The active guidewire technique versus standard technique as different way to approach ureteral endoscopic stone treatment

Background: One of the greatest challenges in semi-rigid ureteroscopies, for both stones and tumors, is the control of endoscopic vision and the maintenance of low intracavitary liquid pressure. We present a comparison between two operative techniques: in the first method an ordinary guide wire (diameter 0.032'') is used for the procedure; in the second one a 5 Fr ureteral catheter replaces the guidewire (we called it “Active guidewire”) Methods We compared 50 semirigid ureteroscopies (sURS) performed using the active guidewire with another 50 procedures conducted with a classic guidewire. We evaluated the difference in operating times, quality of endoscopic vision, periprocedural infections rate and stone-free rate. Results: The use of active guidewire has considerably reduced the standardized operating times per unit stone-volume by about 39%. Vision quality has improved considerably thanks to the continuous flow in-and-out. Consequently, periprocedural infections decreased (3% vs 30%) and the stone-free rate rose from 86% to 92%. Discussion and conclusions: Employing an “active guidewire” instead of the standard guidewire, the risk of complications related to high pressures and operating time is considerably lower, as well as better treatment quality thanks to the cleaner vision. This technique has proven to be safe as well as easy to apply, and in our belief is to be preferred whenever the ureter accepts without forcing, both the presence of the catheter and the semi-rigid 7 F ureteroscope.

Commentary in response to BMC Urology publication entitled “Infection-related hospitalization following ureteroscopic stone treatment: results from a surgical collaborative”

This Commentary is in response to the BMC Urology publication entitled “Infection-related hospitalization following ureteroscopic stone treatment: Results from a surgical collaborative”. This study utilized a registry with prospectively recorded standardized data elements named Reducing Operative Complications from Kidney Stones, part of the Michigan Urological Surgery Improvement Collaborative, to identify risk factors of infection-related hospitalization after ureteroscopy for stone treatment. The study included 1817 primary URS procedures for urinary stones in 11 practices in Michigan. They found 43 patients (2.4%) were hospitalized with an infection-related complication and 3 patients died during their hospitalization (0.2% mortality rate). Just over 20% of patients did not have a pre-operative urinalysis or urine culture, representing a deviation from guideline recommendations. Also, in the hospitalized group, none of the 12 patients (27.9%) who had a positive pre-operative urinalysis or urine culture received pre-operative treatment. A multivariable analysis identified higher Charleston Comorbidity Index, history of recurrent urinary tract infection, increasing stone size, intraoperative complications, and fragments left in-situ as independent risk factors for hospitalization from an infection after ureteroscopy. This commentary discusses caveats to the data as well as short-comings of the study. It also reviews more broadly infection after ureteroscopy, includes findings from similar studies, and highlights guideline recommendations to reduce infection risk.

Outcomes of ureteral stent placement for hydronephrosis in patients with ureteral stone

BackgroundRoutine ureteral stent placement after ureteroscopy (URS) for ureteral stone treatment is arguable due to the possible stent-related symptoms. Several studies claimed that its use is necessary, while others reported that its use is excessive. Hydronephrosis occurs when urine cannot drain out from the kidney to the bladder due to blockage or obstruction. We aimed to evaluate the role of ureteral stents in hydronephrosis resolution in ureteral stone patients following URS lithotripsy. MethodsThis was a prospective observational study using secondary data involving 130 ureteral stone patients undergoing URS lithotripsy [99 patients (76.2%) with stent placement and 31 patients (23.8%) without stent]. Data consisting of baseline characteristics, pre-operative status, intraoperative characteristics, and postoperative complications were collected from the medical record database and presented descriptively. The patients were divided into two groups based on stent placement. Comparison of hydronephrosis resolution between the groups was analyzed with Chi-square. ResultsUreteral lesions were the most common indication of ureteral stent placement following URS lithotripsy (28.3%). The most bothersome symptoms were dysuria in 18 patients (18.2%); followed by frequency in eight patients (8.1%) and low back pain in six patients (6.1%). All symptoms were successfully treated with oral medications. There were 41 patients (91.1%) with pre-operative hydronephrosis significantly resolved after stent placement compared to 5 (62.5%) patients without stent placement (p=0.027). ConclusionUreteral stenting significantly resolves pre-operative hydronephrosis after URS lithotripsy in patients with ureteral stone. Ureteral stent placement is the preferred method for the treatment of pre-operative hydronephrosis.

Adverse Effects Of Flaming As A Surface Treatment Method For Stone Slabs Used In Road Pavements

This paper presents the results of tests on a damaged pavement made of flamed granite slabs. Due to their architectural value, the use of such pavements made of stone materials is a popular trend in Europe, especially in historic city centres. Faming is a popular method of surface treatment of stone elements, including slabs. The use of flame with a temperature around 1300°C on granite rock leads to allotropic transformations of quartz. The accompanying volume changes lead to flaking of the surface. As a result, the flaming gives the slab a natural texture and improves its anti-slip properties. As it was assessed, most slabs used in pavements exhibited characteristic edge and corner damage. Examination of the mechanical properties of rock taken from a slab revealed different results for samples taken from the high temperature impact zone and from other parts of the slab. The mineralogical tests carried out on samples from the high temperature impact zone showed changes in relation to the original mineralogical composition of granite, including the presence of glaze. These changes resulted in the accumulation of stresses, especially in the areas of slab edges and corners. The analysis of the test results was made in relation to the lack of uniform European standards for stone treatment by flaming and the lack of control procedures for this process. As a result of unrestricted flaming conditions, the originally homogeneous properties of the rock may vary within a single product and lead to its accelerated degradation during exploitation.

Endoscopic Ureteral Dilation Balloon Catheter for a Difficult Ureter: A New Novel Approach

<b><i>Objectives:</i></b> This study aims to assess the safety and efficacy of INNOVEX^TM ureteral dilation balloon catheter to promote the likelihood of passing the ureter to complete primary ureteroscopy (URS). <b><i>Methods:</i></b> This was a prospective case series of patients during URS between August 2018 and January 2020 at the Pudong New District People’s Hospital. A 12-Fr INNOVEX^TM ureteral dilation balloon catheter was used to dilate the ureter when a 5° Wolf 6.0/7.5-Fr ureteroscope encounters an unpredictable hindrance to retrograde access for ureteral stones. Patients with documented ureteral strictures, radiation therapy, or urothelial cancer were excluded from the analysis. The primary outcomes were to characterize the use, safety, and efficacy of ureteral dilation balloon catheter to promote stone treatment during URS. <b><i>Results:</i></b> Eight hundred and sixty-two patients underwent primary URS of ureteral stones over the study period. The use of a ureteral dilation balloon catheter to promote ureteral access was performed in 65 (7.54%) cases and effectively allowed completion of the procedure in 58 (89.23%) cases. No ureteral perforation and access loss occurred during the operation. Seven patients required ureteral stent placement for passive ureteral dilation, with definitive stone treatment later. Postoperative radiographic follow-up was available for 63 (96.92%) cases, and no ureteral stenosis was observed after balloon dilation. <b><i>Conclusion:</i></b> The use of a new ureteral dilation balloon catheter before endoscopic treatment of ureteral stones was associated with a high success rate and few complications. The convenient use method under direct vision at the whole process may increase the willingness of doctors to use it. In addition, it may reduce the need for secondary procedures for patients undergoing URS to manage ureteral stones.

Laparoscopic–Endoscopic “Rendezvous” Procedure in Pediatric Gastrointestinal Surgery—Case Series

Laparoscopic–endoscopic “rendezvous” procedures were introduced in surgery for common bile duct stone treatment but are now widely used in other fields of abdominal surgery. An endoscopist navigates a surgeon during the same operative procedure and, thus, enables a better visualization of the location, resection margins, bleeding control, less thermal damage, etc. Here, we present case series of 11 patients that were treated using a “rendezvous” procedure for gastrointestinal lesions on different parts of the gastrointestinal tract such as juvenile polyps on the colon (transversum, ascendens, cecum, sigma), leiomyomatosis of the stomach, Peutz–Jeghers intestinal polyposis, hyperplastic gastric polyp, ectopic pancreatic tissue in the stomach, gastric trichobezoar, and gastric schwannoma. “Rendezvous” procedures are suitable for intestinal lesions that could not be resected endoscopically due to their size, morphology and/or location. In our experience this procedure should be used for endoscopically unresectable lesions as it decreases the time of surgery, possibility of iatrogenic injury, bleeding and technical inability. Furthermore, this procedure has been shown to better navigate the surgeon during laparoscopic surgery, especially in treating polyps in particularly difficult locations such as the duodenum or cecum, and it decreases conversion rates. However, conversion is sometimes necessary, in order to assure all oncological principals are respected, and the best option in some cases.

Evolution of Percutaneous Renal Access

Introduction: Nephrostomy insertion is a vital part of modern-day urology used to manage obstructedrenal tract or gain percutaneous renal access.Method: We carried out a PubMed literature search on the history of the development of nephrostomies. Results: The first percutaneous nephrostomy was performed in 1864 on a child who died in 5 years. Nephroscopy was then described and performed in 1941 during an open surgery with subsequent advancement to percutaneous nephrolithotomy in 1976 and antegrade stent insertion in 1978.Conclusion: Clinical need and innovation have led to percutaneous renal access and subsequent stone treatment modality.