The role of specific biomarkers, as predictors of post-operative complications following flexible ureterorenoscopy (FURS), for the treatment of kidney stones: a single-centre observational clinical pilot-study in 37 patients

Hughes, Stephen; Moyes, Alyson Jayne; Lamb, Rebecca May; Ella-Tongwiis, Peter; Bell, Charles L.; Moussa, Ahmed; Shergill, Iqbal

doi:10.1186/s12894-020-00693-4

Cited by 6 publications

(4 citation statements)

References 33 publications

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“…Among 251 articles identified in the searches, 13 met the eligibility criteria and were included in the systematic review. [9][10][11][12][13][14][15][16][17][18][19][20][21] A PRISMA flow diagram depicting the study identification and selection results is shown in Figure 1. Among 13 studies (5 prospective) with 5597 patients, mean patient age ranged from 43 to 77 years (median 51 years) and 64% were men.…”

Section: Resultsmentioning

confidence: 99%

Risk Factors for Urosepsis After Ureteroscopy for Stone Disease: A Systematic Review with Meta-Analysis

Bhojani

Miller²,

Cutone

et al. 2021

Journal of Endourology

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Introduction: Urosepsis is a serious potential complication of ureteroscopic procedures for stone disease, yet the risk factors for this complication are not well characterized. The purpose of this systematic review with meta-analysis was to identify potential risk factors for urosepsis after ureteroscopy (URS) for stone disease. Materials and Methods: We performed systematic searches of Medline, Embase, and the Cochrane Central Register of Controlled Trials for studies reporting at least one prospectively defined risk factor for urosepsis after URS. Studies that only reported rates of isolated fever, urinary tract infection (UTI), or pooled infectious complications were excluded. The risk factors evaluated in this review were age, sex, body mass index, diabetes mellitus, ischemic heart disease, recent UTI, pyuria, hydronephrosis, stone history, stone size, preoperative stent placement, preoperative positive urine culture, and procedure time. A random effects meta-analysis model with inverse variance weighting was used where the statistic of interest was the odds ratio for dichotomous variables and the mean difference for continuous outcomes. Results: In 13 studies (5 prospective) with 5597 patients, the pooled incidence of postoperative urosepsis was 5.0% (95% confidence interval: 2.4-8.2). Six risk factors were statistically associated with increased postoperative urosepsis risk-preoperative stent placement (odds ratio = 3.94, p < 0.001, 6 studies), positive preoperative urine culture (odds ratio = 3.56, p < 0.001, 6 studies), ischemic heart disease (odds ratio = 2.49, p = 0.002, 2 studies), older age (mean difference = 2.7 years, p = 0.002, 6 studies), longer procedure time (mean difference = 9 minutes, p = 0.02, 1 study), and diabetes mellitus (odds ratio = 2.04, p = 0.04, 6 studies). Conclusions: Current evidence suggests that among patients undergoing URS for treatment of stone disease, the risk of postoperative urosepsis was 5.0%. Older age, diabetes mellitus, ischemic heart disease, preoperative stent placement, a positive urine culture, and longer procedure time were associated with increased postoperative urosepsis risk. These results will assist urologists with preoperative risk stratification before ureteroscopic procedures.

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Section: Resultsmentioning

confidence: 99%

Risk Factors for Urosepsis After Ureteroscopy for Stone Disease: A Systematic Review with Meta-Analysis

Bhojani

Miller²,

Cutone

et al. 2021

Journal of Endourology

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“…Dede et al [28] reported in their post-RIRS findings of 30 patients that NGAL levels increased significantly postoperative second hour. The study of Hughes et al [29] has shown significant increases in blood NGAL values post-FURS peaking between postoperative 30 min and second hour. Furthermore, they highlighted that patients with a postoperative complication had higher NGAL levels than the average patients’ response.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Can Urinary KIM-1 and NGAL Predict Management Endoscopic Surgery in Acute Unilateral Obstructive Stone Disease? Results from a Prospective Cohort Study

et al. 2021

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Introduction: Kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) are the leading novel biomarkers used efficiently in acute kidney injury (AKI). The levels of these biomarkers increase especially in the early period of nephrotoxic and ischemic renal damage. In this study, we aimed to investigate the clinical importance of NGAL and KIM-1 biomarkers used in the effective evaluation of kidney functions in patients with acute unilateral obstructive stone disease (AUOSD) in the management of endoscopic surgery. Materials and Methods: We prospectively included patients who underwent endoscopic surgery due to AUOSD between January 2018 and December 2019. Urine KIM-1 and NGAL values of the patients were measured preoperative period, postoperative 4th h, and postoperative 7th day. The patients were evaluated according to the location and size of the stone, the degree of renal hydronephrosis, the duration of the operation, complications, and JJ stent placement. Results: The study enrolled 50 patients. Urinary KIM-1/Cr and urinary NGAL/Cr ratios were higher in postoperative 4th h than in others (p < 0.001). Also, we found that urinary KIM-1/Cr and urinary NGAL/Cr ratios with Grade 2 and higher hydronephrosis were statistically higher than Grade 0–1 hydronephrosis (p < 0.001 and p: 0.042, respectively). Additionally, a preoperative urinary KIM-1 value of 1.24 ng/mL had a sensitivity of 78% and a specificity of 63% to predict the presence of hydronephrosis. When urine KIM-1 and NGAL results were compared with surgery time, stone size and location, serum creatinine (sCr) value, and Post-Ureteroscopic Lesion Scale grade, the difference was not statistically significant. Postoperative 7th day NGAL/Cr and KIM-1/Cr ratios were statistically higher in those with JJ stents placed (p: 0.03 and p: 0.004, respectively). Conclusion: KIM-1 and NGAL can be used in our assessment of renal function in patients with AUOSD, even if sCr is normal. Also, these biomarkers can predict the presence of hydronephrosis. It can be helpful in determining the time of surgical treatment, as well as providing information in the follow-up of patients with JJ stents after treatment.

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“…It was shown in the study of Hughes et al 24 that compared with rigid ureteroscope surgery, inflammatory markers such as cystatin C and CRP were significantly reduced after flexible ureteroscope surgery.…”

Section: A H E a D O F P R I N Tmentioning

confidence: 97%

Clinical comparative study of standard channel percutaneous nephroscope combined with flexible ureteroscope and traditional standard channel combined with microchannel percutaneous nephrolithotomy in the treatment of multiple renal calculi without hydrone

Guo¹,

Yang²,

Xu³

et al. 2022

Pak J Med Sci

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Objectives: To evaluate the clinical efficacy of standard channel percutaneous nephroscope combined with flexible ureteroscope and traditional standard channel combined with microchannel percutaneous nephrolithotomy in the treatment of multiple renal calculi without hydronephrosis. Methods: Eighty patients with multiple renal calculi without hydronephrosis treated in Shijiazhuang People’s Hospital from January 2020 to October 2021 were randomly divided into two groups: the experimental group and the control group, with 40 cases in each group. Patients in the experimental group were treated with standard channel percutaneous nephroscope combined with flexible ureteroscopy lithotripsy, while those in the control group were treated with standard channel combined with microchannel percutaneous nephrolithotomy. The differences in operative time, postoperative hospital stay, intraoperative blood loss, calculus clearance rate, and number of channels between the two groups were compared and analyzed. Moreover, the changes of renal function indexes such as serum creatinine, urea nitrogen, blood β 2-microglobulin and blood uric acid were compared and analyzed between the two groups postoperatively; Renal static imaging technology was utilized to compare and analyze the renal parenchymal injury of the two groups postoperatively. The incidence of surgical complications such as pain, fever, urine leakage at the incision, chest tightness and chest pain within 72h postoperatively was compared and analyzed between the two groups. Results: The operative time, postoperative hospital stay and intraoperative blood loss in the experimental group were significantly lower than those in the control group, with statistically significant differences (P=0.00). The number of percutaneous renal channels established in the experimental group was significantly superior to that of the control group (P=0.00); No statistically significant difference can be seen in the calculus clearance rate between the two groups (P=0.17); Postoperative TNF-a, CRP, IL-6 and other inflammatory factors in the experimental group were significantly lower than those in the control group (TNF-a, CRP, P=0.00; Il-6, P=0.01), and cortisol level in the experimental group was significantly lower than that in the control group, which was statistically significant (P=0.00). Postoperative renal static imaging showed that the degree of renal injury in the experimental group was lower than that in the control group (P=0.00). No statistically significant difference was observed in renal function indexes such as serum creatinine, urea nitrogen, blood β2-microglobulin and blood uric acid between the two groups (P>0.05). Conclusion: Standard channel percutaneous nephroscope combined with flexible ureteroscope is a safe and effective treatment regimen for the treatment of multiple renal calculi without hydronephrosis, boasting of numerous advantages such as reduced number of channels, less bleeding, short operative time, low kidney injury, low impact on internal environmental factors such as inflammation and stress in the patients, short postoperative hospital stay, and low incidence of complications. doi: https://doi.org/10.12669/pjms.38.7.5526 How to cite this:Guo Y, Yang L, Xu X, Li C. Clinical comparative study of standard channel percutaneous nephroscope combined with flexible ureteroscope and traditional standard channel combined with microchannel percutaneous nephrolithotomy in the treatment of multiple renal calculi without hydronephrosis. Pak J Med Sci. 2022;38(7):---------. doi: https://doi.org/10.12669/pjms.38.7.5526 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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The role of specific biomarkers, as predictors of post-operative complications following flexible ureterorenoscopy (FURS), for the treatment of kidney stones: a single-centre observational clinical pilot-study in 37 patients

Cited by 6 publications

References 33 publications

Risk Factors for Urosepsis After Ureteroscopy for Stone Disease: A Systematic Review with Meta-Analysis

Risk Factors for Urosepsis After Ureteroscopy for Stone Disease: A Systematic Review with Meta-Analysis

Can Urinary KIM-1 and NGAL Predict Management Endoscopic Surgery in Acute Unilateral Obstructive Stone Disease? Results from a Prospective Cohort Study

Clinical comparative study of standard channel percutaneous nephroscope combined with flexible ureteroscope and traditional standard channel combined with microchannel percutaneous nephrolithotomy in the treatment of multiple renal calculi without hydrone

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