureteral Stone in Patients with Previous Ureteral Stenting: Impact on Stone-Free Rate and Morbidity

Dessyn, Jean-François; Balssa, L.; Chabannes, É.; Jacquemet, B.; Bernardini, S.; Bittard, Hugues; Guichard, G.; Kleinclauss, F.

doi:10.1089/end.2016.0045

Cited by 20 publications

(35 citation statements)

References 18 publications

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“…Most of the studies report no significant difference in renal stones, but the SFR in ureteral stones was found out to be significantly different. However, the use of UAS was not clearly described by that study [5]. Zhang et al [8] reported the procedures performed by 5 different surgeons, but the duration for PS was not reported.…”

Section: Discussionmentioning

confidence: 93%

“…The impact of PS on the SFR of urinary stones treatment is controversial, especially for fURS only [5,8,10]. Most of the studies report no significant difference in renal stones, but the SFR in ureteral stones was found out to be significantly different.…”

Section: Discussionmentioning

confidence: 99%

“…Prestenting (PS) of fURS does not seem to be a controversial topic because guidelines suggest routinely performed PS is not necessary before fURS and recommended only in challenging cases [1]. However, selectively PS still induced a high complication rate in different centers from all the reported studies [3][4][5]. The reasons for PS were passive in most studies that support the above idea.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of Prestenting on Outcomes of Flexible Ureteroscopy for Upper Urinary Urolithiasis: A Historical Control Study

Chen

Zhu

et al. 2018

Urol Int

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Objectives: The aim of this study is to explore the efficacy and safety of flexible ureteroscopy (fURS) with prestenting (PS) for patients and a newly starting department. Method: The data of patients who underwent fURS for calculi with nonprestenting (NPS) after a clinical practice change was compared with PS patients before. Result: In all, 199 patients met the inclusion criteria. There was no significant difference for both groups in basic demography except that the NPS group included more proximal ureteral stone. Subgroup analysis was then used by a different site. There was no significance in sheath success (4/100 vs. 1/99, p = 0.369). Stone free rate (SFR) and success rate between PS and NPS group showed significant difference in total (96.94 vs. 89.58%, p = 0.048, 96.97 vs. 85.00%, p = 0.005 respectively). Better SFR and success rate were found only for the renal stones in subgroup analysis (97.67 vs. 80.49%, p = 0.014, 97.67 vs. 74.42%, p = 0.003 respectively). Operative time was significantly longer based on stenting status (45.969 ± 19.4732 vs. 30.553 ± 8.9645 min, p = 0.01) and there was no difference in subgroup analysis. More complications were found in the NPS group, but no severe complications were encountered. Conclusion: Intentional PS is a feasible try for an amateur fURS surgeon or a newly started department in order to gain a better outcome and lower complications in the whole time. It improves the outcomes when additional small surgery is not the trouble.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Analysis of Prestenting on Outcomes of Flexible Ureteroscopy for Upper Urinary Urolithiasis: A Historical Control Study

Chen

Zhu

et al. 2018

Urol Int

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“…A total of 2070 articles were initially identified, and 14 full-text English language articles were included in the final review which fit our inclusion criteria (Fig. 1) [13,15,[18][19][20][21][22][23][24][25][26][27][28]. The total number of ureteroscopies included in these papers was 24,373, and the mean age was 51.2 years (range 42-61 years), male:female ratio of 3:2 and a mean BMI of 26.9 (range 23.7-31.8) ( Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…In the literature, there are many small, medium and highvolume prospective studies that have reported on the infectious complications following URS for renal stone disease [18][19][20][21][22][23][24][25][26][27][28][29]. Some studies have also looked at the risk factors for urinary infections following ureteroscopy and advised on strategies to reduce these risks.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Urinary Infections and Urosepsis After Ureteroscopy for Stone Disease: a Systematic Review from EAU Section of Urolithiasis (EULIS)

et al. 2020

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Purpose of Review To present the latest evidence related to the predictors of urinary tract infections (UTIs) and urosepsis after ureteroscopy (URS) for stone disease. Recent Findings Our review suggests that almost half of all post-URS complications are related to infectious complications although reported rates of urosepsis were low. The use of antibiotic prophylaxis, treatment of pre-operative UTI, and low procedural time seem to reduce this risk. However, the risk is higher in patients with higher Charlson comorbidity index, elderly patients, female gender, long duration of pre-procedural indwelling ureteric stents and patients with a neurogenic bladder and with high BMI. Summary Infectious complications following ureteroscopy can be a source of morbidity and potential mortality. Although majority of these are minor, efforts must be taken to minimise them especially in high-risk patients. This includes the use of prophylactic antibiotics, limiting stent dwell and procedural time, prompt identification and treatment of UTI and urosepsis, and careful planning in patients with large stone burden and multiple comorbidities.

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Clinical outcomes and costs of reusable and single-use flexible ureterorenoscopes: a prospective cohort study

et al. 2018

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The purpose of this study is to analyze clinical outcomes and costs of single-use flexible ureterorenoscopes in comparison with reusable flexible ureterorenoscopes in a tertiary referral center. Prospectively, 68 flexible ureterorenoscopies utilizing reusable (Flex-X2S, Flex-X, Karl Storz) and 68 applying single-use flexible ureterorenoscopes (LithoVue, Boston Scientific) were collected. Clinical outcome parameters such as overall success rate, complication rates according to Clavien-Dindo, operation time and radiation exposure time were measured. Cost analysis was based on purchase costs and recurrent costs for repair and reprocessing divided by number of procedures. In each group 68 procedures were available for evaluation. In 91% of reusable and 88% of single-use ureterorenoscopies stone disease was treated with a mean stone burden of 101 ± 226 and 90 ± 244 mm and lower pole involvement in 47 and 41%, respectively (p > 0.05). Comparing clinical outcomes of reusable vs. single-use instruments revealed no significant difference for overall success rates (81 vs. 87%), stone-free rates (82 vs. 85%), operation time (76.2 ± 46.8 vs. 76.8 ± 40.2 min), radiation exposure time (3.83 ± 3.15 vs. 3.93 ± 4.43 min) and complication rates (7 vs. 17%) (p > 0.05). A wide range of repair and purchase costs resulted in total to $1212-$1743 per procedure for reusable ureterorenoscopy whereas price of single-use ureterorenoscopy was $1300-$3180 per procedure. The current work provided evidence for equal clinical effectiveness of reusable and single-use flexible ureterorenoscopes. Partially overlapping ranges of costs for single-use and reusable scopes stress the importance to precisely know the expenses and caseload when negotiating purchase prices, repair prices and warranty conditions.

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Flexible Ureterorenoscopy for Renal and Proximal Ureteral Stone in Patients with Previous Ureteral Stenting: Impact on Stone-Free Rate and Morbidity

Cited by 20 publications

References 18 publications

Analysis of Prestenting on Outcomes of Flexible Ureteroscopy for Upper Urinary Urolithiasis: A Historical Control Study

Analysis of Prestenting on Outcomes of Flexible Ureteroscopy for Upper Urinary Urolithiasis: A Historical Control Study

Predictors of Urinary Infections and Urosepsis After Ureteroscopy for Stone Disease: a Systematic Review from EAU Section of Urolithiasis (EULIS)

Clinical outcomes and costs of reusable and single-use flexible ureterorenoscopes: a prospective cohort study

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