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1.
BJU Int ; 2024 Aug 11.
Artículo en Inglés | MEDLINE | ID: mdl-39129326

RESUMEN

OBJECTIVES: To evaluate the effects of inserting a Foley catheter after ureteroscopy (URS) and JJ stent placement on pain scores, voiding patterns, biochemical parameters and postoperative complications. PATIENTS AND METHODS: A randomised clinical trial (1:1) with adult patients following unilateral URS + JJ stent placement was planned. In Group A, no Foley catheter was placed, in Group B, a Foley catheter was placed following URS + JJ stent placement. The primary objective was to evaluate effect of placing a Foley catheter on International Prostate Symptom Score (IPSS), Ureteric Stent Symptom Questionnaire (USSQ) score and postoperative biochemical parameters. The secondary objective was to evaluate postoperative complications. RESULTS: A total of 112 patients were included (56/group). A ureteric access sheath was used in each patient. Patients had similar demographic and surgical parameters. The pre- and postoperative biochemical analyses including white blood cell count, C-reactive protein, procalcitonin and creatinine levels were similar between the two groups. The IPSS were similar between the two groups. All the subdomains of the USSQ were similar between two groups except Total Body Pain score, which was lower in Group B. The visual analogue scale scores were similar. Complications were all Clavien-Dindo Grade I and II, and the complication rate was 5.4% and 8.9% in Group A and B, respectively. CONCLUSION: Placing a Foley catheter following URS + JJ stent placement did not show significant effects on postoperative biochemical parameters and voiding symptoms. However, a Foley catheter lowered the Total Body Pain score on the USSQ without having significant effects on VAS scores. The practice of placing a Foley catheter following URS and JJ stent placement should be based on surgeon's preference keeping in mind the potential positive effect on pain scores.

2.
World J Urol ; 42(1): 163, 2024 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-38488927

RESUMEN

INTRODUCTION: Due to the radiation exposure for the urology staff during endourology, our aim was to evaluate the trends of radiation protection in the operation room by endourologists from European centers and to estimate their annual radiation. METHODS: We conducted a multicenter study involving experienced endourologists from different European centers to evaluate whether the protection and threshold doses recommended by the International Commission on Radiation Protection (ICRP) were being followed. A 36-question survey was completed on the use of fluoroscopy and radiation protection. Annual prospective data from chest, extremities, and eye dosimeters were collected during a 4-year period (2017-2020). RESULTS: Ten endourologists participated. Most surgeons use lead aprons and thyroid shield (9/10 and 10/10), while leaded gloves and caps are rarely used (2/10 both). Six out of ten surgeons wear leaded glasses. There is widespread use of personal chest dosimeters under the apron (9/10), and only 5/10 use a wrist or ring dosimeter and 4 use an eye dosimeter. Two endourologists use the ALARA protocol. The use of ultrasound and fluoroscopy during PCNL puncture was reported by 8 surgeons. The mean number of PCNL and URS per year was 30.9 (SD 19.9) and 147 (SD 151.9). The mean chest radiation was 1.35 mSv per year and 0.007 mSv per procedure. Mean radiation exposure per year in the eyes and extremities was 1.63 and 11.5 mSv. CONCLUSIONS: Endourologists did not exceed the threshold doses for radiation exposure to the chest, extremities and lens. Furthermore, the ALARA protocol manages to reduce radiation exposure.


Asunto(s)
Exposición Profesional , Exposición a la Radiación , Protección Radiológica , Humanos , Estudios Prospectivos , Exposición Profesional/prevención & control , Fluoroscopía/efectos adversos , Exposición a la Radiación/prevención & control , Dosis de Radiación
3.
World J Urol ; 42(1): 240, 2024 Apr 17.
Artículo en Inglés | MEDLINE | ID: mdl-38630158

RESUMEN

PURPOSE: To evaluate the impact of ureteroscope position within renal cavities as well as different locations of the tip of the ureteral access sheath (UAS) on fluid dynamics during retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS: A prospective observational clinical study was performed. Measurements with a flexible ureteroscope placed in the upper, middle and lower calyces were obtained with the tip of the UAS placed either 2 cm below the pyelo-ureteric junction (PUJ), or at the level of the iliac crest. RESULTS: 74 patients were included. The outflow rates from the middle and upper calyxes were statistically significantly higher compared to the lower calyx, both with the UAS close to the pyelo-ureteric junction and at the iliac crest. When the UAS was withdrawn and positioned at the level of the iliac crest, a significant decrease in outflow rates from the upper (40.1 ± 4.3 ml/min vs 35.8 ± 4.1 ml/min) and middle calyces (40.6 ± 4.0 ml/min vs 36.8 ± 4.6 ml/min) and an increase in the outflow from the lower calyx (28.5 ± 3.3 ml/min vs 33.7 ± 5.7 ml/min) were noted. CONCLUSIONS: Our study showed that higher fluid outflow rates are observed from upper and middle calyces compared to lower calyx. This was true when the UAS was positioned 2 cm below the PUJ and at the iliac crest. Significant worsening of fluid dynamics from upper and middle calyces was observed when the UAS was placed distally at the level of the iliac crest. While the difference was statistically significant, the absolute change was not significant. In contrast, for lower calyces, a statistically significant improvement was documented.


Asunto(s)
Uréter , Ureteroscopios , Humanos , Hidrodinámica , Riñón , Endoscopía , Uréter/cirugía
4.
Turk J Med Sci ; 54(1): 185-193, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38812627

RESUMEN

Background/aim: Management of asymptomatic kidney stones is an ongoing debate with follow-up and treatment guidelines based on low-level evidence. Our aim was to evaluate current management of asymptomatic urinary stones. Materials and methods: A 70-question survey was designed in collaboration with European Association of Urology, Young Academic Urologists, Section of Uro-Technology and Section of Urolithiasis groups and distributed. Responders filled out hypothetical scenarios from 2 perspectives, either as treating physicians, or as patients themselves. Results: A total of 212 (40.01%) responses were obtained. Median responder age was 39 years. 75% of responders were interested in "urolithiasis". 82.5% had never experienced a renal colic, 89.6% had never undergone urolithiasis treatment.Overall, as the kidney stone scenarios got more complicated, the invasiveness of the treatment preference increased. As "the physician", responders preferred the conservative option in all situations more than they would choose as "the patient". For ureteral stones, conservative approach was most preferred for small stones and ureteroscopy became more preferred as the stone size increased.For smaller kidney stones, the most preferred follow-up schedule was 4-6 monthly, whereas for larger and complicated stones it was 0-3 monthly from both perspectives respectively. For all ureteral stone scenarios, 0-4 weekly follow-up was mostly preferred.Interestingly, having had a renal colic was an independent predictor of an interventional approach, whereas having had an intervention was an independent predictor of a conservative approach. Conclusion: Current treatment and follow-up patterns of asymptomatic urinary stones are in agreement with international guidelines on symptomatic stones.In most of the urolithiasis situations urologists chose a conservative approach for their patients compared to what they would prefer for themselves. Conversely, urologists, in the scenarios as "the patient", would like to have a more frequent follow-up schedule for their stones compared to how they would follow-up their patients.


Asunto(s)
Urólogos , Humanos , Adulto , Encuestas y Cuestionarios , Masculino , Femenino , Urología , Cálculos Renales/terapia , Ureteroscopía , Pautas de la Práctica en Medicina/estadística & datos numéricos , Urolitiasis/terapia , Persona de Mediana Edad , Europa (Continente) , Actitud del Personal de Salud , Enfermedades Asintomáticas/terapia
5.
Andrologia ; 52(9): e13639, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32478903

RESUMEN

A review of the literature indicated that sirtuin-1 expression, a regulator of nitric oxide bioavailability in erectile dysfunction (ED) after melatonin therapy, has not yet been investigated. The objective of this study was to evaluate the protective effects of melatonin for erectile function with sirtuin-1 protein expression in type 1 diabetic rat models. Fifty male Sprague Dawley rats were placed into five groups. Except for those in the control group (C), each animal received a single dose (60 mg/kg) of streptozotocin to induce diabetes. The animals were placed into the diabetes (D) group, insulin (I) group (6 U/kg/day), melatonin (Mel) group (10 mg kg-1  day-1 ) and combined treatment (I + Mel) group. Ten weeks later, the serum testosterone levels, intracavernosal pressure (ICP), mean arterial pressure (MAP), malondialdehyde (MDA), cyclic guanosine monophosphate (c-GMP), 8-hydroxydeoxyguanosine (8-OHdG), nitric oxide synthase (NOS), caspase-3 activity, sirtuin-1 and endothelial nitric oxide synthase (eNOS) protein expression and histological findings were assessed. The mean ICP/MAP ratio for the D group was lower than the mean ratios for the other groups. The treatment groups, particularly the I + Mel group, exhibited lower 8-OHdG and MDA levels and caspase-3 activity than the D group. The sirtuin-1 and eNOS expression and cavernosal tissue (CT) histology seemed to have been preserved by the melatonin and/or insulin therapy. These results were indicative of a profound protective effect of melatonin by the activation of sirtuin-1 protein expression against hyperglycemia-induced oxidative CT injury.


Asunto(s)
Diabetes Mellitus Experimental , Disfunción Eréctil , Melatonina , Animales , Diabetes Mellitus Experimental/complicaciones , Diabetes Mellitus Experimental/tratamiento farmacológico , Disfunción Eréctil/tratamiento farmacológico , Disfunción Eréctil/etiología , Disfunción Eréctil/prevención & control , Humanos , Masculino , Melatonina/farmacología , Melatonina/uso terapéutico , Óxido Nítrico Sintasa de Tipo III , Erección Peniana , Pene , Ratas , Ratas Sprague-Dawley , Sirtuina 1 , Estreptozocina
6.
Arch Ital Urol Androl ; 90(3): 155-158, 2018 Sep 30.
Artículo en Inglés | MEDLINE | ID: mdl-30362676

RESUMEN

INTRODUCTION: Since 2012 Elmed has been working on a robot specifically designed for flexible ureteroscopy. After the first version of Avicenna Roboflex, a second version was developed in 2015, with significant changes especially in the irrigation system. We consider mandatory for the endourologist that works with the Avicenna Roboflex be aware of the functioning of the irrigation system. MATERIALS AND METHODS: We connected a container to the pump's irrigation system and measured the quantity of saline per second delivered by each speed setting, with/without the flush in five different modalities: pump on its own, pump with ureteroscope, with two laser fibers, with 1.9 Fr basket, and with a Terumo guidewire. RESULTS: The highest mean flow-rates were observed in the 200- micrometer laser fiber, after the pump on its own. Median flowrates for all speed settings were significantly higher for the pump on its own than for the URS in both flushed and nonflushed modes (p = 0.045, p = 0.039 respectively). There was no statistically significant difference in median flow-rates between the guide wire and basket in all of the speed settings (p = 0.932 and p = 0.977). For both laser fibers there was no statistically significant difference between the median flow rate on both nonflush and flush modes. (p = 0.590 & p = 0.590). There was a linear correlation between the speed setting and the increase measured with the flush-option for pump only measurements (r = 0.602, p = 0.038). There was no statistically significant difference between laser fibers and the pump on its own on the increase of flow rate with flush mode. (p = 0.443 for the 272- micrometer fiber and p = 0.219 for the 200-micrometer fiber). CONCLUSION: The irrigation system of the new Avicenna Roboflex is optimized compared to the previous version. However other more complex studies concerning the live flow/pressure relationship are needed before firm conclusions can be made.


Asunto(s)
Cálculos Renales/terapia , Robótica , Ureteroscopía/métodos , Diseño de Equipo , Humanos , Técnicas In Vitro , Ureteroscopía/instrumentación
7.
Arch Ital Urol Androl ; 89(4): 287-292, 2017 Dec 31.
Artículo en Inglés | MEDLINE | ID: mdl-29473378

RESUMEN

OBJECTIVE: Clinical presentation of ureteral stones during pregnancy is generally with renal colic pain. The aim of this study is to present our experience in the management of renal colic during pregnancy in emergency settings. MATERIALS AND METHODS: 208 pregnant patients who presented to emergency department with renal colic pain and underwent ureteroscopy (URS) due to failed conservative therapy were enrolled in the study. Urinary tract stones were diagnosed either with ultrasound (US) examination or during URS. Laser lithotripsy and double J (DJ) stent placement were routinely done in all patients with ureteral stones. The incidence of infective complications and premature uterine contractions (PUC) due to URS were compared. RESULTS: No stone was identified in 36.1% (n = 75) of patients with using US and diagnostic URS. Of the remaining 133 patients, 30 (22.6%) had no stone at US but stones were diagnosed during diagnostic URS. The type of anesthesia had no significant effect on PUC. An increased risk of sepsis and PUC was found in patients with fever at the initial presentation. Interestingly, PUC was more frequent in patients with lower serum magnesium levels. There was a significant correlation with time delay until the intervention and the risk of urosepsis and PUC, individually. CONCLUSIONS: Ureteroscopy is a safe option for evaluation of pregnant patients with unresolved renal colic. According to the current findings, timing of the operation is the most important factor affecting the septic risks and abortion threat. Surgical intervention with URS must be planned as soon as possible.


Asunto(s)
Trabajo de Parto Prematuro/epidemiología , Cólico Renal/terapia , Cálculos Ureterales/terapia , Ureteroscopía/métodos , Urgencias Médicas , Femenino , Humanos , Incidencia , Litotripsia por Láser/métodos , Embarazo , Complicaciones del Embarazo/patología , Complicaciones del Embarazo/terapia , Estudios Retrospectivos , Stents , Factores de Tiempo , Resultado del Tratamiento , Ureteroscopía/efectos adversos
8.
Clin Exp Pharmacol Physiol ; 41(4): 309-16, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24552354

RESUMEN

Oxidative stress plays an important role both in spinal cord injury (SCI) and erectile dysfunction (ED). The present study investigated the effects of melatonin and tadalafil treatment alone or in combination on SCI-induced ED. Male Wistar albino rats (n = 40) were divided into five groups: sham-operated control and SCI-injured rats given either vehicle, melatonin (10 mg/kg, i.p.), tadalafil (10 mg/kg, p.o.) or a combination of melatonin and tadalafil. Spinal cord injury was induced using a standard weight-drop method. On Day 7 after SCI, intracavernosal pressure (ICP) was measured and all rats were decapitated. Cavernosal tissues were obtained to examine caspase 3, nitric oxide synthase (NOS), myeloperoxidase (MPO) and superoxide dismutase (SOD) activities, as well as cGMP, nerve growth factor (NGF), malondialdehyde (MDA) and glutathione (GSH) levels. Spinal cord injury caused oxidative damage, as evidenced by increases in MDA and cGMP levels. In addition, MPO and caspase 3 activites were increased after SCI, whereas GSH and NGF levels and SOD activity were reduced. Melatonin effectively reversed these oxidative changes. Furthermore, in rats treated with both melatonin and tadalafil, the recoveries were more pronounced than in rats given either melatonin or tadalafil alone. The ICP/mean arterial pressure value in vehicle-treated SCI rats was significantly higher than in the control group, whereas in the tadalafil- and tadalafil + melatonin-treated groups have returned this value had returned to control levels. As an individual treatment, and especially when combined with tadalafil, a well-known agent in the treatment of ED, melatonin prevented SCI-induced oxidative damage to cavernosal tissues and restored ED, most likely due to its anti-oxidant effects.


Asunto(s)
Antioxidantes/uso terapéutico , Carbolinas/uso terapéutico , Disfunción Eréctil/tratamiento farmacológico , Melatonina/uso terapéutico , Traumatismos de la Médula Espinal/complicaciones , Vasodilatadores/uso terapéutico , Animales , Disfunción Eréctil/etiología , Regulación Enzimológica de la Expresión Génica/efectos de los fármacos , Glutatión/metabolismo , Masculino , Óxido Nítrico Sintasa de Tipo III/metabolismo , Peroxidasa/metabolismo , Ratas , Ratas Wistar , Tadalafilo
9.
North Clin Istanb ; 11(5): 373-381, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39431030

RESUMEN

OBJECTIVE: There is a known association between lower urinary tract dysfunction (LUTD) and constipation. The objective of this study was to investigate any correlation between voiding and bowel symptoms in children with LUTD. METHODS: Children presenting with LUTD to our pediatric urology unit were prospectively included. Demographic data were recorded. All patients filled out the "Pediatric Lower Urinary Tract Symptom Score" (P-LUTSS) and "Constipation and Fecal Incontinence Symptom Severity" (CFISS) questionnaires. Symptom score correlation and associations with clinical findings were evaluated. RESULTS: 76 patients were included. The mean P-LUTSS was 11±7.1; mean CFISS was 7.7±7.5. According to P-LUTSS risk groups, median CFISS score increased as the risk group was increased. There was direct correlation between P-LUTSS and CFISS for all patients. 6th, 7th, 8th, 9th, 10th and 13th questions of P-LUTSS were correlated with CFISS; the 1st and 7th questions of CFISS were correlated with P-LUTSS. Patients who responded not to have constipation on P-LUTSS had lower CFISS scores compared to those who had constipation. Patients who had a 0 score on CFISS had a mean P-LUTSS of 7.7±6.2, which put the majority of patients in low-risk group. Also, out of these 11 patients, 10 of them responded to have no constipation on P-LUTSS. CONCLUSION: A relationship between LUTD and bowel symptoms, as well as the positive correlation between P-LUTSS and CFISS was demonstrated in this study. Patients presenting with LUTD should undergo meticulous evaluation using special questionnaires for bowel symptoms. Only by then, a complete treatment approach can be provided.

10.
Cureus ; 16(5): e61310, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38983791

RESUMEN

Bladder leiomyoma is a rare condition in pediatric and adolescent age groups, accounting for less than 1% of all bladder tumors, presenting a diverse array of histologic types and prevalence. Furthermore, bladder leiomyoma's prevalence is even more seldom with only five reported cases till the present day. Common presentation depends on the localisation and the affected layer in the bladder, urinary outlet or ureteral obstruction, irritative voiding symptoms, pelvic pain, and hematuria are the most common presentations of this condition. Diagnostic, treatment, and follow-up protocols in this entity are not well-established due to their rare occurrence in this age group. After complete surgical excision, the prognosis is excellent and the risk of recurrence is reported to be very low. Up to the present day, no instances of malignant transformation or metastasis have been documented in the literature. This case report aims to enhance current knowledge of the radiological, pathological, and clinical features of bladder leiomyoma in a 15-year-old female patient. The main complaint was lower urinary tract symptoms. An incidental solid bladder mass was discovered during the evaluation with ultrasound and magnetic resonance imaging (MRI). Afterwards, cystoscopy confirmed a 5-centimeter solid mass at the right wall of the bladder, and transurethral piecemeal resection was performed. The bladder mass was found to be intramural, and complete endoscopic resection was considered safe and efficient during the surgery. No complications or recurrence occurred in the postoperative setting.

11.
Cancers (Basel) ; 16(4)2024 Feb 16.
Artículo en Inglés | MEDLINE | ID: mdl-38398201

RESUMEN

This comprehensive review critically examines the transformative impact of artificial intelligence (AI) and radiomics in the diagnosis, prognosis, and management of bladder, kidney, and prostate cancers. These cutting-edge technologies are revolutionizing the landscape of cancer care, enhancing both precision and personalization in medical treatments. Our review provides an in-depth analysis of the latest advancements in AI and radiomics, with a specific focus on their roles in urological oncology. We discuss how AI and radiomics have notably improved the accuracy of diagnosis and staging in bladder cancer, especially through advanced imaging techniques like multiparametric MRI (mpMRI) and CT scans. These tools are pivotal in assessing muscle invasiveness and pathological grades, critical elements in formulating treatment plans. In the realm of kidney cancer, AI and radiomics aid in distinguishing between renal cell carcinoma (RCC) subtypes and grades. The integration of radiogenomics offers a comprehensive view of disease biology, leading to tailored therapeutic approaches. Prostate cancer diagnosis and management have also seen substantial benefits from these technologies. AI-enhanced MRI has significantly improved tumor detection and localization, thereby aiding in more effective treatment planning. The review also addresses the challenges in integrating AI and radiomics into clinical practice, such as the need for standardization, ensuring data quality, and overcoming the "black box" nature of AI. We emphasize the importance of multicentric collaborations and extensive studies to enhance the applicability and generalizability of these technologies in diverse clinical settings. In conclusion, AI and radiomics represent a major paradigm shift in oncology, offering more precise, personalized, and patient-centric approaches to cancer care. While their potential to improve diagnostic accuracy, patient outcomes, and our understanding of cancer biology is profound, challenges in clinical integration and application persist. We advocate for continued research and development in AI and radiomics, underscoring the need to address existing limitations to fully leverage their capabilities in the field of oncology.

12.
J Endourol ; 38(9): 948-955, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-38874939

RESUMEN

Objective: Sepsis is the most serious complication of flexible ureteroscopy (F-URS) and laser lithotripsy. We assessed the influence of positive stone culture (SC) on major infectious complications (sepsis, septic shock). Methods: This prospective study enrolled adult patients deemed suitable for F-URS and laser lithotripsy from nine centers (January 2022-August 2023). Inclusion criteria were as follows: kidney stone(s), preoperative midstream urine culture (MSUC), stone(s) assessed at computed tomography scan, and SC. Exclusion criteria were as follows: bilateral procedures, ureteral stones, and children. Group 1 included patients with sterile SC. Group 2 included patients with positive SC. Data are presented as median (interquartile range). A multivariable logistic regression analysis was performed to evaluate factors associated with having a positive SC. Results: In total, 293 patients were included. Median age was 51.0 (24) years. There were 167 (57.0%) males. Group 2 included 32 (2.5%) patients. Group 2 patients were significantly older [75.0 (14) vs 51.0 (23) years, p = 0.02]. Stone features were similar. Major infectious complications were higher in Group 2 (15.6% vs 0.4%). One patient died because of sepsis in Group 2. Two out of 6 (33.3%) patients with major infectious complications had the same pathogen in MSUC and SC. In the multivariable regression analysis, diabetes (OR 3.23), symptomatic urinary infections within 3 months before operation (OR 4.82) and preoperative stent/nephrostomy (OR 2.92) were factors significantly associated with higher odds of positive SC. Conclusions: Patients with positive SC have a higher incidence of major infectious complications after F-URS lithotripsy. SC should be performed whenever feasible because there is a poor correlation between MSUC and SC.


Asunto(s)
Cálculos Renales , Litotripsia por Láser , Sepsis , Ureteroscopía , Humanos , Masculino , Femenino , Cálculos Renales/cirugía , Estudios Prospectivos , Sepsis/etiología , Persona de Mediana Edad , Litotripsia por Láser/métodos , Litotripsia por Láser/efectos adversos , Ureteroscopía/efectos adversos , Ureteroscopía/métodos , Anciano , Incidencia , Adulto , Complicaciones Posoperatorias/etiología , Anciano de 80 o más Años
13.
Urolithiasis ; 51(1): 97, 2023 Jul 25.
Artículo en Inglés | MEDLINE | ID: mdl-37490149

RESUMEN

To evaluate the general practice among urologists about the use of various radiological imaging and measurement tools, and to compare the different preferences in radiological evaluations between Turkish and European urologists. Our study was designed as a survey study. The survey comprised 22 questions which evaluated the epidemiological information, caseload of participants, general preferences of participants on CT image slice thickness, basic radiologic workup routines prior to surgery, use of special tools and measurements on CT. Data collection was conducted with both an online poll and printed copies. A total of 222 urologists from 23 different countries responded to the survey. The most performed endourologic surgery was semi-rigid URS which was performed more than 25 times/year by 90.1% (n = 200) of the participants. Although PCNL was performed more commonly by Turkish urologists (39.7%) compared to their European (17.3%) colleagues (p < 0.001), it was still the least often performed endourological surgery among all participants (31.5%). The stone size evaluation was the most performed measurement performed by the participants. Although the group of surgeons used size measurement tools, there were differences between the two groups. Turkish urologists used size measurement before PCNL (85.7%) as opposed to European urologists who used it mostly before URS (91.4%). Non-contrast CT images for urolithiasis are mainly evaluated by urologists themselves and a considerable number of urologists do not use additional measurement tools in evaluating CT images. Although there are similarities in the knowledge of various radiological tools, there are distinct regional differences.


Asunto(s)
Cirujanos , Urolitiasis , Humanos
14.
North Clin Istanb ; 10(6): 734-744, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-38328729

RESUMEN

OBJECTIVE: Nephrolithiasis is a common cause of kidney insufficiency. Nephrolithiasis is proven to be the result of various biochemical and inflammatory processes that result in crystal formation and subsequent aggregation. Cotinuscoggygria L. (CCog) is a plant extract which has been used as a Turkish remedy for kidney stones. With this study, we planned to evaluate the effects of CCog extract in ethylene glycol (EG)-induced nephrolithiasis model in rats. METHODS: The study group comprised 32 Wistar albino rats which were divided into Control (C), EG, CCog Prophylaxis (CC+EG+CC), and CCog Treatment (EG+CC) groups. Stone formation was induced by adding EG (0.75%) into rat's drinking water. Normal drinking water was given to Control group for 8 weeks. Throughout the study period of 8 weeks, EG group was given only EG (0.75%) and CC+EG+CC group was given both EG and CCog. In EG+CC group, EG (0.75%) was given for 8 weeks whereas CCog was given for the past 4 weeks. After the 8th week, 24-h urine samples were collected. Rats were then sacrificed and kidney tissue samples were harvested. RESULTS: Metabolites (calcium, citrate) and creatinine in 24 h urine samples were decreased in CC+EG+CC and EG+CC groups. While hyperoxaluria was observed in the EG group, oxalate levels were similar to control levels in the P-CCog and C-CCog groups. The N-acetyl-ß-glucosaminidase and myeloperoxidase activities were both increased in EG group and these parameters were significantly decreased on CCog treatment. CONCLUSION: We can conclude that C. coggygria extract can have beneficial effect on lowering concentration of stone-forming metabolites in urine and consequently protect renal tissues from damage due to nephrolithiasis. C. coggygria extract can be considered as a potential prophylactic and therapeutic option in high-risk stone formers. Furthermore, our data confirm ethnobotanical use of CC against nephrolithiasis.

15.
Investig Clin Urol ; 64(5): 474-479, 2023 09.
Artículo en Inglés | MEDLINE | ID: mdl-37668203

RESUMEN

PURPOSE: Radiation exposure is affected by C-arm fluoroscopy device positioning during percutaneous renal puncture. Our aim was to compare the exposure of surgeon's lens, hand and chest with a fluoroscopy protocol replicated in different C-arm positions. MATERIALS AND METHODS: A standardized fluoroscopy protocol was created using water-equivalent solid phantoms to replicate a surgeon and patient. 111 mGy radiation (360 s) was applied in standard fluoroscopy mode (91 kVp, 2.7 mA/mAs). Dosimeters were placed on lens, chest and hand of surgeon and patient phantom models. 7 different C-arm positions were created: 0°, mediolateral (ML) +90°, ML -90°, ML +30°, ML -15°, craniocaudal (CC) +30°, CC +15°. Measurements were evaluated separately for different positions. RESULTS: The highest radiation exposure was measured on patient dosimeter (2.97 mSv). The highest exposure on surgeon was recorded on finger dosimeter in all C-arm positions; highest dose was recorded in ML +90° position (2.88 mSv). In finger dosimeters, lowest exposure was recorded in 0° position (0.51 mSv). The lowest exposure of all positions was measured in chest dosimeter in ML -90° position (0.24 mSv). CONCLUSIONS: In positions where X-ray generator of the C-arm was facing towards the surgeon, radiation exposure measured in all dosimeters was higher compared to positions where the generator was facing away. The hand radiation exposure in all positions was higher than chest and lens. Special care must be taken to avoid facing the X-ray generator tube and hands should be as well-protected as chest and eyes with special protective gear.


Asunto(s)
Exposición a la Radiación , Urolitiasis , Humanos , Riñón , Fluoroscopía , Punciones
16.
Cent European J Urol ; 75(3): 311-316, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36381161

RESUMEN

Introduction: The aim of this article was to evaluate the current perception of urologists as to what size is considered as a clinically insignificant residual fragment (CIRF). Material and methods: A survey was globally distributed to the members of the Endourological Society via SurveyMonkey. Results: A total of 385 participants responded to the survey on CIRF. Most participants considered 2 mm (29%) as CIRF threshold, followed by 3 mm (24%), 4 mm (22%), 0 mm (14%), 5 mm (8%) and 1 mm (3%). North American urologists considered CIRF to be smaller than urologists from Asia, Eurasia and South America, (p-values ≤0.001, 0.037 and 0.015 respectively). European urologists identified smaller CIRF in comparison to Asian urologists (p-value = 0.001). Urologists mainly using a pneumatic lithotripter accepted larger fragments as CIRF, compared to urologists mainly using ultrasonic devices or a combination of ultrasonic and pneumatic devices (p-value = 0.026 and 0.005 respectively). Similarly, urologists mainly performing X-Ray and ultrasound as post-operative imaging accepted larger fragments as CIRF in comparison to urologists mainly performing non-contrast computed tomography (p-value = 0.001). Conclusions: What is considered as CIRF varies between urologist from different continents and seems to be associated with the lithotripter used and the post-operative imaging modality of preference to assess treatment success.

17.
Cent European J Urol ; 75(3): 317-327, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36381152

RESUMEN

Introduction: Lithotripsy during retrograde intrarenal surgery (RIRS) can be achieved either by fragmentation and extraction or dusting with spontaneous passage. We aimed to perform a systematic review on the safety and stone-free rate after RIRS by comparing the techniques of dusting vs fragmentation/extraction. Material and methods: This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The inverse variance of the mean difference and 95% Confidence Interval (CI), Categorical variables were assessed using Cochran-Mantel-Haenszel Method with the random effect model and reported as Odds Ratio (OR) and 95% CI. Statistical significance was set at p <0.05. Results: There were 1141 patients included in 10 studies. Stone size was up to 2.5 cm All studies used holmium laser for lithotripsy. Meta-analysis showed no significant difference in surgical time (MD -5.39 minutes 95% CI -13.92-2.31, p = 0.16), postoperative length of stay (MD -0.19 days 95% CI -0.60 - -0.22, p=0.36), overall complications (OR 0.98 95% CI 0.58-1.66, p = 0.95), hematuria (OR 1.01 95% CI 0.30-3.42, p = 0.99), postoperative fever (OR 0.70 95% CI 0.41-1.19, p = 0.19) and sepsis (OR 1.03 95% CI 0.10-10.35, p = 0.98), immediate (OR 0.40 95% CI 0.13-1.24, p = 0.11) and overall stone-free rate (OR 0.76 95% CI 0.43-1.32, p = 0.33), and retreatment rate (OR 1.35 95% CI 0.57-3.20, p = 0.49) between the groups. Conclusions: This systematic review infers that urologists can safely use either option of fragmentation and basket extraction or dusting without extraction to achieve similar outcomes as both techniques are similar for efficacy and safety.

18.
J Endourol ; 36(10): 1362-1370, 2022 10.
Artículo en Inglés | MEDLINE | ID: mdl-35651279

RESUMEN

Objective: To assess the diagnostic accuracy and intra-observer agreement of endoscopic stone recognition (ESR) compared with formal stone analysis. Introduction: Stone analysis is a corner stone in the prevention of stone recurrence. Although X-ray diffraction (XRD) and infrared spectroscopy are the recommended techniques for reliable formal stone analysis, this is not always possible, and the process takes time and is costly. ESR could be an alternative, as it would give immediate information on stone composition. Materials and Methods: Fifteen endourologists predicted stone composition based on 100 videos from ureterorenoscopy. Diagnostic accuracy was evaluated by comparing the prediction from visual assessment with stone analysis by XRD. After 30 days, the videos were reviewed again in a random order to assess intra-observer agreement. Results: The median diagnostic accuracy for calcium oxalate monohydrate was 54% in questionnaire 1 (Q1) and 59% in questionnaire 2 (Q2), whereas calcium oxalate dihydrate had a median diagnostic accuracy of 75% in Q1 and 50% in Q2. The diagnostic accuracy for calcium hydroxyphosphate was 10% in Q1 and 13% in Q2. The median diagnostic accuracy for calcium hydrogen phosphate dihydrate and calcium magnesium phosphate was 0% in both questionnaires. The median diagnostic accuracy for magnesium ammonium phosphate was 20% in Q1 and 40% in Q2. The median diagnostic accuracy for uric acid was 22% in both questionnaires. Finally, there was a diagnostic accuracy of 60% in Q1 and 80% in Q2 for cystine. The intra-observer agreement ranged between 45% and 72%. Conclusion: Diagnostic accuracy of ESR is limited and intra-observer agreement is below the threshold of acceptable agreement.


Asunto(s)
Cálculos Renales , Cálculos Urinarios , Calcio , Oxalato de Calcio , Cistina , Humanos , Cálculos Renales/química , Cálculos Renales/diagnóstico , Estruvita , Ácido Úrico , Cálculos Urinarios/química , Cálculos Urinarios/diagnóstico
19.
J Invest Surg ; 34(8): 914-921, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31906743

RESUMEN

BACKGROUND: Surgical trauma due to vaginal wall incision to extract the specimen during transvaginal hybrid Natural-Orifices-Transluminal-Endoscopic-Surgery (NOTES) nephrectomy can result in sexual dysfunction and have traumatic psychological impacts. We evaluated the alteration of sexual functions in the postoperative period. METHODS: Patients who underwent a transvaginal NOTES nephrectomy were prospectively enrolled. Patients and their partners were evaluated with the Golombok-Rust Inventory of Sexual Satisfaction (GRISS) questionnaire pre- and post-operatively. Surgical characteristics were recorded. RESULTS: Fifty-three patients (mean age: 52.72 ± 2.39 years; mean tumor size 4.77 ± 2.55 cm) were included. The total GRISS scores of all patients were similar in pre- and post-operative periods. Although females reported no change in the GRISS score, 60.4% of partners showed a drop in the total score. Non-communication and avoidance subdomains showed significant changes for females; males showed a significant change in avoidance, non-sensuality and dissatisfaction subdomains. Subgroup analyses showed that neither tumor stage nor nulliparous status did not affect total score changes for both genders. The trocar number and perioperative complication rates had no significant effects on total score changes. CONCLUSION: Sexual function can be affected after transvaginal NOTES nephrectomy and care should include a stringent approach to addressing sexual dysfunction. We support the transvaginal NOTES nephrectomy technique if adequate secondary measures to protect sexual function are taken.


Asunto(s)
Cirugía Endoscópica por Orificios Naturales , Nefrectomía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cirugía Endoscópica por Orificios Naturales/efectos adversos , Nefrectomía/efectos adversos , Estudios Prospectivos , Instrumentos Quirúrgicos , Vagina/cirugía
20.
J Clin Med ; 10(17)2021 Aug 29.
Artículo en Inglés | MEDLINE | ID: mdl-34501335

RESUMEN

INTRODUCTION: With the rise in the use of ureteroscopy and laser stone lithotripsy (URSL), a proportionate increase in the risk of post-procedural urosepsis has also been observed. The aims of our paper were to analyse the predictors for severe urosepsis using a machine learning model (ML) in patients that needed intensive care unit (ICU) admission and to make comparisons with a matched cohort. METHODS: A retrospective study was conducted across nine high-volume endourology European centres for all patients who underwent URSL and subsequently needed ICU admission for urosepsis (Group A). This was matched by patients with URSL without urosepsis (Group B). Statistical analysis was performed with 'R statistical software' using the 'randomforests' package. The data were segregated at random into a 70% training set and a 30% test set using the 'sample' command. A random forests ML model was then built with n = 300 trees, with the test set used for internal validation. Diagnostic accuracy statistics were generated using the 'caret' package. RESULTS: A total of 114 patients were included (57 in each group) with a mean age of 60 ± 16 years and a male:female ratio of 1:1.19. The ML model correctly predicted risk of sepsis in 14/17 (82%) cases (Group A) and predicted those without urosepsis for 12/15 (80%) controls (Group B), whilst overall it also discriminated between the two groups predicting both those with and without sepsis. Our model accuracy was 81.3% (95%, CI: 63.7-92.8%), sensitivity = 0.80, specificity = 0.82 and area under the curve = 0.89. Predictive values most commonly accounting for nodal points in the trees were a large proximal stone location, long stent time, large stone size and long operative time. CONCLUSION: Urosepsis after endourological procedures remains one of the main reasons for ICU admission. Risk factors for urosepsis are reasonably accurately predicted by our innovative ML model. Focusing on these risk factors can allow one to create predictive strategies to minimise post-operative morbidity.

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