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2.
Eur Urol Focus ; 2021 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-33741299

RESUMO

CONTEXT: Although percutaneous nephrolithotomy (PCNL) has been performed for decades and has gone through many refinements, there are still concerns regarding its more widespread utilization because of the long learning curve and the potential risk of severe complications. Many technical details are not included in the guidelines because of their nature and research protocol. OBJECTIVE: To achieve an expert consensus viewpoint on PCNL indications, preoperative patient preparation, surgical strategy, management and prevention of severe complications, postoperative management, and follow-up. EVIDENCE ACQUISITION: An international panel of experts from the Urolithiasis Section of the European Association of Urology, International Alliance of Urolithiasis, and other urology associations was enrolled, and a prospectively conducted study, incorporating literature review, discussion on research gaps (RGs), and questionnaires and following data analysis, was performed to reach a consensus on PCNL. EVIDENCE SYNTHESIS: The expert panel consisted of 36 specialists in PCNL from 20 countries all around the world. A consensus on PCNL was developed. The expert panel was not as large as expected, and the discussion on RGs did not bring in more supportive evidence in the present consensus. CONCLUSIONS: Adequate preoperative preparation, especially elimination of urinary tract infection prior to PCNL, accurate puncture with guidance of fluoroscopy and/or ultrasonography or a combination, keeping a low intrarenal pressure, and shortening of operation time during PCNL are important technical requirements to ensure safety and efficiency in PCNL. PATIENT SUMMARY: Percutaneous nephrolithotomy (PCNL) has been a well-established procedure for the management of upper urinary tract stones. However, according to an expert panel consensus, core technical aspects, as well as the urologist's experience, are critical to the safety and effectiveness of PCNL.

3.
Urology ; 148: 63, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33549228
4.
Minerva Urol Nefrol ; 2021 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-33439573

RESUMO

BACKGROUND: To reach a consensus in the classification and standardized reporting for the different types of PCNLs. METHODS: The RAND/UCLA appropriateness methodology was used to reach a consensus. Thirty-two statements were formulated reviewing the literature on guidelines and consensus on PCNLs, and included procedure specific details, outcome measurements and a classification for PCNLs. Experts were invited to two rounds of input, the first enabled independent modifications of the proposed statements and provided the option to add statements. The second round facilitated scoring of all statements. Each statement was discussed in the third round to decide which statements to include. Any suggestion or disagreement was debated and discussed to reach a consensual agreement. RESULTS: Twenty-five recommendations were identified to provide standardised reporting of procedure and outcomes. Consensual scoring above 80% were strongly agreed upon by the panel. The top treatment related outcomes were size of sheath used (99.1%) and position for PCNL (93.5%). The highest ranked Outcome Measures included definition of post-operative hospital length of stay (94.4%) and estimated blood loss (93.5%). CONCLUSIONS: The consensus statements will be useful to clarify operative technique, in the design of clinical trials and standardized reporting, and presentation of results to compare outcomes of different types of PCNLs.

6.
Cell Rep Med ; 1(6): 100094, 2020 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-33205072

RESUMO

Ureteral stents are commonly used to prevent urinary obstruction but can become colonized by bacteria and encrusted, leading to clinical complications. Despite recent discovery and characterization of the healthy urinary microbiota, stent-associated bacteria and their impact on encrustation are largely underexplored. We profile the microbiota of patients with typical short-term stents, as well as over 30 atypical cases (all with paired mid-stream urine) from 241 patients. Indwelling time, age, and various patient comorbidities correlate with alterations to the stent microbiota composition, whereas antibiotic exposure, urinary tract infection (UTI), and stent placement method do not. The stent microbiota most likely originates from adhesion of resident urinary microbes but subsequently diverges to a distinct, reproducible population, thereby negating the urine as a biomarker for stent encrustation or microbiota. Urological practice should reconsider standalone prophylactic antibiotics in favor of tailored therapies based on patient comorbidities in efforts to minimize bacterial burden, encrustation, and complications of ureteral stents.

8.
J Endourol ; 34(8): 811-815, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32363943

RESUMO

Purpose: Splenic injury is a rare complication after left-sided percutaneous nephrolithotomy (PCNL). Although initial observation is often espoused, the natural history of nonoperative conservative management is not well established and the implications of splenic injury are not fully defined in this context. We sought to describe outcomes of conservative management of splenic injury incurred at PCNL. Patients and Methods: We performed a multi-institutional retrospective review of individual patients who underwent PCNL complicated by trans-splenic nephrostomy access injury. Demographic info, intraoperative data, management strategies, and outcomes were reviewed. Results: Nine patients suffered splenic injury after left PCNL. All patients had supracostal upper pole access under fluoroscopic guidance. Splenic injury was identified by computed tomography (CT) in the eight of nine (89%) who had imaging on first postoperative day. All eight patients were managed conservatively with nephrostomy dwell time of 2-21 days, one of whom (11%) required blood transfusion. The remaining patient (11%)-who had tubeless PCNL without postoperative imaging presented 5 days postoperatively with a delayed bleed and underwent emergent splenectomy. Seven of the nine (78%) were managed nonoperatively and without need for transfusion or embolization. Conclusion: The majority of patients incurring splenic injury during PCNL can be managed conservatively with maintenance of nephrostomy tube for ≥2 days. Consequences of unrecognized splenic injury may include splenic bleed and may prompt transfusion and/or splenectomy, underscoring role of routine postoperative CT to allow timely diagnosis, particularly in those undergoing upper pole supracostal left-sided percutaneous renal access.

9.
J Endourol ; 34(5): 550-557, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32008375

RESUMO

Purpose: Stone burden has been reported as an independent predictor of stone-free rate after percutaneous nephrolithotomy (PCNL); however no consensus exists on a standardized method for measuring stone burden. Recently, stone volume has been advocated as the most accurate means of measuring stone burden. We aimed to compare different measuring methods of stone burden and to identify the predictive value of each for outcomes after PCNL. Materials and Methods: We performed a retrospective review of a prospective database of patients who underwent PCNL between 2006 and 2013. A preoperative CT and postoperative imaging at discharge were necessary for eligibility. Stone burden was assessed through four different ways on CT images: (1) cumulative stone diameter; (2) estimated SA (surface area) calculated as longest × orthogonal diameter × π/4; (3) manual outline of stone and computer SA calculation; and (4) automated 3D volume calculation using specific software. Primary outcome was stone-free status (SFS) at discharge. Secondary outcomes included operative time and the need for an ancillary procedure. Regression analysis and receiver operating characteristic curve analysis were used to evaluate the predictive value of each method. Results: Of 313 included patients, 69.6% were stone free at discharge. All measures of stone burden were independent predictors of SFS [OR and 95% CI of 1.027 (1.014, 1.040), 1.481 (1.180, 1.858), 1.736 (1.266, 2.380), and 1.311 (1.127, 1.526), respectively] and demonstrated similar predictive accuracy (area under the curve = 0.630, 0.630, 0.627, and 0.638, respectively). Stone burden by any measure was an independent predictor of operative time and secondary procedure. Conclusions: We demonstrated that measuring stone burden by manual outline or automated 3D volume on reformatted CT images had no added value compared with orthogonal measurement for predicting outcomes after PCNL.

10.
Can Urol Assoc J ; 14(2): 12-16, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31364975

RESUMO

INTRODUCTION: Following the introduction of shock wave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL), the subspecialty of endourology was born in the late 1970s. The purpose of this study was to report milestones in Canadian endourology, highlighting Canada's contributions to the field. METHODS: A review of the literature was performed from the late 1970s to the present. The literature review included bibliographic and digital resources. Additionally, records and recollections by various individuals were used, including some who were directly involved. RESULTS: Endourology was born in Canada when SWL, URS, and PCNL emerged as minimally invasive treatment options for stones in the early to mid-1980s. According to our research, the first PCNL was performed at the University of Toronto in 1981. Dr. Joachim Burhenne, a Harvard-trained radiologist from Germany, first used extracorporeal SWL in Canada at the University of British Columbia (UBC) for the treatment of biliary stones. Treatment for urinary tract stones followed at UBC and Dalhousie University. The first worldwide use of the holmium laser for lithotripsy of urinary tract calculi took place at the University of Western Ontario. Other endourology milestones in Canada include the formation of the Canadian Endourology Group and the emergence of the Endourological Society-accredited fellowship programs at the University of Toronto and Western University in the 1990s. Canada hosted the 21st and 35th World Congress of Endourology and Shock Wave Lithotripsy annual meeting in Montreal and Vancouver, respectively. CONCLUSIONS: Canadian urologists have led many advances in SWL, URS, and PCNL over the past four decades and, for a relatively small community, have made significant contributions to the field. Through the training of the next generation of endourologists at Canadian institutions, the future of endourology in Canada is bright.

11.
Can Urol Assoc J ; 13(10): E317-E324, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31364972

RESUMO

INTRODUCTION: Over time, the incidence of nephrolithiasis has risen significantly, and patient populations have become increasingly complex. Our study aimed to determine the impact of changes in patient demographics on percutaneous nephrolithotomy (PCNL) outcomes. METHODS: A retrospective analysis of a prospectively collected database was carried out from 1990-2015. Patient demographics, comorbidities, stone and procedure characteristics were analyzed. Multivariate logistic regression was used to evaluate differences in operative duration, complications, stone-free rate, and length of stay. RESULTS: A total of 2486 patients with a mean age of 54±15 years, body mass index (BMI) of 31±8, and stone surface area of 895±602 mm2 were analyzed; 47% of patients had comorbidities, including hypertension (22%), diabetes mellitus (14%), and cardiac disease (13%). Complication rate was 19%, including a 2% rate of major complications (Clavien grade III-V). There was a statistically significant increase in patient age, BMI, and comorbidities over time, which was correlated with an increased complication rate (odds ratio [OR] 1.15; p=0.010). The overall transfusion rate was 1.0% and remained stable (p=0.131). With time, both OR duration (mean Δ 16 minutes; p<0.001) and hospital length of stay (mean Δ 2.4 days; p<0.001) decreased significantly. Stone-free rate of 1873 patients with available three-month followup was 87% and decreased significantly over time (OR 1.09; p<0.001), but was correlated with an increased use of computed tomography (CT) scans for followup imaging. CONCLUSIONS: Despite an increasingly complex patient population, PCNL remains a safe and effective procedure with a high stone-free rate and low risk of complications.

12.
J Endourol ; 33(2): 146-150, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30369249

RESUMO

PURPOSE: The holmium laser is used increasingly for a wide array of urological procedures. Laser safety goggles are mandatory at many centers for individuals within the nominal hazard zone, as set out by the institution. Recent ex vivo studies suggest standard eye wear may be equally as protective. We sought to evaluate the perceptions and practice patterns of laser safety goggles in urology. MATERIALS AND METHODS: A 24-question survey was sent out through e-mail to an international e-mail list of ∼2000 urologists that were members of the Endourological Society. Data were collected anonymously using Survey Monkey. RESULTS: A total of 264 (14%) urologists completed the survey. Thirty-four percent worked in the community, whereas 63% worked at an academic institution. Ninety-seven percent routinely used the holmium laser. The most common uses were lithotripsy (99%), tissue incision (71%), tumor ablation (58%), and prostate ablation (26%). Formal laser training and institutional laser safety policies were reported in 76% and 64%, respectively. Forty percent of respondents routinely wore laser safety goggles. Laser adverse events were witnessed by 19%, but there were no eye injuries reported. Seventy percent of surgeons felt that laser safety goggles may impair their vision. When presented with the information that regular eye glasses may be as effective as laser goggles for preventing harm, the majority (86%) would opt for regular eye wear. CONCLUSIONS: Laser safety eyewear practice patterns vary greatly. Many centers have adopted policies for universal mandatory laser goggles in the operating room. With over two thirds of surgeons suggesting laser goggles impair their vision, and recent literature suggesting regular eye wear is equivalent in preventing laser-associated eye injuries, laser goggle safety policies should be updated to better match the potential hazards inherent to the device.


Assuntos
Traumatismos Oculares/prevenção & controle , Lasers de Estado Sólido/efeitos adversos , Padrões de Prática Médica , Urologistas , Canadá , Estudos de Coortes , Feminino , Humanos , Masculino , Inquéritos e Questionários
13.
Asian J Urol ; 5(4): 203-204, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30364511
14.
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
15.
Eur Urol Focus ; 3(1): 18-26, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28720363

RESUMO

CONTEXT: The recent evolution of management options for urolithiasis has presented a unique dilemma for the modern urologist. A comprehensive understanding of epidemiological trends along with current provider preferences in treating urinary stones would be beneficial. OBJECTIVE: To review trends in the prevalence, treatments, and costs of urolithiasis worldwide. EVIDENCE ACQUISITION: A literature review was performed using the MEDLINE database, the Cochrane Library Central search facility, Web of Science, and Google Scholar between 1986 and 2016. Keywords used for the search were "urolithiasis" and "prevalence; treatment; and cost". EVIDENCE SYNTHESIS: The incidence and prevalence of urinary stones are rising around the world, including regions that have historically had low rates of urolithiasis. Common theories explaining this trend involve climate warming, dietary changes, and obesity. Shockwave lithotripsy (SWL) has been the preferred mode of treatment since its introduction in the 1980s. However, ureteroscopy (URS) has become increasingly popular for small stones regardless of location because of lower recurrence rates and costs. Developing countries have been slower to adopt URS technology and continue to use percutaneous nephrolithotomy at a steady rate. CONCLUSIONS: URS has recently challenged SWL as the treatment modality preferred for small upper urinary tract stones. In some cases it is less expensive but still highly effective. As the burden of stone disease increases worldwide, appropriate selection of stone removal therapies will continue to play an important role and will thus require further investigation. PATIENT SUMMARY: Urinary stones are becoming more prevalent. Recent advances in technology have improved the management of this disease and have decreased costs.


Assuntos
Custos de Cuidados de Saúde/tendências , Urolitíase/epidemiologia , Urolitíase/terapia , Ásia/epidemiologia , Austrália/epidemiologia , Europa (Continente)/epidemiologia , Humanos , Litotripsia/economia , Litotripsia/tendências , Nefrolitotomia Percutânea/economia , Nefrolitotomia Percutânea/tendências , América do Norte/epidemiologia , Prevalência , Recidiva , Ureteroscopia/economia , Ureteroscopia/tendências , Urolitíase/economia
16.
J Endourol ; 31(S1): S1-S2, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28414529
17.
J Endourol Case Rep ; 3(1): 24-27, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28265593

RESUMO

This report documents two instances of retained flexible ureteroscopes at the time of ureteroscopy and laser lithotripsy in a healthy 37-year-old male and a 53-year-old male with a pelvic kidney. We describe maneuvers to remove the ureteroscope endoscopically in the first case, while the second case required conversion to open surgery for ureteroscope extrication.

18.
Am J Vet Res ; 78(3): 381-392, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28240956

RESUMO

OBJECTIVE To determine whether passive ureteral dilation (PUD) would occur after an indwelling ureteral stent was left in place in healthy dogs for 2 or 6 weeks, ureteroscopy would be possible at the time of stent removal, and PUD would be reversible after stent removal. ANIMALS 5 healthy adult female Beagles. PROCEDURES A ureteral stent was cystoscopically placed in each ureter of each dog with fluoroscopic guidance (week 0). One stent was removed from 1 ureter in each dog after 2 weeks (ureter group 1), and the other was removed after 6 weeks (ureter group 2); removal timing was randomized. Computed tomographic excretory urography was performed every 2 weeks from weeks 0 through 10 to measure ureteral diameters. Ureteroscopy was attempted at the time of ureteral stent removal in each group. Ureteral diameters were compared among measurement points. RESULTS The degree of PUD was significant after 2 and 6 weeks of stent placement in both ureter groups. Mean diameter of the midportion of the ureter in both groups prior to stent placement was 1.70 mm (range, 1.3 to 2.7 mm). At stent removal, mean diameter of the midportion of the ureter was 2.86 mm (range, 2.4 to 3.1 mm) in group 1 and 2.80 mm (range, 2.1 to 3.4 mm) in group 2. Ureteroscopy was successfully performed in all dogs up to the renal pelvis. Compared with week 0 values for diameter of the midportion of the ureter, the degree of PUD induced by stent placement had reversed by week 8 in group 1 (mean diameter, 2.00 mm [range, 1.5 to 2.3 mm]). CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that ureteral stent placement for 2 weeks would result in sufficient PUD in healthy dogs to allow ureteroscopy at the time of stent removal and that the original ureteral diameter would eventually be restored. Additional research is needed to determine whether findings would be similar for dogs with urinary tract disease.


Assuntos
Dilatação/veterinária , Stents/veterinária , Ureter/anatomia & histologia , Ureteroscopia/veterinária , Animais , Cães , Feminino , Fatores de Tempo
19.
J Endourol ; 31(2): 111-118, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27852120

RESUMO

INTRODUCTION: Partial or complete obstruction of the urinary tract is a common and challenging urological condition that may occur in patients of any age. Serum creatinine is the most commonly used method to evaluate global renal function, although it has low sensitivity for early changes in the glomerular filtration rate or unilateral renal pathology. Hence, finding another measurable parameter that reflects the adaptation of the renal physiology to these circumstances is important. Several recent studies have assessed the use of new biomarkers of acute kidney injury (AKI), but the information among patients with stone disease and those with obstructive uropathy is limited. MATERIAL AND METHODS: A prospective cohort study was conducted to determine the urinary levels of kidney injury molecule-1 (KIM-1), Total and Monomeric neutrophil gelatinase-associated lipocalin (NGAL) in patients with hydronephrosis secondary to renal stone disease, congenital ureteropelvic junction obstruction or ureteral stricture. Comparison between patients with hydronephrosis and no hydronephrosis was carried out along with correlation analysis to detect factors associated with biomarker expression. RESULTS: Urinary levels of KIM-1 significantly decreased after hydronephrosis treatment in patients with unilateral obstruction (1.19 ng/mL vs 0.76 ng/mL creatinine, p = 0.002), additionally KIM-1 was significantly higher in patients with hydronephrosis compared to stone disease patients without radiological evidence of obstruction (1.19 vs 0.64, p = 0.006). Total and Monomeric NGAL showed a moderate correlation with the presence of leukocyturia. We found that a KIM-1 value of 0.735 ng/mg creatinine had a sensitivity of 75% and specificity of 67% to predict the presence of hydronephrosis in preoperative studies (95% CI 0.58-0.87, p = 0.006). CONCLUSION: Our results show that KIM-1 is a promising biomarker of subclinical AKI associated with hydronephrosis in urological patients. NGAL values were influenced by the presence of leukocyturia, limiting its usefulness in this population.


Assuntos
Receptor Celular 1 do Vírus da Hepatite A/análise , Hidronefrose/urina , Cálculos Renais/urina , Lipocalina-2/urina , Obstrução Ureteral/urina , Adulto , Idoso , Biomarcadores/urina , Feminino , Humanos , Cálculos Renais/complicações , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Obstrução Ureteral/complicações
20.
J Am Vet Med Assoc ; 249(12): 1401-1407, 2016 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-27901452

RESUMO

OBJECTIVE To compare perioperative characteristics of dogs with cystic calculi treated via open versus laparoscopic-assisted cystotomy (LAC). DESIGN Retrospective case series. ANIMALS 89 client-owned dogs that underwent open cystotomy (n = 39) or LAC (50). PROCEDURES Medical records of dogs that underwent cystotomy between 2011 and 2015 were reviewed. History, signalment, surgery date, results of physical examination, results of preoperative diagnostic testing, details of surgical treatment, duration of surgery, perioperative complications, treatment costs, and duration of hospitalization were recorded. RESULTS 5 of 50 (10%) dogs required conversion from LAC to open cystotomy (OC). There was no significant difference between the LAC (1/50) and OC (2/39) groups with regard to percentage of patients with incomplete removal of calculi. Duration of surgery was not significantly different between the LAC (median, 80 min; range, 35 to 145 min) and OC (median, 70 min; range, 45 to 120 min) groups. Postoperative duration of hospitalization was significantly shorter for dogs that underwent LAC (median, 24 hours; range, 12 to 48 hours) versus OC (median, 26 hours; range, 12 to 63 hours). Surgical and total procedural costs were significantly higher for patients undergoing LAC. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that LAC may be an acceptable minimally invasive technique for treatment of cystic calculi in dogs. Surgery times were similar to those for dogs undergoing OC; however, surgical and total procedural costs were higher. Further investigation is suggested to determine which patients may benefit from LAC versus traditional OC.


Assuntos
Cistotomia/veterinária , Doenças do Cão/cirurgia , Período Perioperatório/veterinária , Cálculos da Bexiga Urinária/cirurgia , Animais , Cistotomia/métodos , Cães , Feminino , Masculino , Estudos Retrospectivos
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