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1.
Prog. urol. (Paris) ; 30(12): S52-S77, Nov. 2020.
Artigo em Francês | BIGG - guias GRADE | ID: biblio-1146626

RESUMO

The purpose was to propose an update of the French guidelines from the national committee ccAFU on upper tract urothelial carcinomas (UTUC). A systematic Medline search was performed between 2018 and 2020, as regards diagnosis, options of treatment and follow-up of UTUC, to evaluate different references with levels of evidence.The diagnosis of this rare pathology is based on CT-scan acquisition during excretion and ureteroscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment, nevertheless a conservative endoscopic approach can be proposed for low risk lesion: unifocal tumor, possible complete resection and low grade and absence of invasion on CT-scan. Close monitoring with endoscopic follow-up (flexible ureteroscopy) in compliant patients is therefore necessary. After RNU, bladder instillation of chemotherapy is recommended to reduce risk of bladder recurrence. A systemic chemotherapy is recommended after RNU in pT2­T4 N0­3 M0 disease. These updated guidelines will contribute to increase the level of urological care for diagnosis and treatment for UTUC.


L'objectif était de proposer une mise à jour des recommandations du Comité de cancérologie de l'Association française d'urologie (AFU) pour la prise en charge des tumeurs de la voie excrétrice supérieure (TVES). Une revue systématique de la littérature (Medline) a été effectuée de 2018 à 2020 sur les éléments du diagnostic, les options de traitement et la surveillance des TVES en évaluant les références avec leur niveau de preuve. Le diagnostic de cette pathologie rare repose sur l'uro-TDM avec acquisition au temps excréteur et l'urétérorénoscopie souple avec prélèvements biopsiques. Le traitement chirurgical de référence est la néphro-urétérectomie totale (NUT), mais un traitement conservateur peut être discuté pour les lésions dites « à bas risque ¼ : tumeur de bas grade, sans infiltration sur l'imagerie, unifocale < 2 cm, accessible à un traitement complet et nécessitant alors une surveillance endoscopique rapprochée par urétéroscopie souple chez un patient compliant. Une instillation postopératoire de chimiothérapie est recommandée et permet de diminuer le risque de récidive vésicale après NUT. La chimiothérapie adjuvante a démontré son bénéfice clinique comparée à la surveillance après NUT pour les tumeurs (pT2­T4 N0­3 M0). Ces nouvelles recommandations doivent contribuer à améliorer non seulement la prise en charge des patients, mais aussi le diagnostic et la décision thérapeutique des TVES.


Assuntos
Humanos , Sistema Urinário/patologia , Neoplasias Urogenitais/prevenção & controle , Ureteroscopia/métodos , Nefroureterectomia
2.
Medicine (Baltimore) ; 99(43): e22704, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120764

RESUMO

With improvements in endoscopy and laser technology, flexible ureteroscopy (FURS) has been a viable treatment option for large renal stones. Here, we share our experience of the FURS treatment for renal stones 2 cm or greater.We evaluated 251 consecutive patients who underwent FURS and holmium laser lithotripsy for renal stones 2 cm or greater between January 2015 and April 2019. Stone size was defined as the longest axis on non-contrast computed tomography. Data were retrospectively collected from electronic medical records. Patient demographics, stone clearance rates and perioperative complications were evaluated.There were 165 male patients and 86 female patients with an average age of 46.9 years (range 22-80 years). Mean stone size was 2.7 cm and the average number of procedures was 1.4 (range 1-5). The stone-free rate at the end of the first, second and third procedure was 61.9%, 82.9%, and 89.5%, respectively. The final stone-free rate decreased as stone size grows, and it was only 58.3% for kidney stones larger than 4 cm after an average of 2.3 procedures. The lowest clearance rates were observed in lower calyx calculi (87.2%) and multiple calyx calculi (83.5%). The overall complication rate was 15.1%, and the most common complication was postoperative fever (9.6%). One patient required blood transfusion, owing to postoperative coagulation disorders induced by urosepsis.Single or staged FURS is a practical treatment option for the renal stones sized 2 to 4 cm with acceptable efficacy and safety. Stone clearance rate of FURS treatment is mainly affected by stone size and location.


Assuntos
Cálculos Renais/terapia , Litotripsia a Laser/métodos , Ureteroscopia/métodos , Adulto , Feminino , Humanos , Cálculos Renais/patologia , Lasers de Estado Sólido/uso terapêutico , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos
3.
Arch. esp. urol. (Ed. impr.) ; 73(8): 767-776, oct. 2020. tab, graf, ilus
Artigo em Inglês | IBECS | ID: ibc-197474

RESUMO

The SuperPulsed Thulium fiber laser has recently become available to the urologist. It can be safely and efficiently applied to humans for the purposes of laser lithotripsy. Particularly, this innovative technology overcomes the main limitations of Holmium:YAG lasers, which had been the principal source of energy for lithotripsy over the past decades. The SuperPulsed Thulium fiber laser allows a broader range of pulse energy (0.025 to 6.0 J), pulse frequency (up to 2000 Hz) and pulse duration (0.05 to 12 ms), as well as smaller operating laser fibers (50-150 μm core), compared to Holmium:YAG lasers. The laser emission at 1940 nm leads to a four-fold higher energy absorption in water, which ensures precise lithotripsy and a high degree of safety. Multiple comparative in vitro studies suggest a 1.5 to 4 times faster stone ablation rate in favor of the SuperPulsed Thulium fiber laser, when compared to Holmium:YAG lasers. It has also been shown to generate particularly fine stone dust, and electronic pulse modulation allows superior stone stabilization. The SuperPulsed Thulium fiber laser, like the Holmium:YAG laser, has been repeatedly reported thermodynamically safe, provided that a minimal irrigation flow (10-15 ml/min) and relatively low average power (≤ 25 W) is maintaining throughout the lithotripsy process. These new standards are particularly advantageous for fine and rapid ureteroscopic stone dusting, and open paths that were not been amenable to the Holmium:YAG laser


El tulio superpulsado ha salido al mercado recientemente. Se puede usar en humanos para la litotricia. En concreto, esta nueva tecnología mejora las limitaciones del laser holmium, usado hasta ahora. Las fibras de laser tulio permite un pulso de energía (0.025 a 6 J), frecuencia de pulso (hasta 2000 Hz) y duración de este pulso (0.05 a 12 ms) así como diámetros menores (50-150 nm) en comparación con el holmium. La emisión de laser a 1940 nm permite una mejoría hasta 4 veces en la absorción de agua, lo que permite una litotricia mas eficiente y segura. Múltiples estudios comparativos in vitro sugieren que la litotricia es entre 1,5 y 4 veces mas rápida con el tulio superpulsado. Además produce un polvo secundario a litotricia mas fino y el pulso electrónico modulado permite una mejor estabilización de la litiasis. Las fibras de tulio superpulsado, como las de holmium, son térmicamente seguras teniendo en cuenta que la irrigación mínima continua (10-15 ml/min) y el bajo voltaje (menos de 25 W) se mantienen durante el tratamiento de litotricia. Estos nuevos estándares confieren particular ventaja en la litotricia ureteroscopica y permitirán una mejor aceptación que el laser homium


Assuntos
Humanos , Litotripsia a Laser/métodos , Túlio/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Ondas de Choque de Alta Energia , Urolitíase/cirurgia , Ureteroscopia/métodos
4.
Arch. esp. urol. (Ed. impr.) ; 73(7): 643-650, sept. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-195962

RESUMO

OBJECTIVE: To compare miniaturized percutaneous nephrolithotomy (mini-PNL) and retrograde intrarenal surgery (RIRS) in children with 10-20 mm renal stones. MATERIALS AND METHODS: Between 2015 and 2019, 63 pediatric patients aged under 16 years who underwent mini-PNL and RIRS for the treatment of kidney stones sized 10-20 mm were analyzed retrospectively. The mini-PNL group (n=30) was defined as group 1 and the RIRS group (n=33) was defined as group 2. Peri-operative data including stone-free rate, operative time, fluoroscopy time, hospitalization time, number of anesthesia sessions, complication rates, and cost-effectiveness were analyzed. RESULTS: The mean age was 8.09±5.49 years in group 1 and 5.75±4.56 years in group 2. The stonefree rate was not different at the first (80.0% vs. 57.6%) and third month (93.3% vs. 90.9%) follow-up in group 1 and group 2. The mean hospitalization, operative, and fluoroscopy times were statistically significantly longer in group 1. The mean number of anesthesia sessions for patients was 1.20±0.40 in group 1 and 2.15±0.44 in group 2 (p = 0.00). Minor complication rates were not different and no major complications were observed in either group. The cost per patient was calculated as 365.97 Euros in group 1 and 698.64 Euros in group 2 (p = 0.001). CONCLUSIONS: This study suggested that RIRS was an effective alternative treatment method for 10-20 mm kidney stones in children, with comparable stone-free and complication rates. RIRS has a shorter operative time, fluoroscopy time, hospital stay than mini-PNL, with a similar stone-free rate for 10-20 mm kidney stones in children. However, mini-PNL is cheaper and allowed a lower need for anesthesia sessions


OBJETIVO: Comparar nefrolitotomia percutánea mini y ureteroscopia flexible retrógrada intrarenal para litiasis de 10-20 mm en niños. MATERIAL Y METODOS: Entre 2015 y 2019, analizamos retrospectivamente 63 pacientes pediátricos menores de 16 años recibieronmini-nefrolitotomia percutanea y URs flexible para el tratamiento de litiasis renales de entre 10-20 mm. Grupo 1 (n=30) mini nefrolitotomía percutánea, grupo 2 (n= 33) URs flexible. Datos perioperatorios incluyendo la tasa libre de litiasis, tiempo quirúrgico, tiempo hospitalización, número de anestesias requeridas, tasa de complicaciones y coste-efectividad fueron analizados. RESULTADOS: La edad media fue de 8,09±5,49 años en el grupo 1 y 5,75±4,56 en el grupo 2. La tasa libre de litiasis no fue diferente en el primer mes (80,0% vs. 57,6%) y 3er mes (93,3% vs. 90,9%) entre el grupo 1 y grupo 2. La mediana de tiempo hospitalización, tiempo quirúrgico y tiempo exposición a fluoroscopia fueron mas largos en el grupo 1. La media de anestesias fue de 1,20±0,40 en el grupo 1 y 2,15±0,44 en el grupo 2 (p = 0,00). La tasa de complicaciones menores no fue diferente y la de mayores tampoco. El coste por paciente se estableció en 365 euros en el grupo 1 y 698 euros en el grupo 2. CONCLUSIONES: Este estudio sugiere que la ureteroscopia flexible es un tratamiento efectivo como alternativa en niños con litiasis de 10-20 mm con unas tasa libres de litiasis y complicaciones parecidas. La URs flexible comporta un menor tiempo operatorio, fluoroscopia, estancia hospitalaria que la mini percutánea con tasa libre de litaisis similares. Por contra, la mini-percutanea es mas barata y comporta menos sesiones anestésicas


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Nefrolitotomia Percutânea/métodos , Ureteroscopia/métodos , Nefrolitíase/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Duração da Cirurgia , Seguimentos , Complicações Intraoperatórias
5.
Medicine (Baltimore) ; 99(22): e20386, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481425

RESUMO

Use of polyacrylate-polyalcohol copolymer (PPC) after endoscopic correction (EC) of vesico-ureteral reflux (VUR) is highly effective but is associated with a higher risk of obstructive complications (OC) compared with other implants. We undertook a STROBE compliant retrospective investigation and studied the OC risk factors to increase the practical safety of PPC.Overall, 798 patients (464 [58.1%] girls and 334 [41.9%]) boys) from 5 hospitals in whom PPC was routinely used were evaluated retrospectively. The patients were subdivided into 2 groups. Group I consisted of 754 (94.5%) children (449 [59.5%] girls and 305 [40.5%] boys) without OC. Median age was 41 months [Q1: 18.0; Q3: 81.0]. Group II comprised 44 (5.5%) patients (29 [65.9%] boys and 15 [34.1%] girls) experiencing OC, and their median age was 21.5 months [Q1: 12.0; Q3: 43.0]. Clinical and renal ultrasound examinations were carried out 1 day and 1 month after EC, and then every 6 months after EC. At the follow-up examination approximately 6 months after EC, voiding cysto-urethrography (VCUG) was performed. All patients with OC underwent diuretic renography.OC occurred in 44 (5.5%) of 798 children, in some cases as late as 60 months after endoscopic injection of the bulking agent PPC for correction of VUR. Univariate analysis revealed that younger age (P < .001), higher grade of VUR (P < .001), male gender (P < .001), second injection (P = .003), and EC injection using hydrodistension implantation technique (HIT; P < .001) represented significant risk factors. At multivariate analysis, only male gender (P = .0078), younger age (P = .0044), HIT technique (P < .0001), and second injection (P = .04) represented significant risk factors for the occurrence of OC.We identified young age, male gender, high reflux grade, HIT technique, and second endoscopic injections as factors associated with the risk of OC after EC of VUR using PPC as a bulking agent. Thus, patients who have undergone EC with PPC must be monitored sonographically for occurrence of OC for at least 60 months after the intervention.


Assuntos
Resinas Acrílicas/uso terapêutico , Polímeros/uso terapêutico , Obstrução Ureteral/etiologia , Ureteroscopia/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Risco , Ureteroscopia/efeitos adversos , Refluxo Vesicoureteral
6.
J Urol ; 204(4): 769-777, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32364838

RESUMO

PURPOSE: We compared the hydrocoated silicone stent (Coloplast Imajin® hydro) to Percuflex™ Plus stent (Boston Scientific) in terms of patient comfort and quality of life after flexible ureteroscopy for stone disease over a 5-week prospective followup. MATERIALS AND METHODS: This is a multicenter, single-blind, prospective, randomized trial of 141 patients treated with flexible ureteroscopy for renal stones. Primary outcome was Ureteral Stent Symptom Questionnaire (USSQ) Body Pain Index recorded before Double-J® stent removal at day (D) 20. Secondary endpoints were USSQ scores at intermediate dates (D2, D7, D20) and 2 weeks after stent withdrawal (D35), occurrence of adverse events and stent encrustation. RESULTS: The trial was completed by 113 (80.1%) patients. Mean (SD) USSQ body pain scores were 25% lower at D20 for the silicone stent at 18.7 (11.4) vs 25.1 (14.2) (p=0.015). No difference in terms of adverse events and safety profile was observed. USSQ urinary symptoms scores at D2, D7 and D20 were lower in the silicone stent group at 26.4 (7.7) vs 31.8 (8.1) at D20 (p <0.001). The use of USSQ self-questionnaires was associated with a limited number of missing or incomplete answers. CONCLUSIONS: The primary results of this large sample prospective randomized controlled study comparing the silicone Imajin hydro stents to the Percuflex Plus stent show that silicone stents are associated with significantly less patient discomfort. We would recommend their use in patients who require stenting for stone disease.


Assuntos
Cálculos Renais/cirurgia , Qualidade de Vida , Stents , Ureteroscopia , Adulto , Feminino , Humanos , Cálculos Renais/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Silicones , Método Simples-Cego , Avaliação de Sintomas , Ureter , Ureteroscopia/métodos
7.
Curr Urol Rep ; 21(7): 27, 2020 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-32444987

RESUMO

PURPOSE OF REVIEW: Urologists are at significant risk due to radiation exposure (RE) from endourological procedures for stone disease. Many techniques described have shown a reduction of RE. The purpose of this article is to review available protocols to decrease RE during such procedures and provide tips and tricks for their implementation. RECENT FINDINGS: Several low-radiation and radiation-free protocols for percutaneous nephrolithotomy and flexible ureteroscopy have been described as an attempt to reduce RE during surgery. Beginning with specific checklists to ensure adequate C-arm usage, fluoroless procedures are based on endoscopic assessment, tactile guidance, and use of ultrasound to avoid fluoroscopy. A specific preoperative checklist and low radiation or complete fluoroless radiation endourological procedures have shown to be effective, feasible, and safe. It is recommended for urologists to be aware of the risks of RE and apply the "ALARA" (As Low As Reasonably Achievable) protocols.


Assuntos
Nefrolitotomia Percutânea/métodos , Exposição Ocupacional/prevenção & controle , Exposição à Radiação/prevenção & controle , Ureteroscopia/métodos , Cálculos Urinários/diagnóstico por imagem , Lista de Checagem , Fluoroscopia , Humanos , Ultrassonografia , Cálculos Urinários/cirurgia
8.
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
9.
Chirurgia (Bucur) ; 115(1): 63-68, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155400

RESUMO

Introduction: The retrograde flexible ureteroscopic approach is an effective and relatively safe procedure. The aim of this study was to retrospectively evaluate the safety of retrograde flexible ureteroscopic approach in patients with pyelo-caliceal stones on a significant number of cases. Material and method: We retrospectively evaluated 4500 procedures of flexible retrograde ureteroscopic approach for pyelocaliceal lithiasis, operated in two centers. The complications associated with this approach were retrospectively evaluated and data was stratified according to Clavien- Dindo classification. Results: Intraoperative incidents occurred during 5.2% of the procedures. Overall complications occurred in 18.9% of the procedures. Around two thirds of them were septic complications, the use of ureteral access sheath proving to be a protective factor against them. Most of the complications were mild. In 4.8% of the cases in which ureteral access sheath was used, we encountered grade 2 and 3 ureteral wall lesions. Conclusions: Most of the complications associated with retrograde flexible ureteroscopic approach are mild, regardless the type of flexible ureteroscope used. Reduced pressure in the pyelo-caliceal system is important to maintain the complications rate low, both septic and non-septic.


Assuntos
Cálculos Renais/cirurgia , Ureteroscopia/efeitos adversos , Humanos , Morbidade , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscopia/métodos
10.
Medicine (Baltimore) ; 99(10): e19324, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150068

RESUMO

The surgical outcomes of patients with single ureteral stones who had undergone ureteroscopic Holmium laser lithotripsy as outpatients and compare them with those of patients who had received the same procedure as inpatients. Records were obtained from January 2012 to December 2016 for selected patients who had undergone the above mentioned procedure at our institution. Patients were excluded if their ECOG performance status was ≥2, presented with multiple stones or concomitant renal stones, had histories of cancer or congenital urinary system abnormalities, or had undergone urinary system reconstruction surgery. Patients could decide whether to receive the procedure as an outpatient or inpatient. All surgeries were performed by a single surgeon. Patients preoperative, operative, and postoperative data were recorded. The clinical results, such as urinary tract infection, analgesic requirement, rate of returning to the emergency room, stone clearance, surgical complications, and medical expenditure for the treatment courses were analyzed and compared between the 2 cohorts. In total, 303 patients met the inclusion criteria. Among them, 119 patients decided to receive ureteroscopic laser lithotripsy as outpatients, whereas 184 decided to be inpatients. The outpatient cohort was younger (P < .001), had smaller stone diameters (P < .001), and fewer comorbidity factors (P = .038). Patients with a history of stone manipulation favored receiving the procedure under admission (P < .001). After 1:1 propensity score matching, no significant differences were discovered between the cohorts with regard to operative time, rate of lithotripsy failure, and operative complications. Furthermore, rates of stone clearance, post-op urinary tract infection, analgesic requirement, and returning to the emergency room were comparable between the 2 groups. However, the medical expenditure was significantly lower in the outpatient cohort (P < .001). Our data revealed that outpatient ureteroscopic lithotripsy with a Holmium laser was more economical compared with the inpatient group and achieved favorable outcomes for patients with a single ureteral stone.


Assuntos
Litotripsia a Laser/tendências , Pacientes Ambulatoriais/estatística & dados numéricos , Cálculos Ureterais/complicações , Cálculos Ureterais/terapia , Adulto , Idoso , Feminino , Humanos , Litotripsia a Laser/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Cálculos Ureterais/epidemiologia , Ureteroscopia/métodos , Ureteroscopia/tendências
11.
BMC Urol ; 20(1): 10, 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32013936

RESUMO

BACKGROUND: Approximately 80% of patients with indwelling ureteral stents experience stent related symptoms (SRS). We believe SRS can be reduced through altering the composition of ureteral stents to a less firm material. Therefore, we aim to compare modern silicone and polyurethane ureteral stents in terms of SRS intensity and safety. METHODS: From June 2018 to October 2018, patients from two distinct clinical centers were prospectively enrolled in the study and stratified (non-randomly) into either control group A, patients who received polyurethane stents (Rüsch, Teleflex), or experimental group B, patients who received silicone stents (Cook Medical). Each participant completed a survey 1 h after stent insertion, in the middle of the stent dwelling period, and before stent removal or ureteroscopy noting body pain and overactive bladder via the visual analog scale pain (VASP) and overactive bladder (OAB) awareness tool, respectively. Additionally, successfulness of stent placement, hematuria, number of unplanned visits, and stent encrustation rates were assessed within each group. RESULTS: A total of 50 patients participated in the study, control group A consisted of 20 patients and experimental group B consisted of 30 patients. Participants in group B, silicone ureteral stents, demonstrated significantly lower mean values of VASP 2 weeks prior to stent removal and promptly before stent removal (p = 0.023 and p = 0.014, respectively). No other comparisons between the two groups were statistically significant. CONCLUSIONS: Compared to polyurethane ureteral stents, silicone ureteral stents are associated with lower body pain intensity assessed by VASP 2 weeks before stent removal and at the time of stent removal. TRIAL REGISTRATION: Current Controlled Trials NCT04000178. Retrospectively registered on June 26, 2019.


Assuntos
Remoção de Dispositivo/métodos , Medição da Dor/métodos , Poliuretanos , Silicones , Stents , Ureter/cirurgia , Adulto , Cateteres de Demora/efeitos adversos , Remoção de Dispositivo/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Stents/efeitos adversos , Ureteroscopia/efeitos adversos , Ureteroscopia/métodos , Adulto Jovem
12.
Curr Opin Urol ; 30(2): 135-143, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31905178

RESUMO

PURPOSE OF REVIEW: Active stone removal has been entirely revolutionized in the past decades. Smaller instruments, scope and laser technology advancements and novel lithotripter modalities have entirely changed the way urological surgeons treat stones. Nevertheless novel technologies may lead to different and difficult to manage complications. Accurate knowledge of indications, limitations and technical details of these novel modalities can significantly decrease complication rates. The purpose of this review is to provide the most recently acquired knowledge to decrease patient's morbidity after active stone removal. RECENT FINDINGS: Complications of active stone removal are well known for many years, nevertheless novel technologies in stone management can substantially differentiate their rates. Minimal invasive techniques are becoming even more minimal which reflects on the complications. SUMMARY: Mastering the novel techniques in active stone removal and knowing their inherent limitations, in association with the recognition of predisposing factors and preventing measures have led to a highly acceptable low complication rate. Further refinements and technical improvement will reduce even more the complication incidence in the future.


Assuntos
Litotripsia/efeitos adversos , Urolitíase/cirurgia , Competência Clínica , Humanos , Litotripsia/instrumentação , Litotripsia/métodos , Litotripsia/normas , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Ureteroscopia/efeitos adversos , Ureteroscopia/métodos , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodos
13.
Curr Opin Urol ; 30(2): 120-129, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31990816

RESUMO

PURPOSE OF REVIEW: The aim of the article is to evaluate the actual role of extracorporeal shock-wave lithotripsy (ESWL) in the management of urolithiasis based on the new developments of flexible ureterorenoscopy (FURS) and percutaneous nephrolithotomy (PCNL). RECENT FINDINGS: In Western Europe, there is a significant change of techniques used for treatment of renal stones with an increase of FURS and a decrease of ESWL. The reasons for this include the change of indications, technical improvement of the endourologic armamentarium, including robotic assistance. Mostly relevant is the introduction of digital reusable and single-use flexible ureterorenoscopes, whereas micro-PCNL has been abandoned. Some companies have stopped production of lithotripters and novel ideas to improve the efficacy of shock waves have not been implemented in the actual systems. Promising shock-wave technologies include the use of burst-shock-wave lithotripsy (SWL) or high-frequent ESWL. The main advantage would be the very fast pulverization of the stone as shown in in-vitro models. SUMMARY: The role of ESWL in the management of urolithiasis is decreasing, whereas FURS is constantly progressing. Quality and safety of intracorporeal shock-wave lithotripsy using holmium:YAG-laser under endoscopic control clearly outweighs the advantages of noninvasive ESWL. To regain ground, new technologies like burst-SWL or high-frequent ESWL have to be implemented in new systems.


Assuntos
Endoscopia , Cálculos Renais/cirurgia , Litotripsia , Procedimentos Cirúrgicos Robóticos , Endoscopia/métodos , Endoscopia/tendências , Humanos , Terapia a Laser , Lasers de Estado Sólido/uso terapêutico , Litotripsia/métodos , Litotripsia/tendências , Nefrolitotomia Percutânea/métodos , Nefrolitotomia Percutânea/tendências , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/tendências , Resultado do Tratamento , Ureteroscopia/instrumentação , Ureteroscopia/métodos , Ureteroscopia/tendências , Urolitíase/cirurgia
14.
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
15.
World J Urol ; 38(1): 213-218, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30949802

RESUMO

PURPOSE: To report the outcomes of paediatric ureteroscopy (URS) for stone disease from a specialist endourology centre in the UK. Ureteroscopy for management of stone disease has increased worldwide and is now being done more commonly in the paediatric age group. METHODS: Data were analysed retrospectively from a database maintained between April 2010 and May 2018. Consecutive patients ≤ 16 years of age undergoing semi-rigid or flexible URS for stone disease were included. Stone size and stone-free rate (SFR) were routinely assessed using an ultrasound (USS) and/or plain KUB XR. Complications were graded according to the Clavien-Dindo classification and recorded within 30 days post-procedure and readmissions within 90 days after the procedure were also captured. RESULTS: Over the 8-year period between April 2010 and April 2018, 81 patients with a mean age of 8.8 years (range 18 months-16 years) and a male to female ratio 1:1.1 underwent 102 procedures (1.28 procedure/patient to be stone free). Of the 81 patients, 29 (35.8%) had comorbidities, with 26 (32%) having multiple comorbidities. The mean (± SEM) single and overall stone size was 9.2 mm (± 0.48, range 3-30 mm) and 11.5 mm (± 0.74, range 4-46 mm) respectively, with 22 (27.1%) having multiple stones. Thirty-five (34.7%) had stent in situ pre-operatively. The stone location was in the ureter (26.6%), lower pole (35.4%), and renal pelvis (16.5%), with 22/81(27%) having multiple stones and 21/102 (20.5%) where a ureteral access sheath (UAS) was used. With a mean hospital stay of 1.2 days, the initial and final SFR was 73% and 99%, respectively, and 61/102 (60%) had ureteric stent placed at the end of the procedure. While there were no intra-operative complications, the readmission rate was less than 1% and there were only three early complications recorded. This included a case each of prolonged admission for pain control (grade I), urinary retention (grade II) and post-operative sepsis requiring a brief ITU admission (grade IV). CONCLUSION: Our study demonstrates that in appropriate setting a high stone-free rate can be achieved with minimal morbidity for paediatric patients. There is potentially a need to factor the increasing role of URS in future paediatric urolithiasis guidelines.


Assuntos
Cálculos Renais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Ureteroscopia/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Cálculos Renais/diagnóstico , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Reino Unido , Ureteroscopia/estatística & dados numéricos
16.
World J Urol ; 38(1): 159-165, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30993427

RESUMO

PURPOSE: There have recent reports in the literature of increased rates of bladder recurrence (BR) after radical nephroureterectomy (RNU) when diagnostic flexible ureteroscopy (DFU) was performed before RNU. The technical heterogeneity of DFU was a major bias in these studies. Our purpose was to evaluate the impact of a standardized DFU technique before RNU on the risk of BR. METHODS: A retrospective monocenter study including patients who underwent RNU for upper tract urothelial carcinoma (UTUC) between 2005 and 2017. 171 patients were identified. 78 patients were excluded owing to a history of bladder cancer before RNU or neo-adjuvant/adjuvant chemotherapy. 93 included patients were stratified according to pre-RNU ureteroscopy (DFU + 70 patients) or no pre-RNU ureteroscopy (DFU-23 patients). The standardized DFU technique consisted of systematic ureteral sheath (ch9-10), flexible ureteroscopy, biopsy, and drainage with a mono-J/bladder catheter to avoid contact of contaminated urine of the upper tract with the bladder. RESULTS: Epidemiological, initial staging, and postoperative tumoral characteristics were similar in both groups. Mean follow-up was 35 months [2-166], 47(50%) BR occurred with 41(87%) in the DFU + group, and pre-RNU-DFU was an independent predictive factor of BR (OR = 4[1.4-11.9], P = 0.01) (Cox regression model). The characteristics of BR were similar in both groups, although BR occurred earlier in DFU + (427 days vs. 226 days (P = 0.07)). CONCLUSION: Bladder recurrence after diagnostic ureteroscopy + nephroureterectomy was high despite technical precautions to avoid contact of bladder mucosa with contaminated urine from the upper urinary tract. Post-DFU endovesical instillation should be investigated.


Assuntos
Carcinoma de Células de Transição/diagnóstico , Invasividade Neoplásica/prevenção & controle , Nefroureterectomia/métodos , Cuidados Pré-Operatórios/métodos , Neoplasias Ureterais/diagnóstico , Ureteroscopia/métodos , Neoplasias da Bexiga Urinária/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biópsia/métodos , Carcinoma de Células de Transição/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Ureterais/cirurgia , Bexiga Urinária/patologia , Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/cirurgia
17.
Curr Opin Urol ; 30(2): 166-170, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31834083

RESUMO

PURPOSE OF REVIEW: Ureteral stents are necessary in the routine practice of an urologist. Choosing the correct stent and being aware of the options available will allow urologists to provide the best possible care for patients and value to the healthcare system. This review seeks to educate urologists regarding improvements in stent technology currently available or in development. RECENT FINDINGS: Research from around the world is underway to discover an ideal stent - one that is comfortable for patients, resists infection and encrustation and is affordable for hospital systems. Stent design alterations and stent coatings are revealing reductions in encrustation and bacterial colonization. Biodegradable stents and magnetic stents are being tested to prevent the discomfort of cystoscopic removal. Intraureteral stents are proving efficacious while eliminating an irritating coil from the bladder and the symptoms associated with it. SUMMARY: The studies highlighted in this review provide encouraging results in the pursuit of the ideal stent while opening discussion around new concepts and further areas of research.


Assuntos
Implantação de Prótese/efeitos adversos , Implantação de Prótese/normas , Stents/efeitos adversos , Stents/normas , Ureter/cirurgia , Ureteroscopia/efeitos adversos , Implantes Absorvíveis , Materiais Revestidos Biocompatíveis , Constrição Patológica/etiologia , Constrição Patológica/prevenção & controle , Remoção de Dispositivo/instrumentação , Remoção de Dispositivo/métodos , Remoção de Dispositivo/normas , Remoção de Dispositivo/tendências , Humanos , Desenho de Prótese , Ureteroscopia/instrumentação , Ureteroscopia/métodos , Infecções Urinárias/etiologia , Infecções Urinárias/microbiologia , Infecções Urinárias/prevenção & controle , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/instrumentação , Procedimentos Cirúrgicos Urológicos/métodos
18.
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
19.
Minerva Urol Nefrol ; 72(1): 30-37, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31692305

RESUMO

INTRODUCTION: To review current studies and conduct a meta-analysis on the topic of laparoscopic ureterolithotomy (LU) versus ureteroscopic lithotripsy (URSL) with holmium laser for large proximal ureteral stones. EVIDENCE ACQUISITION: A systematic research of PubMed, Ovid, Scopus (up to March 2019), and citation lists was performed to identify eligible comparative studies. All studies comparing LU versus URSL with holmium laser in proximal ureteral stones were included. Statistical analyses were performed using the Cochrane Collaboration's Review Manager (RevMan) 5.3 software. EVIDENCE SYNTHESIS: Overall, seven studies were included in analysis involving 884 patients (LU 387; URSL 497). Our meta-analysis showed that LU group had bigger stone size than URSL group (WMD 0.19 cm; P=0.001). LU group was associated with longer operative time (WMD 36.29 min; P<0.001), and length of hospital stay (WMD 1.24 d; P=0.04). However, LU group showed better initial stone-free rate (OR 11.03; P<0.001), and final stone-free rate (OR 22.37; P<0.001). There were no significant differences in all complications (RR 1.06; P=0.76). While, LU group had fewer Clavien Dindo score ≥3 complications (RR 0.21; P=0.002), fewer ureteral stricture (RR 0.26; P=0.04), and lower need of auxiliary procedures (RR 0.09; P<0.001) compared with URSL group. CONCLUSIONS: LU could provide a higher stone-free rate and fewer severe complications compared with URSL with holmium laser for large proximal ureteral stones. More importantly, LU could also reduce the postoperative ureteral stricture rate.


Assuntos
Laparoscopia/métodos , Litotripsia a Laser/métodos , Ureter/cirurgia , Cálculos Ureterais/cirurgia , Ureteroscopia/métodos , Procedimentos Cirúrgicos Urológicos/métodos , Feminino , Humanos , Litotripsia , Masculino
20.
Int Braz J Urol ; 45(6): 1161-1166, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808404

RESUMO

PURPOSE: To compare two-shift operation mode and single player mode different impact on surgical results and operator comfort in flexible ureteroscopic holmium laser lithotripsy for renal calculi larger than 1.5cm. MATERIALS AND METHODS: From december 2017 to december 2018, 92 patients with renal calculi admitted to Qilu Hospital and were treated through fl exible ureteroscopy. They were randomized in two-shift group (n=50) and single player group (n=42). The operative time, blood loss, hospitalization stay after operation, residual fragments (≥4mm) rate, fragmentation speed, postoperative complications and operator's fatigue score were compared. RESULTS: There was no significant difference between two groups regarding age, gender, illness side, stone size, blood loss, operative time, postoperative hospitalization stay, complications, etc (p >0.05). The fragmentation speed was 44.5±20.0mm3/min in two-shift group compared with 34.2±17.3mm3/min in single player group (p=0.037). Residual fragments (≥4mm) rate after fi rst surgery was 18% in two-shift group, while the residual fragments (≥4mm) rate was 40.5% after first surgery in single player group (p=0.017). The total fatigue score of two-shift group was 8.4 compared to 29.9 in single player group (p <0.001). CONCLUSION: In flexible ureteroscopic holmium laser lithotripsy for the treatment of renal calculi larger than 1.5cm, two-shift operation mode can raise the fragmentation speed and stone clearance rate, as well as signifi cantly lower operator's fatigue level and improve operator's comfort.


Assuntos
Cálculos Renais/cirurgia , Lasers de Estado Sólido/uso terapêutico , Litotripsia a Laser/métodos , Ureteroscopia/métodos , Adulto , Desenho de Equipamento , Ergonomia , Feminino , Humanos , Cálculos Renais/patologia , Tempo de Internação , Litotripsia a Laser/instrumentação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias , Reprodutibilidade dos Testes , Resultado do Tratamento , Ureteroscopia/instrumentação
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