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World Journal of Urology Dec 2022To evaluate the effectiveness and safety of nonpapillary prone endoscopic combined intrarenal surgery (ECIRS) and provide practical tips and tricks for the successful...
PURPOSE
To evaluate the effectiveness and safety of nonpapillary prone endoscopic combined intrarenal surgery (ECIRS) and provide practical tips and tricks for the successful accomplishment of the procedure respecting the anatomical particularities.
MATERIAL AND METHODS
This study is an analysis of a prospectively collected database including all cases of ECIRS performed between January 2019 and December 2021 in a high-volume tertiary center. All patients underwent the procedure in prone-split leg position. A nonpapillary renal puncture was performed. The used access sheaths were 22Fr or 30Fr. Lithotripsy was performed anterogradely with a dual-energy lithotripter with incorporated suction and retrogradely with holmium Yttrium-Aluminum-Garnet laser.
RESULTS
A total of 33 patients were included. The initial stone-free rate (SFR) was 84.8% and the final SFR was 90.9%. The median stone size was 35 mm and 60% of patients had staghorn calculi. The prevalence of renal abnormalities was 21.3%, including 3 cases of horseshoe kidney, 2 cases of malrotation and 2 cases with complete duplicated systems. The median operative time was 47 min. The median hospital stay was 3 days and median hemoglobin loss was 1.2 gr/dL. Overall, the complication rate was 9.1%, all being Grade II complications (n = 2 fever and n = 1 transient bleeding).
CONCLUSIONS
Nonpapillary prone ECIRS is an effective and safe procedure. Standardization of the procedure is critical to achieve good outcomes. Patients who benefit the most are probably the ones where additional punctures can be avoided using this technique, namely patients with renal abnormalities, incrusted ureteral stents and staghorn stones.
Topics: Humans; Nephrostomy, Percutaneous; Ureteroscopy; Kidney Calculi; Retrospective Studies; Lithotripsy; Staghorn Calculi; Treatment Outcome
PubMed: 36251056
DOI: 10.1007/s00345-022-04178-x -
World Journal of Nephrology Feb 2015The main goals for urinary stone treatment are to preserve renal function, reduce or avoid complications related to calculi, and to render the patient free of calculi as... (Review)
Review
The main goals for urinary stone treatment are to preserve renal function, reduce or avoid complications related to calculi, and to render the patient free of calculi as soon as possible. Anatrophic nephrolithotomy (ANL) is a valid and useful alternative for conventional staghorn calculi excision. Although excellent stone free rates can be achieved with ANL there are some drawbacks that may be of concern. Morbidity related to intraoperative and postoperative complications is one of them. Another, great concern is the possibility of reduction on renal function related to the procedure itself. This may be related to nephron injury during nephrotomy and parenchymal closure or to ischemic injury. In this review we assess functional results after anatrophic nephrolithotomy.
PubMed: 25664252
DOI: 10.5527/wjn.v4.i1.105 -
Korean Journal of Urology Sep 2015Since its initial introduction in 1976, percutaneous nephrolithotomy (PCNL) has been widely performed for the management of large renal stones and currently is... (Review)
Review
Since its initial introduction in 1976, percutaneous nephrolithotomy (PCNL) has been widely performed for the management of large renal stones and currently is recommended for staghorn calculi, kidney stones larger than 2 cm, and shock wave lithotripsy-resistant lower pole stones greater than 1 cm. However, except for open and laparoscopic surgery, PCNL is the most invasive of the minimally invasive stone surgery techniques. Over the years, technical and instrumental advances have been made in PCNL to reduce morbidity and improve effectiveness. A thorough review of the recent literature identified five major areas of progress for the advancement of PCNL: patient positioning, method of percutaneous access, development of lithotriptors, miniaturized access tracts, and postoperative nephrostomy tube management. This review provides an overview of recent advancements in PCNL and the outcomes of each area of progress and notes how much we achieve with less invasive PCNL. This information may allow us to consider the future role and future developments of PCNL.
Topics: Catheters, Indwelling; Drainage; Humans; Kidney Calculi; Lithotripsy; Nephrostomy, Percutaneous; Patient Positioning; Postoperative Care; Radiology, Interventional; Ultrasonography, Interventional
PubMed: 26366273
DOI: 10.4111/kju.2015.56.9.614 -
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 -
Canadian Urological Association Journal... Apr 2022Ambulatory percutaneous nephrolithotomy (PCNL) has been limited to highly selected patients. The objective of our study was to compare complication and stone-free rates...
INTRODUCTION
Ambulatory percutaneous nephrolithotomy (PCNL) has been limited to highly selected patients. The objective of our study was to compare complication and stone-free rates after ambulatory PCNL in standard selection criteria vs. extended criteria patients.
METHODS
We conducted a retrospective review of prospective data on all patients who underwent ambulatory PCNL at one academic center from 2007-2018. Extended criteria patients were defined as one or more of: age >75 years, body mass index (BMI) >30 kg/m, American Society of Anesthesiologists (ASA) score >2, bilateral stones, solitary kidney, transplant kidney, complete staghorn calculi, stone burden >40 mm, multiple tracts, or prior nephrostomy tubes/stents. Primary outcomes were complication rates (Clavien-Dindo classification) and stone-free rates.
RESULTS
We identified 118 patients, of which 92 (78%) met extended criteria. Mean BMI was 31 kg/m and 45% were ASA 3 or higher. Mean sum maximum stone diameter was 24 mm. Multiple stones were present in 25%, bilateral stones in 7%, and complete staghorn stones in 4% of patients. There was no difference in complication (12% vs. 18%, p=0.56), emergency department visit (12% vs. 18%, p=0.56), or re-admission (4% vs. 5%, p=1) rates between standard and extended criteria patients, respectively. Of the complications, 85% were Clavien-Dindo grade 1. Stone-free rates were not different between standard (84%) and extended (83%) criteria patients (p=1). No extended criteria variables were associated with complications in multivariable analysis.
CONCLUSIONS
Complication and stone-free rates were not different between standard and extended selection criteria patients undergoing ambulatory PCNL. This data indicates that many of the preoperative patient and stone factors that have previously been used as exclusion criteria for ambulatory PCNL are not strictly necessary.
PubMed: 34812729
DOI: 10.5489/cuaj.7527 -
Urologia Internationalis 2012This article systematically analyses comparative studies to evaluate the efficacy and safety of tubeless percutaneous nephrolithotomy (PCNL) versus standard PCNL. (Review)
Review
OBJECTIVE
This article systematically analyses comparative studies to evaluate the efficacy and safety of tubeless percutaneous nephrolithotomy (PCNL) versus standard PCNL.
METHODS
The Medline, EMBASE, PsycINFO, Cochrane and DARE databases were searched from 1997 to February 2011. Comparative studies evaluating outcomes from standard versus tubeless PCNL were included. Primary outcome measures were post-operative pain scoring, analgesic requirements, duration of hospitalisation/convalescence, operation time, major/minor complications and stone-free rates.
RESULTS
Twenty-four studies were included (11 randomised control trials and 13 retrospective or prospective studies). Levels of pain recorded, analgesic requirements, duration of inpatient stay and convalescence time were all significantly reduced in the tubeless PCNL group. Cost was reduced in two studies. Morbidity was not significantly different between the groups. There was no significant difference between groups regarding stone-free status.
DISCUSSION
This systematic review has demonstrated that tubeless PCNL is a viable alternative to tubed PCNL in uncomplicated cases. Benefits are as described above. There is no evidence suggesting that patient safety is compromised by the absence of post-operative nephrostomy. The tubeless method has been reported in challenging cases such as stag-horn stones, horseshoe or ectopic kidneys. Promising outcomes have been demonstrated in elderly patients and when clinical needs demand a supracostal approach. Multi-centre randomised controlled trials are needed to fully establish the effectiveness of the tubeless method.
Topics: Analgesics; Cost Savings; Cost-Benefit Analysis; Hospital Costs; Humans; Kidney Calculi; Length of Stay; Nephrostomy, Percutaneous; Pain, Postoperative; Recovery of Function; Recurrence; Time Factors; Treatment Outcome
PubMed: 22433470
DOI: 10.1159/000336145 -
Radiology Case Reports Mar 2022Staghorn calculi account for about 4% of presenting renal stones in developed countries, are source of recurrent urinary tract infection, and may be eventually treated...
Staghorn calculi account for about 4% of presenting renal stones in developed countries, are source of recurrent urinary tract infection, and may be eventually treated by surgical stone removal. A 55-year-old female with a history of staghorn renal calculi and recurrent urinary tract infections presented with a left flank and lower abdominal pain following recent left robotic partial nephrectomy and nephrolithotomy. Contrast-enhanced computed tomography (CT) of the abdomen demonstrated a large left-sided retroperitoneal fluid collection with a few dropped renal stones in the dependent portion of the collection. The patient treated with early percutaneous drainage of the collection and antibiotic treatment and responded well clinically. The clinical and imaging presentation of a rare case of retroperitoneal abscess formation caused by dropped renal stones is described in this study. Imaging, particularly ultrasound and CT, plays a key role in detecting the dropped renal stones and can help with differential diagnosis and treatment plans.
PubMed: 34917225
DOI: 10.1016/j.radcr.2021.11.020 -
BioMed Research International 2020To assess current evidence on the effectiveness and safety of single- versus multiple-tract percutaneous nephrolithotomy in the surgical management of complex caliceal... (Meta-Analysis)
Meta-Analysis
Single- versus Multiple-Tract Percutaneous Nephrolithotomy in the Surgical Management of Staghorn Stones or Complex Caliceal Calculi: A Systematic Review and Meta-analysis.
OBJECTIVE
To assess current evidence on the effectiveness and safety of single- versus multiple-tract percutaneous nephrolithotomy in the surgical management of complex caliceal calculi or staghorn stones through a comprehensive literature review.
METHODS
A comprehensive literature review of articles investigating the clinical efficacy and safety of single- versus multiple-tract percutaneous nephrolithotomy was performed. Relevant literature was obtained by systematically searching PubMed, EMBASE, and the Cochrane Library through May 2020. We followed the search strategy based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The primary outcomes, including the stone-free rate (SFR), and secondary outcomes (peri- and postoperative complications and operative data) were evaluated using RevMan 5.3 statistical software.
RESULTS
Ten studies involving 1844 patients with complex caliceal calculi or staghorn stones met the inclusion criteria. Single-tract percutaneous nephrolithotomy (STPCNL) had noninferior clinical efficacy with respect to the immediate SFR (odds ratio (OR) = 0.80, 95% confidence interval (CI) (0.46 to 1.38), = 0.42) and 3-month SFR (OR = 1.22, 95% CI (0.38 to 3.92), = 0.74) compared with multiple-tract percutaneous nephrolithotomy (MTPCNL). In addition, pooled analyses showed that STPCNL resulted in significantly lower hemoglobin decreases (MD = -0.46, 95% CI (-0.68 to -0.25), < 0.0001), fewer blood transfusions (OR = 0.48, 95% CI (0.34 to 0.67), < 0.0001), and fewer pulmonary complications (OR = 0.28, 95% CI (0.09 to 0.83), = 0.02) than MTPCNL. However, the overall evidence was insufficient to suggest a statistically significant difference for other adverse events.
CONCLUSION
This meta-analysis indicated that STPCNL is an effective method for treating complex caliceal calculi or staghorn stones. Compared with MTPCNL, STPCNL not only yields similarly high SFRs but also is associated with many advantages, less blood loss, fewer blood transfusions, and fewer pulmonary complications without an increase in other complications. However, the findings of this study should be further confirmed by well-designed prospective randomized controlled trials (RCTs) with a larger patient series.
Topics: Blood Transfusion; Humans; Kidney Calculi; Nephrolithotomy, Percutaneous; Postoperative Complications; Staghorn Calculi; Treatment Outcome
PubMed: 33381587
DOI: 10.1155/2020/8817070 -
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 -
BMC Urology Sep 2022To assess the outcome of the mini-track, mini-nephroscopy, mini ultrasonic probe percutaneous nephrolithotomy for upper ureteral and kidney stones.
BACKGROUND
To assess the outcome of the mini-track, mini-nephroscopy, mini ultrasonic probe percutaneous nephrolithotomy for upper ureteral and kidney stones.
METHODS
We collected data of 53 patients (55 kidney units) who underwent mini-track, mini-nephroscopy, mini-ultrasonic probe percutaneous nephrolithotomy between September 2020 and March 2021. The study included single and upper ureteral stones from 12 kidneys, multiple stones from 28 kidneys, and staghorn stones from 15 kidneys.
RESULTS
The mean operative duration was 50.6 min, ranging from 15 to 200 min, whereas the mean lithotripsy and stone removal time was 17.2 min (3-45 min). Moreover, the mean postoperative length of stay was 4.0 days (1-7 days). Besides, the stone-free rate (SFR) of discharge was 89.1% (49/55). The mean hemoglobin drop was 15.3 mg/dL, ranging 1-32 mg/dL. Out of the total cases, only 4 of them displayed minor complications. The outcomes of < 40 mm versus ≥ 40 mm calculi were compared by performing subgroup analysis. The results demonstrated a longer operation duration (65.2 vs. 40.2 min), higher complication rate (13.0% vs. 3.3%), and lower SFR in the ≥ 40 mm calculi subgroup.
CONCLUSIONS
In summary, mini-track, mini-nephroscopy, mini-ultrasonic probe percutaneous nephrolithotomy is an effective and safe method to treat patients with upper ureteral and kidney calculi. This is especially significant for the stone size of 20-40 mm, demonstrating excellent SFR and a lower complication rate.
Topics: Humans; Kidney; Kidney Calculi; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Retrospective Studies; Treatment Outcome; Ultrasonics; Ureteral Calculi
PubMed: 36071397
DOI: 10.1186/s12894-022-01061-0