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Clinical Practice and Cases in... Aug 2021A 25-year-old woman presented to the emergency department with two weeks of crampy right-flank pain, and urinary urgency and frequency. She was found to have a staghorn...
CASE PRESENTATION
A 25-year-old woman presented to the emergency department with two weeks of crampy right-flank pain, and urinary urgency and frequency. She was found to have a staghorn calculus filling her entire right renal pelvis on computed tomography imaging.
DISCUSSION
In contrast to ureteral calculi, staghorn calculi are more commonly observed in female patients and typically present with an indolent clinical course. A low threshold for imaging should be maintained, as prompt referral to urology for stone removal or treatment is necessary. Staghorn calculi have a high likelihood of leading to renal failure or urosepsis without treatment.
PubMed: 34437048
DOI: 10.5811/cpcem.2021.4.50360 -
World Journal of Urology Dec 2022To evaluate the effectiveness and safety of nonpapillary prone endoscopic combined intrarenal surgery (ECIRS) and provide practical tips and tricks for the successful...
PURPOSE
To evaluate the effectiveness and safety of nonpapillary prone endoscopic combined intrarenal surgery (ECIRS) and provide practical tips and tricks for the successful accomplishment of the procedure respecting the anatomical particularities.
MATERIAL AND METHODS
This study is an analysis of a prospectively collected database including all cases of ECIRS performed between January 2019 and December 2021 in a high-volume tertiary center. All patients underwent the procedure in prone-split leg position. A nonpapillary renal puncture was performed. The used access sheaths were 22Fr or 30Fr. Lithotripsy was performed anterogradely with a dual-energy lithotripter with incorporated suction and retrogradely with holmium Yttrium-Aluminum-Garnet laser.
RESULTS
A total of 33 patients were included. The initial stone-free rate (SFR) was 84.8% and the final SFR was 90.9%. The median stone size was 35 mm and 60% of patients had staghorn calculi. The prevalence of renal abnormalities was 21.3%, including 3 cases of horseshoe kidney, 2 cases of malrotation and 2 cases with complete duplicated systems. The median operative time was 47 min. The median hospital stay was 3 days and median hemoglobin loss was 1.2 gr/dL. Overall, the complication rate was 9.1%, all being Grade II complications (n = 2 fever and n = 1 transient bleeding).
CONCLUSIONS
Nonpapillary prone ECIRS is an effective and safe procedure. Standardization of the procedure is critical to achieve good outcomes. Patients who benefit the most are probably the ones where additional punctures can be avoided using this technique, namely patients with renal abnormalities, incrusted ureteral stents and staghorn stones.
Topics: Humans; Nephrostomy, Percutaneous; Ureteroscopy; Kidney Calculi; Retrospective Studies; Lithotripsy; Staghorn Calculi; Treatment Outcome
PubMed: 36251056
DOI: 10.1007/s00345-022-04178-x -
Radiology Case Reports Mar 2022Staghorn calculi account for about 4% of presenting renal stones in developed countries, are source of recurrent urinary tract infection, and may be eventually treated...
Staghorn calculi account for about 4% of presenting renal stones in developed countries, are source of recurrent urinary tract infection, and may be eventually treated by surgical stone removal. A 55-year-old female with a history of staghorn renal calculi and recurrent urinary tract infections presented with a left flank and lower abdominal pain following recent left robotic partial nephrectomy and nephrolithotomy. Contrast-enhanced computed tomography (CT) of the abdomen demonstrated a large left-sided retroperitoneal fluid collection with a few dropped renal stones in the dependent portion of the collection. The patient treated with early percutaneous drainage of the collection and antibiotic treatment and responded well clinically. The clinical and imaging presentation of a rare case of retroperitoneal abscess formation caused by dropped renal stones is described in this study. Imaging, particularly ultrasound and CT, plays a key role in detecting the dropped renal stones and can help with differential diagnosis and treatment plans.
PubMed: 34917225
DOI: 10.1016/j.radcr.2021.11.020 -
Archivos Espanoles de Urologia Jan 2020To evaluate the impact of a new renal lithiasis classification on the stone free rate. The new system would allow standarization of comparison between different series...
OBJECTIVE
To evaluate the impact of a new renal lithiasis classification on the stone free rate. The new system would allow standarization of comparison between different series of percutaneous nephrolithotomy.
MATERIAL AND METHODS
Patients undergoing NPCL between November 2011 and November 2016 were retrospectively analyzed. The stones were classified as simple (pelvic and/or calyceal stones that required a single access and/or use of a rigid nephroscope), complex (required the use of more than one percutaneous access and/or flexible instruments and/or combined access) and extremely complex (complete staghorn stones or anatomical alterations), according to the Ibarluzea-Llanes classification. Other variables analyzed were age, sex, diabetes, hypertension or taking anticoagulants, stones composition, placement of postoperative nephrostomy and surgical time. We performed a univariate and multivariate analysis using the chi-square or Fisher test and logistic regression.
RESULTS
Sixty-nine procedures were included in 57 patients with a mean age of 51 years (13-84) and a mean follow-up time of 30 months. The stone free rate was 86%, 75% and 55% for a simple, complex or extremely complex stone, both at three months and a year. Only the stone type was associated with a worse stone free rate (p 0.03) with RR of 2.5 for a 95% CI.
CONCLUSIONS
The Ibarluzea-Llanes clasification could be used as a new system for standarization of PCNL outcomes reporting.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Humans; Kidney Calculi; Middle Aged; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Operative Time; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 31950920
DOI: No ID Found -
Canadian Urological Association Journal... Apr 2022Ambulatory percutaneous nephrolithotomy (PCNL) has been limited to highly selected patients. The objective of our study was to compare complication and stone-free rates...
INTRODUCTION
Ambulatory percutaneous nephrolithotomy (PCNL) has been limited to highly selected patients. The objective of our study was to compare complication and stone-free rates after ambulatory PCNL in standard selection criteria vs. extended criteria patients.
METHODS
We conducted a retrospective review of prospective data on all patients who underwent ambulatory PCNL at one academic center from 2007-2018. Extended criteria patients were defined as one or more of: age >75 years, body mass index (BMI) >30 kg/m, American Society of Anesthesiologists (ASA) score >2, bilateral stones, solitary kidney, transplant kidney, complete staghorn calculi, stone burden >40 mm, multiple tracts, or prior nephrostomy tubes/stents. Primary outcomes were complication rates (Clavien-Dindo classification) and stone-free rates.
RESULTS
We identified 118 patients, of which 92 (78%) met extended criteria. Mean BMI was 31 kg/m and 45% were ASA 3 or higher. Mean sum maximum stone diameter was 24 mm. Multiple stones were present in 25%, bilateral stones in 7%, and complete staghorn stones in 4% of patients. There was no difference in complication (12% vs. 18%, p=0.56), emergency department visit (12% vs. 18%, p=0.56), or re-admission (4% vs. 5%, p=1) rates between standard and extended criteria patients, respectively. Of the complications, 85% were Clavien-Dindo grade 1. Stone-free rates were not different between standard (84%) and extended (83%) criteria patients (p=1). No extended criteria variables were associated with complications in multivariable analysis.
CONCLUSIONS
Complication and stone-free rates were not different between standard and extended selection criteria patients undergoing ambulatory PCNL. This data indicates that many of the preoperative patient and stone factors that have previously been used as exclusion criteria for ambulatory PCNL are not strictly necessary.
PubMed: 34812729
DOI: 10.5489/cuaj.7527 -
Urology Annals 2022Infectious complications following stone lithotripsy is a significant source of patient morbidity and mortality. Post percutaneous nephrolithotomy fever is reported in...
BACKGROUND AND OBJECTIVE
Infectious complications following stone lithotripsy is a significant source of patient morbidity and mortality. Post percutaneous nephrolithotomy fever is reported in 37% of patients undergoing PCNL and sepsis is the most common cause of mortality following PCNL. Thus, there is an urgent need to tackle lithotripsy-associated bacteremia occurring intraoperatively, keeping in mind the threat of emerging global antibiotic resistance. The aim of our study was to study the efficacy of using intermittent 0.35% dilute Povidone-Iodine (PI) irrigation during PCNL in reducing postoperative infection rate.
MATERIALS AND METHODS
This is a prospective observational study done in 24 patients diagnosed with Staghorn and matrix calculi requiring PCNL. All patients were taken up for the procedure with sterile urine culture or after treating them with culture-specific antibiotic with initial positive urine culture. Intraoperative pelvic urine was sent for culture and sensitivity. 0.35% dilute PI irrigation was used intermittently during the procedure. Patients were monitored and assessed for signs of post-PCNL infection and PI-related side effects. The results were compared with similar group of patients with similar stone characteristics who underwent PCNL before adopting the dilute PI irrigation protocol (non-PI irrigation group).
RESULTS
Among 24 patients, 18 patients had partial or complete Staghorn and 6 had matrix calculi. Five patients with Staghorn and three patients with matrix calculi had positive renal pelvic urine culture. In the non-PI irrigation group, 19 patients had Staghorn stones and 5 had matrix calculi. Three patients with Staghorn and two patients with matrix calculi had positive renal pelvic urine culture. Three patients (12.5%) had postoperative fever in the dilute PI irrigation group, compared to 11 patients (45.8%) in the non-PI irrigation group. No patient had PI-related complications.
CONCLUSION
Our prospective study highlights that the use of 0.35% dilute PI irrigation intermittently during PCNL reduces the postoperative infection rate significantly.
PubMed: 36505996
DOI: 10.4103/ua.ua_111_21 -
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 -
Annals of Medicine 2023To compare the anaesthesia methods in percutaneous nephrolithotomy in terms of safety and effectiveness in elderly men. Elderly male patients who had undergone...
To compare the anaesthesia methods in percutaneous nephrolithotomy in terms of safety and effectiveness in elderly men. Elderly male patients who had undergone percutaneous nephrolithotomy were screened retrospectively and divided into 2 groups: percutaneous nephrolithotomy under combined spino-epidural anaesthesia (Group CSEA, = 70) and percutaneous nephrolithotomy under general anaesthesia (Group GA, = 114). Preoperative, perioperative and postoperative outcome measures were examined. Between the two groups, there was no statistically significant difference in terms of stone burden, stone location, presence of the previous operation in the same kidney, presence of staghorn stones, mean American Society of Anesthesiologists scores and presence of abnormal kidney ( > 0.05). The mean duration time in the operation room and post-anaesthesia care unit (PACU) was statistically shorter in the Group CSEA ( < 0.01). There was no significant difference between the two groups in terms of Clavien Grade 1 and above complications ( > 0.05). Stone-free rates and success rates were similar in both groups ( = 0.133 and = 0.273, respectively). The type of anaesthesia does not affect the success rate and complication rate of percutaneous nephrolithotomy in elderly male patients. Patients who underwent percutaneous nephrolithotomy under CSEA needed less analgesic injection during the postoperative period. CSEA can shorten the time a patient spends in the operating room and PACU, which provides more effective use of operation room working hours.
Topics: Aged; Humans; Male; Nephrolithotomy, Percutaneous; Retrospective Studies; Kidney; Anesthesia, Epidural; Anesthesia, General
PubMed: 37480584
DOI: 10.1080/07853890.2023.2238185 -
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 -
Journal of Cancer Research and... Jan 2023Squamous cell carcinoma of the kidney is a rare malignancy, usually not suspected clinically because of the lack of any pathognomic sign and ambiguous clinical and... (Review)
Review
Squamous cell carcinoma of the kidney is a rare malignancy, usually not suspected clinically because of the lack of any pathognomic sign and ambiguous clinical and radiological features, and thus, patients present at advanced stages resulting in poor prognosis. We report here four cases of incidentally diagnosed primary renal squamous cell carcinoma that were treated at our hospital. The mean age of the patients (two females and one male aged above 60 years, except one male whose age was 25 years) was 60 years. Both the males and one of the females had a history of multiple renal calculi, and the other female had staghorn calculus. Interestingly, renal carcinoma was not suspected clinically in all these patients. In one case, a computerized tomography scan (CT scan) showed suspicious mass. All underwent nephrectomy for the non-functioning kidney. In only two cases, tumor was identified on gross examination, whereas the other two only showed a distorted pelvis. Our case series emphasizes the need for pelvicalyceal biopsy during diagnosis and treatment for long-standing nephrolithiasis and thorough sampling of nephrectomy specimens of such patients to rule out malignancy.
Topics: Humans; Male; Female; Middle Aged; Adult; Kidney Neoplasms; Kidney Pelvis; Kidney; Carcinoma, Renal Cell; Nephrectomy; Carcinoma, Squamous Cell
PubMed: 38384082
DOI: 10.4103/jcrt.jcrt_1013_22