Urology Commons^™

Impact Of Frailty On Patient Morbidity And Outcomes Following Surgery For Urolithiasis: A Nsqip Analysis, David Fu, Kaeli Samson, Bryant Van Leeuwen, Andrew J. Blazek, Andrew Christiansen

Graduate Medical Education Research Journal

Background: Kidney stones are prevalent, and surgical treatment is based on multiple factors. Frailty is the collective decline of organ systems that can lead to adverse events and is considered prior to surgery for risk-benefit analysis. The National Surgical Quality Improvement Program (NSQIP) utilizes risk-adjusted data to monitor outcomes, provide quality benchmarks, and decrease complications. The impact of frailty with the modified 5-item frailty index has not previously been evaluated for patients undergoing urolithiasis procedures.

Methods: Data was collected from 1329 patients who underwent surgery for urolithiasis. The primary outcome was 30-day all-cause morbidity. Associations between variables, including those …

Comparison Of Thulium Fiber Laser Versus Holmium Laser In Ureteroscopic Lithotripsy: A Meta-Analysis And Systematic Review, Xiaoyu Tang, Shaojie Wu, Zhilong Li, Du Wang, Cheng Lei, Tongzu Liu, Xinghuan Wang, Sheng Li

Faculty, Staff and Student Publications

OBJECTIVES: To compare the efficacy and safety of thulium fiber laser (TFL) to holmium: YAG (Ho: YAG) laser in ureteroscopic lithotripsy for urolithiasis.

METHODS: PubMed, Web of Science, Embase, CENTRAL, SinoMed, CNKI database, VIP and Wanfang Database were systematically searched for all relevant clinical trials until September 2023. References were explored to identify the relevant articles. Meta-analysis was carried out for the retrieved studies using RevMan5.4.1 software, and the risk ratio, mean difference and 95% confidence interval were expressed. Statistical significance was set at p < 0.05. The main outcomes of this meta-analysis were stone-free rate (SFR), perioperative outcomes and intraoperative or postoperative complications.

RESULTS: Thirteen studies, including 1394 patients, were included. According to the results of pooled analysis, …

An Assessment Of The Impact Of Flow Disruptions On Mental Workload And Performance Of Surgeons During Percutaneous Nephrolithotomy, Sana Hussain, Syed Muhammad Nazim, Basit Salam, Nida Zahid, Hammad Ather

Section of Urology

Objective: The aim of this study was to assess the impact of intraoperative disruptions on surgeons’ workload and performance during percutaneous nephrolithotomy (PCNL).
Materials and methods: A structured and standardized tool was used to identify disruptions and interferences that occurred during 33 PCNL procedures. The surgical steps during PCNL were divided into four phases: ureteric catheter placement (phase I), puncture and tract dilation (phase II), intra-calyceal navigation and stone fragmentation (phase III), and tube placement (phase IV). Surgeons’ workload was evaluated using a validated tool: Surgery Task Load Index (SURG-TLX), and correlated with the mean observed intraoperative disruptions. All operating …

Tamsulosin Use After Shock Wave Lithotripsy: A Systematic Review, Katherine Harte

Senior Honors Projects

Urolithiasis, or the formation of stones in the urinary tract, is a potentially painful process that impacts many people across the world. However, the results of clinical trials disagree on the proper treatment and management of kidney stones. One way to help those who have kidney stones is to perform extracorporeal shock wave lithotripsy (SWL), a medical procedure in which shock waves are directed towards kidney stones to prevent them from migrating and causing pain. Following SWL, patients are sometimes given additional medications, such as alpha blockers (e.g., tamsulosin), to aid in the passage of the stones. However, the benefits …

Design And Challenges Of A Randomized Clinical Trial Of Medical Expulsive Therapy (Tamsulosin) For Urolithiasis In The Emergency Department., Pamela K. Burrows, Judd E. Hollander, Allan B. Wolfson, Michael C. Kurz, Lorna Richards, Sara Difiore, Phillip Watts, Nivedita Patkar, Jeremy Brown, Stephen Jackman, Ziya Kirkali, John W. Kusek, Chloe Michel, Andrew C. Meltzer

Department of Emergency Medicine Faculty Papers

Urolithiasis or urinary stone disease has been estimated to affect about 1 in 11 Americans. Patients with urinary stone disease commonly present to the emergency department for management of their acute pain. In addition to providing analgesia, administration of drug (medical expulsive therapy) is often prescribed to assist passage of the urinary stone. In this methodology paper, we describe the design of a prospective, multi-center, randomized, double-blind placebo controlled clinical trial of the alpha-adrenergic blocker, tamsulosin, to evaluate its effectiveness as medical expulsive therapy. In addition, we describe the unique challenges of conducting a trial of this type within the …

Prospective Evaluation Of Outcome Of Percutaneous Nephrolithotomy Using The ‘Stone’ Nephrolithometry Score: A Single-Centre Experience, Muhammad Farhan, Syed M. Nazim, Basit Salam, Hammad Ather

Department of Surgery Docs

Abstract

OBJECTIVE:

To assess the prediction of stone clearance and complications of percutaneous nephrolithotomy (PCNL) using the 'STONE' nephrolithometry score, assessing stone size, tract length (skin-to-stone distance), degree of obstruction, number of calyces involved and stone essence (density).

PATIENTS AND METHODS:

This was a prospective study of patients undergoing single-tract PCNL while prone, conducted at a university hospital. All patients had non-contrast-enhanced computed tomography within 3 weeks of the procedure. Only patients with a unilateral procedure and radio-opaque stones were included. The five variables of the STONE nephrolithometry score were calculated before the procedure. The stone-free rates were assessed with …

The Prevalence Of Silent Kidney Stones: An Ultrasonographic Screening Study, Buchholz Niels-Peter, Farhat Abbas, R Khan, Jamsheer J. Talati, M Afzal, I Rizvi

Section of Urology

Objective: Silent and not yet discovered stones of the upper urinary tract are potentially dangerous, since in due course they may cause infection, obstruction and renal damage. The aim of this study was to determine the prevalence of such silent kidney stones in a representative Pakistani population of Karachi.
Subjects and Methods: We studied 201 consecutive subjects at our hospital who underwent additional kidney screening whilst undergoing abdominal ultrasound. All these subjects did not have a history or symptoms of urolithiasis.
Results: We found silent kidney stones in 3% of subjects. All stone bearers were males. Most stones were in …

Bone And Renal Stone Disease In Patients Operated For Primary Hyperparathyroidism In Pakistan: Is The Pattern Of Disease Different From The West?, Syed Raziuddin Biyabani, Jamsheer J Talati

Section of Urology

Objective: To document the clinical presentation of primary hyperparathyroidism (PHPT) in a developing country and note differences from the West.
Setting: A tertiary care teaching hospital.
Method: The records of 37 patients operated for PHPT between January 1986 and December 1997 were reviewed. Symptoms, laboratory parameters and histopathology results were analyzed.
Results: Surgery for PHPT accounted for 0.055% of 67,566 operative procedures performed in the Department of Surgery during the 12 year period. The mean age of our patients was 38.4±13.2 years (range 17 to 73 years). Ninety percent of patients were less than 60 years old and 51% less …

Biofilm Mediated Calculus Formation In The Urinary Tract, Robert J. C. Mclean, David J. Stickler, J. Curtis Nickel

Cells and Materials

Mineralization and subsequent calculus formation is a common complication of biofilm infections. In the urinary tract, these infected calculi often arise from infections by urease-producing bacteria. Ammonia, liberated by bacterial urease activity, increases urine pH, resulting in the precipitation of Ca and Mg as carbonateapatite {Ca₁₀(PO₄,CO₃)₆(OH,CO₃)₂} and struvite (NH₄MgP0₄·6H₂O). These minerals become entrapped in the organic matrix which surrounds the infecting organisms and ultimately grow into mature calculi. When the causative organisms grow on urinary catheters and stents, the resulting mineralization can …