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1.
Medicine (Baltimore) ; 100(1): e23964, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429757

RESUMO

INTRODUCTION: Kidney stone is one of the urinary system diseases with a high incidence. In this study, we will evaluate the effectiveness and safety of Sun tip-flexible ureterorenoscope treating patients with kidney stone. METHODS AND ANALYSIS: English and Chinese literature about Sun tip-flexible ureterorenoscope treatment for kidney stones published before October 31, 2020 will be systematic searched in PubMed, Embase, Web of Science, Cochrane Library, Open Grey, Clinicaltrials.gov, Chinese Clinical Trial Registry, WANFANG, VIP Chinese Science and Technology Journal Database, CNKI, Chinese biomedical document service system (SinoMed). Only randomized controlled trials (RCTs) of patients with kidney stones will be included. Literature screening, data extraction, and the assessment of risk of bias will be independently conducted by 2 reviewers, and the 3rd reviewer will be consulted if any different opinions existed. Systematic review and meta-analysis will be produced by RevMan 5.3 and Stata 14.0. This protocol reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) statement, and we will report the systematic review by following the PRISMA statement. RESULTS: The current study is a protocol for systematic review and meta-analysis without results, and data analysis will be carried out after the protocol. We will share our findings in the fourth quarter of 2021. CONCLUSION: This study will provide recommendations for the effectiveness and safety of Sun tip-flexible ureterorenoscope for patients with kidney stones (KS), which may help to guide clinician. ETHICS AND DISSEMINATION: Ethical approval is not required as the review is a secondary study based on published literature. The results of the study will be published in peer-reviewed publications and disseminated electronically or in print. PROTOCOL REGISTRATION NUMBER: INPLASY2020110099.


Assuntos
Protocolos Clínicos , Cálculos Renais/diagnóstico por imagem , Ureteroscópios/normas , Humanos , Rim/diagnóstico por imagem , Rim/fisiopatologia , Cálculos Renais/diagnóstico , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Revisões Sistemáticas como Assunto , Ureter/diagnóstico por imagem , Ureter/fisiopatologia , Ureteroscópios/efeitos adversos
2.
Expert Rev Med Devices ; 17(12): 1257-1264, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33307869

RESUMO

Introduction: Flexible ureteroscopy is a commonly performed urologic procedure for visualization and treatment of the upper urinary tracts. Traditionally, ureteroscopy has been performed with reusable scopes, which have large initial purchasing costs. LithoVue was the first widely adopted single-use flexible ureteroscope clinically available in 2016 and has caused reevaluation of this paradigm. Areas covered: This review is an objective assessment of the LithoVue single-use ureteroscope based on available studies at the time of publication. The authors searched major databases for papers that included the term 'LithoVue' and included relevant papers. The state of the market, technical specifications, results from clinical studies and cost analyses, and competitors are discussed. Expert opinion: The LithoVue single-use flexible ureteroscope has comparable clinical performance to existing reusable ureteroscopes based on available data. Direct clinical comparisons to competing single-use ureteroscopes, many of which are relatively new, are limited. In numerous pre-clinical studies LithoVue performed favorably compared to available competitors. Cost analyses suggest that benefit of single-use ureteroscopes is institution-specific, and will likely be favorable at a low volume of cases and with high local costs for repairs of reusable scopes.


Assuntos
Cálculos Renais/cirurgia , Ureteroscópios/efeitos adversos , Aprovação de Equipamentos , Desenho de Equipamento , Humanos , Vigilância de Produtos Comercializados/economia , Resultado do Tratamento , Ureteroscópios/economia
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 984-987, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018150

RESUMO

This paper presents a signal analysis approach to identify the contact objects at the tip of a flexible ureteroscope. First, a miniature triaxial fiber optic sensor based on Fiber Bragg Grating(FBG) is devised to measure the interactive force signals at the ureteroscope tip. Due to the multidimensional properties of these force signals, the principal components analysis(PCA) method is introduced to reduce dimensions. The signal features are then extracted from the representative principal component signals using the wavelet transform(WT) method. Experimental results show that the contact objects at the tip of a ureteroscope are readily discriminated from the measured force signals with the proposed approach.Clinical Relevance-This work commits to analyze the contact force signals at the tip of a flexible ureteroscope for the purpose of contact objects identification.


Assuntos
Fenômenos Mecânicos , Ureteroscópios , Tecnologia de Fibra Óptica , Fenômenos Físicos , Análise de Ondaletas
5.
J Urol ; 204(5): 976-981, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32459602

RESUMO

PURPOSE: Ureteral access sheaths are commonly used during ureteroscopy to facilitate stone removal, improve visibility and maintain low intrarenal pressures. However, the use of a ureteral access sheath can cause ureteral wall ischemia and ureteral tears, potentially increasing the risk of postoperative ureteral stricture and obstruction. We studied the impact of ureteral access sheath use on postoperative imaging studies. Secondary objectives included studying the impact of other intraoperative parameters on postoperative imaging studies. MATERIALS AND METHODS: A retrospective chart review was conducted of cases that underwent ureteroscopy for nephroureterolithiasis across 2 high volume institutions between January 2012 and September 2016. Patient demographics, cumulative stone size, operative time, use of ureteral access sheath, laser lithotripsy, basket extraction, preoperative ureteral stent and postoperative ureteral stent placement were extracted from the electronic medical record. Findings of followup renal ultrasound, kidney-ureter-bladder x-ray and/or computerized tomography at approximately 8 weeks after surgery were recorded. RESULTS: A total of 1,332 ureteroscopies were performed with 1,060 cases (79.6%) returning for routine upper tract imaging after ureteroscopy. Postoperative hydronephrosis was noted following 127 cases (12.0%). Factors predicting presence of hydronephrosis after ureteroscopy include lower body mass index (p=0.0016), greater cumulative stone size (p=0.0003), increased operative time (p <0.0001), preoperative ureteral stent (OR 1.49, p=0.0299) and postoperative ureteral stent placement (OR 6.43, p=0.0031). Postoperative hydronephrosis was not associated with use of ureteral access sheath, age, laser lithotripsy or basket extraction. CONCLUSIONS: Use of ureteral access sheath did not have a significant impact on development of postoperative hydronephrosis, suggesting ureteral access sheath is safe for use during ureteroscopy. Ureteral strictures remain rare following ureteroscopy, seen in only 1.0% of our cohort. With an observed prevalence of hydronephrosis of 12.0% on followup imaging at 8 weeks, routine upper tract imaging after ureteroscopy remains a valuable prognostic tool.


Assuntos
Hidronefrose/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Ureteroscópios/efeitos adversos , Ureteroscopia/efeitos adversos , Urolitíase/cirurgia , Adulto , Idoso , Índice de Massa Corporal , Feminino , Seguimentos , Humanos , Hidronefrose/diagnóstico por imagem , Hidronefrose/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Stents/efeitos adversos , Tomografia Computadorizada por Raios X , Ureteroscopia/instrumentação
6.
Sci Rep ; 10(1): 5701, 2020 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-32231344

RESUMO

In order to evaluate the technical adaptability of a type of disposable endoscope compared to reusable flexible endoscopes, in vitro and in vivo studies were conducted. A disposable digital ureteroscope ("chip on tip") and two reusable endoscopes were investigated with respect to spatial resolution, geometric distortion in air and water the maximum. Additionally, the clinical performance of the disposable device was tested during clinical procedures (n = 20). The disposable endoscope showed an optical resolution of 6.72 lines/mm at 10 mm distance, similar to the other devices. In comparison, the disposable endoscope showed a barrel-shaped image distortion in air of -24.2%, which is in the middle range, but was best under water (-8.6%). The bendability of 297° (275 µm fiber) and 316° (empty channel, 1.5 F basket) and the maximum irrigation (1 m: 58.1 ml/min, 2 m: 91.9 ml/min) were convincing. Clinically the maneuverability was very good in (13/20), good or satisfactory in (7/20). Visibility was evaluated as very good in (11/20), just in (1/20) either satisfactory or sufficient. The consistency of visibility was not affected in (19/20). In all cases there were no adverse events. The technical examination and clinical application of the disposable endoscope are of equal quality compared to reusable devices. Disposable endoscopes can be an alternative to reusable devices, but economic aspects such as reduction of repair costs, sterilization effort and additional waste must be taken into account.


Assuntos
Reutilização de Equipamento , Ureteroscópios , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ureteroscopia/instrumentação , Ureteroscopia/métodos , Cálculos Urinários/diagnóstico , Cálculos Urinários/cirurgia , Doenças Urológicas/diagnóstico , Adulto Jovem
7.
Int Braz J Urol ; 46(3): 390-397, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32167702

RESUMO

INTRODUCTION: Two automated irrigation systems have been released for use during endoscopic procedures such as ureteroscopy: the Cogentix RocaFlow® (CRF) and Thermedx FluidSmart® (TFS). Accurate pressure control using automated systems may help providers maintain irrigation pressures within a safe range while also providing clear visualization. Our objective was to directly compare these systems based on their pressure accuracy, pressure-flow relationships, and fluid heating capabilities in order to help providers better utilize the temperature and pressure settings of each system. MATERIALS AND METHODS: An in vitro ureteroscopy model was used for testing, consisting of a short semirigid ureteroscope (6/7, 5F, 31cm Wolf 425612) connected to a continuous digital pressure transducer (Meriam m1550). Each system pressure output and flow-rate, via 100mL beaker filling time, was measured using multiple trials at pressure settings between 30 and 300mmHg. Output fluid temperature was monitored using a digital thermometer (Omega DP25-TH). RESULTS: The pressure output of both systems exceeded the desired setting across the entire tested range, a difference of 15.7±2.4mmHg for the TFS compared to 5.2±1.5mmHg for the CRF (p < 0.0001). Related to this finding, the TFS also had slightly higher flow rates across all trials (7±2mL/min). Temperature testing revealed a similar maximum temperature of 34.0°C with both systems, however, the TFS peaked after only 8 minutes and started to plateau as early as 4-5 minutes into the test, while the CRF took over 18 minutes to reach a similar peak. CONCLUSIONS: Our in vitro ureteroscopy testing found that the CRF system had better pressure accuracy than the TFS system but with noticeably slower fluid heating capabilities. Each system provided steady irrigation at safe pressures within their expected operating parameters with small differences in performance that should not limit their ability to provide steady irrigation at safe pressures.


Assuntos
Irrigação Terapêutica , Ureteroscopia , Pressão , Temperatura , Ureteroscópios
9.
BJU Int ; 125(3): 449-456, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31610080

RESUMO

OBJECTIVE: To evaluate whether the position of the working channel affects the effectiveness of flexible ureteroscopy. MATERIALS AND METHODS: We compared the ureteroscopes Flex-X2S and Flex-XC (working channel at the 9 and 3 o'clock positions, respectively) in eight cavities of a K-Box model, simulating the distribution of the right and left intrarenal calyces. In the first and second settings, each cavity contained a 1-cm stone, lying on the bottom and fixed on the anterior sheet covering the box, respectively. In the third setting, the posterior and lateral surface of each cavity was draped with graph paper. Once the flexible ureteroscope entered each cavity, we measured and compared (i) the proportion of stone surface targeted by the laser (STL) and (ii) the proportion of graph paper burned by the laser (PBL) obtained with the two instruments. RESULTS: Higher STLs and PBLs were obtained with the 3 o'clock position than the 9 o'clock position in the right posterior and left anterior cavities (mean ± sd STL 87% ± 15% vs 46% ± 38% and 78% ± 35% vs 43% ± 24%, respectively; P < 0.05), and on the right posterior surfaces of the middle-lower/lower cavities (PBL 72% vs 31% and 77% vs 35%, respectively; P < 0.01) and on the left lateral surface of the lower cavities (PBL 45% vs 25%; P = 0048), respectively. Conversely, the 9 o'clock position provided higher STLs and PBLs than the 3 o'clock position in the left posterior and right anterior cavities (mean ± sd STL 84% ± 20% vs 65% ± 28% and 79% ± 30% vs 44% ± 35%, respectively; P ≤ 0.02), and on the left posterior and right lateral surfaces of the lower cavities (PBL 59% vs 34% and 50% vs 21%, respectively; P ≤ 0.04). CONCLUSIONS: The position of the working channel of the flexible ureteroscope should be considered when planning flexible ureteroscopy, especially when dealing with the lower pole.


Assuntos
Ureteroscópios , Ureteroscopia/métodos , Técnicas In Vitro
10.
Urolithiasis ; 48(1): 57-61, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30370467

RESUMO

Development of surgical expertise and technology has affected the way renal tract stones are treated. Our hypothesis was that flexible ureteroscopy (FURS) for upper tract stones in children produces good results. Our outcomes were reviewed. A retrospective case note review was performed for children with upper tract calculi who were treated by FURS. There were 56 stone episodes in 36 patients. Median age was 10.6 years. Stones were 3-23 mm (median 8 mm); 64.3% had multiple calculi. Median follow-up was for 17.1 months. After the first FURS there was stone clearance in 42/56 (75%). Although there were no immediate complications, two required re-admission; one with stent symptoms, the other with urinary infection. A second FURS was performed in 11, bringing the cumulative clearance to 89%, although this was often done as "another look" before stent removal. There was no statistically significant difference in stone clearance after first FURS for those with single stones (81.0%) compared to those with multiple stones (72.2%). Clearance rates of more than 70% after first FURS were achieved with stones of up to 17 mm. Unexpected disease was found and treated during FURS in 9 (16.1%) children. FURS is safe in children and good clearance rates are achieved. Multiple stones at different sites may be treated during the same treatment. In addition, FURS allows diagnosis and treatment of unexpected problems.


Assuntos
Cálculos Renais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Cálculos Ureterais/cirurgia , Ureteroscópios/efeitos adversos , Ureteroscopia/instrumentação , Adolescente , Assistência ao Convalescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Cálculos Renais/diagnóstico , Masculino , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Resultado do Tratamento , Cálculos Ureterais/diagnóstico , Ureteroscopia/efeitos adversos
11.
Curr Opin Urol ; 30(2): 113-119, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31815748

RESUMO

PURPOSE OF REVIEW: Single-use flexible ureteroscopes (su-fURS) aim at overcoming the main limitations of conventional reusable ureteroscopes in terms of acquisition and maintenance costs, breakages, and reprocessing. However, little data exist to date regarding the superiority of su-fURS at this regard. We aimed to perform a systematic literature review on available su-fURS performance with a focus on clinical data for all articles in the last 10 years. RECENT FINDINGS: To date, more than 10 different su-fURS are available on the market, with different characteristics and performance. Some of these devices have top-level features, almost catching up with those observed in reusable flexible ureteroscopes. Clinical evidence is mainly available only for two models, LithoVue and Uscope PU3022, and to date it is not strong enough to support routine adoption and use of su-fURS, with a consequent lack of consensus of specific clinical indications. Cost-effectiveness analyses seem to indicate an economic disadvantage in the routine adoption of su-fURS. Environmental issues related to the use of su-fURS also remain to be inquired and addressed. SUMMARY: Since their introduction, su-fURS have gained widespread popularity. Despite their ability at addressing reusable ureteroscope limitations, high-cost and a substantial lack of evidence are still limiting their routine adoption.


Assuntos
Cálculos Renais/cirurgia , Ureteroscópios , Ureteroscopia/instrumentação , Análise Custo-Benefício , Equipamentos Descartáveis/normas , Desenho de Equipamento , Humanos , Cálculos Renais/economia , Ureteroscópios/economia , Ureteroscópios/normas , Ureteroscopia/economia , Ureteroscopia/métodos , Ureteroscopia/normas
12.
Nihon Hinyokika Gakkai Zasshi ; 111(1): 16-21, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33473090

RESUMO

(Objectives) We examined the treatment outcomes in cases of chronic unilateral hematuria treated using flexible ureteroscope for observation and hemostasis. (Methods) The study included 14 patients (7 men and 7 women) with a median age of 56.5 years who underwent ureteroscopy using a digital flexible ureteroscope for chronic unilateral hematuria between March 2014 and August 2019. All the patients presented with macroscopic hematuria as a clinical symptom, but in one patient, the hematuria was accompanied by anemia and required a blood transfusion. In addition, bleeding occurred on the left side in 8 patients and on the right side in 3 patients; however, for the remaining 3 patients, the affected side could not be identified. Fourteen patients were examined on the basis of the ureteroscopic findings, number of bleeding sites, hemostatic intervention, treatment effect, and presence or absence of recurrences. (Results) The ureteroscopic findings showed a hemangioma in 7 patients and minute venous rupture in 3, but the remaining 4 patients showed no clear findings. The site of the findings was in the superior calyces in 8 cases, middle calyces in 4 cases, inferior calyces in 4 cases, and renal pelvic wall in 1 case. In addition, the findings were located at multiple sites in 6 cases, including all renal calyces in 2 cases. Ten patients with findings underwent hemostatic interventions (electrocoagulation and laser treatment). The median postoperative follow-up period was 32.4 months (range, 6.4-65.4 months). In all the cases, the hematuria disappeared after treatment. One of the 2 patients with findings in all renal calyces showed recurrence of macroscopic hematuria at 1 year and 6 months, which disappeared after conservative treatment. (Conclusions) In this study, observation using digital flexible ureteroscope was useful in the treatment of chronic unilateral hematuria, and the hemostatic interventions performed on the bleeding sites in the renal pelvis were effective.


Assuntos
Hematúria/cirurgia , Hemostase Endoscópica/instrumentação , Rim/cirurgia , Maleabilidade , Cirurgia Assistida por Computador/instrumentação , Ureteroscópios , Ureteroscopia/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Hematúria/patologia , Humanos , Rim/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
13.
BMC Urol ; 19(1): 134, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31852477

RESUMO

BACKGROUND: To report current worldwide variation in techniques and clinical practice of flexible ureteroscopy (FURS) among endourologists of different case volumes per year. METHODS: Two invitations to complete an internet survey were emailed to Endourological Society members. Some of survey questions asked about indications of using FURS for renal and upper ureteral stones. Others were concerned with clinical practice of FURS (such as preoperative stenting, use of ureteral access sheath (UAS) and safety guidewire, technique of Laser lithotripsy and fragment retrieval, and post-FURS stenting. Responders were distributed into two groups; high-volume (> 100 cases/year) and low-volume surgeons (< 100 cases/year) and data were compared between both groups. RESULTS: Responses were received from 146 endourologists all over the world (62 high-volume and 84 low-volume). FURS for intrarenal stone > 20 mm was used by 61% of high-volume surgeons compared with 28.6% for low-volume (P < 0.001). Semirigid URS was used for upper ureteric stones in 68% among high-volume group and 82% in low-volume group (P = 0.044). UAS was used by 62% in low-volume group and 69% in high volume group (P = 0.516). Laser stone dusting was preferred by 63% in low-volume group versus 45% by high-volume (P = 0.031). More responders in low-volume group preferred to leave the stent for 6 weeks (P = 0.042). CONCLUSIONS: The use of FURS for treating upper tract calculi has expanded by high volume endourologists to include large renal stones > 20 mm. Low-volume surgeons prefer to use semi-rigid URS for treatment of upper ureteral stones, to apply Laser stone dusting and maintain ureteral stents for longer periods.


Assuntos
Intervenção Baseada em Internet , Cálculos Ureterais/cirurgia , Ureteroscópios/estatística & dados numéricos , Ureteroscopia/métodos , Urologistas/estatística & dados numéricos , Humanos , Inquéritos e Questionários/estatística & dados numéricos , Fatores de Tempo , Ureteroscopia/estatística & dados numéricos
14.
J Endourol ; 33(11): 881-886, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31710258

RESUMO

Objective: The aim of this research was to verify the efficacy and complication of flexible ureteroscopic holmium laser incision for simple renal cysts (SRCs). Patients and Methods: We retrospectively reviewed 116 patients who not only had done flexible ureteroscopic holmium laser incision or laparoscopic decortication for SRC in our institution but also had sufficient data: preoperative information and >1-year follow-up records. The following variables were recorded: age, gender, side, cyst size, location (upper pole, lower pole, and interpolar), blood loss, operative duration, complications during and after surgery, pathology report, and presence or absence of flank pain. The primary endpoint was the efficacy of the treatment; secondary endpoints were safety, pain, and the resolution of other complications. All patients underwent radiologic imaging of the kidneys with a repeated CT, before the operation, 3 and 12 months after surgery. If there were no cysts on the most recent imaging, we defined it as a radiologic success. Results: No statistically significant difference in the background variable in patients of group A (64 patients, flexible ureteroscopic holmium laser incision) and group B (52 patients, laparoscopic decortication) was found, including age, gender, cyst's side, cyst's location, and cyst size before the operation. There were less blood loss by surgeons' evaluation and shorter operative duration (p < 0.001) in group A. In group A, there were three patients who had failed in the first time of operation (two patients failed to place flexible ureteroscope through ureter because of ureteral stricture, and one patient was unable to find the renal cyst in the view of flexible ureteroscope), and no severe postoperative complication was observed. The number of postoperative radiologic failure was five at 3 months and three at 12 months in group A, whereas all the procedures were completed laparoscopically, and no conversion was necessary for group B. But there was one patient who had obvious hematuresis for 1 month after the operation and then it was resolved spontaneously at 3 months. There was only one patient who had a radiologic failure in group B, with the cyst of ∼2 cm at 3 months, and his cyst cannot be seen in CT imaging at 12 months without further treatment. There was no statistically significant difference in the rate of effective operation and complication between the two groups. Conclusion: The operation of flexible ureteroscopic holmium laser incision for SRC had the advantages of less blood loss, short operation time, with a similar rate of operative success and radiologic success after the operation, compared with the process of laparoscopic decortication. It was a good option for urologists to deal with endogenous renal cysts.


Assuntos
Doenças Renais Císticas/cirurgia , Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Ureteroscopia/métodos , Idoso , Feminino , Humanos , Neoplasias Renais/cirurgia , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscópios
15.
J Endourol ; 33(11): 914-919, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31596612

RESUMO

Objective: To demonstrate the safety and efficacy of flexible ureteroscopy lithotripsy (FURL) and miniaturized percutaneous nephrolithotomy (MPCNL) through the comparative studies in treating medium-sized lower-pole renal calculi. Methods: Two hundred and twenty eligible patients with lower-pole renal calculi (1-2 cm) were enrolled and further randomly assigned into FURL group and MPCNL group. Patients' demographics, preoperative characteristics, intraoperative and postoperative complications, stone-free rate, and comfort and pain indicated by Bruggrmann Comfort Scale (BCS) and visual analog scale (VAS) were evaluated and recorded. Trauma index such as white blood cells, C-reactive protein (CRP), and interleukin (IL)-6 were also detected. Results: The stone-free rate and the operating time were comparable in FURL and MPCNL groups. Intraoperative and postoperative complication analysis showed that blood loss and hospital stay were significantly lower in the FURL group compared with MPCNL group. No significant difference in minor pelvic perforation, false passage, hemoglobin drop, persistent hematuria, ureteral perforation, moderate fever, urosepsis, and postoperative serum creatinine level was observed. However, as to comfort and pain indicated by BCS and VAS and stress indicated by CRP and IL-6, FURL was superior to MPCNL. Conclusion: FURL could be a better alternative surgical method to MPCNL with similar curative effect and less blood loss and hospital stay.


Assuntos
Cálculos Renais/terapia , Litotripsia a Laser/métodos , Nefrolitotomia Percutânea/métodos , Ureteroscopia/métodos , Adulto , Idoso , Perda Sanguínea Cirúrgica , Proteína C-Reativa/metabolismo , Feminino , Febre/epidemiologia , Hematúria/epidemiologia , Humanos , Interleucina-6/metabolismo , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/metabolismo , Período Pós-Operatório , Resultado do Tratamento , Ureteroscópios
16.
J Laparoendosc Adv Surg Tech A ; 29(11): 1492-1496, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31549927

RESUMO

Objective: To evaluate the experience and result of combined laparoscope and flexible ureteroscope (f-URS) pyelolithotomy in dealing with large-burden complex renal calculi in children <1 year old. Methods: Eleven patients (7 males and 4 females) <1 year old were retrospectively reviewed between December 2015 and May 2017, who had been diagnosed with renal calculi and received combined laparoscope and f-URS pyelolithotomy. The operations were carried out under general anesthesia. Patient' characteristics, presenting symptoms, operative times, and blood loss, stone-free rate, and postoperative complications were all collected retrospectively. Results: All 11 patients received combined laparoscope and f-URS pyelolithotomy. All operations went smoothly without conversion record and blood transfusion. Average time consumed was 109 minutes (55-187 minutes), and blood loss reported was 16 mL (10-25 mL). Average hospital stay after operation was 7 days (5-11 days). On mean follow-up of 6-12 months, no symptomatic urinary tract infections and urinary calculi were detected. Conclusion: Laparoscope combined f-URS pyelolithotomy is considered safe in the treatment of large-burden multiple renal calculi in infant patients with a high stone clearance rate. It has certain advantages in the treatment of renal calculi in infants <1 year old, and it could be an alternative treatment when other treatments fail or are unavailable.


Assuntos
Cálculos Renais/cirurgia , Laparoscopia , Ureteroscopia , Perda Sanguínea Cirúrgica , Feminino , Humanos , Lactente , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscópios , Ureteroscopia/efeitos adversos , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodos
17.
Int Braz J Urol ; 45(4): 658-670, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31397987

RESUMO

PURPOSE: To critically review all literature concerning the cost-effectiveness of flexible ureteroscopy comparing single-use with reusable scopes. MATERIALS AND METHODS: A systematic online literature review was performed in PubMed, Embase and Google Scholar databases. All factors potentially affecting surgical costs or clinical outcomes were considered. Prospective assessments, case control and case series studies were included. RESULTS: 741 studies were found. Of those, 18 were duplicated and 77 were not related to urology procedures. Of the remaining 646 studies, 59 were considered of relevance and selected for further analysis. Stone free and complication rates were similar between single-use and reusable scopes. Operative time was in average 20% shorter with digital scopes, single-use or not. Reusable digital scopes seem to last longer than optic ones, though scope longevity is very variable worldwide. New scopes usually last four times more than refurbished ones and single-use ureterorenoscopes have good resilience throughout long cases. Longer scope longevity is achieved with Cidex and if a dedicated nurse takes care of the sterilization process. The main surgical factors that negatively impact device longevity are lower pole pathologies, large stone burden and non-use of a ureteral access sheath. We have built a comprehensive fi nancial costeffective decision model to fl exible ureteroscope acquisition. CONCLUSIONS: The cost-effectiveness of a fl exible ureteroscopy program is dependent of several aspects. We have developed a equation to allow a literature-based and adaptable decision model to every interested stakeholder. Disposable devices are already a reality and will progressively become the standard as manufacturing price falls.


Assuntos
Reutilização de Equipamento/economia , Ureteroscópios/economia , Ureteroscopia/economia , Análise Custo-Benefício , Desenho de Equipamento , Reutilização de Equipamento/estatística & dados numéricos , Humanos , Duração da Cirurgia , Ureteroscópios/normas , Ureteroscópios/estatística & dados numéricos , Ureteroscopia/instrumentação , Ureteroscopia/estatística & dados numéricos
18.
Urol Int ; 103(3): 326-330, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31394535

RESUMO

INTRODUCTION: It is unclear whether endoscopic assessment of the stone-free rate after flexible ureteroscopy (fURS) is as effective as assessment with low-dose computed tomography (CT) scan. METHODS: Prospective documentation of patients with kidney stones > 10 mm diameter from 2 different centers (Freiburg, Regensburg), who underwent fURS and were declared to be endoscopically completely stone-free. Low-dose CT control performed 4-8 weeks postoperatively. RESULTS/CONCLUSION: Thirty-eight patients were treated between October 2015 and August 2016 (12 F, 26 M). Average age was 55.9 years (range 19-82, SD 17.24), and body mass index was 29.7 kg/m2 (range 23.5-42.5, SD 4.37). There were 2.0 (range 1-7, SD 1.55) stones with a mean diameter of 15 mm (range 10-40, SD 6.78) per kidney. Mean surgery time was 74 min (range 38-124, SD 24.28), and lithotripsy was necessary in 33 cases. CT was performed 5.4 weeks afterwards (range 4-8, SD 1.43). One patient had a 2 mm residual which was extracted by URS. Strictly speaking, endoluminal stone removal control failed in only that patient, yielding a negative predictive value of 97%. A routine postoperative CT scan would thus appear unnecessary in the case of negative endoscopic control for residual fragments and should be avoided to reduce radiation exposure. Further investigations with larger patient populations are necessary.


Assuntos
Cálculos Renais/patologia , Cálculos Renais/cirurgia , Tomografia Computadorizada por Raios X , Ureteroscópios , Ureteroscopia , Adulto , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , Humanos , Cálculos Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doses de Radiação , Indução de Remissão , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Adulto Jovem
19.
J Endourol ; 33(11): 896-901, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31418291

RESUMO

Introduction: MOSES™ technology is a holmium:yttrium-aluminum-garnet laser pulse mode shown to minimize stone retropulsion. This may facilitate lithotripsy at higher power settings. However, power and heat production are proportional, and temperatures capable of tissue injury may occur during ureteroscopic lithotripsy. Although previous in vitro studies demonstrate the importance of irrigation and activation time on heat production, the impact of pulse type has not been evaluated. Methods: A flexible ureteroscope with a 365 µm laser fiber was placed in an 11/13 F access sheath inserted into a 50 mL saline bag to simulate a ureter, renal pelvis, and antegrade irrigant flow. A thermocouple was placed adjacent to the laser tip, and the laser fired for 30 seconds at 0.6 J/6 Hz, 0.8 J/8 Hz, 1 J/10 Hz, 1 J/20 Hz, and 0.2 J/70 Hz at irrigation pressure of 100 mmHg. Four runs were tested per setting using short pulse, long pulse (LP), MOSES-contact (MC), and MOSES-distance (MD) modes. The mean temperature changes (dT) were compared and thermal dose was calculated in cumulative equivalent minutes at 43°C (CEM43) using an adjusted baseline of 37°C. CEM43 ≥ 120 minutes was considered the tissue injury threshold. Results: At 0.8 J/8 Hz, LP produced the greatest dT, significantly higher than MC (p = 0.041). CEM43 did not exceed the injury threshold. At 1 J/10 Hz, dT was significantly higher for LP versus MC and MD (p = 0.024 and 0.045, respectively). Thermal dose remained below the injury threshold. No differences in dT were seen between pulse types at 0.6 J/6 Hz, 0.2 J/70 Hz, or 1 J/20 Hz. At 1 J/20 Hz, thermal dose exceeded the injury threshold for all pulse types within 3 seconds. Conclusions: Laser pulse type and length seemed to impact heat production in our ureteral model. LP produced significantly greater temperatures at 0.8 J/8 Hz and 1 J/10 Hz relative to MOSES settings. Fortunately, thermal dose remained safe at these settings. Both LP and MOSES technology have been shown to reduce stone retropulsion. At power ≤10 W, the latter may confer this advantage with decreased heat production.


Assuntos
Lasers de Estado Sólido/uso terapêutico , Litotripsia a Laser/métodos , Temperatura , Ureter , Cálculos Ureterais/terapia , Ureteroscopia/métodos , Alumínio , Hólmio , Humanos , Modelos Anatômicos , Ureteroscópios , Ítrio
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