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

Ghosh, Anngona; Oliver, Rachel; Way, Carolyn; White, L.; Somani, Bhaskar K.

doi:10.1007/s00345-017-2061-1

Cited by 69 publications

(43 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Stone-free status was determined both endoscopically at the end of the procedure and radiologically (USS) at 3 months follow-up prior to outpatient review. Stone-free rate (SFR) was defined as fragments < 2 mm in size [16][17][18]. Complications were graded according to the Clavien-Dindo classification and recorded within 30 days post-procedure [19].…”

Section: Methodsmentioning

confidence: 99%

Outcomes of ureteroscopy (URS) for stone disease in the paediatric population: results of over 100 URS procedures from a UK tertiary centre

et al. 2019

Self Cite

View full text Add to dashboard Cite

Purpose To report the outcomes of paediatric ureteroscopy (URS) for stone disease from a specialist endourology centre in the UK. Ureteroscopy for management of stone disease has increased worldwide and is now being done more commonly in the paediatric age group. Methods Data were analysed retrospectively from a database maintained between April 2010 and May 2018. Consecutive patients ≤ 16 years of age undergoing semi-rigid or flexible URS for stone disease were included. Stone size and stone-free rate (SFR) were routinely assessed using an ultrasound (USS) and/or plain KUB XR. Complications were graded according to the Clavien-Dindo classification and recorded within 30 days post-procedure and readmissions within 90 days after the procedure were also captured. Results Over the 8-year period between April 2010 and April 2018, 81 patients with a mean age of 8.8 years (range 18 months-16 years) and a male to female ratio 1:1.1 underwent 102 procedures (1.28 procedure/patient to be stone free). Of the 81 patients, 29 (35.8%) had comorbidities, with 26 (32%) having multiple comorbidities. The mean (± SEM) single and overall stone size was 9.2 mm (± 0.48, range 3-30 mm) and 11.5 mm (± 0.74, range 4-46 mm) respectively, with 22 (27.1%) having multiple stones. Thirty-five (34.7%) had stent in situ pre-operatively. The stone location was in the ureter (26.6%), lower pole (35.4%), and renal pelvis (16.5%), with 22/81(27%) having multiple stones and 21/102 (20.5%) where a ureteral access sheath (UAS) was used. With a mean hospital stay of 1.2 days, the initial and final SFR was 73% and 99%, respectively, and 61/102 (60%) had ureteric stent placed at the end of the procedure. While there were no intra-operative complications, the readmission rate was less than 1% and there were only three early complications recorded. This included a case each of prolonged admission for pain control (grade I), urinary retention (grade II) and post-operative sepsis requiring a brief ITU admission (grade IV). Conclusion Our study demonstrates that in appropriate setting a high stone-free rate can be achieved with minimal morbidity for paediatric patients. There is potentially a need to factor the increasing role of URS in future paediatric urolithiasis guidelines.

show abstract

Section: Methodsmentioning

confidence: 99%

Outcomes of ureteroscopy (URS) for stone disease in the paediatric population: results of over 100 URS procedures from a UK tertiary centre

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…The ureteroscopy procedure was performed according to our previously described and validated technique which is used for both endoscopic simulation teaching and clinical use; rigid cystoscopy and placement of a safety guidewire, semirigid ureteroscopy over a working guidewire, placement of an access sheath, and flexible ureterorenoscopy thereafter [16,19,20,22].…”

Section: Techniquementioning

confidence: 99%

“…The stone diagnosis was established using a non-contrast CT scan (NCCT) with follow-up based on plain x-ray for radiopaque stones and ultrasound (USS) for radiolucent stones 2-3 months post-ureteroscopy. Stone-free rate was defined using a combination of being endoscopically stone free immediately after FURS and radiologically stone free (defined as fragments ≤ 2 mm) on follow-up imaging [22].…”

Section: Diagnosis and Follow-upmentioning

confidence: 99%

Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period

et al. 2019

Self Cite

View full text Add to dashboard Cite

Purpose To compare the outcomes (stone free rate and complications) of renal stone treatment with and without the use of ureteral access sheath (UAS). The worldwide use of UAS has risen over the last decade; however, questions still remain on the safety and outcomes with its use. We wanted to look at the role of UAS for treatment of consecutive renal stones over a 7-year period. Methods The outcomes of flexible ureteroscopy and stone treatment (FURS) for renal stones with and without the use of UAS was prospectively compared from March 2012 to July 2018. Patients were divided into two groups: group-1 where UAS was used for stone treatment and group-2 where a UAS was not used. Data were collected prospectively on consecutive patients for demographics, stone size, location and number, pre and post-operative stent usage, operative time duration, stone free rate (SFR), length of stay and complications. Results During the study period, 338 patients underwent FURS for renal stones, of which a UAS was used for 203 (60%) patients. The mean age of patients was 56 years (range 2-89 years) with a male:female ratio of 204:134. The mean cumulative stone size and the mean number of stones was 16.5 ± 10.8 mm and 11.37 ± 8.08 mm (P < 0.001), and 2.17 ± 1.99 and 1.66 ± 1.50 (P = 0.009) for groups 1 and 2 respectively. The pre and post-operative stent insertion rates were similar in the two groups. The procedural time was longer in group-1 (54.8 ± 25.8 min) compared to group-2 (41.3 ± 22.2 min) (P < 0.001). The SFR for group-1 (88%) was slightly lower than group-2 (94%) although this was not statistically significant (P = 0.07). There were no intra-operative complications in either of the groups. Post-operative complications were seen in eight patients in group-1 (7 Clavien I/II and 1 Clavien IVa) and two patients in group-2 (Clavien I) (P = 0.19). Conclusion The use of UAS for renal stones is safe with no intra-operative complications noted in our series. Good stone-free rates were obtained for large and multiple renal stones with a small risk of minor complications post-operatively.

show abstract

“…This provides a strong argument for carrying out bilateral simultaneous endourological procedures rather than the additional morbidity with staged procedures. Case volume would also have a part to play and centres with higher volumes were shown to have lower complications with a higher SFR [7,12,22]. Clearly, the cost argument would be in favour of doing these procedures simultaneously with an overall reduction in operative time and hospital stay associated with the combined approach.…”

Section: Comparison Of Bilateral Simultaneous Procedures To Staged Ormentioning

confidence: 99%

Simultaneous Bilateral Endoscopic Surgery (SBES) for Bilateral Urolithiasis: the Future? Evidence from a Systematic Review

2019

Self Cite

View full text Add to dashboard Cite

Purpose of Review Urolithiasis is a disease of prevalence across the world and up to a quarter of patients present with multiple stones. Most procedures carried out in this scenario are staged; however, there is a growing body of evidence to suggest bilateral simultaneous (BS) procedures are safe. We performed a systematic review to investigate and evaluate the evidence for these procedures. Recent Findings A systematic review was conducted according to Cochrane and PRISMA checklist for all English-language articles from January 1996 to January 2018 using Medline, CINAHL, Scopus, EMBASE, Cochrane library, Clinicaltrials.gov and Google Scholar. All studies (a minimum of 10 patients) with bilateral simultaneous percutaneous nephrolithotomy (BS-PCNL) or bilateral simultaneous ureteroscopy (BS-URS) and ipsilateral URS with contralateral simultaneous PCNL were included. Data was extracted for patient and stone demographics, outcomes and stone-free rate (SFR) and the level of evidence (using the GRADE assessment tool). Overall, 32 studies (1966 patients) were included in the review after the identification of 302 articles in the search. This included 16 studies (1073 patients) with BS-URS, 13 studies (750 patients) with BS-PCNL and 3 studies (143 patients) with URS and simultaneous contralateral PCNL. Of these, 8 were comparative studies and compared bilateral simultaneous procedure to either a unilateral or staged comparator. The mean operating time, SFR, the Clavien I-II and the Clavien ≥ III were 75 min, 91%, 22% and 1.4% for BS-URS; 157 min, 92%, 27% and 6.4% for BS-PCNL; 151 min, 76% and 5.6% for URS with contralateral PCNL. In comparison to staged procedures, although the SFR and complication rates were similar, there was a significantly reduced operative time and hospital stay with simultaneous procedures (p < 0.001). Summary Although evidence for bilateral simultaneous endourological procedures is limited, results from available studies show that outcomes are at least equivalent to staged procedures. Key advantages seem to be reduced operative times, cost and hospital stay which will lead to an increased uptake of these procedures in the future.

show abstract

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

Cited by 69 publications

References 28 publications

Outcomes of ureteroscopy (URS) for stone disease in the paediatric population: results of over 100 URS procedures from a UK tertiary centre

Outcomes of ureteroscopy (URS) for stone disease in the paediatric population: results of over 100 URS procedures from a UK tertiary centre

Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period

Simultaneous Bilateral Endoscopic Surgery (SBES) for Bilateral Urolithiasis: the Future? Evidence from a Systematic Review

Contact Info

Product

Resources

About