Retrospective Analysis of Ultrasound-guided Flexible Ureteroscopy in the Management of Calyceal Diverticular Calculi

Zhang, Jiqing; Wang, Yong; Zhang, Junhui; Zhang, Xiaodong; Xing, Nianzeng

doi:10.4103/0366-6999.189060

Cited by 11 publications

(8 citation statements)

References 28 publications

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“…23 Microperc using a 4.85 Fr needle has the smallest tract size, avoids tract dilation during stone disintegration, and the fragments are left to pass spontaneously. [7][8][9]12,22 In this study, ureteral stents were not placed preoperatively as describedin our previous study, 29 since after ureteroscopy the appropriate UAS was selected and placed successfully under ultrasound guidance. However, flexible ureteroscopy and a stone retrieval basket were used in one case to move the stone fragments to a better location for lithotripsy without repositioning the patient.…”

Section: Discussionmentioning

confidence: 99%

“…13 Now, UAS may provide another access during flexible ureteroscopy to reposition and remove fragments. 29 Our self-assembled visual needle is disposable and less costly than the all-seeing needle. The latter is of narrow caliber and is prone to bending and breakage during lithotripsy.…”

Section: Discussionmentioning

confidence: 99%

“…4,7,8,14,17,27,28 PCNL can be successfully performed on patients in the oblique supine lithotomyposition. 29,30 During retrograde intrarenal surgery, a ureteral access sheath (UAS) is typically used to maintain low IPP. During flexible uteroscopy, when a UAS is utilized and irrigation flow is <100 cm H 2 O, IPP remains lower than 30 mmHg.…”

Section: Introductionmentioning

confidence: 99%

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Microperc with Self-Assembled Fr 4.85 Visual Needle and Ureteral Access Sheath

Zhang

Kang

Jiang

et al. 2021

Journal of Investigative Surgery

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Background: Micropercutaneous nephrolithotomy (microperc) is the least invasive among percutaneous nephrolithotripsy (PCNL) procedures. Although microperc has a high stone-free rate and certain advantages over other methods, modifications may be needed to improve the technique. We describe our experience performing microperc using a self-assembled visual needle and ureteral access sheath (UAS). Methods: Between June 2016 and April 2019, the data of 30 patients with kidney stones undergoing microperc with our self-assembled 4.8 Fr visual needle combined with a UAS was retrospectively analyzed. Patients were placed in an obilique spine lithotomy position. Results: Two cases were excluded: one due to conversion to mini PCNL and the other required flexible ureteroscopy during microperc. The remaining 28 cases included 18 men and 10 women, age 38.4 ± 7.5 years, stone size 1.7 ± 0.4 cm, and stone density on CT 969 ± 233 HU. Operative time was 47 ± 9.9 minutes, visual analogue scale score of tract pain on postoperative day 1 was 2.5 ± 1.0, hemoglobin decrease was 6.4 ± 1.0 g/L, and hospital stay was 3.1 ± 0.8 days. There was 1 case of fever and urinary infection, 2 cases of hematuria, and 1 case of flank pain. All symptoms resolved after conservative or antibiotic treatment. On postoperative day 1, 12 (42.9%) caseswere stone-free. The stone-free rates at postoperative month 1 and 3 were 92.9% (26/28) and 100% (28/28), respectively. Conclusions: Our self-assembled visual needle and UAS instrument is effective for microperc. Use of the UAS may improve the operative outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Microperc with Self-Assembled Fr 4.85 Visual Needle and Ureteral Access Sheath

Zhang

Kang

Jiang

et al. 2021

Journal of Investigative Surgery

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“…3). Therefore, PCNL decision could be made without a nephroscopic evaluation, as the major drawback of fURS is locating the diverticulum, since its neck may be narrow and even concealed [6]. In such a case, the fURS procedure must be converted to PCNL without any need for nephroscopy.…”

Section: Discussionmentioning

confidence: 99%

Calyceal diverticular stones: Does the insistence on less invasive technique keep the patient away from a major complication?

Eren

Özveri

2021

Marmara Medical Journal

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Calyceal diverticular stones are rare clinical entities without a clearly defined consensus on the treatment. Treatment indications include recurrent urinary tract infections, chronic pain and renal impairment. Treatment modality of surgical approach is usually based on the location of calyceal diverticulum. A 23-year-old woman was presented with a calyceal diverticular stone of 16.5 mm. Her medical history revealed multiple urinary tract infections caused by extended spectrum beta-lactamase (ESBL)-producing Escherichia coli of which the stone was predicted to be the reason. The patient was treated ureterorenoscopically, a decision of which was taken intra-operatively. In conclusion, insisting on performing nephroscopy following an intra-operative retrograde pyelography revealed no apparent ostium which could be interpreted as ureterorenoscopic retriaval would fail and development of postoperative bacteremia despite all precautions taken pre-and intra-operatively were two lessons indicating that all efforts must be exercised to reach the most minimal invasive method for the treatment of calyceal diverticular stones.

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“…Some authors suggest that ultrasound-guided puncture facilitates identification of caliceal diverticula during F-URS, and improves the success rate of F-URS surgery. 19 …”

Section: Discussionmentioning

confidence: 99%

Management of symptomatic caliceal diverticular calculi: Minimally invasive percutaneous nephrolithotomy versus flexible ureterorenoscopy

Ding¹,

Xu²,

Huang³

et al. 2016

Chronic Diseases and Translational Medicine

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ObjectiveTo retrospectively evaluate appropriate treatment for patients with symptomatic caliceal diverticular calculi, by comparing the therapeutic outcomes for those undergoing minimally invasive percutaneous nephrolithotomy (MPCNL) and flexible ureterorenoscopy (F-URS).MethodsFrom March 2009 to May 2014, 36 consecutive patients with caliceal diverticular calculi were divided into 2 groups: 21 patients underwent MPCNL, and 15 were treated by F-URS. All procedures were performed by one surgical group, which ensured relatively constant parameters. Patient characteristics, operative time, hospital stay after surgery, stone-free rate, symptomatic improvement rate, complications, diverticular obliteration, and stone composition were analyzed retrospectively in the 2 groups.ResultsPatient preoperative variables were comparable between the two groups, with no significant difference (P > 0.05). Mean operative time was 136.9 ± 22.8 min in the MPCNL group and 117.3 ± 24.3 min in the F-URS group (P = 0.019). Hospital stay was significantly longer in the MPCNL group than in the F-URS group (9.4 ± 3.1 vs. 6.9 ± 2.1 days, P = 0.010). The stone-free rates after MPCNL and F-URS were 90.5% (19/21) and 60.0% (9/15), respectively (P = 0.046). Additionally, 71.4% (15/21) of patients in the MPCNL group and 46.7% (7/15) of patients in the F-URS group had symptomatic improvement at the 6-month follow-up (P = 0.175); the rates of complications in the 2 groups were 19.0% (4/21) and 13.3% (2/15), respectively (P = 0.650). Complete diverticular obliteration was achieved in 16 (76.2%) cases in the MPCNL group and 5 (33.3%) cases in the F-URS group (P = 0.017). The distributions of calcium oxalate and hydroxyapatite in the stones were 66.7% (14/21) and 33.3% (7/21), respectively, in the MPCNL group; however, the distributions in the F-URS group were 46.7% (7/15) and 53.3% (8/15), respectively (P = 0.310).ConclusionMPCNL is an effective method for the treatment of caliceal diverticular calculi. However, F-URS is an alternative technique in selected patients with a patent infundibulum, despite lower stone-free rates than with MPCNL. Fulguration of the diverticular lining with a high-power holmium laser and permitting the cavity to collapse are useful to increase the chance of diverticular obliteration.

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Retrospective Analysis of Ultrasound-guided Flexible Ureteroscopy in the Management of Calyceal Diverticular Calculi

Cited by 11 publications

References 28 publications

Microperc with Self-Assembled Fr 4.85 Visual Needle and Ureteral Access Sheath

Microperc with Self-Assembled Fr 4.85 Visual Needle and Ureteral Access Sheath

Calyceal diverticular stones: Does the insistence on less invasive technique keep the patient away from a major complication?

Management of symptomatic caliceal diverticular calculi: Minimally invasive percutaneous nephrolithotomy versus flexible ureterorenoscopy

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