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1.
Urologe A ; 58(11): 1304-1312, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31506761

RESUMO

The increase of medical knowledge and technical innovations together with the demographic change represent a challenge for the new conception of guidelines and clinical studies. The present S2k guidelines, which are exclusively concerned with kidney and ureteral stones, should support the treatment of urolithiasis in hospitals and private practices and provide information on urolithiasis for patients. Increasing interdisciplinary collaboration in stone treatment is also demonstrated in the number of professional and working groups participating in the update of the new guidelines. The present S2k guidelines emerged from a consensus process and demonstrate the current recommendations in step with actual practice. They provide decision-making guidance for diagnostics, treatment and metaphylactic measures based on expert opinions and available published fundamental evidence from the literature.


Assuntos
Litotripsia/normas , Guias de Prática Clínica como Assunto , Ureteroscopia/normas , Urolitíase/cirurgia , Procedimentos Cirúrgicos Urológicos/normas , Urologia/normas , Tratamento por Ondas de Choque Extracorpóreas , Humanos , Cálculos Renais , Nefrolitotomia Percutânea , Resultado do Tratamento , Cálculos Ureterais , Urolitíase/diagnóstico , Urolitíase/prevenção & controle , Procedimentos Cirúrgicos Urológicos/instrumentação
2.
BMC Med Educ ; 19(1): 318, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438934

RESUMO

BACKGROUND: Difficult surgical procedures may result in a higher mental workload, leading to increased fatigue and subsequent errors. This study was aimed to investigate the effect of repeated simulation training in ureterorenoscopy in a high-fidelity setting on the performance and mental workload of novice operators. METHODS: Medical students voluntarily participated in the present simulation study. After a didactic and video-based lecture, they underwent simulation training involving a renal stone case, including a rigid cystoscope component (task 1, performing a WHO checklist, assembling a scope, and insertion of a guide-wire and an access sheath after examining the bladder) and a flexible ureterorenoscope component (task 2, retrieving a stone located in the upper calyx using a basket after inspecting the upper, middle, and lower calyx). Training was performed in a mock operating theater. Technical skills were assessed by one author (an experienced urologist) onsite using an Objective Structured Assessment of Technical Skills (OSATS) score at each training session. The mental workload was subjectively evaluated by the National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire after each training session. RESULTS: Seventeen students completed a minimum of 6 training sessions (male: female = 10: 7, median age of 22) over a median of 21 days (range, 10-32). In both tasks 1 and 2, the OSATS score improved over the 6 sessions with evidence of plateauing (MANOVA model, task 1: p < 0.0001, task 2: p < 0.0001). In contrast, the NASA-TLX score persistently decreased without plateauing (task 1: p = 0.0005, task 2: p = 0.0028). CONCLUSIONS: Under repeated simulation training in ureterorenoscopy in a high-fidelity setting, participants showed a continual decrease of the mental workload, while the improvement of technical skills reached a plateau over the 6 sessions. Our study showed the important benefit of simulation training to reduce the mental workload by repeated scenario training before actual clinical practice.


Assuntos
Competência Clínica/normas , Treinamento por Simulação , Estudantes de Medicina , Ureteroscopia/educação , Atenção/fisiologia , Humanos , Internato e Residência , Estresse Psicológico , Análise e Desempenho de Tarefas , Fatores de Tempo , Ureteroscopia/normas , Carga de Trabalho
3.
BMC Urol ; 19(1): 58, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272430

RESUMO

BACKGROUND: The use of ureteral access sheath (UAS) during ureteroscopy is controversial. We aimed to explore practice patterns of UAS during ureteroscopy for nephrolithiasis among endourologists worldwide. METHODS: A 15-question survey was designed using the SurveyMonkey® platform. The questions covered the background and professional experience of the potential respondents, indications for UAS insertion, UAS caliber and possible complications associated with its use. The questions were anonymously tabulated in order to determine practice patterns of UAS during ureteroscopy for nephrolithiasis among endourologists. The survey was then distributed via e-mail to all the Endourological Society members. RESULTS: 216 members responded. 99.53% of the respondents practice as endourologists, 63.4% are fellowship trained and 74.4% are at least 6 years post-fellow. 73.2% practice in an academic facility. 77.3% perform at least 100 ureteroscopies annually. 46 and 76% routinely use UAS for the treatment of ureteral and kidney stones, respectively. In both cases, the 12/14 access sheath is the most common. 42% use UAS in primary ureteroscopy. 90.3% believe that a double J stent insertion is not mandatory prior to UAS insertion. 79.1% think the use of UAS does not increase postoperative complications rate, and if the latter does encounter, then most likely it is either a ureteral stricture (93.2%) or pain (48%). CONCLUSIONS: UAS is commonly used by highly skilled endourologists during ureteroscopy. 12/14 UAS is mostly used. Ureteral stricture and post-operative pain are proposed as possible complications following UAS introduction, however pre-stenting is not mandatory as overall low complication rate is expected.


Assuntos
Nefrolitíase/cirurgia , Inquéritos e Questionários , Ureter/cirurgia , Ureteroscopia/métodos , Urologistas , Humanos , Cálculos Renais/diagnóstico , Cálculos Renais/cirurgia , Nefrolitíase/diagnóstico , Ureter/patologia , Cálculos Ureterais/diagnóstico , Cálculos Ureterais/cirurgia , Ureteroscopia/normas , Urologistas/normas
4.
Urol Int ; 102(2): 187-193, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30481771

RESUMO

BACKGROUND: The Post-Ureteroscopic Lesion Scale (PULS) is a validated, standardised scale that classifies iatrogenic ureteral lesions during ureteroscopy (URS). OBJECTIVE: To determine risk factors for the various PULS-grades caused by URS. METHOD: We prospectively investigated the independent influence of various risk factors in correlation with PULS-Grade 1+ and 2+ on 307 patients with ureterorenoscopic stone treatment from 14 German urologic departments. RESULTS: The following are the outcomes of the study: 117 (38.4%) and 188 (61.6%) of the calculi (median stone size 6 mm) were found in the kidney or ureter; 70% and 82.4% underwent preoperative or postoperative ureteral stenting; 44.3 and 7.2% received laser or ballistic lithotripsy; 60% of the patients presented with PULS grade 1+ and 8% with PULS grade of 2+. Only intracorporal lithotripsy revealed a significant independent risk factor for PULS grade 1+ or 2+. Both laser and ballistic therapies raised the probability of PULS grade 1+ by the factors 3.6 (p < 0.001) and 3.9 (p = 0.021), respectively. The ORs in conjunction with PULS grade 2+ were 3.1 (p = 0.038) and 5.8 (p = 0.014) respectively. Neither endpoint exhibited a significant difference regarding the lithotripsic procedure (laser vs. ballistic). CONCLUSION: Intracorporal lithotripsy is associated with a significant increase in damage to the ureter; further research is needed to determine its long-term effects.


Assuntos
Doença Iatrogênica , Cálculos Renais/cirurgia , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Ureter/lesões , Cálculos Ureterais/cirurgia , Ureteroscópios/efeitos adversos , Ureteroscopia/efeitos adversos , Adulto , Idoso , Benchmarking , Feminino , Alemanha , Humanos , Cálculos Renais/diagnóstico , Litotripsia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Intervalo Livre de Progressão , Estudos Prospectivos , Fatores de Risco , Stents , Fatores de Tempo , Cálculos Ureterais/diagnóstico , Ureteroscopia/instrumentação , Ureteroscopia/normas
5.
Prog Urol ; 28(6): 329-335, 2018 May.
Artigo em Francês | MEDLINE | ID: mdl-29705059

RESUMO

INTRODUCTION: Military people are inapt for presence of urinary stones. In this specific population, the treatment of stones is even more aggressive than for the general population without recommendation. The final decision about aptitude is the responsibility of the military doctor. Whereas, ureteroscopy has its place there and must done by any urologist. METHODS: The purpose of this study was to estimate the results of treatments by ureteroscopy in this population. Success was defined by the complete absence of fragment visualized in the imaging of control operating comment and so the end of the inaptitude time. RESULTS: Between 2009 and 2016, forty-two were treated for ureteral or renal calculi. The population comprises of 93% men, 35 years old on average. The stones were mainly multiple (more 2) and the medium size is 5mm; sixteen (42.9%) was at the left and eight (19%) was bilateral. In 78.8% (78) of the cases there was a stone in renal position whose 50% (39) still at the lower calyx. In total, 5% of the patients were stone-free in 2 sessions on average. The average deadline of inaptitude of the initial consultation in the resumption of work was of 6 months. In 4% of the cases there was a complication operating rank 4. CONCLUSION: This study confirms the feasibility, the weak harmlessness of ureteroscopy and the lesser deadline of inaptitude. Every urologist can treat this specific population. The patient must be informed and accept the treatment because of excluding referential. LEVEL OF EVIDENCE: 4.


Assuntos
Aptidão , Competência Clínica , Medicina Militar , Ureteroscopia , Urolitíase/cirurgia , Adulto , Testes de Aptidão , Competência Clínica/normas , Avaliação Educacional , Feminino , Humanos , Cálculos Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Medicina Militar/educação , Medicina Militar/normas , Militares , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscopia/educação , Ureteroscopia/métodos , Ureteroscopia/normas , Cálculos Urinários/cirurgia , Adulto Jovem
6.
Eur Urol Focus ; 4(4): 614-620, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-28753871

RESUMO

BACKGROUND: Simulation-based training offers an acceptable adjunct to the traditional mentor-apprentice model in helping trainees to traverse the early stages of the learning curve for ureteroscopy and percutaneous renal surgery. In addition, nontechnical skills are increasingly important in preventing adverse events in the operating room, and simulation-based training can be used for training in such skills. Incorporation of simulation into formalised, standardised, and validated curricula offers an applicable method for training residents. OBJECTIVE: To develop a curriculum for urolithiasis procedures incorporating technical and nontechnical skills training for implementation across Europe. DESIGN, SETTING, AND PARTICIPANTS: An international panel of experts from EULIS, EUREP, ESU and ESUT was consulted in five stages. The study incorporated a mix of qualitative and quantitative data for collection and analysis. Responses were drawn out in (1) an opinion survey and (2) a curriculum development survey, which were discussed in (3) a focus group meeting. Group responses from this meeting were analysed for themes, which were discussed at (4) a focus group meeting, where consensus was reached among the group. Data analysis and integration at this stage were used to draft the curriculum. RESULTS AND LIMITATIONS: All group meetings were transcribed from the focus group discussion. Eight themes were generated, into which all data were categorised. These were: need for a training curriculum; curriculum objectives; curriculum structure; curriculum content; teaching platforms and tools; assessment and certification; validation and implementation; and global integration of the curriculum. A curriculum, including recommended simulators for use, was subsequently proposed. CONCLUSIONS: We propose a comprehensive curriculum for training in urolithiasis. Additional planning is required for full validation and implementation before it can be used to train residents. PATIENT SUMMARY: Stone disease accounts for a major proportion of surgical interventions worldwide. We describe a consensus guideline for effective training of stone surgeons.


Assuntos
Currículo , Avaliação Educacional/métodos , Treinamento por Simulação/métodos , Ureteroscopia , Urolitíase , Urologia/educação , Competência Clínica , Consenso , Europa (Continente) , Humanos , Curva de Aprendizado , Ureteroscopia/educação , Ureteroscopia/normas , Urolitíase/diagnóstico , Urolitíase/cirurgia
7.
BMC Urol ; 17(1): 50, 2017 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-28662708

RESUMO

BACKGROUND: There are three minimally invasive methods for the management of large upper impacted ureteral stones: mini-percutaneous nephrolithotomy (MPCNL), transurethral ureteroscope lithotripsy (URSL), and retroperitoneal laparoscopic ureterolithotomy (RPLU). This study aimed to compare MPCNL, URSL, and RPLU, and to evaluate which one is the best choice for large upper impacted ureteral stones. METHODS: Between January 2012 and December 2015, at the Department of Urology, Huai'an First People's Hospital, 150 consecutively enrolled patients with a large upper impacted ureteral stone (>15 mm) were included. The patients were randomly divided (1:1:1) into the MPCNL, URSL, and RPLU groups. The primary endpoint was success of stone removal measured 1 month postoperatively and the secondary endpoints were intraoperative and postoperative parameters and complications. RESULTS: Fifteen patients needed auxiliary ESWL after URSL, and 3 patients after MPCNL, but none after RPLU. The stone clearance rate was 96% (48/50) in the MPCNL group and 72% (33/46) in the URSL group. In the RPLU group the stones were completely removed and the stone clearance rate was 100% (48/48) (P = 0.021 vs. URSL; P = 0.083 vs. MPCNL). Operation-related complications were similar among the three groups (all P > 0.05). Hospital stay was shorter in the URSL group compared with MPCNL (P = 0.003). Operation time was the shortest with URSL and the longest with MPCNL (all P < 0.05). CONCLUSIONS: MPCNL and RPUL are more suitable for upper ureteral impacted stones of >15 mm. URSL could be considered if the patient is not suitable for general anesthesia, or the patient requests transurethral uretroscopic surgery. TRIAL REGISTRATION: This study was registered with the Chinese Clinical Trial Registry (Registration number: ChiCTR-INR-17011507 ; Registration date: 2017-5-22).


Assuntos
Laparoscopia/normas , Litotripsia/normas , Nefrolitotomia Percutânea/normas , Cálculos Ureterais/cirurgia , Ureteroscopia/normas , Adulto , Feminino , Seguimentos , Humanos , Laparoscopia/efeitos adversos , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Resultado do Tratamento , Cálculos Ureterais/diagnóstico , Cálculos Ureterais/epidemiologia , Ureteroscopia/efeitos adversos
8.
Urologe A ; 55(10): 1297-1301, 2016 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-27596847

RESUMO

The treatment of urolithiasis is still one of the most frequent tasks in the daily urological practice. Driven by the technological developments, patient demands and also personal experiences of urologists, many interventional treatment options have been established. To identify the most suitable treatment option, it is of utmost importance to consider not only stone size and localization but also the individual situation of the patient and the published evidence, which despite all efforts often lags behind the technical and clinical reality.


Assuntos
Litotripsia/normas , Nefrostomia Percutânea/normas , Assistência Centrada no Paciente/normas , Guias de Prática Clínica como Assunto , Ureteroscopia/normas , Urolitíase/terapia , Terapia Combinada/normas , Medicina Baseada em Evidências/normas , Humanos , Radiologia/normas , Resultado do Tratamento , Urolitíase/diagnóstico , Urologia/normas
9.
Urologe A ; 55(7): 904-22, 2016 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-27325405

RESUMO

Every tenth German citizen will suffer from at least one urinary calculus during the lifetime. The diagnostics, treatment and follow-up treatment of urolithiasis are, therefore, part of the daily routine practice for all urologists in hospitals and private practices as well as in many other disciplines, such as general practitioners, internists, nephrologists and pediatricians. Although the diagnostics and therapy have experienced substantial alterations over the last 10 years, the possibilities of metabolic diagnostics and secondary prevention for patients at risk are, unfortunately and unjustly, in many places very poorly represented. The present S2k guidelines, which for the first time were established in an interdisciplinary consensus process, represent the current practical recommendations and, whenever possible, use tables and algorithms in order to facilitate easy reference in the routine daily work. Last but not least, this greatly simplifies the measures for metaphylaxis.


Assuntos
Litotripsia/normas , Guias de Prática Clínica como Assunto , Ureteroscopia/normas , Urolitíase/diagnóstico , Urolitíase/terapia , Urologia/normas , Técnicas de Diagnóstico Urológico/normas , Medicina Baseada em Evidências , Alemanha , Humanos , Resultado do Tratamento , Ultrassonografia/normas
10.
Eur Urol ; 70(1): 188-194, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27086502

RESUMO

BACKGROUND: Thanks to advancements in the endoscopic armamentarium, flexible ureteroscopy (fURS) has become a viable and attractive option for the treatment of renal stones because of its high stone-free rates (SFRs) and low morbidity. OBJECTIVE: To describe our surgical technique for fURS, step-by-step, for the treatment of renal stones and to assess its effectiveness and safety. DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis of 316 consecutive patients who underwent fURS for renal stones at our institution between March 2014 and September 2015 was performed. SURGICAL PROCEDURE: Ureteroscopy and laser lithotripsy using a standardized technique with last-generation flexible ureteroscopes. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Clinical data were collected in a dedicated database. Intraoperative and postoperative outcomes were assessed. A descriptive statistical analysis was performed. RESULTS AND LIMITATIONS: The mean overall stone size was 16.5 ± 7.9mm. Ureteral access sheath placement was possible in 287 patients (90.8%). At 1-mo follow-up, the overall primary SFR was 79.1%; the secondary and tertiary SFRs were 89.5% and 91.5%, respectively. The mean operative time was 72.6 ± 27.5min. The mean number of procedures was 1.27. Complications were reported in 92 patients (29.1%) overall, with Clavien grade 1 in 55 patients (17.4%), grade 2 in 30 patients (9.5%), grade 3 in 6 patients (1.9%), grade 4 in 1 patient (0.3%), and grade 5 in none. The main limitation of the study was the retrospective nature. CONCLUSIONS: The fURS procedure is safe and effective for the treatment of renal stones. A staged procedure is necessary to achieve stone-free status with large calculi. PATIENT SUMMARY: Flexible ureteroscopy is an effective treatment with low complication rates for the majority of renal stones. Both the modern highly technological armamentarium and surgical know-how should be available.


Assuntos
Cálculos Renais/cirurgia , Ureteroscopia/métodos , Adulto , Feminino , Humanos , Litotripsia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Ureteroscopia/efeitos adversos , Ureteroscopia/normas
11.
Eur Urol ; 69(3): 475-82, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26344917

RESUMO

CONTEXT: Management of urinary stones is a major issue for most urologists. Treatment modalities are minimally invasive and include extracorporeal shockwave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PNL). Technological advances and changing treatment patterns have had an impact on current treatment recommendations, which have clearly shifted towards endourologic procedures. These guidelines describe recent recommendations on treatment indications and the choice of modality for ureteral and renal calculi. OBJECTIVE: To evaluate the optimal measures for treatment of urinary stone disease. EVIDENCE ACQUISITION: Several databases were searched to identify studies on interventional treatment of urolithiasis, with special attention to the level of evidence. EVIDENCE SYNTHESIS: Treatment decisions are made individually according to stone size, location, and (if known) composition, as well as patient preference and local expertise. Treatment recommendations have shifted to endourologic procedures such as URS and PNL, and SWL has lost its place as the first-line modality for many indications despite its proven efficacy. Open and laparoscopic techniques are restricted to limited indications. Best clinical practice standards have been established for all treatments, making all options minimally invasive with low complication rates. CONCLUSION: Active treatment of urolithiasis is currently a minimally invasive intervention, with preference for endourologic techniques. PATIENT SUMMARY: For active removal of stones from the kidney or ureter, technological advances have made it possible to use less invasive surgical techniques. These interventions are safe and are generally associated with shorter recovery times and less discomfort for the patient.


Assuntos
Urolitíase/cirurgia , Procedimentos Cirúrgicos Urológicos/normas , Urologia/normas , Humanos , Laparoscopia/normas , Litotripsia/normas , Nefrostomia Percutânea/normas , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Stents , Resultado do Tratamento , Ureteroscopia/normas , Cateterismo Urinário/normas , Urolitíase/diagnóstico , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/instrumentação
12.
Urol Int ; 95(3): 329-35, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26397097

RESUMO

INTRODUCTION: To analyze the primary stone free rate (pSFR) of flexible ureterorenoscopy (fURS) in the treatment of renal stones and to identify clinical predictors for the primary freedom from renal stones. MATERIALS AND METHODS: Two hundred and seventy five patients, who underwent fURS for kidney stones were analyzed. RESULTS: Index stone size was 6 mm. The stone was located in the lower calyx in 48%. Ureteral access sheath was used in 97%. Operation time was 35 min and primary stone clearance was 83%. pSFR increased from 74% in 2012 to 83% in 2013 and 90% in 2014 (p = 0.001). Preoperative stenting, index stone size, cumulative stone size, lithotripsy, ureteral access sheath and operation time were significantly correlated with the pSFR by univariate analysis. Multivariate regression analysis showed index stone size, cumulative stone size, ureteral access sheath and operation time as independent parameters for pSFR. CONCLUSIONS: fURS for kidney stones is safe with a high pSFR. Clinical parameters for pSFR are stone size, use of ureteral access sheath and operation time. In future, the effective use of fURS for the removal of kidney stones needs to be checked by prospective randomized trials.


Assuntos
Cálculos Renais/cirurgia , Padrão de Cuidado , Ureteroscopia/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Centros de Atenção Terciária , Ureteroscópios
13.
Arch. esp. urol. (Ed. impr.) ; 67(7): 591-604, sept. 2014. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-128734

RESUMO

OBJETIVO: La ureteroscopia ha constituido una de las técnicas más revolucionarias de la urología moderna para el tratamiento de la litiasis urinaria. El desarrollo de nuevos ureteroscopios, de las diferentes técnicas auxiliares, así como de los métodos de fragmentación han sido las causas de esta evolución. Describir la evolución de los sistemas de imagen, las técnicas auxiliares para el manejo de los cálculos, así como los métodos de fragmentación desde sus inicios a nuestros días, poniendo especial énfasis en las diferentes tendencias relativas a la técnica que nos deparará el futuro próximo. MÉTODOS: Se realiza una revisión bibliográfica destacando el desarrollo de los detalles técnicos, así como el impacto sobre los resultados en términos de tasa libre de litiasis, y desarrollo de complicaciones. CONCLUSIONES: La ureteroscopia ha evolucionado hasta convertirse actualmente en una técnica de primera línea para el tratamiento de la litiasis del tracto urinario superior. Los avances tecnológicos producidos tanto en los equipos de imagen como en las diferentes técnicas auxiliares y en los métodos de fragmentación han permitido la mejora de las tasas libres de litiasis y han disminuido la morbilidad de la técnica. Las mejoras en los sistemas de imagen, los instrumentos auxiliares y los métodos de fragmentación permitirán progresivamente el tratamiento de litiasis más complejas del tracto urinario superior (AU)


OBJECTIVES: Ureteroscopy has been considered one of the most revolutionary techniques in modern urology for the treatment of urinary stones. The developments of new ureteroscopes, ancillary techniques or fragmentation devices have contributed to that evolution. To describe the evolution of imaging systems, auxiliary techniques and fragmentation methods for treatment of urinary stones from its beginnings to present time, with special emphasis on the different trends in the technique for the nearest future. METHODS: A bibliographic review is performed highlighting the development of technical details, and the impact on the results in terms of stone-free rate, and complications. CONCLUSIONS: Ureteroscopy has evolved into a first-line technique for the treatment of upper urinary tract stones. Technological advances in both imaging equipment and on different ancillary techniques and fragmentation methods have enabled improved stone free rates and decreased morbidity of the technique. Improvements in imaging systems, auxiliary instruments and fragmentation methods allow the treatment of stones progressively more complex (AU)


Assuntos
Humanos , Masculino , Feminino , Litíase/terapia , Litíase , Ureteroscopia/instrumentação , Ureteroscopia/métodos , Ureteroscopia/tendências , Procedimentos Cirúrgicos Urológicos/tendências , Ureteroscopia/normas
14.
Eur Urol ; 66(6): 1046-51, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25027366

RESUMO

BACKGROUND: The Clinical Research Office of the Endourological Society (CROES) undertook the Ureteroscopy Global Study to establish a prospective global database to examine the worldwide use of ureteroscopy (URS) and to determine factors affecting outcome. OBJECTIVE: To investigate the influence of case volume on the outcomes of URS for ureteral stones. DESIGN, SETTING, AND PARTICIPANTS: The URS Global Study collected prospective data on consecutive patients with urinary stones treated with URS at 114 centres worldwide for 1 yr. Centres were identified as low or high volume based on the median overall annual case volume. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Pre- and intraoperative characteristics, and postoperative outcomes in patients at low- and high-volume centres were compared. The relationships between case volume and stone-free rate (SFR), stone burden, complications, and hospital stay were explored using multivariate regression analysis. RESULTS AND LIMITATIONS: Across all centres, the median case volume was 67; 58 and 56 centres were designated as low volume and high volume, respectively. URS procedures at high-volume centres took significantly less time to conduct. Mean SFR was 91.9% and 86.3% at high- and low-volume centres, respectively (p<0.001); the adjusted probability of a stone-free outcome increased with increasing case volume (p<0.001). Patients treated at a high-volume centre were less likely to need retreatment, had shorter postoperative hospital stay, were less likely to be readmitted within 3 mo, and had fewer and less severe complications. At case volumes approximately >200, the probability of complications decreased with increasing case volume (p=0.02). The study is limited by the heterogeneity of participating centres and surgeons and the inclusion of patients treated by more than one approach. CONCLUSIONS: In the treatment of ureteral stones with URS, high-volume centres achieve better outcomes than low-volume centres. Several outcome measures for URS improve with an increase in case volume. PATIENT SUMMARY: Outcomes following treatment of ureteral stones by ureteroscopy (URS) were studied in a large group of patients at centres worldwide. The proportion of successful procedures (ie, those in which patients became stone free) increased as the annual volume of URS at a hospital increased. Hospital stays were shorter and postoperative complications were less likely at high-volume hospitals. We conclude that for URS, the best outcomes are seen in patients treated at high-volume hospitals.


Assuntos
Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Cálculos Ureterais/terapia , Ureteroscopia/estatística & dados numéricos , Adulto , Idoso , Competência Clínica , Feminino , Hospitais com Alto Volume de Atendimentos/normas , Hospitais com Baixo Volume de Atendimentos/normas , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Readmissão do Paciente , Análise de Regressão , Sociedades Médicas , Resultado do Tratamento , Ureteroscopia/efeitos adversos , Ureteroscopia/normas
15.
Rev. chil. urol ; 79(2): 39-43, 2014. ilus
Artigo em Espanhol | LILACS | ID: lil-785341

RESUMO

En el último tiempo, en la urología, ha ganado terreno la cirugía endoluminal que es menos invasiva pero técnicamente más compleja que la cirugía abierta. Esto sumado a la menor exposición a procedimientos prácticos de los residentes ha puesto la alerta en la necesidad de establecer mecanismos de evaluación objetivos de las competencias técnicas para garantizar la seguridad de los pacientes. El objetivo de nuestro trabajo fue desarrollar un checklist de tareas específicas para la evaluación del procedimiento ureterolitotomía endoscópica. MATERIALES Y MÉTODOS: Para el desarrollo del checklist se utilizó el método de Delphi modificado que busca consenso entre expertos a través de la evaluación y revisión sucesiva de un formulario y el análisis estadístico de las respuestas. RESULTADOS: Con la participación de ocho urólogos expertos en procedimientos endourológicos de distintas instituciones del país se obtuvo un checklist de 23 ítems para el procedimiento ureterolitotomía endoscópica. CONCLUSIÓN: Se describe y presenta el desarrollo de un checklist de tareas específicas para el procedimiento ureterolitotomía endoscópica que permitirá la evaluación de residentes tanto en el laboratorio de simulación como en el pabellón quirúrgico.


In the last years, endoluminal surgery, a less invasive but technically more complex procedure, has gained ground in urology over open surgery. The reduction on exposure to practical procedures of residents has added an alert on the need to establish a mechanism for objective assessment of technical skills to ensure patients safety. The aim of this study was develop a tasks-specific checklist in order to assess resident performing endoscopic ureterolithotomy. MATERIALS AND METHODS: The modified Delphi method was used for the development of the checklist. This technic tries to find a consensus among experts through the evaluation and subsequent revision of a questionnaire and the statistical analysis of the responses. RESULTS: Eight endourologists procedures experts from different institutions of the country participate on this study helping to develop a 23-item checklist for ureterolithotomy endoscopic procedure. CONCLUSIONS: We describe and present the development of a tasks-specific checklist for ureterolithotomy endoscopic that will allow the evaluation of residents in both simulation laboratory and surgical ward.


Assuntos
Humanos , Lista de Checagem , Competência Clínica , Cálculos Ureterais/cirurgia , Ureteroscopia/normas
16.
Urologe A ; 52(8): 1135-45; quiz 1146-8, 2013 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-23860670

RESUMO

The natural course of untreated, asymptomatic calyceal calculi has not yet been clearly defined regarding disease progression and risk of surgical interventions. The decision for an active treatment of calyceal calculi is based on stone composition, stone size and symptoms. Extracorporeal shockwave lithotripsy (ESWL) has a low complication rate and is recommended by the current guidelines of the German (DGU) and European (EAU) Associations of Urology as a first-line therapy for the treatment of calyceal stones <2 cm in diameter. However, immediate removal of stones is not achieved with ESWL. The primary stone-free rates (SFR) after ESWL depend on stone location and stone composition and can show remarkable differences. Minimally invasive procedures, such as percutaneous nephrolitholapaxy and ureteroscopy are alternatives for the treatment of calyceal stones which have low morbidity and high primary SFR when performed in centres of excellence.


Assuntos
Cálculos Renais/diagnóstico , Cálculos Renais/terapia , Litotripsia/normas , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Guias de Prática Clínica como Assunto , Ureteroscopia/normas , Urologia/normas , Humanos , Litotripsia/efeitos adversos
17.
J Endourol ; 26(10): 1329-34, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22563938

RESUMO

BACKGROUND AND PURPOSE: Controversy exists in the literature regarding flexible ureterorenoscopy (F-URS) durability, with a variable expected number of uses from a new F-URS. In this study, a tertiary center experience with the use of two consecutive F-URS is reported and suggestions as to how to improve durability further are made. MATERIALS AND METHODS: All F-URS performed in the same tertiary care center between July 2009 and February 2011, with two new instruments Flex-X, were reviewed retrospectively. All renal pathology were included. Ureteral cases were excluded. A 9.5F semirigid ureteroscope was always used at the start for a ureteral optical predilation and to explore the upper urinary tract for possible lithotripsy/laser ablation/biopsy. The F-URS was introduced sequentially to explore the remaining calices. Data pertaining to the procedure were collected. The method of sterilization was complete immersion with Cidex®. RESULTS: The instruments were substituted after 113 and 102 procedures, respectively. The first F-URS was used for a total operative time of 79 hours and 10 minutes while the second one was used for 71 hours and 25 minutes (mean 75 hours and 15 min). Procedure duration was 15 to 175 minutes (mean 58 min). The flexible instruments were used for a mean of 42 minutes per procedure (range 13-153 min). The indications for F-URS were therapeutic in 75.4% and diagnostic in 22.8% of the cases. For lower pole calculi, the stone was relocated in 65.2% and managed with the nonflexed flexible instrument 90% of the time. The most common causes of damage of F-URS were: Deflection mechanism impairment, inner sheath damage, and fiberoptic bundle breaks. CONCLUSIONS: Increased durability of F-URS was from a variety of factors, a key element of which was the method of sterilization, while routine use of the semirigid instrument initially further contributed significantly to increase the number of F-URS procedures, saving overall costs.


Assuntos
Tecnologia de Fibra Óptica/tendências , Litotripsia/métodos , Ureteroscópios/normas , Ureteroscopia/normas , Cálculos Urinários/terapia , Desenho de Equipamento/tendências , Humanos , Litotripsia/normas , Estudos Retrospectivos , Ureteroscopia/métodos , Cálculos Urinários/diagnóstico
18.
Ann R Coll Surg Engl ; 93(8): 639-41, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22041243

RESUMO

INTRODUCTION: The aim of this study was to validate the use of non-contrast computed tomography (CT) with a ureteral stent in situ instead of ureteroscopy for identification of renal tract stones. METHODS: All patients who had stents inserted for renal tract stones and underwent non-contrast CT with the stent in situ followed by ureteroscopy between May 2008 and October 2009 at The Canberra hospital, Australia, were analysed retrospectively. Statistical analysis was performed to compare any differences between CT and ureteroscopy in the identification of stones. RESULTS: Overall, 57 patients were included in the study. The difference between CT and ureteroscopy findings was statistically significant. CT identification of stones with a stent in situ had a sensitivity of 86%, a specificity of 46%, a positive predictive value of 63%, a negative predictive value of 76% and an accuracy of 67%. CONCLUSIONS: Our study suggests that non-contrast CT is inferior to the 'gold standard' of ureteroscopy. It lacks sensitivity, specificity, positive predictive value, negative predictive value and accuracy. Therefore, we cannot recommend using non-contrast CT to replace ureteroscopy.


Assuntos
Cálculos Renais/diagnóstico , Stents , Tomografia Computadorizada Espiral/normas , Cálculos Ureterais/diagnóstico , Ureteroscopia/normas , Humanos , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada Espiral/métodos
19.
BJU Int ; 108(6): 798-805; discussion 805, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21884354

RESUMO

The aim of the present review was to study factors influencing training and the maintenance of skills in performing ureteroscopy (URS). We searched on the following keywords in the Medline, Embase and Cochrane databases: renal or ureteric stone; ureteroscopy; endourology; educational; training; learning curve; expertise; skill; residency; practice; simulator; and robotics. We have defined, when possible, levels and grades of evidence, based on 2009 recommendations of the Oxford Centre for Evidence-Based Medicine. We found that technological advancement and surgeon experience is a predictive factor for success or complications of URS. Experience may be related to special endourology training, time passed after basic training and the number of procedures performed. Studies suggest that a resident must perform a certain amount of cases to gain proficiency with URS, but there is still a need for well designed studies for the learning curve of URS to be accurately defined. Training models may be useful for training in URS and stone disintegration. Stone centres that provide all the endoscopic treatment options seem to provide the best conditions to ensure a sufficient volume of patients required. Defining minimum requirements for training in URS and for maintaining certification is a major challenge, as is defining the learning curve in URS. Careful curriculum design in high-volume stone centres may be the key to optimizing URS training.


Assuntos
Competência Clínica/normas , Internato e Residência , Ureteroscopia/educação , Cálculos Urinários/cirurgia , Simulação por Computador , Instrução por Computador/instrumentação , Currículo , Humanos , Curva de Aprendizado , Robótica/educação , Robótica/normas , Ureteroscopia/normas
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