Laboratory Studies
Useful pre-operative laboratory stories include:
-
Coagulation factors
Prothrombin time
Activated partial thromboplastin time
Platelet count
-
Urinalysis and urine culture
-
Standard preoperative laboratory workup
CBC count
Electrolyte levels
Serum creatinine and BUN determination
Imaging Studies
Useful preoperative imaging studies depending on the clinical presentation may include the following:
-
Renal ultrasonography
-
IVP (once ubiquitous, now increasingly being phased out)
-
CT scan
- non-contrast (i.e. stone protocol)
- IV contrast with delay (i.e. Hematuria, Mass protocol)
-
MRI
-
Flexible fiberoptic ureteropyeloscope.
-
Secondary endoscope deflection that allows lower-pole intrarenal access.
-
Plain radiograph that defines a large renal pelvic calculus with the flexible ureteroscope passed beyond the stone burden.
-
Ureteroscopic image of an impacted jack stone in the ureter. These calculi are composed of calcium oxalate monohydrate.
-
Ureteroscopic image of a papillary transitional cell carcinoma of the ureter.
-
A parapelvic cyst (star) causes splaying of the middle and lower pole calyces making access to a lower pole stone (arrow) very difficult.
-
Comparison of the semi-rigid Karl Storz ureteroscope and tip (above) with that of the ACMI MR6 endoscope (below).
-
Using secondary deflection, access to this lower pole stone burden is made possible.
-
The use of dilute contrast injected through the ureteroscope ensures adequate mapping and inspection of all calyces
-
Wireless ("no touch") ureteroscopy, laser lithotripsy and stone extraction technique performed with the digital ureteroscope.
Tables
- Table 1. Comparison of Complication Rates Associated With Ureteroscopy, Emphasizing the Noticeable Decrease in the Major Complication Rate With Greater Experience and Endoscope Miniaturization
- Table 2. New York University Experience With Ureteroscopic Treatment of Ureteral Calculi Using the Holmium:YAG Laser
- Table 3. New York University Experience With Ureteropyeloscopic Treatment of Intrarenal Calculi Using the Holmium:YAG Laser
- Table 4. Review of Studies on Ureteroscopic Management of Upper Urinary Tract Calculi > 2 cm
|
Blute, et al. [14] |
Abdel-Razzak and Bagley [18] |
Harmon, et al. [19] |
Grasso [15] |
Jiang, et al. [16] |
Year |
1988 |
1992 |
1997 |
2000 |
2007 |
Number of Procedures |
346 |
290 |
209 |
1000 |
697 |
Minor Complications |
(%) |
(%) |
(%) |
(%) |
(%) |
Colic/pain |
-- |
9.0 |
3.5 |
4.2 |
-- |
Fever |
6.2 |
6.9 |
2.0 |
1.3 |
-- |
False passage |
0.9 |
-- |
-- |
0.4 |
0.4 |
Hematuria Minor Prolonged |
0.5 0.3 |
2.1 1.0 |
0 0 |
0.8 0.2 |
|
Extravasation |
0.6 |
1.0 |
-- |
-- |
-- |
UTI |
-- |
1.0 |
-- |
1.7 |
-- |
Pyelonephritis |
-- |
-- |
-- |
1.0 |
-- |
|
|
|
|
|
|
Major Complications |
(%) |
(%) |
(%) |
(%) |
(%) |
Major perforation |
4.6 |
1.7 |
1.0 |
0 |
0.3 |
Stricture |
1.4 |
0.7 |
0.5 |
0.4 |
0.3 |
Avulsion |
0.6 |
0 |
0 |
0 |
0 |
Urinoma |
0.6 |
-- |
0 |
0 |
-- |
Urosepsis |
0.3 |
0 |
0 |
0 |
-- |
CVA |
-- |
-- |
0.5 |
0.1 |
-- |
DVT |
-- |
-- |
-- |
0.1 |
-- |
MI |
-- |
-- |
-- |
0.1 |
-- |
Segment |
Number of Cases |
Mean Diameter, mm (range, mm) |
Success Rate, First-Stage Treatment and Second -Stage Treatment |
Proximal third |
75 |
11.3 (30-5) |
95% and 96% |
Middle third |
45 |
10.7 (60-5) |
98% and 100% |
Distal third |
91 |
10.3 (50-4) |
99% and 100% |
Totals |
211 |
|
97% and 99% |
Location |
Number of Cases |
Mean Diameter, mm (range, mm) |
Success Rate, Treatment and Multistage Treatment |
Upper pole |
58 |
10.6 (35-4) |
90% and 97% |
Middle pole |
30 |
11.1 (23-4) |
90% and 93% |
Lower pole |
103 |
14.8 (40-3) |
79% and 85% |
Renal pelvic |
37 |
20.5 (60-6) |
78% and 95% |
Totals |
228 |
|
81% and 90% |
STUDY |
Date |
Number of Patients |
Mean Stone Diameter (mm) |
Mean number of procedures |
Stone Free (%) |
Complications number (%) |
Grasso et al. [20] |
1998 |
51 |
24.9 |
1.3 |
93 |
3 (3) |
El-Anany et al. [22] |
2001 |
30 |
>20 |
1 |
77 |
3 (10) |
Ricchiuti et al. [23] |
2007 |
23 |
30.9 |
1.4 |
74 |
0 (0) |
Breda et al. [24] |
2008 |
15 |
22 |
2.3 |
93 |
3 (9) |
Riley et al. [25] |
2009 |
22 |
30 |
1.8 |
91 |
4 (10) |
Hyams et al. [26] |
2010 |
120 |
24 |
1.2 |
83 |
8 (6) |
Takazawa et al. [27] |
2011 |
20 |
31 |
1.4 |
90 |
3 (5) |
Cohen et al. [21] |
2012 |
145 |
29 |
1.6 |
87 |
5 (2) |
