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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 -
Asian Journal of Urology Apr 2020
PubMed: 32257798
DOI: 10.1016/j.ajur.2019.12.015 -
Asian Journal of Urology Apr 2020Due to their large size, rapid growth, and attendant morbidity, staghorn calculi are complex clinical entities that impose significant treatment-related challenges.... (Review)
Review
Due to their large size, rapid growth, and attendant morbidity, staghorn calculi are complex clinical entities that impose significant treatment-related challenges. Moreover, their relative heterogeneity-in terms of both total stone burden and anatomic distribution-limits the ability to standardize their characterization and the reporting of surgical outcomes. Several morphometry systems currently exist to define the volumetric distribution of renal stones, in general, and to predict the outcomes of percutaneous nephrolithotomy; however, they fall short in their applicability to staghorn stones. In this review, we aim to discuss the clinical utility of morphometry systems and the influence of pelvicalyceal anatomy on the management of these complex calculi.
PubMed: 32257799
DOI: 10.1016/j.ajur.2019.06.001 -
American Journal of Clinical and... 2022For urologists, treating staghorn stones remains a difficult challenge. Various studies have evaluated the results of percutaneous nephrolithotomy (PCNL) and open...
BACKGROUND
For urologists, treating staghorn stones remains a difficult challenge. Various studies have evaluated the results of percutaneous nephrolithotomy (PCNL) and open surgery in different populations but these results were controversial. Here, we aimed to compare and evaluate the results of open surgery and PCNL in the treatment of staghorn stones.
METHODS
This retrospective descriptive study was performed to compare the results of open surgery and PCNL in the treatment of staghorn stones in 2013-2021. A total of 360 participants were studied among the population. Demographic data of patients including age, gender, and comorbidities were obtained. We assessed variables including type of stone, serum creatinine, degree of hydronephrosis, and urine culture before the operation. All participants in our study were informed of the two surgical alternatives.
RESULTS
The mean length of hospital stay in PCNL patients was 3.88 ± 1.76 and in open surgery patients was 5.858 ± 2.12 (P = 0.003). In 30 patients (13.9%) in the PCNL group and 27 patients (18.8%) in the open surgery group, bleeding necessitating blood transfusion was the only intraoperative complication. 309 patients (85%) had no residual stones at the time of discharge from the hospital, which was 81.9% (177 cases) in patients treated with PCNL and 91.6% (132 patients) in the open surgery group (P > 0.05).
CONCLUSION
Staghorn calculi can be managed effectively with open surgery or PCNL. Given the reduced postoperative complication rate and higher stone-free rate, we believe open surgery is better technique for complicated staghorn stones with a high burden.
PubMed: 36051615
DOI: No ID Found -
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