Randomized Comparison of 4.5/6 Fr Versus 6/7.5 Fr Ureteroscopes for Laser Lithotripsy of Lower/middle Ureteral Calculi: Towards Optimization of Efficacy and Safety of Semirigid Ureteroscopy

Overview

Journal World J Urol

Specialty Urology

Date 2022 Oct 8

PMID 36208314

Authors

Mohamed Omar

Mohammed Dorrah

Ahmed Khalifa

Eid El Sherif

Khalid Sayedahmed

Yahya Ghazwani

Yasser A Noureldin

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: To compare 4.5/6 Fr versus 6/7.5 Fr semirigid ureteroscopes in terms of safety and efficacy in adult non-obese patients with middle or lower ureteric stones.

Materials And Methods: A total of 198 patients with middle/lower ureteric stone and a BMI ≤ 30 kg/m were recruited. Patients were randomized according to the size of ureteroscope into two groups: group 1 where a 4.5/6 Fr semi-rigid ureteroscope was used, and group 2 where a 6/7.5 Fr semi-rigid ureteroscope was used. Patient's demographic, stone characteristics, intraoperative and postoperative outcomes including stone-free rate (SFR) and complications were compared.

Results: Preoperative characteristics in terms of age, sex, BMI, and stone location, side, size, and HU were comparable between both groups (p values > 0.05). The overall SFR was significantly higher in group 1 (0.004). Balloon dilatation was not required in all patients of group-1 compared with 33% of group-2 (p = 0.0001). The JJ stent was required in 10% of group-1 compared with 30% of group-2 (p = 0.0004). Failure to reach the stone due to tight ureter occurred in 8% of group 2 (p = 0.003), respectively. Traxer's grade 1 ureteral injury occurred in 2% of group-1 versus 14% of group-2 (p = 0.001). Consequently, hematuria was significantly lower in group-1 (1% vs. 8%; p = 0.01), respectively. The hospital stay < 9 h was significantly higher in group 1 (p = 0.0001).

Conclusions: The 4.5/6 Fr semi-rigid Ureteroscope was associated with significantly higher SFR and shorter hospital stay, with lower ureteral injury, fewer double-J stenting, and without the need for intraoperative balloon dilatation for the ureter.

References

JENKINS A . ESWL: distal ureteral stone management--1993. Urology. 1993; 42(4):353-5. DOI: 10.1016/0090-4295(93)90356-f. View

Harmon W, Sershon P, Blute M, Patterson D, Segura J . Ureteroscopy: current practice and long-term complications. J Urol. 1997; 157(1):28-32. DOI: 10.1016/s0022-5347(01)65272-8. View

Preminger G . Technique versus technology: what is the most appropriate method for the removal of ureteral calculi. J Urol. 1994; 152(1):66-7. DOI: 10.1016/s0022-5347(17)32817-3. View

Sofer M, Watterson J, Wollin T, Nott L, Razvi H, Denstedt J . Holmium:YAG laser lithotripsy for upper urinary tract calculi in 598 patients. J Urol. 2001; 167(1):31-4. DOI: 10.1016/s0022-5347(05)65376-1. View

Assimos D, Krambeck A, Miller N, Monga M, Murad M, Nelson C . Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART I. J Urol. 2016; 196(4):1153-60. DOI: 10.1016/j.juro.2016.05.090. View

Traxer O, Thomas A . Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol. 2012; 189(2):580-4. DOI: 10.1016/j.juro.2012.08.197. View

Bagley D . Ureteroscopic stone retrieval: rigid versus flexible endoscopes. Semin Urol. 1994; 12(1):32-8. View

Elashry O, Elgamasy A, Sabaa M, Abo-Elenien M, Omar M, Eltatawy H . Ureteroscopic management of lower ureteric calculi: a 15-year single-centre experience. BJU Int. 2008; 102(8):1010-7. DOI: 10.1111/j.1464-410X.2008.07747.x. View

Kuntz N, Neisius A, Tsivian M, Ghaffar M, Patel N, Ferrandino M . Balloon Dilation of the Ureter: A Contemporary Review of Outcomes and Complications. J Urol. 2015; 194(2):413-7. DOI: 10.1016/j.juro.2015.02.2917. View

10.

Natalin R, Xavier K, Okeke Z, Gupta M . Impact of obesity on ureteroscopic laser lithotripsy of urinary tract calculi. Int Braz J Urol. 2009; 35(1):36-41. DOI: 10.1590/s1677-55382009000100006. View

11.

Soheilipour F, Jesmi F, Rahimzadeh N, Pishgahroudsari M, Almassinokian F, Mazaherinezhad A . Configuring a Better Estimation of Kidney Size in Obese Children and Adolescents. Iran J Pediatr. 2016; 26(2):e4700. PMC: 4904341. DOI: 10.5812/ijp.4700. View

12.

Uzun H, Akca N . Is the 4.5-F ureteroscope (Ultra-Thin) an alternative in the management of ureteric and renal pelvic stones?. Arab J Urol. 2018; 16(4):429-434. PMC: 6277274. DOI: 10.1016/j.aju.2018.04.006. View

13.

Constanti M, Calvert R, Thomas K, Dickinson A, Carlisle S . Cost analysis of ureteroscopy (URS) vs extracorporeal shockwave lithotripsy (ESWL) in the management of ureteric stones <10 mm in adults: a UK perspective. BJU Int. 2019; 125(3):457-466. DOI: 10.1111/bju.14938. View

14.

Lam J, Greene T, Gupta M . Treatment of proximal ureteral calculi: holmium:YAG laser ureterolithotripsy versus extracorporeal shock wave lithotripsy. J Urol. 2002; 167(5):1972-6. View

15.

Omar M, Tarplin S, Brown R, Sivalingam S, Monga M . Shared decision making: why do patients choose ureteroscopy?. Urolithiasis. 2015; 44(2):167-72. DOI: 10.1007/s00240-015-0806-0. View

16.

Drake T, Grivas N, Dabestani S, Knoll T, Lam T, MacLennan S . What are the Benefits and Harms of Ureteroscopy Compared with Shock-wave Lithotripsy in the Treatment of Upper Ureteral Stones? A Systematic Review. Eur Urol. 2017; 72(5):772-786. DOI: 10.1016/j.eururo.2017.04.016. View

17.

Wong S, Hamid H . Observation of ureteric diameter in negative intravenous urogram in hospital universiti kebangsaan malaysia. Malays J Med Sci. 2011; 17(2):4-9. PMC: 3216153. View

18.

Katoh N, Sugiyama T, Itoh M, Ono Y, Yamada S, Kamihira O . [Transurethral ureterolithotripsy with rigid ureteroscope--efficacy of balloon dilation of ureteral orifice and intramural ureter]. Nihon Hinyokika Gakkai Zasshi. 1993; 84(9):1590-4. DOI: 10.5980/jpnjurol1989.84.1590. View

19.

Boddy S, Nimmon C, Jones S, Ramsay J, Britton K, Levison D . Acute ureteric dilatation for ureteroscopy. An experimental study. Br J Urol. 1988; 61(1):27-31. DOI: 10.1111/j.1464-410x.1988.tb09156.x. View

20.

Selmy G, Hassouna M, Begin L, Coolsaet B, Elhilali M . Effect of balloon dilation of ureter on upper tract dynamics and ureteral wall morphology. J Endourol. 1993; 7(3):211-9. DOI: 10.1089/end.1993.7.211. View