Fibrin gel-assisted stone extraction in retrograde intrarenal surgery.
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ABSTRACT:
SUBMITTER: Yu Y
PROVIDER: S-EPMC9300148 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Renal calyceal diverticulum is congenital outpouchings of the renal calyx and communicate with the main collecting system via a narrow channel. Stones have reportedly been found in up to 50% of diverticulum. Surgical intervention is indicated for symptomatic stone. Stenotic infundibulum had been reported but seldom literature reported of calyceal diverticular atresia. Here we presented a case of atretic calyceal diverticular stone which successful managed by retrograde intrarenal surgery safely.
| S-EPMC6562262 | biostudies-literature
Project description:BackgroundRetrograde intrarenal surgery (RIRS) is widely performed for renal stones. Theoretically, removing renal stones could prevent the deterioration of renal function. However, two studies reported that not all patients would see an increase in renal function after RIRS. The aim of our study was to evaluate the change of renal function of the operative site, and to identify predictors of improvement or deterioration of renal function after RIRS.MethodsWe retrospectively reviewed renal stones patients who received RIRS and single-photon emission computed tomography (SPECT) before and after surgery. Improved renal function was defined as the change of glomerular filtration rate (GFR) >10% postoperatively, and that <-10% was regarded as deteriorated renal function. Logistic and least absolute shrinkage and selection operator regression analyses were used to identify predictors for the improvement or deterioration of renal function, and predictive nomogram models were built.ResultsA total of 120 renal stone patients were included. Twenty-one (17.5%), 79 (65.8%) and 20 (16.7%) patients had improved, stable and deteriorated renal function of operative site after surgery, respectively. Lower alkaline phosphatase, lower low-density lipoprotein, lower GFR of the operative site, thicker renal parenchyma, higher serum creatinine, and extracorporeal shock wave lithotripsy (SWL) history were associated with the improved renal function. The predictive accuracy of the model for the improved renal function was 0.800. Additionally, older age, longer flexible ureteroscopic time, thinner renal parenchyma and existence of ureteral stones were risk factors for deteriorated renal function. The predictive accuracy of the model for the deteriorated renal function was 0.725.ConclusionsThe renal function of most renal stone patients did not decrease after RIRS. For patients with potential deterioration of renal function postoperatively, urologists could shorten flexible ureteroscopic time to prevent the occurrence of this outcome.
| S-EPMC8261420 | biostudies-literature
Project description:BACKGROUND:We analyzed the influence of anesthesia methods on surgical outcomes and renal function in retrograde intrarenal surgery (RIRS) in a prospective, randomized controlled study. METHODS:Seventy patients who underwent RIRS from September 2015 to February 2017 were randomly allocated to general anesthesia (GA) or spinal anesthesia (SA) groups. Renal function was assessed using estimated glomerular filtration rate, and separate renal function was evaluated using nuclear medicine tests. Maneuverability and accessibility were evaluated after every surgery. All procedures were performed by a single experienced surgeon (SY Cho). RESULTS:Stone-free rate was higher in the GA (92.3%, 36 of 39) than the SA (71.0%, 22 of 31) (P?=?0.019) group. Pain score was higher in the GA than in the SA group on the first postoperative morning (P?=?0.025), but pain scores of the two groups were similar before discharge (P?=?0.560). There were no differences in the changes of serum creatinine level (P?=?0.792) and changes of estimated glomerular filtration rate (P?=?0.807). Differences of separate renal function between operative and contralateral site increased significantly in patients under GA than under SA at postoperative 3?months (P?=?0.014). Maneuverability and accessibility were better in SA with sedation than GA (P?<?0.001). CONCLUSIONS:RIRS under SA showed advantages in renal function change using renogram at postoperative 3?months and in lower pain score on the first postoperative morning. Performance of operator under SA was worse than that under GA and significantly improved with sedation. RIRS under SA showed advantages in lower pain score at postoperative first day. TRIAL REGISTRATION:Clinicaltrials.gov ID is NCT03957109, and registration date is 17th May 2019. This study was retrospectively registered.
| S-EPMC6927176 | biostudies-literature
Project description:PurposeWe evaluated if, during lithotripsy, bacteria may be detected in the irrigation fluid of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). The concordance between urine culture from stone fragmentation (SFUC), bladder (BUC), renal pelvic (RPUC) and stone (SC) was analyzed. We also assessed the correlation between variables and cultures and their association with systemic inflammatory response syndrome (SIRS) and of a positive SC.MethodsWe included 107 patients who underwent PCNL (n = 53) and RIRS (n = 54) from January 2017 to May 2018. Samples for RPUC were obtained by renal catheterization. Stone fragments and irrigation fluid sample were sent for culture.ResultsSFUC was positive in 17 (15.9%), BUC in 22 (20.6%), RPUC in 26 (24.3%) and SC in 30 patients (28%). The concordance between SFUC and SC was the highest among all cultures: 94.1%. SFUC and SC grew identical microorganisms in 15/17 (88.2%) patients. Out of 17 (15.9%) patients with SIRS, 8 (7.5%) had sepsis. SFUC had the highest PPV and specificity to detect positive SC and SIRS. Previous urinary tract infection, a preoperative nephrostomy, stone diameter and composition, staghorn calculi, PCNL, positive BUC, RPUC and SFUC were predictors of infected stone. Variables that indicate complex stones, complex PCNL and an infection of the upper tract were associated with SIRS.ConclusionSFUC is technically feasible, easy to retrieve and to analyze. The spectrum of SFUC potential application in clinical practice is when is not possible to perform a SC, e.g. complete dusting or during micro-PCNL.
| S-EPMC8217000 | biostudies-literature
Project description:ObjectivesTo perform a systematic review and network meta-analysis comparing stone-free rates following retrograde intrarenal surgery (RIRS), extracorporeal shock wave lithotripsy (SWL), and percutaneous nephrolithotomy (PCNL) treatments of renal stones.Materials and methodsClinical trials comparing RIRS, SWL, and PCNL for treatment of renal stones were identified from electronic databases. Stone-free rates for the procedures were compared by qualitative and quantitative syntheses (meta-analyses). Outcome variables are shown as risk ratios (ORs) with 95% credible intervals (CIs).ResultsA total of 35 studies were included in this network meta-analysis of success and stone-free rates following three different treatments of renal stones. Six studies compared PCNL versus SWL, ten studies compared PCNL versus RIRS, fourteen studies compared RIRS versus SWL, and five studies compared PCNL, SWL, and RIRS. The quality scores within subscales were relatively low-risk. Network meta-analyses indicated that stone-free rates of RIRS (OR 0.38; 95% CI 0.22-0.64) and SWL (OR 0.12; 95% CI 0.067-0.19) were lower than that of PCNL. In addition, stone-free rate of SWL was lower than that of RIRS (OR 0.31; 95% CI 0.20-0.47). Stone free rate of PCNL was also superior to RIRS in subgroup analyses including ≥ 2 cm stone (OR 4.680; 95% CI 2.873-8.106), lower pole stone (OR 1.984; 95% CI 1.043-2.849), and randomized studies (OR 2.219; 95% CI 1.348-4.009). In rank-probability test, PCNL was ranked as No. 1 and SWL was ranked as No. 3.ConclusionsPCNL showed the highest success and stone-free rate in the surgical treatment of renal stones. In contrast, SWL had the lowest success and stone-free rate.
| S-EPMC6383992 | biostudies-literature
Project description:OBJECTIVE:To compare the efficacy and safety of micropercutaneous nephrolithotomy (Microperc) and retrograde intrarenal surgery (RIRS) in treating renal stones using published literature. METHODS:A systematic literature review was performed on August 21, 2017, using PubMed, Embase, and Cochrane Library databases in accordance with the PRISMA guidelines. Summarized mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the differences in outcomes between Microperc and RIRS. RESULTS:A total of nine studies (7 in adult patients and 2 in pediatric patients) containing 842 patients (381 Microperc cases and 461 RIRS cases) with renal stones were included in this analysis. Among the adult patients, Microperc was associated with higher stone-free rate(SFR)(OR: 1.6; 95% CI, 1.03 to 2.48), significantly longer hospital stays (MD: 0.66 day; 95% CI, 0.17 to 1.15), longer fluoroscopy time (MD: 78.12 s; 95% CI, 66.08 to 90.15), and larger decreases in hemoglobin (MD: 0.59 g/dl; 95% CI, 0.16 to 1.02) than was RIRS. No significant differences were observed with respect to operative time, stone-free rate, complication rate or auxiliary procedures. CONCLUSIONS:Our results demonstrated that Microperc might be more effective in adult patients than RIRS will due to its higher SFR. However, longer hospital stays, longer fluoroscopy time and a larger decrease in hemoglobin should be considered cautiously.
| S-EPMC6195289 | biostudies-literature
Project description:BackgroundThe current review aimed to assess if the outcomes of retrograde intrarenal surgery (RIRS) differ with neuraxial anesthesia (NA) or general anesthesia (GA).MethodsThe databases of PubMed, Embase, CENTRAL, ScienceDirect, and Google Scholar were searched up to 3rd December 2021 for randomized controlled trials (RCTs) and observational studies comparing outcomes of RIRS with NA or GA.ResultsThirteen studies involving 2912 patients were included. Eight were RCTs while remaining were observational studies. Meta-analysis revealed that stone free status after RIRS did not differ with NA or GA (OR: 0.99 95% CI: 0.77, 1.26 I2 = 10% p = 0.91). Similarly, there was no difference in operation time (MD: -0.35 95% CI: -4.04, 3.34 I2 = 89% p = 0.85), 24 h pain scores (MD: -0.36 95% CI: -0.96, 0.23 I2 = 95% p = 0.23), length of hospital stay (MD: 0.01 95% CI: -0.06, 0.08 I2 = 35% p = 0.78), Clavien-Dindo grade I (OR: 0.74 95% CI: 0.52, 1.06 I2 = 13% p = 0.10), grade II (OR: 0.70 95% CI: 0.45, 1.07 I2 = 0% p = 0.10) and grade III/IV complication rates (OR: 0.78 95% CI: 0.45, 1.35 I2 = 0% p = 0.37) between NA and GA. Except for grade I complications, the results did not change on subgroup analysis based on study type and NA type.ConclusionOur results suggest that NA can be an alternative to GA for RIRS. There seem to be no difference in the stone-free rates, operation time, 24-h pain scores, complication rates, and length of hospital stay between NA and GA for RIRS. Considering the economic benefits, the use of NA may be preferred over GA while taking into account patient willingness, baseline patient characteristics, and stone burden.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42021295407.
| S-EPMC8960175 | biostudies-literature
Project description:Percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) are widely used for pediatric upper tract stones; however, comparisons of their clinical efficacies are needed.Literature searches for relevant articles were performed using PubMed, the Cochrane Central Register of Controlled Trials, Embase and the China CNKI database. Study quality was assessed by Jadad and Newcastle-Ottawa Scales. Standard mean differences (SMDs) or odds ratios (OR), and 95% confidential intervals (95% CIs) were pooled for meta-analysis. In addition, data was evaluated the quality of the body of evidence by means of grading of recommendations assessment, development, and evaluation (GRADE).Data from 4 studies (231 PCNL, 212 RIRS cases) were analyzed. There was no significant difference in operation time (SMD: 1.39; 95% CIs: -0.049 to 2.82; P?=?.058), overall stone-free rate (OR: 3.72; 95% CIs: 0.55-25.22; P?=?.18), or complication rate (OR: 1.92; 95% CIs: 0.90-4.07; P?=?.091). PCNL cases had longer hospital stays (SMD: 1.22; 95% CIs: 0.95-1.50; P?<?.001), but showed a higher stone-free rate for stones greater than 20 mm (OR: 6.38; 95% CIs: 1.83-22.22; P?=?.004). For stones less than 20 mm, however, no significant difference between PCNL and RIRS was found (OR: 0.92; 95% CIs: 0.33-2.55; P?=?.87). The quality of evidence based on the GRADE system was low.Results of our systematic review and meta-analysis suggest that, for the treatment of larger kidney stones (>20 mm) in pediatric patients, PCNL is a better option due to its higher stone-free rate, although RIRS may be associated with shorter hospital stays. A large-scale clinical trial is necessary to validate our findings.
| S-EPMC5671844 | biostudies-other
Project description:Fibrin gels are responsible for the mechanical strength of blood clots, which are among the most resilient protein materials in nature. Here we investigate the physical origin of this mechanical behavior by performing rheology measurements on reconstituted fibrin gels. We find that increasing levels of shear strain induce a succession of distinct elastic responses that reflect stretching processes on different length scales. We present a theoretical model that explains these observations in terms of the unique hierarchical architecture of the fibers. The fibers are bundles of semiflexible protofibrils that are loosely connected by flexible linker chains. This architecture makes the fibers 100-fold more flexible to bending than anticipated based on their large diameter. Moreover, in contrast with other biopolymers, fibrin fibers intrinsically stiffen when stretched. The resulting hierarchy of elastic regimes explains the incredible resilience of fibrin clots against large deformations.
| S-EPMC2872216 | biostudies-literature
Project description:Background and aimsPancreaticobiliary stone extraction during endoscopic retrograde cholangiopancreatography can be challenging when working space is limited or the duct is irregular and strictured. We aimed to demonstrate several difficult anatomic scenarios in which stone extraction was accomplished by ductoscopic grasping and retrieval using miniature devices.MethodsIn 2 cases, a miniature retrieval basket and snare are used during cholangioscopy to grasp refractory stones in the intrahepatic and cystic ducts, respectively. In cases 3 and 4, a miniature basket and snare are used during pancreatoscopy to facilitate stone extraction from stenotic and tortuous pancreatic ducts. In case 5, a miniature forceps is used to extract a stone from within a dilated pancreatic side branch.ResultsStone extraction was successful in all cases without adverse events.ConclusionsMiniature grasping accessories that fit through the working channel of the cholangioscope/pancreatoscope may allow stone retrieval in difficult anatomic scenarios and thus represent a meaningful addition to our therapeutic armamentarium for the treatment of this condition.
| S-EPMC7332830 | biostudies-literature