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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 -
Anesthesiology and Pain Medicine Aug 2022Percutaneous nephrolithotomy (PNL) is the treatment of choice for renal stones as a safe, effective, and minimally invasive method. However, bleeding remains a major...
BACKGROUND
Percutaneous nephrolithotomy (PNL) is the treatment of choice for renal stones as a safe, effective, and minimally invasive method. However, bleeding remains a major concern in the procedure.
OBJECTIVES
This study aimed to investigate the risk factors of bleeding in PNL.
METHODS
This retrospective descriptive cross-sectional study was conducted in the Urology department of Razi hospital. The data of patients with urinary calculi staghorn type who underwent PNL in a prone position under general anesthesia were recorded. A checklist including patients' demographics, surgical characteristics, and outcomes was filled out for each patient.
RESULTS
The data from 151 complete files were gathered. The mean age of the cases was 47.89 ± 12.41 years. The mean hemoglobin (Hb) drop was 1.92 ± 1.56 mg/dL. At least 1 mg/dL Hb drop was observed in all cases. The highest Hb drop was 3 mg/dL.). There was no significant relationship between stone bulk, age, BMI, GFR, surgery duration, and the number of tracts, and Hb drop during PNL (P > 0.05). But there was a positive correlation between Urinary Tract Infection (UTI) history (P = 0.01) and transfusion (P = 0.0001) and Hb drop during PNL. Also, the history of open kidney surgery (P = 0.031), nephrostomy insertion (P = 0.003), and extracorporeal shock wave lithotripsy therapy (ESWL) (P = 0.041) were correlated with the increased risk of Hb drop.
CONCLUSIONS
Urinary tract infection, history of open surgery, nephrostomy implantation, and ESWL were significantly associated with more bleeding in PNL.
PubMed: 36937085
DOI: 10.5812/aapm-126974 -
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 -
Journal of Personalized Medicine Jan 2023To predict the occurrence of systemic inflammatory response syndrome (SIRS) after percutaneous nephrostrolithotomy(PCNL), preoperative urine culture is a popular method,...
BACKGROUND
To predict the occurrence of systemic inflammatory response syndrome (SIRS) after percutaneous nephrostrolithotomy(PCNL), preoperative urine culture is a popular method, but the debate about its predictive value is ongoing. In order to better evaluate the value of urine culture before percutaneous nephrolithotomy, we conducted a single-center retrospective study.
METHODS
A total of 273 patients who received PCNL in Shanghai Tenth People's Hospital from January 2018 to December 2020 were retrospectively evaluated. Urine culture results, bacterial profiles, and other clinical information were collected. The primary outcome observed was the occurrence of SIRS after PCNL. Univariate and multivariate logistic regression analysis was performed to determine the predictive factors of SIRS after PCNL. A nomogram was constructed using the predictive factors, and the receiver operating characteristic (ROC) curves and calibration plot were drawn.
RESULTS
Our results showed that there was a significant correlation between positive preoperative urine cultures and the occurrence of postoperative systemic inflammatory response syndrome. Meanwhile, diabetes, staghorn calculi, and operation time were also risk factors for postoperative systemic inflammatory response syndrome. Our results suggest that among the positive bacteria in urine culture before percutaneous nephrolithotomy, has become the dominant strain.
CONCLUSION
Urine culture is still an important method of preoperative evaluation. A comprehensive evaluation of multiple risk factors should be undertaken and heeded to before percutaneous nephrostrolithotomy. In addition, the impact of changes in bacterial drug resistance is also worthy of attention.
PubMed: 36836421
DOI: 10.3390/jpm13020187 -
Urology Case Reports Mar 2023A complex staghorn calculus that is concurrent with an impacted large proximal ureteric calculi is rarely found in elderly patients, and morbidity and mortality rates...
A complex staghorn calculus that is concurrent with an impacted large proximal ureteric calculi is rarely found in elderly patients, and morbidity and mortality rates are much higher if left untreated. We report the case of an 88-year-old female with complex high-volume renal and ureteral calculus who was treated successfully using a tubeless mini-percutaneous nephrolithotomy. The entire stone was retrieved, and the patient fully recovered without any complications.
PubMed: 36756621
DOI: 10.1016/j.eucr.2023.102332