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Urologiia (Moscow, Russia : 1999) Mar 2023An important aspect of the prevention of complications in percutaneous nephrolithotomy (PCNL) is to reduce the likelihood of injury to the adjacent structures and...
INTRODUCTION
An important aspect of the prevention of complications in percutaneous nephrolithotomy (PCNL) is to reduce the likelihood of injury to the adjacent structures and perirenal tissues.
AIM
To determine the efficiency and safety of renal puncture during mini-PCNL with a new atraumatic needle MG.
MATERIALS AND METHODS
A total of 67 patients who underwent mini-percutaneous nephrolithotomy at the Institute of Urology and Human Reproductive Health of Sechenov University were included in the prospective study. For the purpose of homogeneity of the groups, those with staghorn nephrolithiasis, nephrostomy, a history of prior kidney surgery (including PCNL), renal and collecting system anomalies, acute pyelonephritis, and blood clotting disorders were not included. The main group consisted of 34 (50.7%) patients who underwent atraumatic kidney puncture with a new needle MG (MIT, Russia), while in the control group there were 33 (49.3%) patients, who underwent standard puncture with Chiba or Troakar needles (Coloplast A/S, Denmark). The outer diameter of all needles was 18 G.
RESULTS
In patients with a standard access, a hemoglobin decrease in the early postoperative period was more pronounced (p=0.024). The incidence of complications according to the Clavien-Dindo classification did not differ significantly (p=0.351), however, a JJ stent was placed in two patients from the control group due to impaired urine flow and the development of urinoma.
CONCLUSION
Together with a similar stone-free rate, atraumatic needle allows to reduce a hemoglobin drop, as well as less development of severe complications.
Topics: Humans; Kidney Calculi; Needles; Nephrolithotomy, Percutaneous; Prospective Studies; Punctures; Treatment Outcome
PubMed: 37401686
DOI: No ID Found -
Annals of Medicine and Surgery (2012) Jun 2023Staghorn calculi (SC) are defined as large kidney stones that fill the renal pelvis and at least one renal calyx. They represent 10-20% of all renal stones in developing...
UNLABELLED
Staghorn calculi (SC) are defined as large kidney stones that fill the renal pelvis and at least one renal calyx. They represent 10-20% of all renal stones in developing countries and require prompt diagnosis and management. Massive SC (over 5 cm) are treated exclusively via open surgery, despite percutaneous nephrolithotomy (PCNL) being the gold standard treatment for large stones. Descriptions of PCNL for massive SC are very limited in the literature.
CASE PRESENTATION
We report a case of a 63-year-old male who presented with chronic abdominal pain, hepatosplenomegaly, and normal renal function. He was later diagnosed with polycythemia vera. Computed tomography of the abdomen revealed massive, bilateral staghorn stones measuring 7.3×5.5 cm and 1.8×4.5 cm on the right and left, respectively. Additionally, the right stone was found to be compressing the inferior vena cava (IVC). The patient was promptly scheduled for right-sided PCNL and the target of 80% stone fragmentation was successfully attained.
DISCUSSION
We present the first case of a stone of such size in the Middle East, as well as the first known case of a renal stone compressing the IVC. Unlike previous reports, the stone was successfully fragmented via PCNL - a procedure that has not been described for stones of such size.
CONCLUSION
This report highlights that ultrasound-guided PNCL without any other intervention is sufficient for the successful treatment of giant SC. Greater research is needed on the potential utility of using ultrasound-guided PCNL for the fragmentation of stones sized over 5 cm.
PubMed: 37363466
DOI: 10.1097/MS9.0000000000000680 -
Urology Journal Feb 2024Three-Dimensional (3D) could help for planning and creating an optimal access route in percutaneous nephrolithotomy (PCNL) procedure by achieving a more accurate... (Randomized Controlled Trial)
Randomized Controlled Trial
Three-Dimensional Virtual Reconstruction Method versus Standard Fluoroscopy as a Guiding Tool for an Optimal Puncture Rout in Patients Undergoing Percutaneous Nephrolithotomy: A Randomized Trial Study.
PURPOSE
Three-Dimensional (3D) could help for planning and creating an optimal access route in percutaneous nephrolithotomy (PCNL) procedure by achieving a more accurate approach to the renal collecting system and stone treatment while decreasing the risk of complications. The aim of our study is to compare the efficacy of 3D imaging technique with standard fluoroscopy method as a guiding tool for renal stone location while striving to reduce intra-operative X-ray exposure in the former method.
MATERIALS AND METHODS
This randomised clinical trial enrolled 48 PCNL candidates who were referred to Sina Hospital (Tehran, Iran). Participants were divided into two equal groups of intervention (3D virtual reconstruction) and control, using block randomization method. Age, sex, stone type and location, X-ray exposure during the procedure, stone access accuracy rate and the necessity of blood transfusion during surgery were taken into account.
RESULTS
The Mean age of participants (n = 48) was 46.4 ± 4.8 years, 34 (70.8%) were male, 27 (56.3%) had partial staghorn stones and all participants had stones within the lower calyx. The radiation exposure time, stone access time and stone size were 2.99 ± 1.81 seconds, 272.3 ± 108.9 seconds and 23.06 ± 2.28 mm, respectively. In the intervention group, the accuracy rate for lower calyceal stone access was 91.5%. Also, X-ray exposure and time to stone access were significantly lower in the intervention group compared to the controls (P < 0.001).
CONCLUSION
We concluded that the utilization of 3D technology in the pre-operative location of renal calculi in PCNL candidates may result in a significant improvement in the accuracy and time to access the renal calculi, as well as reduction in X-ray exposure.
Topics: Humans; Male; Adult; Middle Aged; Female; Nephrolithotomy, Percutaneous; Treatment Outcome; Iran; Kidney Calculi; Punctures; Fluoroscopy; Nephrostomy, Percutaneous
PubMed: 37334741
DOI: 10.22037/uj.v20i.7459 -
Current Opinion in Urology Jul 2023To systematically review the evolution of techniques, technology, clinical utility, limitations and possible future applications of endoscopic combined intrarenal... (Review)
Review
PURPOSE OF REVIEW
To systematically review the evolution of techniques, technology, clinical utility, limitations and possible future applications of endoscopic combined intrarenal surgery (ECIRS) for ureteral and kidney stones.
RECENT FINDINGS
The literature search was performed on 18th January 2023 using PubMed, EMBASE and Scopus. 35 studies were included. Among them, six were reviews. Since its introduction in 2008, ECIRS has evolved and improved. ECIRS can be performed in different patient position, such as modified supine Valdivia position by Galdakao, prone position with split-leg and supine position with good outcomes. Instrument miniaturization has also been introduced in ECIRS making it doable in an ambulatory setting. ECIRS showed shorter operative time, lower complication rate, and retreatment compared with conventional PCNL. Operative outcomes of mini-ECIRS are better than mini-PCNL alone. ECIRS also showed good outcomes in impacted upper ureteric stones. Recently, some studies have explored the robotic-assisted kidney puncture in ECIRS that avoided multitrack surgery, especially in anomalous kidney and staghorn stones.
SUMMARY
ECIRS is ready for primetime in endourology and can be considered the next gold-standard for a personalized stone approach in complex kidney stones.
Topics: Humans; Kidney Calculi; Nephrostomy, Percutaneous; Ureteroscopy; Ureteral Calculi
PubMed: 37158647
DOI: 10.1097/MOU.0000000000001106 -
Annals of Medicine and Surgery (2012) Apr 2023Staghorn calculus usually fills the pelvis of the kidney, the infundibulum, and most of the calyces. It is a rarity for staghorn stones to be asymptomatic; in addition...
UNLABELLED
Staghorn calculus usually fills the pelvis of the kidney, the infundibulum, and most of the calyces. It is a rarity for staghorn stones to be asymptomatic; in addition to that, the calculus discussed in this case report was of a very large size and was removed intact. Open pyelolithotomy, the procedure used, is one that comes with a wide range of complications but can be deemed effective in certain cases. In this scenario, it led to no impediments to normal physiology.
CASE PRESENTATION
Here the authors report the case of a 45-years-old Nepalese male who presented with a large yet asymptomatic staghorn calculus. It was managed with an open pyelolithotomy, and the patient had no intraoperative or postoperative complications.
DISCUSSION
Staghorn stones can be complete or partial and often naturally progress to renal impairment. Thus, an aggressive therapeutic approach is crucial, with careful evaluation of the site and size of the stone, the patient's preference, and the institutional capacity. Ideally, staghorn calculi are completely removed, and it is imperative that the functions of the affected kidney are preserved as far as possible and when applicable. Although percutaneous nephrolithotomy is recommended for the removal of staghorn stones, several clinical, technical, and socioeconomic factors contributed to the use of open pyelolithotomy in the management of the case discussed here.
CONCLUSION
Open pyelolithotomy can prove highly effective in removing large stones intact and in a single setting, the importance of which was accentuated by its unique clinical presentation and pathological anomalies.
PubMed: 37113920
DOI: 10.1097/MS9.0000000000000294 -
International Journal of Surgery Case... May 2023Crossed fused renal ectopia is a rare congenital anomaly characterized by both kidneys being fused together on one side of the spine. Herein, we present an atypical...
INTRODUCTION AND IMPORTANCE
Crossed fused renal ectopia is a rare congenital anomaly characterized by both kidneys being fused together on one side of the spine. Herein, we present an atypical subtype of this disease. To our best knowledge, in the current literature, there is few cases reported with superior crossed fused renal ectopia of the right kidney.
CASE PRESENTATION
A 40-year-old man with diabetes type 1 presented to our hospital with diabetic ketoacidosis and abdominal pain initially taken care of in an endocrinology department then transferred to our urology department after discovery on the CT scan of a staghorn calculus in the solitary right kidney is later discovered during the therapeutic management that it is a superior CFRE.
CLINICAL DISCUSSION
Unilateral fused renal superior ectopia is extremely rare and the management of urinary calculi in this disease is technically challenging for urologists. The choice of treatment for urinary calculi in cases of crossed renal ectopia should be made depending on the size and position of the urinary calculi and the patient's anatomy.
CONCLUSION
Before proceeding to surgery, a preoperative assessment with contrast computed tomography is necessary to explore a solitary kidney with calculi so as not to miss the diagnosis of crossed fused renal ectopia because the management of renal stone in this rare malformation is complicated.
PubMed: 37084557
DOI: 10.1016/j.ijscr.2023.108218 -
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 Apr 2023To explore the risk factors for systemic inflammatory response syndrome (SIRS) after endoscopic lithotripsy for upper urinary calculi.
BACKGROUND
To explore the risk factors for systemic inflammatory response syndrome (SIRS) after endoscopic lithotripsy for upper urinary calculi.
METHODS
This retrospective study included patients with upper urinary calculi who underwent endoscopic lithotripsy in the First Affiliated Hospital of Zhejiang University between June 2018 and May 2020.
RESULTS
A total of 724 patients with upper urinary calculi were included. One hundred and fifty-three patients developed SIRS after the operation. The occurrence of SIRS was higher after percutaneous nephrolithotomy (PCNL) compared with ureteroscopy (URS) (24.6% vs. 8.6%, P < 0.001) and after flexible ureteroscopy compared with ureteroscopy (fURS) (17.9% vs. 8.6%, P = 0.042). In the univariable analyses, preoperative infection history (P < 0.001), positive preoperative urine culture (P < 0.001), history of kidney operation on the affected side (P = 0.049), staghorn calculi (P < 0.001), stone long diameter (P = 0.015), stone limited to the kidney (P = 0.006), PCNL (P = 0.001), operative time (P = 0.020), and percutaneous nephroscope channel (P = 0.015) were associated with SIRS. The multivariable analysis showed that positive preoperative urine culture [odds ratio (OR) = 2.23, 95% confidence interval (CI): 1.18-4.24, P = 0.014] and operative methods (PCNL vs. URS, OR = 2.59, 95% CI: 1.15-5.82, P = 0.012) were independently associated with SIRS.
CONCLUSION
Positive preoperative urine culture and PCNL are independent risk factors for SIRS after endoscopic lithotripsy for upper urinary calculi.
Topics: Humans; Kidney Calculi; Retrospective Studies; Systemic Inflammatory Response Syndrome; Lithotripsy; Urinary Calculi; Risk Factors
PubMed: 37041554
DOI: 10.1186/s12894-023-01230-9 -
Frontiers in Surgery 2023To evaluate the outcomes of patient-centered enhanced recovery after surgery (ERAS) in -percutaneous nephrolithotomy (PCNL) for staghorn stones.
OBJECTIVE
To evaluate the outcomes of patient-centered enhanced recovery after surgery (ERAS) in -percutaneous nephrolithotomy (PCNL) for staghorn stones.
PATIENTS AND METHODS
A retrospective analysis of 106 patients with staghorn calculi who underwent PCNL treatment at the Third Xiangya Hospital from October 01, 2018 to September 30, 2021 was performed. The patients were divided into the ERAS group ( = 56) and traditional group ( = 50). The ERAS program focused on a patient-centered concept, with elaboration on aspects, such as patient education, nutritional support, analgesia, body warming, early mobilization, nephrostomy tube removal, and strict follow-up.
RESULTS
The total stone free rate and total complication rate were similar in both groups. The visual analogue scale (VAS) 6 h after surgery, ambulation off bed time, indwelling fistula time, indwelling catheter time, and postoperative hospital stays were lower in the ERAS group than in the traditional group ( < 0.05). The multiple session rate in the ERAS group (19, 28.57%) was lower than that in the traditional group (30, 60%) ( = 0.007). The 1-year stone recurrence rate in the ERAS group (7, 17.5%) was lower than that in the traditional group (14, 38.9%) ( = 0.037).
CONCLUSION
The patient-centered ERAS in PCNL for staghorn stones accelerated rehabilitation by relieving postoperative pain, shortening hospitalization time, accelerating early ambulation, and reducing multiple session rate and 1-year stone recurrence rate, which have socioeconomic benefits.
PubMed: 37025266
DOI: 10.3389/fsurg.2023.1138814