Guido M. Kamphuis

Lessons learned from the CROES percutaneous nephrolithotomy global study

PurposeThe purpose of the study was to give an overview of the data derived from the CROES PCNL Global Study published previously in 25 articles.MethodsA comprehensive overview of the outcome of the CROES PCNL Global Study was made, analysed and compared with the current literature and guidelines.ResultsPercutaneous nephrolithotomy (PCNL) was predominately performed in prone position. Although the supine position claims to be favourable over the prone approach, the present study showed a longer operation time and lower stone-free rate (SFR). This might be explained by differences in definition in operation time and methods in the evaluation of residual stones. Ultrasound (US)-guided access proves beneficial in lowering puncture time and radiation exposure. Renal anomalies can safely be treated by PCNL and have similar outcomes to a normal situation. In patients with a solitary kidney, however, there is a lower SFR and more bleeding. Also, severe chronic kidney disease (CKD) patients have less favourable outcome. Morbidity and complications following PCNL are dominated by fever (10.5xa0%) and bleeding (7.8xa0%). A matched control analysis confirmed that antibiotic prophylaxis gives a threefold lower post-operative fever rate. In a multivariate analysis, it was elegantly demonstrated that bleeding was directly related to the size of the dilatation: the larger the bore, the higher the chance for bleeding. Elderly patients are at higher risk of complications and longer hospital stay. Overall, obese patients have similar outcome as the general population; however, super-obese (BMIxa0>xa040) patients have a higher chance of more severe complications. For the first time, this database illustrated a significant relationship between results and complications of PCNL, and caseload volume. The optimal case volume per centre appears to be 120 PCNL’s/year. Finally, a nomogram has been developed that enables better patient counselling and decision-making.ConclusionThe CROES PCNL Global Study is the largest real-life study providing new insights into general and special conditions. Because of the vast number of patients included, rare conditions including renal anomalies, solitary kidneys and patient characteristics like severe CKD, super obesity and old age could be analysed. Besides this information, a nomogram was developed. And for the first time, the influence of caseload volume was established.

Optical Coherence Tomography as a Tool for In Vivo Staging and Grading of Upper Urinary Tract Urothelial Carcinoma: A Study of Diagnostic Accuracy

PURPOSEnBiopsies and cytology are cornerstones in the diagnosis of upper urinary tract urothelial carcinoma. However, a high rate of nondiagnostic biopsies, tumor upgrading and tumor up staging after nephroureterectomy has been observed. In this prospective inxa0vivo study we evaluated the diagnostic accuracy of optical coherence tomography for the grading and staging of upper tract urothelial carcinoma.nnnMATERIALS AND METHODSnA total of 26 patients underwent diagnostic ureterorenoscopy including biopsies and optical coherence tomography, followed by nephroureterectomy or segmental ureter resection. The sensitivity, specificity, negative predictive value and positive predictive value of upper tract urothelial carcinoma grading and staging by optical coherence tomography were evaluated according to the STARD (Standards for Reporting of Diagnostic Accuracy) initiative and the second stage (2a and 2b) of the IDEAL model. For tumor staging a 2×2 table for sensitivity and specificity was calculated. For tumor grading the Wilcoxon rank sum test was used to test μoct in low and high grade lesions followed by ROC analysis for sensitivity and specificity.nnnRESULTSnIn 83% the staging of lesions was in accordance with final histopathology. Sensitivity and specificity analysis for tumor invasion was 100% and 92%, respectively. Tumor size greater than 2 mm and inflammation were risks for false-positives. For low and high grade lesions median μoct was 2.1 and 3.0xa0mm-1, respectively (p <0.01). ROC analysis showed a sensitivity of 87% and a specificity of 90% using a μoct cutoff of 2.4 mm-1.nnnCONCLUSIONSnThis report describes optical coherence tomography as a real-time, intraoperatively diagnostic modality in the diagnostic evaluation of upper tract urothelial carcinoma. We confirmed the ability of optical coherence tomography to visualize, grade and stage urothelial carcinoma in the upper urinary tract.

The glue-clot technique: a new technique description for small calyceal stone fragments removal

AbstractnDuring the last 20xa0years, the technology advancement of small flexible ureterorenoscopes has dramatically changed the management of renal calculi. Retrograde intrarenal surgery (RIRS) has currently a high impact on active stone treatment, and it is increasingly used worldwide. Nevertheless, kidney stone fragmentation and direct removal of fragments require many passages of the ureteroscope, is often time-consuming, and may be very difficult through anatomical and technical factors. We describe a simple, feasible and efficient technique for small stone fragments retrieval, which are often difficult to remove during RIRS.

Validation of Confocal Laser Endomicroscopy Features of Bladder Cancer: The Next Step Towards Real-time Histologic Grading

BACKGROUNDnCystoscopy enables the visualisation of suspicious bladder lesions but lacks the ability to provide real-time histopathologic information. Confocal laser endomicroscopy (CLE) is a probe-based optical technique that can provide real-time microscopic images. This high-resolution optical imaging technique may enable real-time tumour grading during cystoscopy.nnnOBJECTIVEnTo validate and adapt CLE criteria for bladder cancer diagnosis and grading.nnnDESIGN, SETTING, AND PARTICIPANTSnProspectively, 73 patients scheduled for transurethral resection of bladder tumour(s) were included. CLE imaging was performed intraoperatively prior to en bloc resection. Histopathology was the reference standard for comparison.nnnINTERVENTIONnCystoscopic CLE imaging.nnnOUTCOME MEASUREMENTS AND STATISTICAL ANALYSISnThree independent observers evaluated the CLE images to classify tumours as low- or high-grade urothelial carcinoma (UC), or benign lesions. Interobserver agreement was calculated with Fleiss kappa analysis and diagnostic accuracy with 2×2 tables.nnnRESULTS AND LIMITATIONSnHistopathology of 66 lesions (53 patients) revealed 25 low-grade UCs, 27 high-grade UCs, and 14 benign lesions. For low-grade UC, most common features were papillary configuration (100%), distinct cell borders (81%), presence of fibrovascular stalks (79%), cohesiveness of cells (77%), organised cell pattern (76%), and monomorphic cells (67%). A concordance between CLE-based classification and histopathology was found in 19 cases (76%). For high-grade UC, pleomorphic cells (77%), indistinct cell borders (77%), papillary configuration (67%), and disorganised cell pattern (60%) were the most common features. A concordance with histopathology was found in 19 cases (70%). In benign lesions, the most prevalent features were disorganised cell pattern (57%) and pleomorphic cells (52%), and a concordance with histopathology was found in four cases (29%).nnnCONCLUSIONSnThe CLE criteria enable identification of UC. CLE features correlate to histopathologic features that may enable real-time tumour grading. However, flat lesions remain difficult to classify.nnnPATIENT SUMMARYnConfocal laser endomicroscopy may enable real-time cancer differentiation during cystoscopy, which is important for prognosis and disease management.

Première évaluation clinique d’un nouvel urétéroscope souple à usage unique (LithoVue™) : étude préliminaire prospective européenne multicentrique

Objectifs Evaluer un nouvel ureteroscope souple (URSS) numerique a usage unique (LithoVue™) par rapport a la deflexion, la qualite de l’image et la manipulation. Methodes Une etude prospective a ete conduite dans 8xa0centres europeens entre decembre 2015xa0et janvier 2016. Tous les patients ont ete inclus consecutivement et ont ete traites par ureteroscopie souple. Un total de 40xa0interventions a ete realise (5xa0par centre). L’indication pour URSS etait le traitement de calculs renaux dans 92,5xa0% des cas. Les criteres suivants ont ete evalues avant et apres utilisation de l’ureteroscope a l’aide d’une echelle de Likertxa0: la deflexion, la qualite de l’image et la manipulation. Resultats Avant utilisation de l’ureteroscopexa0: les deflexions dans les sens ventral et dorsal etaient de 270° chacunexa0; la qualite de l’image etait evaluee comme tres bonne dans 65xa0% et bonne dans 30xa0% des casxa0; la manipulation tres bonne dans 77,5xa0% et bonne dans 17,5xa0% des cas. Lors de l’evaluation apres utilisation, les deflexions dans les deux sens etaient toujours de 270°. La qualite de l’image etait tres bonne dans 65xa0% et bonne dans 30xa0% des cas, pxa0=xa01. Il n’y avait pas de difference significative avec l’evaluation initiale concernant la manipulation, pxa0=xa00,92. Deux ureteroscopes ont casse durant les interventions pour les raisons suivantesxa0: un du fait d’une deflection forcee pour acceder au calice inferieur et l’autre resultant d’une perte de signal visuel spontane. Conclusion D’apres ces resultats, l’ureteroscope souple a usage unique LithoVue™ affiche de bonnes performances sur la qualite de l’image, la deflexion et la manipulation. Cependant, des evaluations cliniques et economiques supplementaires sont necessaires afin de preciser les indications pour son utilisation dans la pratique courante.

Beyond Endoscopy-Ultrasound, Optical Coherence Tomography and Confocal Laser Endomicroscopy

One of the main challenges in endoscopic diagnosis and treatment of upper urinary tract urothelial carcinoma is the complicated anatomy and the small size of the upper urinary tract, resulting in high demands on the armamentarium and expertise of the urologist. Difficulties to reach the complete collecting system could result in an incomplete visual inspection.