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Urology Annals 2016To determine the predictors of infectious complications following percutaneous nephrolithotomy (PCNL) in a prospective study.
OBJECTIVE
To determine the predictors of infectious complications following percutaneous nephrolithotomy (PCNL) in a prospective study.
MATERIALS AND METHODS
A total of 332 patients with renal or upper ureteric calculi who underwent PCNL between January 2013 and June 2014 were included in the study. Infectious complications included febrile urinary tract infection and septicemia. The patients were divided into Group A and B depending on whether they developed or did not develop infectious complications. Patient, stone, renal, and procedure-related factors were compared between the two groups.
RESULTS
There was no significant ( > 0.05) correlation among age (37.03 ± 16.24 vs. 36.72 ± 14.88), sex, and body mass index (21.00 ± 1.77 vs. 21.03 ± 2.25) between Group A and B. The patients in Group A were found to have significantly higher incidence of renal failure (39.5% vs. 9.2%,P= 0.0001), diabetes mellitus (12 [31.5%] vs. 33 [11.2%],P= 0.0001), previous percutaneous nephrostomy (PCN) tube placement (11 [28%] vs. 21 [7.1%]P= 0.0001), moderate to severe hydronephrosis (HDN), larger stone surface area (812.68 ± 402.07 vs. 564.92 ± 361.32,P= 0.0001), mean number of punctures (1.57 ± 0.50 vs. 1.20 ± 0.47,P= 0.002), and mean duration of surgery (94.28 ± 18.23 vs. 69.12 ± 21.23,P= 0.0001) than Group B.
CONCLUSION
Post-PCNL infectious complications were found to be more common in patients with renal failure, diabetes mellitus, preoperative PCN placement, staghorn calculi, severe HDN, multiple punctures, and prolonged duration of surgery.
PubMed: 28057987
DOI: 10.4103/0974-7796.192105 -
Journal of Postgraduate Medicine 2022Unilateral acquired diaphragmatic paresis is a known complication of thoracic surgeries. Direct mechanical injury to the phrenic nerve during surgery results in this...
Unilateral acquired diaphragmatic paresis is a known complication of thoracic surgeries. Direct mechanical injury to the phrenic nerve during surgery results in this complication. However its occurrence post-percutaneous nephrolithotomy (PCNL) has not been described. We report a 43-year-old man who underwent prone PCNL for endourological management of left complete staghorn calculus. Access via the 10 left intercostal space, under fluoroscopy, was carried out to remove the calculus. Post-operative, the routine chest radiograph revealed left hemidiaphragmatic blunting. Computerized tomography of the chest confirmed left hemidiaphragmatic elevation, suggesting unilateral diaphragmatic paresis. He did not have any respiratory symptoms, was managed conservatively with chest physiotherapy and incentive spirometry and responded extremely well. The absence of reported cases of diaphragmatic paresis post PCNL lends to a dearth in knowledge regarding recognition and management. This case report aims to acquaint urologists with this rare complication associated with supracostal PCNL and provide a rational management plan.
Topics: Adult; Digestive System Diseases; Fluoroscopy; Humans; Kidney Calculi; Male; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Paresis
PubMed: 34708699
DOI: 10.4103/jpgm.JPGM_13_21 -
BMC Urology Apr 2022To explore the feasibility, safety, and effectiveness of single tract minimally invasive endoscopic combined intrarenal surgery (stmECIRS) in the improved prone frog...
OBJECTIVE
To explore the feasibility, safety, and effectiveness of single tract minimally invasive endoscopic combined intrarenal surgery (stmECIRS) in the improved prone frog split-leg position for staghorn stones.
METHOD
A total of 83 patients with staghorn stones were retrospectively reviewed between January 2018 and June 2021. According to surgical procedure and position, patients were divided into a group of single tract minimally invasive percutaneous nephroscopy (stmPNL) in the prone position and a group of stmECIRS in the improved prone frog split-leg position (turned to the prone position after preset the flexible ureteroscope sheath in lithotomy position, meanwhile, bend both hips and knees to be frog abduction). Demographic characteristics, laboratory tests, stone characters, surgical information, stone-free rate (SFR), and perioperative complications were observed and analyzed.
RESULTS
There were no significant differences in demographic characteristics, changes level of Scr and Hb, stone size, radiation density, length of hospital stay, and operation time between the two groups. One-stage SFR in the stmECIRS group was significantly higher than that in the stmPNL group (84.4% vs. 57.9%) (P = 0.007), only 2 patients required blood transfusion after surgery (P = 0.862), and other postoperative complications were not statistically significant (P = 0.345).
CONCLUSIONS
StmECIRS in improved prone frog split-leg position has a higher one-stage SFR than stmPNL for staghorn renal stones, and without complications increased, which is a safe, efficient and feasible treatment.
Topics: Humans; Kidney Calculi; Leg; Nephrostomy, Percutaneous; Prone Position; Retrospective Studies; Staghorn Calculi; Treatment Outcome
PubMed: 35387631
DOI: 10.1186/s12894-022-01003-w -
Evidence-based Complementary and... 2022The aim of this study is to explore and analyze the high risk factors and preventive measures of percutaneous nephrolithotomy under the guidance of B-ultrasound in the...
OBJECTIVE
The aim of this study is to explore and analyze the high risk factors and preventive measures of percutaneous nephrolithotomy under the guidance of B-ultrasound in the treatment of postoperative renal calculi.
METHODS
The clinical data of 220 patients with renal calculi admitted to our hospital from 2018 to October 2021 were retrospectively analyzed. All patients were treated with percutaneous nephrolithotomy = 36) and nonbleeding group ( = 184), comparing the personal data, disease-related data, surgical operation related data of the two groups of patients, single factor and logistic multifactor regression analysis to explore the influence of B-guided percutaneous. Nephrolithotomy is a high-risk factor for postoperative bleeding in patients with kidney stones, and preventive measures are based on high-risk factors.
RESULTS
There was no significant difference in the proportion of patients with different genders, whether they had renal surgery, whether they had hypertension, and those with postoperative hepatic insufficiency in the hemorrhagic group and the nonbleeding group ( > 0.05). There was no significant difference in age and body mass index between the bleeding group and the nonbleeding group ( > 0.05). The proportion of patients with diabetes in the bleeding group was higher than that in the nonbleeding group, and the difference between the groups was statistically significant ( < 0.05). Compared with the nonbleeding group, the bleeding group had a higher proportion of patients with calculus diameter ≥2 cm. The proportion of patients with staghorn calculi in the bleeding group was higher than that in the nonbleeding group. The difference between the groups was statistically significant ( < 0.05). There was no significant difference in the proportion of patients with hemorrhage, single or multiple renal stones, and ureteral stones in the hemorrhage group compared with the nonbleeding group ( > 0.05). Compared with the nonbleeding group, the proportion of patients with bleeding in the first stage was higher, and the proportion of patients with operation time >90 min was higher. The difference between the groups was statistically significant ( < 0.05). There was no significant difference in the proportion of patients in the bleeding group compared with the nonbleeding group ( > 0.05). Using Logic multifactorial regression analysis, independent risk factors for bleeding after percutaneous nephrolithotomy under ultrasound-guided bovery include diabetes mellitus, stone diameter, staghorn kidney stones, surgical timing, and staging surgery ( < 0.05).
CONCLUSION
The independent high-risk factors affecting bleeding after percutaneous nephrolithotomy guided by B-ultrasound include diabetes, stone diameter, staghorn type kidney stones, operation time, and staged surgery. According to this, effective preventive measures can effectively reduce the operation and the occurrence of postbleeding.
PubMed: 35911133
DOI: 10.1155/2022/1287910 -
Urology Annals 2020Surgical management of elderly patients with renal calculi is inherently challenging. We compared the efficacy and safety of percutaneous nephrolithotomy (PCNL)...
INTRODUCTION
Surgical management of elderly patients with renal calculi is inherently challenging. We compared the efficacy and safety of percutaneous nephrolithotomy (PCNL) performed under regional anesthesia between elderly patients (age >65 years) and patients aged <65 years.
MATERIALS AND METHODS
Between July 2015 and June 2016, fifty patients aged >65 years with renal stones (size >1.5 cm) were treated with PCNL under regional anesthesia (elderly group). We retrospectively compared the outcomes with those obtained in an equal number of patients aged <65 years (younger group) who underwent PCNL under regional anesthesia. Patients with staghorn stones and pyonephrosis and falling under the American Society of Anesthesiologists (ASA) Grade IV were excluded. Data pertaining to demographic characteristics, body mass index, stone bulk, operative time, tract size, number of tracts required, blood loss, clearance rates, complications, and length of hospital stay were analyzed.
RESULTS
The mean age at presentation in the elderly and younger groups was 66.8 ± 2.1 years and 38.7 ± 11 years, respectively; 56% of the patients in the elderly age group had ASA Grade II, whereas 58% in the younger age group had ASA Grade I. The mean stone size and the number of tracts were comparable in both the groups, whereas operative time was slightly longer in the elderly group (58.54 ± 18 vs. 51.98 ± 18 min; < 0.05). Postoperative complications and stone-free rates (94% vs. 92%, respectively) were comparable in the two groups.
CONCLUSIONS
Age itself should not deter the treatment of elderly patients with renal stones as PCNL under regional anesthesia is safe and effective in elderly patients; outcomes in elderly and younger patients were comparable in this study.
PubMed: 33100751
DOI: 10.4103/UA.UA_69_19 -
BioMed Research International 2019This study investigated the risk factors for bleeding during minimally invasive percutaneous nephrolithotomy, so as to prevent the occurrence of bleeding and improve the...
OBJECTIVE
This study investigated the risk factors for bleeding during minimally invasive percutaneous nephrolithotomy, so as to prevent the occurrence of bleeding and improve the surgical effect.
PATIENTS AND METHODS
The data of 396 patients who underwent percutaneous nephrolithotomy by an experienced surgeon between May 2014 and December 2017 were retrospectively analyzed. To identify the risk factors for bleeding during percutaneous nephrolithotomy, each group was stratified according to the decrease in median hemoglobin. Age, gender, body mass index, stone size, operation time, stone type, degree of hydronephrosis, number of accesses, puncture guidance, underlying disease (diabetes; hypertension), and previous surgical history were evaluated. Univariate analysis was performed to calculate the potential factors. In order to determine the independence of each factor, we finally selected stone size, staghorn stone, degree of hydronephrosis, and operation time. Multivariate logistic regression analysis was used to identify the risk factors for bleeding during minimally invasive percutaneous nephrolithotomy.
RESULTS
A total of 396 patients were successfully treated with percutaneous nephrolithotomy. The univariate analysis demonstrated that the potential risk factors for bleeding during percutaneous nephrolithotomy included stone size, type of stone, operative time, and degree of hydronephrosis. According to the previous studies, stone size, staghorn stone, degree of hydronephrosis, and operation time were ultimately selected. Multivariate logistic regression analysis was used to identify the risk factors for bleeding during percutaneous nephrolithotomy. According to the outcome of logistic regression analysis, stone size, staghorn stone, operation time, and degree of hydronephrosis were the risk factors for bleeding during minimally invasive percutaneous nephrolithotomy.
CONCLUSIONS
Percutaneous nephrolithotomy is an effective method for the treatment of upper urinary calculi with few complications. According to the results achieved by an experienced surgeon, the size of stone, staghorn stone, operation time, and degree of hydronephrosis were associated with the bleeding during minimally invasive percutaneous nephrolithotomy.
Topics: Adolescent; Adult; Aged; Child; Female; Hemorrhage; Humans; Kidney Calculi; Male; Middle Aged; Minimally Invasive Surgical Procedures; Nephrolithotomy, Percutaneous; Operative Time; Postoperative Complications; Retrospective Studies; Risk Factors; Treatment Outcome; Urinary Calculi; Urinary Tract; Young Adult
PubMed: 30834279
DOI: 10.1155/2019/8619460 -
Iranian Journal of Medical Sciences Nov 2019The incidence of renal hemorrhage during percutaneous nephrolithotomy (PCNL) is high. We sought to evaluate the effects of tranexamic acid (TXA) on bleeding and...
BACKGROUND
The incidence of renal hemorrhage during percutaneous nephrolithotomy (PCNL) is high. We sought to evaluate the effects of tranexamic acid (TXA) on bleeding and hemoglobin levels of patients with staghorn calculi treated with PCNL.
METHODS
In a double-blind clinical trial, 120 patients with staghorn calculi candidated for PCNL in Alzahra Hospital between January 2014 and November 2017, Isfahan, Iran, were classified into two groups in terms of the stone size (>4 cm and <4 cm). The patients in both groups were then randomly assigned to receive either 1 g of TXA intravenously or normal saline. (The generation of random numbers was done by computer.) Thus, there were four groups of 30 patients each. The transfusion rate, the mean volume of blood loss, the operative duration, and the hemoglobin level were compared between the intervention and control groups for each stone-size category. Statistical analysis was performed using SPSS, version 19. The paired and independent t test and the Pearson coefficient correlation were used, and a P value less than 0.05 was considered statistically significant.
RESULTS
The mean volume of blood loss was significantly higher in the control group patients than in those receiving TXA, in both stone-size categories (P<0.001). There was no significant difference in the postoperative hemoglobin level between the intervention and control groups, in both stone-size categories (P=0.26 and P=0.10, respectively). In addition, the mean volume of blood loss increased significantly with an increase in the operative duration (P<0.001).
CONCLUSION
TXA reduced the risk of bleeding during and after PCNL and attenuated the drop in the hemoglobin level in the postoperative period. Longer operative procedures were associated with an increase in the bleeding volume. IRCT20180209038673N1.
PubMed: 31875080
DOI: 10.30476/ijms.2019.44969 -
International Journal of Surgery Case... 2020Pancreatolithiasis is an uncommon disease and the diagnosis of pancreatic duct stones is challenging. The radiological findings of pancreatic duct stones may mimic other...
INTRODUCTION
Pancreatolithiasis is an uncommon disease and the diagnosis of pancreatic duct stones is challenging. The radiological findings of pancreatic duct stones may mimic other diseases, such as renal stones.
CASE PRESENTATION
A 42-year-old male came with chief complaint of recurrent bilateral flank pain accompanied by fever which worsen 7 days before admission. The patient was diagnosed as gastritis and received analgesics in several hospitals. Ultrasonography and IVP examinations showed stones in both kidneys. CT-scan was not performed due to limitation in the hospital. Patient was diagnosed bilateral staghorn nephrolithiasis. The patient underwent bilateral bivalve nephrotomy for staghorn renal stone performed by urologist, but intraoperatively, no stones were found. The patient was then consulted intraoperatively to the digestive surgeon and get immediate median laparotomy. Intraoperatively, stones were palpated in the head and tail of the pancreas. The stones were evacuated. The symptoms were relieved, neither recurrence, nor pain, nor postoperative leakage was found. Patient was discharged uneventfully 4 days after the procedure and had no complaints in further follow-ups.
DISCUSSION
The symptoms of pancreatolithiasis may overlap with nephrolithiasis and gastritis. The presented case was unique because from the history taking, clinical symptoms, USG, and IVP findings supported the diagnosis of nephrolithiasis, but intraoperative findings reveal pancreatic duct stones.
CONCLUSION
For patient diagnosed with renal calculi based on sonography and IVP findings, differential diagnosis of pancreatic stone should be considered especially if no underlying cause is detected. In such circumstances relying on IVP and sonographic findings alone can be misleading.
PubMed: 33395837
DOI: 10.1016/j.ijscr.2020.11.066 -
Anatrophic Nephrolithotomy in the Management of Large Staghorn Calculi - A Single Centre Experience.Journal of Clinical and Diagnostic... May 2017With advances in endourology, open stone surgery for staghorn calculi has markedly diminished. Anatrophic Nephrolithotomy (AN) is performed for complex staghorn stones...
INTRODUCTION
With advances in endourology, open stone surgery for staghorn calculi has markedly diminished. Anatrophic Nephrolithotomy (AN) is performed for complex staghorn stones which cannot be cleared by a reasonable number of Percutaneous Nephrolithotomy (PNL) attempts.
AIM
To assess the indications and outcomes of AN in the modern era.
MATERIALS AND METHODS
Between April 2008 and July 2015, AN was done in 14 renal units in 13 patients. In this retrospective study, demography, stone characteristics, operative details, clearance and long term outcomes were assessed.
RESULTS
AN was performed for complex staghorn calculi involving pelvis and all calyces in 10 patients, infundibular stenosis in two patients and failed PNL in one patient. Mean (SD) in situ cold ischemia time was 47.64 (5.27) minutes. Retroperitoneal drain and double J stent were placed in all 13 patients. Median (IQR) estimated blood loss was 130 (75) ml. There was no perioperative mortality. Surgical site infection was seen in 2 patients and urosepsis in 2 patients. Drain was removed at a mean (SD) of 9.11 (6.15) days. Mean (SD) postoperative length of hospitalization was 15.44 (7.14) days. Stent removal was done in all patients between 2-8 weeks. Median (IQR) clearance was 95 (7.5%). There was no renal failure or new calculi during the follow up period {median (IQR): 1(3) years}.
CONCLUSION
AN is effective in management of large staghorn calculi failed minimally invasive approaches and achieves 80%-100% clearance without much need for secondary interventions. Renal function is preserved and with emergence of laparoscopy and robotics, postoperative stay is minimized with expedited recovery and comparable results with open surgery.
PubMed: 28658843
DOI: 10.7860/JCDR/2017/24723.9837 -
Anesthesiology and Pain Medicine Aug 2022Percutaneous nephrolithotomy (PNL) is the treatment of choice for renal stones as a safe, effective, and minimally invasive method. However, bleeding remains a major...
BACKGROUND
Percutaneous nephrolithotomy (PNL) is the treatment of choice for renal stones as a safe, effective, and minimally invasive method. However, bleeding remains a major concern in the procedure.
OBJECTIVES
This study aimed to investigate the risk factors of bleeding in PNL.
METHODS
This retrospective descriptive cross-sectional study was conducted in the Urology department of Razi hospital. The data of patients with urinary calculi staghorn type who underwent PNL in a prone position under general anesthesia were recorded. A checklist including patients' demographics, surgical characteristics, and outcomes was filled out for each patient.
RESULTS
The data from 151 complete files were gathered. The mean age of the cases was 47.89 ± 12.41 years. The mean hemoglobin (Hb) drop was 1.92 ± 1.56 mg/dL. At least 1 mg/dL Hb drop was observed in all cases. The highest Hb drop was 3 mg/dL.). There was no significant relationship between stone bulk, age, BMI, GFR, surgery duration, and the number of tracts, and Hb drop during PNL (P > 0.05). But there was a positive correlation between Urinary Tract Infection (UTI) history (P = 0.01) and transfusion (P = 0.0001) and Hb drop during PNL. Also, the history of open kidney surgery (P = 0.031), nephrostomy insertion (P = 0.003), and extracorporeal shock wave lithotripsy therapy (ESWL) (P = 0.041) were correlated with the increased risk of Hb drop.
CONCLUSIONS
Urinary tract infection, history of open surgery, nephrostomy implantation, and ESWL were significantly associated with more bleeding in PNL.
PubMed: 36937085
DOI: 10.5812/aapm-126974