Imaging for urolithiasis

Lipkin, Michael; Ackerman, Anika

doi:10.1097/mou.0000000000000241

Cited by 26 publications

(10 citation statements)

References 65 publications

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“…A ecografia é um exame inócuo, mais barato e disponível, mas, além da menor sensibilidade (cálculos < 5 mm têm maior probabilidade de não serem detetados), é menos precisa na determinação da carga litiásica. 20 Além desta heterogeneidade no exame de seguimento, que poderá ter introduzido um viés no nosso estudo, também as diferenças no tempo de avaliação após o procedimento poderão ter resultado num viés, dado que dificilmente se distingue pela imagem a presença de litíase residual versus agregação de pequenos cálculos fragmentados.…”

Section: Discussionunclassified

Tratamento da Litíase Renal com Ureterorrenoscopia: Experiência de um centro

Cerqueira¹,

Cerqueira²,

Dinis³

2017

aup

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ResumoIntrodução: No presente estudo, analisámos os resultados iniciais desta técnica no nosso centro, com o objetivo de avaliar a eficácia e segurança da cirurgia intra-renal retrógrada no tratamento de cálculos renais e fatores preditores do seu sucesso. Material e Métodos: Após a recolha dos dados dos processos clínicos e exames de imagem dos doentes submetidos a cirurgia intra-renal retrógrada para tratamento de cálculos renais em 2014 e 2015 no Centro Hospitalar de São João, e aplicação dos critérios de exclusão, analisámos os dados relativos a 138 doentes (total de 179 cirurgia intra-renal retrógrada). Os nossos desfechos primários foram a taxa de sucesso imediata, avaliada pela perceção do cirurgião, e a taxa de sucesso pós-operatória, avaliada pela imagiologia de controlo, considerando como litíase residual significativa cálculos > 3 mm. Resultados: A taxa de sucesso global foi de 67,0% tendo em conta a perceção do cirurgião. Considerando o controlo imagiológico, a taxa de sucesso foi de 66,7% nos cálculos < 150 mm 2 fora do grupo calicial inferior, mas menor nas restantes localizações ou carga litiásica maior. Na análise univariada, a carga litiásica, o número de cálculos e a localização foram estatisticamente significativos como preditores do sucesso da cirurgia intra-renal retrógrada. Não foram registadas complicações major. Conclusão: A localização no grupo calicial inferior foi considerada um preditor do insucesso da cirurgia intra-renal retrógrada, sendo que neste grupo calicial a eficácia foi maior nos cálculos com <150 mm 2 ; esta diferença não se verificou nos cálculos fora desta localização. É uma intervenção segura, permitindo a sua utilização seriada.

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Section: Discussionunclassified

Tratamento da Litíase Renal com Ureterorrenoscopia: Experiência de um centro

Cerqueira¹,

Cerqueira²,

Dinis³

2017

aup

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“…Good imaging assessment before surgery is essential for surgical planning. CT remains the gold standard for diagnosing urolithiasis, with the advantages of being readily available, having higher diagnostic accuracy, faster imaging acquisition and shorter evaluation time . CT also can evaluate the relationship of the stone to other organs.…”

Section: Pcnlmentioning

confidence: 99%

“…CT remains the gold standard for diagnosing urolithiasis, with the advantages of being readily available, having higher diagnostic accuracy, faster imaging acquisition and shorter evaluation time. 10,11 CT also can evaluate the relationship of the stone to other organs. With intravenous contrast, the function of the kidneys, as well as the anatomy of the pelvicalyceal system, can be determined.…”

Section: Preoperative Preparationmentioning

confidence: 99%

Updates in endourological management of urolithiasis

Teoh

2018

Int J of Urology

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Urinary stone disease, or urolithiasis, is a very common disease with increasing prevalence and incidence. With the advancement of endoscopic techniques, the treatment outcomes of ureteroscopy (or transureteral lithotripsy) and percutaneous nephrolithotomy are continuously improving. In recent years, there have been many new developments in the field, including new endoscopy design, more effective auxiliary tools, improvement in treatment protocols, introduction of robotic technology, combining both ureteroscopy and percutaneous nephrolithotomy (endoscopic combined intrarenal surgery or transureteral lithotripsy‐assisted percutaneous nephrolithotomy), improvement in laser technology, and so on. All these new inputs will further improve the treatment efficacy and safety of the procedures, thus benefiting our patients. In the present review, we briefly go through the main steps of ureteroscopy and percutaneous nephrolithotomy, with a concise description and application of these new advances.

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“…It is important to identify patients with an increased risk of NURS in order to develop successful pathways that may help prevent unnecessary surgical interventions with their associated complications and economic costs. Another factor to be taken into account is radiation exposure associated with computed tomography (CT) scan, which is the imaging modality of choice for the detection of urolithiasis; this exposure has been reported to be around 3 millisieverts (mSv) for low-dose CT and between 9.6 and 12.6 mSv for standard CT 6 . Again, this highlights the importance of appropriate selection of patients at high risk of NURS for preoperative imaging.…”

Section: Introductionmentioning

confidence: 99%

Long surgical waiting list times are associated with an increased rate of negative ureteroscopies

González-Padilla

González-Díaz

Peña-Vallejo

et al. 2021

CUAJ

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Introduction: Negative ureteroscopy (NURS) is “a ureteroscopy in which no stone is found during the procedure.” We aimed to determine the association between the surgical waiting list time (WLT) and the NURS rate. Methods: We retrospectively analyzed all patients scheduled for ureteroscopy in our center between January 2017 and July 2019. The inclusion criterion was unilateral semirigid ureteroscopy for a single ureteral stone; exclusion criteria were renal-only stones, incomplete ureteroscopy, and stones >10 mm. We analyzed age, gender, body mass index, stone size, density and location, presence of a temporary double-J (DJ) stent, use of medical expulsive therapy, and WLT. Complications while waiting for surgery were also collected and analyzed. Results: We included 219 patients, 41 (18.7%) of whom had NURS. The median WLT was 74 days (interquartile range [IQR] 45–127). Variables protective against NURS were large stone size (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.66–0.93), presence of a temporary DJ stent (OR 0.43, 95% CI 0.2–0.8), and radiopaque stones (OR 0.44, 95% CI 0.21–0.88). A long WLT (>60 days) increased the risk of NURS (OR 2.18, 95% CI 1.02–4.61). Complications requiring emergency department visits while waiting for surgery were documented in 58/137 (42.3%) patients with indwelling DJ stents; nonetheless, a WLT greater than the median was not associated with an increased risk of complications (p=0.38). Conclusions: Long WLT has an independent, direct, and linear correlation with NURS rates. Patients at higher risk of NURS, may be offered preoperative re-evaluation with a computed tomography scan in a resource-limited setting.

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Imaging for urolithiasis

Abstract: Urolithiasis is a prevalent and recurrent condition and patient radiation exposure throughout diagnosis and management of this disease needs to be considered. Imaging modalities that limit radiation and preserve diagnostic accuracy must be utilized.

Cited by 26 publications

References 65 publications

Tratamento da Litíase Renal com Ureterorrenoscopia: Experiência de um centro

Tratamento da Litíase Renal com Ureterorrenoscopia: Experiência de um centro

Updates in endourological management of urolithiasis

Long surgical waiting list times are associated with an increased rate of negative ureteroscopies

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