Indian Journal of Urology最新文献

Introduction: This study aimed to evaluate the efficacy of ultraslow shockwave (SW) lithotripsy compared with slow-rate SW lithotripsy (SWL) in the management of renal stones using a common power ramping protocol.

Methods: This randomized trial enrolled patients with solitary renal calculus ≤2 cms between December 2021 and February 2024. Ultraslow lithotripsy (40 patients) was applied at a rate of 30 shocks per minute and slowrate lithotripsy (40 patients) was applied at a rate of 60 shocks per minute. Common power ramping protocol was followed for both the groups. Up to a maximum of three sessions were carried out with follow-up at 3 months after the last session. The primary outcome was the stone-free rate.

Results: The overall stone-free rate (SFR) was 77.5% in the ultraslow arm and 72.5% in the slow-rate arm (P = 0.60). Ultraslow group attained a higher SFR after the first session (37.5% vs. 20%; P = 0.07) with significantly lesser number of shocks (1300 vs. 1500; P < 0.01). Complications were only mild and similar between both the groups (P = 0.06), with a longer treatment duration in the ultraslow group (100 min vs. 50 min; P < 0.01).

Conclusions: In the setting of an electromagnetic lithotripter with a common ramping protocol and equal energy SWs, both ultraslow and slowrate SWL achieved a comparable overall stone-free rate with a similar safety profile. Higher number of patients in the ultraslow arm, almost double that of the slow arm, attained stone-free status after the first session itself with significantly fewer shocks.

Introduction: Retrograde intrarenal surgery (RIRS) for renal lithiasis is widely used, with single-use ureteroscopes offering an excellent option. However, their high cost poses a challenge, prompting consideration of reusing disposable instruments. This study aims to compare stone-free rates (SFR) and complications between reprocessed disposable ureteroscopes and new ones in a multicenter cohort.

Methods: This prospective, observational, multicenter study included patients who underwent RIRS between May 2022 and May 2023 at three centers in Argentina. Patients were divided into two groups: Group 1 used a brand new disposable ureteroscope and Group 2 used a reprocessed disposable ureteroscope. Stone size, location, stone-free rate, postoperative complications, and subjective evaluations of deflection and vision were analyzed.

Results: Seventy-seven patients were included: 21 in Group 1 and 56 in Group 2. The average stone size was 10.9 mm in Group 1 and 8.6 mm in Group 2 (P = 0.0188). Stone location in the renal pelvis was 42% in Group 1 and 25% in Group 2 (P = 0.406). SFR were 71.4% in Group 1 and 73.2% in Group 2 (P = 0.999). No differences were found regarding the subjective assessment of vision and deflection as evaluated by the surgeons. Postoperative urinary tract infections occurred in 9.5% of Group 1 and 16% of Group 2 (P = 0.717).

Conclusions: Despite the larger stone size in Group 1, the stone-free rate and postoperative infection rates were similar between both groups. Reprocessing disposable instruments does not appear to affect the effectiveness or infection rate of RIRS.

Introduction: Removal of entombed ureteral stents can be technically challenging, particularly if the stent were to fragment during removal. The purpose of this study was to compare the therapeutic suitability of the thulium fiber laser (TFL) and the holmium laser (HL) in the treatment of entombed stents.

Methods: In this benchtop study, first, the time taken for each laser to transect the stent was recorded in 10 experiments/laser. Next, the force required to break the stent following 5 s of laser contact was measured in 15 randomized experiments/laser. Finally, seven experiments of simulated ureteroscopy on entombed stents were performed per laser. Lasers were operated at 0.8 J, 12 Hz with 270 µm fibers, and 6 Fr stents were utilized. Endpoints included time to release the stent, laser energy, and stent damage.

Results: The stent transection time was shorter with the TFL compared to the HL (22.02 vs. 61.46 s; P < 0.001). After 5 s, the TFL transected the stent with lesser force compared to the HL (5.34 vs. 15.24 N; P = 0.004). Both required lesser force to break the stent compared to the baseline (33.8 N; P < 0.001). On simulated lithotripsy, the lithotripsy time (12.7 vs. 8.5 min; P = 0.11) and laser energy (4.7 vs. 2.7 kJ; P = 0.09) were similar between the TFL and HL. The mean stent damage score was higher when using the TFL compared to the HL (36.9 vs. 15.7; P = 0.017).

Conclusions: The TFL resulted in faster stent transection, reduced breakage force, and greater stent damage. Urologists should be cautious when releasing entombed stents using the TFL as the laser may significantly weaken the stent, increasing the risk of fracture during removal.

Benign metastasizing leiomyoma (BML) is thought to arise from either coelomic metaplasia of mesenchymal tissue or peritoneal seeding of uterine fibroid tissue, though its exact etiology is unknown. Herein, we present a 44-year-old Hispanic female with BML identified in the retroperitoneum in the setting of clear cell renal carcinoma. Routine follow-up computed tomography scan, 18 months after a robotic left partial nephrectomy for stage 1 renal tumor, revealed retroperitoneal (para-aortic) adenopathy. Percutaneous biopsy followed by robotic lymph node dissection confirmed the presence of BML. The patient remained asymptomatic with unremarkable imaging and laboratories within a 3-year follow-up.

Renal lymphangiectasia is a benign disorder characterized by cystic dilatation of lymphatic channels in the kidney. It can occur in the perinephric, renal sinus, and intrarenal locations. We describe an uncommon case of renal sinus lymphangiectasia with a characteristic imaging appearance in a 25-year-old female. She presented with loin pain that was managed conservatively.