The Influence of NBI Vision Over the First Follow-up Cystoscopy Outcomes in Newly Diagnosed NMIBC Patients.

BACKGROUND: A retrospective study was aimed to establish the eventual impact of narrow band imaging (NBI) cystos copy over the short term residual tumors’ rate determined during the first follow-up endoscopic control in newly determined non-muscle invasive bladder cancer (NMIBC) cases. METHODS: 68 patients were found with NMIBC by means of both white light cystoscopy (WLC) and NBI. A follow-up using both investigation modalities was performed at 3 months from the initial procedure in 67 cases (one was lost from follow-up). RESULTS concerning the short termer currences were retrospectively compared to those obtain ending a similar series of 67 patients previously diagnosed and treated by means of classical WLC and resection only. RESULTS: The short term residual tumors’ rate established during the first follow-up cystoscopy was lower in the study group initially benefiting from the NBI mode by comparison to the WLC control series (4.5% versus 11.9%). When drawing a parallel with the tumor map location outlined during the initial procedure, the most important differences were emphasized concerning other site recurrences (3%versus 8.95%). CONCLUSIONS: NBI cystoscopy and resection displayed a substantially favorable influence over the short termoncologic outcome in newly diagnosed NMIBC cases when compared to the standard protocol. ABBREVIATIONS: NBI â€" narrow band imaging; NMIBC â€"non-muscle invasive bladder cancer; WLC â€" white light cystoscopy; TURBT â€" transurethral resection of bladdertumors; CIS â€" carcinoma in situ.

Intraoperative complications after 8150 semirigid ureteroscopies for ureteral lithiasis: risk analysis and management.

OBJECTIVES: To evaluate semirigid retrograde ureteroscopy complications on a significant series of patients and to establish the factors associated with the occurrence of intraoperative complications. PATIENTS AND METHODS: Between June 1994 and June 2013, 8150 semirigid ureteroscopic procedures for ureteral lithiasis were performed in 7456 patients. We used semirigid ureteroscopes(8 9.8F Wolf, 8 and 10F Storz, Olympus Endoeye digital 8.5 9.9F). Lithotripsy was done with pneumatic, electrohydraulic or Ho:YAG laser lithotripters. The preoperative parameters including gender, calculi location and size, impaction, degree of hydronephrosis, stone number and associated malformation as well as intraoperative aspects (stone extractors, fragmentation devices, operative time and surgeon experience) were evaluated in relation with complication rate. RESULTS: The stone-free rate after a single ureteroscopic procedure was 90.9%. Intraoperative incidents occurred in 348 cases (4.3%). The overall rate of intraoperative complications was 2.8% (228 cases). These were represented by lesions of the ureteral mucosa (139 cases), perforation (58 cases), bleeding (16 cases), ureteral avulsion (3 cases) and extra-ureteral stone migration (12 cases). Statistical analysis shows a significant association between the complication rate on the one hand and stone size, location and impaction,operative time and surgeon experience on the other hand. CONCLUSIONS: Due to technological advances and increased experience, the semirigid retrograde ureteroscopic treatment of ureteral lithiasis increased efficacy, while the incidence of intraoperative complications decreased. Most of these complications are minor and can be managed by conservative approach.

Holmium laser intrarenal lithotripsy in pyelocaliceal lithiasis treatment: to dust or to extractable fragments?

BACKGROUND: Pyelocaliceal calculi flexible ureteroscopic approach raises problems related to operative time, associated morbidity and costs, especially by potential endoscope damage. METHODS: 5 series, each of 20 patients with single pyelocaliceal lithiasis, were analyzed: Group I with calculi 1 cm fragmented to dust, Group II with calculi 1 cm with lithotripsy in fragments, Group III with calculi of 1-2 cm fragmented to dust, Group IV with calculi of 1-2 cm with lithotripsy in fragments, Group V with calculi of 1-2 cm fragmented to dust until they reached 1 cm, and lithotripsy in fragments afterwards. In all cases Ho:YAG lithotripsy was used. RESULTS: Ureteral access sheath was used in 70% of the cases. Mean operating time was 39 min in group I, 21 min in Group II, 112 min in group III, 72 min in group IV and 51 min in group V. Minor complications occurred in 7 cases,while a single major complication occurred in group IV. CONCLUSIONS: The optimal lithotripsy method for calculi 1cm seems to be in extractable fragments. Larger calculi should be fragmented to dust until they reach 1 cm and then the lithotripsy should be continued into extractable fragments. ABBREVIATIONS: Ho: YAG - Holmium: Yttrium Aluminium Garnet, Hz - Hertz, mJ - milli joule.

Ureteroscopy -- first-line treatment alternative in ureteral calculi during pregnancy?

BACKGROUND: Urolithiasis during pregnancy is not common but remains both a diagnostic and treatment challenge. The aim of the study was to assess the ureteroscopy results as definitive treatment option in pregnant women with obstructive ureteral calculi. MATERIAL METHODS: Between 2006 and 2012, in our clinical department, 54 pregnant women underwent active treatment for ureteral lithiasis and in 38 of these cases ureteroscopy was applied as definitive therapy. The average patients age was 27.2 years (range 20-37 years) and the gestation period varied between 9 to 35 weeks. Flank pain was the common presenting symptom (52 54 cases), 4 women had associated fever, and 14 complained of irritative voiding symptoms.Semirigid ureteroscopy was the first choice alternative for the first 2 trimesters while flexible approach or double J in dwelling were preferred for patients in the last trimester of pregnancy. RESULTS: Semirigid ureteroscopy allowed stone treatment in 28 32 cases. In 17 patients, calculi fragmentation using Ho:YAG laser or ballistic lithotripsy were performed, while in 11 cases, the stone was removed intact. Minor intraoperative complications were encountered in 5 patients. Postoperatively,urinary tract infection developed in 4 patients, renal colic in 2 and prolonged hematuria in one case, while 4 patients complained of stent-induced bladder irritation. Flexible ureteroscopy was successfully completed in all patients. There were no complications related to this procedure. All pregnancies were carried out to full term. CONCLUSIONS: Ureteroscopy may be considered a safe and effective first-line definitive therapeutic option in pregnant patients requiring intervention for ureteral stone.

Semirigid vs Flexible Ureteroscopy in the Management of Ureteral Stones - Review.

Ureteral stones are a major clinical problem in urology that require effective and safe therapeutic options. Semirigid and flexible ureteroscopy ar two well-established procedures for treating these stones. The present review provides an outline of the advantages and disadvantages of these approaches. Semirigid ureteroscopy, which uses a rigid straight instrument, provides excellent stone visualisation and successful fragmentation. It is especially useful for proximal and bigger stones, frequently resulting in high stone-free rates and reduced procedure times. Nonetheless, its stiffness can make it difficult to navigate the delicate ureteral anatomy and increase the risk of mucosal injury. On the other hand, flexible ureteroscopy employs a more adjustable flexible scope, allowing access to complicated ureteral configurations while reducing the risk of ureteral trauma. It excels at treating distal and difficult stones but has a lower efficacy with larger stones and often requires longer procedure times. The choice between semirigid and flexible ureteroscopy is determined by patient-specific factors such as stone characteristics or anatomical considerations and the surgeon's skill. A customised approach that uses the capabilities of both treatments as needed can improve stone management outcomes while reducing potential problems. The continued advancement of technology and methodological modifications is predicted to improve the field of ureteroscopic stone management.

The Management of Reno-Ureteral Lithiasis - from Emergency Presentation to Definitive Treatment.

Introduction: The aim of our study was to retrospectively evaluate the stone-free rate after the second intervention for every performed procedure (semirigid ureteroscopy, flexible ureteroscopy, semirigid plus flexible ureteroscopy and percutaneous nephrolithotomy). Materials and methods: A total of 149 patients, who came to the emergency room of "Saint John" Emergency Clinical Hospital, Bucharest, Romania, with acute renal pathology suggesting the presence of renal and/or ureteral lithiasis confirmed by imagining (x-ray, ultrasonography or computer tomography), were included in this retrospective study, which was conducted between September 2021 and September 2022. All selected patients had an indication of emergency surgical intervention that consisted of a double-J stent mounting. We analyzed the stone-free rate after the secondary intervention, which was one of the following procedures: semirigid ureteroscopy, flexible ureteroscopy, combined semirigid and flexible ureteroscopy (F-URS), and percutaneous nephrolithotomy (PCNL). Patients came back for the secondary intervention and were reevaluated using imaging techniques. Results:Endoscopic procedures were performed by 14 surgeons over a time period of two to six weeks after the initial stenting procedure. Encrusted stents were encountered in four cases and in five cases the patients were admitted with obstruction of previously inserted stents. From the total of 149 patients, 68 (45,6%) subjects underwent semirigid ureteroscopy, with a stone-free rate of 86% (59 cases), 32 (21,4%) F-URS, with a stone-free rate of 90,6% (30 cases), 41 (27,5%) combined flexible and semirigid ureteroscopy, with a stone-free rate of 90,24% (37 cases), and eight (5,3%) patients received PCNL, with a stone-free rate of 75% (six cases). Overall stone-free rate for all procedures was 90,06%. The mean operative time was 23 minutes. No major incidents or complications occurred during the procedures. Conclusion:The emergency pre-stenting before the definitive treatment of reno-ureteral lithiasis is a safe procedure. Flexible ureteroscopy was the most successful secondary intervention, with the highest rate of achieving stone-free status.

Ureteroscopy Versus Double J Stenting in Emergency Treatment of Obstructive Lithiasis.

Objective: Ureteroscopy (URS) is a commonly used procedure for the management of ureteral stones. While elective URS has been extensively studied, the literature on emergency URS remains limited. The aim of the present study is to evaluate the efficacy and safeness of URS performed in emergency settings and to determine the ideal candidates for this type of intervention. Methods:Patients who underwent URS for ureteral stones in a single healthcare unit, "Saint John" Emergency Clinical Hospital, Bucharest, Romania, were included in a retrospective investigation between April 2022 and March 2023. The study group was divided into two subgroups: group A (138 patients who underwent semirigid URS in an emergency setting) which was subdivided into group A1 (95 patients with stone on the distal ureter) and group A2 (43 patients with stone on the proximal ureter), and group B (151 patients who underwent a double J stent insertion). The success rate defined as stone fragmentation and resolution of renal obstruction, along with intraoperative and postoperative complications were assessed. A URS procedure was considered unsuccessful if either the instrument could not be passed to access the stone or it was deemed unsafe to perform the URS. In such cases, patients were managed by inserting a ureteric stent and scheduled for a subsequent procedure. Results:It could be observed that most complications occurred in emergency ureteroscopy on distal ureter (95 cases) and the most severe ones on proximal ureter (two cases - Clavien 4). Double J stenting provided a reduced number of complications (51 cases). It should be mentioned that patients with emergency semirigid ureteroscopy had more complications than those with double J stent for every group of BMI, while most of the complications were observed in the groups with the highest BMI. The success of the URS procedure was determined based on complete stone fragmentation and extraction, and it was of 91.3% for cases with emergency ureteroscopy. Conclusion:Patients who underwent URS for ureteral stones at a single facility, "Saint John" Emergency Clinical Hospital, Bucharest, Romania, were included in a retrospective investigation. The success rates and complication rates of emergency URS were comparable to those of elective URS, providing valuable insights for clinical decision-making.

Endoscopic surgery for urolithiasis: what does "stone free" mean in 2012.

There is still an ongoing debate regarding the optimal endourological treatment of upper urinary tract lithiasis, a significant parameter being the stone free rate. However, despite the apparent simplicity of notions such as stone free or success rate, when analyzing the available literature one may discover the complex, intricate and debatable issues behind them. The main problems reside in the heterogeneous way of defining intervention success, the timing at which a patient is considered stone-free and also in the lack of standard postoperative evaluation of patients with urolithiasis. A review of the literature in regard of these notions was performed, in order to identify methods to improve the standardization of these notions.

[Innovative technique in large benign prostatic hyperplasia--enucleation by plasma vaporization]. / Tehnica inovatoare in tratamentul endoscopic al adenomului de prostata voluminos--enucleerea prin vaporizare cu plasma.

OBJECTIVES: The trial evaluated a new endoscopic treatment alternative for large benign prostatic hyperplasia (BPH) cases, the bipolar plasma enucleation of the prostate (BPEP), in terms of surgical efficiency, safety and short-term postoperative results. MATERIALS AND METHODS: A total of 30 patients with prostates larger than 80 ml were included in the study. All cases were investigated preoperatively and at 1 and 3 months after surgery by international prostate symptoms score (IPSS), quality of life score (QoL), maximum flow rate (Q(max)) and abdominal and transrectal ultrasonography. RESULTS: All procedures were successfully performed. The enucleation and morcellation times were 69.8 minutes and 18.5 minutes, while the morcellated tissue weight was 77 grams. The mean hemoglobin drop was 0.8 g/dl and the mean catheterization period and hospital stay were 26.5 hours and 2.3 days. The rate of early irritative symptoms was 10%. At 1 and 3 months, significant improvements were determined concerning the IPSS (5.3 and 4.8), QoL (1.2 and 1.1) and Q(max) (25.9 and 25.1 ml/s). CONCLUSIONS: BPEP represents a promising endoscopic approach in large BPH cases, characterized by good surgical efficacy, reduced morbidity, fast postoperative recovery and satisfactory follow-up parameters.

The Influence of SARS-CoV-2 on Minimally Invasive Therapeutic Approach for Benign Prostatic Hyperplasia.

Introduction: The COVID-19 pandemic definitely changed the management of patients with benign prostatic hyperplasia (BPH). This study followed the modalities of treatments in patients with BPH associated with SARS-CoV-2 attending the Urology Clinic of "Sf. Ioan" Emergency Clinical Hospital, Bucharest, Romania. Material and methods:The present study included 81 patients (mean age 63.2 years, age range 55-87 years) with SARS-CoV-2 and BPH who were admitted to our Urology Department between January 2021 and January 2022. The diagnosis of SARS-CoV-2 was based on the PCR test and that of BPH by using the diagnostic triad consisting of digital rectal examination, PSA, free PSA and ultrasound examination. It should be noted that some of the hospitalized patients were following treatment with alpha blockers and/or 5-alpha-reductase inhibitors at the time of admission. Results:Out of the 81 hospitalized cases, 13 required emergency endoscopic intervention under spinal anaesthesia (TURP or TURisP) for haemostasis because those patients presented with persistent haematuria which did not respond to conservative treatment. A number of 17 cases showed acute urinary retention during hospitalization and a urethrovesical catheter was fitted and will be re-evaluated urologically after the COVID episode. Of the remaining 51 subjects with BPH, 17 already had chronic urinary retention on admission, with urethrovesical probe present, 13 cases began during hospitalization with alpha-blocker treatment associated with 5-alpha-reductase inhibitors; meanwhile, there were no urological interventions to modify the treatment regimen in the remaining 21 patients, who were strictly managed on the side of COVID-19 infection. Conclusion:There was no clear influence of the evolution of patients with BPH due to SARS-CoV-2 pathology, and the general management trend was to delay chronic cases until the time of viral infection remission.

Retrograde flexible ureteroscopy: reshaping the upper urinary tract endourology.

Introduction of retrograde flexible ureteroscopy represented a leap forward in upper urinary tract endourology. Nowadays, areas of the pyelocaliceal system accessible otherwise only by percutaneous or open surgery, can be approached in a retrograde fashion, using the anatomical pathways. The flexible ureteroscopes evolved from the limited deflectable first generation ones to the digital very maneuverable models. The ancillary instruments and the energy sources underwent a similar evolution. Flexible ureteroscopy is a very useful investigative method, especially in patients with equivocal data provided by the imaging. Introduction of this procedure decreased significantly the number of cases with so called "essential" hematuria. The conservatively treated upper urinary tract tumors can be also followed-up more efficiently, the recurrence being identified before becoming radiological obvious. Initially reserved only for diagnostic purposes, flexible ureteropyeloscopy may be used also in the treatment of various pathological conditions of the upper urinary tract such as lithiasis, stenosis, tumors, pyelocaliceal abnormalities etc. However, technical limitations regarding the visibility and access are still influencing the outcome of the method. The characteristics of the available flexible endoscope, and how they are influenced by the used energy sources and ancillary instruments is crucial for achieving the best performances. Also the particularities of the lesion and upper urinary tract anatomy have a significant impact over the flexible ureteroscopic approach. Despite the already achieved efficacy, the technological progress may still allow various improvements of the method, including robotic flexible ureteroscopy.

Endoscopic identification of urinary stone composition: A study of South Eastern Group for Urolithiasis Research (SEGUR 2). / Identificación endoscópica de la composición de los cálculos urinarios: un estudio del Southeastern Group for Lithiasis Research (SEGUR 2).

INTRODUCTION AND OBJECTIVES: To assess the surgeon's ability to evaluate the composition of the stone by observation of endoscopic images. MATERIALS AND METHODS: A series of 20 video clips of endoscopic treatments of urinary stones of which was also available the result of infrared spectroscopy was uploaded to a YouTube site accessible only to members of the South Eastern Group for Urolithiasis Research (SEGUR) who were asked to identify the composition of the stones. RESULTS: A total of 32 clinicians from 9 different countries participated in the study. The average number of correct detections of participants was 7.81 ± 2.68 (range 1-12). Overall accuracy was 39% (250 out of 640 predictions). Calcium oxalate dihydrate stones have been correctly detected in 69.8%, calcium oxalate monohydrate in 41.8%, uric acid in 33.3%, calcium oxalate/uric acid in 34.3% and cystine in 78.1%. Precision rates for struvite (15.6%), calcium phosphate (0%) and mixed calcium oxalate/calcium phosphate (9.3%) were quite low. CONCLUSIONS: Observation of the stone during the endoscopic procedure was not reliable to identify the composition of most stones although it gave some information allowing to identify with a good sensitivity calcium oxalate dihydrate and cystine stones. Nevertheless, photo or video reporting of the intact stone and its internal structure could should be encouraged to implement results of still mandatory post-operative stone analysis. Endourologists should improve their ability of visual identification of the different types of stones.

[Bipolar plasma vaporization--new endoscopic technique in non-invasive bladder cancer]. / Vaporizarea bipolara cu plasma--o noua tehnica endoscopica în cancerul vezical non-invaziv.

OBJECTIVES: The aim of our study was to evaluate the efficacy and safety of a newly introduced endoscopic technique in the treatment of non-muscle invasive bladder cancer (NMIBC), the bipolar plasma vaporization of bladder tumors (BPV-BT). MATERIALS AND METHODS: Between May and November 2009, 72 consecutive patients presenting papillary bladder tumors over 1 cm underwent BPV-BT and a 3 months follow-up. Initial biopsy followed by plasma vaporization of the tumor and biopsies of the tumoral bed were performed in all cases. The follow-up protocol included abdominal ultrasonography, urinary cytology and cystoscopy at 3 months. RESULTS: BPV-BT was successfully performed in all cases. Multiple tumors were found in 45.9% and tumors over 3 cm in 33.3% of the cases. The mean tumoral volume was 10.5 ml. The mean operative time was 16 minutes, the mean hemoglobin decrease was 0.4 g/dl, the mean catheterization period was 2.3 days and the mean hospital stay was 3.4 days. There was no major intra- or postoperative complications. The pathological exam diagnosed 58.3% pTa, 30.6% pT1 and 11.1% pT2 cases. No tumoral base biopsies were positive for malignancy. The recurrence rate was 15.6% for the NMIBC patients, 13.3% for patients with single tumor under 3 cm and 16.3% in cases of single tumors over 3 cm or multiple tumors. Orthotopic recurrent tumors were encountered in 3.1% of the cases. CONCLUSIONS: BPV-BT seems to represent a promising endoscopic treatment alternative for NMIBC patients, with good efficacy, reduced morbidity, fast postoperative recovery and satisfactory follow-up parameters.

[Percutaneous approach in postureteroenterostomy ureteral stenosis. Experience of the Urological Department of Sf. Ioan Emergency Hospital, Bucharest]. / Abordul percutanat în stenoza ureterala postureteroenterostomie. Experienta Clinicii de Urologie a Spitalului Clinic de Urgenta "Sf. Ioan" Bucuresti.

INTRODUCTION: Uretero-enteric stenosis may raise some specific problems due to difficulties concerning the retrograde access. The aim of our study was to evaluate the effectiveness of antegrade flexible ureteroscopic approach for this specific pathology. MATERIAL AND METHODS: Between January 2002 and June 2008, a number of 7 patients underwent antegrade flexible ureteroscopy for uretero-enteric stenosis: 3 patients with stenosis of the uretero-neobladder anastomosis (Group I), 2 patients with stenosis of the uretero-sigmoidian implantation (Group II) and 2 patients with stenosis of the ureteral implantation in an ileal conduit (Group III). In Group I, we performed antegrade Nd:YAG laser star incision in 2 cases and balloon dilation in 1 case. In Group II, the antegrade Nd:YAG laser star incision was applied in 1 case and balloon dilation was performed in the other one. In Group III, we performed antegrade insertion of the guidewire followed by retrograde cold-knife incision in one case, and bipolar ureteral approach (cut-to-the-light technique) in 1 case. RESULTS: The mean operative time was 58 min. (range 25 to 120 min). We didn't describe major intraoperative complications. Ultrasonography, IVP and isotopic renogram (in selected cases) have been the follow-up evaluation methods. Postoperatively, 2 cases from Group I and all cases from Groups II and III had a good evolution, with significant reduction of the hydronephrosis degree at 6, 12 and 18 months. One patient from Group I, in which balloon dilation of the stenosis was performed, developed recurrence at 6 months. CONCLUSIONS: According to our experience, antegrade flexible ureteroscopic approach may represent an efficient and safe technique in uretero-enteric stenosis treatment. Being a minimally invasive approach, this procedure has a reduced rate of complications and good anatomical and functional results.

[Percutaneous approach in the treatment of matrix lithiasis. Experience of the urological department of "Saint John" Emergency Clinical Hospital]. / Abordul percutanat in litiaza moale. Experienta clinicii de urologie a Spitalului Clinic de Urgenta "Sfântul Iano" Bucuresti.

INTRODUCTION: Matrix lithiasis has been relatively rarely described. Our goal was to establish the value of percutaneous approach in this pathology. MATERIAL AND METHODS: Between July 1995 and January 2008 in Department of Urology of "Saint John" Emergency Clinical Hospital in Bucharest, 11 patients with pyelocaliceal matrix lithiasis (seven females and four males) were treated by percutaneous approach. The mean age was 55 years old (between 41 and 83 years old). The rigid nephroscope was exclusively used in seven cases. The approach of caliceal fragments imposed the flexible nephroscopic approach in the other four cases. The mean follow-up period was 48 months (range two to 86). RESULTS: 10/11 patients (90,9%) were stone-free at the end of procedures. In the other case, the spontaneous passage of the remaining matrix lithiasis fragments was encountered. No major complications were recorded. Recurrences occurred in two cases (18.2%), despite the long-term antibiotic therapy. CONCLUSIONS: Percutaneous approach may represent an effective and safe therapy of matrix lithiasis. The management of this pathology must associate the preoperative treatment and postoperative prophylaxis of the urinary tract infections.

[Hexvix induced fluorescence blue light cystoscopy--a new perspective in superficial bladder tumors diagnosis]. / Cistoscopia în lumina albastra cu fluorescenta indusa de Hexvix--o noua perspectiva in diagnosticul tumorilor vezicale superficiale.

INTRODUCTION: The aim of our study was to establish the place of Hexvix blue light cystoscopy (BLC) in superficial bladder tumors (SBT) diagnosis and to compare it with standard white light cystoscopy (WLC). MATERIAL AND METHODS: Between December 2007 and February 2008, WLC and BLC and transurethral bladder resection (TURB) of all apparent detected lesions were performed in 25 cases. The patients diagnosed with superficial bladder tumors have been followed-up after 18 weeks by WLC and BLC. The control group included the same number of consecutive patients with SBT, diagnosed only by WLC, which underwent the same treatment and follow-up protocol as the study group. RESULTS: WLC identified 40 suspicious lesions (37 pathologically confirmed), while BLC detected 58 apparent tumors (52 pathologically confirmed). So, from the 54 tumors with positive histology, WLC correctly diagnosed 68.5%, with a rate of 7.5% false-positive results, while BLC diagnosed 96.3%, presenting a 10.3% rate of false-positive results. 22 cases of the study group diagnosed with SBT were followed. The tumor recurrence rate after 18 weeks was 4.5% for the study group and 22.7% for the control group. CONCLUSIONS: Hexvix fluorescence cystoscopy is a valuable diagnostic method, with considerably better results by comparison to WLC. The improved diagnostic accuracy may have a significant impact upon the recurrence rate.