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World Journal of Clinical Cases Mar 2024It is possible that this condition will lead to urosepsis and progressive deterioration of renal function in the absence of surgical intervention. Several recent...
BACKGROUND
It is possible that this condition will lead to urosepsis and progressive deterioration of renal function in the absence of surgical intervention. Several recent clinical studies have shown that multi-tract percutaneous nephrolithotomy (M-PCNL) has a similar stone free rate (SFR) as standard percutaneous nephrolithotomy (S-PCNL). As a result, M-PCNL was also recommended as a treatment option for staghorn calculi.
AIM
To examine the perioperative and long-term results of ultrasonography-guided single- and M-PCNL.
METHODS
This was a retrospective cohort study. Between March 2021 and January 2022, the urology department of our hospital selected patients for the treatment of staghorn calculi using percutaneous nephrolithotomy. The primary outcomes were complication rate and SFR, and the characteristics of patients, operative parameters, laboratory measurements were also collected.
RESULTS
In total, 345 patients were enrolled in the study (186 in the S-PCNL group and 159 in the M-PCNL group). The SFR in the M-PCNL group was significantly higher than that in the S-PCNL group ( = 0.033). Moreover, the incidence rates of hydrothorax ( = 0.03) and postoperative infection ( = 0.012) were higher in the M-PCNL group than in the S-PCNL group. Logistic regression analysis demonstrated that post-operative white blood cell count (OR = 2.57, 95%CI: 1.90-3.47, < 0.001) and stone size (OR = 1.59, 95%CI: 1.27-2.00, < 0.001) were associated with a higher overall complication rate in the S-PCNL group. Body mass index (OR = 1.22, 95%CI: 1.06-1.40, = 0.004) and stone size (OR = 1.70, 95%CI: 1.35-2.15, < 0.001) were associated with increased overall complications in the M-PCNL group.
CONCLUSION
Multiple access tracts can facilitate higher SFR while slightly increasing the incidence of acceptable complications.
PubMed: 38524503
DOI: 10.12998/wjcc.v12.i7.1243 -
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 -
Revista Da Sociedade Brasileira de... 2023
Topics: Humans; Staghorn Calculi; Candida albicans; Abscess; Kidney Diseases; Urinary Tract Infections
PubMed: 37851830
DOI: 10.1590/0037-8682-0421-2023 -
Urolithiasis Feb 2024The aim is to compare the efficacy and safety between single percutaneous nephrolithotomy (sPNL) and antegrade flexible ureteroscopy-assisted percutaneous... (Randomized Controlled Trial)
Randomized Controlled Trial
The aim is to compare the efficacy and safety between single percutaneous nephrolithotomy (sPNL) and antegrade flexible ureteroscopy-assisted percutaneous nephrolithotomy (aPNL) for the treatment of staghorn calculi. A prospective randomized controlled study was conducted at the Second Hospital of Tianjin Medical University. A total of 160 eligible patients were included, with 81 in the sPNL group and 79 in the aPNL group. The study first compared the overall differences between sPNL and aPNL. Then, the patients were divided into two subgroups: Group 1 (with less than 5 stone branches) and Group 2 (with 5 or more stone branches), and the differences between the two subgroups were further analyzed. The results showed that aPNL had a higher stone-free rate (SFR) and required fewer percutaneous tracts, with a shorter operation time compared to sPNL (P < 0.05). Moreover, aPNL significantly reduced the need for staged surgery, particularly in patients with 5 or more stone branches. Moreover, there were no significant differences in the changes of hemoglobin levels and the need for blood transfusions between the sPNL and aPNL groups, and the incidence of multiple tracts was lower in the aPNL group. The two groups showed comparable rates of perioperative complications. We concluded that aPNL resulted in a higher SFR for staghorn calculi, and required fewer multiple percutaneous tracts, reduced the need for staged surgery, and had a shorter operative time than PNL alone, especially for patients with 5 or more stone branches. Furthermore, aPNL did not increase the incidence of surgical complications.
Topics: Humans; Staghorn Calculi; Nephrolithotomy, Percutaneous; Ureteroscopy; Prospective Studies; Treatment Outcome; Kidney Calculi; Nephrostomy, Percutaneous; Retrospective Studies
PubMed: 38340170
DOI: 10.1007/s00240-024-01528-9 -
Journal of Research in Medical Sciences... 2024The objective is to evaluate the prevalence of acute kidney injury (AKI) as an early complication of the percutaneous nephrolithotomy (PCNL) procedure.
BACKGROUND
The objective is to evaluate the prevalence of acute kidney injury (AKI) as an early complication of the percutaneous nephrolithotomy (PCNL) procedure.
MATERIALS AND METHODS
From May 2022 to October 2022, we conducted a retrospective study on patients undergoing PCNL procedures in two of the tertiary medical centers affiliated with Isfahan University of Medical Sciences. Patients' baseline characteristics, laboratory values, perioperative data, and stone features were documented. AKI was defined either as a ≥0.3 mg/dL increase in the serum creatinine level within 2 days, or a ≥1.5-fold increase in baseline serum creatinine level within 7 days after the operation. Laboratory values were measured 1 day before PCNL and daily thereafter until discharge. Patients were followed 1 week later to detect all of the possible cases of AKI.
RESULTS
The final analysis was performed on 347 individuals. AKI developed in 16 (4.61%) cases. The two groups were comparable regarding age ( = 0.887), gender ( = 0.566), and underlying comorbidities including diabetes mellitus ( = 0.577) and hypertension ( = 0.383). The mean body mass index (BMI) ( < 0.001) and both frequency and severity of hydronephrosis ( < 0.001) were significantly different. A higher mean PCNL duration ( < 0.001), period of hospitalization ( < 0.001), and blood loss volume ( < 0.001) were observed in those who developed AKI. Overall, 56.3% (9) of patients in the AKI group and 2.7% (9) in the non-AKI group required the establishment of more than one access tract, during the procedure ( < 0.001). A lower preoperative hemoglobin level was observed in the AKI group ( < 0.001). Those with AKI had significantly larger stones (3.08 ± 0.46 vs. 2.41 ± 0.23 cm, < 0.001) and higher Hounsfield units ( < 0.001). In addition, in the AKI group, most of the calculi (81.3%, 13) were of staghorn type, whereas in the non-AKI group, calculi were most frequently located in the middle calyx (30.2%, 100), ( < 0.001).
CONCLUSION
The prevalence of post-PCNL AKI is approximately 4.61%. The mean BMI, preoperative hemoglobin level, PCNL duration, intraoperative blood loss volume, and hospitalization period were significantly higher among patients who developed AKI. Those with AKI had significantly larger stones with higher Hounsfield units and more frequently of staghorn type. The two groups were not statistically different regarding age, gender, and presence of comorbidities (hypertension and diabetes mellitus).
PubMed: 38808219
DOI: 10.4103/jrms.jrms_317_23 -
Frontiers in Endocrinology 2023A model to predict preoperative outcomes after percutaneous nephrolithotomy (PCNL) with renal staghorn stones is developed to be an essential preoperative consultation...
BACKGROUND
A model to predict preoperative outcomes after percutaneous nephrolithotomy (PCNL) with renal staghorn stones is developed to be an essential preoperative consultation tool.
OBJECTIVE
In this study, we constructed a predictive model for one-time stone clearance after PCNL for renal staghorn calculi, so as to predict the stone clearance rate of patients in one operation, and provide a reference direction for patients and clinicians.
METHODS
According to the 175 patients with renal staghorn stones undergoing PCNL at two centers, preoperative/postoperative variables were collected. After identifying characteristic variables using PCA analysis to avoid overfitting. A predictive model was developed for preoperative outcomes after PCNL in patients with renal staghorn stones. In addition, we repeatedly cross-validated their model's predictive efficacy and clinical application using data from two different centers.
RESULTS
The study included 175 patients from two centers treated with PCNL. We used a training set and an external validation set. Radionics characteristics, deep migration learning, clinical characteristics, and DTL+Rad-signature were successfully constructed using machine learning based on patients' pre/postoperative imaging characteristics and clinical variables using minimum absolute shrinkage and selection operator algorithms. In this study, DTL-Rad signal was found to be the outstanding predictor of stone clearance in patients with renal deer antler-like stones treated by PCNL. The DTL+Rad signature showed good discriminatory ability in both the training and external validation groups with AUC values of 0.871 (95% CI, 0.800-0.942) and 0.744 (95% CI, 0.617-0.871). The decision curve demonstrated the radiographic model's clinical utility and illustrated specificities of 0.935 and 0.806, respectively.
CONCLUSION
We found a prediction model combining imaging characteristics, neural networks, and clinical characteristics can be used as an effective preoperative prediction method.
Topics: Animals; Humans; Nephrolithotomy, Percutaneous; Artificial Intelligence; Nephrostomy, Percutaneous; Deer; Prognosis; Kidney Calculi
PubMed: 37780621
DOI: 10.3389/fendo.2023.1184608 -
CRSLS : MIS Case Reports From SLS 2023The Boston Scientific Swiss LithoClast® Trilogy lithotripter was intended for use in percutaneous nephrolithotomy. We performed, to our knowledge, the first two robotic...
INTRODUCTION
The Boston Scientific Swiss LithoClast® Trilogy lithotripter was intended for use in percutaneous nephrolithotomy. We performed, to our knowledge, the first two robotic pyelolithotomies using the Trilogy lithotripter for intracorporeal lithotripsy.
CASE DESCRIPTION
Two cases are presented involving a 65-year-old female with a complete left staghorn calculus and hydronephrosis secondary to a left ureteropelvic junction (UPJ) obstruction, and a 69-year-old male with a large left staghorn calculus and multiple large left sided simple renal cysts. In both cases, a robotic pyelolithotomy was scheduled for stone removal along with concurrent UPJ repair and cyst decortication respectively. Following pyeloplasty and cyst decortication respectively, and following stone visualization, the 2.4-mm Trilogy probe was inserted into the 12-mm assistant port and under direct visualization the stone was fragmented and removed using Trilogy's built-in mechanisms. Both patients were treated successfully without complications and were found to be stone-free on follow-up.
CONCLUSION
The Trilogy lithotripter may be an effective tool for stone management when introduced during robotic pyelolithotomy and provides additional optionality when manual extraction poses challenges.
Topics: Aged; Female; Humans; Male; Cysts; Lithotripsy; Robotic Surgical Procedures; Staghorn Calculi
PubMed: 37671366
DOI: 10.4293/CRSLS.2023.00027 -
Jornal Brasileiro de Nefrologia 2023
Topics: Humans; Staghorn Calculi; Kidney Calculi
PubMed: 37930143
DOI: 10.1590/2175-8239-JBN-2023-0072en -
World Journal of Clinical Cases Aug 2023Jackstone is a rare entity of calculi in urinary tracts and has the characteristic appearance resembling toy jacks. They are nearly always reported to occur in the...
BACKGROUND
Jackstone is a rare entity of calculi in urinary tracts and has the characteristic appearance resembling toy jacks. They are nearly always reported to occur in the urinary bladder, we first report a rare case of jackstone located in the obstructed renal calyx.
CASE SUMMARY
We report a 46-year-old man presenting with intermittent, painless gross hematuria and left flank pain. Urinary computed tomography revealed staghorn stones and secondary hydronephrosis. A jackstone with radiating branches was found in one of the dilated renal calyx. Percutaneous nephrolithotomy was performed and endoscopic images were recorded during the operation. Postoperative stone composition analysis revealed it as calcium oxalate monohydrate stones.
CONCLUSION
Jackstones can occur in the renal collecting system besides the bladder. The unique appearance and imaging manifestations are the most important factors in the diagnosis of jackstones, and further exploration of the formation mechanism is required.
PubMed: 37637701
DOI: 10.12998/wjcc.v11.i23.5554