Effect of Preoperative Double-J Ureteral Stenting before Flexible Ureterorenoscopy on Stone-free Rates and Complications

The effect of preoperative Double-J(DJ)ureteral stenting before flexible ureterorenoscopy(FURS)in the treatment for urinary stones was evaluated.We retrospectively enrolled 306 consecutive patients who underwent FURS from Jan.2014 to Dec.2017.All the patients were classified into two groups according to whether they had DJ ureteral stenting before FURS.Baseline characteristics(age,sex,stone location,stone size,surgical success rate,operation time,stone-free rate of the first day after surgery,stone-free rate of the first month after surgery,total complication rate)were compared using Chi-square test for categorical variables and Kruskal-Wallis test for continuous variables.In total,306 patients were included in this study.The group of DJ stenting before FURS included 203(66.3%)patients,and non-DJ stenting before FURS was observed in 103(33.7%)patients.The group of DJ stenting before FURS was significantly associated with a shorter operation time(53.8 vs.59.3 min,P<0.001),a higher stone-free rate of the first day after surgery(69.0%vs.51.5%,P=0.003).However,statistical significant differences were not found in the age,sex,stone location,stone size,surgical success rate,stone-free rate of the first month after surgery(89.2%vs.81.6%,P=0.065)and total complication rate(5.4%vs.9.7%,P=0.161)between the two groups.Preoperative DJ ureteral stenting before FURS could reduce the operation time and increase stone-free rate of the first day after surgery.However,it might not benefit the stone-free rate of the first month after surgery and reduce the complication rate.Preoperative DJ stenting should be not routinely performed.

手术并Double-J管治疗输尿管结石并发急性肾功能衰竭的体会

本文报告３０例输尿管结石并发急性肾功能衰竭患者，采用开放手术取石并应用Ｄｏｕｂｌｅ－Ｊ管（双Ｊ管）作输尿管支架及内引流，所有病例术后１个月左右肾功能完全恢复正常，无一例发生漏尿及吻合口狭窄，收到满意效果。说明及时手术解除梗阻及采用有效内引流有利于这类病人的康复。

The effect of perirenal fat stranding on infectious complications after ureterorenoscopy in patients with ureteral calculi

Objective:Perirenal fat stranding(PFS)is linear areas of soft-tissue attenuation in the perirenal space on non-contrast computed tomography.The present study aimed to investigate whether PFS is associated with infectious complications after ureterorenoscopy(URS)in patients with ureteral calculi in any location.Methods:The data of 602 patients with ureteral stones who underwent URS were analyzed retrospectively.The patients were divided into two groups as Group 1(PFS not detected)and Group 2(PFS detected).Gender,and age of patients,size,side,and location of the stone,operation time,double-J stent insertion status,perioperative ureter injury,postoperative infection after URS and related complications,and duration of hospital stay were compared.Results:While PFS was not detected in 530 patients,PFS was detected in 72 patients.The mean age,male/female ratio,side and localization of the stones,operation time,and perioperative insertion of the double-J after lithotripsy were statistically similar(p>0.05).The median stone diameter was smaller in Group 2(9 mm vs.8 mm)(p=0.033).Fever was observed in 30 and 38 patients in Group 1 and Group 2,respectively(p=0.0001).Urinary tract infection was detected in 24 and 27 patients in Group 1 and Group 2,respectively(p=0.0001).The urosepsis did not occur in any patients in Group 1,whereas 8(11.1%)patients in Group 2 experienced urosepsis(p=0.0001).Conclusion:According to the results of the present study,patients with ureteral stones accompanied by PFS are much more prone to ureteral injuries and infectious complications such as urinary tract infection,fever,and sepsis after URS.

Evaluation of Extracorporeal Shockwave Lithotripsy in the Management of Renal and Ureteral Calculi

Aim: To evaluate the efficacy of extracorporeal lithotripsy in the management of renal and ureteric calculi in a urology center in Douala, Cameroon. Materials and Methods: This is a retrospective study carried out over six years, between January 2014 and December 2020. All the patients were treated using a Direx Integra lithotripter, with the number of shockwaves ranging from 1200 to 3500, without anaesthesia and were discharged a few hours after the procedure on the same day. In a majority (63.75%) of the cases, the calculi were incidental findings. A Double-J stent was indicated in two patients and preceded extracorporeal lithotripsy because of renal colic and signs of urinary tract infection. Results: We recruited a total of 122 patients with a mean age of 42.19 ± 13.08. We had 65 (53.3%) males and all patients had at least one calculus confirmed by CT scan with a mean size of 13.84 ± 4.17 mm, 85 (69.7%) patients became completely stone-free after a maximum of four sessions of extracorporeal lithotripsy (ESWL). 21 (17.2%) patients had intermediate results, being asymptomatic and/or having less than three residual fragments that measured less than 4 mm. The failure rate was 13.9%, with 17 patients still having more than three fragments measuring more than 4 mm after 4 ESWL sessions. 1 (0.8%) had septic shock as a post ESWL complication while 6 (4.9%) benefitted from a complimentary medical and/or surgical treatment (double J stent placement). Conclusion: The management of renal and ureteral calculi through extracorporeal lithotripsy in adults seems to be particularly effective for renal calculi measuring less than 20 mm and ureteral calculi measuring less than 15 mm. Extracorporeal lithotripsy, which can be performed on an outpatient basis (and without anaesthesia) is associated with minimal complications, and remains the option of choice for most upper urinary tract calculi.

Persistent fever during treatment of a pregnant woman with acute pyelonephritis

Acute pyelonephritis is a serious infection in pregnancy. It is presented with fever, shaking chills and flank pain. Intravenous hydration and antimicrobial therapy are sufficient in the treatment unless pyelonephritis is complicated. In case of fever persisting for more than 48 h despite appropriate antimicrobial treatment, a possible complication such as urinary tract obstruction, abscess or phlegmon should be considered. Here, we present an 18-year-old pregnant woman with acute pyelonephritis whose persistent fever returned to normal after double-J ureteral stent was placed even if she had no finding of such a complication.

The"ins and outs"of the magnetic ureteral stent:A novel innovation in Endourology

Background:Ureteral stents play a major role in maintaining ureteral patency.Various innovations are advocated in the design and subsequent removal of traditional double-J ureteral stents,such as the magnetic-end double-J ureteral stent(MEDJUS).This stent facilitates outpatient removal using a magnetic stent removal device.This systematic review was conducted to analyze the published role,efficacy,and outcomes of MEDJUS.Materials and methods:After PROSPERO registration(CRD42021235739),an electronic database search(PubMed,EMBASE,Cochrane Library,Scopus,and Web of Science)was performed on December 31,2020.The search terms were as follows:"magnetic,""ureteric,""stent,""double-J,""urotech,"and"Black-Star."Results:Nine studies with atotalof 685 patients wereincluded in the systematic review.The totalnumber of MEDJUS procedures used was 498(73%)compared to the 187(27%)traditional double-J stent method.Magnetic-end double-J ureteral stent extraction failure was reported in 8 cases(1.61%).Compared with traditional stents,MEDJUS showed a cost benefit in 5/5 studies.Better pain scores(during stent in situ)and(at stent removal)were observed in 2/3 and 3/4 of the studies,respectively.Conclusions:Magnetic-end double-J ureteral stent may serve as a viable alternative to traditional double-J stents,offering cost and pain benefits with similar rates of complications.Magnetic-end double-J ureteral stent also offers relative ease of extraction and a reduced need for inpatient removal.This ambulatory stent removal technique has forged its use in modern urological practice.