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Flexible ureteroscopy and Holmium:YAG laser lithotripsy for stone disease in patients with bleeding diathesis: a systematic review of the literature
Aboumarzouk, Omar M;Somani, Bhaskar K.;Monga, Manoj;
International braz j urol , 2012, DOI: 10.1590/S1677-55382012000300002
Abstract: introduction and objectives: the management of urolithiasis in patients on anticoagulants presents a challenge to the endourologist. due to multiple comorbidities, it may be impossible to safely discontinue the anticoagulant treatment. other modalities such as shock wave lithotripsy and pcnl are contraindicated in these patients, so ureteroscopic treatment may be the only option. we conducted a systematic review of the literature to look at the safety and efficacy of ureteroscopic management in these patients. methods: systematic review and quantitative meta-analysis was performed using studies identified by a systematic electronic literature search from january 1990 to august 2011. all articles reporting on treatment for stones in patients with a bleeding diathesis using ureteroscopy and a holmium:yag laser were included. two reviewers independently extracted the data from each study. the data was included into a meta-analysis and discussed. results: three studies were identified reporting on 70 patients (73 procedures). all patients had stone fragmentation using holmium laser. the mean stone size was 13.2mm with a range of 5-35mm. the quality of the included studies was modest. stone free status was achieved in sixty-four patients (87.7%). there were no major complications and only 11% of the patients developed minor complications with only 4% rate of minor bleeding. conclusions: retrograde stone treatment using ureteroscopy and holmium laser lithotripsy can be safely performed in patients with bleeding diathesis with a low complication rate.
Perinephric Hematoma Following Ureteroscopy and Holmium Laser Lithotripsy
Branden G. Duffey, Joseph Y. LeeManoj Monga
The Open Urology & Nephrology Journal , 2008, DOI: 10.2174/1874303X00801010036]
Abstract: We present a case of a ureteropyeloscopy with holmium laser lithotripsy for a 5mm distal ureteral calculus that was complicated by perinephric hemorrhage despite utilization of a ureteral access sheath and the absence of any bleeding disorders. Conservative management was elected and the patient did not require transfusion of blood products. We believe this is the first case of perinephric hemorrhage under these circumstances and suggest that surgeons inform their patients of the low risk of bleeding complications with ureteroscopy.
Holmium-YAG Laser Ureteroscopic Lithotripsy in a Patient with Ectopic Malrotated Kidney  [cached]
Mohammad Reza Razzaghi,Mohammad Mohsen Mazloomfard,Reza Mohammadi,Hooman Bahrami-Motlagh
Journal of Lasers in Medical Sciences , 2012,
Abstract: The incidence of stone disease among patients with congenital renal anomalies including malrotated kidney is more than in normal population due to poor urine drainage and stasis (1). Various minimally invasive options have been used for the management. Ureteroscopy and Holmium:YAG laser lithotripsy have been reported with favorable outcomes (2). We report a 30-year-old male who presented to our hospital having a right side malrotated kidney with a large stone in it. He underwent two session of ureteroscopy and Holmium:YAG laser lithotripsy
Comparison of ESWL and Ureteroscopic Holmium Laser lithotripsy in Management of Ureteral Stones  [PDF]
Yon Cui, Wenzhou Cao, Hua Shen, Jianjun Xie, Tamara S. Adams, Yuanyuan Zhang, Qiang Shao
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0087634
Abstract: Background There are many options for urologists to treat ureteral stones that range from 8 mm to 15 mm, including ESWL and ureteroscopic holmium laser lithotripsy. While both ESWL and ureteroscopy are effective and minimally invasive procedures, there is still controversy over which one is more suitable for ureteral stones. Objective To perform a retrospective study to compare the efficiency, safety and complications using ESWL vs. ureteroscopic holmium laser lithotripsy in management of ureteral stones. Methods Between October 2010 and October 2012, 160 patients who underwent ESWL or ureteroscopic holmium laser lithotripsy at Suzhou municipal hospital for a single radiopaque ureteral stone (the size 8–15 mm) were evaluated. All patients were followed up with ultrasonography for six months. Stone clearance rate, costs and complications were compared. Results Similarity in stone clearance rate and treatment time between the two procedures; overall procedural time, analgesia requirement and total cost were significantly different. Renal colic and gross hematuria were more frequent with ESWL while voiding symptoms were more frequent with ureteroscopy. Both procedures used for ureteral stones ranging from 8 to 15 mm were safe and minimally invasive. Conclusion ESWL remains first line therapy for proximal ureteral stones while ureteroscopic holmium laser lithotripsy costs more. To determining which one is preferable depends on not only stone characteristics but also patient acceptance and cost-effectiveness ratio.
Outcomes of flexible ureteroscopic lithotripsy with holmium laser for upper urinary tract calculi
Cocuzza, Marcello;Colombo Jr, Jose R.;Cocuzza, Antonio L.;Mascarenhas, Frederico;Vicentini, Fabio;Mazzucchi, Eduardo;Srougi, Miguel;
International braz j urol , 2008, DOI: 10.1590/S1677-55382008000200003
Abstract: objective: to assess the perioperative and financial outcomes of flexible ureteroscopic lithotripsy with holmium laser for upper tract calculi in 44 patients. materials and methods: between february 2004 and september 2006, 44 patients treated for upper tract stone with flexible ureteroscopic lithotripsy were evaluated. renal stones were associated with collecting system obstruction in 15 (34%) patients, failed extracorporeal shock-wave lithotripsy (swl) occurred in 14 (32%) patients, unilateral multiple stones in 18 (41%) patients, and multiple bilateral stones in 3 (7%). in 29 (66%) patients, the stone was located in the inferior calyx. perioperative and financial outcomes were also evaluated. results: 50 procedures were performed in 44 patients. the mean stone burden on preoperative ct scan was 11.5 ± 5.8 mm. the mean operative time was 61.3 ± 29.4 min. the stone free rate was 93.1% after one procedure and 97.7% after a second procedure, with overall complication rate of 8%. therapeutic success occurred in 92% and 93% of patients with lower pole stones and swl failure, respectively. treatment failure of a single session was associated with presence of a stone size larger than 15 mm (p = 0.007), but not associated with inferior calyx location (p = 0.09). surgical disposables were responsible for 78% of overall costs. conclusion: flexible ureteroscopy using holmium laser is a safe and effective option for the treatment of upper urinary tract calculi. in addition, it can be considered an attractive option as salvage therapy after swl failure or kidney calculi associated with ureteral stones. stone size larger than 15 mm is associated with single session treatment failure.
Comparison between the Holmium Laser (Made in Iran) and Pneumatic Lithotripsy in Patients Suffering from Upper Ureteral Stone between 1-2cm
Mohammad Reza Razaghi,Abdollah Razi
Journal of Lasers in Medical Sciences , 2012,
Abstract: INTRODUCTION: The aim of this study is to compare holmium laser (LL) with pneumatic lithoclast (PL) in patients with upper ureteral stones and their ability to destruct the stones and making the patient stone free. We also compare the duration of these procedures and their complications, such as urosepsis, perforation, and pushing the stone backward. METHODS: This has been a clinical randomized trail study in 26 patients with upper ureteral stone more than 1 cm. Patients were divided into 2 randomized groups, each treated with one of the following approaches: pneumatic lithoclast(14 patients), or holmium laser(12 patients). The goal of lithotripsy was to break the stone into particles less than 3 mm. IVP (Intravenous Pyelogram) was performed 4 weeks after. RESULTS: The immediate stone free rate was 100% in LL group and 42.9% in PL group (P=0.001). Stone pushing back was 0% in LL group and 57.1% in PL group. Complications such as a perforation, or urosepsis, or bleeding were not seen in any of these groups. Fever more than 38o C was observed in 1.8% in LL, and 3.8% in PL group (p=0.56). After 4 weeks no complication was seen in IVP. CONCLUSION: According to our experience, for upper ureteral stones larger than 1 cm, lithotripsy with holmium laser is preferred approach with high success rate and low complication.
Treatment of large proximal ureteral stones: extra corporeal shock wave lithotripsy versus semi-rigid ureteroscope with lithoclast
Ehab R Tawfick
International Archives of Medicine , 2010, DOI: 10.1186/1755-7682-3-3
Abstract: The study included 147 patients with large upper ureteral stones. SWL and ureteroscopy were performed in 71 and 76 patients respectively. Patients in the SWL group were treated with Siemens: - Modularis lithovario under intravenous sedation on an out patient basis. Patients in the ureteroscopy group were treated with (7.5 Fr) semi-rigid ureteroscope and lithoclast under spinal anesthesia on a day care basis.Stone - free rate for in situ SWL was 58% (41 of 71) patients. For semi-rigid ureteroscope accessibility of the stones was 94% (72 of 76) and the stone free rate was 92% (70 of 76) No major complications were encountered in both groups.Mean stone size was 1.34 ± 0.03 cm in the SWL group and 1.51 ± 0.04 in the ureteroscopy group.Our study demonstrates that ureteroscopy with lithoclast can be considered as acceptable treatment modality for large proximal ureteral calculi and can be considered as fist line for treatment of large proximal ureteral stones.Most ureteral stones pass spontaneously. Those that do not can be removed by either shock wave lithotripsy or ureteroscopy. Open surgery is appropriate as a salvage procedure or in certain unusual circumstances. SWL has been recommended as first line treatment for proximal ureteral calculi less than I cm. for large proximal ureteral calculi it remains to be defined [1].Stone size is an important variable in determining the out come of SWL, but little information is available on the influence that stone size has on the treatment of proximal ureteral stones. Advances during the last 2 decades with the advent of small diameter ureteroscopes and intra corporeal lithotripsy such as ultrasound, electro hydraulic, lithoclast and more recently the Holmium: YAG laser, have allowed more successful and safer endoscopic removal of upper ureteral calculi [2-5]. In this study for treatment of large proximal ureteral stones we compared treatment outcomes in patients undergoing semi-rigid ureteroscope and lithoclast with in situ SWL
Stone ConeTM: Un dispositivo que previene la migración de litiasis ureteral durante la litotricia intracorpórea
Rodríguez García,Nuria; Fernández González,Inmaculada; Pascual Mateo,Carlos; Chiva Robles,Vicente; Luján Galán,Marcos; Llanes González,Luis; Berenguer Sánchez,Antonio;
Archivos Espa?oles de Urología (Ed. impresa) , 2005, DOI: 10.4321/S0004-06142005000400008
Abstract: objectives: proximal migration of stone fragments during ureteroscopic lithotripsy is a common problem influenced by pressure of irrigation solution, type of energy for lithotripsy, site and degree of fixation of the stone to the ureteral wall, and degree of proximal ureteral dilation. the stone cone tm (boston scientific & spencer) is a device that helps to prevent proximal migration of fragments and favours a safe extraction during ureteroscopic lithotripsy. technique: the stone cone tm is an helical device made of stainless steel and nitinol alloy, which consists of an internal guide wire and a sheath-like radiopaque catheter with a 3 fr. calibre. once the cone is placed above the stone it is maintained in that position during lithotripsy to avoid fragment migration. the external catheter is used to coil and unroll the cone, and allows access to place the cone above the stone. methods: we describe two cases of urinary calculi in the left lumbar ureter treated by ureteroscopy and intracorporeal lithotripsy with holmium yag laser using the stone cone tm to avoid migration of fragments. results: one month after surgery no lithiasic fragments were observed in the imaging tests. conclusions: the stone cone tm decreases the need to perform repeated ureteral instrumentations, and is also a safer and simpler method for the extraction of stone fragments. the use of stone cone tm seems to have more advantages than dormia‘s basket during ureteroscopic lithotripsy in terms of lower incidence of residual fragments and reoperation rate.
Trans-Ureteral Ureterolithotripsy of Ureteral Calculi:Which is the Best; Pneumatic or Holmium Laser Technique?
Mohammad Reza Razzaghi,Abdollah Razi,Mohammad Mohsen Mazloomfard,Hooman Mokhtarpour
Journal of Lasers in Medical Sciences , 2011,
Abstract: INTRODUCTION: Our aim was compare of two types of lithotripter include holmium: YAG laser and pneumatic one in transurethral ureterolithotripsy (TUL) for the management of ureteral calculi ≥1 cm. METHODS: 112 patients with ureteral calculi more than 1 cm were selected in randomized order for pneumatic or holmium: YAG laser transurethral ureterolithotripsy (56 patients in each group). Ultrasonography and intravenous urography were performed for all patients before surgery. Complete clearance and success was defined as the absence of any fragments on post operation KUB and ultrasonography images. RESULTS: Success rate was 85.7% in pneumatic group and 100% in holmium: YAG laser group (p =0.003). Stone migration up in the pelvicalyceal system was observed only in 8 cases of pneumatic group. No statically differences were observed in terms of patient’s age, hospital stay, and complications between two groups. CONCLUSION: According to our experience, for ureteral stone larger than 1 Cm treatment with ureteroscopy and laser lithotripsy is a preferring approach with favorable operation time and hospital admission, and no more significant complication.
Ureteroscopy in patients with coagulopathies is associated with lower stone-free rate and increased risk of clinically significant hematuria
Elkoushy, Mohamed A.;Violette, Philipe D.;Andonian, Sero;
International braz j urol , 2012, DOI: 10.1590/S1677-55382012000200007
Abstract: purpose: patients with coagulopathy are at increased risk of peri-operative hemorrhage. the aim of the present study was to compare ureteroscopy (urs) in these high risk patients to those with normal bleeding profile. materials and methods: twelve patients with coagulopathies (group i) undergoing 17 urs were included in the study [3 for biopsy of ureteral lesions and 9 for holmium laser lithotripsy (hll)]. a patient had child b (meld 11) cirrhosis, 6 patients were on warfarin, 3 patients on asa, 1 patient on asa and clopidogrel, and the last patient was on heparin. urs in group i was performed without correction of coagulopathy. group ii consisted of 32 patients with normal bleeding profile who underwent 34 urs concurrently. results: group i included 4 ureteral biopsies in 3 patients with suspicious ureteral lesions and 13 urs for hll in 9 patients with nephrolithiasis. there were no significant differences between the two groups in terms of patient age, sex, percent of renal stones, median operative and fluoroscopy times. when compared with group ii, group i had significantly larger median stone size (9.2 vs. 14.0 mm, p = 0.01) and significantly lower stone-free rate after first urs (94.1% vs. 69.2%, p = 0.04). however, after second urs, stone-free rates were comparable in both groups (92.3% vs. 100%, p = 0.9). two (16.7%) patients with coagulopathy were readmitted due to gross hematuria. there were no post-operative complications in group ii. conclusions: although urs in selected patients with coagulopathies is safe, it is associated with significantly lower stone-free rates and higher readmissions due to gross hematuria.
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