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Jornal Brasileiro de Nefrologia 2023
Topics: Humans; Staghorn Calculi; Kidney Calculi
PubMed: 37930143
DOI: 10.1590/2175-8239-JBN-2023-0072en -
Progres En Urologie : Journal de... Nov 2023The primary objective of the combined approach is to limit the number of percutaneous access tracts for the treatment of staghorn, or complex kidney stones by... (Review)
Review
The primary objective of the combined approach is to limit the number of percutaneous access tracts for the treatment of staghorn, or complex kidney stones by simultaneous percutaneous antegrade and retrograde ureteroscopy. The other indication is the simultaneous presence of several kidney and ureteral stones or of an impacted pelvic stone. The combination of the two techniques may increase the stone-free rate and decrease the retreatment rate of complex stones compared with percutaneous nephrolithotomy alone. The patient is usually in the modified supine position. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU Guidelines on urolithiasis. 2022] and their adaptability to the French context.
Topics: Humans; Lithiasis; Nephrostomy, Percutaneous; Ureteroscopy; Ureteral Calculi; Kidney Calculi; Kidney; Treatment Outcome
PubMed: 37918986
DOI: 10.1016/j.purol.2023.08.009 -
Medicine Oct 2023Black hairy tongue (BHT) is a rare condition that is conventionally managed by discontinuing associated medications or habits and practicing good oral hygiene, including...
RATIONALE
Black hairy tongue (BHT) is a rare condition that is conventionally managed by discontinuing associated medications or habits and practicing good oral hygiene, including tongue brushing. Previous studies have indicated that black tongue coating is often associated with gastrointestinal discomfort, which traditional Chinese medicine (TCM) could be a potentially effective option for treating this condition with minimal side effects. We present a case of BHT diagnosed and treated within 2 weeks by using TCM methods.
PATIENT CONCERNS
A 73-year-old woman presented with a chief concern of a black tongue that had persisted for 2 weeks and was accompanied by thirst and diarrhea. These symptoms were initially observed during her hospitalization for the treatment of staghorn calculi, xanthogranulomatous pyelonephritis, and urosepsis. Using the "four diagnostic methods" of TCM, we observed that her tongue had a thick black coating surrounded by a thick white coating; her tongue was of medium size with tooth marks, and its body color was light red.
DIAGNOSES, INTERVENTIONS, AND OUTCOMES
On the basis of TCM theory, we made a clinical diagnosis of BHT and "spleen Qi deficiency with turbid dampness," which may have been caused by the antibiotic treatment during hospitalization. Subsequently, we administered a Chinese herbal medicine (CHM) formula comprising a combination of Wu-Ling-San () and a modification of Da-Yuan-Yin (). After 2 weeks of CHM treatment, the patient's BHT was nearly eliminated, and the thick white coating and the corresponding symptoms were ameliorated. After 4 weeks of CHM treatment, the BHT was completely resolved.
LESSON AND CONCLUSION
We present a case of BHT, a benign condition that may be caused by antibiotics. The literature does not contain reports on TCM-based diagnosis and treatment strategies for BHT. Using the 4 diagnostic methods of TCM, we observed that BHT was associated with gastrointestinal symptoms, which is consistent with the TCM theory. Moreover, CHM treatment rapidly relieved BHT and related symptoms without adverse events.
Topics: Humans; Female; Aged; Medicine, Chinese Traditional; Tongue, Hairy; Anti-Bacterial Agents; Tongue
PubMed: 37904483
DOI: 10.1097/MD.0000000000034430 -
Qatar Medical Journal 2023Staghorn calculi (SC) occupy the renal pelvis and calyces and are common in females linked to repeated urinary tract infections (UTIs). Judicious surgery planning...
INTRODUCTION
Staghorn calculi (SC) occupy the renal pelvis and calyces and are common in females linked to repeated urinary tract infections (UTIs). Judicious surgery planning reduces the chance of further damage to the kidney due to renal SCs. Open stone surgery (OSS) is one of the various operative techniques to remove such huge stones with one operative intervention and protect the kidney from ongoing functional damage.
CASE REPORT
A 47-year-old male patient presented with right-sided renal colic pain, and on further investigations, he was diagnosed with a large renal stone responsible for substantial renal function impairment on the same side. The SC measured 8 × 4 cm with another stone in the lower calyx. thinner parenchyma, and only 16% relative function. Therefore, open surgery was selected over less invasive approaches because multiple lithotripsy (ESWL) sittings may have been required in less invasive options.
DISCUSSION
SCs, which can be complete or partial, often result in renal impairment. Hence, it is crucial to implement a proactive therapeutic approach that includes a thorough evaluation of the stone's size and position, the patient's choice, and institutional capacity. Complete elimination of SCs is preferred to maintain maximal renal function. Based on clinical, technical, and socioeconomic considerations, open pyelolithotomy or OSS was chosen over percutaneous nephrolithotomy for SC removal in the discussed case.
CONCLUSION
The ability to remove large stones in a single intervention with open pyelolithotomy has been very effective due to its distinctive clinical presentation and pathological abnormalities.
PubMed: 37885907
DOI: 10.5339/qmj.2023.30 -
Urologia Internationalis 2023The goal of this study was to evaluate the efficacy and safety of needle-perc-assisted endoscopic surgery (NAES) in the treatment of staghorn renal stones via a... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
The goal of this study was to evaluate the efficacy and safety of needle-perc-assisted endoscopic surgery (NAES) in the treatment of staghorn renal stones via a single-center prospective randomized controlled study.
METHODS
A total of 219 patients with partial or complete staghorn renal stones were prospectively randomized into two groups between January 2020 and April 2022. In group A (n = 112), patients were treated with traditional standard access, multiple if necessary, and in group B (n = 107), only one standard access was made, and needle-perc was assisted to remove the residual stones in the same stage. All procedures were guided under ultrasound totally. Stone size, operating time, blood loss, pain score, complications, and other related characteristics were monitored and analyzed.
RESULTS
Procedures were successful in all patients. The baseline characters were similar between the groups. The mean stone size was comparable (4.5 ± 1.4 vs. 4.7 ± 1.7, p = 0.35). The 1-month stone-free status was achieved in 85 patients (75.9%) in group A and 80 (74.8%) patients in group B (p = 0.72). The operation time was shorter in group A than B (75.1 ± 28.1 min vs. 97.2 ± 20.4 min, p = 0.02). A less blood loss (p = 0.01), shorter hospital stay (p = 0.04), lower pain score (p = 0.04), and lower severe complication rates (p = 0.03) were observed in group B.
CONCLUSION
NAES reveals better postoperative recurrence compared with traditional multiple tracts method for treating staghorn renal stones. The stone-free rate was comparable between the two groups.
Topics: Humans; Prospective Studies; Nephrolithotomy, Percutaneous; Kidney Calculi; Staghorn Calculi; Pain; Treatment Outcome; Retrospective Studies; Nephrostomy, Percutaneous
PubMed: 37883927
DOI: 10.1159/000533955 -
International Journal of Computer... May 2024We propose the utilization of patient-specific concentric-tube robots (CTRs) whose designs are optimized to enhance their volumetric reachability of the renal stone,...
PURPOSE
We propose the utilization of patient-specific concentric-tube robots (CTRs) whose designs are optimized to enhance their volumetric reachability of the renal stone, thus reducing the morbidities associated with percutaneous nephrolithotomy procedures. By employing a nested optimization-driven scheme, this work aims to determine a single surgical tract through which the patient-tailored CTR is deployed. We carry out a sensitivity analysis on the combined percutaneous access and optimized CTR design with respect to breathing-induced excursion of the kidneys based on preoperative images. Further, an investigation is also performed of the appropriateness and effectiveness of the percutaneous access provided by the proposed algorithm compared to that of an expert urologist.
METHODS
The method is based on an ellipsoidal approximation to the renal calculi and a grid search over candidate skin areas and available renal calyces using an anatomically constrained kinematic mapping of the CTR. Percutaneous access is selected for collision-free CTR deployment to the centroid of the stones with minimal positional error at the renal calyx. Further optimization of the CTR design results in a robot tailored to the therapeutic anatomical features of each clinical case. The study examined 14 sets of clinical data of PCNL patients, analyzing stone reachability using preoperative images and breathing-induced motions of the kidney. An experienced urologist qualitatively assessed the adequacy of percutaneous access generated by the algorithm.
RESULTS
An assessment conducted by an expert urologist found that the percutaneous accesses produced by the proposed approach were found to be comparable to those chosen by the expert surgeon in most clinical cases. The simulated results demonstrated a mean volume coverage of for static anatomy and and when considering a 1 cm excursion of the kidney in the craniocaudal directions due to respiration or tool-tissue interaction.
CONCLUSION
The optimization-driven scheme for determining a single tract surgical plan, coupled with the use of a patient-specific CTR, shows promising results for improving percutaneous access in PCNL procedures. This approach clearly shows the potential for enhancing the quality and suitability of percutaneous accesses, addressing the challenges posed by staghorn and non-staghorn stones during PCNL procedures. Further research involving clinical validation is necessary to confirm these findings and explore the potential clinical benefits of the approach.
Topics: Humans; Nephrolithotomy, Percutaneous; Kidney Calculi; Surgery, Computer-Assisted; Algorithms; Robotic Surgical Procedures; Tomography, X-Ray Computed; Female; Male
PubMed: 37882980
DOI: 10.1007/s11548-023-03029-3 -
Journal of Medical Case Reports Oct 2023The most common source of pyogenic liver abscess is biliary tract infection. Other less common routes include the spread of bacteria from distant foci. However, direct...
BACKGROUND
The most common source of pyogenic liver abscess is biliary tract infection. Other less common routes include the spread of bacteria from distant foci. However, direct extension of a perinephric infection focus to the liver is extremely rare.
CASE REPORT
The patient was a non-diabetic, immunocompetent, 29-year-old woman of mixed race ancestry with a history of recurrent urinary tract infections who was referred to our hospital because of an ultrasound-detected liver abscess. She was initially treated with metronidazole for 20 days at the referring institution for suspected amebic abscess without improvement. On admission to our center, she was febrile and complained of a dull right upper quadrant pain. A POCUS ultrasound suggested a pyogenic abscess, probably from a staghorn calculus infection. She received meroperem and amikacin for 22 and 10 days, respectively. Repeat hemocultures showed no growth, but urine cultures were positive for Proteus sp. Complete remission of clinical and imaging findings was observed under antibiotics. The patient was referred to the urology outpatient clinic to discuss the option of radical nephrectomy. CONCLUSION : This case underlines the high morbidity of staghorn calculi.
Topics: Female; Humans; Adult; Staghorn Calculi; Liver Abscess; Ultrasonography; Anti-Bacterial Agents; Amikacin
PubMed: 37867194
DOI: 10.1186/s13256-023-04173-9 -
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 -
The Canadian Journal of Urology Oct 2023Proper antegrade access for percutaneous nephrolithotomy (PCNL) is essential for success but can be challenging. Previous work evaluating access obtained by...
INTRODUCTION
Proper antegrade access for percutaneous nephrolithotomy (PCNL) is essential for success but can be challenging. Previous work evaluating access obtained by interventional radiology (IR), largely in the emergent setting, has shown high rates of additional access at the time of PCNL. We hypothesize that efforts to improve pre-procedural communication between urology and IR can impact the utility of the access for subsequent PCNL.
MATERIAL AND METHODS
We conducted a retrospective review of patients undergoing PCNL at a single hospital from January 2011 to December 2022. Adult patients undergoing PCNL with established preoperative access were included.
RESULTS
A total of 141 cases were identified with preoperative access. A total of 111 patients had evidence of planning with IR prior to antegrade access. There were high rates of anatomic abnormality (50%) and staghorn calculus (53%). Patients with planned access had higher body mass index (BMI). While preoperative access was initially utilized in 97% of cases, 6% required additional access to be obtained intraoperatively; this included a low rate of new access in those that were previously discussed with IR (4% vs. 17%, p = 0.02). Overall stone free rates (91%), rates of second stage procedures (55%) and complications (14%) were similar between planned and unplanned groups.
CONCLUSION
In this retrospective study of complex patients with large stone burden presenting for PCNL with preoperative antegrade access obtained by IR, the rate of new access was far lower than prior reports. This was likely influenced by urologist involvement in planning access.
Topics: Adult; Humans; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Kidney Calculi; Retrospective Studies; Treatment Outcome; Radiologists
PubMed: 37838997
DOI: No ID Found -
Cureus Sep 2023Xanthogranulomatous pyelonephritis is a rare disease resulting from chronic inflammation and infection of the renal parenchyma. It usually arises as a consequence of...
Xanthogranulomatous pyelonephritis is a rare disease resulting from chronic inflammation and infection of the renal parenchyma. It usually arises as a consequence of obstructive chronic pyelonephritis. Primary squamous cell carcinoma of the renal pelvis is a distinct pathology, very rare in clinical practice, with a well-established association with xanthogranulomatous pyelonephritis. The authors present the case of a 57-year-old woman with chronic pyelonephritis containing xanthogranulomatous features. Subsequent workup revealed a concomitant, unsuspected, primary squamous cell carcinoma of the renal pelvis. With this case, the authors intend to emphasize and reinforce the need to be alert to an uncommon association between two rare diseases due to its diagnostic, therapeutic, and prognostic implications.
PubMed: 37809217
DOI: 10.7759/cureus.44750