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Journal of Endoluminal Endourology
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This is an Open Access Journal

Open Access journal
ISSN (Online) 2561-9187
Published by Dougmar Publishing Group

[4 journals]

A Prospective Evaluation of a Nurse-Led Stent Removal Service Using the
Single-Use Isiris® in a Tertiary Referral Stone Unit and its Impact on
Patient Waiting Times
- Authors: Niyukta Thakare, Jane Collie, Syed Shah, Sami Al-Hayek, Jordan Durrant, Laurian Dragos, Kasra Saeb-Parsy, Oliver Wiseman
  Abstract: Background and Objective
  Double J (JJ) ureteric stenting represents one of the most significant causes of patient discomfort and dissat-isfaction following endourological procedures. At our institution, a large tertiary referral centre for complex stones, standard JJ stent removal was previously undertaken with a flexible cystoscope (FC) in the endoscopy department by a doctor. The pathway was prone to delays through capacity constraints and prioritization being given to cancer investigations. The Isiris® is a single-use stent removal system consisting of a ‘camera on chip’ disposable FC with an integrated grasper. We examine the feasibility of a nurse-led stent removal service using Isiris®, performed as an office-based procedure, and its effect on waiting times. Material and Methods
  A specialist stone nurse undertook training in FC approved by the British Association of Urological Surgeons (BAUS) and the British Association of Urological Nurses (BAUN). Once competency was reached, a nurse-led service was offered to patients in the outpatient setting. A prospective database from April 2018 to March 2020 was maintained to include patient data for stent removals in the nurse-led clinic using Isiris®. This was compared to a retrospective dataset of FC and stent removal between July 2016 and December 2016, per-formed by a doctor in the endoscopy department. The delays in stent removal compared to the ‘ideal’ stent removal date (planned date plus or minus 3 days tolerance allowed) were compared between the two pathways. Results
  The specialist nurse undertook BAUS theory training and competency was reached using an approved BAUS/BAUN competency package. 414 stent removals were booked in the nurse group, of which 395 were undertaken. 291 of 395 (74%) patients in the nurse removal Isiris® group had their stent removed on time, whereas only 16 of 54 (30%) patients had their stents removed on time in the FC stent removal group. A delay of more than 21 days was seen in 22% of FC group vs only 2% in the nurse-led Isiris® group. Both planned removal and actual stent dwell time were longer in the FC group compared to Isiris® group (p < 0.0001). There were no major complications with the use of Isiris® for stent removal in the nurse-led clinic. Conclusion
  This study has demonstrated that it is feasible to introduce a nurse-led stent removal service. The introduction of this service using the Isiris® system has led to a reduction in delays of stent removal, which is likely to trans-late into significant quality of life improvement for patients and economic benefits for the healthcare system.
  PubDate: 2021-04-14
  Issue No: Vol. 4, No. 1 (2021)
The First UK Experience with Single-use Disposable Flexible Cystoscopes:
An In-depth Cost Analysis, Service Delivery and Patient Satisfaction Rate
with Ambu® aScope™ 4 Cysto
- Authors: Anton Wong, YC Phan , Helen Thursby, Wasim Mahmalji
  Abstract: Background and Objective
  Ambu® aScope™ 4 Cysto is a single-use disposable flexible cystoscope that allows clinicians to perform the procedure at any time and any place. It simplifies workflow, frees up resources and allows clinicians to treat more patients. Our trust became the first in the UK and Europe to utilise these cystoscopes. An in-depth evaluation was performed to test its practicality, cost analysis and patient satisfaction against traditional reusable flexible cystoscopes. Material and Methods
  We compared the cost of using Ambu® aScope™ 4 Cysto to perform flexible cystoscopies in 20 patients prospectively against traditional flexible cystoscopes in 20 patients retrospectively. The cost of the equip-ment, reprocessing, cleaning supplies and maintenance were consulted from relevant departments and companies. All prospective patients were also given a patient satisfaction questionnaire to complete. An unpaired t-test was used to analyse the data.
  Results
  Our study revealed that it costs £135.23 and £166.33 on average to perform a flexible cystoscopy using Ambu® aScope™ 4 Cysto and the traditional flexible cystoscopes, respectively. Our patient survey revealed that there was a statistical significance between the patient experience using the single-use disposable scopes compared with the traditional reusable flexible cystoscopes (P = 0.0455). Further, 95% of patients also preferred a single-use disposable cystoscope over traditional reusable ones, given the option.
  Conclusion
  Single-use disposable flexible cystoscopes are a safe and cost-efficient method of performing the procedure. It is portable and proves to be a simple, efficient and practical way of performing a flexible cystoscopy in an inpatient, outpatient, or emergency setting.
  PubDate: 2021-04-06
  Issue No: Vol. 4, No. 1 (2021)
A Rare Cause of Hydroenphrosis; Case Presentation of an Intrathoracic
Herniated Ureter
- Authors: Ibrahim Alkhafaji, Ehab Abusada, Adam Jones, Mooyad Ahmed, Talal Jabbar, Omar Al-Mula Abed
  Abstract: Background
  Thoracic ureteric herniation is an uncommon finding with a varying presentation. Since its first documen-tation in 1958, few case reports have been published, and there is no consensus on its management. This condition is typically asymptomatic, with most cases identified incidentally from cross-sectional imaging or discovered intra-operatively.
  As a result of differing presentations and a lack of consensus or evidence of best practice, this rare finding’s management is not defined. This can range from adopting a conservative approach to more invasive measures such as ureteric stenting or pyeloplasty to repair the thoracic hernia.
  The authors present a case of thoracic ureteric herniation in a 74-year-old male presenting with right-sided abdominal pain. This patient was known to have a diaphragmatic hernia following pulmonary fibrosis investigations and chronic obstructive pulmonary disease (COPD). At presentation, there was acute kidney injury (AKI), and subsequent computed topography (CT) demonstrated right-sided hydronephrosis and perinephric fat stranding. This was caused by ureteric obstruction with a transition point at the site of thoracic herniation. The patient was successfully managed with retrograde ureteric stent insertion.
  This case report aims to highlight variance in the presentation of ureteric thoracic herniation and discuss management options. There is no consensus on management for this condition and choices dependant on specific symptoms and patient factors to the best of our knowledge.
  PubDate: 2021-03-03
  Issue No: Vol. 4, No. 1 (2021)
Mechanisms of Delayed Lower Urinary Tract Stone Formation
- Authors: Fawad Arif, West Alaiyi
  Abstract: Materials and methods:
  We analysed Holmium Laser Enucleation of Prostate (HOLEP) database consisting of 1300 patients who presented more than 18 months after undergoing the procedure with lower urinary tract symptoms (LUTS-voiding lower urinary tract symptoms, dysuria, haematuria, recurrent urinary tract infections-UTIs) second-ary to delayed lower urinary tract stone formation. Information was gathered from the case notes, imaging modalities, operation notes and pathology reports. Results:
  Three patients were identified who presented with delayed lower urinary tract stone formation 18 months after undergoing HOLEP. Case 1: A 68-year-old presented with a 4-cm mobile bladder stone on a retained prostatic fragment 29 months after HOLEP.
  Case 2: A 74-year-old presented with 2.5 cm bulbar urethral stone 18 months after HOLEP.
  Case 3: A 77-year-old presented with dystrophic calcification of the entire prostatic fossa 60 months after HOLEP. Conclusion:
  Delayed lower urinary tract stone presentation is unusual after HOLEP. Recurrent urethral pain, recurrent UTI, gross haematuria and voiding lower urinary tract symptoms in the presence of a lower urinary tract stone (bladder, prostate and urethra) with a radiolucent centre on a background of HOLEP should raise the suspicion that this may represent calcification on a prostatic tissue fragment or dystrophic calcification of the residual prostate/prostatic fossa. Careful morcellation, inspection of the prostatic fossa on withdrawing the morcellator for large residual prostate fragments still attached to the prostatic bed/bladder neck or simply stuck to the fossa (usually in a clot) will reduce the risk of retainment of such a significant prostatic fragment that can potentially cause complications in the future.
  PubDate: 2021-02-01
  Issue No: Vol. 4, No. 1 (2021)
Flexible Nephroscopy: A Step Towards Complete Stone Clearance in PCNL
- Authors: Vasudevan Thirugnanasambandam, Kalyanram Kone
  Abstract: Objectives
  To determine the usefulness of flexible nephroscopy after per-cutaneous nephrolithotomy (PCNL) in detecting residual fragments. Materials and Methods
  A prospective study was conducted between January 2018 and December 2019 on patients undergoing standard PCNL using a flexible nephroscope to inspect all the calyces for residual stones. When residual stones were noted, either they were removed by basketing or by performing additional puncture to ensure complete clearance. Patients were followed up for 6 months and at the end of 1 month a plain CT KUB was done to look for residual fragments. Results
  The study cohort included 212 patients. Significant RFs were found in 28 patients during flexible nephroscopy and in two patients at 1 month follow up CT scan. All patients were stone free during 6 months follow up. Conclusion
  Flexible nephroscopy during PCNL decreases the chance of residual fragments and thereby reducing the chance of re-procedure rates.
  PubDate: 2021-01-18
  Issue No: Vol. 4, No. 1 (2021)
Comparative Evaluation of Outcomes After Standard versus “Modified Large
PCNL”- Is Larger Better…'
- Authors: Deep Kumar Jain, Padmaraj Hegde, Arun Chawla
  Abstract: Objectives
  To comparatively evaluate the outcomes of standard percutaneous nephrolithotomy (PCNL) versus a 36 Fr PCNL in terms of operative time, complications, hospital stay, and stone free rates. Patients and Methods
  The data of 125 PCNL cases, out of the 168 PCNLs done from January 2014 to December 2015, was retrospectively analyzed within two subsets, namely group-A (standard PCNL with 22-32 Fr Amplatz) and group-B (modified large PCNL with 36 Fr Amplatz). The demographic profile, stone characteristics, operative and laboratory parameters, and stone clearance rate were analyzed to determine the safety and efficacy of the modified large PCNL as against standard PCNL. Results
  Group-A comprised 88 patients with 100 renal units, while group-B comprised 37 patients with 45 renal units. The mean age of the patients in Group-A was 49.1 + 13.1 years, and in Group-B was 52.4 + 11.4 years (range 25-84 years) with a male to female ratio of 4:1. 54.5% and 75.7% unilaterally intervened, group-A and group-B patients respectively, required < 90 minutes for the procedure. Nine patients (10.2%) each of unilaterally and bilaterally intervened group-A cases had an operative time that exceeded 120 minutes compared to only two (5.4%) bilaterally intervened group-B cases. For patients with stone burden >1000 mm2, there was statistically significant (p = < 0.0001) higher complete stone clearance rates with the 36Fr PCNL compared to standard PCNL. Conclusion
  Our retrospective analysis revealed that 36 Fr PCNL is safe and efficacious in carefully selected patients with large stone burdens providing the advantage of better stone-free rates, less operative time, lesser need for additional punctures without increasing blood transfusion and complications rates. However, more extensive prospective randomized trials are needed to confirm this perceived benefit.
  PubDate: 2020-11-30
  Issue No: Vol. 4, No. 1 (2020)