Pub Date : 2024-04-01DOI: 10.1016/j.ajur.2024.02.002
Pilar Bahilo-Mateu , Alberto Budia-Alba
Objective
Extracorporeal shockwave lithotripsy (SWL) currently plays an important role in the treatment of urinary tract lithiasis. The purpose of this article was to describe new concepts and procedural strategies that would improve results using SWL as a treatment for urolithiasis, thereby achieving better clinical practice.
Methods
A systematic review process was carried in PubMed/PMC from January 2003 to March 2023. A narrative synthesis of the most important aspects has been made.
Results
The important recommendations for the adequate selection of the candidate patient for treatment with SWL are summarized, as well as the new strategies for a better application of the technique. Aspects about intraoperative position, stone localization and monitoring, analgesic control, machine and energy settings, and measures aiming at reduced risk of complications are described.
Conclusion
To achieve the therapeutic goal of efficient stone disintegration without increasing the risk of complications, it is necessary to make an adequate selection of patients and to pay special attention to several important factors in the application of treatment. Technological development in later generation devices will help to improve current SWL results.
{"title":"Extracorporeal shockwave lithotripsy in the management of urinary stones: New concepts and techniques to improve outcomes","authors":"Pilar Bahilo-Mateu , Alberto Budia-Alba","doi":"10.1016/j.ajur.2024.02.002","DOIUrl":"10.1016/j.ajur.2024.02.002","url":null,"abstract":"<div><h3>Objective</h3><p>Extracorporeal shockwave lithotripsy (SWL) currently plays an important role in the treatment of urinary tract lithiasis. The purpose of this article was to describe new concepts and procedural strategies that would improve results using SWL as a treatment for urolithiasis, thereby achieving better clinical practice.</p></div><div><h3>Methods</h3><p>A systematic review process was carried in PubMed/PMC from January 2003 to March 2023. A narrative synthesis of the most important aspects has been made.</p></div><div><h3>Results</h3><p>The important recommendations for the adequate selection of the candidate patient for treatment with SWL are summarized, as well as the new strategies for a better application of the technique. Aspects about intraoperative position, stone localization and monitoring, analgesic control, machine and energy settings, and measures aiming at reduced risk of complications are described.</p></div><div><h3>Conclusion</h3><p>To achieve the therapeutic goal of efficient stone disintegration without increasing the risk of complications, it is necessary to make an adequate selection of patients and to pay special attention to several important factors in the application of treatment. Technological development in later generation devices will help to improve current SWL results.</p></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"11 2","pages":"Pages 143-148"},"PeriodicalIF":2.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214388224000134/pdfft?md5=bb5f932b58adbe161b5a0366650f9ddf&pid=1-s2.0-S2214388224000134-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139820374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.ajur.2023.03.007
Andreia Cardoso , Aparício Coutinho , Gonçalo Neto , Sara Anacleto , Catarina Laranjo Tinoco , Nuno Morais , Mário Cerqueira-Alves , Estevão Lima , Paulo Mota
Objective
To assess if there is a preferable intervention between retrograde ureteral stent (RUS) and percutaneous nephrostomy (PCN) tube, in cases of upper urinary tract stone obstruction with complications requiring urgent drainage, by evaluating outcomes regarding urinary symptoms, quality of life (QoL), spontaneous stone passage, and length of hospital stays, since there is no literature stating the superiority of one modality over the other.
Methods
We searched MEDLINE and other sources for relevant articles in June 2019 without any date restrictions or filters applied. The selection was done first by the title and abstract screening and then by full-text assessment for eligibility. Only randomized controlled trials or cohort studies in patients with hydronephrosis secondary to obstructive urolithiasis that presented comparative data between PCN and RUS placement concerning at least one of the defined outcome measures were included. Lastly, MEDLINE database and PubMed platform were screened again using the same terms, from June 2019 until November 2022.
Results
Of 556 initial articles, seven were included in this review. Most works were considered of moderate-to-high quality. Three studies regarding QoL showed a tendency against stenting, even though only one demonstrated statistically significant negative impact on overall health state. Two works reported significantly more post-intervention urinary symptoms in stenting patients. One article found that PCN is a significant predictor of spontaneous stone passage, when adjusted for stone size and location. Findings on length of hospital stays were not consistent among articles.
Conclusion
PCN appears to be the intervention better tolerated, with less impact on the patient’s perceived QoL and less post-operative urinary symptoms, in comparison with RUS. Nevertheless, further studies with larger samples and a randomized controlled design are suggested.
{"title":"Percutaneous nephrostomy versus ureteral stent in hydronephrosis secondary to obstructive urolithiasis: A systematic review and meta-analysis","authors":"Andreia Cardoso , Aparício Coutinho , Gonçalo Neto , Sara Anacleto , Catarina Laranjo Tinoco , Nuno Morais , Mário Cerqueira-Alves , Estevão Lima , Paulo Mota","doi":"10.1016/j.ajur.2023.03.007","DOIUrl":"10.1016/j.ajur.2023.03.007","url":null,"abstract":"<div><h3>Objective</h3><p>To assess if there is a preferable intervention between retrograde ureteral stent (RUS) and percutaneous nephrostomy (PCN) tube, in cases of upper urinary tract stone obstruction with complications requiring urgent drainage, by evaluating outcomes regarding urinary symptoms, quality of life (QoL), spontaneous stone passage, and length of hospital stays, since there is no literature stating the superiority of one modality over the other.</p></div><div><h3>Methods</h3><p>We searched MEDLINE and other sources for relevant articles in June 2019 without any date restrictions or filters applied. The selection was done first by the title and abstract screening and then by full-text assessment for eligibility. Only randomized controlled trials or cohort studies in patients with hydronephrosis secondary to obstructive urolithiasis that presented comparative data between PCN and RUS placement concerning at least one of the defined outcome measures were included. Lastly, MEDLINE database and PubMed platform were screened again using the same terms, from June 2019 until November 2022.</p></div><div><h3>Results</h3><p>Of 556 initial articles, seven were included in this review. Most works were considered of moderate-to-high quality. Three studies regarding QoL showed a tendency against stenting, even though only one demonstrated statistically significant negative impact on overall health state. Two works reported significantly more post-intervention urinary symptoms in stenting patients. One article found that PCN is a significant predictor of spontaneous stone passage, when adjusted for stone size and location. Findings on length of hospital stays were not consistent among articles.</p></div><div><h3>Conclusion</h3><p>PCN appears to be the intervention better tolerated, with less impact on the patient’s perceived QoL and less post-operative urinary symptoms, in comparison with RUS. Nevertheless, further studies with larger samples and a randomized controlled design are suggested.</p></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"11 2","pages":"Pages 261-270"},"PeriodicalIF":2.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214388223001431/pdfft?md5=67b963992974d28f6569b36716460e00&pid=1-s2.0-S2214388223001431-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138626708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.ajur.2022.08.003
Paul Gravestock , Daniel Cullum , Bhaskar Somani , Rajan Veeratterapillay
Objective
The role of ureteroscopy in the diagnosis of upper tract urothelial carcinoma is yet to be fully determined. We aimed to provide an up to date evaluation of its role and the emerging technologies in the field.
Methods
A literature search of the last two decades (from 24th May, 2001 to 24th May, 2021) was carried out identifying 147 papers for potential inclusion within this narrative review.
Results
Diagnostic ureteroscopy is undeniably useful in its ability to visualise and biopsy indeterminate lesions, and to risk stratify malignant lesions that may be suitable for kidney sparing surgery. However, an increased risk of intravesical recurrence following nephroureterectomy when a prior diagnostic ureteroscopy has been performed, inadequate sampling at biopsy, complications from the procedure, and difficult ureteric access are all potential drawbacks. Furthermore, whilst generally an accurate diagnostic procedure, it risks missing carcinoma in-situ lesions. Despite this, evidence shows that routine use of ureteroscopy changes the management of patients in a large proportion of cases, preventing unnecessary surgery or facilitating kidney sparing surgery. The overall rate of complications is low, and improved biopsy techniques and the use of tissue biomarkers for improved staging and grading are encouraging. The risks of delays to definitive management and post-ureteroscopy intravesical recurrence do not seem to affect survival, and trials are in progress to determine whether intravesical therapy can mitigate the latter. Further promising techniques are being investigated to improve shortcomings, particularly in relation to improved diagnosis of carcinoma in situ and preoperative staging.
Conclusion
Ureteroscopy has a role in the diagnosis of upper tract malignancy, though whether it should be used routinely is yet to be determined.
{"title":"Diagnosing upper tract urothelial carcinoma: A review of the role of diagnostic ureteroscopy and novel developments over last two decades","authors":"Paul Gravestock , Daniel Cullum , Bhaskar Somani , Rajan Veeratterapillay","doi":"10.1016/j.ajur.2022.08.003","DOIUrl":"10.1016/j.ajur.2022.08.003","url":null,"abstract":"<div><h3>Objective</h3><p>The role of ureteroscopy in the diagnosis of upper tract urothelial carcinoma is yet to be fully determined. We aimed to provide an up to date evaluation of its role and the emerging technologies in the field.</p></div><div><h3>Methods</h3><p>A literature search of the last two decades (from 24th May, 2001 to 24th May, 2021) was carried out identifying 147 papers for potential inclusion within this narrative review.</p></div><div><h3>Results</h3><p>Diagnostic ureteroscopy is undeniably useful in its ability to visualise and biopsy indeterminate lesions, and to risk stratify malignant lesions that may be suitable for kidney sparing surgery. However, an increased risk of intravesical recurrence following nephroureterectomy when a prior diagnostic ureteroscopy has been performed, inadequate sampling at biopsy, complications from the procedure, and difficult ureteric access are all potential drawbacks. Furthermore, whilst generally an accurate diagnostic procedure, it risks missing carcinoma <em>in-situ</em> lesions. Despite this, evidence shows that routine use of ureteroscopy changes the management of patients in a large proportion of cases, preventing unnecessary surgery or facilitating kidney sparing surgery. The overall rate of complications is low, and improved biopsy techniques and the use of tissue biomarkers for improved staging and grading are encouraging. The risks of delays to definitive management and post-ureteroscopy intravesical recurrence do not seem to affect survival, and trials are in progress to determine whether intravesical therapy can mitigate the latter. Further promising techniques are being investigated to improve shortcomings, particularly in relation to improved diagnosis of carcinoma <em>in situ</em> and preoperative staging.</p></div><div><h3>Conclusion</h3><p>Ureteroscopy has a role in the diagnosis of upper tract malignancy, though whether it should be used routinely is yet to be determined.</p></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"11 2","pages":"Pages 242-252"},"PeriodicalIF":2.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214388222001059/pdfft?md5=3e98f1903159b1b3b2b8386e1bea7c47&pid=1-s2.0-S2214388222001059-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42609403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.ajur.2023.05.001
Victoria Jahrreiss , Christian Seitz , Fahad Quhal
Objective
To provide a comprehensive review on the existing literature on medical management of urolithiasis.
Methods
A thorough literature review was performed using Medline, PubMed/PMC, Embase, and the Cochrane Database of Systematic Reviews up to December 2022 to identify publications on the medical management of urolithiasis. Studies that assessed dietary and pharmacologic management of urolithiasis were reviewed; studies on medical expulsive therapy were not included in this review.
Results
Medical management of urolithiasis ranges from the prophylactic management of kidney stone disease to dissolution therapies. While most treatment concepts have been long established, large randomized controlled trials are scarce. Dietary modification and increased fluid intake remain cornerstones in the conservative management of urolithiasis. A major limitation for medical management of urolithiasis is poor patient compliance.
Conclusion
Medical management of urolithiasis is more important in patients with recurrent urolithiasis and patients with metabolic abnormalities putting them at higher risk of developing stones. Although medical management can be effective in limiting stone recurrence, medical interventions often fail due to poor compliance.
{"title":"Medical management of urolithiasis: Great efforts and limited progress","authors":"Victoria Jahrreiss , Christian Seitz , Fahad Quhal","doi":"10.1016/j.ajur.2023.05.001","DOIUrl":"10.1016/j.ajur.2023.05.001","url":null,"abstract":"<div><h3>Objective</h3><p>To provide a comprehensive review on the existing literature on medical management of urolithiasis.</p></div><div><h3>Methods</h3><p>A thorough literature review was performed using Medline, PubMed/PMC, Embase, and the Cochrane Database of Systematic Reviews up to December 2022 to identify publications on the medical management of urolithiasis. Studies that assessed dietary and pharmacologic management of urolithiasis were reviewed; studies on medical expulsive therapy were not included in this review.</p></div><div><h3>Results</h3><p>Medical management of urolithiasis ranges from the prophylactic management of kidney stone disease to dissolution therapies. While most treatment concepts have been long established, large randomized controlled trials are scarce. Dietary modification and increased fluid intake remain cornerstones in the conservative management of urolithiasis. A major limitation for medical management of urolithiasis is poor patient compliance.</p></div><div><h3>Conclusion</h3><p>Medical management of urolithiasis is more important in patients with recurrent urolithiasis and patients with metabolic abnormalities putting them at higher risk of developing stones. Although medical management can be effective in limiting stone recurrence, medical interventions often fail due to poor compliance.</p></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"11 2","pages":"Pages 149-155"},"PeriodicalIF":2.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S221438822300067X/pdfft?md5=55e75fb4478117c9cc6fd5d05a4adcc8&pid=1-s2.0-S221438822300067X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47596222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.ajur.2023.07.003
Gede W.K. Duarsa , Yeremia G. Kusumah , Ronald Sugianto , Pande M.W. Tirtayasa , Tjokorda G.B. Mahadewa
Objective
Erectile dysfunction (ED) is a condition of insufficient penile erection, consistently or recurrently, for sexual activity. Tumor necrosis factor-alpha (TNF-α) induces transforming growth factor-beta (TGF-β), which causes the transition of epithelial cells into mesenchymal cells that affect ED. This study aimed to evaluate the roles of TNF-α, TGF-β, degree of lower urinary tract symptoms, and prostatic volume for the presence of ED in benign prostatic hyperplasia (BPH) patients.
Methods
Our study performed an analytic observational retrospective cohort study using secondary data from four hospitals in Bali, Indonesia, including medical records and other administrative data. The sample was BPH patients with several history qualifications.
Results
Our sample was 83 respondents, ranging from 50 years to 80 years, 61 respondents with ED and 22 with non-ED. The International Prostate Symptom Score showed a significant result, which indicates that ED is more common in patients with higher International Prostate Symptom Score (p=0.002). Moreover, the TNF-α of ≥43.9 pg/mg and TGF-β of ≥175.8 pg/mL were significantly associated with the presence of ED in BPH patients (p<0.0001). Despite these results, prostate volume is not significant with ED (p=0.947).
Conclusion
TNF-α, TGF-β, and lower urinary tract symptoms severity can predict the occurrence of ED in BPH, while prostatic volume was not significant.
目的勃起功能障碍（ED）是指阴茎持续或反复勃起不足，无法进行性活动。肿瘤坏死因子-α（TNF-α）可诱导转化生长因子-β（TGF-β），使上皮细胞转化为间质细胞，从而影响 ED。本研究旨在评估 TNF-α、TGF-β、下尿路症状程度和前列腺体积对良性前列腺增生症（BPH）患者出现 ED 的作用。样本为具有多种病史资格的良性前列腺增生症患者。结果我们的样本有 83 名受访者，年龄从 50 岁到 80 岁不等，其中 61 名受访者患有前列腺增生症，22 名受访者没有前列腺增生症。国际前列腺症状评分结果显示，ED在国际前列腺症状评分较高的患者中更为常见（P=0.002）。此外，TNF-α≥43.9 pg/mg和TGF-β≥175.8 pg/mL与良性前列腺增生症患者出现ED显著相关（p<0.0001）。结论TNF-α、TGF-β和下尿路症状严重程度可预测良性前列腺增生症患者发生 ED 的情况，而前列腺体积与 ED 的关系不大。
{"title":"Tumor necrosis factor-alpha, transforming growth factor-beta, degree of lower urinary tract symptoms as predictors of erectile dysfunction in benign prostatic hyperplasia patients","authors":"Gede W.K. Duarsa , Yeremia G. Kusumah , Ronald Sugianto , Pande M.W. Tirtayasa , Tjokorda G.B. Mahadewa","doi":"10.1016/j.ajur.2023.07.003","DOIUrl":"10.1016/j.ajur.2023.07.003","url":null,"abstract":"<div><h3>Objective</h3><p>Erectile dysfunction (ED) is a condition of insufficient penile erection, consistently or recurrently, for sexual activity. Tumor necrosis factor-alpha (TNF-α) induces transforming growth factor-beta (TGF-β), which causes the transition of epithelial cells into mesenchymal cells that affect ED. This study aimed to evaluate the roles of TNF-α, TGF-β, degree of lower urinary tract symptoms, and prostatic volume for the presence of ED in benign prostatic hyperplasia (BPH) patients.</p></div><div><h3>Methods</h3><p>Our study performed an analytic observational retrospective cohort study using secondary data from four hospitals in Bali, Indonesia, including medical records and other administrative data. The sample was BPH patients with several history qualifications.</p></div><div><h3>Results</h3><p>Our sample was 83 respondents, ranging from 50 years to 80 years, 61 respondents with ED and 22 with non-ED. The International Prostate Symptom Score showed a significant result, which indicates that ED is more common in patients with higher International Prostate Symptom Score (<em>p</em>=0.002). Moreover, the TNF-α of ≥43.9 pg/mg and TGF-β of ≥175.8 pg/mL were significantly associated with the presence of ED in BPH patients (<em>p</em><0.0001). Despite these results, prostate volume is not significant with ED (<em>p</em>=0.947).</p></div><div><h3>Conclusion</h3><p>TNF-α, TGF-β, and lower urinary tract symptoms severity can predict the occurrence of ED in BPH, while prostatic volume was not significant.</p></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"11 2","pages":"Pages 280-285"},"PeriodicalIF":2.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214388223000929/pdfft?md5=30481fee0e8afc9362894c7d8b3acabd&pid=1-s2.0-S2214388223000929-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45667096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.ajur.2022.08.004
Gajanan S. Bhat , Anuradha Shastry
Objective
To evaluate and compare the effect of semi-rigid ureterorenoscopy on post-procedural sexual function with three different operating room settings.
Methods
In this prospective randomized study, consecutive sexually active patients with normal pre-operative sexual function undergoing uncomplicated semi-rigid ureterorenoscopy for distal ureteric stones were randomized into three groups, with three different operating room settings. Procedure-related anxiety and sexual function were assessed pre-operatively using Amsterdam Preoperative Anxiety and Information Scale and Brief Sexual Function Inventory (in males) and Female Sexual Function Index-6 (in females), respectively. All the participants were stented following the procedure, and the stent was removed after 3 weeks. Post-procedural sexual function and general discomfort were assessed and compared between three groups at 1 week, 3 weeks, and 12 weeks. The effect of surgery-related anxiety, preoperative sexual function, age, and general discomfort (including stent-related discomfort) on post-procedural sexual function were analyzed using multiple regression analysis. A p-value of less than 0.05 was considered statistically significant.
Results
Totally, 327 eligible patients were randomized into three groups. The group of patients who underwent the procedural with a screen separating the operating area from the patient vision, while the patient could watch the endoscopy through a separate monitor, had better post-procedural sexual function compared to those who had total vision of the operating area as well as to those whose eyes were blocked. This difference was statistically significant. This post-procedural reduction in sexual function could not be attributed to in situ stent alone.
Conclusions
Our study showed that semi-rigid ureterorenoscopy can have significant negative effect on sexual function, which can be reduced with proper preoperative counseling and an ideal operating room settings.
{"title":"Prospective randomized study to evaluate and compare the post-procedural sexual function in patients undergoing semi-rigid ureterorenoscopy for distal ureteric stones in three different operating room settings","authors":"Gajanan S. Bhat , Anuradha Shastry","doi":"10.1016/j.ajur.2022.08.004","DOIUrl":"10.1016/j.ajur.2022.08.004","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate and compare the effect of semi-rigid ureterorenoscopy on post-procedural sexual function with three different operating room settings.</p></div><div><h3>Methods</h3><p>In this prospective randomized study, consecutive sexually active patients with normal pre-operative sexual function undergoing uncomplicated semi-rigid ureterorenoscopy for distal ureteric stones were randomized into three groups, with three different operating room settings. Procedure-related anxiety and sexual function were assessed pre-operatively using Amsterdam Preoperative Anxiety and Information Scale and Brief Sexual Function Inventory (in males) and Female Sexual Function Index-6 (in females), respectively. All the participants were stented following the procedure, and the stent was removed after 3 weeks. Post-procedural sexual function and general discomfort were assessed and compared between three groups at 1 week, 3 weeks, and 12 weeks. The effect of surgery-related anxiety, preoperative sexual function, age, and general discomfort (including stent-related discomfort) on post-procedural sexual function were analyzed using multiple regression analysis. A <em>p</em>-value of less than 0.05 was considered statistically significant.</p></div><div><h3>Results</h3><p>Totally, 327 eligible patients were randomized into three groups. The group of patients who underwent the procedural with a screen separating the operating area from the patient vision, while the patient could watch the endoscopy through a separate monitor, had better post-procedural sexual function compared to those who had total vision of the operating area as well as to those whose eyes were blocked. This difference was statistically significant. This post-procedural reduction in sexual function could not be attributed to <em>in situ</em> stent alone.</p></div><div><h3>Conclusions</h3><p>Our study showed that semi-rigid ureterorenoscopy can have significant negative effect on sexual function, which can be reduced with proper preoperative counseling and an ideal operating room settings.</p></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"11 2","pages":"Pages 331-338"},"PeriodicalIF":2.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214388222001643/pdfft?md5=b5e7703949e5e928e4cd522106a4e178&pid=1-s2.0-S2214388222001643-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46821795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.ajur.2023.11.001
Simin Yu, Linhu Liu, Ya Li, Liang Zhou, Jixiang Chen, Hong Li, Kunjie Wang
Objective
Flexible ureteroscopy (fURS) has become a widely accepted and effective technique for treating kidney stones. With the development of new laser systems, the fURS approach has evolved significantly. This literature review aims to examine the current state of knowledge on fURS treatment of kidney stones, with a particular focus on the impact of the latest laser technologies on clinical outcomes and patient safety.
Methods
We conducted a search of the PubMed/PMC, Web of Science Core Collection, Scopus, Embase (Ovid), and Cochrane Databases for all randomized controlled trial articles on laser lithotripsy in September 2023 without time restriction.
Results
We found a total of 22 relevant pieces of literature. Holmium laser has been used for intracavitary laser lithotripsy for nearly 30 years and has become the golden standard for the treatment of urinary stones. However, the existing holmium laser cannot completely powder the stone, and the retropulsion of the stone after the laser emission and the thermal damage to the tissue have caused many problems for clinicians. The introduction of thulium fiber laser and Moses technology brings highly efficient dusting lithotripsy effect through laser innovation, limiting pulse energy and broadening pulse frequency.
Conclusion
While the holmium:yttrium-aluminum-garnet laser remains the primary choice for endoscopic laser lithotripsy, recent technological advancements hint at a potential new gold standard. Parameter range, retropulsion effect, laser fiber adaptability, and overall system performance demand comprehensive attention. The ablation efficacy of high-pulse-frequency devices relies on precise targeting, which may pose practical challenges.
{"title":"Flexible ureteroscopic treatment of kidney stones: How do the new laser systems change our concepts?","authors":"Simin Yu, Linhu Liu, Ya Li, Liang Zhou, Jixiang Chen, Hong Li, Kunjie Wang","doi":"10.1016/j.ajur.2023.11.001","DOIUrl":"10.1016/j.ajur.2023.11.001","url":null,"abstract":"<div><h3>Objective</h3><p>Flexible ureteroscopy (fURS) has become a widely accepted and effective technique for treating kidney stones. With the development of new laser systems, the fURS approach has evolved significantly. This literature review aims to examine the current state of knowledge on fURS treatment of kidney stones, with a particular focus on the impact of the latest laser technologies on clinical outcomes and patient safety.</p></div><div><h3>Methods</h3><p>We conducted a search of the PubMed/PMC, Web of Science Core Collection, Scopus, Embase (Ovid), and Cochrane Databases for all randomized controlled trial articles on laser lithotripsy in September 2023 without time restriction.</p></div><div><h3>Results</h3><p>We found a total of 22 relevant pieces of literature. Holmium laser has been used for intracavitary laser lithotripsy for nearly 30 years and has become the golden standard for the treatment of urinary stones. However, the existing holmium laser cannot completely powder the stone, and the retropulsion of the stone after the laser emission and the thermal damage to the tissue have caused many problems for clinicians. The introduction of thulium fiber laser and Moses technology brings highly efficient dusting lithotripsy effect through laser innovation, limiting pulse energy and broadening pulse frequency.</p></div><div><h3>Conclusion</h3><p>While the holmium:yttrium-aluminum-garnet laser remains the primary choice for endoscopic laser lithotripsy, recent technological advancements hint at a potential new gold standard. Parameter range, retropulsion effect, laser fiber adaptability, and overall system performance demand comprehensive attention. The ablation efficacy of high-pulse-frequency devices relies on precise targeting, which may pose practical challenges.</p></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"11 2","pages":"Pages 156-168"},"PeriodicalIF":2.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214388224000195/pdfft?md5=3337cc9215bd57dc0ebb81b935d7ff58&pid=1-s2.0-S2214388224000195-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140468191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.ajur.2021.11.004
Oktay Özman , Hacı M. Akgül , Cem Başataç , Önder Çınar , Eyüp B. Sancak , Cenk M. Yazıcı , Bülent Önal , Haluk Akpınar , on behalf of the RIRSearch Study Group
Objective
To evaluate the effect of ureteral access sheath (UAS) use and calibration change on stone-free rate and complications of retrograde intrarenal surgery (RIRS).
Methods
Data from 568 patients undergoing RIRS for kidney or upper ureteral stones were retrospectively included. Firstly, patients were compared after 1:1 propensity score matching, according to UAS usage during RIRS (UAS used [+] 87 and UAS non-used [−] 87 patients). Then all UAS+ patients (n=481) were subdivided according to UAS calibration: 9.5–11.5 Fr, 10–12 Fr, 11–13 Fr, and 13–15 Fr. Primary outcomes of the study were the success and complications of RIRS.
Results
Stone-free rate of UAS+ patients (86.2%) was significantly higher than UAS− patients (70.1%) after propensity score matching (p=0.01). Stone-free rate increased with higher caliber UAS (9.5–11.5 Fr: 66.7%; 10–12 Fr: 87.0%; 11–13 Fr: 90.6%; 13–15 Fr: 100%; p<0.001). Postoperative complications of UAS+ patients (11.5%) were significantly lower than UAS− patients (27.6%) (p=0.01). Complications (8.7%) with 9.5–11.5 Fr UAS was lower than thicker UAS (17.2%) but was not statistically significant (p=0.09). UAS usage was an independent factor predicting stone-free status or peri- and post-operative complications (odds ratio [OR] 3.654, 95% confidence interval [CI] 1.314–10.162; OR 4.443, 95% CI 1.350–14.552; OR 4.107, 95% CI 1.366–12.344, respectively).
Conclusion
Use of UAS in RIRS may increase stone-free rates, which also increase with higher caliber UAS. UAS usage may reduce complications; however, complications seemingly increase with higher UAS calibration.
{"title":"Multi-aspect analysis of ureteral access sheath usage in retrograde intrarenal surgery: A RIRSearch group study","authors":"Oktay Özman , Hacı M. Akgül , Cem Başataç , Önder Çınar , Eyüp B. Sancak , Cenk M. Yazıcı , Bülent Önal , Haluk Akpınar , on behalf of the RIRSearch Study Group","doi":"10.1016/j.ajur.2021.11.004","DOIUrl":"10.1016/j.ajur.2021.11.004","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the effect of ureteral access sheath (UAS) use and calibration change on stone-free rate and complications of retrograde intrarenal surgery (RIRS).</p></div><div><h3>Methods</h3><p>Data from 568 patients undergoing RIRS for kidney or upper ureteral stones were retrospectively included. Firstly, patients were compared after 1:1 propensity score matching, according to UAS usage during RIRS (UAS used [<sup>+</sup>] 87 and UAS non-used [<sup>−</sup>] 87 patients). Then all UAS<sup>+</sup> patients (<em>n</em>=481) were subdivided according to UAS calibration: 9.5–11.5 Fr, 10–12 Fr, 11–13 Fr, and 13–15 Fr. Primary outcomes of the study were the success and complications of RIRS.</p></div><div><h3>Results</h3><p>Stone-free rate of UAS<sup>+</sup> patients (86.2%) was significantly higher than UAS<sup>−</sup> patients (70.1%) after propensity score matching (<em>p</em>=0.01). Stone-free rate increased with higher caliber UAS (9.5–11.5 Fr: 66.7%; 10–12 Fr: 87.0%; 11–13 Fr: 90.6%; 13–15 Fr: 100%; <em>p</em><0.001). Postoperative complications of UAS<sup>+</sup> patients (11.5%) were significantly lower than UAS<sup>−</sup> patients (27.6%) (<em>p</em>=0.01). Complications (8.7%) with 9.5–11.5 Fr UAS was lower than thicker UAS (17.2%) but was not statistically significant (<em>p</em>=0.09). UAS usage was an independent factor predicting stone-free status or peri- and post-operative complications (odds ratio [OR] 3.654, 95% confidence interval [CI] 1.314–10.162; OR 4.443, 95% CI 1.350–14.552; OR 4.107, 95% CI 1.366–12.344, respectively).</p></div><div><h3>Conclusion</h3><p>Use of UAS in RIRS may increase stone-free rates, which also increase with higher caliber UAS. UAS usage may reduce complications; however, complications seemingly increase with higher UAS calibration.</p></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"11 1","pages":"Pages 80-85"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214388221001089/pdfft?md5=d212c3da4e21af038a20fc249571c277&pid=1-s2.0-S2214388221001089-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45674243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ureteral stents are customarily inserted to facilitate urinary drainage, but they come with their own glitches of being forgotten and/or encrusted leading to serious consequences. The present study aimed to report the complications in patients with forgotten and encrusted stents according to the Clavien-Dindo system specific to urological procedures and identify the factors leading to high-grade (Clavien-Dindo Grade 4A or above) complications.
Methods
The hospital records of patients with forgotten encrusted double-J stents over a period of 8 years were reviewed. The parameters recorded included patient demographics, indwelling time, need for percutaneous nephrostomy, hemodialysis, urine culture, blood culture, total blood counts, serum creatinine, radiologic findings, management techniques, number of surgical interventions, modified Clavien-Dindo complications, follow-up, and mortality, if any.
Results
Forty patients were included in the study. The median age was 52 (range 6–85) years. Of the total, 25 (62.5%) patients had a “significant” stent load; 31 (77.5%) had renal failure or acute kidney injury on presentation; 19 (47.5%) patients had sepsis at presentation. Among the patients presented with sepsis, 11 (57.9%) patients demonstrated a positive urine culture; and 7/11 (63.6%) patients exhibited pan-resistant organisms. Twelve out of 40 (30.0%) patients in our series developed high-grade Clavien-Dindo complications. On univariate analysis, sepsis at presentation (p=0.007), stent load (p=0.031), diabetes (p=0.023), positive urine culture (p=0.007), and stent indwelling time of more than 1 year (p=0.031) were found to be significant. On multivariate logistic regression analysis, sepsis at presentation (p=0.017) and positive urine culture (p=0.016) were significant predictors for high-grade complications.
Conclusion
It is prudent to identify specific risk factors, namely sepsis at presentation and positive urine culture to triage and optimize these patients before surgical management.
{"title":"Can we predict the incidence of high-grade Clavien-Dindo complications in patients with forgotten encrusted stents undergoing endourologic management?","authors":"Praanjal Gupta, Ramanitharan Manikandan, Lalgudi Narayanan Dorairajan, Kodakattil Sreenivasan Sreerag, Sidhartha Kalra, Swapnil Singh Kushwaha","doi":"10.1016/j.ajur.2022.03.018","DOIUrl":"10.1016/j.ajur.2022.03.018","url":null,"abstract":"<div><h3>Objective</h3><p>Ureteral stents are customarily inserted to facilitate urinary drainage, but they come with their own glitches of being forgotten and/or encrusted leading to serious consequences. The present study aimed to report the complications in patients with forgotten and encrusted stents according to the Clavien-Dindo system specific to urological procedures and identify the factors leading to high-grade (Clavien-Dindo Grade 4A or above) complications.</p></div><div><h3>Methods</h3><p>The hospital records of patients with forgotten encrusted double-J stents over a period of 8 years were reviewed. The parameters recorded included patient demographics, indwelling time, need for percutaneous nephrostomy, hemodialysis, urine culture, blood culture, total blood counts, serum creatinine, radiologic findings, management techniques, number of surgical interventions, modified Clavien-Dindo complications, follow-up, and mortality, if any.</p></div><div><h3>Results</h3><p>Forty patients were included in the study. The median age was 52 (range 6–85) years. Of the total, 25 (62.5%) patients had a “significant” stent load; 31 (77.5%) had renal failure or acute kidney injury on presentation; 19 (47.5%) patients had sepsis at presentation. Among the patients presented with sepsis, 11 (57.9%) patients demonstrated a positive urine culture; and 7/11 (63.6%) patients exhibited pan-resistant organisms. Twelve out of 40 (30.0%) patients in our series developed high-grade Clavien-Dindo complications. On univariate analysis, sepsis at presentation (<em>p</em>=0.007), stent load (<em>p</em>=0.031), diabetes (<em>p</em>=0.023), positive urine culture (<em>p</em>=0.007), and stent indwelling time of more than 1 year (<em>p</em>=0.031) were found to be significant. On multivariate logistic regression analysis, sepsis at presentation (<em>p</em>=0.017) and positive urine culture (<em>p</em>=0.016) were significant predictors for high-grade complications.</p></div><div><h3>Conclusion</h3><p>It is prudent to identify specific risk factors, namely sepsis at presentation and positive urine culture to triage and optimize these patients before surgical management.</p></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"11 1","pages":"Pages 99-104"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214388223000036/pdfft?md5=889e86318f6eccee24a0c3379fdb87be&pid=1-s2.0-S2214388223000036-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43947651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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