Evaluation of the relation between size of stone and its attenuation measured by Hounsfield units and the total laser energy required to fragment it.

BACKGROUND: Anticipating the total laser energy (TLE) of Holmium YAG laser required for ureteroscopic (URS) lithotripsy is essential to guide urologists in selecting the optimal fiber size. This study aimed at evaluating the relationship between stone size and stone attenuation measured by HU as predictors for the TLE during the procedure. METHODS: We conducted an observational prospective cohort study of patients undergoing URS lithotripsy at the Urology department of Ain Shams University Hospitals from September 2018 to September 2019 with the use of a holmium YAG laser as the lithotripsy method. Patients' demographic and clinical characteristics, stone location, stone size, stone attenuation measured by HU from the non-contrast CT, TLE, and procedure time were recorded. Data were analyzed using Jamovi software (version 2.0 for macOS). RESULTS: Forty patients were included in the study (22 males and 18 females) with a mean age of 57.8 years. The mean stone size was 9.8 mm3, the mean HU was 858.8 units, and the mean TLE was 3.5 KJ. Both stone size and stone attenuation measured by HU were positively correlated with TLE (r = 0.81 and 0.84, respectively; p < 0.001 for both). Further, regression analysis showed that both variables could significantly predict the TLE (ß = 0.001 and 0.71, respectively). CONCLUSIONS: Both stone attenuation, as measured by HU, and stone size positively correlate with TLE required for URS lithotripsy. Therefore, both HU and stone size can predict the TLE, which will be helpful to guide the urologist in selecting the optimal fiber size for the procedure.

Clinical and Urodynamic Findings Before and After Surgical Repair of Pelvic Organ Prolapse in Women With Lower Urinary Tract Symptoms. A Prospective Observational Study.

OBJECTIVE: To investigate the association between urodynamic findings and lower urinary tract symptoms (LUTS) before and after surgical treatment of pelvic organ prolapse (POP). PATIENTS AND METHODS: Seventy-four patients with stage II or more anterior POP associated with LUTS and eligible for surgical repair of POP were included in this prospective study. All cases had clinical evaluation and urodynamic testing (UDS) before and 6 months after surgical repair of POP. RESULTS: Mean age was 45 ± 9 years. Mean BMI was 28 ± 6 kg/m2. Most cases were multiparous, had stage III cystocele (50/74, 68%), and an associating apical prolapse (37/74, 50%). Native tissue repair was done in 53/74 (72%) cases with a concomitant anti-incontinence procedure in 41/74 (55%) for overt (26/74, 35%) or occult (15/74, 20%) stress urinary incontinence (SUI). Preoperative UDS revealed detrusor overactivity (DO) in 19/56 (34%) patients of those presenting with storage LUTS and an obstructed detrusor pressure at maximum flow rate in 20/26 (77%) patients presenting with voiding LUTS. At the 6-month postoperative follow-up, 61/74 (82%) patients had marked improvement of their LUTS, SUI resolved in 39/41 (95%) patients and 1/33 (3%) patient developed de novo SUI. Preoperative DO and post-void residual urine volume were not related to the postoperative improvement, or persistence of LUTS. Meanwhile, detrusor underactivity was detected both on preoperative and postoperative UDS of 4 patients with persistent voiding LUTS. CONCLUSION: Patients had significant improvement in LUTS after POP surgery with or without an anti-incontinence procedure. Detrusor underactivity was associated with persistence of voiding LUTS. Meanwhile, preoperative DO and post-void residual urine volume were of limited prognostic value.

Evaluation of Galdakao-modified Valdivia position in endoscopic management of malignant ureteric obstruction.

BACKGROUND: Malignant ureteric obstruction (MUO) due to pelvic malignancies is challenging for endourological management and carries high failure rates for retrograde cystoscopic ureteric stenting. METHODS: We adopted Galdakao-modified Valdivia (GMV) position in the management of MUO in an operating room equipped with a C-arm fluoroscopy unit and an ultrasound device. We prospectively studied the added value of this approach in 50 cases who failed retrograde ureteric stenting. RESULTS: Thirty-seven (74%) cases were done under a high level of spinal anesthesia. Mean operative time was 62 min. Antegrade ureteric stenting succeeded in 45/50 (90%) patients who failed retrograde ureteric stenting. GMV position facilitated simultaneous retrograde and antegrade management of MUO. Eight patients (16%) underwent auxiliary cystoscopic procedures to reduce the mass over the ureteric orifice (UO) guided by antegrade methylene blue or over a probing antegrade guidewire. Nephrostomy tube was inserted in the same setting in 16/50 (32%) cases. Antegrade flow of contrast to the bladder (P < 0.001) and ureteric kinks rather than tight stenosis or infiltration of UO (P = 0.014) were significantly associated with the success of antegrade ureteric stenting. No major complications were encountered. CONCLUSION: GMV position is an ideal choice for management of MUO as it allows simultaneous access to the lower and the upper urinary systems to accomplish ureteric stenting either in a retrograde or an antegrade fashion as well as the ability to insert a nephrostomy tube in the same setting, thus shortening the inpatient care and this should be the standard of care in cases with MUO.

Simultaneous antegrade and retrograde endourological approach in Galdakao-modified supine Valdivia position for the management of missed stents associated with complex renal stones: a non-randomized pilot study.

PURPOSE: To evaluate the simultaneous antegrade and retrograde endourological approach in the Galdakao-modified supine Valdivia position (GMSVP) for the management of missed stent with complex renal stones. METHODS: Over 5 years, patients presented to our clinic or referred to our hospital with missed DJ stent and complex renal stones were included prospectively in our study. Inclusion criteria were patients with neglected DJ stents (more than 6 months) complicated with complex stone burden, in addition to stents that was Fragmented and required renal access for removal. Stent and stone removal were performed using a simultaneous antegrade and retrograde renal approach in the GMSVP. The success rate and any perioperative complications were recorded. RESULTS: 45 patients were available for evaluation. The average stone size was 3.9 ± 0.8 cm. Renal stones, ureteric stones, and bladder stones were present in 39, 24, and 10 patients, respectively .Two patients had fragmented DJs. Semirigid ureteroscopy with PCNL was used in 19 (42.2%) cases, ECIRS in 17 (37.7%) cases, Cystolitholapaxy and PCNL in 10 (22.2%) cases. Mean operative time was 70.8 ± 10.2 min, mean hospital stay was 2.3 ± 0.8 days. The stone-free rate was 93.3% after one procedure, two patients needed an auxiliary SWL for residual stones, postoperative complications were seen in 24.4% of patients. CONCLUSION: Simultaneous antegrade and retrograde renal approach in the GMSVP is safe and effective in the management of missed DJ stents with a complex stone burden.