Journal of Clinical Medicine

Editorial

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3 pages, 185 KiB

Open AccessEditorial

Minimally Invasive Urological Procedures and Related Technological Developments—Series 2

by Bhaskar Somani

J. Clin. Med. 2023, 12(8), 2879; https://doi.org/10.3390/jcm12082879 - 14 Apr 2023

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Abstract

The world of minimally invasive urology has experienced enormous growth in recent decades with technological innovations related to new techniques and equipment, better training, and the clinical adoption of translational research [...] Full article

(This article belongs to the Special Issue Minimally Invasive Urological Procedures and Related Technological Developments—Series 2)

Research

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8 pages, 260 KiB

Open AccessArticle

Comparison and Evaluation of Outcomes of Ureteroscopy and Stone Laser Fragmentation in Extremes of Age Groups (≤10 Years and ≥80 Years of Age): A Retrospective Comparative Analysis of over 15 Years from 2 Tertiary European Centres

by Mriganka M. Sinha, Amelia Pietropaolo, Yesica Quiroz Madarriaga, Erika Llorens de Knecht, Anna Bujons Tur, Stephen Griffin and Bhaskar K. Somani

J. Clin. Med. 2023, 12(4), 1671; https://doi.org/10.3390/jcm12041671 - 20 Feb 2023

Cited by 2 | Viewed by 1152

Abstract

Aim: To assess and compare the outcomes associated with ureteroscopy and laser fragmentation (URSL) for extremes of age group (≤10 and ≥80 years). Methods: Retrospective consecutive data were collected from two European centres for all paediatric patients ≤10 undergoing URSL over a 15-year [...] Read more.

Aim: To assess and compare the outcomes associated with ureteroscopy and laser fragmentation (URSL) for extremes of age group (≤10 and ≥80 years). Methods: Retrospective consecutive data were collected from two European centres for all paediatric patients ≤10 undergoing URSL over a 15-year period (group 1). It was compared to consecutive data for all patients ≥80 years (group 2). Data were collected for patient demographics, stone characteristics, operative details, and clinical outcomes. Results: A total of 168 patients had 201 URSL procedures during this time (74 and 94 patients in groups 1 and 2 respectively). The mean age and stone sizes were 6.1 years and 85 years, and 9.7 mm and 13 mm for groups 1 and 2 respectively. While the SFR was slightly higher in group 2 (92.5% versus 87.8%, p = 0.301), post-operative stent rate was also significantly higher in the geriatric population (75.9% versus 41.2%, p = 0.0001). There was also no significant difference in pre-operative stenting (p = 0.886), ureteric access sheath use (UAS) (p = 0.220) and post-operative complications. Group 1 had an intervention rate of 1.3/patient as compared to 1.1/patient in group 2. The overall complications were 7.2% and 15.3% in groups 1 and 2 respectively (0.069), with 1 Clavien IV complication related to post-operative sepsis and brief ICU admission in group 2. Conclusion: The paediatric population had a marginally higher incidence of repeat procedure, but the overall SFR and complications were similar, and post-operative stent insertion rates were much better compared to geriatric patients. URSL is a safe procedure in the extremes of age groups with no difference in the overall outcomes between the two groups. Full article

(This article belongs to the Special Issue Minimally Invasive Urological Procedures and Related Technological Developments—Series 2)

9 pages, 241 KiB

Open AccessArticle

Venous Thromboembolism and Bleeding after Transurethral Resection of the Prostate (TURP) in Patients with Preoperative Antithrombotic Therapy: A Single-Center Study from a Tertiary Hospital in China

by Zhongyi Li, Zhihuan Zheng, Xuesong Liu, Quan Zhu, Kaixuan Li, Li Huang, Zhao Wang and Zhengyan Tang

J. Clin. Med. 2023, 12(2), 417; https://doi.org/10.3390/jcm12020417 - 04 Jan 2023

Cited by 1 | Viewed by 1705

Abstract

Background: Venous thromboembolism (VTE) and postoperative hemorrhage are unavoidable complications of transurethral resection of the prostate (TURP). At present, more and more patients with benign prostate hyperplasia (BPH) need long-term antithrombotic therapy before operation due to cardiovascular diseases or cerebrovascular diseases. The purpose [...] Read more.

Background: Venous thromboembolism (VTE) and postoperative hemorrhage are unavoidable complications of transurethral resection of the prostate (TURP). At present, more and more patients with benign prostate hyperplasia (BPH) need long-term antithrombotic therapy before operation due to cardiovascular diseases or cerebrovascular diseases. The purpose of this study was to investigate the effect of preoperative antithrombotic therapy history on lower extremity VTE and bleeding after TURP. Methods: Patients who underwent TURP in the Department of Urology, Xiangya Hospital, Central South University, from January 2017 to December 2021 and took antithrombotic drugs before operation were retrospectively analyzed. The baseline data of patients were collected, including age, prostate volume, preoperative International Prostate Symptom Score (IPSS), complications, surgical history within one month, indications of preoperative antithrombotic drugs, drug types, medication duration, etc. Main outcome measures included venous thromboembolism after TURP, intraoperative and postoperative bleeding, and perioperative blood transfusion. Secondary outcome measures included operation duration and postoperative hospitalization days, the duration of stopping antithrombotic drugs before operation, the recovery time of antithrombotic drugs after operation, the condition of lower limbs within 3 months after operation, major adverse cardiac events (MACEs), and cerebrovascular complications and death. Results: A total of 31 patients after TURP with a long preoperative history of antithrombotic drugs were included in this study. Six patients (19.4%) developed superficial venous thrombosis (SVT) postoperatively. Four of these patients progressed to deep vein thrombosis (DVT) without pulmonary thromboembolism (PE). Only one patient underwent extra bladder irrigation due to blockage of their urinary catheter by a blood clot postoperatively. The symptoms of hematuria mostly disappeared within one month postoperatively and lasted for up to three months postoperatively. No blood transfusion, surgical intervention to stop bleeding, lower limb discomfort such as swelling, MACEs, cerebrovascular complications, or death occurred in all patients within three months after surgery. Conclusion: Short-term preoperative discontinuation may help patients with antithrombotic therapy to obtain a relatively safe opportunity for TURP surgery after professional evaluation of perioperative conditions. The risks of perioperative bleeding, VTE, and serious cardiovascular and cerebrovascular complications are relatively controllable. It is essential for urologists to pay more attention to the perioperative management of these patients. However, further high-quality research results are needed for more powerful verification. Full article

(This article belongs to the Special Issue Minimally Invasive Urological Procedures and Related Technological Developments—Series 2)

8 pages, 4438 KiB

Open AccessArticle

Real Time Intrarenal Pressure Control during Flexible Ureterorrenscopy Using a Vascular PressureWire: Pilot Study

by Alba Sierra, Mariela Corrales, Merkourios Kolvatzis, Steeve Doizi and Olivier Traxer

J. Clin. Med. 2023, 12(1), 147; https://doi.org/10.3390/jcm12010147 - 24 Dec 2022

Cited by 12 | Viewed by 1906

Abstract

(1) Introduction: To evaluate the feasibility of measuring the intrapelvic pressure (IPP) during flexible ureterorenoscopy (f-URS) with a PressureWire and to optimize safety by assessing IPP during surgery. (2) Methods: Patients undergoing f-URS for different treatments were recruited. A PressureWire (0.014”, St. Jude [...] Read more.

(1) Introduction: To evaluate the feasibility of measuring the intrapelvic pressure (IPP) during flexible ureterorenoscopy (f-URS) with a PressureWire and to optimize safety by assessing IPP during surgery. (2) Methods: Patients undergoing f-URS for different treatments were recruited. A PressureWire (0.014”, St. Jude Medical, Little Canada, MN, USA) was placed into the renal cavities to measure IPP. Gravity irrigation at 40 cmH₂O over the patient and a hand-assisted irrigation system were used. Pressures were monitored in real time and recorded for analysis. Fluid balance and postoperative urinary tract infection (UTI) were documented. (3) Results: Twenty patients undergoing f-URS were included with successful IPP monitoring. The median baseline IPP was 13.6 (6.8–47.6) cmH₂O. After the placement of the UAS, the median IPP was 17 (8–44.6) cmH₂O. With irrigation pressure set at 40 cmH₂O without forced irrigation, the median IPP was 34 (19–81.6) cmH₂O. Median IPP during laser lithotripsy, with and without the use of on-demand forced irrigation, was 61.2 (27.2–149.5) cmH₂O. The maximum pressure peaks recorded during forced irrigation ranged from 54.4 to 236.6 cmH₂O. After the surgery, 3 patients (15%) presented UTI; 2 of them had a positive preoperative urine culture, previously treated, and a positive fluid balance observed after the surgery. (4) Conclusion: Based on our experience, continuous monitoring of IPP with a wire is easy to reproduce, effective, and safe. In addition, it allows us to identify and avoid high IPPs, which may affect surgery-related complications. Full article

(This article belongs to the Special Issue Minimally Invasive Urological Procedures and Related Technological Developments—Series 2)

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9 pages, 560 KiB

Open AccessArticle

Totally X-ray-Free Ultrasound-Guided Mini-Percutaneous Nephrolithotomy in Galdakao-Modified Supine Valdivia Position: A Novel Combined Surgery

by Yi-Yang Liu, Yen-Ta Chen, Hao-Lun Luo, Yuan-Chi Shen, Chien-Hsu Chen, Yao-Chi Chuang, Ko-Wei Huang and Hung-Jen Wang

J. Clin. Med. 2022, 11(22), 6644; https://doi.org/10.3390/jcm11226644 - 09 Nov 2022

Cited by 1 | Viewed by 1491

Abstract

We introduced a novel surgery that combines ultrasound guidance, miniaturization and Galdakao-modified supine Valdivia (GMSV) position in percutaneous nephrolithotomy (PCNL) and evaluated the safety and efficacy. This retrospective, single-center study retrospectively reviewed 150 patients who underwent ultrasound-guided mini-PCNL in the GMSV position from [...] Read more.

We introduced a novel surgery that combines ultrasound guidance, miniaturization and Galdakao-modified supine Valdivia (GMSV) position in percutaneous nephrolithotomy (PCNL) and evaluated the safety and efficacy. This retrospective, single-center study retrospectively reviewed 150 patients who underwent ultrasound-guided mini-PCNL in the GMSV position from November 2019 to March 2022. All perioperative parameters were collected. Stone-free status was defined as no residual stones or clinically insignificant residual fragments (CIRF) <0.4 cm on postoperative day one. Among the 150 patients, the mean age was 56.96 years. The mean stone size was 3.19 cm (427 mm²). The mean S.T.O.N.E. score was 7.61, including 36 patients (24%) with scores ≥9. The mean operative time was 66.22 min, and the success rate of renal access creation in the first attempt was 88.7%. One hundred and forty (93.3%) patients were stone free. The mean decrease in Hemoglobin was 1.04 g/dL, and no patient needed a blood transfusion. Complications included transient hematuria (n = 13, 8.7%), bladder blood clot retention (n = 2, 1.3%), fever (n = 15, 10%) and sepsis (n = 2, 1.3%). Totally X-ray-free ultrasound-guided mini-PCNL in the GMSV position is feasible, safe and effective for patients with upper urinary tract stones, indicating the synergistic and complementary effects of the three novel techniques. Full article

(This article belongs to the Special Issue Minimally Invasive Urological Procedures and Related Technological Developments—Series 2)

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9 pages, 777 KiB

Open AccessArticle

Variation in Tap Water Mineral Content in the United Kingdom: Is It Relevant for Kidney Stone Disease?

by Kirolos G. F. T. Michael and Bhaskar K. Somani

J. Clin. Med. 2022, 11(17), 5118; https://doi.org/10.3390/jcm11175118 - 30 Aug 2022

Cited by 2 | Viewed by 2242

Abstract

Introduction: The dissolved mineral content of drinking water can modify a number of excreted urinary parameters, with potential implications for kidney stone disease (KSD). The aim of this study is to investigate the variation in the mineral content of tap drinking water in [...] Read more.

Introduction: The dissolved mineral content of drinking water can modify a number of excreted urinary parameters, with potential implications for kidney stone disease (KSD). The aim of this study is to investigate the variation in the mineral content of tap drinking water in the United Kingdom and discuss its implications for KSD. Methods: The mineral composition of tap water from cities across the United Kingdom was ascertained from publicly available water quality reports issued by local water supply companies using civic centre postcodes during 2021. Water variables, reported as 12-monthly average values, included total water hardness and concentrations of calcium, magnesium, sodium and sulphate. An unpaired t-test was undertaken to assess for regional differences in water composition across the United Kingdom. Results: Water composition data were available for 66 out of 76 cities in the United Kingdom: 45 in England, 8 in Scotland, 7 in Wales and 6 in Northern Ireland. The median water hardness in the United Kingdom was 120.59 mg/L CaCO₃ equivalent (range 16.02–331.50), while the median concentrations of calcium, magnesium, sodium and sulphate were 30.46 mg/L (range 5.35–128.0), 3.62 mg/L (range 0.59–31.80), 14.72 mg/L (range 2.98–57.80) and 25.36 mg/L (range 2.86–112.43), respectively. Tap water in England was markedly harder than in Scotland (192.90 mg/L vs. 32.87 mg/L as CaCO₃ equivalent; p < 0.001), which overall had the softest tap water with the lowest mineral content in the United Kingdom. Within England, the North West had the softest tap water, while the South East had the hardest water (70.00 mg/L vs. 285.75 mg/L as CaCO₃ equivalent). Conclusions: Tap water mineral content varies significantly across the United Kingdom. Depending on where one lives, drinking 2–3 L of tap water can contribute over one-third of recommended daily calcium and magnesium requirements, with possible implications for KSD incidence and recurrence. Full article

(This article belongs to the Special Issue Minimally Invasive Urological Procedures and Related Technological Developments—Series 2)

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8 pages, 212 KiB

Open AccessArticle

Comparison of the Safety and Efficacy of Laser Versus Pneumatic Intracorporeal Lithotripsy for Treatment of Bladder Stones in Children

by Ziad H. Abd and Samir A. Muter

J. Clin. Med. 2022, 11(3), 513; https://doi.org/10.3390/jcm11030513 - 20 Jan 2022

Cited by 3 | Viewed by 1419

Abstract

This study aimed to compare the safety and efficacy of laser lithotripsy and pneumatic lithotripsy, the two most commonly used transurethral lithotripsy methods for treating bladder stones in children in Iraq. Between January 2013 and December 2016, 64 children with bladder stones were [...] Read more.

This study aimed to compare the safety and efficacy of laser lithotripsy and pneumatic lithotripsy, the two most commonly used transurethral lithotripsy methods for treating bladder stones in children in Iraq. Between January 2013 and December 2016, 64 children with bladder stones were included in this prospective randomized study, after ethical committee approval and written consent from the children’s parents or caregivers were obtained. Patients were assigned randomly by computer software to two groups treated with either pneumatic cystolithotripsy or laser lithotripsy. A 9 Fr. semirigid ureteroscope was used to pass the lithotripter through and fragment the stone. A catheter of 8–12 Fr. was then introduced and kept in place for 24 h. All children were hospitalized for 24 h, and the catheter was removed the next morning. Outpatient follow-up was maintained for 6–12 months. In terms of operation outcomes and complications, the laser lithotripsy group had a significantly longer duration of operation (74.5 ± 26.6 min vs. 51.5 ± 17.2 min, p = 0.001), whereas the number of patients requiring an extended hospital stay was significantly higher in the pneumatic lithotripsy group (48.5% vs. 16.1%, p = 0.006). Moreover, pneumatic lithotripsy was associated with a significantly greater risk of having at least one adverse effect (64% greater than that in the laser group). Stone clearance rates did not significantly differ between treatment groups. In conclusion, both pneumatic and laser lithotripters can be used to treat children with bladder stones with high efficacy and safety. Full article

(This article belongs to the Special Issue Minimally Invasive Urological Procedures and Related Technological Developments—Series 2)

Other

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11 pages, 1516 KiB

Open AccessSystematic Review

Radiomics in Urolithiasis: Systematic Review of Current Applications, Limitations, and Future Directions

by Ee Jean Lim, Daniele Castellani, Wei Zheng So, Khi Yung Fong, Jing Qiu Li, Ho Yee Tiong, Nariman Gadzhiev, Chin Tiong Heng, Jeremy Yuen-Chun Teoh, Nithesh Naik, Khurshid Ghani, Kemal Sarica, Jean De La Rosette, Bhaskar Somani and Vineet Gauhar

J. Clin. Med. 2022, 11(17), 5151; https://doi.org/10.3390/jcm11175151 - 31 Aug 2022

Cited by 8 | Viewed by 2437

Abstract

Radiomics is increasingly applied to the diagnosis, management, and outcome prediction of various urological conditions. Urolithiasis is a common benign condition with a high incidence and recurrence rate. The purpose of this scoping review is to evaluate the current evidence of the application [...] Read more.

Radiomics is increasingly applied to the diagnosis, management, and outcome prediction of various urological conditions. Urolithiasis is a common benign condition with a high incidence and recurrence rate. The purpose of this scoping review is to evaluate the current evidence of the application of radiomics in urolithiasis, especially its utility in diagnostics and therapeutics. An electronic literature search on radiomics in the setting of urolithiasis was conducted on PubMed, EMBASE, and Scopus from inception to 21 March 2022. A total of 7 studies were included. Radiomics has been successfully applied in the field of urolithiasis to differentiate phleboliths from calculi and classify stone types and composition pre-operatively. More importantly, it has also been utilized to predict outcomes and complications after endourological procedures. Although radiomics in urolithiasis is still in its infancy, it has the potential for large-scale implementation. Its greatest potential lies in the correlation with conventional established diagnostic and therapeutic factors. Full article

(This article belongs to the Special Issue Minimally Invasive Urological Procedures and Related Technological Developments—Series 2)

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