Faculty Bibliography

OBJECTIVE:Clinical presentation of ureteral stones during pregnancy is generally with renal colic pain. The aim of this study is to present our experience in the management of renal colic during pregnancy in emergency settings. MATERIALS AND METHODS/METHODS:208 pregnant patients who presented to emergency department with renal colic pain and underwent ureteroscopy (URS) due to failed conservative therapy were enrolled in the study. Urinary tract stones were diagnosed either with ultrasound (US) examination or during URS. Laser lithotripsy and double J (DJ) stent placement were routinely done in all patients with ureteral stones. The incidence of infective complications and premature uterine contractions (PUC) due to URS were compared. RESULTS:No stone was identified in 36.1% (n = 75) of patients with using US and diagnostic URS. Of the remaining 133 patients, 30 (22.6%) had no stone at US but stones were diagnosed during diagnostic URS. The type of anesthesia had no significant effect on PUC. An increased risk of sepsis and PUC was found in patients with fever at the initial presentation. Interestingly, PUC was more frequent in patients with lower serum magnesium levels. There was a significant correlation with time delay until the intervention and the risk of urosepsis and PUC, individually. CONCLUSIONS:Ureteroscopy is a safe option for evaluation of pregnant patients with unresolved renal colic. According to the current findings, timing of the operation is the most important factor affecting the septic risks and abortion threat. Surgical intervention with URS must be planned as soon as possible.

OBJECTIVE:To analyze the risk factors for laser fiber fractures when deflected to form a curve, including laser settings, size of the laser fiber, and the fiber bending diameter. MATERIALS AND METHODS:, Monaco) were employed along with a holmium laser (Rocamed). Five different fiber curve diameters were tested: 9, 12, 15, 18, and 20 mm. Fragmentation and dusting settings were used at a theoretical power of 7.5 W. The laser was activated for 5 minutes and the principal judgment criterion was fiber fracture. Every test for each parameter, bending diameter, and fiber size combinations was repeated 10 times. RESULTS:With dusting settings, fibers broke more frequently at a curved diameter of 9 mm for both 272 and 365 μm fibers (p = 0.037 and 0.006, respectively). Using fragmentation settings, fibers broke more frequently at 12 mm for 272 μm and 15 mm for 365 μm (p = 0.007 and 0.033, respectively). Short pulse and high energy were significant risk factors for fiber fracture using the 365 μm fibers (p = 0.02), but not for the 272 μm fibers (p = 0.35). Frequency was not a risk factor for fiber rupture. Fiber diameters also seemed to be involved in the failure with a higher number of broken fibers for the 365 μm fibers, but this was not statistically significant when compared with the 272 μm fibers (p > 0.05). CONCLUSION:Small-core fibers are more resistant than large-core fibers as lower bending diameters (<9 mm) are required to break smaller fibers. In acute angles, the use of small-core fibers, at a low energy and long-pulse (dusting) setting, will reduce the risk of fiber rupture.

PURPOSE:The purpose of this study was to evaluate the popcorn technique using a wide range of holmium laser settings and fiber sizes in a systematic in vitro assessment. MATERIALS AND METHODS:Evaluations were done with 4 artificial stones in a collection tube. A fixed ureteroscope was inserted through a ureteral access sheath to provide constant irrigation flow and the laser was placed 1 mm from the bottom. Combinations of 0.5 to 1.5 J, 10 to 20 and 40 Hz, and long and short pulses were tested for 2 and 4 minutes. We used 273 and 365 μm laser fibers. All tests were repeated 3 times. The stones were weighed before and after the experiments to evaluate the setting efficiency. Significant predictors of a highly efficient technique were assessed. RESULTS:A total of 144 tests were performed. Mean starting weight of the stones was 0.23 gm, which was consistent among the groups. After the experiment the median weight difference was 0.07 gm (range 0.01 to 0.24). When designating a 50% reduction in stone volume as the threshold indicating high efficiency, the significant predictors of an efficient popcorn technique were a long pulse (OR 2.7, 95% CI 1.05-7.15), a longer duration (OR 11.4, 95% CI 3.88-33.29), a small (273 μm) laser fiber (OR 0.23, 95% CI 0.08-0.70) and higher power (W) (OR 1.14, 95% CI 1.09-1.20). CONCLUSIONS:Higher energy, a longer pulse, frequencies higher than 10 Hz, a longer duration and a smaller laser fiber predict a popcorn technique that is more efficient at reducing stone volume.

PURPOSE/OBJECTIVE:We describe a feasible flexible ureteroscopy (fURS) technique with the latest instruments to and to discuss their advantages. METHODS:Three patients underwent a fURS for stone treatment. A 7F angled orifice catheter and a hydrophilic angled tip stiff wire is used to guide the wire in the proper ureteral direction sighting the ureter allowing the use of a 10/12 ureteral access sheath. A single use ureteroscope was used. RESULTS:All of them had successful ureteral access and laser lithotripsy being stone free endoscopically. No complications reported. CONCLUSION/CONCLUSIONS:The modern fURS technique was found feasible and safe in patients with cross-trigonal ureteroneocystostomy.

OBJECTIVE:To describe the laparoscopic approach for uretero-ileal anastomosis strictures and to analyse our long term series. METHODS:A retrospective review was performed evaluating our series of patients with benign ureteroileal anastomosis strictures treated laparoscopically from 2011 to 2017. Demographics and perioperative data were obtained and analyzed. Complications were described with the Clavien-Dindo classification. The surgical technique was described and a literature review was performed. RESULTS:Eleven procedures were performed in ten patients. Mean blood loss was 180 ml. All the operations were performed laparoscopically without conversion. Mean hospital stay was 10 days (4-23). Early complications were Clavien-Dindo I y II: Two cases of limited anastomosis leakage, one lymphorrea, one paralitic ileum and one accidental descent of the ureteral catheter. Mean follow-up was 56 months (12-179) No late complications have been described. CONCLUSION/CONCLUSIONS:Based on our series with 5 year follow up, the laparoscopic approach for uretero-ileal anastomosis strictures is feasible and safe.

INTRODUCTION/BACKGROUND:Over the last few decades, numerous surgical procedures have been proposed to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). However, all are characterized by a certain rate of treatment failure due to bladder neck contracture (BNC). Treatment of secondary BNC appears to be challenging. The main purpose of this review is to evaluate current published knowledge on this topic. EVIDENCE ACQUISITION/METHODS:The MEDLINE/PubMed database was searched for all original articles published between 2000 and 2016 analyzing the incidence, prevalence and management of BNC as a post-operative complication following surgical treatment of LUTS/BPH. Prospectively designed studies, and those with prospectively maintained databases and/or rigorous inclusion and exclusion criteria were included. Given the lack of prospective studies examining treatment options for BNC, retrospective studies were also included in this section. EVIDENCE SYNTHESIS/RESULTS:Thirty-four studies were included. The huge heterogeneity of patients, gland characteristics, surgical strategies and follow-up procedures limited the overall quality of results. BNC incidence after surgery for LUTS/BPH ranges from 0% to 9.6%. Given the dearth of well-designed studies, it seems rational to leave the choice of treatment procedure to the specialist's own decision. CONCLUSIONS:BNC incidence varies greatly depending on the examined cohorts, with only few precautionary measures available for prevention. Treatment is challenging and it seems reasonable to leave the choice of BNC treatment technique to the surgeon's own judgement.

OBJECTIVE:Epidemiological data on urolithiasis in Spain have appeared in publications especially local and regional level, with few referrals to Spanish national territory. The aim of this paper is to review and systematize the epidemiological data published on urolithiasis in Spain. METHODS:We reviewed publications in national and international scientific journals, meetings and conferences, and research reports (1977-2016). PubMed search (indexed papers) and manual bibliography search (not indexed works) were performed. Bibliometric data evaluated: Year of publication, geographic area, number of cases, sample type, study design and publishing format. Demographic systematization of data: age, age and frequency distribution by gender, family history, social stratum, profession, place of residence, ethnics, seasonality and dietary habits. RESULTS:Publications revised: 79 corresponding to 56 main authors. Selected publications with original data: 42 (2 composed by Part I and II, and 2 composed by paper and thesis), corresponding to 35 authors. Bibliometric and demographic data of all publications are displayed in tables, sorted by variables. CONCLUSIONS:The comprehensive review of studies on epidemiology in Spain constitutes a solid basis for future research about epidemiology of urolithiasis.

PURPOSE OF REVIEW:Flexible ureteroscopy has been widely developed in the last decade been nowadays one of the first line treatment options for urolithiasis and conservative management for upper tract urothelial tumors. Even though some unfavorable features of the reusable flexible scopes can limit the surgical procedure such as their availability, lack of sterilization or costly repairs. Disposable scopes have been developed with the intention of improving such problems. RECENT FINDINGS:To our knowledge, seven devices have been developed. Of the scopes features, size, deflection, image quality and ergonomic handling have to be at least as good as reusable ones as they are expected to be noninferior. Three devices match all the features of reusable scopes, although only one has been properly studied. SUMMARY:Not all the available disposable devices have been properly studied or compared with standard scopes. Although some devices are promising more studies are needed to proof their benefits.