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Medicine Aug 2022To assess the efficacy and safety of robot-assisted anatrophic nephrolithotomy (RANL) as a choice of minimally invasive treatment for patients with complete staghorn...
To assess the efficacy and safety of robot-assisted anatrophic nephrolithotomy (RANL) as a choice of minimally invasive treatment for patients with complete staghorn stone. In a single-tertiary referral center retrospective study, 10 consecutive patients underwent RANL for complete staghorn stone. After dissection to the renal hilum and clamping of the renal vessels, an incision was made along the Brodel line and exposed the collecting system to extract the stone. Then, the collecting system and parenchyma were closed in layers. The outcomes included reduction of the stone burden, short- and long-term postoperative kidney function, and pain score. The average age of patients was 54.6 years and body mass index was 27.58 kg/m2. Mean warm ischemia time was 28.40 minutes, mean robotic console time was 137 minutes, and mean estimated blood loss was 83 mL. The mean length of stay was 5.4 days and there were no severe perioperative complications. Eight of 10 patients had >90% reduction in stone burden and 5 (50%) patients were completely stone-free. There was no significant decrease in postoperative estimated glomerular filtration rate compared with preoperative values after 1 month and 1 year. Our experience with RANL demonstrated efficacy and safety in the minimally invasive treatment of complete staghorn stone in short- and long-term follow-up periods.
Topics: Humans; Kidney Calculi; Middle Aged; Nephrostomy, Percutaneous; Retrospective Studies; Robotics; Staghorn Calculi; Treatment Outcome
PubMed: 36042683
DOI: 10.1097/MD.0000000000030154 -
Journal of Surgical Case Reports Nov 2022A bifid ureter is an atypical anatomical variation that occurs with an incidence of 1-10%. This anomaly is in a continuum of duplex collecting systems and most commonly...
A bifid ureter is an atypical anatomical variation that occurs with an incidence of 1-10%. This anomaly is in a continuum of duplex collecting systems and most commonly involves a common distal ureter. This is usually asymptomatic and is predominantly an incidental diagnosis, nevertheless, is a potential risk factor for urolithiasis formation. Current surgical management of larger staghorn calculi favours percutaneous nephrolithotomy (PCNL) over traditional open surgery, however for multiple calculi and complex anatomy PCNL would require multiple punctures, with increased risk of bleeding, pleural injury, sepsis and ultimately failed stone clearance. We describe the case of a 71-year-old female with multiple calculi in bifid anatomy. A single open approach, aided with cold-ischaemia was successfully utilized in this context.
PubMed: 36452279
DOI: 10.1093/jscr/rjac547 -
Therapeutic Advances in Urology 2019Staghorn calculi are complex renal stones that occupy the majority of the renal collecting system. These stones are associated with high morbidity and can lead to... (Review)
Review
Staghorn calculi are complex renal stones that occupy the majority of the renal collecting system. These stones are associated with high morbidity and can lead to recurrent urinary tract infections, urosepsis, renal deterioration, and death if left untreated. Managing patients with staghorn calculi can be challenging. Fortunately, advances in technology and endourology techniques have enabled urologists to effectively treat these stones with minimal morbidity to the patient. This article describes the contemporary best practices in the initial evaluation, management, and follow up of patients with staghorn calculi to help the practicing urologist navigate this complex condition.
PubMed: 35173810
DOI: 10.1177/1756287219847099 -
International Braz J Urol : Official... 2020Patients with staghorn renal stones are challenging cases, requiring careful preoperative evaluation and close follow-up to avoid stone recurrence. In this article we... (Review)
Review
Patients with staghorn renal stones are challenging cases, requiring careful preoperative evaluation and close follow-up to avoid stone recurrence. In this article we aim to discuss the main topics related to staghorn renal stones with focus on surgical approach. Most of staghorn renal stones are composed of struvite (magnesium ammonium phosphate) and are linked to urinary tract infection by urease-producing pathogens. Preoperative computed tomography scan and careful evaluation of all urine cultures made prior surgery are essential for a well-planning surgical approach and a right antibiotics choice. Gold standard surgical technique is the percutaneous nephrolithotomy (PCNL). In cases of impossible percutaneous renal access, anatrophic nephrolithotomy is an alternative. Shockwave lithotripsy and flexible ureteroscopy are useful tools to treat residual fragments that can be left after treatment of complete staghorn renal stone. PCNL can be performed in supine or prone position according to surgeon's experience. Tranexamic acid can be used to avoid bleeding. To check postoperative stone-free status, computed tomography is the most accurate imaging exam, but ultrasound combined to KUB is an option. Intra-operative high-resolution fluoroscopy and flexible nephroscopy have been described as an alternative for looking at residual fragments and save radiation exposure. The main goals of treatment are stone-free status, infection eradication, and recurrence prevention. Long-term or short-term antibiotic therapy is recommended and regular control imaging exams and urine culture should be done.
Topics: Female; Humans; Kidney; Male; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Staghorn Calculi; Treatment Outcome; Urologists
PubMed: 32213203
DOI: 10.1590/S1677-5538.IBJU.2020.99.07 -
Diagnostics (Basel, Switzerland) Apr 2023: Benign nephrectomy to treat patients with renal inflammatory disease in cases of severe urinary infection represents a diagnostic and management challenge because of...
: Benign nephrectomy to treat patients with renal inflammatory disease in cases of severe urinary infection represents a diagnostic and management challenge because of significant inflammatory, fibrotic, and infectious components. Among renal inflammatory diseases, fistulization and invasiveness to adjacent structures are some of the hallmarks of xanthogranulomatous pyelonephritis (XGP). The aims of this study were as follows 1. to retrospectively determine key demographic and clinical features of XGP among benign nephrectomies; 2. to assess the CT preoperative diagnostic accuracy; and 3. to define the imaging characteristics of the CT stage. : A retrospective review of clinical, laboratory, and radiological features and operative methods of patients who underwent benign nephrectomy with histologically proven XGP was performed. : XPG was diagnosed in 18 patients over a 4-year (2018-2022) period. XGP represented 43.90% among benign nephrectomies. The mean age of the patients was 63 years, and the sex prevalence was higher in women (72.22%). Symptoms were vague and not specifically referrable to urinary tract disorders and unilateral (100%), with the left kidney affected in 61.11% of cases. Staghorn calculi and stone disease were the most common underlying cause (72.22%). All patients underwent CT. The preoperative CT imaging accuracy for renal inflammatory disease was 94.44% and indeterminate in 5.56%. A suspected diagnosis of XGP was formulated in 66.67% (12/18; 2 stage II/10 stage III), meanwhile, in 33.33% (6 patients with stage I), a non-specific diagnosis of renal inflammatory disease was formulated. CT was reported according to the Malek and Elder classification and staged in the stage I nephric form (33.33%), stage II perinephric form (11.11%), stage III paranephric form (55.56%). : The CT diagnostic accuracy for kidney inflammatory disease was extremely high, whereas the suspected diagnosis of XGP was formulated preoperatively in only 66.67% of high-stage disease, where the hallmarks of invasiveness and fistulization of the pathology increased the diagnostic confidence.
PubMed: 37046557
DOI: 10.3390/diagnostics13071340 -
BMC Urology Aug 2021To explore the risk factors for severe bleeding complications after percutaneous nephrolithotomy (PCNL) according to the modified Clavien scoring system.
BACKGROUND
To explore the risk factors for severe bleeding complications after percutaneous nephrolithotomy (PCNL) according to the modified Clavien scoring system.
METHODS
We retrospectively analysed 2981 patients who received percutaneous nephrolithotomies from January 2014 to December 2020. Study inclusion criteria were PCNL and postoperative mild or severe renal haemorrhage in accordance with the modified Clavien scoring system. Mild bleeding complications included Clavien 2, while severe bleeding complications were greater than Clavien 3a. It has a good prognosis and is more likely to be underestimated and ignored in retrospective studies in bleeding complications classified by Clavien 1, so no analysis about these was conducted in this study. Clinical features, medical comorbidities and perioperative characteristics were analysed. Chi-square, independent t tests, Pearson's correlation, Fisher exact tests, Mann-Whitney and multivariate logistic regression were used as appropriate.
RESULTS
Of the 2981 patients 70 (2.3%), met study inclusion criteria, consisting of 51 men and 19 women, 48 patients had severe bleeding complications. The remaining 22 patients had mild bleeding. Patients with postoperative severe bleeding complications were more likely to have no or slight degree of hydronephrosis and have no staghorn calculi on univariate analysis (p < 0.05). Staghorn calculi (OR, 95% CI, p value 0.218, 0.068-0.700, 0.010) and hydronephrosis (OR, 95% CI, p value 0.271, 0.083-0.887, 0.031) were independent predictors for severe bleeding via multivariate logistic regression analysis. Other factors, such as history of PCNL, multiple kidney stones, site of puncture calyx and mean corrected intraoperative haemoglobin drop were not related to postoperative severe bleedings.
CONCLUSIONS
The absence of staghorn calculi and a no or mild hydronephrosis were related to an increased risk of post-percutaneous nephrolithotomy severe bleeding complications.
Topics: Aged; Female; Humans; Hydronephrosis; Kidney Calculi; Male; Middle Aged; Nephrolithotomy, Percutaneous; Postoperative Hemorrhage; Retrospective Studies; Risk Factors; Staghorn Calculi
PubMed: 34388999
DOI: 10.1186/s12894-021-00866-9 -
Proceedings (Baylor University. Medical... 2023We report a case of nephrobronchial fistula complicated by the development of a broncholith within the lung, which led to hemoptysis and blood loss anemia. A 71-year-old...
We report a case of nephrobronchial fistula complicated by the development of a broncholith within the lung, which led to hemoptysis and blood loss anemia. A 71-year-old man with a medical history of untreated urinary stones was admitted for flank pain, hemoptysis, blood loss anemia, and exacerbation of chronic pyelonephritis. Computed tomography showed staghorn calculi, terminal hydronephrosis, xanthogranulomatous pyelonephritis of the left kidney, nephrobronchial fistula, and large intraparenchymal pulmonary calcification. Surgical treatment was performed in two steps: nephrectomy and then left lower lobectomy. Pathological findings were suggestive of chronic inflammatory changes.
PubMed: 36876248
DOI: 10.1080/08998280.2022.2146932 -
Arab Journal of Urology Jan 2021: To compare the outcomes of standard- and mini-percutaneous nephrolithotomy (PCNL) for the treatment of staghorn stones. : The data of consecutive adult patients who...
: To compare the outcomes of standard- and mini-percutaneous nephrolithotomy (PCNL) for the treatment of staghorn stones. : The data of consecutive adult patients who underwent PCNL for the treatment of staghorn stones, between July 2015 and December 2019 from three hospitals, were retrospectively reviewed. All cases were performed in a prone position under fluoroscopic guidance. The nephrostomy tracts were dilatated to 30 F in standard-PCNL and to 18-20 F in mini-PCNL. Stones were fragmented with pneumatic lithotripsy in both groups. Fragments were removed with forceps in the standard-PCNL, while they were evacuated through the sheath using the vacuum clearance effect in mini-PCNL. A ureteric stent was inserted after mini-PCNL, while a nephrostomy tube was inserted after standard-PCNL. : The study included 153 patients; 70 underwent standard-PCNL and 83 underwent mini-PCNL. The stone-free rates of PCNL monotherapy were comparable for both groups (83% for mini-PCNL and 88.6% for standard-PCNL, = 0.339). The incidence (12% vs 24.3%, = 0.048) and severity of complications were significantly lesser with mini-PCNL ( = 0.031). Standard-PCNL was associated with increased rate of blood transfusion (12.9% vs 2.4%, = 0.013) and a significant decrease in haemoglobin ( = 0.018). Hospital stay was significantly longer for standard-PCNL than mini-PCNL (median stay of 6 vs 3 days, 0.001). : The efficacy of mini-PCNL was comparable to standard-PCNL in the treatment of staghorn stones. The advantages of mini-PCNL included a lesser incidence and severity of complications, and shorter hospital stay.
PubMed: 34104489
DOI: 10.1080/2090598X.2021.1878670 -
Clinical Nephrology. Case Studies 2023We present two atypical cases of calciphylaxis presenting with ocular ischemic pathology - both without the hallmark cutaneous manifestations - to raise awareness of...
PURPOSE
We present two atypical cases of calciphylaxis presenting with ocular ischemic pathology - both without the hallmark cutaneous manifestations - to raise awareness of this rare yet highly disabling condition.
OBSERVATIONS
We report two cases of ophthalmic calciphylaxis presenting as (1) anterior ischemic optic neuropathy (AION) and cilioretinal artery occlusion in a 76-year-old woman with pre-dialysis kidney failure, and (2) AION with contralateral central retinal artery occlusion (CRAO) in a 44-year-old man on hemodialysis.
CONCLUSION AND IMPORTANCE
These cases highlight the need for judicious clinical suspicion of calciphylaxis in patients with kidney failure, presenting with microvascular ischemic ophthalmic pathology such as AION or CRAO. Confirmation with temporal artery biopsy is essential to direct targeted individualized multi-disciplinary treatment of calciphylaxis and avoid unnecessary steroid exposure in cases masquerading as giant cell arteritis (GCA).
PubMed: 38169875
DOI: 10.5414/CNCS111088 -
Medical Ultrasonography Dec 2018Nowadays percutaneous nephrolithotomy (PCNL) is the standard of care for renal staghorn calculus or large (>20 mm) pelvic or caliceal stones, as well as for the failure... (Review)
Review
Nowadays percutaneous nephrolithotomy (PCNL) is the standard of care for renal staghorn calculus or large (>20 mm) pelvic or caliceal stones, as well as for the failure of other treatment options. This review aims to evaluate the contemporary use of ultrasound imaging in PCNL, by comparing it to conventional fluoroscopy, reviewing data regarding the complication and success rate of nephrostomy tract creation and stone free rate (SFR), as well as data concerning the learning curve for these procedures and cost indicators. The evidence acquired shows that the ultrasound guided access (USGA) is a comparable method with the classic fluoroscopic guided access (FGA), with a similar safety profile, with a significant reduction in radiation exposure, up to radiation free complete PCNL. USGA PCNL seems to lead to decreased bleeding and need for transfusion, especially when the Doppler mode is used, and also to a slightly higher SFR than conventional FGA PCNL. USGA PCNL reduces the overall costs of the procedure by about 30% and can be safely learnt and performed by urologists. For an experienced endourologist, familiar withFGA PCNL, the learning curve for shifting to USGA PCNL is of approximately 20 procedures.
Topics: Humans; Kidney; Kidney Calculi; Nephrolithotomy, Percutaneous; Ultrasonography, Interventional
PubMed: 30534660
DOI: 10.11152/mu-1618