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INTRODUCTION: Use of a ureteral access sheath (UAS) within flexible ureteroscopy (fURS) for the management of kidney and ureteral stones has shown improvements in its effectiveness, but it is also associated with increased risk of ureteral injury. Use of ureteral stent (US) after fURS is recommended by some authors, because of its role in reducing postoperative pain and preventing complications. Our objective is to determine if postoperative stenting is necessary in pre-stented patients that underwent fURS using UAS. MATERIAL AND METHODS: A retrospective history review of patients who underwent fURS using UAS at our hospital between July 1st 2013 and May 31st 2016 was performed. Only pre-stented patients were included. All procedures were performed using the same UAS (Boston Navigator TM., 11-13 Fr.). Patients were separated according to the use or not of postoperative US. The same US (26 cm 6 Fr percuflex, Boston Scienfic) was used for all stented patients. Clinical parameters, stone demographics, operative time and postoperative events were analyzed. RESULTS: Seventy patients met the inclusion criteria. Mean stone size was 8.5 mm (SD 7.06), 68.49% were located in the renal pelvis and 31.51% were in the proximal ureter. Reasons of preoperative stenting were: 14 (19.18%) ureteral stricture, 17 (23.29%) urosepsis, 29 (39.73%) residual stones after a first intervention (stage procedure) and 13 (17.8%) unsuccessful extracorporeal shockwave lithotripsy. Mean operative time was 88 minutes (SD 37.20); 32 patients (45.71%) were stented and 38 (54.28%) were not. There were no significant differences in operative time (p = 0.85) or postoperative outcomes (p = 1). CONCLUSIONS: A postoperative ureteral stent is not necessary after fURS using UAS in pre-stented patients.
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We report a case of a 53-year-old woman affected by a left kidney stone and persistent positive urinary culture treated by retrograde intrarenal surgery. During postoperative day 1, she developed a sudden back pain associated with a decrease in hemoglobin. CT scan showed a subcapsular hematoma giving the impression of partial compression of kidney and upper urinary tract. For that reason, in the first instance, a Double-J ureteral stent was installed. Unfortunately, an open surgical drainage was necessary because a secondary infection of the hematoma was evident during the following days.
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PURPOSE: To establish the construct validity of a semirigid ureteroscopy in a high-fidelity simulation model, incorporating hand motion analysis as a paramount part of evaluation. METHODS: Participants were divided into 3 groups: group 1 (9 junior residents, without experience in ureteroscopy), group II (9 senior residents, with variable experience in ureteroscopy) and group III (2 experts in endourologist); each group performed a single practice session in the high-fidelity bench model, which was previously prepared with small urinary stone phantom in the mid-ureter. Assessment was done using motion tracking device (ICSAD). Procedures were recorded in external vision and endoscopic vision and scored by two blinded evaluators using a Global Rating Scale and ureteral checklist (OSATS). RESULTS: Significant differences were observed in time taken, path length, numbers of movements, Global Rating Scale and checklist in favor of the experts group. Subanalysis demonstrated no relevant differences between groups II and III in general dexterity parameters except for the non-dominant hand, where experts showed a significant less number of movement (34 vs 221; p = 0.03) and path length (12.1 vs 45.1; p = 0.03). The interrater reliability of the GRS was excellent (0.81; p < 0.001), while for checklist ICC was moderate (0.45; p = 0.03). CONCLUSIONS: The incorporation of ICSAD into the construct validity of this ureteroscopy model complements traditional methods used to achieve construct validity (OSATS). To our knowledge, this study is the first report using motion analysis as a tool for performance evaluation in a simulated endourological procedure.
