Flexible Ureterorenoscopy for Treatment of Kidney Stones: Establishment as Primary Standard Therapy in a Tertiary Stone Center

Ising, Stephan; Labenski, Heike; Baltes, Stefan; Khaffaf, Aso; Thomas, Christian; Wiesner, Christoph

doi:10.1159/000439574

Cited by 4 publications

(3 citation statements)

References 32 publications

(32 reference statements)

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“…Our findings are consistent with those reported in the literature, which conclude that SFR is influenced by multiple factors, including stone size, location, number of stones, stone composition, renal anomaly, lower pole-infundibulopelvic angle, gender, use of UAS, and operator experience [50] , [51] , [52] , [53] , [54] , [55] .…”

Section: Discussionsupporting

confidence: 92%

Sheathless and fluoroscopy-free retrograde intrarenal surgery: An attractive way of renal stone management in high-volume stone centers

Mahmood

Toffeq²,

Fakhralddin³

2020

Asian Journal of Urology

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Objective To evaluate the efficacy and safety of sheathless and fluoroscopy-free flexible ureterorenoscopic laser lithotripsy (FURSL) for treating renal stones. Methods Between May 2015 and May 2017, 135 patients with renal stones treated with sheathless and fluoroscopy-free FURSL were prospectively evaluated. Our technique involved a semi-rigid ureteroscopic assessment of the ureter, and the guidewire was left in situ to railroad the flexible ureteroscope. A holmium laser was used to fragment and dust the stones; fragments were neither grasped nor collected. Results The study population consisted of 135 patients including 85 males (62.96%) and 50 females (37.04%) with a mean age of 40.65 years (range: 3–70 years) were evaluated. The mean stone size was 17.23 mm (range: 8–41 mm). Complete stone-free status was achieved in 122 (90.37%) patients and clinically insignificant residual fragments (CIRF) in two (1.48%), while residual stones were still present in 11 (8.15%) patients. Postoperative complications occurred in 23 (17.4%) cases and were mostly minor, including fever in 17 (12.6%), pyelonephritis in four (3.0%), subcapsular hematoma in one (0.7%) and steinstrasse in one (0.7%). These complications were Clavien I-II, GI in 17 (12.6%) patients, GII in five (3.7%), and Clavien IIIb in one (0.7%). No major complications were observed. Stone size ≥2 cm, operative time ≥30 min, and lasing time ≥20 min were significantly associated with a higher rate of complications and lower stone-free rates upon univariate analysis ( p <0.05). Conclusion Sheathless and fluoroscopy-free FURSL are effective and safe for renal stone management, especially for stones under 2 cm in diameter. This process is a feasible option for avoiding sheath complications, which can protect surgeons from the negative effects of radiation.

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Section: Discussionsupporting

confidence: 92%

Sheathless and fluoroscopy-free retrograde intrarenal surgery: An attractive way of renal stone management in high-volume stone centers

Mahmood

Toffeq²,

Fakhralddin³

2020

Asian Journal of Urology

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“…These data might indicate the recent trends in the increased use of the flexible ureteroscope. A flexible ureteroscope can treat renal stones, including lower pole stones, which overlaps with the patients treated with ESWL . Furthermore, miniaturization techniques have led to the rise of minimally invasive PNL techniques, such as mini and ultra‐mini PNL procedures .…”

Section: Discussionmentioning

confidence: 99%

“…A flexible ureteroscope can treat renal stones, including lower pole stones, which overlaps with the patients treated with ESWL. 17,18 Furthermore, miniaturization techniques have led to the rise of minimally invasive PNL techniques, such as mini and ultramini PNL procedures. 19 Such developments in treatment modalities could affect the shift in the treatment options for upper urinary tract urolithiasis.…”

Section: Discussionmentioning

confidence: 99%

Chronological changes in the epidemiological characteristics of upper urinary tract urolithiasis in Japan

et al. 2018

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Objectives: To assess epidemiological and chronological trends of upper urinary tract stones in Japan in 2015.Methods: Patients with a first episode of upper urinary tract stones in 2015 were enrolled in this nationwide survey. The study included all hospitals approved by the Japanese Board of Urology, therefore covering most of the hospitals where urologists practice in Japan. The annual incidence and composition of urolithiasis were evaluated by age and sex. These results were compared with the previous results of the nationwide surveys from 1965 to 2005 to analyze temporal trends. Results: The estimated annual incidence of a first-episode upper urinary tract stone in 2015 was 137.9 (191.9 in men and 86.9 in women) per 100 000. The estimated agestandardized first-episode upper urinary tract stone incidence in 2015 was 107.8 (150.6 in men and 63.3 in women) per 100 000, which did not represent a significant increase since 2005. An equivalent incidence was observed in patients aged >50 years, whereas a reduced incidence was observed in patients aged <50 years in both sexes. The proportion of patients who received percutaneous nephrolithotomy and/or ureteroscopy increased by approximately fivefold in the past 10 years. Conclusions: The steady increase in the annual incidence of upper urinary tract stones since 1955 leveled off in 2015. The current results show novel trends in the incidence and treatment modalities in the nationwide surveys of urolithiasis in Japan.

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Systematic review of ureteral access sheaths: facts and myths

et al. 2018

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The aim of the present paper was to review the literature on all available ureteral access sheaths (UASs) with their indications, limitations, risks, advantages and disadvantages in current modern endourological practice. Two authors searched Medline, Scopus, Embase and Web of Science databases to identify studies on UASs published in English. No time period restriction was applied. All original articles reporting outcomes or innovations were included. Additional articles identified through references lists were also included. Case reports, editorials, letters, review articles and meeting abstracts were excluded. A total of 754 abstracts were screened, 176 original articles were assessed for eligibility and 83 articles were included in the review. Based on a low level of evidence, UASs increase irrigation flow during flexible ureteroscopy and decrease intrapelvic pressure and probably infectious complications. Data were controversial and sparse on the impact of UASs on multiple reinsertions and withdrawals of a ureteroscope, stone-free rates, ureteroscope protection or damage, postoperative pain, risk of ureteral strictures, and also on its cost-effectiveness. Studies on the benefit of UASs in paediatrics and in patients with a coagulopathy were inconclusive. In the absence of good randomized data, the true impact of UASs on surgery outcome remains unclear. The present review may contribute to the evidence-based decision-making process at the individual patient level regarding whether or not a UAS should be used.

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Flexible Ureterorenoscopy for Treatment of Kidney Stones: Establishment as Primary Standard Therapy in a Tertiary Stone Center

Cited by 4 publications

References 32 publications

Sheathless and fluoroscopy-free retrograde intrarenal surgery: An attractive way of renal stone management in high-volume stone centers

Sheathless and fluoroscopy-free retrograde intrarenal surgery: An attractive way of renal stone management in high-volume stone centers

Chronological changes in the epidemiological characteristics of upper urinary tract urolithiasis in Japan

Systematic review of ureteral access sheaths: facts and myths

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