Urgent ureterorenoscopy as a primary treatment for ureteral stone: why not?

To evaluate the feasibility of urgent ureteroscopy (uURS) and elective ureteroscopy (eURS) in the management of patients with renal colic due to ureteral stones. Patients who were operated for ureteral stones between September 2020 and March 2022 were determined retrospectively. The patients who were operated within the first 24 h constituted the uURS group, while the patients who were operated after 24 h were classified as eURS. No limiting factors such as age, gender and concomitant disease were determined as inclusion criteria. Patients with bilateral or multiple ureteral stones, bleeding diathesis, patients requiring emergency nephrostomy or decompression with ureteral JJ stent, and pregnant women were not included. The two groups were compared in terms of stone-free rate, complications, and overall outcomes. According to the inclusion-exclusion criteria, a total of 572 patients were identified, including 142 female and 430 male patients. There were 219 patients in the first group, the uURS arm, and 353 patients in the eURS arm. The mean stone size was 8.1 ± 2.6. The stone-free rate was found to be 87.8% (502) in general, and 92 and 85% for uURS and eURS, respectively. No major intraoperative or postoperative complications were observed in any of the patients. Urgent URS can be performed effectively and safely as the primary treatment in patients with renal colic due to ureteral stones. In this way, the primary treatment of the patient is carried out, as well as the increased workload, additional examination, treatment and related morbidities are prevented.

Factors predicting duration and success of semirigid ureteroscopy for ureteral stones in different localizations. / Factores predictores de la duración y éxito de la ureteroscopia semirígida para litiasis ureterales en diferentes localizaciones.

OBJECTIVE: In this study, we aimed to determine the factors predicting the duration and successof semirigid ureteroscopy performed for the treatment of ureteral stones in different localizations. MATERIALS AND METHODS: Medical records of the patients whom under went semirigid ureteroscopy for urolithiasis in our centre between January 2015 and December 2019 were retrospectively reviewed. The study group composed of 170 patients and divided into three subgroups; of which 54 in proximal ureter (31.8%), 51 in the mid (30 %) and 65 (38.2%) in the distal ureter. Predictive factors of semirigid ureteroscopy duration and success were determined by performance of correlation analysis and multivariate analysis. RESULTS: Overall stone-free rate was calculated as 78.8%. Success rates for proximal, mid and distal ureteral stones were 72.2% (39/54 patients), 74.5% (38/51 patients) and 87.7% (57/65 patients), respectively. Complications were present in 19 patients (11.2%). Multivariate analysis indicated that stone diameter and stone burden independently affected the stone-free rate. Statistically significant negative correlation was determined between success of the procedure and stone diameter, stone burden, impaction and more proximal stone localization. While there was a statistically significant positive correlation between duration of procedure and stone burden, diameter, impaction, historyof ipsilateral ureteroscopy and more proximal stone localization, there was negative correlation between duration of procedure and stone-free status. CONCLUSION: We conclude that stone diameter, stone burden, impaction and more proximal stone localization are common factors affecting both duration and success of semirigid ureteroscopy. In addition, stone size and stone burden were determined as independent markers of stone-free status.

OBJETIVO: En este estudio determinamos los factores predictores de la duración y el éxito de la ureteroscopia semirígida realizada como tratamiento de las litiasis ureterales en diferentes localizaciones. MATERIALES Y MÉTODOS: Revisamos retrospectivamente las historias clínicas de los pacientes que han sido sometidos a una ureteroscopia semirígida por litiasis en nuestro centro entre enero 2015 y diciembre 2019. El grupo de estudio está formado por 170 pacientes y dividido en 3 subgrupos: 54 con litiasis en uréter proximal (31,8%) 51 en medio (30%) y 65 (38,2%) en el uréter distal. Los factores predictores de duración y éxito de la ureteroscopia semirígida fueron determinados con análisis de correlación y multivariante. RESULTADOS: La tasa global libre de litiasis fue de 78,8%. La tasa de éxito en uréter proximal, medio y distal fue de 72,2% (39/54 pacientes), 74,5% (38/51pacientes) y 87,7% (57/65 pacientes), respectivamente. Las complicaciones estuvieron presentes en 19 pacientes (11,2%). El análisis multivariante indicó que el diámetro de la litiasis y el volumen afectaron de forma independiente la tasa libre de litiasis. Una significación estadística negativa fue determinada entre el éxito del procedimiento y el diámetro de la litiasis, volumen, impactación y localización proximal. Una significación estadística positiva entre la duración del procedimiento y el volumen de la litiasis, diámetro, impactación, previas ureteroscopias y localización proximal. Se observó una correlación negativa entre la duración del procedimiento y el estado libre de litiasis. CONCLUSIÓN: Concluimos que el diámetro de la litiasis,volumen, impactación y localización proximal son los factores que afectan a la duración y el éxito de la ureteroscopia semirígida. Además, el tamaño de la litiasis y el volumen fueron predictores independientes de la tasa libre de litiasis.

Die präoperative Anwendung von Dutasterid hat keine Auswirkung auf intraoperative Blutungen bei transvesikaler offener einfacher Prostatektomie zur Behandlung der benignen Prostatahyperplasie.

OBJECTIVE: There are a few studies in the literature investigating the effect of preoperative dutasteride use on bleeding in open simple prostatectomy. We aimed to evaluate the effect of preoperative dutasteride use on perioperative bleeding during open simple prostatectomy. METHODS: We retrospectively analyzed the medical records of all patients who underwent transvesical open prostatectomy due to benign prostatic hyperplasia in our institution between 2008 and 2018. Patients were divided into 2 groups regarding the use of dutasteride prior to surgery as group 1 = received dutasteride during at least six weeks prior to surgery; group 2 = dutasteride naive. RESULTS: A total of 167 patients who met the inclusion criteria were included in the study. The mean operative time was 86.5±18.7 min while the estimated blood loss was 640.7±55.7 ml. There was no statistically significant difference in operative time, estimated blood loss, hemoglobin, and hematocrit decrease among the two groups. CONCLUSION: We were not able to find an advantage of pre-operative dutasteride use in terms of perioperative bleeding in open simple prostatectomy performed for benign prostatic hyperplasia.