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Diagnosing upper tract urothelial carcinoma: A review of the role of diagnostic Ureteroscopy and novel developments over last two decades

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Asian Journal of Urology 2024年第2期11卷 242-252页

作者： Paul Gravestock Daniel Cullum Bhaskar Somani Rajan Veeratterapillay Urology Department Freeman HospitalNewcastle Upon TyneUK Department of Urology University Hospital SouthamptonSouthamptonUK

Objective: The role of Ureteroscopy in the diagnosis of upper tract urothelial carcinoma is yet to be fully determined. We aimed to provide an up to date evaluation of its role and the emerging technologies in the field.Methods: A literature search of the last two decades (from 24th May, 2001 to 24th May, 2021) was carried out identifying 147 papers for potential inclusion within this narrative review.Results: Diagnostic Ureteroscopy is undeniably useful in its ability to visualise and biopsy indeterminate lesions, and to risk stratify malignant lesions that may be suitable for kidney sparing surgery. However, an increased risk of intravesical recurrence following nephroureterectomy when a prior diagnostic Ureteroscopy has been performed, inadequate sampling at biopsy, complications from the procedure, and difficult ureteric access are all potential drawbacks. Furthermore, whilst generally an accurate diagnostic procedure, it risks missing carcinoma in-situ lesions. Despite this, evidence shows that routine use of Ureteroscopy changes the management of patients in a large proportion of cases, preventing unnecessary surgery or facilitating kidney sparing surgery. The overall rate of complications is low, and improved biopsy techniques and the use of tissue biomarkers for improved staging and grading are encouraging. The risks of delays to definitive management and post-Ureteroscopy intravesical recurrence do not seem to affect survival, and trials are in progress to determine whether intravesical therapy can mitigate the latter. Further promising techniques are being investigated to improve shortcomings, particularly in relation to improved diagnosis of carcinoma in situ and preoperative staging.Conclusion: Ureteroscopy has a role in the diagnosis of upper tract malignancy, though whether it should be used routinely is yet to be determined.

关键词： Ureteroscopy Carcinoma Transitional cell Ureteralneoplasms Urinary bladder neoplasms Carcinomainsitu Biopsy

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The role of Ureteroscopy for treatment of staghorn calculi: A systematic review

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Asian Journal of Urology 2020年第2期7卷 110-115页

作者： Etienne Xavier Keller Vincent De Coninck Steeve Doizi Olivier Traxer Sorbonne Universite Service d’UrologieAP-HPHopital TenonF-75020ParisFrance Sorbonne Universite GRC n°20Groupe de Recherche Clinique sur la Lithiase UrinaireHopital TenonF-75020ParisFrance Department of Urology University Hospital ZurichUniversity of ZurichZurichSwitzerland Department of Urology AZ KlinaBrasschaatBelgium

Objective:To define the role of Ureteroscopy for treatment of staghorn calculi.Methods:A systematic review was conducted using the Scopus and Medline databases.Original articles and systematic reviews were selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.Only studies relating to the role of Ureteroscopy for treatment of staghorn calculi were included.Results:In five studies on ureteroscopic monotherapy,stone-free rate(SFR)ranged from 33%to 93%,with a maximum four Ureteroscopy sessions per patient and no major complications.Endoscopic combined intrarenal surgery(ECIRS)was compared with percutaneous nephrolithotomy(PNL)in two studies and reached significantly higher SFR(88%e91%vs.59%e65%)and lower operative times(84e110 min vs.105e129 min).The role of salvage Ureteroscopy for residual stones after primary PNL has been highlighted by two studies with a final SFR of 83%e89%.One study reported on the feasibility of Ureteroscopy for ureteral stones and same-session PNL for contralateral staghorn calculi,with a SFR of 92%.Conclusion:Ureteroscopy plays a pivotal role in the setting of a combined approach to staghorn calculi.Ureteroscopy is also particularly suitable for clearance of residual stones.In specific cases,Ureteroscopy may become the sole applicable therapeutic option to staghorn calculi.Technological advances and refinement of techniques suggest a major role of Ureteroscopy for staghorn calculi treatment in close future.

关键词： Staghorn calculi Ureteroscopy Percutaneous nephrolithotomy Combined approach Intrarenal surgery Simultaneous bilateral endoscopic surgery

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Rigid Ureteroscopy in prone split-leg position for fragmentation of female ureteral stones:A case report

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World Journal of Clinical Cases 2020年第7期8卷 1301-1305页

作者： Kai Huang Department of Urology Clinical Medicine CollegeYangzhou UniversityNorthern Jiangsu People’s HospitalYangzhou 225001Jiangsu ProvinceChina

BACKGROUND Ureteroscopy is widely used in the treatment of ureteral stones due to the increased morbidity of turolithiasis.This is the first report of a case of ureteral calculi treated with rigid Ureteroscopy in the modified prone split-leg position.CASE SUMMARY A 62-year-old Asian woman was diagnosed with a ureteral stone and underwent extracorporeal shock wave lithotripsy twice.However,the abdominal computer tomography scan showed persistent calculi on the right lower ureter.Her left hip movement was limited because of a left femoral neck fracture that did not receive proper treatment in a timely manner.She was unable to undergo surgery in the lithotomy position and refused to accept flexible Ureteroscopy treatment.Therefore,rigid Ureteroscopy was performed with her in the modified prone split-leg position.The ureteral calculi were successfully fragmented.CONCLUSION It is feasible to treat lower ureteral calculi in women in the prone split-leg position with the implementation of rigid Ureteroscopy.

关键词： Ureteroscopy Ureteral calculi Lithotripsy Prone position Female Case report

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Thermal effect of holmium laser lithotripsy under Ureteroscopy

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Chinese Medical Journal 2019年第16期132卷 2004-2007页

作者： Xin-Kun Wang Zhi-Qiang Jiang Jing Tan Guang-Ming Yin Kai Huang Department of Urology Third Xiangya HospitalCentral South UniversityChangshaHunan 410013China

To the Editor: Ureteral calculus is a common urological disease. In recent years, one of the main treatment methods is Ureteroscopy with holmium laser lithotripsy. However, with the extensive application of holmium laser lithotripsy, the increasing incidence of postoperative ureteral stricture or even occlusion has attracted the attention of clinicians to its etiology. The issue of the intraoperative holmium laser thermal effect has also gradually gained attention. The holmium laser is a long-wavelength pulsed laser, which crushes calculi by an optomechanical/photoacoustic mechanism as well as a photothermal mechanism, and it is mainly based on the photothermal mechanism.[1] Currently, multiple in vitro studies worldwide have confirmed that the holmium laser did increase the water temperature in the working area. However, these studies only simulated the lithotripsy process of the holmium laser in vitro, which did not completely reflect the thermal effect of the holmium laser during an actual operation. Accordingly, this study monitored the temperature changes of the lavage fluid in the operative field during the actual holmium laser lithotripsy process under an ureteroscope, with the aim of providing more information for the etiology study of ureteral stricture after Ureteroscopy with holmium laser lithotripsy.

关键词： Thermal effect holmium laser lithotripsy Ureteroscopy

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Use of a modified ureteral access sheath in semi-rigid Ureteroscopy to treat large upper ureteral stones is associated with high stone free rates

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Asian Journal of Urology 2019年第3期6卷 217-221页

作者： Jad Khaled AlSmadi Xiaohang Li Guohua Zeng Department of Urology Minimally Invasive Surgery Centerthe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina Guangdong Key Laboratory of Urology GuangzhouChina

Objective:To examine differences in outcomes of semi-rigid Ureteroscopy(URS)with or without a modified-ureteral-access-sheath(mUAS)to treat large upper ureteral stones.Methods:Patients with single,radio-opaque large upper ureteral stone(≥10 mm)treated using semi-rigid URS between August 2013 and October 2016 were retrospectively evaluated.The stone-free status was determined from Kidney-ureter-bladder(KUB)X-ray films taken on postoperative Day 1 and after 1 month.Results:Of 103 patients meeting inclusion criteria,43(41.75%)and 60(58.25%)were treated with semi-rigid URS with and without mUAS,respectively.The immediate stone-free rate(SFR)for the mUAS group was significantly higher than the non-mUAS group(40[93.0%]vs.46[76.7%];p=0.033).The SFR at 1 month was also high for patients treated using mUAS,but not statistically different from patients not treated with mUAS(41[95.3%]mUAS vs.51[85.0%]non-mUAS;p=0.115).Auxiliary procedure rates were significantly lower for mUAS patients compared to non-mUAS patients(2[4.7%]vs.14[23.3%];p=0.01).There were no significant differences in surgical duration and hospital stays,and the overall complication rates were statistically similar for mUAS patients compared to non-mUAS patients(1[2.3%]vs.3[5.0%];p=0.638).

关键词： Ureteroscopy Semi-rigid Large ureteral stones Ureteral access sheath Modified ureteral access sheath

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Validation of laparoscopy and flexible Ureteroscopy tasks in inanimate simulation training models at a large-scale conference setting

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Asian Journal of Urology 2021年第2期8卷 215-219页

作者： Jirong Lu Karthik Thandapani Tricia Kuo Ho Yee Tiong Department of Urology National University HospitalSingapore Department of Urology Singapore General HospitalSingapore Urology Service Sengkang HealthSingapore

Objective:Simulation based training with training models is being increasingly used as a tool to help trainees mount the learning curve.However,validation studies of surgical simulators are often limited by small numbers.We aim to evaluate the feasibility of validating simulation-training tasks in laparoscopy and flexible Ureteroscopy(FURS)rapidly at a large-scale conference setting for residents.Methods:Seventy-six urology residents from various Asian countries were assessed on their laparoscopic and FURS skills during the 14th Urological Association of Asia Congress 2016.Residents performed the peg transfer task from the fundamentals of laparoscopic surgery(FLS)and completed inspection of calyces and stone retrieval using a flexible ureteroscope in an en-dourological model.Each participant’s experience(no experience,1-30 or>30 procedures)in laparoscopy,rigid Ureteroscopy(RURS)and FURS was self-reported.Results:Median time taken to complete the laparoscopic task decreased with increasing laparoscopic experience(209 s vs.177 s vs.145 s,p=0.008)whereas median time taken to complete the FURS tasks reduced with increasing FURS experience(405 s vs.250 s vs.163 s,p=0.003)but not with RURS experience(400.5 s vs.397 s vs.331 s,p=0.143),demonstrating construct validity.Positive educational impact of both tasks was high,with mean ratings of 4.16/5 and 4.10/5 respectively,demonstrating face validity.Conclusion:Our study demonstrates construct and face validities of laparoscopy and FURS simulation tasks among residents at a conference setting.Validation studies at a conference setting can be an effective avenue for evaluating simulation models and curriculum in the future.

关键词： Education Laparoscopy Simulation Ureteroscopy Endourology

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Laparoscopic ureterolysis with simultaneous Ureteroscopy and percutaneous nephroscopy for treating complex ureteral obstruction after failed endoscopic intervention:A technical report

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Asian Journal of Urology 2015年第4期2卷 238-243页

作者： Zhixiang Wang Bing Liu Xiaofeng Gao Yi Bao Yang Wang Huamao Ye Yinghao Sun Linhui Wang Department of Urology Changzheng HospitalSecond Military Medical UniversityShanghaiChina Department of Urology Changhai HospitalSecond Military Medical UniversityShanghaiChina

Objective:Complex ureteral obstruction is refractory to conventional urological intervention.This report describes a case of laparoscopic ureterolysis with simultaneous Ureteroscopy and percutaneous nephroscopy for treating complex ureteral obstruction.Methods:Right-side multiple ureteral stones and complicating ureteral obstruction failed an initial attempt of Ureteroscopy lithotripsy with simultaneous percutaneous nephroscopy in a 23-year-old male.Laparoscopic ureterolysis with Ureteroscopy and percutaneous nephroscopy was used simultaneously to dissect the periureteral adhesions with the patient placed in the Galdakao-modified supine Valdivia position.The ureter was incised to allow the insertion of a ureteral catheter through the twisted ureter,and a guide wire was advanced into the pelvis using Ureteroscopy.A double-J stent was placed into the right-side ureter using antegrade percutaneous nephroscopy.Results:The laparoendoscopic procedure lasted 330 min with an estimated bleeding volume of 100 mL.The patient underwent an uneventful postoperative course,and postoperative followup radiography confirmed good positioning of the double-J stent.The double-J stent was removed 3 months after operation.The patient remained asymptomatic within a 13-month follow-up period.Conclusion:Laparoscopic ureterolysis with simultaneous Ureteroscopy and percutaneous nephroscopy is an effective and safe treatment option for complex ureteral obstruction.

关键词： Ureteral obstruction Laparoscopic ureterolysis Ureteroscopy Percutaneous nephrostomy

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Effects of flexible Ureteroscopy combined with percutaneous nephrolithotomy on inflammatory immune indexes and related factors in patients with renal calculi

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Journal of Hainan Medical University 2019年第1期25卷 22-26页

作者： Wen-Biao Peng Xin Wang Zhi-Bin Zhong Ya-Wen Xu Department of Urology Zhongshan Guzhen People's HospitalZhongshan 528421GuangdongChina Department of Urology Zhujiang Hospital of Southern Medical UniversityGuangzhou 510000GuangdongChina

Objective:To explore the effects of flexible Ureteroscopy combined with percutaneous nephrolithotomy on inflammatory immune indexes and related factors in patients with renal calculi.Methods: From December 2016 to November 2017, 97 patients with renal calculi were selected and divided into control group (48 cases) and observation group (49 cases), the control group was treated with percutaneous nephrolithotomy. On the basis of the treatment of the control group, the observation group was treated with ureteroscopic lithotripsy. The changes of inflammatory mediators, immune index, thyroxine (TH), urokinase (UK) and renal function were compared between the two groups before and after treatment.Results: After treatment, the levels of prostaglandin E2 (PGE2), substance P (SP), nitric oxide (NO) and lipid peroxide (LPO) in the two groups were significantly higher than those before treatment, and the levels of PGE2, SP, NO and LPO in the control group were significantly higher than those in the observation group;the levels of CD4+, CD4+/CD8+ in the two groups were significantly lower than those before treatment, but the levels of CD8+ were significantly higher than those before treatment, and the levels of CD4+, CD4+/CD8+in the control group were significantly lower than those in the observation group, and the levels of CD8+ were significantly higher than those in the observation group;the levels of TH in the two groups were significantly lower than those before treatment, but the levels of UK were significantly higher than those before treatment, and the levels of TH in the observation group were significantly lower than those in the control group, and the levels of UK were significantly higher than those in the control group;the levels of urea nitrogen (BUN), serum creatinine (Scr), cystatin C (CysC) in the two groups were significantly higher than those before treatment, and the levels of BUN, Scr, CysC in the control group were significantly higher than those in the observation group. Conclusions:The combination of

关键词： Ureteroscopy Percutaneous nephrolithotomy Renal calculi Inflammatory immunity Related factors

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Ureteroscopy with Holmium: YAG Laser—A Initial Study in the Urology Department of the Pr Bocar Sidy Sall University Hospital of Kati

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Open Journal of Urology 2024年第4期14卷 207-216页

作者： Amadou Kassogue Idrissa Sissoko Daouda Sangare Moussa Salifou Diallo Hamed Sylla Mahamadou Traore Boureima Coulibaly Salia Coulibaly Modibo Diakite Modibo Togola Fadima Tall Ilias Guindo Ben Naoum Kamel Mamadou Lamine Diakite Urology Department University Hospital of Pr Bocar Sidy Sall Kati Mali Radiology Department University Hospital of Pr Bocar Sidy Sall Kati Mali Anesthesy and Reanimation Department University Hospital of Pr Bocar Sidy Sall Kati Mali Urology Department University Hospital Nimes France Urology Department University Hospital of Point G Bamako Mali

Introduction: Ureteroscopy is a minimally invasive endoscopic surgery which provides access to the ureter, pyelon and calyceal cavities via the urethra and the bladder. Laser Ureteroscopy uses the laser as an energy source to treat the stone and eliminate it naturally. Minimally invasive endoscopic methods are struggling to become popular in sub-Saharan African countries, especially for the upper urinary tract. The objective of our work was to report the results of our first laser Ureteroscopy experience in the department. Materials and Methods: This was a prospective and descriptive study running from December 1, 2023 to February 19, 2024. Included in our study was any case of upper urinary tract stone operated by Laser Ureteroscopy. The characteristics of the lithiasis were determined by CT scan. Sterilization of urine was verified by carrying out a cytobacteriological examination of urine. Ureteral lithiasis was approached by semi-rigid Ureteroscopy. Renal lithiasis was immediately addressed by flexible Ureteroscopy. Ureteroscopy was coupled with a Holmium YAG laser. A double J ureteral catheter was placed after the operation. A 230 µm laser fiber was used in each case with a generator with a power of 35 watts (Storz Calculase III type). An access sheath was used in all cases of flexible Ureteroscopy. The parameters studied were: sociodemographic characteristics, lithiasis (site, size, number, density, topography), type of anesthesia, duration of laser use, duration of intervention, postoperative outcomes. Data entry and analysis were carried out using the software (Word 2016 and SPSS). Result: We collected 30 cases of laser Ureteroscopy. The average age was 37 years with extremes of 9 and 79 years. The male gender was more represented. The most common age group was 24-39 years old. Renal colic was the most frequent reason for admission, 12 patients (40%). On physical examination, lumbar tenderness was present in 47% (14 patients). ECBU was positive in 4 patients (13%). CT scan was performed in all our patient

关键词： Ureteroscopy Semi-Rigid Flexible Holmium YAG Laser

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Can Computerized Hounsfield Unit Estimation Be Used as Predictor for Ureteric Stone Localization by Fluoroscopy during Extra Corporal Shock Wave Lithotripsy and Ureteroscopy?

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Open Journal of Urology 2022年第9期12卷 449-458页

作者： Mohamed Izeldeen Ibrahim Ahmed Ibrahim Ahmed Department of Urology Prince Osman Digna Hospital Port Sudan Sudan Department of Urology National Rebat University Khartoum Sudan

Current minimally invasive interventions for ureteric stones involve either ESWL or Ureteroscopy and stone localization is mandatory for successful treatment in both. Objectives: To avoid doing KUB radiograph before ESWL routinely by correlating the stone attenuation value on CT KUB with stone visualization at fluoroscopy. Methods: This is a prospective cross sectional hospital based, Multicentric study carried out on 1010 patients with ureteric stones in Sudan from August 2014 to March 2016. Results: Mean stone density in HU was 704.45 ± 300 (SD) ranging (81 - 1873) HU. All of the stones were localized using fluoroscopy and only 26.5% of them were not seen under fluoroscopy. I.V contrast was used mostly, and also mainly in the upper ureter. More than 80% of the application of contrast through the ureteric catheter was in the lower ureteric stones. 91.2% of patients with stone density ≤ 400 HU failed to appear at fluoroscopy and therefore 400 HU attenuation value can be used as a cut-off level to request doing KUB before ESWL and Ureteroscopy. Conclusion: the ureteric stones with density ≤400 HU the likelihood of being non-visualized at fluoroscopy is 91.2% therefore if the stone has ≤400 HU at CT KUB it is mandatory to do KUB before treatment above that it is most likely to be seen at fluoroscopy and no need to request KUB for them before ESWL or URS. 1) Inclusion Criteria: All patients diagnosed by CT scan to have ureteric stones for ESWL or Ureteroscopy. 2) Exclusion Criteria: Patients for whom treatment of ureteric stone by ESWL or Ureteroscopy is not indicated like severe infection or poor kidney function where nephrectomy is needed.

关键词： Ureteric Stones Hounsfield Unit Attenuation KUB CT KUB Cut off Level Visualization of Ureteric Stones ESWL Ureteroscopy

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