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Öğe Classification and standardized reporting of percutaneous nephrolithotomy (PCNL): International alliance of urolithiasis (IAU) consensus statements(2022) Choong, Simon; de la Rosette, Jean J. M. C. H.; Denstedt, John; Zeng, Guohua; Sarıca, Kemal; Mazzon, Giorgio; Saltirov, Iliya; Pal, Shashi Kumar; Agrawal, Madhu; Desai, Janak; Petrik, Aleš; Buchholz, Noor; Maroclo, Marcus V.; Gordon, Stephen; Sridhar, AshwinBackground: To reach a consensus in the classification and standardized reporting for the different types of PCNLs. Methods: The RAND/UCLA appropriateness methodology was used to reach a consensus. Thirty-two statements were formulated reviewing the literature on guidelines and consensus on PCNLs, and included procedure specific details, outcome measurements and a classification for PCNLs. Experts were invited to two rounds of input, the first enabled independent modifications of the proposed statements and provided the option to add statements. The second round facilitated scoring of all statements. Each statement was discussed in the third round to decide which statements to include. Any suggestion or disagreement was debated and discussed to reach a consensual agreement. Results: Twenty-five recommendations were identified to provide standardised reporting of procedure and outcomes. Consensual scoring above 80% were strongly agreed upon by the panel. The top treatment related outcomes were size of sheath used (99.1%) and position for PCNL (93.5%). The highest ranked Outcome Measures included definition of post-operative hospital length of stay (94.4%) and estimated blood loss (93.5%). Conclusions: The consensus statements will be useful to clarify operative technique, in the design of clinical trials and standardized reporting, and presentation of results to compare outcomes of different types of PCNLs.Öğe Concomitant bladder tumor is a risk factor for bladder recurrence but not upper tract(MDPI, 2022) Liu, Kang; Zhao, Hongda; Alvarez-Maestro, Mario; Gravas, Stavros; Van Renterghem, Koen; Zeng, Guohua; Ng, Chi-Fai; del Pilar Laguna Pes, Maria; Teoh, Jeremy Yuen-Chun; de la Rosette, Jean J. M. C. H.Objective: To evaluate the clinical outcomes of UTUC patients with or without concurrent bladder tumor. Design, Setting, and Participants: The Clinical Research Office of the Endourology Society-Urothelial Carcinomas of the Upper Tract (CROES-UTUC) Registry included 1134 UTUC patients with or without concurrent bladder tumor treated between 2014 and 2019. Results: In 218 (19.2%) cases, concurrent bladder tumor was present, while in 916 (80.8%) patients, no bladder cancer was found. In the multivariable Cox regression analysis, concomitant bladder tumor (hazard ratio (HR) 1.562, 95% confidence interval (CI) 0.954-2.560, p = 0.076) indicated a trend associated with recurrence-free survival for UTUC. Further data dissection confirmed that concomitant bladder tumor is a risk factor of bladder recurrence (HR 1.874, 95% CI 1.104-3.183, p = 0.020) but not UTUC recurrence (HR 0.876, 95% CI 0.292-2.625, p = 0.812). Kidney-sparing surgery (KSS) (HR 3.940, 95% CI 1.352-11.486, p = 0.012), pathological T staging >= pT2 (HR 2.840, 95% 1.039-7.763, p = 0.042) were significantly associated with UTUC recurrence. KSS does not affect bladder recurrence (HR 0.619, 95% CI 0.242-1.580, p = 0.315). A limitation is the retrospective nature of the present study analysis. Conclusions: The presence of concomitant bladder tumor does not increase risk of UTUC recurrence, but it results in an increased risk of bladder recurrence. KSS does not affect bladder recurrence and can still be considered in patients with concomitant bladder tumor.Öğe Consensus statement addressing controversies and guidelines on pediatric urolithiasis(2024) Güven, Selçuk; Tokas, Theodoras; Tozsin, Atınç; Haid, B.; Lendvay, Thomas Sean; Sılay, Mesrur Selçuk; Mohan, Chandra Vamsi; Cansino, Jose Ramon; Saulat, Sherjeel; Straub, Manuela; Bujons Tur, Anna; Akgül, Burak; Samotyjek, J.; Lusuardi, L.; Ferretti, Stefania; Çavdar, Ömer Faruk; Ortner, G.; Sultan, Sajid; Choong, Simon; Micali, Salvatore; Saltirov, Ilya; Sezer, Ali; Netsch, Christopher; de Lorenzis, Elisa; Çakır, Ömer Onur; Zeng, Guohua; Gözen, Ali Sedar; Bianchi, Giampaolo; Jurkiewicz, Beata; Knoll, Thomas; Rassweiler, Jens; Ahmed, Kamran; Sarıca, KemalPurpose: We aimed to investigate controversial pediatric urolithiasis issues systematically, integrating expert consensus and comprehensive guidelines reviews. Methods: Two semi-structured online focus group meetings were conducted to discuss the study’s need and content, review current literature, and prepare the initial survey. Data were collected through surveys and focus group discussions. Existing guidelines were reviewed, and a second survey was conducted using the Delphi method to validate findings and facilitate consensus. The primary outcome measures investigated controversial issues, integrating expert consensus and guideline reviews. Results: Experts from 15 countries participated, including 20 with 16+ years of experience, 2 with 11–15 years, and 4 with 6–10 years. The initial survey identified nine main themes, emphasizing the need for standardized diagnostic and treatment protocols and tailored treatments. Inter-rater reliability was high, with controversies in treatment approaches (score 4.6, 92% agreement), follow-up protocols (score 4.8, 100% agreement), and diagnostic criteria (score 4.6, 92% agreement). The second survey underscored the critical need for consensus on identification, diagnostic criteria (score 4.6, 92% agreement), and standardized follow-up protocols (score 4.8, 100% agreement). Conclusion: The importance of personalized treatment in pediatric urolithiasis is clear. Prioritizing low-radiation diagnostic tools, effectively managing residual stone fragments, and standardized follow-up protocols are crucial for improving patient outcomes. Integrating new technologies while ensuring safety and reliability is also essential. Harmonizing guidelines across regions can provide consistent and effective management. Future efforts should focus on collaborative research, specialized training, and the integration of new technologies in treatment protocols.Öğe European association of urology section of urolithiasis and international alliance of urolithiasis joint consensus on retrograde intrarenal surgery for the management of renal stones(Elsevier B.V., 2022) Zeng, Guohua; Zhao, Zhijian; Mazzon, Giorgio; Pearle, Margaret; Choong, Simon; Skolarikos, Andreas; Denstedt, John; Seitz, Christian; Olvera Pasada, Daniel; Fiori, Cristian; Bosio, Andrea; Papatsoris, Athanasios; Méndez Probst, Carlos Enrique; Perez Fentes, Daniel; Ann Git, Kah; Wu, Qinghui; Wiseman, Oliver; Emiliani, Esteban; Farahat, Yasser; Gökçe, Mehmet İlker; Giannakopoulos, Stilianos; Goumas Kartalas, Ioannis; Somani, Bhaskar; Knoll, Thomas; de la Rosette, Jean J. M. C. H.; Zhong, Jiehui; Vinicius Maroccolo, Marcus; Saltirov, lliya; Chew, Ben; Wang, Kunjie; Lahme, Sven; Giusti, Guido; Ferretti, Stefania; Yong Cho, Sung; Geavlete, Petrisor; Cansino, Ramon; Kamphuis, Guido M.; Smith, Daron; Matlaga, Brian R.; Ghani, Khurshid D.; Bernardo, Norberto; Silva, Andres D.; Ng, Anthony C.F.; Yang, Sixing; Gao, Xiaofeng; Traxer, Olivier; Miernik, Arkadiusz; Liatsikos, Evangelos; Priyakant Parikh, Kandarp; Duvdevani, Mordechai; Celia, Antonio; Yasui, Takahiro; Aquino, Albert; Alomar, Mohammad; Choonhaklai, Vorapot; Erkurt, Bulent; Glass, Jonathan; Sriprasad, Seshadri; Osther, Palle J.; Keeley, Francis X.; Preminger, Glenn M.; Cepeda Delgado, Marcos; Beltran Suarez, Edgar; Ye, Zhangqun; Sarica, KemalBackground: Retrograde intrarenal surgery (RIRS) has become the preferred treatment modality for nephrolithiasis. However, because of ongoing uncertainties regarding the optimal perioperative management, operative technique, and postoperative follow-up, as well as a lack of standardization for outcome reporting, consensus is needed to achieve more uniform clinical practice worldwide. Objective: To develop recommendations for RIRS on the basis of existing data and expert consensus. Design, setting, and participants: A protocol-driven, three-phase study was conducted by the European Association of Urology Section of Urolithiasis (EULIS) and the International Alliance of Urolithiasis (IAU). The process included: (1) a nonsystematic review of the literature to define domains for discussion; (2) a two-round modified Delphi survey involving experts in this field; and (3) an additional group meeting and third-round survey involving 64 senior representative members to formulate the final conclusions. Outcome measurements and statistical analysis: The results from each previous round were returned to the participants for re-evaluation of their decisions during the next round. The agreement threshold was set at 70%. Results and limitations: The panel included 209 participants who developed 29 consensus statements on the following topics of interest: (1) perioperative infection management; (2) perioperative antithrombotic therapy; (3) fundamentals of the operative technique; and (4) standardized outcome reporting. Although this consensus can be considered as a useful reference for more clinically oriented daily practice, we also acknowledge that a higher level of evidence from further clinical trials is needed. Conclusions: The consensus statements aim to guide and standardize clinical practice and research on RIRS and to recommend standardized outcome reporting. Patient summary: An international consensus on the best practice for minimally invasive surgery for kidney stones was organized and developed by two international societies. It is anticipated that this consensus will provide further guidance to urologists and may help to improve clinical outcomes for patients.Öğe How does the COVID-19 pandemic affect the preoperative evaluation and anesthesia applied for urinary stones? EULIS eCORE-IAU multicenter collaborative cohort study(Springer, 2020) Gökçe, Mehmet İlker; Yin, Shanfeng; Sönmez, Mehmet Giray; Eryıldırım, Bilal; Kallidonis, Panagiotis; Petkova, Kremena; Güven, Selçuk; Kiremit, Murat Can; de Lorenzis, Elisa; Tefik, Tzevat; Villa, Luca; Zeng, Guohua; Sarıca, KemalStone disease is a unique condition that requires appropriate management in a timely manner as it can result in both emergent conditions and long term effects on kidney functions. In this study it is aimed to identify the up-to-date practice patterns related to preoperative evaluation and anesthesia for stone disease interventions during COVID-19 pandemic. The data of 473 patients from 11 centers in 5 different countries underwent interventions for urinary stones during the Covid-19 pandemic was collected and analyzed retrospectively. Information on the type of the stone related conditions, management strategies, anesthesiologic evaluation, anesthesia methods, and any alterations related to COVID-19 pandemic was collected. During the preoperative anesthesia evaluation thorax CT was performed in 268 (56.7%) and PCR from nasopharyngeal swab was performed in 31 (6.6%) patients. General anesthesia was applied in 337 (71.2%) patients and alteration in the method of anesthesia was recorded in 45 (9.5%) patients. A cut-off value of 21 days was detected for the hospitals to adapt changes related to COVID-19. Rate of preoperative testing, emergency procedures, conservative approaches and topical/regional anesthesia increased after 21 days. The preoperative evaluation for management of urinary stone disease is significantly affected by COVID-19 pandemic. There is significant alteration in anesthesia methods and interventions. The optimal methods for preoperative evaluation are still unknown and there is discordance between different centers. It takes 21 days for hospitals and surgeons to adapt and develop new strategies for preoperative evaluation and management of stones.Öğe Mini percutaneous nephrolithotomy is a noninferior modality to standard percutaneous nephrolithotomy for the management of 20-40 mm renal calculi: A Multicenter randomized controlled trial(Elsevier, 2021) Zeng, Guohua; Cai, Chao; Duan, Xianzhong; Xun, Xu; Mao, Houping; Li, Xuedong; Nie, Yong; Xie, Jianjun; Li, Jiongming; Lu, Jun; Zou, Xiaofeng; Mok, Jianfeng; Li, Chengyang; Li, Jianzhong; Wang, Weiguo; Yu, Yonggang; Fei, Xiang; Gu, Xianen; Chen, Jianhui; Kong, Xiangbo; Pan, Jian; Zhu, Wei; Zhao, Zhijian; Wu, Wenqi; Sun, Hongling; Liu, Yongda; de la Rosette, Jean J. M. C. H.Background: High quality of evidence comparing mini percutaneous nephrolithotomy (mPNL) with standard percutaneous nephrolithotomy (sPNL) for the treatment of larger-sized renal stones is lacking. Objective: To compare the efficacy and safety of mPNL and sPNL for the treatment of 20–40 mm renal stones. Design, setting, and participants: A parallel, open-label, and noninferior randomized controlled trial was performed at 20 Chinese centers (2016–2019). The inclusion criteria were patients 18–70 yr old, with normal renal function, and 20–40 mm renal stones. Intervention: Percutaneous nephrolithotomy PNL was performed using either 18 F or 24 F percutaneous nephrostomy tracts. Outcome measurements and statistical analysis: The primary outcome was the one-session stone-free rate (SFR). The secondary outcomes included operating time, visual analog pain scale (VAS) score, blood loss, complications as per the Clavien-Dindo grading system, and length of hospitalization. Results and limitations: The 1980 intention-to-treat patients were randomized. The mPNL group achieved a noninferior one-session SFR to the sPNL group by the one-side noninferiority test (0.5% [difference], p < 0.001). The transfusion and embolization rates were comparable; however, the sPNL group had a higher hemoglobin drop (5.2 g/l, p < 0.001). The sPNL yielded shorter operating time (–2.2 min, p = 0.008) but a higher VAS score (0.8, p < 0.001). Patients in the sPNL group also had longer hospitalization (0.6 d, p < 0.001). There was no statistically significant difference in fever or urosepsis occurrences. The study's main limitation was that only 18F or 24F tract sizes were used. Conclusions: Mini mPNL achieves noninferior SFR outcomes to sPNL, but with reduced bleeding, less postoperative pain, and shorter hospitalization. Patient summary: We evaluated the surgical outcomes of percutaneous nephrolithotomy using two different sizes of nephrostomy tracts in a large population. We found that the smaller tract might be a sensible alternative for patients with 20–40 mm renal stones. This multicenter, parallel, open-label, and noninferior randomized controlled trial showed that mini percutaneous nephrolithotomy achieved noninferior stone-free rate with advantages of reduced blood loss, less postoperative pain, and shorter hospitalization. Mini percutaneous nephrolithotomy should be considered a sensible alternative treatment of 20–40 mm renal stones.Öğe Radical nephroureterectomy for UTUC conferred survival benefits irrespective of age and comorbidities(Springer, 2022) Teoh, Jeremy Yuen-Chun; Ng, Chi-Fai; Eto, Masatoshi; Chiruvella, Mallikarjuna; Capitanio, Umberto; Esen, Tarık; Zeng, Guohua; Lechevallier, Eric; Andonian, Sero; de la Rosette, Jean J. M. C. H.Purpose We investigated the effects of age, American Society of Anesthesiologists Physical Status Classification (ASA) grading and Charlson Comorbidity Index (CCI) on the survival outcomes of upper tract urothelial carcinoma (UTUC). Methods The CROES-UTUC registry was an international, multicenter study on patients with UTUC. Primary outcomes were overall survival (OS) and disease-free survival (DFS). Kaplan-Meier and multivariate Cox regression analyses were performed by stratifying patients according to their age (<= 70 and > 70 years old) and ASA grade (I-II and III-V)/CCI (0-1 and >= 2). Results A total of 2352 patients were included in this study. Patients aged <= 70 years with ASA grading of I-II (p = 0.002), and patients aged <= 70 years with a CCI of 0-1 (p = 0.002) had the best OS. Upon multivariate analysis, both in patients aged <= 70 and > 70 years, ASA grading and CCI were not significantly associated with OS. Patients aged <= 70 years with ASA grading of III-IV (p = 0.024) had the best DFS. When stratified according to age and CCI, no significant difference in DFS was noted. Upon multivariate analysis, radical nephroureterectomy (RNU) was significantly associated with better DFS in patients aged <= 70 and > 70 years; CCI of >= 3 was significantly associated with worse DFS in patients <= 70 years; ASA grading was not associated with DFS in patients aged <= 70 and > 70 years. Conclusions A high ASA grading and CCI should not be considered contraindications for RNU. RNU should be considered even in elderly patients when it is deemed feasible and achievable after a geriatric assessment.Öğe Recommended antibiotic prophylaxis regimen in retrograde intrarenal surgery: Evidence from a randomised controlled trial(Blackwell Publishing Ltd, 2019) Zhao, Zhijian; Fan, Junhong; Sun, Hongling; Zhong, Wen; Zhu, Wei; Liu, Yongda; Wu, Wenqi; de la Rosette, Jean J. M. C. H.; del Pilar Laguna Pes, Maria; Zeng, GuohuaObjective: To study the incidence of postoperative systemic inflammatory response syndrome (SIRS) following different antibiotic prophylaxis (ABP) regimens in retrograde intrarenal surgery (RIRS). Patients and Methods: Single-centre, randomised, controlled trial (August 2014–September 2017) including 426 patients with renal stones with preoperative sterile urine managed by RIRS (ClinicalTrials.gov NCT02304822). Different ciprofloxacin-based ABP regimens were used and included a zero dose, single dose (30 min before surgery) or two doses (first dose at 30 min before RIRS and additional dose within 6 h after RIRS). The incidence of SIRS was compared using intention-to-treat (ITT) and per-protocol (PP) analyses. Results: Each group enrolled 142 patients. In the ITT analysis, a zero dose of ABP was statistically similar to the two ABP regimes for the incidence of SIRS (9.9% vs single dose 4.9%, P = 0.112; vs two doses 4.2%, P = 0.062). There were also no relevant differences across groups in the PP analysis; no urosepsis was recorded. In subgroup analysis with stratification by stone area, the three regimens all had a low and similar incidence of SIRS for stones of ?200 mm2 in the ITT analysis with a sufficient power value (5.4% vs 6.2% vs 3.6%, P = 0.945 vs single dose and P = 0.553 vs two doses). However, there was a greater chance of SIRS in patients who received no ABP with stones of >200 mm2 (18% vs single dose 4.3%, P = 0.036; vs two doses 5.5%, P = 0.044). Similar trends were seen in the PP analysis. Conclusions: For patients with preoperative sterile urine, ABP is not strongly recommended in patients with stones of ?200 mm2, but for stones >200 mm2 single-dose ABP is still required.Öğe Super-mini percutaneous nephrolithotomy (SMP) vs retrograde intrarenal surgery for the treatment of 1-2 cm lower-pole renal calculi: An international multicentre randomised controlled trial(Wiley, 2018) Zeng, Guohua; Zhang, Tao; Agrawal, Madhu; He, Xiang; Zhang, Wei; Xiao, Kefeng; Li, Hulin; Li, Xuedong; Xu, Changbao; Yang, Sixing; de la Rosette, Jean J. M. C. H.; Fan, Junhong; Zhu, Wei; Sarıca, KemalObjectives To compare the safety and effectiveness of super-minipercutaneous nephrolithotomy (SMP) and retrograde intrarenal surgery (RIRS) for the treatment of 1-2 cm lowerpole renal calculi (LPC). Patients and Methods An international multicentre, prospective, randomised, unblinded controlled study was conducted at 10 academic medical centres in China, India, and Turkey, between August 2015 and June 2017. In all, 160 consecutive patients with 1-2 cm LPC were randomised to receive SMP or RIRS. The primary endpoint was stone-free rate (SFR). Stone-free status was defined as no residual fragments of >= 0.3 cm on plain abdominal radiograph of the kidneys, ureters and bladder, and ultrasonography at 1-day and on computed tomography at 3-months after operation. Secondary endpoints included blood loss, operating time, postoperative pain scores, auxiliary procedures, complications, and hospital stay. Postoperative follow-up was scheduled at 3 months. Analysis was by intention-totreat. The trial was registered at http://clinicaltrials. gov/ (NCT02519634). Results The two groups had similar baseline characteristics. The mean (SD) stone diameters were comparable between the groups, at 1.50 (0.29) cm for the SMP group vs 1.43 (0.34) cm for the RIRS group (P = 0.214). SMP achieved a significantly better 1-day and 3-month SFR than RIRS (1-day SFR 91.2% vs 71.2%, P = 0.001; 3-months SFR 93.8% vs 82.5%, P = 0.028). The auxiliary procedure rate was lower in the SMP group. RIRS was found to be superior with lower haemoglobin drop and less postoperative pain. Blood transfusion was not required in either group. There was no significant difference in operating time, hospital stay, and complication rates, between the groups. Conclusions SMP was more effective than RIRS for treating 1-2 cm LPC in terms of a better SFR and lesser auxiliary procedure rate. The complications and hospital stay were comparable. RIRS has the advantage of less postoperative pain.Öğe Systematic review and cumulative analysis of the managements for proximal impacted ureteral stones(Springer Verlag, 2019) Deng, Tuo; Chen, Yiwen; Liu, Bing; Laguna, Maria Pilar; de la Rosette, Jean J. M. C. H.; Duan, Xiaolu; Wu, Wenqi; Zeng, GuohuaPurpose: To compare the efficacy and safety of different treatment options for the management of proximal impacted ureteral stones (PIUS). Methods: A systematic literature search using Pubmed, Medline, Embase and Cochrane Library was conducted to obtain studies concerning different managements for PIUS up to Jan 2018. Summary odds ratios (ORs), standard mean differences (SMDs) or weighted mean differences with their 95% confidence intervals (CIs) were calculated to compare the efficacy and safety of all included treatment methods, registered in PROSPERO under number CRD42018092745. Results: A total of 15 comparative studies with 1780 patients were included. Meta-analyses of final stone-free rate (SFR) favored percutaneous nephrolithotomy (PCNL) over ureteroscopic lithotripsy (URL) (OR 10.35; 95% CI 5.26–20.35; P <0.00001), laparoscopic ureterolithotomy over URL (OR 0.11; 95% CI 0.05–0.25; P <0.00001) and URL over extracorporeal shockwave lithotripsy (OR 0.47; 95% CI 0.28–0.77; P = 0.003). As to complications, PCNL had a significantly higher blood transfusion rate (OR 7.47; 95% CI 1.3–42.85; P = 0.02) and a lower ureteral injury rate (OR 0.15; 95% CI 0.04–0.52; P = 0.003) compared with URL. It also shared a significantly lower stone-retropulsion rate (OR 0.03; 95% CI 0.01–0.15; P <0.0001) and higher treatment costs (SMD = 2.71; 95% CI 0.71–4.70; P = 0.008) than URL. Conclusions: Our meta-analysis suggested that PCNL might be the best option for PIUS owing to its higher successful rate. Complications such as hemorrhage could be decreased by the application on mini-PCNL.Öğe Treatment of urinary tract infections in the old and fragile(Springer, 2020) Zeng, Guohua; Zhu, Wei; Lam, Wayne; Bayramgil, AyberkIntroduction Urinary tract infection (UTI) is highly prevalent in the frail elderly population. This review aimed to outline the diagnostic, treatment, and prevention of UTI in the frail aging population. Methods Pubmed and Web of Science search to identify publications until March 2019 relating to the management of UTI in the elderly population was performed. A narrative review of the available literature was performed. Results 64 publications were considered as relevant and included in this review. The diagnosis of symptomatic UTI in the old and fragile could be challenging. Routine screening and antimicrobial therapy for asymptomatic bacteriuria should not be recommended for frail elderly patients. Cautious choice of antibiotics should be guided by uropathogen identified by culture and sensitivity. Understanding local antibiotic resistance rates plays a fundamental part in selecting appropriate antimicrobial treatment. Impact of associated adverse effect, in particular those with effects on cognitive function, should be considered when deciding choice of antibiotics for symptomatic UTI in the elderlies. Optimal management of comorbidities such as diabetes mellitus, adequate treatment of urinary incontinence, and judicious use of urinary catheter is essential to reduce the development of UTI. Conclusion UTI is a significant but common problem in elderly population. Physicians who care for frail elderly patients must be aware of the challenges in the management of asymptomatic UTI, and identifying symptomatic UTI in this population, and their appropriate management strategies. There is strong need in studies to evaluate nonantimicrobial therapies in the prevention of UTI for the frail elderly population.
