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Gap between UAS and ureteroscope predicts renal stone-free rate after flexible ureteroscopy with the fragmentation technique
Purpose To assess the effect of our new classification on surgical outcomes after flexible ureteroscopy (fURS) for kidney stones. Methods We retrospectively examined 128 patients after single renal fURS procedures performed using ureteral access sheaths (UASs) with the fragmentation technique. Based...
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| Published in: | World journal of urology 2021-07, Vol.39 (7), p.2733-2739 |
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| container_title | World journal of urology |
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| creator | Komeya, Mitsuru Odaka, Hisakazu Watanabe, Takahiko Kiuchi, Hirokazu Ogawa, Takehiko Yao, Masahiro Matsuzaki, Junichi |
| description | Purpose
To assess the effect of our new classification on surgical outcomes after flexible ureteroscopy (fURS) for kidney stones.
Methods
We retrospectively examined 128 patients after single renal fURS procedures performed using ureteral access sheaths (UASs) with the fragmentation technique. Based on the gap (calculated by subtracting the ureteroscope diameter from the UAS diameter), enrolled patients were divided into three groups: small ( |
| doi_str_mv | 10.1007/s00345-020-03459-7 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2446988050</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2557678555</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-1cfcd82ffc81456d544f5a63d32cdc2e002da0a7061106aea0ccfc4799f94fd33</originalsourceid><addsrcrecordid>eNp9kU1rFTEUhoMo9lr9Ay4k4Kab6Mn3zLIUrULBhXYdcjMnvVPmZsYkQ1vwx5v21g9cuMqBPO97ODyEvObwjgPY9wVAKs1AALsfemafkA1XUrLOCvOUbMAKxVTfySPyopRrAG4N6OfkSIq-M1yqDflx7he6xXqDmOjl6Vfq00DXjBXzXMK8IF0yDmOohWZMfqKlzglZzIg0-4rUx4bSOOHtuJ3w7-gdvRnrjtYd0pj91R5T9XWcE60Ydmn8vuJL8iz6qeCrx_eYXH788O3sE7v4cv757PSCBWl1ZTzEMHQixtBxpc2glYraGzlIEYYgEEAMHrwFwzkYjx5CSyjb97FXcZDymJwcepc8t7Wluv1YAk6TTzivxQmlTN91oKGhb_9Br-c1t8MbpbU1ttNaN0ocqNBOLRmjW_K49_nOcXD3btzBjWtu3IMbZ1vozWP1ut3j8DvyS0YD5AEo7StdYf6z-z-1PwGIz5wU</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2557678555</pqid></control><display><type>article</type><title>Gap between UAS and ureteroscope predicts renal stone-free rate after flexible ureteroscopy with the fragmentation technique</title><source>Springer Nature</source><creator>Komeya, Mitsuru ; Odaka, Hisakazu ; Watanabe, Takahiko ; Kiuchi, Hirokazu ; Ogawa, Takehiko ; Yao, Masahiro ; Matsuzaki, Junichi</creator><creatorcontrib>Komeya, Mitsuru ; Odaka, Hisakazu ; Watanabe, Takahiko ; Kiuchi, Hirokazu ; Ogawa, Takehiko ; Yao, Masahiro ; Matsuzaki, Junichi</creatorcontrib><description>Purpose
To assess the effect of our new classification on surgical outcomes after flexible ureteroscopy (fURS) for kidney stones.
Methods
We retrospectively examined 128 patients after single renal fURS procedures performed using ureteral access sheaths (UASs) with the fragmentation technique. Based on the gap (calculated by subtracting the ureteroscope diameter from the UAS diameter), enrolled patients were divided into three groups: small (< 0.6 mm), medium (0.6 to < 1.2 mm), and large space groups (≥ 1.2 mm). Stone-free (SF) status was defined as either complete absence of stones (SF) or the presence of stones < 4 mm in diameter on non-contrast computed tomography (NCCT).
Results
The SF rate was significantly lower in the small space group (50% in small, 97.9% in medium, 89.2% in large;
p
= 0.001). Perioperative complications over Clavien–Dindo Grade I were observed in 16.7%, 4.2%, and 8.1% of patients, respectively (
p
= 0.452). The ratio of stone volume and operative time (efficiency of stone removal) was significantly higher in the large space group compared to the small and medium space groups (0.009 ± 0.003 ml/min, 0.013 ± 0.005 ml/min, 0.027 ± 0.012 ml/min, respectively;
p
< 0.001).
Conclusion
Our findings that gaps > 0.6 mm (1.8 Fr), including the combination of a 9.5-Fr UAS and a small caliber ureteroscope, improve SF rates, and larger gaps facilitate stone removal efficiency providing the basis for future development of clinical protocols aimed at improving outcomes.</description><identifier>ISSN: 0724-4983</identifier><identifier>EISSN: 1433-8726</identifier><identifier>DOI: 10.1007/s00345-020-03459-7</identifier><identifier>PMID: 32986134</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Aged ; Calculi ; Computed tomography ; Female ; Humans ; Kidney Calculi - surgery ; Kidney stones ; Lithiasis ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Nephrolithiasis ; Nephrology ; Oncology ; Original Article ; Patients ; Retrospective Studies ; Sheaths ; Treatment Outcome ; Ureteroscopes ; Ureteroscopy - instrumentation ; Ureteroscopy - methods ; Urology</subject><ispartof>World journal of urology, 2021-07, Vol.39 (7), p.2733-2739</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020</rights><rights>2020. Springer-Verlag GmbH Germany, part of Springer Nature.</rights><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-1cfcd82ffc81456d544f5a63d32cdc2e002da0a7061106aea0ccfc4799f94fd33</citedby><cites>FETCH-LOGICAL-c375t-1cfcd82ffc81456d544f5a63d32cdc2e002da0a7061106aea0ccfc4799f94fd33</cites><orcidid>0000-0002-0744-7492</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32986134$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Komeya, Mitsuru</creatorcontrib><creatorcontrib>Odaka, Hisakazu</creatorcontrib><creatorcontrib>Watanabe, Takahiko</creatorcontrib><creatorcontrib>Kiuchi, Hirokazu</creatorcontrib><creatorcontrib>Ogawa, Takehiko</creatorcontrib><creatorcontrib>Yao, Masahiro</creatorcontrib><creatorcontrib>Matsuzaki, Junichi</creatorcontrib><title>Gap between UAS and ureteroscope predicts renal stone-free rate after flexible ureteroscopy with the fragmentation technique</title><title>World journal of urology</title><addtitle>World J Urol</addtitle><addtitle>World J Urol</addtitle><description>Purpose
To assess the effect of our new classification on surgical outcomes after flexible ureteroscopy (fURS) for kidney stones.
Methods
We retrospectively examined 128 patients after single renal fURS procedures performed using ureteral access sheaths (UASs) with the fragmentation technique. Based on the gap (calculated by subtracting the ureteroscope diameter from the UAS diameter), enrolled patients were divided into three groups: small (< 0.6 mm), medium (0.6 to < 1.2 mm), and large space groups (≥ 1.2 mm). Stone-free (SF) status was defined as either complete absence of stones (SF) or the presence of stones < 4 mm in diameter on non-contrast computed tomography (NCCT).
Results
The SF rate was significantly lower in the small space group (50% in small, 97.9% in medium, 89.2% in large;
p
= 0.001). Perioperative complications over Clavien–Dindo Grade I were observed in 16.7%, 4.2%, and 8.1% of patients, respectively (
p
= 0.452). The ratio of stone volume and operative time (efficiency of stone removal) was significantly higher in the large space group compared to the small and medium space groups (0.009 ± 0.003 ml/min, 0.013 ± 0.005 ml/min, 0.027 ± 0.012 ml/min, respectively;
p
< 0.001).
Conclusion
Our findings that gaps > 0.6 mm (1.8 Fr), including the combination of a 9.5-Fr UAS and a small caliber ureteroscope, improve SF rates, and larger gaps facilitate stone removal efficiency providing the basis for future development of clinical protocols aimed at improving outcomes.</description><subject>Adult</subject><subject>Aged</subject><subject>Calculi</subject><subject>Computed tomography</subject><subject>Female</subject><subject>Humans</subject><subject>Kidney Calculi - surgery</subject><subject>Kidney stones</subject><subject>Lithiasis</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Nephrolithiasis</subject><subject>Nephrology</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Sheaths</subject><subject>Treatment Outcome</subject><subject>Ureteroscopes</subject><subject>Ureteroscopy - instrumentation</subject><subject>Ureteroscopy - methods</subject><subject>Urology</subject><issn>0724-4983</issn><issn>1433-8726</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kU1rFTEUhoMo9lr9Ay4k4Kab6Mn3zLIUrULBhXYdcjMnvVPmZsYkQ1vwx5v21g9cuMqBPO97ODyEvObwjgPY9wVAKs1AALsfemafkA1XUrLOCvOUbMAKxVTfySPyopRrAG4N6OfkSIq-M1yqDflx7he6xXqDmOjl6Vfq00DXjBXzXMK8IF0yDmOohWZMfqKlzglZzIg0-4rUx4bSOOHtuJ3w7-gdvRnrjtYd0pj91R5T9XWcE60Ydmn8vuJL8iz6qeCrx_eYXH788O3sE7v4cv757PSCBWl1ZTzEMHQixtBxpc2glYraGzlIEYYgEEAMHrwFwzkYjx5CSyjb97FXcZDymJwcepc8t7Wluv1YAk6TTzivxQmlTN91oKGhb_9Br-c1t8MbpbU1ttNaN0ocqNBOLRmjW_K49_nOcXD3btzBjWtu3IMbZ1vozWP1ut3j8DvyS0YD5AEo7StdYf6z-z-1PwGIz5wU</recordid><startdate>20210701</startdate><enddate>20210701</enddate><creator>Komeya, Mitsuru</creator><creator>Odaka, Hisakazu</creator><creator>Watanabe, Takahiko</creator><creator>Kiuchi, Hirokazu</creator><creator>Ogawa, Takehiko</creator><creator>Yao, Masahiro</creator><creator>Matsuzaki, Junichi</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0744-7492</orcidid></search><sort><creationdate>20210701</creationdate><title>Gap between UAS and ureteroscope predicts renal stone-free rate after flexible ureteroscopy with the fragmentation technique</title><author>Komeya, Mitsuru ; Odaka, Hisakazu ; Watanabe, Takahiko ; Kiuchi, Hirokazu ; Ogawa, Takehiko ; Yao, Masahiro ; Matsuzaki, Junichi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-1cfcd82ffc81456d544f5a63d32cdc2e002da0a7061106aea0ccfc4799f94fd33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Calculi</topic><topic>Computed tomography</topic><topic>Female</topic><topic>Humans</topic><topic>Kidney Calculi - surgery</topic><topic>Kidney stones</topic><topic>Lithiasis</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Nephrolithiasis</topic><topic>Nephrology</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Sheaths</topic><topic>Treatment Outcome</topic><topic>Ureteroscopes</topic><topic>Ureteroscopy - instrumentation</topic><topic>Ureteroscopy - methods</topic><topic>Urology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Komeya, Mitsuru</creatorcontrib><creatorcontrib>Odaka, Hisakazu</creatorcontrib><creatorcontrib>Watanabe, Takahiko</creatorcontrib><creatorcontrib>Kiuchi, Hirokazu</creatorcontrib><creatorcontrib>Ogawa, Takehiko</creatorcontrib><creatorcontrib>Yao, Masahiro</creatorcontrib><creatorcontrib>Matsuzaki, Junichi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Komeya, Mitsuru</au><au>Odaka, Hisakazu</au><au>Watanabe, Takahiko</au><au>Kiuchi, Hirokazu</au><au>Ogawa, Takehiko</au><au>Yao, Masahiro</au><au>Matsuzaki, Junichi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Gap between UAS and ureteroscope predicts renal stone-free rate after flexible ureteroscopy with the fragmentation technique</atitle><jtitle>World journal of urology</jtitle><stitle>World J Urol</stitle><addtitle>World J Urol</addtitle><date>2021-07-01</date><risdate>2021</risdate><volume>39</volume><issue>7</issue><spage>2733</spage><epage>2739</epage><pages>2733-2739</pages><issn>0724-4983</issn><eissn>1433-8726</eissn><abstract>Purpose
To assess the effect of our new classification on surgical outcomes after flexible ureteroscopy (fURS) for kidney stones.
Methods
We retrospectively examined 128 patients after single renal fURS procedures performed using ureteral access sheaths (UASs) with the fragmentation technique. Based on the gap (calculated by subtracting the ureteroscope diameter from the UAS diameter), enrolled patients were divided into three groups: small (< 0.6 mm), medium (0.6 to < 1.2 mm), and large space groups (≥ 1.2 mm). Stone-free (SF) status was defined as either complete absence of stones (SF) or the presence of stones < 4 mm in diameter on non-contrast computed tomography (NCCT).
Results
The SF rate was significantly lower in the small space group (50% in small, 97.9% in medium, 89.2% in large;
p
= 0.001). Perioperative complications over Clavien–Dindo Grade I were observed in 16.7%, 4.2%, and 8.1% of patients, respectively (
p
= 0.452). The ratio of stone volume and operative time (efficiency of stone removal) was significantly higher in the large space group compared to the small and medium space groups (0.009 ± 0.003 ml/min, 0.013 ± 0.005 ml/min, 0.027 ± 0.012 ml/min, respectively;
p
< 0.001).
Conclusion
Our findings that gaps > 0.6 mm (1.8 Fr), including the combination of a 9.5-Fr UAS and a small caliber ureteroscope, improve SF rates, and larger gaps facilitate stone removal efficiency providing the basis for future development of clinical protocols aimed at improving outcomes.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>32986134</pmid><doi>10.1007/s00345-020-03459-7</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-0744-7492</orcidid></addata></record> |
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| source | Springer Nature |
| subjects | Adult Aged Calculi Computed tomography Female Humans Kidney Calculi - surgery Kidney stones Lithiasis Male Medicine Medicine & Public Health Middle Aged Nephrolithiasis Nephrology Oncology Original Article Patients Retrospective Studies Sheaths Treatment Outcome Ureteroscopes Ureteroscopy - instrumentation Ureteroscopy - methods Urology |
| title | Gap between UAS and ureteroscope predicts renal stone-free rate after flexible ureteroscopy with the fragmentation technique |
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