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 ...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.展开更多
Background:Despite the continuous update of guidelines for the management of kidney stones,the ability to predict a successful response to extracorporeal shockwave lithotripsy(SWL)remains a topic of research.This is d...Background:Despite the continuous update of guidelines for the management of kidney stones,the ability to predict a successful response to extracorporeal shockwave lithotripsy(SWL)remains a topic of research.This is due to the need to refine the decision making in the context of technological advancements and current pandemics.This study aimed to determine the predictors of stone-free rate(SFR)after single-session SWL in adult patients with a single kidney stone 10 to 20 mm in diameter.Materials and methods:A retrospective review of the records of patients with a single kidney stone 10 to 20 mm in diameter was performed at a private SWL center from December 2019 to February 2021.Univariate and multivariate analyses were performed for stoneand patient-related factors,using the Student t and Mann-Whitney U tests for the quantitative variables and the Fisher exact and Pearson correlation tests for the qualitative variables.Results:A total of 138 patients were eligible for this study,including 92 men and 46 women.The mean age was 38.6±12.4years,and the mean body mass index(BMI)was 25.9±3.4kg/m^(2).Four weeks after SWL,120 patients(87%)were free of stones,and 18(13%)needed further treatment.Univariate analyses showed that SFR was negatively correlated with increased BMI(p=0.0001),maximum stone length(p=0.0001),transverse diameter of the stone(p=0.0001),number of shocks per session(p=0.052),and Hounsfield unit(HU)(p=0.0001).Multivariate analysis revealed that HU(p=0.009),maximum stone length(p=0.01),BMI(p=0.000),and presence of double-J stent(p=0.034)were independent risk factors for failure of single-session SWL in the treatment of kidney stones 10 to 20 mm in diameter.The estimated average cost per case was USD 450.5.Conclusions:Increased HU,maximum stone length,BMI,and presence of double-J stents were independent risk factors for low SFR after single-session SWL for a kidney stone 10 to 20 mm in diameter.The cost of SWL remains an advantage in the private sector.展开更多
Objectives:The aim of our study was to compare the effects on quality of life(QoL)and stone-free rate(SFR)of percutane nephrolithotomy(PNL)and retrograde intrarenal surgery(RIRS)in patients with renal stones 2-4 cm.Ma...Objectives:The aim of our study was to compare the effects on quality of life(QoL)and stone-free rate(SFR)of percutane nephrolithotomy(PNL)and retrograde intrarenal surgery(RIRS)in patients with renal stones 2-4 cm.Materials and methods:A total of 102 patients with renal pelvis stones were enrolled in this prospective controlled study,of which 52 were performed RIRS and 50 with PNL.The QoL was evaluated by using Short From-36 pre-and post-operatively.Also,the surgical data of all patients during and after the operations were compared between the 2 groups.Results:The mean age,body mass index,stone size and density of the patients in the 2 groups were statistically similar(p>0.05).The SFR of PNL and RIRS were found 94%(47/50)and 73%(38/52),respectively(p<0.01).There were no statistically differences between operation times,minor complication rates and Short From-36 scores of the 2 groups.Hospitalization times were 1.13±0.34days for RIRS and 2.9±5.7days for PNL(p<0.05).While the blood transfusion rate of PNL group was 8%(4/50),none patient was made blood transfusion in RIRS.Conclusions:The results of our study show that the blood transfusion rates and hospitalization times of RIRS group are significantly lower than PNL for management of renal pelvis stone 2-4 cm.Despite these advantages of RIRS,the SFR is significantly lower than PNL for these stones.The effects on QoL of the both interventions before and after surgery were similar.展开更多
The principle of PCNL is the extraction through a nephrostomy channel of kidney stones which are defined as the presence of crystalline concretions in the kidneys. Objectives: The objective of this work was to study t...The principle of PCNL is the extraction through a nephrostomy channel of kidney stones which are defined as the presence of crystalline concretions in the kidneys. Objectives: The objective of this work was to study the epidemiological, clinical and paraclinical aspects of patients with renal lithiasis treated by PCNL and on the other hand the different technical aspects of PCNL. Materials and Methods: This was a retrospective descriptive study, conducted in the urology department of HOGIP, covering the period from January 2015 to January 2019. We studied the demographic and clinical aspects of patients presenting renal lithiasis;we also studied the technical aspects and treatment outcomes. Statistical significance was set for α = 0.05. Results: Our series covered 82 PCNLs performed during the study period. The average age was 45.95 years, the age group [40 - 49 years] was more affected. Our study involved 44 men and 38 women, a sex ratio of 1.15. At the clinic, atypical lumbar pain was more frequent in 45.83% of cases. On URO-CT, the calculations were located more at the pyelic level (31.2%) and lower caliceal (27.2%). The size of stones measured between 15 and 20 mm in 30.52%. The stone density was between 500 and 1000 HU in 47.54% of cases. Intraoperatively, the patients were placed in lateral decubitus in 41.46% of cases. Only one access to the kidney was necessary in 87.8% of cases. The lithoclast was used in 65.85% of cases. The overall success rate (stone free) in our series was 96%. The majority of cases, 41.44%, drainage were done by natural means (totally tubeless). The average duration was 92 minutes. The complications encountered in our experience concerned 10 cases, a rate of 12.19%. Conclusion: Urinary lithiasis is more and more frequent in our regions. The development of Endo-urology offers several therapeutic options. Thus, PCNL occupies an important place in the management of kidney stones.展开更多
Objective:To evaluate the long-term stone-free rate(SFR)of retrograde intrarenal surgery(RIRS)in the treatment of lower pole renal calculi using only basket relocation and identify independent predictors of stone-free...Objective:To evaluate the long-term stone-free rate(SFR)of retrograde intrarenal surgery(RIRS)in the treatment of lower pole renal calculi using only basket relocation and identify independent predictors of stone-free status.Methods:All consecutive patients undergoing RIRS lower pole renal calculi at a single highvolume tertiary center were analyzed retrospectively.Lower pole stones were relocated to the upper pole,where laser lithotripsy was performed.All patients were followed up in the clinic following the surgery and yearly thereafter.The stone-free status was assessed with a combination of an abdominal ultrasound and abdominal X-ray,or an abdominal non-contrast computed tomography if the stones were known to be radiolucent.Results:A total of 480 consecutive patients who underwent RIRS for treatment of lower pole renal calculi,between January 2012 and December 2018,were analyzed from a prospectively maintained database of 3000 ureteroscopies.With a median follow-up time of 18.6 months,the mean SFR was 94.8%.The procedures were unsuccessful in 26(5.4%)patients due to unreachable stones.The median stone size of the unreachable stones was 12 mm(range 10e30 mm).Multivariable logistic regression analysis revealed two predictors of SFR for lower pole stones:a small cumulative stone burden(odds ratio[OR]:0.903,95%confidence interval[CI]:0.867e0.941,p<0.0001)and preoperative ureteral stent insertion(OR:0.515,95%CI:0.318e0.835,pZ0.007).Conclusion:The long-term SFR of RIRS for the treatment of lower pole stones with basket displacement with appropriate patient selection is high.展开更多
基金the Natural Science Foundation of Fujian(No.2017D0010)Young and Middle-aged Backbone Talents Training Project of Fujian(No.2017-ZQN-81)the National Natural Science Foundation of China(No.81970604).
文摘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.
文摘Background:Despite the continuous update of guidelines for the management of kidney stones,the ability to predict a successful response to extracorporeal shockwave lithotripsy(SWL)remains a topic of research.This is due to the need to refine the decision making in the context of technological advancements and current pandemics.This study aimed to determine the predictors of stone-free rate(SFR)after single-session SWL in adult patients with a single kidney stone 10 to 20 mm in diameter.Materials and methods:A retrospective review of the records of patients with a single kidney stone 10 to 20 mm in diameter was performed at a private SWL center from December 2019 to February 2021.Univariate and multivariate analyses were performed for stoneand patient-related factors,using the Student t and Mann-Whitney U tests for the quantitative variables and the Fisher exact and Pearson correlation tests for the qualitative variables.Results:A total of 138 patients were eligible for this study,including 92 men and 46 women.The mean age was 38.6±12.4years,and the mean body mass index(BMI)was 25.9±3.4kg/m^(2).Four weeks after SWL,120 patients(87%)were free of stones,and 18(13%)needed further treatment.Univariate analyses showed that SFR was negatively correlated with increased BMI(p=0.0001),maximum stone length(p=0.0001),transverse diameter of the stone(p=0.0001),number of shocks per session(p=0.052),and Hounsfield unit(HU)(p=0.0001).Multivariate analysis revealed that HU(p=0.009),maximum stone length(p=0.01),BMI(p=0.000),and presence of double-J stent(p=0.034)were independent risk factors for failure of single-session SWL in the treatment of kidney stones 10 to 20 mm in diameter.The estimated average cost per case was USD 450.5.Conclusions:Increased HU,maximum stone length,BMI,and presence of double-J stents were independent risk factors for low SFR after single-session SWL for a kidney stone 10 to 20 mm in diameter.The cost of SWL remains an advantage in the private sector.
基金supported by Research Fund of Manisa Celal Bayar Univeristy
文摘Objectives:The aim of our study was to compare the effects on quality of life(QoL)and stone-free rate(SFR)of percutane nephrolithotomy(PNL)and retrograde intrarenal surgery(RIRS)in patients with renal stones 2-4 cm.Materials and methods:A total of 102 patients with renal pelvis stones were enrolled in this prospective controlled study,of which 52 were performed RIRS and 50 with PNL.The QoL was evaluated by using Short From-36 pre-and post-operatively.Also,the surgical data of all patients during and after the operations were compared between the 2 groups.Results:The mean age,body mass index,stone size and density of the patients in the 2 groups were statistically similar(p>0.05).The SFR of PNL and RIRS were found 94%(47/50)and 73%(38/52),respectively(p<0.01).There were no statistically differences between operation times,minor complication rates and Short From-36 scores of the 2 groups.Hospitalization times were 1.13±0.34days for RIRS and 2.9±5.7days for PNL(p<0.05).While the blood transfusion rate of PNL group was 8%(4/50),none patient was made blood transfusion in RIRS.Conclusions:The results of our study show that the blood transfusion rates and hospitalization times of RIRS group are significantly lower than PNL for management of renal pelvis stone 2-4 cm.Despite these advantages of RIRS,the SFR is significantly lower than PNL for these stones.The effects on QoL of the both interventions before and after surgery were similar.
文摘The principle of PCNL is the extraction through a nephrostomy channel of kidney stones which are defined as the presence of crystalline concretions in the kidneys. Objectives: The objective of this work was to study the epidemiological, clinical and paraclinical aspects of patients with renal lithiasis treated by PCNL and on the other hand the different technical aspects of PCNL. Materials and Methods: This was a retrospective descriptive study, conducted in the urology department of HOGIP, covering the period from January 2015 to January 2019. We studied the demographic and clinical aspects of patients presenting renal lithiasis;we also studied the technical aspects and treatment outcomes. Statistical significance was set for α = 0.05. Results: Our series covered 82 PCNLs performed during the study period. The average age was 45.95 years, the age group [40 - 49 years] was more affected. Our study involved 44 men and 38 women, a sex ratio of 1.15. At the clinic, atypical lumbar pain was more frequent in 45.83% of cases. On URO-CT, the calculations were located more at the pyelic level (31.2%) and lower caliceal (27.2%). The size of stones measured between 15 and 20 mm in 30.52%. The stone density was between 500 and 1000 HU in 47.54% of cases. Intraoperatively, the patients were placed in lateral decubitus in 41.46% of cases. Only one access to the kidney was necessary in 87.8% of cases. The lithoclast was used in 65.85% of cases. The overall success rate (stone free) in our series was 96%. The majority of cases, 41.44%, drainage were done by natural means (totally tubeless). The average duration was 92 minutes. The complications encountered in our experience concerned 10 cases, a rate of 12.19%. Conclusion: Urinary lithiasis is more and more frequent in our regions. The development of Endo-urology offers several therapeutic options. Thus, PCNL occupies an important place in the management of kidney stones.
文摘Objective:To evaluate the long-term stone-free rate(SFR)of retrograde intrarenal surgery(RIRS)in the treatment of lower pole renal calculi using only basket relocation and identify independent predictors of stone-free status.Methods:All consecutive patients undergoing RIRS lower pole renal calculi at a single highvolume tertiary center were analyzed retrospectively.Lower pole stones were relocated to the upper pole,where laser lithotripsy was performed.All patients were followed up in the clinic following the surgery and yearly thereafter.The stone-free status was assessed with a combination of an abdominal ultrasound and abdominal X-ray,or an abdominal non-contrast computed tomography if the stones were known to be radiolucent.Results:A total of 480 consecutive patients who underwent RIRS for treatment of lower pole renal calculi,between January 2012 and December 2018,were analyzed from a prospectively maintained database of 3000 ureteroscopies.With a median follow-up time of 18.6 months,the mean SFR was 94.8%.The procedures were unsuccessful in 26(5.4%)patients due to unreachable stones.The median stone size of the unreachable stones was 12 mm(range 10e30 mm).Multivariable logistic regression analysis revealed two predictors of SFR for lower pole stones:a small cumulative stone burden(odds ratio[OR]:0.903,95%confidence interval[CI]:0.867e0.941,p<0.0001)and preoperative ureteral stent insertion(OR:0.515,95%CI:0.318e0.835,pZ0.007).Conclusion:The long-term SFR of RIRS for the treatment of lower pole stones with basket displacement with appropriate patient selection is high.
