Holmium: Yag Laser Lithotripsy for Upper Urinary Tract Calculi in 598 Patients

Sofer, Mario; Watterson, James; Wollin, Timothy A.; Nott, Linda; Razvi, Hassan; Denstedt, John D.

doi:10.1016/s0022-5347(05)65376-1

Cited by 287 publications

(149 citation statements)

References 31 publications

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“…5 However, the finding that incomplete SCI was associated with worse peri-operative outcomes is difficult to understand and might simply reflect the small numbers of cases with incomplete SCI in the study (13.4%). In addition, our perioperative obstruction rate of 4.5% was similar to rates reported in the general population.…”

Section: Discussionmentioning

confidence: 86%

“…This is significantly lower than reported clearance rates of 77-93% for URS in the non-SCI population. 2,4,5 In the SCI population, average clearance rates using SWL are 44-55%, [9][10][11] and percutaneous nephrolithotripsy clearance rates are 54-87%. 12,13 One possible explanation for the high failure rate of URS in the SCI population may be that chronic neurogenic bladder dysfunction can cause fibrosis and bladder wall contractures which alter the ureteral orifice and urethral anatomy.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, our perioperative obstruction rate of 4.5% was similar to rates reported in the general population. 5,6 Surprisingly, there were only two cases of documented AD. The incidence of AD appears to be significantly higher with SWL in the SCI population, ranging between 16 and 95%.…”

Section: Discussionmentioning

confidence: 99%

“…Success varies depending on size, number and location of stones. [2][3][4][5] Intra-operative complications range between 0 and 6%, and major peri-operative complications between 1 and 3%. 2,4,6 Unfortunately, it is not known whether these studies are directly applicable to patients with SCI.…”

Section: Introductionmentioning

confidence: 99%

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Ureteroscopy with laser lithotripsy for urolithiasis in the spinal cord injury population

et al. 2012

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Study design: Retrospective study. Objectives: The purpose of this investigation was to review the outcomes and safety of retrograde ureteroscopic laser lithotripsy (URS) for the treatment of urolithiasis in the spinal cord injury (SCI) population. Setting: Virginia, USA. Methods: All patients with SCI who underwent URS with holmium:YAG laser lithotripsy for urolithiasis over a 15-year period were identified. Stone size, location and number at presentation were recorded. Information regarding patient characteristics, intra-operative complications, surgical efficacy, stone clearance, peri-operative complications, and follow-up stone events was collected and analyzed. Results: A total of 67 URS procedures were performed on 29 SCI patients during the study period with an average follow-up of 3.4 years. Patients had an average of 2.3 ipsilateral ureteroscopies. The majority (85.1%) used indwelling catheters for long-term bladder management, and complete stone clearance after the first procedure was 34.3%. Of the 44 cases with residual stones 44 mm, 20 (45.5%) were secondary to technical or procedural limitations. The intra-operative complication rate was comparable to non-SCI studies at 1.5%, but peri-operative complications were significantly higher at 29.9% with the majority due to urosepsis. Factors associated with peri-operative complications include chronic obstructive pulmonary disease, motor incomplete injuries and lack of a pre-operative ureteral stent. Conclusion: URS in the SCI population is an effective treatment for ureteral or renal stones but may be associated with greater risks and reduced efficacy. With advances in endourology, ureteroscopic surgery has become a popular choice for the minimally invasive treatment of urolithiasis. In the general population, studies reveal stone-free rates between 77 and 93% after one procedure. Success varies depending on size, number and location of stones. 2-5 Intra-operative complications range between 0 and 6%, and major peri-operative complications between 1 and 3%. 2,4,6 Unfortunately, it is not known whether these studies are directly applicable to patients with SCI. SCI results in neurogenic bladder, which significantly alters bladder function including ability to empty, bladder pressure, continence and bladder compliance. 7 Detrusor-sphincter-dyssynergia, a common problem in SCI patients with neurogenic bladder dysfunction, can cause elevated detrusor

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ureteroscopy with laser lithotripsy for urolithiasis in the spinal cord injury population

et al. 2012

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“…MAU was used in 112 patients (mean age 38 years, range 26-57) between 1991 and 2001; the mean (range) stone size was 12 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)) mm, with 30 stones in the upper, 69 in the mid-and 13 in the lower ureter. In 15 patients the stones were impacted and there were signs of infection in the proximal ureter.…”

Section: Methodsmentioning

confidence: 99%

Open mini‐access ureterolithotomy: the treatment of choice for the refractory ureteric stone?

2003

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RESULTSMAU was successful in 111 patients; the one failure was caused by proximal stone migration early in the series. The mean (range) operative duration was 28 (10-44) min and the hospital stay 42 (24-72) h; 33 patients were in hospital for 24 h, 72 for 48 h and seven for 72 h. The blood loss was minimal, at 50 (30-150) mL. The drain was removed after 5 (5-7) days. Patients reported using opioid or nonsteroidal anti-inflammatory analgesia for a mean of 4 (1-7) days after surgery. The mean time to resumption of work was 16 (8-35) days. CONCLUSIONSMAU is a safe and reliable minimally invasive procedure; its role is mainly confined to salvage for failed first-line stone treatments but in selected cases, where a poor outcome can be predicted from other methods, it is an excellent first-line treatment. KEYWORDS mini-access, ureterolithotomy, technique, complications, indications, surgeon OBJECTIVETo report the experience in one centre of the efficacy and safety of open mini-access ureterolithotomy (MAU) and to discuss relevant current indications. PATIENTS AND METHODSMAU was undertaken in 112 patients (mean age 38 years, range 26-57) between 1991 and 2001; the details and outcomes are reviewed. The mean (range) stone size was 12 (8-22) mm, with 30 stones in the upper, 69 in the mid-and 13 in the lower ureter. In 15 cases the stones were impacted and there were signs of infection in the proximal ureter.

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