Urological Survey Urolithiasis/Endourology Re: Do the Residual Fragments after Shock Wave Lithotripsy Affect the Quality of Life? C. Sahin, M. Tuncer, O. Yazıcı, R. Horuz, A. C. Cetinel, B. Eryıldırım, F. Tarhan and K. Sarica Urology Clinics, Dr. Lutfi Kirdar Training and Research Hospital, and Faculty of Medicine, Medipol University, Istanbul, Turkey Urology 2014; 84: 549e554.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.011 available at http://jurology.com/ Editorial Comment: Residual stone fragments are not inconsequential. These investigators demonstrated that larger residual stone fragments had more of a negative impact on quality of life. This study could have been improved if the quality of life of those rendered stone-free had also been assessed. Dean G. Assimos, MD
Suggested Reading Penniston KL and Nakada SY: Development of an instrument to assess the health related quality of life of kidney stone formers. J Urol 2013; 189: 921. Bensalah K, Tuncel A, Gupta A et al: Determinants of quality of life for patients with kidney stones. J Urol 2008; 179: 2238.
Re: Management of Calyceal Diverticular Calculi: A Comparison of Percutaneous Nephrolithotomy and Flexible Ureterorenoscopy O. Bas, E. Ozyuvali, Y. Aydogmus, N. C. Sener, O. Dede, S. Ozgun, F. Hizli, C. Senocak, O. F. Bozkurt, H. Basar and A. Imamoglu Department of Urology, Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ministry of Health, Ankara, Turkey Urolithiasis 2014; Epub ahead of print.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.012 available at http://jurology.com/ Editorial Comment: This study reveals that ureteroscopy and percutaneous nephrolithotomy (PNL) are effective treatments for patients harboring stones in calyceal diverticular cavities. The choice of treatment is based on stone size and location of the diverticular cavity. Patients with smaller stones are good candidates for ureteroscopy. It may be difficult to access lower pole diverticula with this approach. PNL is reserved for those with larger stones, especially in posteriorly located diverticula. I generally do not incise or dilate the ostium during PNL. After stone removal I proceed with fulguration of the cavity and placement of a drainage tube, which is left indwelling for 24 to 36 hours. Laparoscopy or robotic surgery is reserved for those with large stones in anteriorly located diverticula or in patients with type 2 calyceal diverticula (ones that communicate directly with the renal pelvis or infundibulum), where there is typically little or no overlying renal parenchyma. The difference in certain postoperative metrics in this series is mainly due to the degree of invasiveness of the procedure. Dean G. Assimos, MD
0022-5347/15/1934-1275/0 THE JOURNAL OF UROLOGY® © 2015 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2015.01.011 Vol. 193, 1275-1277, April 2015 Printed in U.S.A.
www.jurology.com
j
1275
1276
LAPAROSCOPY/NEW TECHNOLOGY
Suggested Reading Estrada CR, Datta S, Schneck FX et al: Caliceal diverticula in children: natural history and management. J Urol 2009; 181: 1306. Kim SC, Kuo RL, Tinmouth WW et al: Percutaneous nephrolithotomy for caliceal diverticular calculi: a novel single stage approach. J Urol 2005; 173: 1194. Monga M, Smith R, Ferral H et al: Percutaneous ablation of caliceal diverticulum: long-term followup. J Urol 2000; 163: 28.
Re: Predicting an Effective Ureteral Access Sheath Insertion: A Bicenter Prospective Study Y. Mogilevkin, M. Sofer, D. Margel, A. Greenstein and D. Lifshitz Department of Urology, Rabin Medical Center, Petah Tikva, Israel J Endourol 2014; 28: 1414e1417.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.013 available at http://jurology.com/ Editorial Comment: Ureteral access sheaths are now commonly used to facilitate flexible ureteroscopic procedures. These authors identified certain factors that predict the ability to successfully insert a ureteral access sheath. I routinely perform semirigid ureteroscopy with a 7.5Fr instrument before attempting to place an access sheath. If the ureter does not readily accommodate the ureteroscope, I do not attempt to pass an access sheath, and proceed with either flexible ureteroscopy or placement of an internalized stent. I believe that this approach saves dollars and ureters. Dean G. Assimos, MD
Suggested Reading Traxer O and Thomas A: Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 2013; 189: 580. Kourambas J, Byrne RR and Preminger GM: Does a ureteral access sheath facilitate ureteroscopy? J Urol 2001; 165: 789. Wang HH, Huang L, Routh JC et al: Use of the ureteral access sheath during ureteroscopy in children. J Urol, suppl., 2011; 186: 1728.
Laparoscopy/New Technology Re: Warmed, Humidified Carbon Dioxide Insufflation versus Standard Carbon Dioxide in Laparoscopic Cholecystectomy: A Double-Blinded Randomized Controlled Trial B. Klugsberger, M. Schreiner, A. Rothe, D. Haas, P. Oppelt and A. Shamiyeh 2nd Surgical Department, Academic Teaching Hospital, Ludwig Boltzmann Institute for Operative Laparoscopy, Linz General Hospital, Linz, Austria Surg Endosc 2014; 28: 2656e2660.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.005 available at http://jurology.com/ Editorial Comment: In this well-done randomized study of 148 patients undergoing laparoscopic cholecystectomy the use of warmed humidified CO2 for insufflation decreased postoperative pain on the day of surgery. However, the advantage was small. There was a significant difference in patient reported pain using a visual analogue scale 6 hours postoperatively (0.3 points on a 0 to 10-point scale) but no difference on postoperative day 1. There was no difference in the mean amounts of pain medication used on the day of surgery or postoperative day 1. The authors also observed no difference in the return of bowel function and a 0.2C higher intraoperative core
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.011 available at http://jurology.com/ Editorial Comment: Residual stone fragments are not inconsequential. These investigators demonstrated that larger residual stone fragments had more of a negative impact on quality of life. This study could have been improved if the quality of life of those rendered stone-free had also been assessed. Dean G. Assimos, MD
Suggested Reading Penniston KL and Nakada SY: Development of an instrument to assess the health related quality of life of kidney stone formers. J Urol 2013; 189: 921. Bensalah K, Tuncel A, Gupta A et al: Determinants of quality of life for patients with kidney stones. J Urol 2008; 179: 2238.
Re: Management of Calyceal Diverticular Calculi: A Comparison of Percutaneous Nephrolithotomy and Flexible Ureterorenoscopy O. Bas, E. Ozyuvali, Y. Aydogmus, N. C. Sener, O. Dede, S. Ozgun, F. Hizli, C. Senocak, O. F. Bozkurt, H. Basar and A. Imamoglu Department of Urology, Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ministry of Health, Ankara, Turkey Urolithiasis 2014; Epub ahead of print.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.012 available at http://jurology.com/ Editorial Comment: This study reveals that ureteroscopy and percutaneous nephrolithotomy (PNL) are effective treatments for patients harboring stones in calyceal diverticular cavities. The choice of treatment is based on stone size and location of the diverticular cavity. Patients with smaller stones are good candidates for ureteroscopy. It may be difficult to access lower pole diverticula with this approach. PNL is reserved for those with larger stones, especially in posteriorly located diverticula. I generally do not incise or dilate the ostium during PNL. After stone removal I proceed with fulguration of the cavity and placement of a drainage tube, which is left indwelling for 24 to 36 hours. Laparoscopy or robotic surgery is reserved for those with large stones in anteriorly located diverticula or in patients with type 2 calyceal diverticula (ones that communicate directly with the renal pelvis or infundibulum), where there is typically little or no overlying renal parenchyma. The difference in certain postoperative metrics in this series is mainly due to the degree of invasiveness of the procedure. Dean G. Assimos, MD
0022-5347/15/1934-1275/0 THE JOURNAL OF UROLOGY® © 2015 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2015.01.011 Vol. 193, 1275-1277, April 2015 Printed in U.S.A.
www.jurology.com
j
1275
1276
LAPAROSCOPY/NEW TECHNOLOGY
Suggested Reading Estrada CR, Datta S, Schneck FX et al: Caliceal diverticula in children: natural history and management. J Urol 2009; 181: 1306. Kim SC, Kuo RL, Tinmouth WW et al: Percutaneous nephrolithotomy for caliceal diverticular calculi: a novel single stage approach. J Urol 2005; 173: 1194. Monga M, Smith R, Ferral H et al: Percutaneous ablation of caliceal diverticulum: long-term followup. J Urol 2000; 163: 28.
Re: Predicting an Effective Ureteral Access Sheath Insertion: A Bicenter Prospective Study Y. Mogilevkin, M. Sofer, D. Margel, A. Greenstein and D. Lifshitz Department of Urology, Rabin Medical Center, Petah Tikva, Israel J Endourol 2014; 28: 1414e1417.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.013 available at http://jurology.com/ Editorial Comment: Ureteral access sheaths are now commonly used to facilitate flexible ureteroscopic procedures. These authors identified certain factors that predict the ability to successfully insert a ureteral access sheath. I routinely perform semirigid ureteroscopy with a 7.5Fr instrument before attempting to place an access sheath. If the ureter does not readily accommodate the ureteroscope, I do not attempt to pass an access sheath, and proceed with either flexible ureteroscopy or placement of an internalized stent. I believe that this approach saves dollars and ureters. Dean G. Assimos, MD
Suggested Reading Traxer O and Thomas A: Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 2013; 189: 580. Kourambas J, Byrne RR and Preminger GM: Does a ureteral access sheath facilitate ureteroscopy? J Urol 2001; 165: 789. Wang HH, Huang L, Routh JC et al: Use of the ureteral access sheath during ureteroscopy in children. J Urol, suppl., 2011; 186: 1728.
Laparoscopy/New Technology Re: Warmed, Humidified Carbon Dioxide Insufflation versus Standard Carbon Dioxide in Laparoscopic Cholecystectomy: A Double-Blinded Randomized Controlled Trial B. Klugsberger, M. Schreiner, A. Rothe, D. Haas, P. Oppelt and A. Shamiyeh 2nd Surgical Department, Academic Teaching Hospital, Ludwig Boltzmann Institute for Operative Laparoscopy, Linz General Hospital, Linz, Austria Surg Endosc 2014; 28: 2656e2660.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.005 available at http://jurology.com/ Editorial Comment: In this well-done randomized study of 148 patients undergoing laparoscopic cholecystectomy the use of warmed humidified CO2 for insufflation decreased postoperative pain on the day of surgery. However, the advantage was small. There was a significant difference in patient reported pain using a visual analogue scale 6 hours postoperatively (0.3 points on a 0 to 10-point scale) but no difference on postoperative day 1. There was no difference in the mean amounts of pain medication used on the day of surgery or postoperative day 1. The authors also observed no difference in the return of bowel function and a 0.2C higher intraoperative core
