PMID- 29737199
OWN - NLM
STAT- MEDLINE
DCOM- 20190930
LR  - 20190930
IS  - 1557-900X (Electronic)
IS  - 0892-7790 (Linking)
VI  - 32
IP  - 7
DP  - 2018 Jul
TI  - Steep Infundibulopelvic Angle as a New Risk Factor for Flexible Ureteroscope 
      Damage and Complicated Postoperative Course.
PG  - 597-602
LID - 10.1089/end.2018.0147 [doi]
AB  - OBJECTIVE: The increasing number of flexible ureterorenoscopy (fURS) procedures, 
      the fragility of devices, and their growing repair costs represent a substantial 
      burden for urological departments worldwide. No risk factors of flexible 
      ureteroscope damage have been identified so far. The objective of this study was 
      to investigate the impact of infundibulopelvic angle (IPA) on device damage and 
      on other intraoperative and postoperative factors such as length of hospital 
      stay, surgical complications, stone-free rate (SFR), operation, and fluoroscopy 
      time. MATERIALS AND METHODS: In a retrospective monocentric study, IPA was 
      measured based on intraoperative retrograde pyelography images taken during fURS. 
      All procedures were conducted with modern reusable flexible ureteroscopes: Karl 
      Storz Flex-X2 or Olympus URF-V. Statistical analysis was performed in RStudio 
      (version 1.0.136) with the unpaired t-test and Mann-Whitney U test. Pearson 
      correlation coefficient (Pearson's r) was measured whenever applicable. RESULTS: 
      In total, 381 fURS performed between September 2013 and March 2017 were analyzed: 
      260 (68.24%) for kidney stone operation and 121 (31.76%) for diagnostic purposes; 
      of these, 38 (9.97%) devices were postoperatively deemed defective. IPA values 
      were significantly steeper in cases with flexible ureteroscope damage compared to 
      cases without damage (median 42.5 degrees vs 56.0, p < 0.001). Steeper IPA was 
      significantly associated with the occurrence of Clavien-Dindo >/=2 complications 
      (median 51.0 degrees vs 55.0, p = 0.005) as well as prolonged hospital stay 
      (median 51.0 degrees vs 55.0, p = 0.014). No influence on SFR was observed 
      (p > 0.05). IPA did not correlate with operation or fluoroscopy time. 
      CONCLUSIONS: Steep IPA can be considered the first risk factor predicting both 
      flexible ureteroscope damage and an unfavorable postoperative course. A better 
      understanding of damage mechanisms is the key for the proper indications to use 
      costly single-use devices.
FAU - Ozimek, Tomasz
AU  - Ozimek T
AD  - Department of Urology, University Hospital Schleswig-Holstein , Luebeck, Germany 
      .
FAU - Cordes, Jens
AU  - Cordes J
AD  - Department of Urology, University Hospital Schleswig-Holstein , Luebeck, Germany 
      .
FAU - Wiessmeyer, Judith R
AU  - Wiessmeyer JR
AD  - Department of Urology, University Hospital Schleswig-Holstein , Luebeck, Germany 
      .
FAU - Schneider, Michael H
AU  - Schneider MH
AD  - Department of Urology, University Hospital Schleswig-Holstein , Luebeck, Germany 
      .
FAU - Hupe, Marie C
AU  - Hupe MC
AD  - Department of Urology, University Hospital Schleswig-Holstein , Luebeck, Germany 
      .
FAU - Gilbert, Nils
AU  - Gilbert N
AD  - Department of Urology, University Hospital Schleswig-Holstein , Luebeck, Germany 
      .
FAU - Merseburger, Axel S
AU  - Merseburger AS
AD  - Department of Urology, University Hospital Schleswig-Holstein , Luebeck, Germany 
      .
FAU - Kramer, Mario W
AU  - Kramer MW
AD  - Department of Urology, University Hospital Schleswig-Holstein , Luebeck, Germany 
      .
LA  - eng
PT  - Journal Article
DEP - 20180607
PL  - United States
TA  - J Endourol
JT  - Journal of endourology
JID - 8807503
SB  - IM
MH  - Adult
MH  - Aged
MH  - Equipment Design
MH  - Equipment Failure/*statistics & numerical data
MH  - Female
MH  - Hospital Costs/statistics & numerical data
MH  - Humans
MH  - Kidney Calculi/diagnostic imaging/*surgery
MH  - Length of Stay/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Operative Time
MH  - Pelvis/*anatomy & histology
MH  - Postoperative Complications/etiology
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Ureteroscopes/economics/*statistics & numerical data
MH  - Ureteroscopy/*statistics & numerical data
OTO - NOTNLM
OT  - complications
OT  - flexible ureterorenoscopy
OT  - flexible ureteroscope damage
OT  - infundibulopelvic angle
EDAT- 2018/05/09 06:00
MHDA- 2019/10/01 06:00
CRDT- 2018/05/09 06:00
PHST- 2018/05/09 06:00 [pubmed]
PHST- 2019/10/01 06:00 [medline]
PHST- 2018/05/09 06:00 [entrez]
AID - 10.1089/end.2018.0147 [doi]
PST - ppublish
SO  - J Endourol. 2018 Jul;32(7):597-602. doi: 10.1089/end.2018.0147. Epub 2018 Jun 7.