Is Retrograde Intrarenal Surgery as Safe for Children as It Is for Adults?

2021 ◽  
pp. 1-7
Author(s):  
Mehmet Serkan Ozkent ◽  
Mehmet Mesut Piskin ◽  
Mehmet Balasar ◽  
Yunus Emre Goger ◽  
Mehmet Giray Sonmez
Keyword(s):  
Multivariate Analysis ◽  
Age Groups ◽  
Complication Rates ◽  
Adult Group ◽  
Retrograde Intrarenal Surgery ◽  
Stone Size ◽  
Flexible Ureterorenoscopy ◽  
Factors Affecting ◽  
The Mean ◽  
Group 2

<b><i>Introduction:</i></b> The primary aim of this study is to compare the efficacy and safety of retrograde intrarenal surgery (RIRS) among the children and adults with similar stone burdens and locations. Also, the secondary aim of this study is to identify the factors affecting the stone-free rates (SFRs) of RIRS. <b><i>Methods:</i></b> We retrospectively compared perioperative results, SFRs, and complication rates (CRs) between pediatric (group 1, <i>n</i>: 55) and adult (group 2, <i>n</i>: 220) age groups diagnosed with kidney stones and treated by flexible ureterorenoscopy using the same instruments. Furthermore, multivariate analysis was performed to determine the factors affecting the SFR. <b><i>Results:</i></b> A total of 275 patients (pediatric group: 55; adult group: 220) were included in this study. The mean age of pediatric and adult groups was 7.2 ± 5.3 and 43.9 ± 15.1, respectively. The mean stone size was 13.9 ± 6.6 mm in the pediatric group compared to 14.8 ± 6.7 mm in the adult group (<i>p</i> = 0.35). Stone localizations and number were similar. JJ stenting for passive dilatation and use of UAS were higher in the pediatric group (<i>p</i> = 0.002; <i>p</i> = 0.017). However, postoperative double pigtail stenting rate was higher in the adult group (<i>p</i> &#x3c; 0.001). Total CR was 13.8% and mostly Clavien I–II, and no difference was observed between the 2 groups (<i>p</i> = 0.541). The SFRs between the groups were similar (pediatric group: 81.8%; adult group: 78.2%; <i>p</i> = 0.554). On multivariate analysis, stone size (<i>p</i> &#x3c; 0.001) and lower calyx stone (<i>p</i> &#x3c; 0.001) were the negative predictive factors for SFR. <b><i>Conclusion:</i></b> There are small technical differences between pediatric patients and adult patients in our study, but RIRS in children is as safe and efficient as it is in adults.

scholarly journals Super-mini percutaneous nephrolithotomy (SMP) vs retrograde intrarenal surgery (RIRS) in the management of renal calculi ≤ 2 cm: a propensity matched study

2021 ◽  
Author(s):  
Sunil Bhaskara Pillai ◽  
Arun Chawla ◽  
Jean de la Rosette ◽  
Pilar Laguna ◽  
Rajsekhar Guddeti ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Pain Score ◽  
Final Analysis ◽  
High Volume ◽  
Renal Calculi ◽  
Complication Rates ◽  
Retrograde Intrarenal Surgery ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Abstract Objective To compare the effectiveness and safety of Super-Mini PCNL (SMP) and Retrograde Intrarenal Surgery (RIRS) in the management of renal calculi ≤ 2 cm. Patients and methods A prospective, inter-institutional, observational study of patients presenting with renal calculi ≤ 2 cm. Patients underwent either SMP (Group 1) or RIRS (Group 2) and were performed by 2 experienced high-volume surgeons. Results Between September 2018 and April 2019, 593 patients underwent PCNL and 239 patients had RIRS in two tertiary centers. Among them, 149 patients were included for the final analysis after propensity-score matching out of which 75 patients underwent SMP in one center and 74 patients underwent RIRS in the other. The stone-free rate (SFR) was statistically significantly higher in Group 1 on POD-1 (98.66% vs. 89.19%; p = 0.015), and was still higher in Group 1 on POD-30 (98.66% vs. 93.24%, p = 0.092) SFR on both POD-1 and POD-30 for lower pole calculi was higher in Group 1 (100 vs. 82.61%, p = 0.047 and 100 vs 92.61% p = 0.171). The mean (SD) operative time was significantly shorter in Group 1 at 36.43 min (14.07) vs 51.15 (17.95) mins (p < 0.0001). The mean hemoglobin drop was significantly less in Group 1 (0.31 vs 0.53 gm%; p = 0.020). There were more Clavien–Dindo complications in Group 2 (p = 0.021). The mean VAS pain score was significantly less in Group 2 at 6 and 12 h postoperatively (2.52 vs 3.67, 1.85 vs 2.40, respectively: p < 0.0001), whereas the mean VAS pain score was significantly less in Group 1 at 24 h postoperatively (0.31 vs 1.01, p < 0.0001). The mean hospital stay was significantly shorter in Group 1 (28.37 vs 45.70 h; p < 0.0001). Conclusion SMP has significantly lower operative times, complication rates, shorter hospital stay, with higher stone-free rates compared to RIRS. SMP is associated with more early post-operative pain though.

scholarly journals Retrograde intrarenal surgery in the management of solitary large renal stones, 2-3 cm: a single center experience

2021 ◽  
Vol 8 (3) ◽  
pp. 939
Author(s):  
Ahmed Eissa ◽  
Maged Ragab ◽  
Giampoalo Bianchi ◽  
Ayman Hassan
Keyword(s):  
Operative Time ◽  
Treatment Options ◽  
Renal Stones ◽  
Complication Rates ◽  
Retrograde Intrarenal Surgery ◽  
Stone Size ◽  
Single Center Experience ◽  
Stone Free Rate ◽  
Efficient Alternative ◽  
The Mean

Background: Nephrolithiasis represents a major health burden worldwide. Several treatment options are available for renal stones such as open stone surgery, percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and extracorporeal shockwave lithotripsy. PCNL is considered the gold standard treatment for large renal stones (>2 cm); however, it is associated with higher blood loss, complication rates, and longer hospitalization. In this setting, we aimed to assess the value of RIRS in the management of single large renal stones between 2-3 cm. Methods: The database of our center was reviewed to include all the patients who underwent RIRS for single large renal stone (2-3 cm) between February 2018 and April 2019. All the patients were evaluated by preoperative computed tomography to evaluate the stone size, site, and density. Furthermore, the following variables were also collected; pre- and post-operative hemoglobin and creatinine, the operative time, stone free rate (SFR), and duration of hospital stay. All the statistical analysis was performed using SPSS version 20.Results: Overall, the data of 31 patients were retrieved for the current study. The mean age of the patients was 56.9±12.9 years, and the mean stone size was 22.6±7 mm. The mean operative time was 96.4±37.3 minutes and the SFR was 74.2% after single session of RIRS. No major postoperative complications were reported in the current series.Conclusions: RIRS is a safe and efficient alternative to PCNL in the management of single renal stones between 2-3 cm; however, further prospective studies are required to confirm these findings.

scholarly journals The comparison of laparoscopy, shock wave lithotripsy and retrograde intrarenal surgery for large proximal ureteral stones

2013 ◽  
Vol 7 (11-12) ◽  
pp. 673 ◽  
Author(s):  
Ufuk Ozturk ◽  
Nevzat Can Şener ◽  
H.N. Goksel Goktug ◽  
Adnan Gucuk ◽  
Ismail Nalbant ◽  
...  
Keyword(s):  
Shock Wave ◽  
Shock Wave Lithotripsy ◽  
Ureteral Stones ◽  
Complication Rates ◽  
Success Rates ◽  
Retrograde Intrarenal Surgery ◽  
Flexible Ureterorenoscopy ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Invasive Method

Introduction: In this study we compare the success rates and complication rates of shock wave lithotripsy (SWL), laparoscopic, and ureteroscopic approaches for large (between 1 and 2 cm) proximal ureteral stones.Methods: In total, 151 patients with ureteral stones between 1 and 2 cm in diameter were randomized into 3 groups (52 SWL, 51 laparoscopy and 48 retrograde intrarenal surgery [RIRS]). The groups were compared for stone size, success rates, and complication rates using the modified Clavien grading system.Results: Stone burden of the groups were similar (p = 0.36). The success rates were 96%, 81% and 79%, respectively in the laparoscopy, SWL, and ureteroscopy groups. The success rate in laparoscopy group was significantly higher (p < 0.05). When these groups were compared for complication rates, RIRS seemed to bethe group with the lowest complication rates (4.11%) (p < 0.05). SWL and laparoscopy seem to have similar rates of complication (7.06% and 7.86%, respectively, p = 0.12).Interpretation: To our knowledge, this is the first study to compare the results of laparoscopy, SWL and RIRS in ureteral stones. Our results showed that in management of patients with upper ureteral stones between 1 and 2 cm, laparoscopy is the most successful method based on its stone-free rates and acceptable complication rates. However, the limitations of our study are lack of hospital stay and cost-effectiveness data. Also, studies conducted on larger populations should support our findings. When a less invasive method is the only choice, SWL and flexible ureterorenoscopy methods have similar success rates. RIRS, however, has a lower complication rate than the other approaches.

scholarly journals Do we have a limit for retrograde intrarenal surgery for solitary kidney stone?

2021 ◽  
Vol 93 (3) ◽  
pp. 318-322
Author(s):  
Bulent Kati ◽  
Eyyup Sabri Pelit ◽  
Mehmet Demir ◽  
Ismail Yagmur ◽  
Adem Tuncekin ◽  
...  
Keyword(s):  
Kidney Stone ◽  
Surgical Complication ◽  
Operation Time ◽  
Patient Characteristics ◽  
Solitary Kidney ◽  
Retrograde Intrarenal Surgery ◽  
Stone Size ◽  
Operation Duration ◽  
The Mean ◽  
Duration Of Operation

Objective: The management of urolithiasis in patients with a solitary kidney is challenging for urologists. This study aimed to evaluate the safety of retrograde intrarenal surgery (RIRS) in the treatment of stones in patients with solitary kidney and to reply to the question if there is any limit for this surgery. Methods: Between January 2016 and December 2019, we enrolled 52 patients who had a solitary kidney and underwent RIRS. We collected data on preoperative patient characteristics, stone dimensions, and postoperative outcomes. Stone size, duration of operation, duration of fluoroscopy, type of anesthesia, and degree of surgical complication were evaluated retrospectively. Surgeries performed in less and more than 60 minutes and with and without complications were compared. Results: A total of 52 patients with a kidney stone and a solitary kidney were evaluated. The mean stone size was 14 ± 0.4 cm and surgical success rate was 87.3%. In our study, 13 patients (24.5%) had grade 1 minor complications, and none required a blood transfusion. The mean operation time was 51.9 ± 17.3 minutes. The postoperative creatinine value increased in 6 patients. The duration of operation in the group with complications was significantly higher than that in the group without complications. In patients who underwent an operation lasting ≥ 60 minutes, stone size, fluoroscopy time, and complication rate were significantly higher than in patients who underwent an operation lasting ≤ 60 minutes. Conclusion: Our opinion is to be careful in patients with a solitary kidney with a big stone and we recommend assigning these procedure to experienced hands for not exceeding 60 minutes in one session.

scholarly journals Clinical features and outcome of Covid-19 in individuals without Comorbidities. Do children have the advantage?

2021 ◽  
Vol 8 (2) ◽  
pp. 88-93
Author(s):  
Dr. Abhishek Kumar ◽  
◽  
Dr. Nilu Kumari ◽  
Dr. Ranjeet Kumar Singh ◽  
Dr. Alok Kumar ◽  
...  
Keyword(s):  
Severe Disease ◽  
Age Groups ◽  
Asymptomatic Infection ◽  
Healthy Individuals ◽  
Adult Group ◽  
Middle Aged ◽  
History Of ◽  
Adults And Children ◽  
The Mean ◽  
Respiratory Complaints

Objective: Information regarding clinical characteristics and the natural course of COVID-19amongst individuals without comorbidities is scarce. We therefore conducted a retrospectiveobservational study to decipher the disease profile in two different age groups, middle-aged (40-59years) and children (up to 12 years). Method: Study was conducted by reviewing the medicalrecords of all patients in the desired age groups and excluding all those with preexisting illness(called comorbidities). Result: A total of 154 and 27 patients were enrolled and studied in themiddle-aged adults and children group respectively. Males dominated in both groups with a sex ratioof 2.9 in adults and 1.7 in children. Most of the children (92.5%) had a history of exposure from aninfected family member, while in the adult group history of contact was present in 71.4% ofpatients.62.9% of children had an asymptomatic infection which was significantly higher than 22.8%in adults. Cough and fever were the most common symptoms in both age groups, but adults weremore likely to have respiratory complaints when compared with children.11 (7.1%) patients in theadult group had severe disease while in the children group none had severe disease. Similarly in theadult group 11 patients required ICU admission, but none in the children group. The mean durationof RTPCR positivity was similar in both groups. There was 1 (0.6%) expiry in the adult groupwhereas none in children. Conclusion: Healthy individuals in both middle-aged and children grouptend to have milder disease and both harbour the virus for the almost same duration but adults aremore symptomatic in comparison to children and hence children are more likely to be potentialasymptomatic carrier and transmitter of infection.

scholarly journals Dynamics of the mean transmitral pressure gradient and its impact on clinical outcomes after MitraClip

2021 ◽  
Author(s):  
Can Öztürk ◽  
Kim Sprenger ◽  
Noriaki Tabata ◽  
Atsushi Sugiura ◽  
Marcel Weber ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Clinical Outcomes ◽  
Functional Outcomes ◽  
Independent Predictor ◽  
Time Varying ◽  
Severe Mitral Regurgitation ◽  
The Mean ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Background: The impact of the increased mitral gradient (MG) on outcomes is ambiguous. Therefore, we aimed to evaluate a) periinterventional dynamics of MG, b) the impact of intraprocedural MG on clinical outcomes, and c) predictors for unfavourable MG values after MitraClip. Methods: We prospectively included patients undergoing MitraClip. All patients underwent echocardiography at baseline, intraprocedurally, at discharge, and after six months. 12-month survival was reassessed. Results: 175 patients (age 81.2±8.2 years, 61.2% male) with severe mitral regurgitation (MR) were included. We divided our cohort into two groups with a threshold of intraprocedural MG of 4.5 mmHg, which was determined by the multivariate analysis for the prediction of 12-month mortality (<4.5 mmHg: Group 1, 4.5 mmHg: Group 2). Intraprocedural MG 4.5 mmHg was found to be the strongest independent predictor for 12-month mortality (HR: 2.33, p=0.03, OR: 1.70, p=0.05) and ≥3.9 mmHg was associated with adverse functional outcomes (OR: 1.96, p=0.04). The baseline leaflet-to-annulus index (>1.1) was found to be the strongest independent predictor (OR: 9.74, p=0.001) for unfavourable intraprocedural MG, followed by the number of implanted clips (p=0.01), MG at baseline (p=0.02) and central clip implantation (p=0.05). Conclusion: MG shows time-varying and condition-depended dynamics periinterventionally. Patients with persistent increased (≥4.5 mmHg) MG at discharge showed the worst functional outcomes and the highest 12-month mortality, followed by patients with an intra-hospital decrease in MG to values below 4.5 mmHg. Pre-interventional echocardiographic and procedural parameters can predict unfavourable postprocedural MG.

scholarly journals Role of dorsal onlay buccal mucosal graft urethroplasty for long anterior urethral strictures

2021 ◽  
Vol 9 (10) ◽  
pp. 3110
Author(s):  
Vedamurthy Reddy Pogula ◽  
Ershad Hussain Galeti ◽  
Venkatesh Velivela ◽  
Bhargava Reddy Kanchi
Keyword(s):  
Statistical Difference ◽  
Age Groups ◽  
Factors Affecting ◽  
Urethral Strictures ◽  
Buccal Mucosal Graft ◽  
Significant Difference ◽  
Dorsal Onlay ◽  
The Mean

Background: Treatment of the urethral strictures is challenging and with appropriate evaluation preoperatively and surgery planning it is possible to achieve good results. The objective of the study was to evaluate the efficacy of dorsal onlay buccal mucosal graft urethroplasty in treating long anterior urethral strictures.Methods: Between August 2018 to July 2019 a total of 25 patients with anterior urethral stricture were treated with dorsal onlay buccal mucosal graft urethroplasty. Age, etiology of the stricture, stricture length (≤ 7 cm, and > 7 cm), and site of the stricture were assessed as the factors affecting the success rate.Results: The clinical outcome as Success was defined as the patient not needing any form of urethral instrumentation postoperatively. The mean follow-up period was 18 months. Of 25 patients, 22 (92%) were successful and 3 (8%) were a failure. There was no statistically significant difference between the age groups, etiology of the stricture and success rate (p=0.21 and p=0.444). The statistical difference was significant for the site and length of the stricture by means of success (p=0.005 and p=0.025).Conclusions: Our results show stricture length and localization are the most important variables for good success. Because of less failure rate, single-stage dorsal onlay buccal mucosal graft urethroplasty may be offered as an alternative to staged urethroplasty in case of long urethral strictures.  

scholarly journals Retrograde Intrarenal Surgery in Patients Who Previously Underwent Open Renal Stone Surgery

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Erdal Alkan ◽  
Ali Saribacak ◽  
Ahmet Oguz Ozkanli ◽  
Mehmet Murad Başar ◽  
Oguz Acar ◽  
...  
Keyword(s):  
Renal Stone ◽  
Perioperative Complications ◽  
Renal Stones ◽  
Control Group ◽  
Complication Rates ◽  
Retrograde Intrarenal Surgery ◽  
Renal Stone Surgery ◽  
Recorded Data ◽  
Group 2 ◽  
Control Group Group

Purpose. To ascertain whether retrograde intrarenal surgery (RIRS) is as effective in patients treated previously with open renal stone surgery (ORSS) on the same kidney as in patients with no previous ORSS.Methods. There were 32 patients with renal stones who had previous ORSS and were treated with RIRS in the study group (Group 1). A total of 38 patients with renal stones who had no previous ORSS and were treated with RIRS were selected as the control group (Group 2). Recorded data regarding preoperative characteristics of the patients, stone properties, surgical parameters, outcomes, SFRs (no fragments or small fragments <4 mm), and complications between groups were compared.Results. Mean age, mean BMI, mean hospital stay, and mean operative time were not statistically different between groups. Mean stone size (10.1 ± 5.6 versus 10.3 ± 4.2;p=0.551) and mean stone burden (25.4 ± 14.7 versus 23.5 ± 9.9;p=0.504) were also similar between groups. After the second procedures, SFRs were 100% and 95% in groups 1 and 2, respectivelyp=0.496. No major perioperative complications were seen.Conclusion. RIRS can be safely and effectively performed with acceptable complication rates in patients treated previously with ORSS as in patients with no previous ORSS.

scholarly journals Donor demographics and factors affecting corneal utilisation in Eye Bank of North India

2021 ◽  
Vol 41 (5) ◽  
pp. 1773-1781
Author(s):  
S. K. Arya ◽  
Amit Raj ◽  
Jyoti Deswal ◽  
Piyush Kohli ◽  
Raghavendra Rai
Keyword(s):  
Age Groups ◽  
Tertiary Hospital ◽  
North India ◽  
Donor Age ◽  
Eye Bank ◽  
Factors Affecting ◽  
The Past ◽  
Northern India ◽  
The Mean ◽  
In The Beginning

Abstract Introduction Nearly 6.8 million people in India have vision less than 6/60 in at least one eye due to corneal diseases; of these, about a million had bilateral involvement. Purpose To identify the challenges faced; the trends in collection, storage and utilisation of corneal tissues in an eye bank in north India. Materials and methods The past records of Eye Bank linked to a tertiary hospital in northern India were analysed from November’1999 to October’2015 with respect to number of eye donations per year, donor demographics and utilisation of corneal tissues. Results The number of donations during the first 6 years were 100, 279 in the next 5 years and 473 in the last 5 years. The mean donor age was 63.2 ± 19.5 years. The percentage of donors less than 30, 31–60 and more than 60 years was 10%, 28% and 62%. Forty-two percent donations were from the hospital. The average time between the death and enucleation was 4.74 ± 5.31 hours. The percentage of corneas used in the donor age groups less than 30, 31–60 and above 60 years was 61.9%, 61.6% and 53.8%, respectively. The usability rate of the corneas from home and hospital was 63.7% and 55.3%, respectively. Conclusions The eye bank had a lukewarm response in the beginning, but gained momentum with time. The myths and beliefs prevalent in our society deter people from donating eyes freely. Each eye bank needs to individualise its problems and find solutions for adequate procurement and utilisation of tissue.

scholarly journals Effect of Renal Function on Success and Complications of Percutaneous Nephrolithotomy

2021 ◽  
pp. 68-73
Author(s):  
Serkan Yarimoglu ◽  
Mehmet Erhan Aydin ◽  
Murat Sahan ◽  
Omer Koras ◽  
Onur Erdemoglu ◽  
...  
Keyword(s):  
Renal Function ◽  
Glomerular Filtration ◽  
Percutaneous Nephrolithotomy ◽  
Kidney Stones ◽  
Complication Rates ◽  
Number Of Patients ◽  
Group 3 ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Objective: In this study, we aimed to compare the success and complication rates of percutaneous nephrolithotomy (PCNL) according to preoperative glomerular filtration rates (GFR) of patients who underwent PCNLdue to kidney stones. Material and Methods: Between January 2012 and December 2016, 794 patients who underwent PCNL due to kidney Stones were evaluated retrospectively. Preoperative GFR values of patients were calculated according to Cockcroft –Gault formula. The patients with preoperative GFR values>90 ml/min, 60-90 ml/min, 30-60 ml/min were respectively defined as group-1, group-2 and group-3. Preoperative and perioperative values, Stone free rates and complication rates were compared between the groups. Postoperatively , <4 mm residual stone was identified as success. Results: There were 466 patients in Group-1, 259 in Group-2 and 67 patients in Group-3. The mean preoperative GFR values of the patients were 118.53 ml/min, 77.76 ml/min and 48.52 ml/min, respectively in group-1, group-2 and group-3 (p <0.001).The mean age of the patients was 62.8±11.47, 51.86±11.10, and60.31±12.7, respectively, in group-1, group-2 and group-3 (p<0.001).The mean Stone burden of the patients were 497.34±518.60 mm2, 517.6±493.8 mm2and 711.06±679.07 mm2, respectively, in group-1, group-2 and group-3 (p=0.013). The number of patients identified with success after surgery was 355 (86.2%), 195 (76.1%) and 50 (74.6%) in group-1, group-2 and group-3, respectively (p = 0.542). The number of patients who develop complications was 114 (%24.65), 57 (%22) and 11 (%16.4) in group-1, group-2 and group-3, respectively (p=0.310). Conclusion: Preoperative GFR valuesare not lonely sufficient to predict success and complications after PCNL. Keywords: Percutaneous nephrolithotomy, renal function, renal stone, glomerular filtration rates

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