Eric Ghiraldi

Impact of tumour location and surgical approach on recurrence‐free and cancer‐specific survival analysis in patients with ureteric tumours

Study Type – Therapy (case series)

Predictive factors for intraoperative balloon dilation in semirigid ureteroscopic lithotripsy.

PURPOSE To analyze preoperative predictive factors for intraoperative balloon dilation in semirigid ureteroscopic lithotripsy. PATIENTS AND METHODS We retrospectively reviewed data from 397 consecutive semirigid ureteroscopic lithotripsies performed in 389 patients with ureteral stones at our institution during the calendar year 2010. Preoperative patient-related variables (age, sex, body mass index, history of urinary tract infection, previous stent placement, and time from initial presentation to intervention) and stone-related variables (laterality, numbers, location, width, and degree of hydronephrosis) were collected. Univariate analysis and multivariate logistic regression were performed to examine the statistical association between these variables and the use of intraoperative balloon ureteral dilation. RESULTS Intraoperative balloon dilation was performed in 109 (27.5%) procedures. Univariate analysis identified increasing stone width (P<0.001) and lack of previous stent placement (P<0.001) as preoperative predictors of intraoperative balloon dilation. Stone width (P<0.001, odds ratio [OR] 1.274, 95% confidence interval [CI] 1.147-1.415) and lack of previous stent placement (P<0.001, OR 0.025, CI 0.006-0.105) remained independently associated with intraoperative balloon dilation in multivariate logistic regression. CONCLUSIONS To our knowledge, our study is the first to statistically analyze the potential predictive factors for intraoperative balloon dilation in semirigid ureteroscopic lithotripsy. Larger stone width was significantly associated with intraoperative balloon dilation, whereas the presence of an indwelling ureteral stent, for at least 1 week, nearly eliminated the need for balloon dilation in subsequent ureteroscopic lithotripsy.

Extracorporeal Shock Wave Therapy: Current Perspectives and Future Directions.

Purpose of ReviewSince its introduction, extracorporeal shock wave lithotripsy (ESWL) has undergone a variety of changes; however, it remains one of the most utilized treatment modalities for urolithiasis. The goal of this review is to provide the practicing urologist an update on contemporary trends, new technologies, and related controversies in utilizing ESWL for stone treatment.Recent FindingsESWL use has come under scrutiny with a shift in focus to cost-effectiveness and healthcare outcomes. Fortunately, advances in lithotripter technology have spawned several generations of devices that strive to improve stone-free rates and decrease complications. Most of all, a focus on patient selection criteria has helped improve procedural success.SummaryYears of experience utilizing ESWL for stone treatment have helped urologists better optimize its use and minimize complications. Improvements in technique along with more stringent patient and stone selection have helped ESWL remain a mainstay in the treatment of stone disease.

A Novel Transvesical Port for Natural Orifice Translumenal Endoscopic Surgery

PURPOSE To evaluate the feasibility of a novel transvesical port (TVEP) for natural orifice translumenal endoscopic surgery (NOTES) in the porcine model. MATERIALS AND METHODS The TVEP consisted of an internal guide core and external sheath design using computer-aided design software. Transvesical peritoneoscopy, renal biopsy, as well as combined transvesical/transgastric nephrectomy were performed through the TVEP in a porcine model. Operative parameters and port performance were measured. RESULTS Twelve procedures were successfully performed by four surgeons. No complications occurred with introduction of the TVEP. The mean time for placement was 5.6 minutes. Steady pressure controlled CO(2) pneumoperitoneum up to 15 mm Hg with a flow of 2 L/min was achievable. The average scoring by physician of the TVEP was 4.75 for ease of placement, 5 for ability to maintain pneumoperitoneum, 4.25 for convenience of inserting instruments, and 4.5 for overall satisfaction. The average score regarding instruments exchangeability, however, was relatively low: 3.25. CONCLUSIONS Real surgery using a novel TVEP is feasible in performing transvesical NOTES.