both AUA and EAU guidelines offer a detailed, evidence-based framework to guide the urologists in the management of stone diseases. Although some discrepancies exist, particularly regarding the choice of surgical management in specific scenarios, there is generally a consensus between both the groups. However, the guidelines are not applicable to every clinical situation and need to be used in conjunction with the most recently published material and tailored to each individual patient.
Time to lithotripsy is strongly associated with SFR followingSWL. SWL in an urgent care setting does not improveSFR if it is performed within 1 month, while time toSWL > 2 months reduces the likelihood of stone-free status.
The purpose of this article is to emphasize some important aspects on how SWL best should be used. Based on decades of experience, it stands to reason that success with SWL does not come automatically and attention has to be paid to all details of this technique.
In conclusion, ESWL has been used by urologists as a first-line treatment for uncomplicated urinary calculi in very elderly patients. Despite changes associated with aging, and the high prevalence of comorbidities, this procedure seems to be safe and well tolerated in elderly people.
we examine recent developments in percutaneous stone surgery, including advances in diagnosis and preoperative planning, renal access, patient position, tract dilation, nephroscopes, lithotripsy, exit strategies, and post-operative antibiotic prophylaxis.
Several risk factors for urosepsis following PCNL for struvite stones have been identified. These risk factors should be taken into consideration in peri-operative care to mitigate the risks of urosepsis.
Our meta-analysis demonstrated that Microperc could produce an SFR that was comparable with that of Miniperc. Microperc was associated with lower hemoglobin drop, while Miniperc was associated with lower renal colic rates. In addition, the operation time and hospital stay time for both these procedures were similar.
Percutaneous nephrolithotomy is an effectivemethod for the treatment of upper urinary calculi with few complications. According to the results achieved by an experienced surgeon, the size of stone, staghorn stone, operation time, and degree of hydronephrosis were associated with the bleeding during minimally invasive percutaneous nephrolithotomy.
New-generation dual-mode single-probe lithotripsy devices have shown favourable results compared with use of ballistic or ultrasonic lithotripters only. However, ballistic and ultrasonic lithotripters are also highly effective and safe and have been the backbone of PCNL for many years. Compared with standard PCNL, it seems that mini PCNL is associated with fewer bleeding complications and shorter hospital admissions, but also with longer operating room (OR) time and higher intrarenal pressure. Use of laser lithotripsy combined with suction in mini PCNL is a promising alternative that may improve such PCNL by shortening OR times. Furthermore, supine PCNL is a good alternative, especially in cases with complex renal stones and large proximal ureteric stones; in addition, it facilitates endoscopic combined intrarenal surgery (ECIRS).
Double pigtail ureteric stent placement appears to be unnecessary in procedures considered ‘uncomplicated’ by operating urologists during surgery. The advantages of the double pigtail ureteric stent with extraction string over the double pigtail ureteric stent only include earlier and easier removal with earlier relief of symptoms, and less analgesia requirements.