: In the field of Urology, flexible ureterorenoscopy (fURS) remains a challenging skill for junior residents to develop due to its steep learning curve. Hence, training models were incorporated into simulation-based training to allow for novice trainees to overcome the learning curve without potentially compromising patient outcomes and minimize complications. OBJECTIVE: To describe the design and test the validity of a non-biological three-dimensional (3D) model of the pelvocalyceal system as a tool for simulation-based training for flexible ureterorenoscopy. METHODS: This was a prospective, quasi-experimental, surgical innovation research stage 2a study conducted in a tertiary government hospital. The retrograde intrarenal surgery (RIRS) box was composed of four siliconized pelvocalyceal systems which were 3D printed using computed tomography urograms of actual patients. Thirty-two urologists were asked to perform flexible ureteroscopy using the RIRS box and were given a questionnaire to assess face and content validity using the Likert scale. RESULTS: The RIRS Box training model showed good face and content validity. The 3D printed pelvocalyceal system was judged to have a close anatomical resemblance to an actual calyceal system. While performing fURS, the RIRS box provided similar pelvocalyceal visualization and instrument handling as in an actual procedure. Majority of participants considered the training model useful for training (75%) and believed that it may improve the RIRS technique (46.8%). CONCLUSION The RIRS Box training model may help urologists improve the manner in which they acquire technical knowledge and skills necessary in performing fURS.
Ureteroscopy ; Ureteroscopes ; Printing, Three-Dimensional

To analyze the effectiveness and safety of intermittent lung inflation combined with rigid ureteroscopy in the treatment of upper ureteral stones that were not fully visible. The clinical and imaging data of 56 patients with upper ureteral stone undergoing rigid ureteroscopic lithotripsy combined with intermittent lung inflation in Zhejiang Quhua Hospital from March 2016 to October 2017 were retrospectively analyzed.Intermittentt lung inflation was used to change and stabilize the position of ureteral calculi during the operation,so as to ensure the visual field of ureteroscopy.Holmium laser lithotripsy was performed to remove the stones.Urinary tract abdominal plain X-ray or CT urography was performed 1 and 3 months after the operation to evaluate the residual stones and the clinical efficacy. Stones were successfully removed after a single attempt in 48 patients.In 5 patients,stones escaped into the kidney during ureteroscopic lithotripsy,and thus flexible ureteroscopy were performed.In 3 patients,a second session of auxiliary procedure was required,among whom 2 patients received extracorporeal shock wave lithotripsy and 1 patient underwent extracorporeal shock wave lithotripsy+ureteroscopic lithotripsy.The stone-free rates 1 and 3 months after surgery were 94.6%(53/56)and 100%(56/56),respectively.No severe complication such as ureter perforation,gross hematuria,septic shock,or pneumothorax occurred during and after surgery. Intermittent lung inflation in tracheal intubation under general anesthesia in patients with proximal ureteral stones that can not be fully visible during rigid ureteroscopic lithotripsy was feasible and reliable.It can effectively change the location of stones and thus enable safe and effective lithotripy.It expands the indications of rigid ureteroscopy for treating upper ureteral stones.
Humans ; Lithotripsy, Laser ; Retrospective Studies ; Ureteral Calculi ; diagnostic imaging ; Ureteroscopes ; Ureteroscopy

BACKGROUNDPercutaneous nephrolithotomy (PCNL) is the most widely recommended treatment for calyceal diverticular calculi, providing excellent stone-free results. However, its invasiveness is not negligible considering its major complication rates. Flexible ureteroscopy (FURS) is currently used to treat calyceal diverticula. However, the greatest drawback of FURS is locating the diverticulum since its neck is narrow and concealed. In such a case, the FURS procedure must be converted to PCNL. The aim of this study was to evaluate ultrasound-guided flexible ureteroscopy (UFURS) identifying diverticulum and the management of calyceal diverticular calculi.

METHODSA retrospective analysis was conducted on 24 patients who had calyceal diverticular calculi. In all 12 patients in the UFURS group, direct FURS failed to find evidence of calyceal diverticula but were confirmed with imaging. The other 12 patients in the PCNL group received PCNL plus fulguration of the diverticular walls.

RESULTSPuncture of calyceal diverticulum was successful in all 12 UFURS patients. Two patients in this group had postoperative residual calculi and two patients developed fever. In the PCNL group, percutaneous renal access and lithotomy were successful in all 12 patients. One patient in this group had residual calculi, one had perirenal hematoma, and two patients developed fever. No significant difference was found in the operating time (UFURS vs. PCNL, 91.8 ± 24.2 vs. 86.3 ± 18.7 min), stone-free rate (UFURS vs. PCNL, 9/12 vs. 10/12), and rate of successful lithotripsy (UFURS vs. PCNL, 10/12 vs. 11/12) between the two groups (all P> 0.05). Postoperative pain scores in the FURS group were significantly lower than that in the PCNL group (2.7 ± 1.2 vs. 6.2 ± 1.5, P< 0.05). Hospital stay in the UFURS group was significantly shorter than that in the PCNL group (3.4 ± 0.8 vs. 5.4 ± 1.0 days, P< 0.05). All patients were symptom-free following surgery (UFURS vs. PCNL, 10/10 vs. 12/12).

CONCLUSIONUltrasound-guided puncture facilitates identification of calyceal diverticula during FURS and improves the success rate of FURS surgery.

Adult ; Diverticulum ; diagnosis ; surgery ; Female ; Humans ; Kidney Calculi ; diagnosis ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Ultrasonography ; methods ; Ureteroscopes ; Ureteroscopy ; instrumentation ; methods

OBJECTIVETo investigate the clinical application of the ureteral dilation catheter combined with the balloon catheter under the ureteroscope in the treatment of urethral stricture in men.

METHODSUnder the ureteroscope, 45 male patients with urethral stricture received placement of a zebra guide wire through the strictured urethra into the bladder and then a ureteral dilation catheter along the guide wire, followed by dilation of the urethra from F8 initially to F14 and F16. Again, the ureteroscope was used to determine the length of the strictured urethra, its distance to the external urethral orifice, and whether it was normally located. An F24 balloon catheter and then a metal urethral calibrator was used for the dilation of the strictured urethra. After removal of the F18-F22 urethral catheter at 8 weeks, the urinary flow rate was measured immediately and again at 3 months.

RESULTSAll the operations were successfully performed without serious complications. The maximum urinary flow rate was (13.3-29.9) ml/s (mean [17.7 ± 3.2] ml/s) at the removal of the catheter and (15.2-30.8) ml/s (mean [19.8 ± 3.9] ml/s) at 3 months after it. Smooth urination was found in all the patients during the 6-24 months follow-up.

CONCLUSIONThe application of the ureteral dilation catheter combined with, the balloon catheter under the ureteroscope is a good option for the treatment of male urethral stricture for its advantages of uncomplicatedness, safety, effectiveness, few complications, less pain, high success rate, and repeatable operation.

Catheterization ; Humans ; Male ; Ureteroscopes ; Urethra ; Urethral Stricture ; therapy ; Urinary Bladder ; Urinary Catheters ; Urination

PURPOSE: To evaluate the outcomes of rigid ureterorenoscopy (URS) for renal pelvic stones (RPS) sized 1 to 2 cm and to determine the predictive factors for the requirement for flexible URS (F-URS) when rigid URS fails. MATERIALS AND METHODS: A total of 88 patients were included into the study. In 48 patients, the RPS were totally fragmented with rigid URS and F-URS was not required (group 1). In 40 patients, rigid URS was not able to access the renal pelvis or fragmentation of the stones was not completed owing to stone position or displacement and F-URS was utilized for retrograde intrarenal surgery (RIRS) (group 2). The predictive factors for F-URS requirement during RIRS for RPS were evaluated. Both groups were compared regarding age, height, sex, body mass index, stone size, stone opacity, hydronephrosis, and previous treatments. RESULTS: The mean patient age was 48.6+/-16.5 years and the mean follow-period was 39+/-11.5 weeks. The overall stone-free rate in the study population was 85% (75 patients). In groups 1 and 2, the overall stone-free rates were 83% (40 patients) and 87% (35 patients), respectively (p>0.05). The independent predictors of requirement for F-URS during RIRS were male gender, patient height, and higher degree of hydronephrosis. CONCLUSIONS: Rigid URS can be utilized in selected patients for the fragmentation of RPS sized 1 to 2 cm with outcomes similar to that of F-URS. In case of failure of rigid URS, F-URS can be performed successfully in this group of patients.
Adult ; Aged ; Equipment Design ; Female ; Humans ; Kidney Calculi/pathology/*surgery/therapy ; Kidney Calculi/*surgery ; Kidney Pelvis/pathology/*surgery ; Kidney Pelvis/*surgery ; Lithotripsy ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Treatment Failure ; Treatment Outcome ; Ureteroscopes ; Ureteroscopy/*methods

PURPOSE: The aim of this study was to evaluate the effectiveness of simultaneous flexible ureteroscopic removal of stones (URS) for ureteral and ipsilateral renal stones and to analyze the predictive factors for renal stone-free status. MATERIALS AND METHODS: We retrospectively reviewed the records of patients who underwent simultaneous flexible URS of ureteral and ipsilateral renal stones from January 2010 to May 2012. All operations used a flexible ureteroscope. We identified 74 cases of retrograde intrarenal surgery and 74 ureteral stones (74 patients). Stone-free status was respectively defined as no visible stones and clinically insignificant residual stones <3 mm on a postoperative image study. Predictive factors for stone-free status were evaluated. RESULTS: The immediate postoperative renal stone-free rate was 70%, which increased to 83% at 1 month after surgery. The immediate postoperative ureteral stone-free rate was 100%. Among all renal stones, 15 (20.3%) were separately located in the renal pelvis, 11 (14.8%) in the upper calyx, 15 (20.3%) in the mid calyx, and 33 (44.6%) in the lower calyx. The mean cumulative stone burden was 92.22+/-105.75 mm2. In a multivariate analysis, cumulative stone burden <100 mm2 was a significant predictive factor for postoperative renal stone-free status after 1 month (p<0.01). CONCLUSIONS: Flexible URS can be considered simultaneously for both ureteral and renal stones in selected patients. Flexible URS is a favorable option that promises high stone-free status without significant complications for patients with a stone burden <100 mm2.
Humans ; Kidney Calculi ; Kidney Pelvis ; Lithotripsy ; Multivariate Analysis ; Retrospective Studies ; Treatment Outcome ; Ureter ; Ureteroscopes

PURPOSE: We evaluated the influence of urinary stone components on the outcomes of ureteroscopic removal of stones (URS) by electrohydraulic lithotripsy (EHL) in patients with distal ureteral stones. MATERIALS AND METHODS: Patients with a single distal ureteral stone with a stone size of 0.5 to 2.0 cm that was completely removed by use of EHL were included in the study. Operating time was defined as the time interval between ureteroscope insertion and complete removal of ureteral stones. Ureteral stones were classified into 5 categories on the basis of their main component (that accounting for 50% or more of the stone content) as follows: calcium oxalate monohydrate (COM), calcium oxalate dihydrate, carbonate apatite (CAP), uric acid (UA), and struvite (ST). RESULTS: A total of 193 patients (131 males and 62 females) underwent EHL. The mean operating time was 25.1+/-8.2 minutes and the mean stone size was 1.15+/-0.44 cm. Calcium oxalate stones accounted for 64.8% of all ureteral stones, followed by UA (19.7%), CAP (8.3%), and ST (7.2%) stones. The mean operating time was significantly longer in the UA group (28.6+/-8.3 minutes) than in the COM group (24.0+/-7.8 minutes, p=0.04). In multivariate analyses, the stone size was negatively associated with the odds ratio (OR) for successful fragmentation. UA as a main component (OR, 0.42; 95% confidence interval, 0.20 to 0.89; p=0.023) was also found to be significantly important as a negative predictive factor of successful fragmentation after adjustment for stone size. CONCLUSIONS: The results of the present study suggest that successful fragmentation by URS with EHL could be associated with the proportion of the UA component.
Accounting ; Apatites ; Calcium Oxalate ; Carbon ; Humans ; Lithotripsy ; Magnesium Compounds ; Male ; Multivariate Analysis ; Odds Ratio ; Phosphates ; Ureter ; Ureteroscopes ; Ureteroscopy ; Uric Acid ; Urinary Calculi

In the past several decades there has been a remarkable development of small-caliber, flexible ureteroscopes and various ancillary instruments for stone manipulation and retrieval. Percutaneous antegrade ureteroscopy can be substituted in select cases for retrograde ureteroscopy. We report a case of a 60-year-old man with severe ankylosis in both hip joints who was diagnosed with bilateral ureteral stones. The patient underwent antegrade flexible ureteroscopy and laser lithotripsy. This case illustrates the role of antegrade flexible ureteroscopy combined with the holmium:YAG laser as a minimally invasive, safe, and effective technique for the management of stones in a patient who cannot undergo a retrograde approach.
Ankylosis ; Hip ; Hip Joint ; Humans ; Lithotripsy, Laser ; Middle Aged ; Ureter ; Ureteroscopes ; Ureteroscopy ; Urinary Calculi

PURPOSE: With recent technological advances, the indications for retrograde intrarenal surgery (RIRS) have gradually increased. We evaluated the efficacy and treatment outcomes of RIRS for the treatment of renal stones. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 23 patients with renal stones (7 in the renal pelvis, 9 in the renal calyx, and 7 in the renal diverticulum) treated with RIRS from January 2001 to July 2008. Mean stone burden was 110 mm2 (range, 9.42-428.6 mm2), and all operations were performed under general anesthesia using a semi-rigid ureteroscope in 9 cases, a flexible ureteroscope in 11 cases, and both types simultaneously in 3 cases. The holmium:yttrium-aluminum-garnet (Ho: YAG) laser and the nitinol basket were used for stone fragmentation and retrieval. The patients were followed up postoperatively with KUB (21 cases) or nonenhanced computed tomography (CT; 2 cases). Success was defined as no visible stones on KUB or nonenhanced CT. RESULTS: The mean operating time was 93 minutes (range, 30-205 minutes) and the mean hospital stay was 3.7 days (range, 1-9 days). Of 23 patients, 16 (70%) experienced complete elimination of the stone after only a single intervention. After ancillary extracorporeal shock wave lithotripsy (ESWL), the success rate was increased to 74% (17/23). In the remaining 6 patients, residual stone findings were less than 3 mm and were followed up with X-ray. CONCLUSIONS: RIRS is a feasible procedure for treating renal stone disease with minimal complications. The results of our study suggest that RIRS can be recommended as a primary modality in the management of renal stone disease in selected patients such as those with ESWL failure and renal diverticular stones.
Alloys ; Anesthesia, General ; Humans ; Kidney Pelvis ; Length of Stay ; Lithotripsy ; Medical Records ; Retrospective Studies ; Shock ; Ureteroscopes

PURPOSE: The ureteral access sheath (UAS) was developed to facilitate difficult ureteroscopic procedures. However, some have questioned the safety of the UAS and its likelihood of causing significant ureteral traumas. We evaluated the efficacy and safety of a UAS for managing ureteral calculi. MATERIALS AND METHODS: From July 2005 to June 2008, a total of 122 patients underwent ureteroscopic removal of stones (67 patients with UAS, 55 patients without UAS). Under local, spinal, or general anesthesia, all patients were treated by using a semirigid ureteroscope with or without UAS. The operative results of the patients were assessed with KUB, and excretory urography or ultrasonography were assessed postoperatively after 2 to 4 weeks. We also analyzed the success rates of stone removal and the complication rates for each procedure. RESULTS: Mean stone size and mean operation time were 9.3 mm and 38.8 minutes, respectively, with UAS and 8.9 mm and 40.4 minutes, respectively, without UAS. Overall stone-free rates were 89.6% and 76.4%. Mean hospital stay was 2.0 days and 2.2 days. The time for operation was significantly decreased for upper ureteral stones treated with UAS (p=0.022). The stone-free rates were higher for upper ureteral stones treated with UAS (28/32, 87.5%, p=0.027), especially for stones greater than 10 mm in size (p=0.048). CONCLUSIONS: The use of UAS is effective and safe. The stone-free rates of ureteroscopic removal of stones with UAS were significantly higher than the rates without UAS for large (> or =10 mm) upper ureteral calculi.
Anesthesia, General ; Equipment and Supplies ; Humans ; Length of Stay ; Ureter ; Ureteral Calculi ; Ureteroscopes ; Ureteroscopy ; Urography