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      Retrograde intrarenal surgery: An expanding role in treatment of urolithiasis

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          Abstract

          During the past 3 decades, the surgical management of kidney stones has undergone many technological advances and one is the development of the flexible ureteroscopy. The development of this instrument as well as ancillary equipment such as baskets, graspers, and others, and improvements in lithotripsy with Holmium: YAG laser have led to expand its indications with diagnostic and therapeutic management of medical issues of the upper urinary tract such as urolithiasis and urothelial tumors. The objective of this review is to describe its indications and results in the different scenarios for the treatment of urinary stones.

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          Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs. 2000.

          A. Hesse, E. Brändle, D Wilbert … (2003)
          In 1979, we conducted a representative study to determine the prevalence and incidence of urolithiasis in Germany. Significant progress in stone therapy and changes in nutritional and environmental factors since then consequently led to a second study in 2001 under the same conditions as in 1979. A representative sample of 7500 persons from all over Germany was questioned on the occurrence of urinary stones during their lifetimes (prevalence) and on acute urolithiasis in 2000 (incidence). Additionally, data were collected on urinary stone therapy and metaphylaxis. The current data were then compared with those from 1979. Prevalence has risen from 4% to 4.7% from 1979 to 2001. 9.7% of the 50-64 year old males in 2000 had already had urinary stones (females: 5.9%). The current recurrence rate of urinary stones was estimated to be 42%. In the year 2000, the incidence of urolithiasis in Germany was found to be 1.47% (1979: 0.54%). Over 40% of the stones were passed spontaneously. There has been a marked increase in the prevalence and incidence of urolithiasis in Germany within the last 22 years. This probably results from improvements in clinical-diagnostic procedures, changes in nutritional and environmental factors and a general apathy towards metabolic clarification and metaphylaxis.
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            2007 Guideline for the management of ureteral calculi.

            Glenn Preminger, Hans-Göran Tiselius, Dean Assimos … (2007)
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              Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation.

              B Auge, Glenn Preminger, Sumal V. Raj … (2004)
              New-generation flexible ureteroscopes allow the management of proximal ureteral and intrarenal pathology with high success rates, including complete removal of ureteral and renal calculi. One problem is that the irrigation pressures generated within the collecting system can be significantly elevated, as evidenced by pyelovenous and pyelolymphatic backflow seen during retrograde pyelography. We sought to determine if the ureteral access sheath (UAS) can offer protection from high intrarenal pressures attained during routine ureteroscopic stone surgery. Five patients (average age 72.6 years) evaluated in the emergency department for obstructing calculi underwent percutaneous nephrostomy (PCN) tube placement to decompress their collecting systems. The indications for PCN tube placement were obstructive renal failure (N=1), urosepsis (N=2), and obstruction with uncontrolled pain and elevated white blood cell counts (N=2). Flexible ureteroscopy was subsequently performed with and without the aid of the UAS while pressures were measured via the nephrostomy tube connected to a pressure transducer. Pressures were recorded at baseline and in the distal, mid, and proximal ureter and renal pelvis, first without the UAS, and then with the UAS in place. The average baseline pressure within the collecting system was 13.6 mm Hg. The mean intrarenal pressure with the ureteroscope in the distal ureter without the UAS was 60 mm Hg and with the UAS was 15 mm Hg. With the ureteroscope in the midureter, the pressures were 65.6 and 17.5 mm Hg, respectively; with the ureteroscope in the proximal ureter 79.2 and 24 mm Hg, and with the ureteroscope in the renal pelvis 94.4 and 40.6 mm Hg, respectively. All differences at each location were statistically significant (P<0.008). Compared with baseline, all pressures measured without the UAS were significantly greater, but only pressures recorded in the proximal ureter and renal pelvis after UAS insertion were significantly higher (P<0.03). The irrigation pressures transmitted to the renal pelvis and subsequently to the parenchyma are significantly greater during routine URS without the use of the UAS. The access sheath is potentially protective against pyelovenous and pyelolymphatic backflow, with clinical implications for the ureteroscopic management of upper-tract transitional cell carcinoma, struvite stones, or calculi associated with urinary tract infection.
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                Author and article information

                Contributors
                Olivier Traxer
                Journal
                Journal ID (nlm-ta): Asian J Urol
                Journal ID (iso-abbrev): Asian J Urol
                Title: Asian Journal of Urology
                Publisher: Second Military Medical University
                ISSN (Print): 2214-3882
                ISSN (Electronic): 2214-3890
                Publication date PMC-release: 22 June 2018
                Publication date (Print): October 2018
                Publication date (Electronic): 22 June 2018
                Volume: 5
                Issue: 4
                Pages: 264-273
                Affiliations
                [1]Department of Urology, Tenon Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France
                Author notes
                [∗ ]Corresponding author. olivier.traxer@ 123456aphp.fr
                Article
                Publisher ID: S2214-3882(18)30057-2
                DOI: 10.1016/j.ajur.2018.06.005
                PMC ID: 6197554
                PubMed ID: 30364659
                SO-VID: eaa7d510-0389-4ec1-9cef-b439bc916ed1
                Copyright © © 2018 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 13 April 2018
                Date revision received : 5 May 2018
                Date accepted : 10 May 2018
                Categories
                Subject: Review

                Keywords: ureteroscopy,retrograde intrarenal surgery,endourology,urolithiasis
                Data availability:
                Keywords: ureteroscopy, retrograde intrarenal surgery, endourology, urolithiasis

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