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Frontiers in Endocrinology 2023A model to predict preoperative outcomes after percutaneous nephrolithotomy (PCNL) with renal staghorn stones is developed to be an essential preoperative consultation...
BACKGROUND
A model to predict preoperative outcomes after percutaneous nephrolithotomy (PCNL) with renal staghorn stones is developed to be an essential preoperative consultation tool.
OBJECTIVE
In this study, we constructed a predictive model for one-time stone clearance after PCNL for renal staghorn calculi, so as to predict the stone clearance rate of patients in one operation, and provide a reference direction for patients and clinicians.
METHODS
According to the 175 patients with renal staghorn stones undergoing PCNL at two centers, preoperative/postoperative variables were collected. After identifying characteristic variables using PCA analysis to avoid overfitting. A predictive model was developed for preoperative outcomes after PCNL in patients with renal staghorn stones. In addition, we repeatedly cross-validated their model's predictive efficacy and clinical application using data from two different centers.
RESULTS
The study included 175 patients from two centers treated with PCNL. We used a training set and an external validation set. Radionics characteristics, deep migration learning, clinical characteristics, and DTL+Rad-signature were successfully constructed using machine learning based on patients' pre/postoperative imaging characteristics and clinical variables using minimum absolute shrinkage and selection operator algorithms. In this study, DTL-Rad signal was found to be the outstanding predictor of stone clearance in patients with renal deer antler-like stones treated by PCNL. The DTL+Rad signature showed good discriminatory ability in both the training and external validation groups with AUC values of 0.871 (95% CI, 0.800-0.942) and 0.744 (95% CI, 0.617-0.871). The decision curve demonstrated the radiographic model's clinical utility and illustrated specificities of 0.935 and 0.806, respectively.
CONCLUSION
We found a prediction model combining imaging characteristics, neural networks, and clinical characteristics can be used as an effective preoperative prediction method.
Topics: Animals; Humans; Nephrolithotomy, Percutaneous; Artificial Intelligence; Nephrostomy, Percutaneous; Deer; Prognosis; Kidney Calculi
PubMed: 37780621
DOI: 10.3389/fendo.2023.1184608 -
BMJ Case Reports Sep 2023A man in his 50s presented with right flank pain and intermittent haematuria for 15 days. He was evaluated and diagnosed to have bilateral staghorn renal calculi with...
A man in his 50s presented with right flank pain and intermittent haematuria for 15 days. He was evaluated and diagnosed to have bilateral staghorn renal calculi with left poorly functioning kidney. He underwent right kidney stone clearance followed by laparoscopic left simple nephrectomy. Postoperatively, he developed recurrent urinary tract infections. On evaluation, non-contrast CT of the abdomen revealed calculus in left ureteral stump and he was diagnosed to have ureteric stump syndrome. He underwent ureteroscopy which revealed multiple stump calculi and complete stone clearance was achieved. Currently, the patient is asymptomatic and doing well after a follow-up of 1 year.
Topics: Male; Humans; Ureter; Kidney; Ureteroscopy; Abdominal Cavity; Kidney Calculi; Staghorn Calculi; Syndrome
PubMed: 37723093
DOI: 10.1136/bcr-2023-255126 -
Diagnostic Microbiology and Infectious... Dec 2023A member of the Enterobacteriaceae family, Providencia alcalifaciens is typically recognized as a source of gastrointestinal illness. Although its pathogenicity is not...
A member of the Enterobacteriaceae family, Providencia alcalifaciens is typically recognized as a source of gastrointestinal illness. Although its pathogenicity is not well known, many studies have suggested its mechanism of action involves the invasion of the intestinal mucosal layer. Although P. alcalifaciens is a urease producing microorganism, it has not been associated with the formation of a staghorn calculus in the setting of a urinary tract infection. This organism is neither commonly pursued in research or investigation nor is it commonly tested for in the clinical setting. This is especially true when combined with other disease processes, such as calculus formation. The advancement of antibiotic resistance, such as carbapenemase-producing strains, should bring more attention and routine investigation to this organism in the acute stage of infection. In this case report we introduce a 43-year-old Cuban female, who presents with a left-sided staghorn calculi and urine culture positive for carbapenemase-producing P. alcalifaciens.
Topics: Humans; Female; Adult; Staghorn Calculi; Providencia; Enterobacteriaceae
PubMed: 37716218
DOI: 10.1016/j.diagmicrobio.2023.116055 -
CRSLS : MIS Case Reports From SLS 2023The Boston Scientific Swiss LithoClast® Trilogy lithotripter was intended for use in percutaneous nephrolithotomy. We performed, to our knowledge, the first two robotic...
INTRODUCTION
The Boston Scientific Swiss LithoClast® Trilogy lithotripter was intended for use in percutaneous nephrolithotomy. We performed, to our knowledge, the first two robotic pyelolithotomies using the Trilogy lithotripter for intracorporeal lithotripsy.
CASE DESCRIPTION
Two cases are presented involving a 65-year-old female with a complete left staghorn calculus and hydronephrosis secondary to a left ureteropelvic junction (UPJ) obstruction, and a 69-year-old male with a large left staghorn calculus and multiple large left sided simple renal cysts. In both cases, a robotic pyelolithotomy was scheduled for stone removal along with concurrent UPJ repair and cyst decortication respectively. Following pyeloplasty and cyst decortication respectively, and following stone visualization, the 2.4-mm Trilogy probe was inserted into the 12-mm assistant port and under direct visualization the stone was fragmented and removed using Trilogy's built-in mechanisms. Both patients were treated successfully without complications and were found to be stone-free on follow-up.
CONCLUSION
The Trilogy lithotripter may be an effective tool for stone management when introduced during robotic pyelolithotomy and provides additional optionality when manual extraction poses challenges.
Topics: Aged; Female; Humans; Male; Cysts; Lithotripsy; Robotic Surgical Procedures; Staghorn Calculi
PubMed: 37671366
DOI: 10.4293/CRSLS.2023.00027 -
International Journal of Surgery Case... Sep 2023Renal cancer is a relatively common form of cancer; however, squamous cell carcinoma of the kidney is extremely rare and it carries poor prognosis.
INTRODUCTION
Renal cancer is a relatively common form of cancer; however, squamous cell carcinoma of the kidney is extremely rare and it carries poor prognosis.
CLINICAL PRESENTATION
We present a rare case of renal squamous cell carcinoma that was manifested with the psoas sign in a patient with a history of chronic staghorn calculus.
DISCUSSION
Squamous cell carcinoma of kidney is rare and more invasive. Even though many risk factors have been identified, staghorn renal calculi with chronic infection have a higher incidence of renal squamous cell carcinoma (SCC). Squamous cell carcinoma (SCC) has a wider range of atypical presentations; the psoas sign is not commonly reported in other literature. Due to the lack of reporting and sufficient knowledge, there are currently no established management guidelines. Despite advancements in contemporary medicine, the survival rate of renal SCC remains remarkably low, necessitating further research to develop a standardized treatment protocol.
CONCLUSION
Primary renal SCCs are rare tumors and exhibit a strong association with renal stones, requiring prompt assessment and treatment of renal stones in affected patients. Despite their aggressiveness and poor prognosis, timely intervention is crucial.
PubMed: 37647754
DOI: 10.1016/j.ijscr.2023.108732 -
World Journal of Clinical Cases Aug 2023Jackstone is a rare entity of calculi in urinary tracts and has the characteristic appearance resembling toy jacks. They are nearly always reported to occur in the...
BACKGROUND
Jackstone is a rare entity of calculi in urinary tracts and has the characteristic appearance resembling toy jacks. They are nearly always reported to occur in the urinary bladder, we first report a rare case of jackstone located in the obstructed renal calyx.
CASE SUMMARY
We report a 46-year-old man presenting with intermittent, painless gross hematuria and left flank pain. Urinary computed tomography revealed staghorn stones and secondary hydronephrosis. A jackstone with radiating branches was found in one of the dilated renal calyx. Percutaneous nephrolithotomy was performed and endoscopic images were recorded during the operation. Postoperative stone composition analysis revealed it as calcium oxalate monohydrate stones.
CONCLUSION
Jackstones can occur in the renal collecting system besides the bladder. The unique appearance and imaging manifestations are the most important factors in the diagnosis of jackstones, and further exploration of the formation mechanism is required.
PubMed: 37637701
DOI: 10.12998/wjcc.v11.i23.5554 -
Urologia Feb 2024PCNL (percutaneous nephrolithotripsy) is considered the gold standard treatment for renal stone more than 2 cm. In today's scenario, supine PCNL is considered equally...
INTRODUCTION
PCNL (percutaneous nephrolithotripsy) is considered the gold standard treatment for renal stone more than 2 cm. In today's scenario, supine PCNL is considered equally effective as prone PCNL. The ideal position for supine PCNL is still debatable. We hereby describe our initial experiences of supine PCNL in a novel position.
METHODS AND MATERIALS
This prospective study includes 60 patients who underwent supine PCNL in the 'Calcutta position' in our institute from August 2021 to August 2022. Successful procedure was defined as a complete stone free rate or a clinically insignificant residual stone (<4 mm).
RESULTS
Average Operative room (OR) occupancy time was 130.9 ± 19.63 min. The immediate stone free rate was 84.2%, 71.4% and 37.5% for single, multiple and staghorn calculus respectively. Complications include fever, requirement of blood transfusions and renal colic. The average hospital stay was 83.6 ± 17.42 h. Eight patients (13.3%) required secondary procedures like extracorporeal shock wave lithotripsy (ESWL) or relook PCNL. At 3 months average stone free rates were 92%, 85%, 75% for single, multiple and staghorn calculus respectively. We performed supine PCNL in Calcutta position in obese, kyphoscoliosis, poliomyelitis, autosomal polycystic kidney disease (ADPKD), malrotated kidney and diverticular stone with comparable success.
CONCLUSION
Supine PCNL in Calcutta position is a safe and effective option for nephrolithiasis management. Apart from the inherent advantages of supine PCNL it also has the advantages of better C-Arm and nephroscope manoeuvrability. Supine PCNL in Calcutta position was performed in a variety of scenarios with comparable results.
Topics: Humans; Kidney Calculi; Prospective Studies; Staghorn Calculi; Nephrostomy, Percutaneous; Lithotripsy; Supine Position; Patient Positioning; India; Treatment Outcome; Prone Position
PubMed: 37632393
DOI: 10.1177/03915603231191268 -
Urolithiasis Aug 2023To describe a concept of ideal 'puncture zone' as against any single ideal 'puncture tract' for percutaneous nephro-lithotomy (PCNL) and present our results. Through...
To describe a concept of ideal 'puncture zone' as against any single ideal 'puncture tract' for percutaneous nephro-lithotomy (PCNL) and present our results. Through this narrative, we aim to reduce the gaps in inter-understanding of an erstwhile description of ideal tract and real-life puncture making. The puncture zone principle was applied for our novel puncture making technique during PCNL. The largest imaginary cone that can fit into a respective calyx, with its tip in the pelvis defines the 'puncture zone' for that calyx. This concept allows fine-tuning of the ideal puncture tract based upon the desired corresponding manipulation zone and also shifts the focus of puncture making to infundibulum anatomy from the tip of calyx. The surgical technique and retrospective review of 136 cases done between 2015 and 2021 using this concept are presented. Primary outcome included stone-free rate, pseudo-aneurysm and blood transfusion at 3 months of follow-up. 33 cases had multiple (> 3) stones, 21 only calyceal/infundibular stones, eight partial staghorn and 12 were complete staghorn stones. Mean stone size was 29 ± 15 (Range: 5-53) mm. Complete clearance was achieved in 127 cases, four of which required two tracts. Blood transfusion was required in one case. No pseudo-aneurysms were encountered. The puncture zone concept has provided good results in our hands. It may help easier understanding of PCN puncture making and provides a background for reconciliation between description of an ideal tract and practical puncturing techniques used by different surgeons.
Topics: Humans; Nephrostomy, Percutaneous; Treatment Outcome; Kidney Calculi; Punctures; Staghorn Calculi; Retrospective Studies
PubMed: 37555988
DOI: 10.1007/s00240-023-01477-9 -
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 -
American Journal of Clinical and... 2023The choice of lithotripter is an important part of planning in mini-percutaneous nephrolithotomy (mini perc) as the operating time is prolonged due to reduced sheath...
OBJECTIVE
The choice of lithotripter is an important part of planning in mini-percutaneous nephrolithotomy (mini perc) as the operating time is prolonged due to reduced sheath size and smaller working channel. Previous studies mostly reported the use of laser lithotripter for stone fragmentation while the literature on pneumatic lithotripter use in miniperc is scant.
METHODS
In this study, we compared the efficacy and safety of the laser lithotripter (LL) vs pneumatic lithotripter (PL) in miniperc for small to medium-sized renal/upper ureteric stones (size: 1-2 cm). All consecutive patients who underwent miniperc from September 2020 to August 2022 were included in the study. Laser lithotripter was used in 81 patients (group LL), while pneumatic was used in 75 patients (group PL). The preoperative, operative, and postoperative findings were compared.
RESULTS
Baseline patient characteristics (age, sex, body mass index, and co-morbid illness) and stone characteristics (size, stone number, laterality, presence of staghorn calculi, presence of hydronephrosis, Guy's stone scores) were comparable between the two groups (P>0.05). The mean operative time was comparable (P=0.38) while the mean fragmentation time was significantly higher in the PL group (35.42±6.34 vs 28.96±2.82 minutes; P<0.01). 29.3% required forceps/basket for stone removal in PL group as compared to 7.4% in LL group (P=0.02). Mean VAS (Visual Analog Scale) score on the first post-operative day, stone clearance, drop in hemoglobin, average hospital stay, stone clearance at 3 months postoperative, and complications were comparable (P>0.05).
CONCLUSION
Lithotripsy with pneumatic lithotripter can be used as an equally effective and safe alternative to laser lithotripter in mini-perc for treatment of small-medium sized renal/upper ureteric calculi.
PubMed: 37441439
DOI: No ID Found