Ohguchi Higashi General Hospital

Yokohama-shi, Japan

Ohguchi Higashi General Hospital

Yokohama-shi, Japan

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PubMed | University of Rochester, Yokohama City University and Ohguchi Higashi General Hospital
Type: Journal Article | Journal: Urolithiasis | Year: 2016

We investigated the correlation between computed tomography (CT) density of ureteral stones and their mineral composition. A total of 346 patients who underwent ureteroscopic lithotripsy for calculi all fragments of which were acquired at a single institution from 2009 to 2011 were analyzed. The maximum and mean CT densities were measured preoperatively. A mineral analysis revealed calcium oxalate in 203 (58.7%), mixed calcium oxalate and calcium phosphate in 78 (23.0%), calcium phosphate in 18 (5.2%), uric acid in 8 (2.3%), struvite in 3 (0.9%), and cysteine in 5 (1.4%). The mean Hounsfield units (HUs) of the CT density were 1046 HUs in calcium oxalate, 1101 HUs in mixed calcium oxalate and calcium phosphate, 835 HUs in calcium phosphate, 549 HUs in uric acid, 729 HUs in struvite, and 698 HUs in cystine. The HUs in calcium oxalate were significantly higher than those in uric acid (p<0.01) and struvite (p<0.01). Those in monohydrate stones were significantly higher, compared with dehydrate stones (p<0.05). We analyzed the largest number of stones than each published study to correlate their mineral composition and CT density. Calcium component stones showed significantly higher CT densities than other types.


Kawahara T.,Ohguchi Higashi General Hospital | Kawahara T.,Yokohama City University | Ito H.,Ohguchi Higashi General Hospital | Ito H.,Yokohama City University | And 7 more authors.
BJU International | Year: 2012

Objective To describe a technique for ureteroscopy assisted retrograde nephrostomy. Patients and Methods Under general and epidural anaesthesia, the patient is placed in a modified-Valdivia position. Flexible ureteroscopy is carried out, and a Lawson retrograde nephrostomy puncture wire is placed in the ureteroscope (URS). After the needle has exited through the skin, no further steps are required in preparation for dilatation. Results After informed consent was obtained, two patients (a 43-year-old man with left renal stones and a 57-year-old woman with right renal stones) underwent this procedure. The URS was positioned in the middle posterior calyx and punctured toward the skin. ConclusionS This procedure involves less radiation exposure and shorter surgery than the previous percutaneous nephrostomy technique. Our technique represents another new option for percutaneous nephrolithotomy in patients with a non-dilated intrarenal collecting system. © 2011 BJU INTERNATIONAL.


Kawahara T.,Ohguchi Higashi General Hospital | Kawahara T.,Yokohama City University | Ito H.,Ohguchi Higashi General Hospital | Ito H.,Yokohama City University | And 5 more authors.
PLoS ONE | Year: 2012

Objective: To determine the impact of ureteroscopy-assisted retrograde nephrostomy (UARN) during percutaneous nephrolithotomy (PCNL). Materials and Methods: From April 2009 to September 2011, a total of 50 patients underwent PCNL for large renal stones (stone burden >2 cm). We performed UARN in the Galdakao-modified Valdivia position for 27 patients (UARN PCNL) and ultrasonography-assisted percutaneous nephrostomy in the prone position for 23 patients (prone PCNL). Results: UARN PCNL significantly improved the stone-free rate (81.5% vs 52.2%) and the rate of residual stones (<4 mm, 92.6% vs 65.2%, P<0.05). The median length of the operation was significantly shorter for UARN PCNL, at 160 min, compared to 299 min for prone PCNL (P<0.001). There was one intraoperative complication in prone PCNL, namely a hemorrhage that resulted in stopping the initial treatment, but it was cured conservatively. The postoperative complications included a high grade fever that persisted for three days in two UARN PCNL patients (7.4%) and six prone PCNL patients (26.1%). The Clavien grading scores showed significantly lower postoperative complications for UARN PCNL compared to prone PCNL. Conclusion: UARN is associated with a higher stone-free rate, shorter operation time, and fewer complications during PCNL than prone PCNL. © 2012 Kawahara et al.


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.


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.
PLoS ONE | Year: 2012

Introduction: We developed a method for ureteral stent removal in female patients that requires no cystoscopy or fluoroscopic guidance using a crochet hook. In addition, we also investigated the success rate, complications and pain associated with this procedure. Methods: A total of 40 female patients (56 stents) underwent the removal of ureteral stents. All procedures were carried out with the patients either under anesthesia, conscious sedation, or analgesic suppositories as deemed appropriate for each procedure including Shock Wave Lithotripsy (SWL), Ureteroscopy (URS), Percutaneous Nephrolithotomy (PCNL), and ureteral stent removal. At the time of these procedures, fluoroscopy and/or cystoscopy were prepared, but they were not used unless we failed to successfully remove the ureteral stent using the crochet hook. In addition, matched controls (comprising 50 stents) which were removed by standard ureteral stent removal using cystoscopy were used for comparison purposes. Results: A total of 47 of the 56 stents (83.9%) were successfully removed. In addition, 47 of 52 (90.4%) were successfully removed except for two migrated stents and two heavily encrusted stents which could not be removed using cystoscopy. Ureteral stent removal using the crochet hook technique was unsuccessful in nine patients, including two encrustations and two migrations. Concerning pain, ureteral stent removal using the crochet hook technique showed a lower visual analogue pain scale (VAPS) score than for the standard technique using cystoscopy. Conclusions: Ureteral stent removal using a crochet hook is considered to be easy, safe, and cost effective. This technique is also easy to learn and is therefore considered to be suitable for use on an outpatient basis. © 2012 Kawahara et al.


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.


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.


PubMed | Ohguchi Higashi General Hospital and Yokohama City University
Type: Journal Article | Journal: International journal of urology : official journal of the Japanese Urological Association | Year: 2016

To compare outcomes of retrograde intrarenal surgery for urolithiasis between patients with solitary kidneys and patients who have single-side urolithiasis with bilateral kidneys.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.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.Retrograde intrarenal surgery in solitary kidney patients is as safe and effective as in bilateral kidney patients.


PubMed | Johns Hopkins University, Yokohama City University and Ohguchi Higashi General Hospital
Type: Journal Article | Journal: BMC urology | Year: 2016

Ureteral stenting has been a fundamental part of various urological procedures. Selecting a ureteral stent of optimal length is important for decreasing the incidence of stent migration and complications. The aim of the present study was to develop and internally validate a model for predicting the ureteral length for ureteral stent insertion.This study included a total of 127 patients whose ureters had previously been assessed by both intravenous urography (IVU) and CT scan. The actual ureteral length was determined by direct measurement using a 5-Fr ureteral catheter. Multiple linear regression analysis with backward selection was used to model the relationship between the factors analyzed and actual ureteral length. Bootstrapping was used to internally validate the predictive model.Patients all of whom had stone disease included 76 men (59.8%) and 51 women (40.2%), with the median and mean ( SD) ages of 60 and 58.7 (14.2) years. In these patients, 53 (41.7%) right and 74 (58.3%) left ureters were analyzed. The median and mean ( SD) actual ureteral lengths were 24.0 and 23.3 (2.0) cm, respectively. Using the bootstrap methods for internal validation, the correlation coefficient (R2) was 0.570.07.We have developed a predictive model, for the first time, which predicts ureteral length using the following five preoperative characteristics: age, side, sex, IVU measurement, and CT calculation. This predictive model can be used to reliably predict ureteral length based on clinical and radiological factors and may thus be a useful tool to help determining the optimal length of ureteral stent.


PubMed | Ohguchi Higashi General Hospital and Yokohama City University
Type: Journal Article | Journal: International journal of urology : official journal of the Japanese Urological Association | Year: 2016

To identify risk factors of developing systemic inflammation response syndrome after endoscopic combined intrarenal surgery in the modified Valdivia position for renal stone treatment.We retrospectively analyzed 370 consecutive patients who underwent endoscopic combined intrarenal surgery procedures in the modified Valdivia position to treat renal stones. Antibiotic therapy based on preoperative urine cultures was administered to all patients from induction of anesthesia until at least postoperative day 3. Postoperative systemic inflammation response syndrome was diagnosed if the patient met two or more systemic inflammation response syndrome criteria. A multivariate logistic regression model with backward selection was used to evaluate the relationships between the incidence of systemic inflammation response syndrome after endoscopic combined intrarenal surgery and other clinical factors.Of the 370 patients, 61 patients (16.5%) were diagnosed with systemic inflammation response syndrome after endoscopic combined intrarenal surgery. Significant differences were found between the non-systemic inflammation response syndrome and systemic inflammation response syndrome groups with regard to female sex (29.8% vs 44.3%, P = 0.027), history of febrile urinary tract infection (16.5% vs 32.8%, P = 0.015) and number of involved calyces (2.68 vs 4.1, P < 0.001). Multivariate analysis found three independent predictors of postoperative systemic inflammation response syndrome: the number of involved calyces (P = 0.017), stone surface area (P = 0.021) and history of febrile urinary tract infection (P = 0.005).The number of involved calyces larger than four, stone surface area >500 mm(2) and a history of febrile urinary tract infection independently predicted the development of systemic inflammation response syndrome after endoscopic combined intrarenal surgery. This is the first study to identify the independent predictors of systemic inflammation response syndrome after endoscopic combined intrarenal surgery in the modified Valdivia position.

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