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  • 1
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    Online Resource
    Correlation between Prostate-Specific Antigen Levels and Prostate Imaging Reporting and Data System score: A Retrospective Study
    Endourology Foundation ; 2024
    In:  Journal of Endourology and Minimally Invasive Surgery Vol. 12, No. 1 ( 2024-04-1), p. 13-15
    Details
    In: Journal of Endourology and Minimally Invasive Surgery, Endourology Foundation, Vol. 12, No. 1 ( 2024-04-1), p. 13-15
    Abstract: Introduction: Prostate cancer is a prevalent and potentially lethal malignancy affecting men worldwide. To enhance early detection and accurate risk stratification, various diagnostic methods have been developed. Prostate cancer diagnoses include a digital rectal examination, prostate-specific antigen analysis and prostate biopsy in case prostate cancer is suspected. Total prostate-specific antigen (tPSA) is a widely used, first line and acceptable biomarker for prostate cancer screening. Rising tPSA levels cannot be a definitive diagnosis for prostate cancer and further examination is needed. Мagnetic resonance imaging (MRI) is an irreplaceable part of prostate cancer diagnosis. The introduction of Prostate Imaging-Reporting and Data System (PI-RADS) in MRI of prostate gland precises the cases in which performance of target biopsy is needed by classifying suspected prostate lеsions according to the probability of detecting prostate cancer. Objectivе: The objective of this study is to assess the correlation between tPSA levels and PI-RADS scores in patients who underwent MRI of the prostate gland due to elevated tPSA levels. Material and methods: A retrospective study of 374 patients medical records was carried out from January 2019 to June 2023. All patients had tPSA over 4 ng/ml and underwent MRI. Lesions were classified according to PI-RADS v2.1. Results: Patients mean age was 67.8 ± 8.2 years. Mean prostate volume was 52.67 ± 19.6 cc. 87.5 % of the patients had a negative rectal digital exam and 12.5 % had a positive one. tPSA levels ranged from 4.10 to 500 ng/ml. Patients were categorized in four groups according to their tPSA levels: group A with tPSA levels ranging from 4 to 9.9 ng/ml; group B – tPSA from 10 to 19.9 ng/ ml; group C – tPSA from 20 to 39.9 ng/ml; group D – tPSA over 40 ng/ml. MRI and PI-RADS v2 scoring were performed in all patients. 29.4 % of the MRI exams found lesions scored as PI-RADS 3, 47.1 % – as PI-RADS 4 and 22.5 % as PI-RADS 5. There were only 3 cases of lesions categorized as PI-RADS 2 in the study. These patients did not undergo a biopsy and were followed up. 33.9 % of patients in group A were c assified with PI-RADS score 3, 52.3 % – PI-RADS score 4 and 13.8 % – PI-RADS 5. In group B 1.8 %were categorized in PI-RADS score 2, 28.9 % – PI-RADS score 3, 44.7 % were PI-RADS 4 and 24.6 % PI-RADS 5. In group C the majority of patients (47.9 % and 32.6 %) had lesions classified as PI-RADS 4 and 5. In group D most of the patients` lesions – 60.7 %, were categorized as PI-RADS 5. Conclusion: There is a significant correlation between PI-RADS score and serum total PSA levels with a tendency of higher PI-RADS scores as the tPSA level reaches 10 ng/ml. Elevation of tPSa levels over 4 ng/ml requires MRI of the prostate gland and PI-RADS classification as a diagnostic and confirmation tool for further decision making.
    Type of Medium: Online Resource
    ISSN: 1314-846X , 2815-3235
    URL: Journal
    URL: Article
    DOI: 10.57045/jemis
    DOI: 10.57045/jemis/1210424.pp13-15
    Language: Unknown
    Publisher: Endourology Foundation
    Publication Date: 2024
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  • 2
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    Online Resource
    Efficacy and safety of retrograde laser endopyelotomy in the treatment of strictures of thepyeloureteral segment
    Endourology Foundation ; 2023
    In:  Journal of Endourology and Minimally Invasive Surgery Vol. 11, No. 1 ( 2023-11-1), p. 29-34
    Details
    In: Journal of Endourology and Minimally Invasive Surgery, Endourology Foundation, Vol. 11, No. 1 ( 2023-11-1), p. 29-34
    Abstract: Introduction: Retrograde endoscopic laser pyelotomy is a minimally invasive procedure that is increasingly used for the management of ureteropelvic junction (UPJ) strictures. Holmium laser has been recognized as having ideal qualities for cutting tissue, namely, precision and minimal thermal spread. Objective: The objective of our study is to evaluate the efficacy and safety of Holmium laser endopyelotomy in the treatment of ureteropelvic junction strictures. Material and methods: A retrospectively collected database of 14 patients who unederwent laser endopyelotomy for UPJ strictures between January 2017 and January 2020 in the Clinic of Endourology and SWL, Military Medical Academy, Sofia, Bulgaria was reviewed. Confirmation of obstruction and the results of the intervention were obtained by combinations of retrograde ureteropyelography, ultrasonography and CT. The endopyelotomy was performed under direct vision using a semirigid or a flexible ureteroscope. The first postoperative and latest radiographic follow-up studies were compared with the preoperative studies to determine whether the obstruction was resolved, unchanged, or worsened. Success was defined as symptomatic relief and the absence of obstruction from the radiographic studies. Results: Patients’ mean age was 50.2±12.7 years and male-to-female ratio – 57.1%/42.9%. Congenital obstruction of the UPJ was observed in 5 patients(35.7%). Nine of the patients(64.3%) were with secondary strictures of the UPJ – 5 people(35.7%) had a previous open pyeloplastic, 4(28.6%) had an anamnesis of impacted stones in the UPJ in the past. Mean length of the UPJ stricture was 10.3±2.8 mm. Six of the patients (42.9%) were with severe degree of hydronephrosis, 7 (50%) were with moderate hydronephrosis and 1 (7,1%) were with mild degree of hydronephrosis There were no intraoperative complications. Mean hospital stay was 3.6±1.2 days. In all of the patients pyelostent Retromax Plus 7/14 Fr was put postoperatively. The pyelostent was removed 4 to 6 weeks (mean 5 weeks) after the procedure. The success rate after the endopyelotomy was 85,7% (12/14), while 2 cases (14.3%) needed the placement of stent JJ 5 months after the intervention. Conclusions: Ureteroscopic laser endopyelotomy is a minimally invasive, short-stay outpatient procedure associated with a good success rate that is a method of choice mostly for secondary UPJ strictures. It is a minimally invasive procedure with less morbidity for the treatment of UPJ obstruction.
    Type of Medium: Online Resource
    ISSN: 1314-846X , 2815-3235
    URL: Issue
    URL: Journal
    URL: Article
    DOI: 10.57045/10.1.07.22.pp5-63
    DOI: 10.57045/jemis
    DOI: 10.57045/jemis/1111123.pp29-34
    Language: Unknown
    Publisher: Endourology Foundation
    Publication Date: 2023
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  • 3
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    Safety and efficacy of ureteroscopy for the treatment of large impacted proximal ureteralstones
    Endourology Foundation ; 2024
    In:  Journal of Endourology and Minimally Invasive Surgery Vol. 12, No. 1 ( 2024-04-1)
    Details
    In: Journal of Endourology and Minimally Invasive Surgery, Endourology Foundation, Vol. 12, No. 1 ( 2024-04-1)
    Abstract: Introduction and objective: Management of large impacted proximal ureteral stones is often challenging due to the presence of mucosal edema, inflammation and angulations of the ureter. Improvements in ureteroscopic technology increased the efficacy and safety of ureteroscopy (URS) as a first-line treatment in large impacted stones in the proximal ureter. The objective of this retrospective study is to evaluate the efficacy and safety of URS for the management of impacted proximal ureteral stones ≥ 10 mm. Material and methods: The medical records of 700 patients with ureteral stones, who underwent ureteroscopy and intracorporeal lithotripsy between January 2016 and Аpril 2024 were retrospectively reviewed. 179 patients had impacted stones ≥ 10 mm located in the proximal ureter – 125 (70%) were stones sized 10÷15 mm and 54 (30%) – stones ≥ 15 mm. URS was performed with 8.6 or 6.4Fr semirigid ureteroscope and Holmium laser. Flexible URS was performed in cases with tortuous ureter or stone retropulsion. Data on patients‘ preoperative characterstics, stone-free rates, operating times, intra- and postoperative complications were analyzed. Results: Patients’mean age was 54.1±12.3 years and mean stone size – 14.7±.4.8 mm. 30 % of the patients had previous unsuccessful shock- wave lithotripsy of the stone. Mean operative time was 45.1±15.7 min min and overall success rate – 85.3%. 66.2% of patients were treated with semirigid URS and 33.8% – with flexible URS. On subgroup analysis patients with stones 10÷15 mm and patients with stones ≥ 15 mm had similar preoperative characteristics. Success rate after a single procedure was higher and operating times significantly shorter in the subgroup of stones sized 10÷15 mm (87.1% vs 71.3%, p=0.159 and 41.3±12.9 vs 53.3±21.3 min, p=0.040,respectively). There were no statistically significant differences between the two subgroups in intraoperative stent JJ placement (34.1% vs 50.0%, p=0.400), stone retropulsion (21.3% vs 23.1%, p=0.847) and overall postoperative complications rate (9.3% vs 0%, p=0.161). Conclusion: The results of this study suggest that URS is a safe and effective treatment for management of patients with large impacted proximal ureteral stones. Larger stone size was a predictor of lower success rate after a single procedure.
    Type of Medium: Online Resource
    ISSN: 1314-846X , 2815-3235
    URL: Journal
    URL: Article
    DOI: 10.57045/jemis
    DOI: 10.57045/jemis/1210424.pp20-22
    Language: Unknown
    Publisher: Endourology Foundation
    Publication Date: 2024
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  • 4
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    Efficacy and safety of minimally invasive percutaneous nephrolithotomy in patients with lower pole kidney stones 1-2 cm in diameter
    Endourology Foundation ; 2022
    In:  Journal of Endourology and Minimally Invasive Surgery Vol. 10, No. 1 ( 2022-7-10), p. 25-32
    Details
    In: Journal of Endourology and Minimally Invasive Surgery, Endourology Foundation, Vol. 10, No. 1 ( 2022-7-10), p. 25-32
    Abstract: Introduction: Anatomical features of the lower pole calyces plays an important role in the treatment of urolithiasis. The optimal treatment options for lower pole stones with a diameter below 2 cm are controversially discussed. Extracorporeal shock wave lithotripsy (SWL) is non-invasive, but is hampered by low stone-free rates and a significant retreatment rate in patients with unfavourable factors for lithotripsy. Retrograde intrarenal surgery (RIRS) has been demonstrated to have high stone-free rates since the development of modern flexible endoscopes. But the long operative time in the case of a large stone burden, unfavourable anatomy and considerable costs for consumables represent limiting factors for this technique. With the miniaturization of percutaneous approach and decreasing the morbidity, minimally invasive percutaneous nephrolithotomy (miniPCNL) is a promising method for treatment of lower pole stones in one stage procedure. The objective of this study is to investigate the efficacy and safety of mini-PCNL for the treatment of lower pole stones 1-2 cm. Material and methods: The medical records of 54 patients with lower pole kidney stones 1-2 cm, treated at the Clinic of Endurology and SWL, Military Medical Academy, Sofia between January 2020 to January 2022, were retrospectively reviewed. All patients underwent mini-PCNL under spinal anesthesia in prone position with fluoroscopic guidance through 18 Fr sheath using semirigid nephroscope and Ho:YAG laser for lithotripsy. Stone-free rate was defined as absence of residual fragments ≥2 mm. Data on patients’ preoperative characterstics, stone-free rates, operating times, intra- and postoperative complications were analyzed. Results: Patients mean age was 54,68±11,99 years. Mean stone surface was 169,02±57,40mm2 and mean CT stone density was 1112,26±250,47 HU. Stone-free rate after single procedure was 96,3 % (52 patients). 14,8% of patients had preoperative urinary tract infection. Mean operative time was 27,46±12,40 min and mean hospital stay - 2,5±1,17 days. The mean Hgb drop was 11.9±15.6 g/l. Lower pole puncture was performed in all patients. Two tracts were required in 1 (1,9 %) patient. One patient had intraoperative haemorrhage at the end of the procedure. Postoperative complications were observed in 2 (3,8 %) patients: postoperative fever t 〉 38.5o C in 1 patient (1,9%) and postoperative AV-fistula in 1 (1,9%) patient, who needed hemotransfusion and selective embolization. 2 patients required auxiliary procedures: 1 patient needed stent JJ and 1 underwent ureteroscopy for fragments in ureter. Conclusion: Various factors are important for management of lower pole kidney stones and should be taken into consideration, when choosing the optimal treatment modality. The results from this study suggest that mini-PCNL is an effective and safe procedure with high stone free rates and low complication rates in patients with lower pole kidney stones unfavourable for SWL and RIRS. Key words: minimally invasive nephrolithotomy, lower pole kidney, urolithiasis
    Type of Medium: Online Resource
    ISSN: 1314-846X , 2815-3235
    URL: Journal
    URL: Article
    DOI: 10.57045/jemis
    DOI: 10.57045/jemis/1010722.pp25-32
    Language: Unknown
    Publisher: Endourology Foundation
    Publication Date: 2022
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  • 5
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    Online Resource
    Impact of ureteral access sheath use on outcomes of flexible ureteroscopy for renal stones
    Endourology Foundation ; 2022
    In:  Journal of Endourology and Minimally Invasive Surgery Vol. 10, No. 2 ( 2022-11-1), p. 43-48
    Details
    In: Journal of Endourology and Minimally Invasive Surgery, Endourology Foundation, Vol. 10, No. 2 ( 2022-11-1), p. 43-48
    Abstract: Introduction and objective: Improvements in endoscopic technologies have led to an expansion of flexible ureteroscopy indications in the treatment of renal and ureteral stones. Ureteral access sheath (UAS) was introduced in the clinical practice to facilitate endoscopic access into the upper urinary tract, reduce intrarenal pressure during the procedure and allow the extraction of fragments. The objective of this study is to analyze the impact of UAS on the efficacy and safety of flexible ureteroscopy (fURS) for the treatment of renal stones. Material and methods: a prospectively collected database including 251 consecutive patients treated with fURS between January 2018 and November 2022 was analyzed. Patients were divided into two groups: group 1 – without UAS, 21 patients (8.3%) and group 2 – with UAS, 231 patients (91.7%). UAS was used at the surgeon’s discretion and 3 patients (1.2%) underwent a sheathless procedure due to failure of UAS insertion. Data on patients’ preoperative characteristics and fURS efficacy and safety were compared. Results: There were no statistically significant differences in patients’ preoperative characteristics except for stone size and surface, which were significantly larger in group 2 (9.6±4.1 vs 13.8±5.2 mm; р 〈 0.001 and 68.6±74.2 vs 128.3±109.3 mm2, p=0.002, respectively). Operating time was significantly longer in group 2 (33.6±12.9 vs 42.0±12.9 min, p=0.005). Stone-free rate after a single procedure and at 3rd postoperative month was similar between groups (95.2% vs 87%, p=0.486 and 95.2% vs 88.7%, p=0.709, respectively). The intra- and postoperative complication rates were higher for group 1 (4.8% vs 0.8%, р=0.011 and 14.3% vs 12.1%, p=0.062, respectively). Multivariate regression model identified stone surface (р 〈 0.001), number of stones (p=0.005) and calcium oxalate monohydrate stone composition (р=0.005), but not UAS use (p=0.580), as independent predictors for stone-free rate following fURS. Conclusions: The results of this study suggest that UAS use has no impact on the efficacy of fURS and is not associated with an increased rate of intra- and postoperative complications.
    Type of Medium: Online Resource
    ISSN: 1314-846X , 2815-3235
    URL: Journal
    URL: Article
    DOI: 10.57045/jemis
    DOI: 10.57045/jemis/1021122.pp43-48
    Language: Unknown
    Publisher: Endourology Foundation
    Publication Date: 2022
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  • 6
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    Online Resource
    ESWL as a method for kidney decompression in treatment of ureteral calculi during the Covid-19 pandemic
    Endourology Foundation ; 2022
    In:  Journal of Endourology and Minimally Invasive Surgery Vol. 10, No. 1 ( 2022-7-10), p. 39-42
    Details
    In: Journal of Endourology and Minimally Invasive Surgery, Endourology Foundation, Vol. 10, No. 1 ( 2022-7-10), p. 39-42
    Abstract: Introduction and objective: The application of ESWL in treatment of ureteral calculi is to achieve kidney desobstruction with minimal pain, aiming to reduce the need of analgesia and hospital stay. In times of Covid-19 pandemic by reducing the hospital stay, patients have less contacts and it is more safe for them from an epidemiological point of view. The objective of our study is to evaluate the efficacy and safety of ESWL as a method of kidney desobstruction caused of ureteral calculi during Covid-19 pandemic. Material and methods: A retrospectively collected database of 77 patients, who underwent ESWL for ureteral stones between February 2020 and January 2022 in the Clinic of Endourology and SWL, Military Medical Academy, Sofia, Bulgaria, was reviewed. Data on patients’ preoperative characteristics, stone-free rates, complications and auxiliary procedures were analyzed. Results: Patients’ mean age was 49.1±12.8 years and male-to-female ratio – 75.3%/24.7%. Mean stone length was 6.5±2 mm and mean stone width was 4.5±1.5 mm. Fifty-two (n=52, 67.5%) of the cases were with stones located in the proximal ureter, in the middle ureter (n=14, 18.2%) and in the distal ureter (n=11, 14.3%). Preoperative drainage with ureteral stent was completed in 13 cases (16.9%). Mean hospital stay was 1.28 days Mean number of SWL hits was 3527±692. Full stone disintegration was observed in 55 patients (71.4%) and partial disintegration was observed in 22 patients (28.6%). Eight (36.4%) of the patients with partial disintegration of the stone needed another ESWL, in 2 (9%) people was performed RIRS afterward and 8 cases (36.4%) required performing an URS at a later stage. Conclusions: The ESWL as a method of treatment in ureteral calculi has good success rate. With the short hospital stay, it is an appropriate method for times of Covid-19 pandemic. However in some cases, invasive endourological operations such as ureteroscopy could not be avoided in order to be achieved full kidney desobstruction. Key words: extracorporeal lithotripsy, ureteral stones, Covid 19
    Type of Medium: Online Resource
    ISSN: 1314-846X , 2815-3235
    URL: Journal
    URL: Article
    DOI: 10.57045/jemis
    DOI: 10.57045/jemis/1010722.pp39-42
    Language: Unknown
    Publisher: Endourology Foundation
    Publication Date: 2022
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  • 7
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    Online Resource
    Efficacy and safety of laser endoureterotomy for the treatment of ureteral strictures with length ≤ 10 mm
    Endourology Foundation ; 2024
    In:  Journal of Endourology and Minimally Invasive Surgery Vol. 12, No. 1 ( 2024-04-1), p. 17-18
    Details
    In: Journal of Endourology and Minimally Invasive Surgery, Endourology Foundation, Vol. 12, No. 1 ( 2024-04-1), p. 17-18
    Abstract: Introduction: Ureteral strictures are severe and difficult to treat disorders and significantly affect the quality of life of patients. Endoscopic laser ureterotomy is a minimally invasive procedure that is increasingly used for the management of ureteral strictures. Objective:The objective of our study is to evaluate the efficacy and safety of Holmium laser endoureterotomy in the treatment of ureteral strictures with length ≤ 10 mm. Material and methods:A retrospectively collected database of 21 patients who unederwent laser endoureterotomy for uretereral strictures with length ≤ 10 mm between January 2018 and January 2021 in the Clinic of Endourology and SWL, Military Medical Academy, Sofia, Bulgaria was reviewed. The endoureterotomy was performed under direct vision using a semirigid or flexible ureteroscope. Confirmation of obstruction and the results of the intervention were obtained by combinations of retrograde ureteropyelography, ultrasonography and CT. Success was defined as symptomatic relief and the absence of obstruction from the radiographic studies. Results: Patients’ mean age was 57.5±12 years and male-to-female ratio – 52.4%/47.6%. Mean length of the ureteral stricture was 7.2±2 mm. Eighteen of the patients (85.7%) were with secondary ureteral structures mainly with anamnesis for previous endoscopic surgery for impacted ureteral stones. There were no intraoperative complications. In 20 of the patients (95.2%) stent JJ 7 Fr was put postoperatively. The stent JJ was removed mean 84.2±51.6 days after the procedure. The success rate after the endoureterotomy was 85,7% (18/21), while 3 cases(14.3%) presented with a recurrent stricture. The mean follow-up period was 30.5±14.9 months. Conclusions: Ureteroscopicholmium:YAG laser endoureterotomyfor the treatment of ureteral strictures is a minimally invasive, short-stay out-patient procedure associated with a good success rate and less morbidity.
    Type of Medium: Online Resource
    ISSN: 1314-846X , 2815-3235
    Uniform Title: https://jemis.org/efficacy-and-safety-of-laser-endoureterotomy-for-the-treatment-of-ureteral-strictures-with-length-%e2%89%a4-10-mm/
    URL: Journal
    URL: Article
    DOI: 10.57045/jemis
    DOI: 10.57045/jemis/1210424.pp17-18
    Language: Unknown
    Publisher: Endourology Foundation
    Publication Date: 2024
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  • 8
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    Online Resource
    Efficacy of Magnetic Resonance Imaging/ Ultrasound-Guided Target Biopsy in Detecting Clinically Significant Prostate Cancer
    Endourology Foundation ; 2024
    In:  Journal of Endourology and Minimally Invasive Surgery Vol. 12, No. 1 ( 2024-04-1), p. 18-19
    Details
    In: Journal of Endourology and Minimally Invasive Surgery, Endourology Foundation, Vol. 12, No. 1 ( 2024-04-1), p. 18-19
    Abstract: Introduction: Prostate cancer remains a formidable health challenge, demanding diagnostic strategies that balance accuracy and invasiveness. To enhance early detection and accurate risk stratification, various diagnostic methods have been developed. Magnetic Resonance Imaging (MRI) is considered the standard imaging modality for the detection and localization of prostate cancer. Prostate Imaging Reporting and Data System (PI-RADS) is a standardized system that assigns scores to suspicious lesions based on MRI findings. This system helps distinguish the likelihood of clinically significant prostate cancer (CsPCa), guiding clinicians in decision-making. Magnetic Resonance Imaging/Ultrasound-Guided fusion target biopsy (MRI/US) has emerged as a promising technique in diagnosis of prostate cancer, fusing advanced imaging modalities with real-time ultrasound guidance. Material and methods: A retrospective study was carried out from January 2019 to June 2023. Patients included in the study had elevated tPSA levels and underwent MRI of the prostate. MRI findings were characterized on the basis of PIRADS grading. All patients with a score equal or higher than PI-RADS 3 underwent MRI/US-guided fusion target biopsy. The histopathological results were retrospectively analyzed. Results: 375 patients were included in the study. The mean age of the patients in our study was 67.8 ± 8.2 years. tPSA levels ranged 17.21 ± 31.36 ng/ml and mean prostate volume was 52.67 ± 19.6 cc. 87.5 % of the patients had a negative rectal digital exam and 12.5 % had a positive one. 29.4 % of the MRI exams had lesions scored as PI-RADS 3, 47.1 % – as PI-RADS 4 and 22.5 % as PI-RADS 5. 67.1 % of detected lesions were located in the peripheral zone, 26.5 % – in the transitional zone, 4.5 % in the anterior zone and 1.6% of the lesions were apical. 35.7 % patients had a negative for carcinoma histopathological result and were diagnosed with benign prostatic hyperplasia; 39.2 % of the histopathological results were classified as low grade prostate carcinoma and 29.5 % as high grade prostate carcinoma. All results were classified according to the Gleason score. 30.1 % were Gleason score 3+3=6, 25.1 % were Gleason 7 (13.1 % as Gleason 3+4 and 12 % as 4+3), 5.1 % were Gleason 8 and 5.6 % were Gleason 4+5 or 5+4. Conclusion: The integration of MRI/US fusion biopsy into the diagnostic pathway has significantly improved the detection and characterization of clinically significant prostate cancer. This approach enables more personalized and precise management strategies for patients with prostate cancer.
    Type of Medium: Online Resource
    ISSN: 1314-846X , 2815-3235
    URL: Journal
    URL: Article
    DOI: 10.57045/jemis
    DOI: 10.57045/jemis/1210424.pp18-19
    Language: Unknown
    Publisher: Endourology Foundation
    Publication Date: 2024
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  • 9
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    Comparison of minimally invasive percutaneous nephrolithotomy and ureteroscopy in the management of impacted proximal ureteral stones
    Endourology Foundation ; 2022
    In:  Journal of Endourology and Minimally Invasive Surgery Vol. 10, No. 2 ( 2022-11-1), p. 55-65
    Details
    In: Journal of Endourology and Minimally Invasive Surgery, Endourology Foundation, Vol. 10, No. 2 ( 2022-11-1), p. 55-65
    Abstract: Introduction and objective: Management of large impacted proximal ureteral stones is often challenging due to the presence of mucosal edema, inflammation and angulations of the ureter and other factors which impede stone access, visibility and lithotripsy and can lead to different types of complications. The objective of our study is to compare the efficacy and safety of minimally invasive percutaneous nephrolithotripsy (mini-PCNL) and ureteroscopy (URS) in the treatment of impacted proximal ureteral stones. Material and methods: The medical records of 345 patients with impacted proximal ureteral stones 10-20 mm, treated between January 2016 – November 2022 were retrospectively reviewed. 178 patients (51.6%) underwent mini-PCNL, and 167 (48.4%) – URS. Data on patients’ preoperative characteristics, stone-free rates, operating times, intra- and postoperative complications were compared. Results: Patients’ preoperative characteristics were comparable between the two groups, except for mean stone surface and stone size, which were significantly higher in the mini-PCNL group (respectively, 137.87±44.32mm2 vs 80.94±29.66mm2, p=0.000; and 15.03±2.43 vs 12.02±2.22mm, p=0.000). The stone free rate after single procedure was 94.9% for mini-PCNL and 89,3% in the URS group (p=0,116). Four patients (2.3%) in the mini-PCNL group had significant hemorrhage necessitating selective renovasography and angioembolization of AV fistula. 21 (12.5%) patients had stones showing upward migration during the URS procedure and 3 (1.8%) had partial perforation of the ureteral wall. Hemoglobin drop was significantly higher in mini-PNL group (13.58±12.79g/l vs 4.69±5.72g/l, p=0,000). Mean operative time was significantly longer in the URS group, despite the smaller size of the stones (respectively, 41.41±13.62min vs. 30.67±10.34min, p=0,000). There were statistically significant difference of the necessity of auxiliary procedures in the URS group (respectively, 78 patients (46,4%) vs 6 patients (3.6%), p=0.000). Conclusions: For an impacted, proximal ureteral stone mini-PNL had better stone-free rates, shorter operative time and low percentage of auxiliary procedure and hospitalizations. However, URS had the advantages of less invasiveness procedure and shorter postoperative hospital stay.
    Type of Medium: Online Resource
    URL: Journal
    URL: Article
    DOI: 10.57045/jemis
    DOI: 10.57045/jemis/1021122.pp55-65
    Language: Unknown
    Publisher: Endourology Foundation
    Publication Date: 2022
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  • 10
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    Safety of the ureteral access sheath in unstented ureters
    Endourology Foundation ; 2022
    In:  Journal of Endourology and Minimally Invasive Surgery Vol. 10, No. 2 ( 2022-11-1), p. 49-54
    Details
    In: Journal of Endourology and Minimally Invasive Surgery, Endourology Foundation, Vol. 10, No. 2 ( 2022-11-1), p. 49-54
    Abstract: Introduction and objective: With advances in technology in recent years, the indications for flexible ureterorenoscopy (fURS) for the treatment of upper urinary tract stones have expanded. To facilitate retrograde access to the kidney, extraction of fragments and reduction of intrarenal pressure during surgery, the ureteral access sheath (UAS) was introduced. The aim of the present study was to investigate the incidence of postoperative stricture after the use of UAS in unstented patients and the effectiveness and safety of different sizes of UAS. Material and methods: A retrospective study was performed, including 240 fURS procedures with the use of UAS, performed between January 2019 and April 2022. We excluded cases in which a previous intervention was performed, patients with a JJ stent, nephrostomy or impacted stones, patients who underwent radiation treatment, or had urinary tract malignancies. The postoperative stricture was considered the presence of hydronephrosis on ultrasound examination or on CT scan in the first and third months. A comparative analysis of the effectiveness and safety of using the 11/13 Fr UAS and the 12/14 Fr UAS was performed. Results: The cohort included 167 patients with a postoperative follow-up of 3 months. In 143 patients (85.7%) UAS 11/13 Fr was used, in 24 patients (14.3%) UAS 12/14 Fr. No postoperative stricture was found in any of the patients. There was no significant difference in efficacy after one procedure using UAS 11/13 versus UAS 12/14 (93.0% vs. 91.7%, p=0.684), despite the larger stone volume in UAS 12/14 (123.4±93.5 mm2 vs. 95.5±41.5, p=0.009). Mean operative time was significantly longer in UAS 11/13 (38.7±11.2 min vs 50.2±16.2 min; p=0.049). Larger UAS size was not associated with more complications compared to a smaller size, comparative safety analysis found no significant differences in the incidence of intra- and postoperative complications (0% vs. 0.7%, p=0.821 and 8.4% vs. 7.2% p=.705, respectively). Conclusions: The results of this study suggest that UAS use has no impact on the efficacy of fURS and is not associated with an increased rate of intra- and postoperative complications.
    Type of Medium: Online Resource
    ISSN: 1314-846X , 2815-3235
    URL: Journal
    URL: Article
    DOI: 10.57045/jemis
    DOI: 10.57045/jemis/1021122.pp49-54
    Language: Unknown
    Publisher: Endourology Foundation
    Publication Date: 2022
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