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BMC Anesthesiology Mar 2022Urosepsis is an infectious complication after percutaneous nephrolithotomy (PCNL). This study aimed to analyze the perioperative factors related to urosepsis after PCNL...
BACKGROUND
Urosepsis is an infectious complication after percutaneous nephrolithotomy (PCNL). This study aimed to analyze the perioperative factors related to urosepsis after PCNL for upper urinary calculi and establish a nomogram to predict the probability of postoperative urosepsis based on the risk factors.
METHODS
The Clinical data of one-stage PCNL for upper urinary stones in patients already diagnosed with type 2 diabetes between June 2010 and June 2020 were retrospectively analyzed. The patients were divided into two groups according to whether urosepsis occurred after surgery, and univariate and multivariate logistic regression analyses evaluated the risk factors for urosepsis. Moreover, the corresponding nomogram prediction model was determined by the regression coefficient.
RESULTS
All 366 patients with diabetes underwent one-stage PCNL. Seventy-one (19.4%) patients had urosepsis after surgery, and their hospitalization time was longer than that of patients without urosepsis. Moreover, the incidence of non-infection-related complications was higher. Multivariate logistic regression analysis revealed four independent risk factors associated with postoperative urosepsis, including positive urine nitrite (odds ratio [OR] = 3.326, P = 0.007), positive urine culture (OR = 2.213, P = 0.023), intraoperative hypotension (OR = 8.968, P < 0.001), and staghorn calculi (OR = 3.180, P = 0.002). The above independent risk factors were used as variables to construct the nomogram. The nomogram model was internally validated. The calculated concordance index was 0.824. The Hosmer-Lemeshow goodness-of-fit test was performed (P = 0.972 > 0.05). The area under the curve of this model was 0.831, indicating that the nomogram model had good accuracy in predicting the probability of urosepsis in patients who underwent PCNL with diabetes and had good consistency with the actual risk.
CONCLUSION
Positive urine culture, positive urine nitrite, staghorn calculi, and intraoperative hypotension were independent risk factors for urosepsis in patients who underwent one-stage PCNL with diabetes. The new nomogram could accurately assess the risk of urosepsis after PCNL in patients with diabetes.
Topics: Diabetes Mellitus, Type 2; Humans; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Nomograms; Retrospective Studies; Risk Factors
PubMed: 35361116
DOI: 10.1186/s12871-022-01629-1 -
Archivio Italiano Di Urologia,... Dec 2014To report our experience of diagnosis and multimodal management of urolithiasis in renal transplantation.
OBJECTIVES
To report our experience of diagnosis and multimodal management of urolithiasis in renal transplantation.
PATIENTS AND METHODS
From January 1995 to December 2012, 953 patients underwent renal transplantation in the Kidney Transplant Unit of Treviso General Hospital. Ten (10%) of them developed urinary calculi and were referred at our institution. Their mode of presentation, investigation and treatment were recorded.
RESULTS
Seven had renal and 3 ureteral calculi. Urolithiasis was incidentally discovered on routine ultrasound in 6 patients, 1 presented with oliguria, 1 with anuria and acute renal failure and in 2 urolithiasis was found at removal of the ureteral stent. Nephrostomy tube was placed in 5 patients. Hypercalcemia with hyperparathyroidism (HPT) was present in 5 patients and hyperuricemia in 3. Two patients were primary treated by shock wave lithotripsy (SWL) and one of them was stone-free after two sessions. Two patients, one with multiple pielocaliceal calculi and the other with staghorn calculus in the lower calyx, were treated with percutaneous nephrolitothotomy (PCNL). Three patients were treated by ureteroscopy (URS) and in one of them two treatments were carried out. One patient had calculus impacted in the uretero-vesical anastomosis and surgical ureterolithotomy with re-do ureterocystoneostomy was performed after failure of URS. Two patients with calculi discovered at removal of the ureteral stent were treated by URS.
CONCLUSIONS
The incidence of urolithiasis in renal transplantation is uncommon. In the most of patients the condition occurs without pain. Metabolic anomalies and medical treatment after renal transplantation may cause stone formation. Advancements in endourology and interventional radiology have influenced the management of urolithiasis that can be actually treated with a minimal incidence of risk for the renal allograft.
Topics: Adult; Female; Humans; Kidney Transplantation; Male; Middle Aged; Urolithiasis
PubMed: 25641446
DOI: 10.4081/aiua.2014.4.257 -
Current Opinion in Urology Jul 2023To systematically review the evolution of techniques, technology, clinical utility, limitations and possible future applications of endoscopic combined intrarenal... (Review)
Review
PURPOSE OF REVIEW
To systematically review the evolution of techniques, technology, clinical utility, limitations and possible future applications of endoscopic combined intrarenal surgery (ECIRS) for ureteral and kidney stones.
RECENT FINDINGS
The literature search was performed on 18th January 2023 using PubMed, EMBASE and Scopus. 35 studies were included. Among them, six were reviews. Since its introduction in 2008, ECIRS has evolved and improved. ECIRS can be performed in different patient position, such as modified supine Valdivia position by Galdakao, prone position with split-leg and supine position with good outcomes. Instrument miniaturization has also been introduced in ECIRS making it doable in an ambulatory setting. ECIRS showed shorter operative time, lower complication rate, and retreatment compared with conventional PCNL. Operative outcomes of mini-ECIRS are better than mini-PCNL alone. ECIRS also showed good outcomes in impacted upper ureteric stones. Recently, some studies have explored the robotic-assisted kidney puncture in ECIRS that avoided multitrack surgery, especially in anomalous kidney and staghorn stones.
SUMMARY
ECIRS is ready for primetime in endourology and can be considered the next gold-standard for a personalized stone approach in complex kidney stones.
Topics: Humans; Kidney Calculi; Nephrostomy, Percutaneous; Ureteroscopy; Ureteral Calculi
PubMed: 37158647
DOI: 10.1097/MOU.0000000000001106 -
BMC Urology Jun 2022Although hepatitis B virus (HBV) is a recognized risk factor for renal diseases, little is known about HBV infection in individuals with upper urinary calculi (UUC). We...
BACKGROUND
Although hepatitis B virus (HBV) is a recognized risk factor for renal diseases, little is known about HBV infection in individuals with upper urinary calculi (UUC). We investigated the relationship between chronic HBV infection and UUC.
METHODS
We retrospectively analysed data from 1399 patients who were discharged from the Department of Urology (2017-2018). The diagnosis of UUC was determined using urinary tract ultrasonography or computed tomography, and HBV infection was evaluated by a positive hepatitis B surface antigen (HBsAg) test. Data on patients with and without UUC and HBsAg-positive and HBsAg-negative patients were compared by univariate and multivariate analyses.
RESULTS
Data on chronic HBV infection and UUC were available for 1062 patients, including 514 who presented with UUC and 548 who did not. Overall, 5.8% of total patients, 8.0% of UUC patients and 3.8% of non-UUC patients had chronic HBV infection. UUC patients (41/514) had a significantly higher prevalence of HBsAg positivity (OR 2.175; 95% CI 1.267-3.734; P = 0.004) than non-UUC patients (21/548). After stratifying by sex, the relative odds of HBsAg positivity were statistically significant in men (OR 2.156; 95% CI 1.162-4.003; P = 0.015) but not in women (OR 2.947; 95% CI 0.816-10.643; P = 0.099). The incidence of urinary pH > 6 and staghorn stones was significantly higher in HBsAg-positive UUC patients than in HBsAg-negative UUC patients.
CONCLUSION
This is the first study to demonstrate that chronic HBV infection is strongly associated with UUC, at least in men. The urinary pH > 6 and staghorn stones were more common in UUC patients with chronic HBV infection.
Topics: Female; Hepatitis B; Hepatitis B Surface Antigens; Hepatitis B virus; Hepatitis B, Chronic; Humans; Male; Retrospective Studies; Urinary Calculi; Urinary Tract
PubMed: 35668522
DOI: 10.1186/s12894-022-01038-z -
BMC Urology Sep 2022To assess the outcome of the mini-track, mini-nephroscopy, mini ultrasonic probe percutaneous nephrolithotomy for upper ureteral and kidney stones.
BACKGROUND
To assess the outcome of the mini-track, mini-nephroscopy, mini ultrasonic probe percutaneous nephrolithotomy for upper ureteral and kidney stones.
METHODS
We collected data of 53 patients (55 kidney units) who underwent mini-track, mini-nephroscopy, mini-ultrasonic probe percutaneous nephrolithotomy between September 2020 and March 2021. The study included single and upper ureteral stones from 12 kidneys, multiple stones from 28 kidneys, and staghorn stones from 15 kidneys.
RESULTS
The mean operative duration was 50.6 min, ranging from 15 to 200 min, whereas the mean lithotripsy and stone removal time was 17.2 min (3-45 min). Moreover, the mean postoperative length of stay was 4.0 days (1-7 days). Besides, the stone-free rate (SFR) of discharge was 89.1% (49/55). The mean hemoglobin drop was 15.3 mg/dL, ranging 1-32 mg/dL. Out of the total cases, only 4 of them displayed minor complications. The outcomes of < 40 mm versus ≥ 40 mm calculi were compared by performing subgroup analysis. The results demonstrated a longer operation duration (65.2 vs. 40.2 min), higher complication rate (13.0% vs. 3.3%), and lower SFR in the ≥ 40 mm calculi subgroup.
CONCLUSIONS
In summary, mini-track, mini-nephroscopy, mini-ultrasonic probe percutaneous nephrolithotomy is an effective and safe method to treat patients with upper ureteral and kidney calculi. This is especially significant for the stone size of 20-40 mm, demonstrating excellent SFR and a lower complication rate.
Topics: Humans; Kidney; Kidney Calculi; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Retrospective Studies; Treatment Outcome; Ultrasonics; Ureteral Calculi
PubMed: 36071397
DOI: 10.1186/s12894-022-01061-0 -
Annals of Medicine and Surgery (2012) Apr 2023Staghorn calculus usually fills the pelvis of the kidney, the infundibulum, and most of the calyces. It is a rarity for staghorn stones to be asymptomatic; in addition...
UNLABELLED
Staghorn calculus usually fills the pelvis of the kidney, the infundibulum, and most of the calyces. It is a rarity for staghorn stones to be asymptomatic; in addition to that, the calculus discussed in this case report was of a very large size and was removed intact. Open pyelolithotomy, the procedure used, is one that comes with a wide range of complications but can be deemed effective in certain cases. In this scenario, it led to no impediments to normal physiology.
CASE PRESENTATION
Here the authors report the case of a 45-years-old Nepalese male who presented with a large yet asymptomatic staghorn calculus. It was managed with an open pyelolithotomy, and the patient had no intraoperative or postoperative complications.
DISCUSSION
Staghorn stones can be complete or partial and often naturally progress to renal impairment. Thus, an aggressive therapeutic approach is crucial, with careful evaluation of the site and size of the stone, the patient's preference, and the institutional capacity. Ideally, staghorn calculi are completely removed, and it is imperative that the functions of the affected kidney are preserved as far as possible and when applicable. Although percutaneous nephrolithotomy is recommended for the removal of staghorn stones, several clinical, technical, and socioeconomic factors contributed to the use of open pyelolithotomy in the management of the case discussed here.
CONCLUSION
Open pyelolithotomy can prove highly effective in removing large stones intact and in a single setting, the importance of which was accentuated by its unique clinical presentation and pathological anomalies.
PubMed: 37113920
DOI: 10.1097/MS9.0000000000000294 -
Urologiia (Moscow, Russia : 1999) Apr 2020Percutaneous nephrolithotomy (PCNL) is the method of choice for large and staghorn renal stones, including those in patients with solitary kidney. The aim of the... (Review)
Review
Percutaneous nephrolithotomy (PCNL) is the method of choice for large and staghorn renal stones, including those in patients with solitary kidney. The aim of the literature review was to analyze the results of PCNL in patients with large stones in the solitary kidney. The literature search was conducted in databases Embase, Medline, Google Scholar, Scopus for the period from 2010 to 2019. A total 94 articles were selected, of which 16 papers were included in the review after analyzing the abstracts. Data was pooled and analyzed using SPSS Statistics 22.0. The primary stone-free rate for PCNL in these patients was 68.3+/-14.2%, and the final stone-free rate increased by 86.5+/-4.9%. The average duration of the operation was 86+/-25 (43.7-138.3) min, the length of stay was 5 (2-6) days. The baseline creatinine level was 137 (110-200) mmol/L, compared to 142 (122-183) mmol/L postoperatively. The mean difference between the baseline and postoperative Hb level was 7.8 (1.3-17.5) g/l. The estimated glomerular filtration rate (GFR) before PCNL was 62.3+/-7.5 ml/min/1.73 m2, and it did not exceed 62.5+/-9.3 ml/min/1.73 m2 postoperatively. The overall complication rate ranged from 10.6 to 68.8%, averaging 29.9%. In most cases, there were grade I and II complications, according to Clavien-Dindo classification, which didnt require additional interventions. PCNL is a highly effective treatment method for patients with large stones in solitary kidney. Complications rate is relatively low, which is achieved by an individual approach, with a consideration of the condition and all risk factors.
Topics: Humans; Kidney Calculi; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Retrospective Studies; Solitary Kidney; Staghorn Calculi; Treatment Outcome
PubMed: 32351072
DOI: No ID Found -
African Journal of Urology : the... 2021Overall incidence of stones in kidney transplant recipients is 1%. En-bloc kidney transplant is a rare anatomical condition in which kidney stones treatment can be...
BACKGROUND
Overall incidence of stones in kidney transplant recipients is 1%. En-bloc kidney transplant is a rare anatomical condition in which kidney stones treatment can be extremely difficult to treat. As far as we know, no cases of staghorn calculi in en-bloc kidney transplant have been published so far.
CASE PRESENTATION
A 27-year-old woman presented to the Emergency Department because of asthenia, adynamia and weight loss associated with lower urinary tract symptoms and subfebrile temperature. Ten years before, she had undergone an en-bloc kidney transplant because of end-stage renal disease secondary to perinatal asphyxia syndrome. One kidney was implanted capo-volta in the right iliac fossa and the other one in the right flank. NCCT scan showed incomplete staghorn calculi in the iliac fossa transplanted kidney. Besides, severe dilation of the native and the right flank transplanted kidney, due to two ureteral stones of 6 and 7 mm impacted in the uretero-ureteral anastomosis, was found. After hospital admission and under ceftriaxone prophylaxis, an attempt to perform primary RIRS following our COVID protocol was carried out. Nevertheless, we ended up placing a JJ stent because once the guidewire passed through the ureteral stones, purulent material came out from the ureteral orifice. She stayed 9 days in-hospital for management of postobstructive polyuria and was discharged with oral antibiotics. Three weeks afterward, we removed the stent and performed flexible ureteroscopy and holmium laser lithotripsy of the ureteral stones. In the same procedure, we performed Mini-ECIRS (21 French) previous ultrasound-guided upper pole puncture. Postoperative NCCT scan showed neither residual fragments nor operative complications.
CONCLUSION
This is the first clinical case reporting Mini-ECIRS in a patient with an en-bloc kidney transplant. This endourological approach seems to be a feasible, safe and effective approach to treat stones in this anatomically challenging condition.
PubMed: 34720577
DOI: 10.1186/s12301-021-00249-4 -
Surgical Innovation Feb 2018To present our experience of combined single-percutaneous tract minimally invasive percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopic lithotripsy (FURL) in...
PURPOSE
To present our experience of combined single-percutaneous tract minimally invasive percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopic lithotripsy (FURL) in managing staghorn calculi (SC) in oblique supine lithotomy position and to define the safety, efficiency, and feasibility of this approach.
PATIENTS AND METHODS
Eighty-seven patients with SC treated with surgery in our hospital from March 2014 to January 2016 were retrospectively analyzed. The 87 patients were divided into 2 groups according to operative type: MPCNL combined with FURL (Group 1, n = 44) and MPCNL (Group 2, n = 43). The clinical data, perioperative parameters, and postoperative complications of the 2 groups were compared and analyzed.
RESULTS
There were no significant differences in age, gender, stone type, and size ( P = .873, .570, .448, and .593, respectively). The average operative time, the average hospitalization time after surgery, the hemoglobin level, and the complication rate of Group 1 were lower than that of Group 2 ( P < .05 each). The first and second time stone free rates of Group 1 were higher than that of Group 2 ( P < .05 each).
CONCLUSION
Single-tract MPCNL combined with FURL in the oblique supine lithotomy position to treat SC could improve stone free rates, reduce operative time and length of hospital stay, decrease renal hemorrhage, and avoid other complications. We think this is an efficient and safe operative approach to manage SC.
Topics: Adult; Female; Humans; Male; Middle Aged; Nephrolithotomy, Percutaneous; Postoperative Complications; Retrospective Studies; Staghorn Calculi; Supine Position; Ureteroscopy
PubMed: 29130401
DOI: 10.1177/1553350617741023 -
Urology Annals 2021Percutaneous nephrolithotomy (PCNL) carries a small risk of postoperative sepsis due to the liberation of bacteria into the patients' bloodstream during stone...
OBJECTIVES
Percutaneous nephrolithotomy (PCNL) carries a small risk of postoperative sepsis due to the liberation of bacteria into the patients' bloodstream during stone fragmentation. The study aims to identify the incidence of post-PCNL sepsis in our center, as well as to delineate perioperative characteristics associated with increased rates of sepsis.
MATERIALS AND METHODS
We performed a retrospective review on all PCNLs performed in our center between July 2012 and June 2017, with emphasis on preoperative urine results, intra-operative findings, and postoperative septic complications.
RESULTS
Among 425 cases of PCNL performed, 16 (3.76%) developed sepsis postoperatively. Patients with positive preoperative urine cultures were almost four times as likely to develop post-PCNL sepsis compared to those with negative cultures (8.41% vs. 2.2%, = 0.004). Among patients with positive urine leukocytes and positive urine cultures, the presence of Staghorn calculi and multiple PCNL punctures both predicted significantly higher risks of postoperative sepsis. In contrast, diabetes mellitus and preoperative stenting were not found to be associated with a greater risk of post-PCNL sepsis.
CONCLUSIONS
Patients who had positive preoperative urine leukocytes and/or cultures, and either harbor Staghorn calculi or are deemed to require more than one puncture on PCNL, were at an increased risk of developing post-PCNL sepsis. Such at-risk patients should be identified preoperatively, given aggressive perioperative antibiotic treatment, and monitored closely for septic complications during the convalescence period.
PubMed: 34194142
DOI: 10.4103/UA.UA_28_20