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Yokohama-shi, Japan

Kawahara T.,Ohguchi Higashi General Hospital | Matsuzaki J.,Ohguchi Higashi General Hospital | Kubota Y.,Yokohama City University
Indian Journal of Urology | Year: 2012

Obesity is associated with increased surgical morbidity and mortality. We previously reported on the usefulness of ureteroscopy assisted retrograde nephrostomy (UARN) and here we report a case of renal calculi successfully treated with UARN during percutaneous nephrolithotomy (PCNL) in an obese patient. A 63-year-old female with left renal calculi was referred to Department of Urology, Ohguchi Higashi General Hospital. Her body mass index was 34.0 kg/m2. Stone fragments were completely extracted. URS-assisted puncture from the renal collecting system to the skin under fluoroscopic guidance was a safe and easy procedure in our obese patient. Source

Kuroda S.,Ohguchi Higashi General Hospital | Fujikawa A.,Ohguchi Higashi General Hospital | Tabei T.,Ohguchi Higashi General Hospital | Ito H.,Ohguchi Higashi General Hospital | And 4 more authors.
International Journal of Urology | Year: 2016

Objectives: To compare outcomes of retrograde intrarenal surgery for urolithiasis between patients with solitary kidneys and patients who have single-side urolithiasis with bilateral kidneys. Methods: We retrospectively analyzed outcomes of retrograde intrarenal surgery in solitary kidney patients (group A) carried out during 2007-2014, and in patients with bilateral kidneys with comparable stone burdens (group B). Stone-free status was defined as no residual fragment on computed tomography 1 month later. Results: There were 19 patients in group A (mean age 62.5 ± 18.4 years, range 14-76 years). The mean stone diameter and burden were 6.0 mm (range 3-24 mm) and 10.42 ± 6.92 mm, respectively. The stone-free rate was 94.7%, and no repeat procedure was required. The glomerular filtration rate tended to rise post-surgery (postoperative day 1: 48.67 ± 15.92 mL/min, 100.2%, P = 0.940; postoperative month 1: 51.32 ± 16.90 mL/min, 105.7%, P = 0.101) compared with preoperative rates. The stone-free rate and surgery time were not significantly different between the two groups, although post-surgical hospitalization time was longer for group A (4.05 vs 3.08 days, P = 0.037). The change in glomerular filtration rate was not significantly different between groups A and B (postoperative day 1: +0.101 vs +0.547 mL/min, respectively, P = 0.857; postoperative month 1: +2.749 vs 3.161 mL/min, respectively, P = 0.882). No significant difference was found in terms of complication rate. Conclusions: Retrograde intrarenal surgery in solitary kidney patients is as safe and effective as in bilateral kidney patients. © 2016 The Japanese Urological Association. Source

Kawahara T.,Ohguchi Higashi General Hospital | Kawahara T.,Yokohama City University | Ito H.,Ohguchi Higashi General Hospital | Ito H.,Yokohama City University | And 6 more authors.
International Journal of Urology | Year: 2012

A large renal stone can be treated ureteroscopically, but the treatment often requires more than one procedure. The use of stenting before ureteroscopy was recently reported. The present study investigated the effectiveness of preoperative stenting before ureteroscopic lithotripsy for large (>15mm) renal stones. A ureteral stent was intentionally inserted in 25 patients undergoing ureteroscopic surgery. A group of 36 non-prestented patients was used as control. Median stone diameter was 21mm in both groups. Pre-ureteroscopy stenting significantly improved the stone-free rate, defined as stones <2mm and <4mm (P<0.05), whereas it did not significantly improve the stone-free rate defined as 0mm (P=0.12). The uretereoscopy success rate was 72.0% in the stented and 55.6% in the control group (P=0.09). A 14/16-Fr ureteral access sheath was successfully inserted in 94.7% of the stented patients, and 74.2% of the non-stented patients (P<0.05). Our findings showed that preoperative stenting is effective for dilation of the ureter, and also to facilitate the insertion of a ureteral access sheath in patients undergoing ureteroscopic lithotripsy for large renal stones. © 2012 The Japanese Urological Association. Source

Suzuki K.,Ohguchi Higashi General Hospital | Yamashita Y.,Ohguchi Higashi General Hospital | Matuzaki J.,Ohguchi Higashi General Hospital
Acta Urologica Japonica | Year: 2010

We investigated the patients with ammonium acid urate (AAU) calculi in relation to dietary history, habit and lifestyle. From April, 2002 to March, 2009, AAU calculi were found in 9 patients (0.66%) out of 1,365 cases of stones. Three cases were pure, and 6 were mixed stones. We examined the risk factor of this stone generation, "continuation of malnutrition and dehydration" were seen in 5, "continuing urinary tract infection" was seen in 4 and "continuation of super-saturation of uric acid in urine" was seen in 3 cases. All the patients with "continuation of malnutrition and dehydration" were women, and 4 patients had a history of severe body weight loss. 2 patients were dieting consciously, and the other 2 were eating a poorly balanced diet unconsciously. One patient had no notable past history, but malnutrition was detected in blood examination. It is suggested that AAU calculi is generated even by dieting at a usual level. Compared with the report in the United States, obesity and inflammatory bowel disease were not major risk factors, and "continuation of malnutrition and dehydration" is the major factor in Japan. Source

Kawahara T.,Ohguchi Higashi General Hospital | Kawahara T.,Yokohama City University | Ito H.,Ohguchi Higashi General Hospital | Ito H.,Yokohama City University | And 6 more authors.
Urological Research | Year: 2013

A ureteral access sheath (UAS) can facilitate ureteroscopy (URS) and the retrieval of stone fragments while reducing the intrarenal pressure, thereby improving irrigate flow and decreasing the length of an operation. Ureteral stenting after URS is unnecessary for uncomplicated cases. This study examined the early removal of postoperative ureteral catheterization after URS for cases that used a UAS. A total of 93 patients underwent ureteroscopic lithotripsy with the early removal of ureteral catheterization. Sixty-three of these patients underwent surgery with the use of UAS and were analyzed in this study. Postoperative hydronephrosis was assessed using ultrasonography 3 days after the operation and computed tomography 2 weeks after operation in all patients. Post-operative complications including fever, prolonged hospitalization, frequent usage of painkillers and the re-insertion of ureteral stent were also investigated. Hydronephrosis was detected 3 days after the operation in 34 patients (54.0 %) and 2 weeks after the operation in four patients (6.3 %). No hydronephrosis was detected after a 2-month follow-up in these four patients. The mean operation time in the hydronephrosis group was significantly higher at 58.9 min than in the non-hydronephrosis group at 45.5 min (p < 0.05). Post-operative fever (38 C) was seen in one case, the frequent usage of painkillers was seen in four cases, a prolonged hospital stay was seen in five cases, and ureteral stent re-insertion was observed in one case. The early removal of ureteral catheterization can be safely performed for the patients that undergo URS with UAS. © 2012 Springer-Verlag Berlin Heidelberg. Source

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