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1.
Int Urol Nephrol ; 52(5): 829-834, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31863294

RESUMO

PURPOSE: To evaluate the clinical significance of discordant stone analyses in patients undergoing bilateral ureteroscopy. MATERIALS AND METHODS: A retrospective chart review was performed for all patients undergoing stone extraction with bilateral ureteroscopy at our institution in an aim to identify patients who had bilateral stone analysis and 24-h urine chemistry data available. Stones were then classified based upon the dominant present (> 50%). Twenty-four hour urinalysis results were reviewed and statistical analysis performed comparing discordant and concordant patient populations, assessing significant differences that would potentially influence clinical management. RESULTS: We identified 79 patients (158 renal units) who had bilateral stones removed at the time of ureteroscopy. The majority of stones were classified as calcium oxalate (CaOx) (60.1%) followed by calcium phosphate (CaP) (27.8%), brushite (5.1%), uric acid (UA) (4.4%), and cystine (2.5%). Discrepancies in stone classifications were present 24% of the time. Evaluation of 24-h urinalysis results demonstrated that patients with CaOx:CaP stone discordance compared to CaOx:CaOx concordant stone formers were more likely to have an elevated pH (p = 0.02) and lower uric acid supersaturation (p = 0.01). CONCLUSIONS: Discrepancies in stone mineral content are common in patients with bilateral stone disease. A single stone analysis from one side in the setting of bilateral stone disease is insufficient for management of patients with bilateral renal stones, and may lead to mismanagement when this misrepresented information is utilized in addition to 24-h urinalysis results. At least one stone analysis should be performed from both sides during a bilateral stone extraction procedure.


Assuntos
Cálculos Renais/química , Cálculos Renais/metabolismo , Correlação de Dados , Humanos , Cálculos Renais/patologia , Cálculos Renais/cirurgia , Estudos Retrospectivos , Ureteroscopia
2.
Int Urol Nephrol ; 52(3): 455-460, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31745707

RESUMO

PURPOSE: To evaluate if HoLEP is a viable option for male patients with medication-refractory urinary symptoms due to an enlarged prostate who are surgical candidates, but do not accept blood product transfusion. MATERIALS AND METHODS: Between August 2008 and March 2019, nine Jehovah's Witness patients were undergoing HoLEP for relief of lower urinary tract symptoms and urinary retention. We described change in hemoglobin, change in PSA, enucleated prostate weight, enucleation and morcellation times, length of stay, and postoperative retention rate. RESULTS: The average age was 71.4 years (range 53-87). Urinary retention requiring catheterization was present in seven patients (78%). Two patients had a known diagnosis of prostate cancer preoperatively. The mean preoperative PSA on average was 21.6 ng/dL. Patients had a wide range of gland sizes, with a mean enucleated weight of 141 g (range 18-344 g). Mean reduction in hemoglobin was 16.9% following HoLEP. All patients managed to void postoperatively. All but one patient went home on postoperative day 1, and this patient went home on postoperative day 2. No patients required blood product transfusion or return to the operating room for clot irrigation postoperatively. CONCLUSION: HoLEP is a reasonable option for Jehovah's Witness and other patients with contraindications to blood product transfusion requiring surgical management of urinary symptoms due to enlarged prostate.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Terapia a Laser , Lasers de Estado Sólido/uso terapêutico , Complicações Pós-Operatórias , Hiperplasia Prostática , Retenção Urinária , Idoso , Humanos , Testemunhas de Jeová , Terapia a Laser/efeitos adversos , Terapia a Laser/instrumentação , Terapia a Laser/métodos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Tamanho do Órgão , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Próstata/patologia , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/fisiopatologia , Hiperplasia Prostática/terapia , Cateterismo Urinário/métodos , Retenção Urinária/diagnóstico , Retenção Urinária/etiologia , Retenção Urinária/terapia
3.
Urology ; 124: 52-56, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30391680

RESUMO

OBJECTIVE: To assess stone-free rates following ureteroscopy (URS) for renal calculi at our institution using low-dose renal only computed tomography (CT). METHODS: A retrospective review of patients undergoing flexible URS for renal stones only with subsequent CT scan within 3 months. Meticulous basketing of all stone fragments was performed whenever possible. A "true" zero-fragment stone-free rate was determined by reviewing the CT scan and radiologist's report. Patients with nephrocalcinosis (as determined by visual inspection of papilla at the time of URS) were assigned the "stone-free" category. RESULTS: Flexible URS was performed in 288 renal units of 214 patients with renal calculi from 2013 to 2016. Median preoperative stone size was 6.2 mm with the average kidney containing 6.4 stones. An access sheath was used in 92% of cases. A total of 73% (209/288) renal units were completely stone free by CT assessment. Patients with residual fragments were as follows: 1 mm in 2% (7/288), 2-4 mm in 16% (46/288), and >4 mm in 9% of kidneys (26/288). CONCLUSION: The true stone-free rate in patients undergoing flexible URS for renal calculi utilizing active basketing of fragments as determined by strict CT assessment was 73%. In patients with residual fragments, the majority are 2-4 mm in size making URS a treatment option for renal calculi with excellent stone-free results.


Assuntos
Cálculos Renais/diagnóstico por imagem , Cálculos Renais/cirurgia , Tomografia Computadorizada por Raios X , Ureteroscopia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscópios , Adulto Jovem
4.
Urology ; 111: 54-58, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29030074

RESUMO

OBJECTIVE: To evaluate operating room (OR) costs associated with the 2 available morcellators in the United States in a matched cohort and to determine benign prostatic hyperplasia surgeon's morcellator preference. MATERIALS AND METHODS: Patients from 2013, the last year our institution exclusively used the VersaCut device, were matched 1:1 with the most recent patient cohort, utilizing the Wolf Piranha morcellator. Cost of morcellation including the expense of OR time and disposable instrument costs were calculated. A survey to the Endourological Society e-mail listserv was sent to determine morcellator preference. RESULTS: We identified 142 patients who underwent holmium laser enucleation of the prostate in 2013. When compared with the VersaCut group, morcellation efficiency (4.4 vs 7.0 g/min, P <.01) and expense of OR time ($1420.80 vs $992.21, P <.005) both favored the Piranha morcellator system even when the costs of disposable instruments were factored into the analysis ($1338.81 vs $1637.50, P <.05). A total of 126 urologists responded to the survey. Of these, 56 (44.5%) perform transurethral prostate enucleations, which included 48 (86%) holmium. More endourologists use the VersaCut (n = 33, 59%) than the Piranha (n = 24, 43%) morcellator. Qualities that impacted the preference of morcellator included the preferred device is safer, faster, easier to use, reusable, and less expensive. CONCLUSION: We identified a significant improved efficiency and improved cost savings utilizing the Piranha morcellator even when controlling for disposable costs. Of the endourologists who responded to the survey, less than half perform transurethral enucleation. Morcellator preference is largely based on safety, efficiency, and ease of use, whereas cost and reusablility were of lesser importance.


Assuntos
Custos e Análise de Custo , Morcelação/economia , Morcelação/instrumentação , Padrões de Prática Médica , Hiperplasia Prostática/cirurgia , Urologia , Estudos de Coortes , Desenho de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos , Procedimentos Cirúrgicos Urológicos Masculinos/economia
5.
J Endourol ; 31(11): 1145-1151, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28859485

RESUMO

PURPOSE: To compare the efficiency (stone fragmentation and removal time) and complications of three models of intracorporeal lithotripters in percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: Prospective, randomized controlled trial at nine centers in North America from 2009 to 2016. Patients were randomized to one of three lithotripter devices: the Cyberwand, a dual-probe ultrasonic device; the Swiss Lithoclast Select, a combination pneumatic and ultrasonic device; and the StoneBreaker, a portable pneumatic device powered by CO2 cartridges. Since the StoneBreaker lacks an ultrasonic component, it was used with the LUS-II ultrasonic lithotripter to allow fair comparison with combination devices. RESULTS: Two hundred seventy patients were enrolled, 69 were excluded after randomization. Two hundred one patients completed the study: 71 in the Cyberwand group, 66 in the Lithoclast Select group, and 64 in the StoneBreaker group. The baseline patient characteristics of the three groups were similar. Mean stone surface area was smaller in the StoneBreaker group at 407.8 mm2 vs 577.5 mm2 (Lithoclast Select) and 627.9 mm2 (Cyberwand). The stone clearance rate was slowest in the StoneBreaker group at 24.0 mm2/min vs 28.9 mm2/min and 32.3 mm2/min in the Lithoclast Select and Cyberwand groups, respectively. After statistically adjusting for the smaller mean stone in the StoneBreaker group, there was no difference in the stone clearance rate among the three groups (p = 0.249). Secondary outcomes, including complications and stone-free rates, were similar between the groups. CONCLUSIONS: The Cyberwand, Lithoclast Select, and the StoneBreaker lithotripters have similar adjusted stone clearance rates in PCNL for stones >2 cm. The safety and efficacy of these devices are comparable.


Assuntos
Cálculos Renais/cirurgia , Litotripsia/instrumentação , Nefrolitotomia Percutânea/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá , Desenho de Equipamento , Falha de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Resultado do Tratamento , Estados Unidos , Adulto Jovem
6.
Urol Pract ; 4(3): 187-192, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-37592634

RESUMO

INTRODUCTION: Modern flexible ureteroscope ownership costs are considerable. Most prior estimates focus exclusively on repair costs, likely underestimating overall costs, including those of acquisition and reprocessing. Furthermore, to our knowledge no prior cost analyses focus on the latest generation digital flexible ureteroscope, which may differ due to unique purchase and repair prices. We sought to gain greater insight into the comprehensive costs associated with modern flexible ureteroscope use, particularly the difference between digital and fiberoptic models. METHODS: Data on use and repair of fiberoptic Storz Flex-X2 and digital Flex-Xc flexible ureteroscopes from 2011 to 2015 were reviewed. List prices and repair costs were obtained from Storz. Per case reprocessing costs were estimated, accounting for disposables, reagents and labor. Maintenance costs were estimated by combining cost of repairs and reprocessing. Analyses were performed at list pricing and standard discount rates. Global flexible ureteroscope costs were calculated to account for the cost of acquisition, repair and maintenance of a new scope during its first 100 uses. RESULTS: Global costs associated with digital flexible ureteroscope ownership were 1.3 to 1.4 times greater than fiberoptic on a per case basis ($1,008/$1,086 vs $715/$835). The majority of expenses went toward scope repairs (73% vs 71%), with instrument purchase (23% vs 24%) and reprocessing (4% vs 5%) being less costly. Repair rates were not significantly different between fiberoptic and digital devices (12.5 vs 11.5, p=0.757). CONCLUSIONS: Expenditures associated with ownership of modern flexible ureteroscopes are considerable and driven primarily by the high cost of repairs. Digital instruments are more costly despite comparable rates of flexible ureteroscope damage.

7.
Expert Opin Drug Saf ; 14(12): 1865-77, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26600291

RESUMO

INTRODUCTION: Renal stones are one of the most painful medical conditions patients experience. For many they are also a recurrent problem. Fortunately, there are a number of drug therapies available to treat symptoms as well as prevent future stone formation. AREAS COVERED: Herein, we review the most common drugs used in the treatment of renal stones, explaining the mechanism of action and potential side effects. Search of the Medline databases and relevant textbooks was conducted to obtain the relevant information. Further details were sourced from drug prescribing manuals. Recent studies of drug effectiveness are included as appropriate. EXPERT OPINION: Recent controversies include medical expulsive therapy trials and complex role of urinary citrate in stone disease. Future directions in research will involve new medical therapies for stone prevention, for example new drugs for hyperoxaluria.


Assuntos
Ácido Cítrico/urina , Desenho de Fármacos , Cálculos Renais/tratamento farmacológico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Humanos , Cálculos Renais/patologia , Preparações Farmacêuticas/administração & dosagem
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