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BMJ Case Reports Jan 2023Fistula formation between the kidney, colon and the skin is an extremely rare complication arising from renal infections secondary to renal stone formation. During the...
Fistula formation between the kidney, colon and the skin is an extremely rare complication arising from renal infections secondary to renal stone formation. During the 1980s, reports of nephrocolic fistulas, with or without involvement of the skin, were commonly caused by genitourinary tuberculosis. Due to improvements in diagnosis and specifically the development of anti-Koch's therapy, the incidence of nephrocolic or nephrocolocutaneous fistulas has become uncommon especially in developed countries.We report a case of a patient residing in a developing country, presenting with a 20-year history of a left flank lesion extruding minimal purulent output daily. He was seen at the emergency department due to weakness and was managed as a case of urosepsis. Contrast-enhanced CT scan and fistulogram showed a staghorn calculus in the left kidney with connections to the descending colon and skin. The patient eventually underwent a left hemicolectomy with en bloc excision of the kidney and fistula tract.
Topics: Male; Humans; Staghorn Calculi; Urinary Fistula; Kidney Calculi; Radiography; Tomography, X-Ray Computed
PubMed: 36653049
DOI: 10.1136/bcr-2022-249351 -
Journal of Endourology Apr 2023This retrospective cohort study aimed to evaluate the clinical outcomes of vacuum-assisted mini-endoscopic combined intrarenal surgery (vmECIRS) for staghorn stones....
This retrospective cohort study aimed to evaluate the clinical outcomes of vacuum-assisted mini-endoscopic combined intrarenal surgery (vmECIRS) for staghorn stones. We analyzed a total of 61 cases treated with initial vmECIRS using 14F/16F ClearPetra percutaneous sheaths for staghorn stones. We primarily measured complications and stone-free rates (SFRs) to evaluate the safety and efficiency of vmECIRS. In addition, pre- and intraoperative factors in patients who experienced postoperative fever >38°C and achieved an initial stone-free status were evaluated. The percentages of staghorn stones were 36.1% and 63.9% for complete and partial stones, respectively. The median stone volume was 8.48 cm. The median operation time was 117 minutes, and the mean number of procedures was 1.54. Regarding postoperative complications, postoperative fever >38°C was reported in 18 patients (29.5%). The initial and final SFRs were 50.8% and 91.8%, respectively. Among patients with emerging fever >38°C, positive urine culture was the only significant risk factor in the multivariate analysis (odds ratio [OR], 7.500; 95% confidence interval [CI], 1.772-31.751; = 0.006). Moreover, for achieving initial stone-free status, body mass index and stone volume were significant risk factors in the multivariate analysis (OR, 0.872; 95% CI, 0.776-0.980; = 0.021; and OR, 0.882; 95% CI, 0.784-0.994; = 0.039, respectively). These findings suggest that vmECIRS is safe and effective for treatment of staghorn stones. Although current guidelines suggest that percutaneous nephrolithotomy is the gold standard surgical technique for staghorn stones, vmECIRS could also be a treatment strategy. The Clinical Trial Registration number (ID: 2022-05-17-1).
Topics: Humans; Retrospective Studies; Nephrostomy, Percutaneous; Staghorn Calculi; Endoscopy; Nephrolithotomy, Percutaneous; Kidney Calculi; Treatment Outcome
PubMed: 36641643
DOI: 10.1089/end.2022.0579 -
Urologiia (Moscow, Russia : 1999) Dec 2022to study the safety and efficacy of using a new method of performing percutaneous nephrolithotripsy under ultrasound and endovisual control.
[Safety and efficacy of a new method of percutaneous nephrolithotripsy performed under ultrasound and endovisual control without the use of intraoperative x-ray examination].
PURPOSE OF THE STUDY
to study the safety and efficacy of using a new method of performing percutaneous nephrolithotripsy under ultrasound and endovisual control.
MATERIALS AND METHODS
A comparative analysis of the results of percutaneous nephrolithotripsy performed under ultrasound and endovisual control in 515 (84.1%) patients (main group) and percutaneous nephrolithotripsy performed under fluoroscopic control in 97 (15.8%) patients (control group) was carried out. The groups did not differ in age, gender, body mass index, the number and location of stones, and the duration of the disease. In the main group, there were more patients with large, staghorn and X-ray negative stones, and there were also more patients with kidney block. To analyze and stratify the complications of percutaneous nephrolithotripsy, we used a modified classification of surgical complications according to the Clavien-Dindo system. Statistical analysis of the material was carried out using the licensed package IBM SPSS Statistics Version 14.0.1.
RESULTS
The average duration and number of stages of operations in the main and control groups was the same. Almost all operations in groups (93,8% 91,8%) were performed in one step (=0,55). In the main group, in the vast majority of cases95,1%; <0,001), percutaneous nephrolithotripsy was performed through one puncture access, with the degree of complete elimination of stones statistically the same as in the control group (80.6% in the main group and 70.1% in the control group, p=0.158). The degree of decrease in hemoglobin in the postoperative period in the groups did not differ (=0,271). The frequency of postoperative complications in both groups did not differ statistically: in the control - 33.0%; in the main group - 29.3% (p=0.469). The severity of complications according to Clavien-Dindo did not differ in the groups either (p=0.17).
CONCLUSION
Percutaneous nephrolithotripsy under ultrasound and endovisual control is a safe and effective operation. The results of the operation and the frequency of early complications are comparable with the traditional X-ray control technique.
Topics: Humans; Kidney Calculi; X-Rays; Lithotripsy; Radiography; Postoperative Complications; Nephrostomy, Percutaneous
PubMed: 36625620
DOI: No ID Found -
Case Reports in Infectious Diseases 2022infective endocarditis is a rare disease with only 17 reported cases. It is typically associated with urinary tract infections (UTIs), staghorn calculi, and/or...
infective endocarditis is a rare disease with only 17 reported cases. It is typically associated with urinary tract infections (UTIs), staghorn calculi, and/or asymptomatic bacteriuria. We present a case of a 73-year-old male who presented with positive blood cultures for but with a negative urinalysis and urine culture. He presented with acute renal failure and required hemodialysis. TTE was remarkable for a 30% ejection fraction, and no vegetations were visualized. TEE demonstrated a small vegetation on the left aortic valve. The initial urine culture remained negative throughout his hospitalization. He was treated with IV antibiotics and discharged without hemodialysis.
PubMed: 36624879
DOI: 10.1155/2022/7569148 -
Case Reports in Urology 2022A 50-year old male patient with morbid obesity was admitted for removal of large staghorn calculi and multiple small stones in the left kidney. The patient was managed...
A 50-year old male patient with morbid obesity was admitted for removal of large staghorn calculi and multiple small stones in the left kidney. The patient was managed by Percutaneous Nephrolithotomy (PCNL). Surgery was carried out in prone position and Alken's metal dilators were used for tract dilation. Alken dilators were inserted without any challenges, and the procedure was completed in a shorter span of time than anticipated with total operative time of 2 hours, including the change of positioning from lithotomy to prone. No intra-operative or post-operative complications were encountered. The patient has been followed up for 6 months post-operatively, without any complications or any evidence of stone recurrence.
PubMed: 36624815
DOI: 10.1155/2022/5899896 -
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 -
Journal of Endourology Apr 2023To study the predictors of sepsis and the progression of sepsis to septic shock in patients after percutaneous nephrolithotomy (PCNL) and to establish and validate...
To study the predictors of sepsis and the progression of sepsis to septic shock in patients after percutaneous nephrolithotomy (PCNL) and to establish and validate predictive models. The patients were assigned to either the development cohort or the validation cohort depending on their hospital. In the development cohort, univariate and multivariate logistic regression analyses were used to screen independent risk factors for sepsis after PCNL and sepsis progression to septic shock. Nomogram prediction models were established according to the related independent risk factors. Areas under the receiver operating characteristic curves, calibration plots, and decision curve analysis (DCA) were used to estimate the discrimination, calibration, and clinical usefulness of the prediction models, respectively. The two sets of models were further validated on the validation cohort. In the development cohort, the risk factors for sepsis after PCNL were diabetes, urine nitrite, staghorn calculi, HU value, albumin-globulin ratio, and high-sensitivity C-reactive protein/albumin ratio. The pre- and postoperative white blood cell counts were risk factors for the progression of sepsis to septic shock. The area under the ROC curve value for predicting sepsis risk was 0.891 and that for predicting septic shock risk was 0.981 in the development cohort; in the validation cohort, these values were 0.893 and 0.996, respectively. In the development cohort, the calibration test values in the sepsis and septic shock cohorts were 0.946 and 0.634, respectively; in the validation cohort, these values were 0.739 and 0.208, respectively. DCA of the model in the sepsis and septic shock cohorts showed threshold probabilities of 10%-90% in the development cohort; in the validation cohort, these values were 10%-90%. The individualized nomogram prediction models can help improve the early identification of patients who are at higher risk of developing sepsis after PCNL and the progression of sepsis to septic shock to avoid further damage.
Topics: Humans; Shock, Septic; Nephrolithotomy, Percutaneous; Retrospective Studies; Sepsis; Albumins
PubMed: 36585859
DOI: 10.1089/end.2022.0384 -
Journal of Endourology Apr 2023To evaluate the efficacy and safety of minipercutaneous nephrolithotomy (PCNL) in the management of large and complex calculi in children. From May 2017 to April 2021,...
To evaluate the efficacy and safety of minipercutaneous nephrolithotomy (PCNL) in the management of large and complex calculi in children. From May 2017 to April 2021, a total of 41 pediatric cases were diagnosed with large/complex renal stones (partial-total staghorn) and following a detailed biochemical evaluation and thorough radiological examination (plain abdominal radiograph, urinary ultrasound, noncontrast and/or computed tomography), all cases underwent mini-PCNL procedure for the minimal invasive management of these calculi. Preoperative, intraoperative, and postoperative data were analyzed and reported in detail. A total of 41 procedures were performed in 26 boys and 15 girls (male/female = 1.73). While the age of the kids ranged from 2.5 to 10 years (mean 6.74 ± 2.76), mean size of the stones was 16.28 ± 3.43 mm (range 11-24) with a mean stone density value of 816 HU (range 550-1350). Evaluation of the success rates in terms of complete stone clearance on postoperative day 1 revealed that while 73.2% (30/41), residual fragments have been noted in 11 cases (26.8%). Size of the residual fragments ranged from 2 to 7 mm (mean 4.3). Of those children, 10 cases required flexible ureteroscopy for stone removal, and in 1 case, placement of Double-J was adequate for spontaneous passage. During a 3-month follow-up, the stone-free rate (SFR) increased to 100% without any residual fragment left. Mini-PCNL with holmium laser lithotripsy is an effective and safe treatment alternative in the minimal invasive management of large/complex kidney stones in children with high SFRs.
Topics: Child; Humans; Male; Female; Child, Preschool; Ureteroscopy; Kidney Calculi; Lithotripsy; Lithotripsy, Laser; Ureteroscopes; Retrospective Studies; Treatment Outcome; Nephrostomy, Percutaneous
PubMed: 36578212
DOI: 10.1089/end.2022.0508 -
Journal of Nepal Health Research Council Nov 2022Due to the risk of pleural injury leading to thoracic complications, many urologist still hesitate to perform supracostal puncture during percutaneous nephrolithotomy....
BACKGROUND
Due to the risk of pleural injury leading to thoracic complications, many urologist still hesitate to perform supracostal puncture during percutaneous nephrolithotomy. Our aim of this study was to evaluate the thoracic complications in supracostal access percutaneous nephrolithotomy.
METHODS
This is a retrospective analysis of 101 patients who were treated with supracostal access percutaneous nephrolithotomy at our institute from September 2013 and December 2019. Indications for supracostal punctures were staghorn 28(27.7%), middle calyceal stones 10(9.9%), pelvic stones 29(28.7%), complex inferior calyceal stones 26(25.7%), upper calyceal stone 10(9.9%)and upper ureteric stone17(16.8%).The intercostal space between the 11th and 12th ribs was used in all the cases.
RESULTS
Among the 101 patients who undergone percutaneous nephrolithotomy by supracostal access, three patients (2.97%) had pleural injury. Among them one patient developed hydrothorax and needed chest tube insertion and remaining two patients had minimal pneumo thorax with blunting of costo-phrenic angle, which was managed conservatively. The lung parenchymal or other viscera injury was not observed in our study. Most punctures were, a single supracostal superior calyceal access 18(17.8%) and middle posterior calyceal access 88(82.2%), except for staghorn and multiple complex lower calyceal calculi needed multiple tracts 23(22.8%). Complete clearance was observed in 77(76.2%) patients.
CONCLUSIONS
The supracostal puncture was a safe and effective approach with high stone clearance rate and acceptable morbidity in selected cases of staghorn, upper ureteral, and upper calyceal calculi. It should be adapted whenever needed and should not be avoided due to fear of chest complications.
Topics: Humans; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Retrospective Studies; Nepal; Kidney Calculi; Treatment Outcome; Postoperative Complications
PubMed: 36550713
DOI: 10.33314/jnhrc.v20i02.3950 -
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