Urology Annals最新文献

{"title":"Interobserver reproducibility of RENAL nephrometry score in comparison to simplified PADUA Renal nephrometry score.","authors":"Manali Arora, Lovepreet Singh Randhawa, Devkant Lakhera, Vishal Thakker, K Aditya Abhishek, Dipesh Singh, Rohit Chaudhary, Rajiv Kumar Azad","doi":"10.4103/ua.ua_37_23","DOIUrl":"10.4103/ua.ua_37_23","url":null,"abstract":"<p><strong>Introduction: </strong>Nephron-sparing surgery (NSS) is the standard of care for renal tumors, especially in the early stages. RENAL Nephrometry scores provide a comprehensive presurgical predictive module for the choice of NSS or Radical Nephrectomy. The validity and reliability of Nephrometry scores is being tested continuously with advancement in the surgical techniques. The Simplified PADUA Nephrometry score (SPARE NS) is a newer proposed score which aims to better the reproducibility of the previously established nephrometry scores.</p><p><strong>Materials and methods: </strong>The retrospective observational study studied the comparative inter-observer reliability of RENAL (RENAL NS) and SPARE nephrometry scoring systems amongst two radiologists while assessing solid renal tumors in contrast-enhanced computed tomography scans of 42 patients. Interobserver reliability for all components of both scores, final scores and risk grading was done by Kendall's Concordance Coefficient (Tau).</p><p><strong>Results: </strong>Both RENAL NS and SPARE NS showed strong to excellent agreement (RENAL NS = 78.57% and SPARE NS = 88.09%) among observers with comparable correlation co-efficient (RENAL NS = 0.944 and SPARE NS = 0.935). Lesion radius and exophytic/endophytic properties were the most reproducible components of RENAL NS with 97.61% and 92.85% agreement, respectively. Location across polar lines was the least reproducible component with 85.71% agreement among observers. Exophytic rate (97.61%) and Rim location were the most reproducible components of SPARE NS. The final lesion risk stratification by both observers for both was concordant in 92.85% of cases.</p><p><strong>Conclusion: </strong>The SPARE system of scoring matches up to the RENAL NS in total score and risk stratification reproducibility. However, the individual components of the SPARE score are more reproducible than those of RENAL NS, bringing about better compliance among radiology consultants. Comparable reproducibility with the RENAL NS, lesser number of variables, and ease of doing make SPARE NS a plausible option for the customary preoperative assessment of renal tumors.</p>","PeriodicalId":23633,"journal":{"name":"Urology Annals","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10699184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46613145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiofrequency-assisted, laparoscopic, clampless partial nephrectomy in patients with low-complexity small renal tumors: A retrospective cohort study.","authors":"Ioannis Zachos,&nbsp;Panagiotis Vlachostergios,&nbsp;Lampros Mitrakas,&nbsp;Anastasios Karatzas,&nbsp;Athanasios Oeconomou,&nbsp;Charalampos Mamoulakis,&nbsp;Vasileios Tzortzis","doi":"10.4103/ua.ua_20_23","DOIUrl":"10.4103/ua.ua_20_23","url":null,"abstract":"<p><strong>Background: </strong>This single-center, retrospective study was performed to investigate the safety and efficacy of radiofrequency-assisted (RF), laparoscopic partial nephrectomy (PN) with zero ischemia in patients with low-complexity small renal tumors.</p><p><strong>Materials and methods: </strong>Patients with small renal masses (SRMs) who underwent laparoscopic, clampless laparoscopic partial nephrectomy - radiofrequency assisted (LPN-RFA) between January 2016 and June 2020 were studied. Demographics, clinical and pathological characteristics, recurrence-free survival, and overall survival were recorded.</p><p><strong>Results: </strong>Fifty-two SRMs were excised from corresponding patients using RFA-LPN. The median tumor size was 2.5 cm and all specimens involved low-complexity masses according to the renal nephrometry score. No conversions to radical nephrectomy were recorded. Postoperatively, there were one patient with fever, one with hematuria, and two with urinary leakage treated endoscopically. The majority of tumors (48/52, 86.2%) were clear-cell carcinomas. According to the glomerular filtration rate postoperatively and 12 months' posttreatment, adequate renal function was preserved in all patients. There were no positive surgical margins identified postoperatively and no recurrences during a median follow-up 24 months. All patients were alive at the last follow-up.</p><p><strong>Conclusions: </strong>This study suggests that RFA laparoscopic clampless PN represents an effective method for managing patients with low-complexity SRMs. It offers adequate intraoperative safety and excellent mid-term oncological control and functional preservation.</p>","PeriodicalId":23633,"journal":{"name":"Urology Annals","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/88/aa/UA-15-315.PMC10471811.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10153735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small-cell neuroendocrine tumor of the bladder: Unexpected long-term survival with carboplatin-etoposide therapy in a patient with metastatic stage disease.","authors":"Eduardo J García Rico,&nbsp;Luis Enrique Ortega Polledo,&nbsp;Alejandro Sánchez Pellejero,&nbsp;Sonia Vázquez Valdés,&nbsp;Isabel Montuenga Fernandez","doi":"10.4103/ua.ua_106_22","DOIUrl":"10.4103/ua.ua_106_22","url":null,"abstract":"<p><p>Neuroendocrine small-cell bladder cancer is an extremely rare and aggressive entity, it constitutes <1% of all bladder malignancies. The small-cell neuroendocrine histological variant has a worse prognosis than the classical subtypes. A case of a 53-year-old female consulting with gross hematuria is presented. Cystoscopy revealed a solid aspect lesion involving the posterior wall and dome that was resected. Histopathological findings showed small-cell pure variant carcinoma, high grade, with lymph, vascular, and perineural infiltration, infiltrating the muscle layer. The extension study made by hole body computed tomography scan, showed evidence of multiple lymph nodes and multiple visceral radiological involvements, with pulmonary, hepatic, and peritoneal implants. More than 10 years later, after receiving nine cycles of carboplatin-etoposide remains in complete remission and without radiological evidence of the disease. This is, to our knowledge, one of the longest disease-free survival cases in metastatic small-cell bladder cancer published nowadays.</p>","PeriodicalId":23633,"journal":{"name":"Urology Annals","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/06/ea/UA-15-331.PMC10471807.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10153741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurofibroma of the external genitalia, extreme enlargement of the clitoris.","authors":"Razan Almesned,&nbsp;Mohamed Alhagbani,&nbsp;Mohammed Sultan,&nbsp;Mohammed Alshayie,&nbsp;Naif Alqarni,&nbsp;Ahmed Alshammari","doi":"10.4103/ua.ua_86_22","DOIUrl":"10.4103/ua.ua_86_22","url":null,"abstract":"<p><p>Neurofibromatosis of the genitourinary tract is rare, with a prevalence of 0.65%, and it is exceedingly rare to involve the external genitalia. Involvement of the clitoris, labia majora, and prepuce was reported with clitoromegaly being the most frequently occurring. Herein, we are reporting the case of a 6-year-old girl who was diagnosed with a neurofibroma of the clitoris; measuring 9.4 cm in its largest dimension. To the best of our knowledge, this is the largest clitoral neurofibroma reported in the literature. Due to the rarity of such cases and reports limitations in the literature, the diagnosis of neurofibroma of the external genitalia requires a high index of suspicion by health-care providers. Surgical excision and postoperative follow-up for possible recurrence remain the gold standard of management.</p>","PeriodicalId":23633,"journal":{"name":"Urology Annals","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c4/42/UA-15-328.PMC10471813.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10155284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of varicocelectomy on semen parameters and conception rates.","authors":"Salahadin H Lamy,&nbsp;Abdullah K Mohammedkhalil,&nbsp;Hashim M Bafaqeeh,&nbsp;Shatha A Alsuwaida,&nbsp;Adel S Khan Alhindi,&nbsp;Sara A Maqboli,&nbsp;Muhammad A Khan","doi":"10.4103/ua.ua_49_22","DOIUrl":"10.4103/ua.ua_49_22","url":null,"abstract":"<p><strong>Objective: </strong>Varicocele, the dilation of the pampiniform plexus of the spermatic cord. It is discovered incidentally in most patients. Symptoms vary, but its impact is especially experienced in the field of fertility and reflected in semen parameters. Varicocelectomy is a surgical approach to correct the varicocele, however, reports are conflicting regarding its success. Our aim was to evaluate the efficacy of varicocelectomy on semen parameters and conception rates in patients who underwent surgery and its association with comorbidities such as diabetes, hypertension, and obesity.</p><p><strong>Materials and methods: </strong>This cross-sectional study included the complete medical records of 86 patients. Data collection form included the patient's age, body mass index (BMI), chronic diseases, smoking, surgical history, medication usage, and the reason for performing surgery. Presurgical and postsurgical semen parameters were evaluated 3 months before surgery and an average of 6 months postoperatively. Data were analyzed with SPSS, Chi-square test, and independent and paired <i>t</i>-test.</p><p><strong>Results: </strong>No significant difference was found between primary and secondary infertility regarding semen analysis, postoperative semen analysis indicated an improvement in semen motility at 180 min with no effect on other parameters. Using spontaneous intercourse or <i>in vitro</i> fertilization (IVF) after varicocelectomy was significantly associated with increasing conception rates irrespective of the type of infertility. Diabetes, hypertension, BMI, and smoking did not appear to affect semen parameters.</p><p><strong>Conclusion: </strong>Patients who underwent varicocelectomy had improved sperm motility at 180 min and subsequently had a higher chance of successful conception either through spontaneous intercourse or IVF. Further studies are needed to understand the relationship between conception and sperm motility. Semen parameters were not affected if the patient had comorbidities such as diabetes and hypertension. Furthermore, smoking and BMI did not appear to affect the conception rate.</p>","PeriodicalId":23633,"journal":{"name":"Urology Annals","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/53/77/UA-15-256.PMC10471810.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10155738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dorsal inlay inner preputial graft repair versus ventral-only preputial graft repair in primary distal penile hypospadias with narrow urethral plate.","authors":"Rabea Gomaa Omar,&nbsp;Mostafa M Khalil,&nbsp;Hammouda W Shereef,&nbsp;Mahmoud R Al Ashram,&nbsp;Alaa Elshaer","doi":"10.4103/ua.ua_14_23","DOIUrl":"10.4103/ua.ua_14_23","url":null,"abstract":"<p><strong>Background: </strong>Tubularized incised plate (TIP) is the most common technique used for distal hypospadias repair with good outcome but with a high rate of urethral stricture. Inner preputial-free graft can be used as an inlay graft in the incised area of the narrow urethral plate, also can be used as an onlay graft for urethroplasty in hypospadias repair to avoid this complication.</p><p><strong>Patients and methods: </strong>A comparative prospective randomized study was conducted on two groups of hypospadias patients with narrow urethral plate. Group A: dorsal inlay inner preputial graft repair was performed (grafted TIP [G-TIP]) and Group B: ventral onlay preputial graft repair was performed. The assessment of outcome and hypospadias objective scoring evaluation (HOSE) score was done at 2 weeks and 6 months.</p><p><strong>Results: </strong>Group A included 55 patients for whom dorsal inlay inner preputial graft repair was performed (G-TIP), and Group B which was planned to be conducted on 55 patients using onlay preputial graft (onlay graft) but was terminated after 15 cases due to high failure rate (33%). Group A showed better success rate 96% and better HOSE score (score 16) at 2 months and 6 months 83.6% and 88.2% versus 26.7% and 33.3% in Group B. Postoperative complications showed a statistically significant difference; glans dehiscence (3.6% vs. 40%), wound infection (1.8% vs. 33.3%), and skin sloughing (3.6% vs. 26.7%) in Groups A and B, respectively.</p><p><strong>Conclusion: </strong>G-TIP is a good technique for the management of distal hypospadias with narrow urethral plate with good success rate, cosmetic outcome, and with less complications compared to onlay graft.</p>","PeriodicalId":23633,"journal":{"name":"Urology Annals","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/10/67/UA-15-271.PMC10471820.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10155742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Varicocelectomy for scrotal pain: Is it effective?","authors":"Abdullah Alkhayal,&nbsp;Sahar Aljumaiah,&nbsp;Abdullah Alhagbani,&nbsp;Muhannad Alnahdi,&nbsp;Saad Abumelha,&nbsp;Khalid Alrabeeah","doi":"10.4103/UA.UA_64_20","DOIUrl":"10.4103/UA.UA_64_20","url":null,"abstract":"<p><strong>Introduction: </strong>Varicocelectomy is the prevailing management of scrotal pain secondary to varicocele. However, the literature is controversial on this topic. Some data showed that pain may persist after the surgery even if the varicocele is not detected postoperatively.</p><p><strong>Objectives: </strong>The objectives of the study were to identify the effect of varicocelectomy in patients with chronic scrotal pain, to report the association between the clinical grade and postoperative pain resolution, and to identify the need for a secondary procedure after varicocelectomy to control the pain.</p><p><strong>Materials and methods: </strong>This was a retrospective study of 47 patients who underwent varicocelectomy between March 2016 and December 2018.</p><p><strong>Results: </strong>Postoperatively, the pain totally resolved after surgery in 64.3% of patients with scrotal pain; it improved in 21.4%, 11.9% have persistent pain, and the pain got worse in only 2.4%. Our study showed 100% complete resolution or improvement with Grade I, 85.7% in Grade II, and 81.3% in Grade III. In addition, all patients who underwent bilateral varicocelectomy had pain that either completely resolved or improved postoperatively. On the other hand, all patients who had persistent pain or pain worsening postoperatively had unilateral varicocelectomy. An additional intervention for postoperative pain control was needed in only 14% of patients, 7% of them underwent embolization, 4.7% had a cord block, and 2.3% were sent to a pain clinic.</p><p><strong>Conclusion: </strong>Varicocelectomy offers good outcomes in most patients with varicocele-related scrotal pain. The most significant predictor for success was low grade and bilaterality. However, there is a subset of patients whose symptoms will not improve postoperatively. Careful preoperative counseling and expectation management are crucial when discussing surgical options for those patients.</p>","PeriodicalId":23633,"journal":{"name":"Urology Annals","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dc/e6/UA-15-311.PMC10471819.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10155743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristic of penile cancer and prognostic factors of inguinal and pelvic lymph node involvement.","authors":"Kritanu Kultravut,&nbsp;Satit Siriboonrid","doi":"10.4103/ua.ua_6_22","DOIUrl":"10.4103/ua.ua_6_22","url":null,"abstract":"<p><strong>Background: </strong>Penile cancer is a rare malignancy which inguinal and pelvic lymph node involvement plays a major role in patients' survival. The prognosis of patients with lymph node metastasis is poorer.</p><p><strong>Objective: </strong>The objective of the study was to evaluate the prognostic factors for inguinal lymph node and pelvic lymph node involvement.</p><p><strong>Materials and methods: </strong>This was a retrospective analytic study of medical records between January 2010 and December 2020.</p><p><strong>Results: </strong>Thirty-nine patients were diagnosed with penile cancer, median age of 59 ± 14.898 (range: 32-86 years) were included in the analysis. Twenty-eight patients underwent inguinal lymph node dissection, 13 patients had inguinal lymph node metastasis (46.4%), 8 patients underwent pelvic lymph node dissection, and 5 patients had pelvic lymph node metastasis (62.5%). Inguinal lymph node metastasis was associated with tumor grading (odds ratio [OR]: 2.92, confidence interval [CI]: 0.123-0.704), lymphovascular invasion (LVI) (OR: 5.182, CI: 0.430-0.996), perineural invasion (PNI) (OR: 3.687, CI: 0.277-0.975), and fixation of inguinal node (OR: 2.463, CI: 0.078-1.195). Pelvic lymph node metastasis was associated with tumor grading (OR: 2.619, CI: 0.033-0.967).</p><p><strong>Conclusion: </strong>Grading, LVI and PNI of primary tumor, and fixation of inguinal node are significantly associated with inguinal lymph node metastasis. While primary tumor grading is significantly associated with pelvic lymph node metastasis. These factors are associated with poorer prognosis.</p>","PeriodicalId":23633,"journal":{"name":"Urology Annals","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/77/68/UA-15-278.PMC10471824.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10208810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors predicting infective complications following percutaneous nephrolithotomy and retrograde intrarenal surgery according to systemic inflammatory response syndrome and quick sequential organ failure assessment: A prospective study.","authors":"Amit Mishra,&nbsp;Jayesh Mittal,&nbsp;Sujata Tripathi,&nbsp;Sourabh Paul","doi":"10.4103/ua.ua_150_22","DOIUrl":"10.4103/ua.ua_150_22","url":null,"abstract":"<p><strong>Purpose: </strong>Myriad operative factors and characteristics of patients may influence the risk of infection in a patient undergoing stone surgery. We prospectively determined the risk factors for systemic inflammatory response syndrome (SIRS) and quick sequential organ failure assessment (qSOFA) in patients undergoing percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS).</p><p><strong>Materials and methods: </strong>Patients who underwent PCNL and RIRS from March 2018 to January 2020 satisfying our selection criteria were enrolled. Samples of urine from the renal pelvis, bladder, and retrieved stones were sent for culture testing. Postoperatively patients were keenly supervised for any indications of SIRS and qSOFA. The association between stone and urine cultures across various sites was examined. Regression analysis was performed to ascertain clinical variables affiliated with SIRS and qSOFA.</p><p><strong>Results: </strong>The study included a total of 150 patients including both PCNL and RIRS, of which 23% post-PCNL and 20% post-RIRS met the criteria of SIRS and qSOFA. On univariate analysis in PCNL-Dilated pelvicalyceal system (PCS), renal pelvic urine culture (RPUC), stone culture (SC), and operative time >124 min among others were identified as risk factors whereas, in RIRS-residual calculus, RPUC, SC and operative time >62 min were risk factors. Multivariate analysis identified dilated PCS and SC for PCNL and only intraoperative RPUC for RIRS as independent risk factors. Only a significantly strong correlation among culture analysis was found between RPUC and SC in both the procedures.</p><p><strong>Conclusion: </strong>Intraoperative RPUC and SCs are better predictors of post-PCNL SIRS while Intraoperative RPUC and duration of surgery are better predictors of post-RIRS sepsis. We, therefore, recommend that both these cultures must routinely be obtained in the above procedures to identify the offending organisms and amend antibiotic therapy during treatment and surgical duration should be kept <62 min in RIRS. SIRS serves as a sensitive review tool which is specifically useful for initial care and on the contrary qSOFA is well suited for patients at greater risk of demise, thereby guiding clinicians to decide future care and course of treatment of patients.</p>","PeriodicalId":23633,"journal":{"name":"Urology Annals","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a4/f5/UA-15-295.PMC10471817.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10150419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ureteroscopic lithotripsy by thulium fiber laser versus holmium laser: A single-center prospective randomized study.","authors":"Vaddi Chandramohan,&nbsp;P M Siddalinga Swamy,&nbsp;Paidakula Ramakrishna,&nbsp;Soundarya Ganesan,&nbsp;Manas Babu,&nbsp;Hemnath Anandan,&nbsp;Rakesh Panda","doi":"10.4103/ua.ua_115_22","DOIUrl":"10.4103/ua.ua_115_22","url":null,"abstract":"<p><strong>Objective: </strong>Laser lithotripsy has been the standard of care for lower and mid-ureteric calculi. Thulium fiber laser (TFL) is a new introduction to this field, which has been extensively studied for retrograde intrarenal surgery. We have done a prospective randomized study of ureteroscopic lithotripsy between TFL and holmium: Yttrium-aluminum-garnet (HO: YAG) laser to know the efficacy of stone fragmentation, stone-free rate, and complications.</p><p><strong>Methodology: </strong>A prospective randomized study was done in our hospital from March 2021 to May 2022 on patients planned for ureteroscopic laser lithotripsy. Patients with distal and mid-ureteral stones from 4 mm to 15 mm were included. The laser was used to fragment the stone. All the stones were fragmented from the center to periphery. The setting used was up to 10 W (6-10 Hz, 1J) for TFL and up to 10 W for HO: YAG (5-10 Hz, 0.5-1J). Once the stones were fragmented, they were retrieved until complete visual clearance. Demographic data and stone parameters such as stone size, volume, density, laterality, laser usage time, total operative time, and total energy used were recorded. Operative time, lasering time, retropulsion rate, ablation speed, and visibility score were recorded.</p><p><strong>Results: </strong>Each group had 90 randomized patients. Both the groups had similar kinds of patient and stone profiles. The mean operating time was 18.5 ± 1.5 min (95% confidence interval [CI] 16.2-25.6) in the TFL group, which was shorter than the holmium group 31.6 ± 1.2 min (95% CI 18.4-38.5), and it was statistically significant (<i>P</i> = 0.024,). Lasering time was also statistically significant with less lasering time with TFL group 7.4 ± 1.8 min (95% CI 5.2-10.3) versus holmium group 14.8 ± 1.5 min (95% CI 12.3-18.4) (<i>P</i> = 0.011). Laser efficacy and ablation speed were better in the TFL group compared to the HO: YAG group and were statistically significant. The visual score was better in HO: YAG group compared to the TFL group.</p><p><strong>Conclusion: </strong>TFL is more efficacious and faster than Holmium: Yag laser. Complications were similar between the groups. Stone-free rate was also similar between both the groups.</p>","PeriodicalId":23633,"journal":{"name":"Urology Annals","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/02/5b/UA-15-285.PMC10471822.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10208805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}