ABSTRACT: Bilateral ureteroscopy can be done in 1 sitting, obviating the need for multiple procedures. We analyzed our experience with same session bilateral ureteroscopy to determine its safety and efficacy.
In this retrospective study of a 9-year period at Emory University Hospital 1,575 consecutive ureteroscopic procedures were done, of which 95 (6.0%) were done as same session bilateral ureteroscopy, thus constituting our study cohort. Bilateral procedures were performed for urolithiasis in 71 cases, urothelial carcinoma in 9, ureteral stricture in 2 and another indication in 13. Patients were followed at least 1 month postoperatively to evaluate procedural success and assess perioperative complications.
Mean age of the 44 male and 40 female patients was 49.8 years. Multiple procedures were done in 9 patients and same session bilateral ureteroscopy was done in 93 of 95 (98%). Intraoperative and postoperative (greater than 1 month) bilateral stone-free rates were 86% and 64%, respectively. The mean change in serum creatinine postoperatively was 0.02 mg/dl (range -0.9 to 1.3). No patient had acute postoperative azotemia. Postoperative complications in 9.7% of patients included pain necessitating an emergency room visit in 4, pyelonephritis/urinary tract infection in 2, and urinary retention, intractable stent pain leading to early removal and urosepsis/death in 1 each.
Same session bilateral ureteroscopy is efficacious and safe to evaluate and treat upper tract pathology. While most complications are minor, they may be higher than that typically reported for unilateral ureteroscopic procedures.
The Journal of urology 11/2010; 185(1):170-4. · 4.02 Impact Factor
ABSTRACT: The incidence of urolithiasis is twofold to threefold higher in men than in women. Several animal studies have suggested an association between testosterone levels and the formation of kidney stones. Specifically, castration has been shown to decrease stone formation in rat models. The association between testosterone and stone formation in humans, however, has not been well investigated.
Early morning total and free testosterone levels were recorded for 55 male patients. Participants completed a demographics questionnaire, and clinical records of enrolled subjects were reviewed. When available, stone composition was determined in the stone formers. Mann-Whitney tests and logistic regression models were used to examine the data.
Of the 55 patients, 25 had no history of urolithiasis and 30 had a history of urolithiasis. Although the differences between the two groups were not statistically significant, the stone formers compared with stone-free controls tended to be older (median age 48.4 vs 36.5 years, P = 0.072) and have higher serum levels of testosterone (median serum concentration 384 vs 346 ng/dL, P = 0.112). In the multivariate analyses, after adjusting for age and body mass index, the testosterone-related odds ratio was 1.004 with a corresponding P value 0.051.
Male stone formers were found to have higher serum total testosterone levels compared with a similar cohort without stones. This result is consistent with several animal models that have demonstrated that testosterone is a risk factor for stone formation. Our findings warrant confirmation in a larger, prospective study. There are potential therapeutic implications if testosterone is found to be a risk factor in urolithogenesis.
Journal of endourology / Endourological Society 07/2010; 24(7):1183-7. · 1.75 Impact Factor
ABSTRACT: We evaluated the usefulness and interobserver concordance of a novel grading system for dynamic ureteral hydrodistention.
Between May 1, 2002 and July 1, 2008 the hydrodistention grade in 697 ureters was prospectively assigned and recorded, including H0-no hydrodistention, H1-ureteral orifice open but tunnel not evident, H2-tunnel seen only and H3-extravesical ureter visualized. Specifically 489 refluxing ureters (vesicoureteral reflux group) were compared to 100 normal control ureters (normal control group). Additionally, the posttreatment hydrodistention grade in 56 ureters in which surgery for reflux failed was compared to that in 52 ureters with successful surgery. Hydrodistention grades assigned to an additional 77 ureters by 3 blinded observers were compared to assess the interobserver concordance of this system.
Vesicoureteral reflux and hydrodistention grades correlated significantly (p <0.001). Ureters with a higher reflux grade also showed a higher hydrodistention grade. The normal control group (mean +/- SEM hydrodistention grade 0.62 +/- 0.07) showed a statistically lower hydrodistention grade than the reflux groups (overall mean hydrodistention grade 2.26 +/- 0.01). Mean posttreatment hydrodistention grade in the failed reflux surgery group was statistically higher than that in the mean successful reflux surgery group (2.03 +/- 0.09 vs 1.33 +/- 0.08). By defining the degree of hydrodistention as normal (H0-H1) and abnormal (H2-H3) the concordance between observers was 95% and 96%.
The dynamic hydrodistention classification is a reliable method of evaluating the presence or absence of vesicoureteral reflux as it correlates significantly with radiographic reflux grade. It has high interobserver concordance.
The Journal of urology 08/2009; 182(4 Suppl):1688-92. · 4.02 Impact Factor