https://europeanurology.com/article/S0302-2838(15)00700-9/pdf/eau-guidelines-on-interventional-treatment-for-urolithiasis

EAU Guidelines on Interventional Treatment for Urolithiasis.

Purpose: To assess the current indications, perioperative morbidity, and stone-free outcomes for percutaneous nephrolithotomy (PCNL) worldwide. Patients and Methods: The Clinical Research Office of the Endourological Society (CROES) collected prospective data for consecutive patients who were treated with PCNL at centers around the world for 1 year. PCNL was performed according to study protocol and local clinical practice guidelines. Stone load and location were recorded, and postoperative complications were graded according to the modified Clavien grading system. Results: Between November 2007 and December 2009, 5803 patients were treated at 96 centers in Europe, Asia, North America, South America, and Australia. Staghorn calculus was present in 1466 (27.5%) patients, and 940, 956, and 2603 patients had stones in the upper, interpolar, and lower pole calices, respectively. The majority of procedures (85.5%) were uneventful. Major procedure-related complications included significant bleeding (7....

The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients.

Le but de ce travail etait d’evaluer l’importance de la derivation bilio-digestive dans le traitement palliatif des cancers de la tete du pancreas. Il s’agissait d’une etude retrospective sur une periode de 11 ans et 6 mois (janvier 1999 a juin 2010) dans le service de chirurgie A du CHU du Point G. Les dossiers cliniques de 45 patients atteints de cancer de la tete du pancreas a des stades avances ont ete colliges. Ont ete inclus dans l’etude les malades operes pour tumeurs malignes de la tete du pancreas non resecables confirmees a l’histologie. Les malades non operes ou ceux presentant des tumeurs d’autres localisations pancreatiques n’ont pas ete inclus dans l’etude. Les procedures de derivations bilio-digestives ont ete conduites chez 45 malades pour tumeurs de la tete du pancreas. Elles ont consiste en une anastomose choledoco-jejunale dans 18 cas (40%), une cholecysto-jejunostomie dans 15 cas (33,3%), une anastomose choledoco-duodenale dans 12 cas (28%). Cette derivation bilio-digestive a ete associee a une gastro-entero-anastomose dans 100% des cas. La morbidite etait de 13,3% avec 3 cas de fistules bilio-digestives et 3 cas d’evisceration. La mortalite operatoire a ete de 11,1%. Les derivations bilio-digestives dans la prise en charge chirurgicale palliative des cancers de la tete du pancreas permettent d’ameliorer la qualite de vie des patients. Mots cles : cancer, pancreas, derivation bilio-digestive

The Clavien-Dindo Classification of Surgical Complications

Aim: The aim of this study was to assess the efficacy, safety, and morbidity of minimally invasive tract in percutaneous nephrolithotomy (Mini-PCNL) for renal stones in comparison with the standard PCNL. Patients and Methods: In a randomized trial, 69 patients (72 renal units) undergoing Mini-PCNL (group 1) from May 2004 to December 2007 were compared with a similar group of 111 (115 renal units) patients undergoing standard PCNL (group 2). Patients who needed more than one percutaneous tract or who had simultaneously undergone the two techniques on the same renal unit were excluded from the study group. Chi-square test was performed for statistical analysis of qualitative variables, and Student's t-test for quantitative variables. A p-value of <0.05 was considered significant. Results: The two groups had comparable demographic data and some outcome of characteristics such as time of stay in hospital, postoperative pain, dose of postoperative analgesics, ratio of positive fever, and stone-free ra...

Minimally invasive tract in percutaneous nephrolithotomy for renal stones.

Purpose: The study compared characteristics and outcomes in patients with staghorn or nonstaghorn stones who were treated with percutaneous nephrolithotomy (PCNL) within the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study. Patients and Methods: Data over a 1-year period from consecutively treated patients from 96 centers worldwide were collated. The following variables in patients with staghorn or nonstaghorn stones were compared: National prevalence, patient characteristics, access method, puncture frequency and outcomes, including bleeding rates, operative time, and duration of hospital stay. Results: Data from 5335 eligible patients were collated; 1466 (27.5%) with staghorn and 3869 (72.5%) with nonstaghorn stones. Staghorn stone presentation varied between centers from 67% in Thailand to 13% in Argentina. The frequencies of previous procedures were similar between groups, but shockwave lithotripsy was less frequent in patients with staghorn stones compared wit...

/pdf/the-clinical-research-office-of-the-endourological-society-fesqbbyjpa.pdf

The clinical research office of the endourological society percutaneous nephrolithotomy global study: staghorn versus nonstaghorn stones.

Background and Purpose: Fluoroscopy is used daily by endourologic surgeons worldwide without knowledge of received radiation doses. We wanted to assess the radiation exposure of endourologic surgeons by frequently performed endourologic interventions with an over-the-table x-ray system. Patients and Methods: In this prospective single-center study, 235 endourologic interventions in 188 patients from April to September 2010 were included. Sixty-seven ureteral stent placements (USP), 51 ureteral stent changes (USC), 67 percutaneous stent changes (PSC), 11 percutaneous nephrolithotomies (PCNL), and 39 ureterorenoscopies (URS) were performed by 12 surgeons. The surgeon`s radiation exposure was measured with one thermoluminescent dosimeter (TLD) at the forehead and one at the ring finger. TLDs were analyzed at a central institute. The radiation dose detected at the forehead was counted as representative for the lens of the eye and the thyroid. Results: Mean patient age was 60.6 (±18.8) years. Analysis...

Radiation Exposure During Endourologic Procedures Using Over-the-Table Fluoroscopy Sources

The objective of this study was to assess the functional efficacy of newly developed antirefluxive ureter stents (DJ), by performing immediate post-stenting cystograms on patients with acute ureteral obstruction requiring a DJ stent, and assessing stent-related symptoms by means of ureteral stent symptoms questionnaire (USSQ). Patients with acute hydronephrosis requiring internal drainage were randomized to receive either an antirefluxive DJ or a conventional DJ (7 Fr., 26 cm, polyurethane, Urovision(®), Germany). Mean stone size was 6.64 ± 3.33 and 6.5 ± 3.54 mm. Immediately after correct placement of the DJ, 200 ml of diluted contrast media was introduced into the bladder under fluoroscopic control to detect vesicoureteral reflux (VUR). Patients completed German versions of the USSQ on days 2 and 7 following stent placement, and 1 week after stent removal. The results were analyzed. 13 conventional and 16 antirefluxive stents were placed in 29 patients. Reflux was documented in eight conventionally stented patients (62.5%). Two of the 16 patients with antirefluxive stents (22%) presented reflux. 1 week after stent implantation, the mean pain value was 1.1 in the antirefluxive group and 3 in the standard group (p < 0.062). Flank pain during micturition occurred after 2 days in seven patients (58%) with standard stents and in three patients (33%) with antirefluxive stents (p < 0.23). 1 week after stent insertion, flank pain had dropped to 40% in the standard group and 11% in the antirefluxive group (p < 0.3). Our initial experience showed that the antirefluxive system might be effective in terms of reflux prevention and reduction of stent related symptoms especially during sexual intercourse.

Initial experience with a newly developed antirefluxive ureter stent

There has been controversy over whether extracorporeal shock wave lithotripsy (ESWL) can cause damage to the endocrine cells of the pancreas, leading to the later development of diabetes mellitus. Authors from Germany prospectively evaluated acute endocrine pancreatic injury as collateral damage caused by the ESWL for treating upper urinary tract stones. In a careful study they showed that there was no effect on serum levels of variables indicating exocrine and endocrine pancreatic tissue damage, suggesting that the idea that ESWL might lead to future diabetes mellitus is unlikely to be correct.



OBJECTIVE

To detect acute damage to pancreatic cells by extracorporeal shock wave lithotripsy (ESWL), with a focus on endocrine function, as recently the development of diabetes mellitus has been suggested to be a late complication of treatment of upper urinary tract stones, and injury to pancreatic tissue by ESWL, leading to insufficient endocrine function, has been proposed as an explanation of this effect.



PATIENTS AND METHODS

The study included 12 consecutive patients treated with ESWL for proximal ureteric or kidney stones, using a third-generation electromagnetic lithotripter. To evaluate pancreatic tissue injury caused by ESWL we determined blood variables known to indicate exocrine and endocrine pancreatic cell damage; blood samples were taken before, during, immediately after, and 1 h and 24 h after ESWL to determine the serum levels of amylase, lipase, insulin, glucose, c-peptide and glucagon. Eight patients treated with ESWL for distal ureteric stones were evaluated in the same way and served as the control group.



RESULTS

Neither the variables indicating islet cell damage (c-peptide, insulin and glucagon), nor those indicating damage of exocrine pancreatic cells (amylase and lipase) changed significantly over the time course in both groups.



CONCLUSION

We could detect no immediate effect on the serum levels of variables indicating exocrine or endocrine pancreatic tissue damage caused by ESWL for urinary tract stones. The hypothesis that ESWL leads to pancreatic trauma with consecutive development of diabetes mellitus therefore seems unlikely.

Prospective evaluation of acute endocrine pancreatic injury as collateral damage of shock-wave lithotripsy for upper urinary tract stones.

Cystinuria is responsible for up to 2% of all renal stones, and up to 10% of childhood stone disease. Patients affected by this inherited disease suffer from recurrent stone formation, leading to repeated surgical/endoscopic interventions, consecutive renal impairment, and, consequently, a significant impairment of life quality. The responsible genes causing cystinuria were first described in 1994. Unfortunately, the rarity of the disease accounts for the absence of large clinical series. The establishment of the International Cystinuria Consortium attempts to combine small single-center series, which already has led to a better genetic understanding and a recently revised classification.

Cystinuria and Cystine Stones

The next 30 cases – guideline conformity of real life stone treatment

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