Factors Affecting the Complications of Pneumatic Lithotripsy for the Treatment of Ureteral Stones with Different Localizations: A Multivariate Analysis of Complications

Günlüsoy, Bülent; Değirmenci, Tansu; Kozacıoğlu, Zafer; Arslan, Murat; Ceylan, Yasin; Nergiz, N.; Minareci, Süleyman

doi:10.1159/000350243

Cited by 9 publications

(5 citation statements)

References 25 publications

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“…We report an overall SFR of 94.2% after URS treatment at follow-up, a rate similar to previous studies [ 20 ] and a day-case SFR of 95.4%. We did not find a correlation between LoS and SFR, with both the day-case and prolonged admission groups producing excellent SFRs.…”

Section: Discussionsupporting

confidence: 90%

“…Higher mean pre-operative serum creatinine and longer mean overall stone length were highest in the prolonged stay group (>3 days). With regards to stone parameters, previous studies have reported stone number and stone burden to be associated with higher complication rates post-procedure and this might partly explain our findings [ 19 , 20 ]. In addition, we found that deployment of an access sheath was highest in the group with prolonged stay suggesting a more complex and larger nature of these stones.…”

Section: Discussionmentioning

confidence: 63%

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Results of day-case ureterorenoscopy (DC-URS) for stone disease: prospective outcomes over 4.5 years

et al. 2017

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PurposeTo investigate the prospective outcomes of day-case ureterorenoscopy (DC-URS) for stone disease. With the rising prevalence of stone disease in the face of finite resources, there is increasing pressure to undertake procedures as a day case avoiding in-patient stay. There are a limited number of studies reporting on the feasibility of ureteroscopy as a day-case procedure. This study aimed to investigate the prospective outcomes and predictors precluding to DC-URS for stone disease in patients treated in our university teaching hospital.Materials and methodsBetween March 2012 and July 2016, consecutive cases of adult stone ureteroscopy performed or supervised by a single surgeon were recorded in a prospective database. Patients underwent pre-operative counselling in a specialist stone clinic and were admitted to a dedicated ‘Surgical day unit’ on the day of surgery. A standardised anaesthetic protocol was adhered to in all cases. Data on patient demographics, stone parameters, pre-operative assessment, operative details, length of stay, stone-free rate and complication rates were collected and analysed.ResultsA total of 544 consecutive adult ureteroscopy for stone disease were conducted over the study period with a day-case rate of 77.7%. Thirty-nine percent of failed day-case ureteroscopy were due to late completion of ureteroscopy and due to associated social circumstances of patients. The mean stone size, operating time duration and post-operative stent insertion rates for DC-URS patients were 14 mm, 46 min and 96.5%, respectively. Post-operatively, the mean stone-free rate (SFR), unplanned re-admissions and complications for DC-URS patients were 95, 4 and 4%, respectively. A higher failure of DC-URS was related to patient’s age (p = 0.003), positive pre-operative urine culture (p < 0.001), elevated pre-operative serum creatinine (p < 0.001) and higher mean operating time (p < 0.02).ConclusionBased on our results, a day-case ureteroscopy rate of nearly 78% can be achieved. With its acceptable complication rate, and low re-admission rates, DC-URS is a safe and feasible option in a majority of patients with stone disease.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 63%

Results of day-case ureterorenoscopy (DC-URS) for stone disease: prospective outcomes over 4.5 years

et al. 2017

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“…Although URS is a more invasive option than SWL, it has a better success rate with an overall success rate extending from 85.6%[ 14 ] to 95.7%. [ 15 ]…”

Section: Discussionmentioning

confidence: 99%

Reporting ureteroscopy complications using the modified clavien classification system

Ibrahim

2015

Urol Ann

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Objective:Perioperative complications are one of the surrogate indicators of surgical outcomes. However, reporting these complications need a precise grading system. Our aim is to report and grade the complications of semirigid ureteroscopy in ureteral stone management according to the modified Clavien classification system.Materials and Methods:This is a prospective study conducted From January 2012 to June 2013. All patients with ureteral stones who were indicated for semirigid URS were evaluated. All procedures were performed by the same surgeon. The data recorded including patient demographics, clinical indication, stone size and location, operative time and complications were classified according to the modified Clavien classification system. The patients were followed for 8 weeks postoperatively.Results:148 patients included, Stone distribution was: 89 (60.1%) lower ureteral, 26 (17.6%) mid ureteral, and 33 (22.3%) upper ureteral. the mean stone size was 8.6 mm. Urgent URS done in 23% of patient. The overall stone free rate was 88.5%, the individual stone free rate for the upper, middle and lower ureter were 87.9%, 84.6%, and 89.9%, respectively. The mean operative time was 31.9 min (20-50 min.). Complications occurred in 26.35% of patients. Grade I complications occurred in 32 patients (26.1%), grade II in 9 (6.1%), grade IIIa in 7 (4.7%), grade IIIb in 8 (5.4%), grade IVa in two patient (1.35%), and grade IVb in one patient (0.7%). No grade V complication was encountered.Conclusion:Ureteroscopy becomes the vanguard interventional therapy for ureteral stones with well-established efficacy and safety. It is of paramount importance to adopt a precise structured classification system for reporting surgical complications, that should be flexible and comprehensive in order to accommodate the various and rapidly expanding surgical fields.

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“…They found that stone area is one of the key risk factors affecting URS success (OR = 0.993, p = 0.002). For analysis of negative outcomes, Gunlusoy et al 18 showed stone diameter was a significant parameter for the occurrence of complications (relative risk of 2 in multivariate analysis). However, we found conflicting evidence in a previous study that stone clearance is not affected by stone size.…”

Section: Discussionmentioning

confidence: 99%

External Validation of the S.T.O.N.E. Score in Predicting Stone-Free Status After Rigid Ureteroscopic Lithotripsy

Sirirak

Sangkum

Phengsalae

et al. 2021

RRU

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Background: The Size, Topography, Obstruction, Number, and Evaluation of Hounsfield units (S.T.O.N.E.) scoring system has been proposed as a novel prognostic surgical classification for urolithiasis in predicting success rate and complications. Objective: We carried out an externally validated S.T.O.N.E. score on rigid ureteroscopic lithotripsy (rURS). Materials and Methods: The data of patients who had undergone rURS between 2012 and 2019 at a tertiary referral center were audited retrospectively. The S.T.O.N.E. score was calculated based on factors determined through preoperative computed tomography images and was analyzed in association with stone-free rate (SFR), operating time, surgical complications, and length of stay (LOS). Results: A total of 155 patients were included in the study with a median stone size of 10 mm (7-12) and a median S.T.O.N.E. score of 9 (8-10). The overall SFR was 89.68%. SFRs were 100.0%, 97.83%, and 77.42% in low (5), moderate (6-9), and high (10-13) score groups, respectively. The S.T.O.N.E. score (p = 0.002) and stone size (p = 0.037) were predictive factors for SFR in multivariate analysis. Moreover, there was a significant correlation between the S.T.O.N.E. score and operative time, LOS, and presence of complications (r = 0.22, p = 0.006; r = 0.30, p < 0.001; and r = 0.27, p < 0.001, respectively). The area under the curve of the receiving operator characteristics' curve for the S.T.O.N.E. score was 0.815. Conclusion: The S.T.O.N.E. scoring system is simple and effective in predicting postoperative outcomes; therefore, this score would be a valuable tool in clinical planning for every patient who undergoes rURS.

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Factors Affecting the Complications of Pneumatic Lithotripsy for the Treatment of Ureteral Stones with Different Localizations: A Multivariate Analysis of Complications

Cited by 9 publications

References 25 publications

Results of day-case ureterorenoscopy (DC-URS) for stone disease: prospective outcomes over 4.5 years

Results of day-case ureterorenoscopy (DC-URS) for stone disease: prospective outcomes over 4.5 years

Reporting ureteroscopy complications using the modified clavien classification system

External Validation of the S.T.O.N.E. Score in Predicting Stone-Free Status After Rigid Ureteroscopic Lithotripsy

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