Guideline of the guidelines: urolithiasis

Quhal, Fahad; Seitz, Christian

doi:10.1097/mou.0000000000000855

Cited by 50 publications

(36 citation statements)

References 15 publications

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“…Retrograde exible ureteroscopy and laser lithotripsy is one of the main minimally invasive methods for the treatment of renal calculi and upper ureteral calculi. The AUA/ES guidelines recommend the provision of exible endoscopy for the treatment of non-lower pole stones with 20mm or less in diameter [2,11]. The characteristics of safety, noninvasiveness and easy manipulation of exible ureteroscopy technique are favored by surgeons and patients.…”

Section: Discussionmentioning

confidence: 99%

“…It is highly prevalent worldwide and ranks the rst in terms of prevalence among hospitalized patients. The incidence rate of nephrolithiasis varies with geographical location, dietary habits, socio-economic and genetic factors, ranging from 7-13% in North America, 5-9% in Europe and 1-5% in Asia [1][2]. The latest survey showed that about 1 in 17 Chinese adults suffered from kidney stones [3].…”

Section: Instructionmentioning

confidence: 99%

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The study of Double-J stent free mode of flexible ureteroscopy and laser lithotripsy: A single center experience

Han

Zhu

et al. 2022

Preprint

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Purpose To evaluate the effectiveness and safety of flexible ureteroscopy in the treatment of kidney and upper ureteral calculi under the Double-J stent free mode. Methods We retrospectively collected the data of patients who underwent flexible ureteroscopy and laser lithotripsy from February 2018 to September 2021 in our hospital. Cases were divided into three groups according to used of the Double-J stent pre-operation and post-operation, namely, the Postoperative Double-J stent free (Post-F) group with pre-indwelling Double-J stent before operation and non-indwelling Double-J stent after operation, the Preoperative Double-J stent free (Pre-F) group with the Double-J stent not preset before operation and retained after operation, and the Routine group with the Double J stents placed in the ureter before and after operation. The data of all patients, including demographic and stone characteristics, perioperative data, postoperative outcomes and complications, were recorded, evaluated and compared. Results 554 patients as per prescribed research criteria were included with 101 cases in the Post-F group, 154 cases in the Pre-F group and 299 cases in the Routine group. There was no significant difference in baseline characteristics among the three groups, such as age, body mass index, the cumulative calculi maximum length diameter (CMD), average CT value of stones (p > 0.05). The average operation time among the three groups was also similar which demonstrated no statistical difference. The incidence of grade 0–1 ureteral injury in the Post-F group was higher than the other two groups, and the difference was statistically significant (p < 0.01). There was no significant difference in the operation related complications such as bleeding, renal subcapsular effusion, urosepsis, and ureteral stricture. During the follow-up, the data showed there was a certain proportion of Double-J stent associated complications between the Pre-F group and the Routine group, while no risk of these complications were identified in the Post-F group. At the end of time intervals of one month, three months and six months after operation, the stone clearance rates of the three groups were (88.1% vs 87.7% vs89.6%), (91.5% vs 91.9% vs 93.8%), (93.1% vs 93.0% vs 94.9%) respectively, and the differences did not reach statistical significance. (p > 0.05). Conclusion It was a safe, feasible and effective management method to treat renal and upper ureteral calculi by flexible ureteroscopy using Double-J stent free mode. This model could avoid the stent associated complications after operation and is suggested to be widely used in clinic.

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Section: Discussionmentioning

confidence: 99%

Section: Instructionmentioning

confidence: 99%

The study of Double-J stent free mode of flexible ureteroscopy and laser lithotripsy: A single center experience

Han

Zhu

et al. 2022

Preprint

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“…For stones >5 mm and ≤10 mm, a meta-analysis of three groups (104 patients) estimated that 47% would pass spontaneously (95% CI: 36% to 59%). This study showed that the SSP rates within 4 weeks for patients with stones <5 mm, and those with stones 5–10 mm, were 75.6% and 68.2%, respectively [ 4 ]. Our findings, which are from the largest sample of 833 patients, were in accordance with the previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…The location of the stone was classified into two groups based on its anatomical position in the upper or lower ureter. Plain radiographic characteristics were used to classify stones as radiopaque or radiolucent [ 4 ]. In patients with a history of ureteral stones, the present episode on the other side was considered the first ureteral stone.…”

Section: Methodsmentioning

confidence: 99%

“…Intervention for ureterolithiasis is recommended after a 4-week observation period for patients with a ureteral stone who visit the outpatient department through the emergency department. As recommended by the European Association of Urology (EAU) and American Association of Urology (AUA) joint guidelines [ 4 ], our team determines the SSP rate of ureteral stones among patients with pain control and without complications during the observation period. Therefore, this study aimed to identify predictive prognostic factors for SSP.…”

Section: Introductionmentioning

confidence: 99%

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Development of prediction models of spontaneous ureteral stone passage through machine learning: Comparison with conventional statistical analysis

et al. 2021

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Objectives To develop a prediction model of spontaneous ureteral stone passage (SSP) using machine learning and logistic regression and compare the performance of the two models. Indications for management of ureteral stones are unclear, and the clinician determines whether to wait for SSP or perform active treatment, especially in well-controlled patients, to avoid unwanted complications. Therefore, suggesting the possibility of SSP would help make a clinical decision regarding ureteral stones. Methods Patients diagnosed with unilateral ureteral stones at our emergency department between August 2014 and September 2018 were included and underwent non-contrast-enhanced computed tomography 4 weeks from the first stone episode. Predictors of SSP were applied to build and validate the prediction model using multilayer perceptron (MLP) with the Keras framework. Results Of 833 patients, SSP was observed in 606 (72.7%). SSP rates were 68.2% and 75.6% for stone sizes 5–10 mm and <5 mm, respectively. Stone opacity, location, and whether it was the first ureteral stone episode were significant predictors of SSP. Areas under the curve (AUCs) for receiver operating characteristic (ROC) curves for MLP, and logistic regression were 0.859 and 0.847, respectively, for stones <5 mm, and 0.881 and 0.817, respectively, for 5–10 mm stones. Conclusion SSP prediction models were developed in patients with well-controlled unilateral ureteral stones; the performance of the models was good, especially in identifying SSP for 5–10-mm ureteral stones without definite treatment guidelines. To further improve the performance of these models, future studies should focus on using machine learning techniques in image analysis.

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Fluorescence‐guided laser lithotripsy: Estimation of the potential effectiveness and safety increase based on first clinical data

Lange

Ozimek

Wießmeyer

et al. 2023

Journal of Biophotonics

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In clinically approved laser lithotripsy systems, there is no automatic monitoring of fiber position to date. We investigated whether detecting stone autofluorescence, excited by a green aiming beam, is possible via the fiber during fragmentation by continuously recording the fluorescence signal in 12 ureterosopic lithotripsy procedures. We estimated which threshold the fluorescence signal's amplitude exceeds before laser pulses with visible stone removal by retrospective inspection of the endoscope's video data. For all procedures, blocking the laser when the fluorescence amplitude is below a threshold corresponding to the signal's baseline plus its range (maximum-minimum value) would have been appropriate to suppress ineffective pulses-the energy input could have been reduced by a mean of 14% (1%-29%) without changing the operation time. Ablation of the PTFE coating of the guidewire could have been prevented three times and cutting of a wire of the retrieval basket two times.

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Guideline of the guidelines: urolithiasis

Cited by 50 publications

References 15 publications

The study of Double-J stent free mode of flexible ureteroscopy and laser lithotripsy: A single center experience

The study of Double-J stent free mode of flexible ureteroscopy and laser lithotripsy: A single center experience

Development of prediction models of spontaneous ureteral stone passage through machine learning: Comparison with conventional statistical analysis

Fluorescence‐guided laser lithotripsy: Estimation of the potential effectiveness and safety increase based on first clinical data

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