Comparison of the Efficacy of ShuoTong Ureteroscopy and Simple Flexible Ureteroscopy in the Treatment of Unilateral Upper Ureteral Calculi

Longhui Lai, Wenzhao Zhang, Fangjian Zheng, Tao Wang, Peide Bai, Zhengsheng Liu, Jiaxin Zheng, Zhiqiang Shao, Bo Duan, Huiqiang Wang, Jinchun Xing, Huixin Chen, Yushan Huang, Bin Chen, Longhui Lai, Wenzhao Zhang, Fangjian Zheng, Tao Wang, Peide Bai, Zhengsheng Liu, Jiaxin Zheng, Zhiqiang Shao, Bo Duan, Huiqiang Wang, Jinchun Xing, Huixin Chen, Yushan Huang, Bin Chen

Abstract

Background: ShuoTong ureteroscopy (Sotn-ureteroscopy, ST-URS), a new lithotripsy operation method developed on the basis of ureteroscopy, is widely used to treat ureteral stones in China. Its composition includes rigid ureteral access sheath, standard mirror, lithotripsy mirror, and ShuoTong perfusion aspirator (ST-APM). Here, we compared the efficacy and safety of the ST-URS and the flexible ureteroscope (F-URS) holmium laser lithotripsy in the treatment of unilateral upper ureteral calculi. Methods: Retrospective analysis was conducted on the clinical data of 280 patients who met the inclusion 1) urinary tract CT was diagnosed with unilateral single upper ureteral calculi above the L4 lumbar spine; 2) patient age was from 18 to 80 years old; 3) patients were informed and consented to this study; and 4) patients were approved by the hospital ethics committee (proof number: KY-2019-020) and the exclusion criteria for unilateral upper ureteral calculi in the First Affiliated Hospital of Xiamen University from January 2018 to November 2020, and they were divided into the ST-URS group and the flexible ureteroscopy (F-URS) group. Results: The stone-free rate of 1 day after operation of the ST-URS group was significantly higher than the F-URS group (63.71 vs. 34.62%, P < 0.0001). The operative time (38.45 vs. 46.18 min, P = 0.005) and hospitalization cost (27,203 vs. 33,220 Yuan, P < 0.0001) of the ST-URS group were significantly lower than the F-URS group. There were no significant differences in the success rate of ureteral access sheath placement, operative blood loss, stone-free rate of 1 month after operation, postoperative complications, postoperative hospital stay, and postoperative visual analog scale (VAS) pain score between the two groups (P > 0.05). In subgroups of a diameter of calculi ≥ 1.5 cm, calculi CT numerical value ≥ 1,000 Hounsfield unit and the preoperative hydronephrosis range ≥ 3.0 cm, ST-URS shows more advantages in the operative time, stone-free rate of 1 day after the operation, the hospitalization cost, and the incidence of postoperative complications. Conclusion: In unilateral upper ureteral stones treated with a holmium laser, compared with the simple F-URS, the ST-URS has a shorter operative time, lower hospitalization cost, and a higher stone-free rate of 1 day after the operation, suggesting that the ST-URS could be more widely applied in clinics.

Keywords: ShuoTong ureteroscopy; efficacy and safety; flexible ureteroscopy; stone-free rate; unilateral upper ureteral calculi.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Lai, Zhang, Zheng, Wang, Bai, Liu, Zheng, Shao, Duan, Wang, Xing, Chen, Huang and Chen.

Figures

Figure 1
Figure 1
ShuoTong mirror compositions and surgical procedures. (A) The mirror sheath portion of the standard mirror. (B) Standard mirror. (C) Gravel mirror. (D) Adjustable negative pressure suction device and stone collector. (E) Vacuum suction system, perfusion system. (F) Connection diagram. (G) Use of the gravel mirror. (H) Use of vacuum suction to remove stone fragments and powder. (I) The rigid outer sheath is inserted into the flexible ureteroscope for examination.

References

    1. Alatab S, Pourmand G, El Howairis Mel F, Buchholz N, Najafi I, Pourmand MR, et al. . National profiles of urinary calculi: a comparison between developing and developed worlds. Iran J Kidney Dis. (2016) 10:51–61.
    1. Abeywickarama B, Ralapanawa U, Chandrajith R. Geoenvironmental factors related to high incidence of human urinary calculi (kidney stones) in Central Highlands of Sri Lanka. Environ Geochem Health. (2016) 38:1203–14. 10.1007/s10653-015-9785-x
    1. Modi PK, Kwon YS, Davis RB, Elsamra SE, Dombrovskiy V, Olweny OE. Pediatric hospitalizations for upper urinary tract calculi: epidemiological and treatment trends in the United States, 2001-2014. J Pediatr Urol. (2018) 14:13 e1–13 e6. 10.1016/j.jpurol.2017.09.001
    1. Yasui T, Okada A, Hamamoto S, Taguchi K, Ando R, Mizuno K, et al. . Efficacy of retroperitoneal laparoscopic ureterolithotomy for the treatment of large proximal ureteric stones and its impact on renal function. Springerplus. (2013) 2:600. 10.1186/2193-1801-2-600
    1. Alivizatos G, Skolarikos A. Is there still a role for open surgery in the management of renal stones? Curr Opin Urol. (2006) 16:106–11. 10.1097/01.mou.0000193379.08857.e7
    1. Turk C, Petrik A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. . EAU guidelines on interventional treatment for urolithiasis. Eur Urol. (2016) 69:475–82. 10.1016/j.eururo.2015.07.041
    1. Scales CD, Jr. Practice patterns in the management of urinary lithiasis. Curr Urol Rep. (2013) 14:154–7. 10.1007/s11934-013-0313-1
    1. Lee SH, Kim TH, Myung SC, Moon YT, Kim KD, Kim JH, et al. . Effectiveness of flexible ureteroscopic stone removal for treating ureteral and ipsilateral renal stones: a single-center experience. Korean J Urol. (2013) 54:377–82. 10.4111/kju.2013.54.6.377
    1. Aboumarzouk OM, Monga M, Kata SG, Traxer O, Somani KB. Flexible ureteroscopy and laser lithotripsy for stones >2 cm: a systematic review and meta-analysis. J Endourol. (2012) 26:1257–63. 10.1089/end.2012.0217
    1. Giusti G, Proietti S, Luciani LG, Peschechera R, Giannantoni A, Taverna G, et al. . Is retrograde intrarenal surgery for the treatment of renal stones with diameters exceeding 2 cm still a hazard? Can J Urol. (2014) 21:7207–12.
    1. Traxer O, Wendt-Nordahl G, Sodha H, Rassweiler J, Meretyk S, Tefekli A, et al. . Differences in renal stone treatment and outcomes for patients treated either with or without the support of a ureteral access sheath: the clinical research office of the endourological society ureteroscopy global study. World J Urol. (2015) 33:2137–44. 10.1007/s00345-015-1582-8
    1. Xu C, Song RJ, Jiang MJ, Qin C, Wang XL, Zhang W. Flexible ureteroscopy with holmium laser lithotripsy: a new choice for intrarenal stone patients. Urol Int. (2015) 94:93–8. 10.1159/000365578
    1. Dindo D, Demartines N, Clavien A P. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. (2004) 240:205–13. 10.1097/
    1. Berardinelli F, De Francesco P, Marchioni M, Cera N, Proietti S, Hennessey D, et al. . Infective complications after retrograde intrarenal surgery: a new standardized classification system. Int Urol Nephrol. (2016) 48:1757–62. 10.1007/s11255-016-1373-1
    1. O'Grady NP, Barie PS, Bartlett JG, Bleck T, Garvey G, Jacobi J, et al. . Practice guidelines for evaluating new fever in critically ill adult patients. Task Force of the Society of Critical Care Medicine and the Infectious Diseases Society of America. Clin Infect Dis. (1998) 26:1042–59. 10.1086/520308
    1. Hamamoto S, Yasui T, Okada A, Taguchi K, Kawai N, Ando R, et al. . Endoscopic combined intrarenal surgery for large calculi: simultaneous use of flexible ureteroscopy and mini-percutaneous nephrolithotomy overcomes the disadvantageous of percutaneous nephrolithotomy monotherapy. J Endourol. (2014) 28:28–33. 10.1089/end.2013.0361
    1. Bai PD, Wang T, Huang HC, Wu Z, Wang XG, Qin JX, et al. . Effect of preoperative Double-J ureteral stenting before flexible ureterorenoscopy on stone-free rates and complications. Curr Med Sci. (2021) 41:140–4. 10.1007/s11596-021-2328-z
    1. Al-Qahtani SM, Letendre J, Thomas A, Natalin R, Saussez T, Traxer O. Which ureteral access sheath is compatible with your flexible ureteroscope? J Endourol. (2014) 28:286–90. 10.1089/end.2013.0375
    1. Bader MJ, Eisner B, Porpiglia F, Preminger GM, G H. Tiselius: contemporary management of ureteral stones. Eur Urol. (2012) 61:764–72. 10.1016/j.eururo.2012.01.009
    1. Aboutaleb H, Omar M, Salem S, Elshazly M. Management of upper ureteral stones exceeding 15 mm in diameter: shock wave lithotripsy versus semirigid ureteroscopy with holmium:yttrium-aluminum-garnet laser lithotripsy. SAGE Open Med. (2016) 4:2050312116685180. 10.1177/2050312116685180
    1. Mursi K, Elsheemy MS, Morsi HA, Ali Ghaleb AK, Abdel-Razzak MO. Semi-rigid ureteroscopy for ureteric and renal pelvic calculi: predictive factors for complications and success. Arab J Urol. (2013) 11:136–41. 10.1016/j.aju.2013.04.008
    1. Hyams ES, Monga M, Pearle MS, Antonelli JA, Semins MJ, Assimos DG, et al. . A prospective multi-institutional study of flexible ureteroscopy for proximal ureteral stones smaller than 2 cm. J Urol. (2015) 193:165–9. 10.1016/j.juro.2014.07.002
    1. de la Rosette J, Denstedt J, Geavlete P, Keeley F, Matsuda T, Pearle M, et al. . The clinical research office of the endourological society ureteroscopy global study: indications, complications, and outcomes in 11,885 patients. J Endourol. (2014) 28:131–9. 10.1089/end.2013.0436
    1. Zhong W, Leto G, Wang L, Zeng G. Systemic inflammatory response syndrome after flexible ureteroscopic lithotripsy: a study of risk factors. J Endourol. (2015) 29:25–8. 10.1089/end.2014.0409
    1. Rehman J, Monga M, Landman J, Lee DI, Felfela T, Conradie MC, et al. . Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology. (2003) 61:713–8. 10.1016/S0090-4295(02)02440-8
    1. Auge BK, Pietrow PK, Lallas CD, Raj GV, Santa-Cruz RW, Preminger M G. Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol. (2004) 18:33–6. 10.1089/089277904322836631
    1. Michel MS, Honeck P, Alken P. Conventional high pressure versus newly developed continuous-flow ureterorenoscope: urodynamic pressure evaluation of the renal pelvis and flow capacity. J Endourol. (2008) 22:1083–5. 10.1089/end.2008.0016
    1. Jung H, Norby B, Frimodt-Moller PC, Osther J P. Endoluminal isoproterenol irrigation decreases renal pelvic pressure during flexible ureterorenoscopy: a clinical randomized controlled study. Eur Urol. (2008) 54:1404–13. 10.1016/j.eururo.2008.03.092
    1. Yang Z, Song L, Xie D, Hu M, Peng Z, Liu T, et al. . Comparative study of outcome in treating upper ureteral impacted stones using minimally invasive percutaneous nephrolithotomy with aid of patented system or transurethral ureteroscopy. Urology. (2012) 80:1192–7. 10.1016/j.urology.2012.08.045
    1. Yang Z, Song L, Xie D, Deng X, Zhu L, Fan D, et al. . The new generation mini-PCNL system - monitoring and controlling of renal pelvic pressure by suctioning device for efficient and safe PCNL in managing renal staghorn Calculi. Urol Int. (2016) 97:61–6. 10.1159/000442002
    1. Deng X, Song L, Xie D, Huang J, Zhu L, Wang X, et al. . Predicting outcomes after minimally percutaneous nephrolithotomy with the aid of a patented system by using the guy's stone score. Urol Int. (2016) 97:67–71. 10.1159/000443774
    1. Li K, Liao Z, Lin T, Li Z, He W, Liu C, et al. . A novel semirigid ureterorenoscope with vacuum suctioning system for management of single proximal ureteral and renal pelvic stones: an initial experience. J Endourol. (2018) 32:1154–9. 10.1089/end.2018.0565
    1. Gan S, Guo Z, Zou Q, Gu C, Xiang S, Li S, et al. . Novel semirigid ureterorenoscope with irrigation and vacuum suction system: introduction and initial experience for management of upper urinary calculi. Int Braz J Urol. (2020) 46:786–93. 10.1590/s1677-5538.ibju.2019.0521
    1. Zeng G, Wang D, Zhang T, Wan PS. Modified access sheath for continuous flow ureteroscopic lithotripsy: a preliminary report of a novel concept and technique. J Endourol. (2016) 30:992–6. 10.1089/end.2016.0411
    1. Zhu Z, Cui Y, Zeng F, Li Y, Chen Z, Hequn C. Comparison of suctioning and traditional ureteral access sheath during flexible ureteroscopy in the treatment of renal stones. World J Urol. (2019) 37:921–29. 10.1007/s00345-018-2455-8
    1. Atis G, Gurbuz C, Arikan O, Canat L, Kilic M, Caskurlu T. Ureteroscopic management with laser lithotripsy of renal pelvic stones. J Endourol. (2012) 26:983–7. 10.1089/end.2011.0664
    1. Knoll T, Jessen JP, Honeck P, Wendt-Nordahl G. Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10-30 mm size. World J Urol. (2011) 29:755–9. 10.1007/s00345-011-0784-y
    1. Levy MM, Artigas A, Phillips GS, Rhodes A, Beale R, Osborn T, et al. . Outcomes of the surviving sepsis campaign in intensive care units in the USA and Europe: a prospective cohort study. Lancet Infect Dis. (2012) 12:919–24. 10.1016/S1473-3099(12)70239-6
    1. Deng X, Song L, Xie D, Fan D, Zhu L, Yao L, et al. . A novel flexible ureteroscopy with intelligent control of renal pelvic pressure: an initial experience of 93 cases. J Endourol. (2016) 30:1067–72. 10.1089/end.2015.0770
    1. Huang J, Xie D, Xiong R, Deng X, Huang C, Fan D, et al. . The application of suctioning flexible ureteroscopy with intelligent pressure control in treating upper urinary tract calculi on patients with a solitary kidney. Urology. (2018) 111:44–7. 10.1016/j.urology.2017.07.042
    1. Aldoukhi AH, Ghani KR, Hall TL, Roberts WW. Thermal response to high-power holmium laser lithotripsy. J Endourol. (2017) 31:1308–12. 10.1089/end.2017.0679
    1. Ito H, Kawahara T, Terao H, Ogawa T, Yao M, Kubota Y, et al. . Predictive value of attenuation coefficients measured as Hounsfield units on noncontrast computed tomography during flexible ureteroscopy with holmium laser lithotripsy: a single-center experience. J Endourol. (2012) 26:1125–30. 10.1089/end.2012.0154

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