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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 -
International Journal of Surgery Case... 2020Pancreatolithiasis is an uncommon disease and the diagnosis of pancreatic duct stones is challenging. The radiological findings of pancreatic duct stones may mimic other...
INTRODUCTION
Pancreatolithiasis is an uncommon disease and the diagnosis of pancreatic duct stones is challenging. The radiological findings of pancreatic duct stones may mimic other diseases, such as renal stones.
CASE PRESENTATION
A 42-year-old male came with chief complaint of recurrent bilateral flank pain accompanied by fever which worsen 7 days before admission. The patient was diagnosed as gastritis and received analgesics in several hospitals. Ultrasonography and IVP examinations showed stones in both kidneys. CT-scan was not performed due to limitation in the hospital. Patient was diagnosed bilateral staghorn nephrolithiasis. The patient underwent bilateral bivalve nephrotomy for staghorn renal stone performed by urologist, but intraoperatively, no stones were found. The patient was then consulted intraoperatively to the digestive surgeon and get immediate median laparotomy. Intraoperatively, stones were palpated in the head and tail of the pancreas. The stones were evacuated. The symptoms were relieved, neither recurrence, nor pain, nor postoperative leakage was found. Patient was discharged uneventfully 4 days after the procedure and had no complaints in further follow-ups.
DISCUSSION
The symptoms of pancreatolithiasis may overlap with nephrolithiasis and gastritis. The presented case was unique because from the history taking, clinical symptoms, USG, and IVP findings supported the diagnosis of nephrolithiasis, but intraoperative findings reveal pancreatic duct stones.
CONCLUSION
For patient diagnosed with renal calculi based on sonography and IVP findings, differential diagnosis of pancreatic stone should be considered especially if no underlying cause is detected. In such circumstances relying on IVP and sonographic findings alone can be misleading.
PubMed: 33395837
DOI: 10.1016/j.ijscr.2020.11.066 -
Arab Journal of Urology Dec 2012To evaluate a supracostal approach for percutaneous nephrolithotomy (PCNL) of staghorn calculi through a prospective study and review of previously reported cases.
OBJECTIVES
To evaluate a supracostal approach for percutaneous nephrolithotomy (PCNL) of staghorn calculi through a prospective study and review of previously reported cases.
METHODS
From June 2009 to November 2011, 40 patients with staghorn calculi were scheduled for supracostal S-PCNL in a prospective study. Of the 40 renal units, 16 (40%) had a complete staghorn and 24 (60%) had a partial staghorn calculus. Perioperative complications were stratified according to the modified Clavien system. Univariate and multiple logistic regression analyses were used to determine statistically significant variables affecting the stone-free rate and development of complications.
RESULTS
In all, 57 tracts were established in the 40 renal units; 23 (58%) renal units were approached through one supracostal upper pole calyx, while 13 (33%) and four (10%) required a second middle- or lower-pole puncture, respectively. Overall, 78% of patients were rendered stone-free or had clinically insignificant residual fragments with PCNL monotherapy, and this increased to 88% with auxiliary procedures. In the logistic regression analysis, a complete staghorn stone was the only independent variable for residual stones (P = 0.005). There was an overall complication rate of 38%. Independent variables with an influence on complications were staghorn stone burden (P = 0.007), and operative duration (P = 0.045).
CONCLUSIONS
The supracostal upper calyceal approach provides optimum access for the percutaneous removal of staghorn stones. Appropriate attention to the technique and to monitoring before and after surgery can detect thoracic complications, and these can be managed easily with intercostal chest tube drainage, with no serious morbidity.
PubMed: 26558050
DOI: 10.1016/j.aju.2012.08.001 -
Urology Journal Jun 2019Metabolic disorders are common in patients with staghorn renal stones. Aim of this study was to evaluate and compare the metabolic disorders in patients with unilateral... (Comparative Study)
Comparative Study
PURPOSE
Metabolic disorders are common in patients with staghorn renal stones. Aim of this study was to evaluate and compare the metabolic disorders in patients with unilateral and bilateral staghorn stones.
MATERIALS AND METHODS
In this cross sectional study, 78 patients who underwent percutaneous nephrolithotomy (PCNL) for staghorn renal stones were included. The urine volume, the level of calcium, oxalate, uric acid, phos-phate, sodium, citrate, creatinine, and cystine from 24 hour urine collection as well as the serum levels of calcium, phosphorus, magnesium, creatinine, blood urea nitrogen (BUN), parathyroid hormone (PTH) and uric acid were recorded and compared among the two groups with unilateral and bilateral renal stones.
RESULTS
56 patients (71.8%) had unilateral and 22 (28.2%) had bilateral renal stones. At least one abnormal meta-bolic factor was found in 32 (57.1%) and 15 (68.2%) patients with unilateral and bilateral renal stones, respectively (P = .044). Cystine urine levels and serum levels of BUN were higher in cases with bilateral compared to unilateral renal stones (36.4% vs. 12.5%, P = .025 and 27.3% vs. 1.8%, P = .002, respectively).
CONCLUSION
Metabolic factors are strongly correlated with the formation of staghorn renal stones specially bilat-eral ones. In our study among different metabolic factors, cystine urine levels and serum levels of BUN were sig-nificantly higher in patients with bilateral renal stones. Proper metabolic assessments are recommended in patients with staghorn urolithiasis.
Topics: Cross-Sectional Studies; Female; Humans; Male; Metabolic Diseases; Middle Aged; Nephrolithotomy, Percutaneous; Retrospective Studies; Staghorn Calculi
PubMed: 30206923
DOI: 10.22037/uj.v0i0.4316 -
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 -
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 -
Iranian Journal of Medical Sciences Nov 2019The incidence of renal hemorrhage during percutaneous nephrolithotomy (PCNL) is high. We sought to evaluate the effects of tranexamic acid (TXA) on bleeding and...
BACKGROUND
The incidence of renal hemorrhage during percutaneous nephrolithotomy (PCNL) is high. We sought to evaluate the effects of tranexamic acid (TXA) on bleeding and hemoglobin levels of patients with staghorn calculi treated with PCNL.
METHODS
In a double-blind clinical trial, 120 patients with staghorn calculi candidated for PCNL in Alzahra Hospital between January 2014 and November 2017, Isfahan, Iran, were classified into two groups in terms of the stone size (>4 cm and <4 cm). The patients in both groups were then randomly assigned to receive either 1 g of TXA intravenously or normal saline. (The generation of random numbers was done by computer.) Thus, there were four groups of 30 patients each. The transfusion rate, the mean volume of blood loss, the operative duration, and the hemoglobin level were compared between the intervention and control groups for each stone-size category. Statistical analysis was performed using SPSS, version 19. The paired and independent t test and the Pearson coefficient correlation were used, and a P value less than 0.05 was considered statistically significant.
RESULTS
The mean volume of blood loss was significantly higher in the control group patients than in those receiving TXA, in both stone-size categories (P<0.001). There was no significant difference in the postoperative hemoglobin level between the intervention and control groups, in both stone-size categories (P=0.26 and P=0.10, respectively). In addition, the mean volume of blood loss increased significantly with an increase in the operative duration (P<0.001).
CONCLUSION
TXA reduced the risk of bleeding during and after PCNL and attenuated the drop in the hemoglobin level in the postoperative period. Longer operative procedures were associated with an increase in the bleeding volume. IRCT20180209038673N1.
PubMed: 31875080
DOI: 10.30476/ijms.2019.44969 -
BMC Urology Sep 2021Drug-induced urolithiasis falls into two categories: drug-induced and metabolically-induced. Certain antimicrobials are associated with each; sulfonamides are associated...
BACKGROUND
Drug-induced urolithiasis falls into two categories: drug-induced and metabolically-induced. Certain antimicrobials are associated with each; sulfonamides are associated with drug- or metabolite-containing calculi when taken in large doses over a long period of time. Trimethoprim-sulfamethoxazole, a member of the sulfonamide family, is a rare cause of drug-induced calculi. Cases of sulfonamide urolithiasis occurring in patients with known stone disease have rarely been reported.
CASE PRESENTATION
We report a case of a patient with a brief history of recurrent calcium oxalate nephrolithiasis requiring 2 ureteroscopic procedures whose existing 6 mm lower pole renal stone more than quadrupled in size to form a 4 cm renal staghorn after 4 months of high-dose treatment for Nocardia pneumonia with trimethoprim-sulfamethoxazole. After ureteroscopy with laser lithotripsy and basketing of fragments, the stone was found to be predominantly composed of N-acetyl-sulfamethoxazole, a metabolite of sulfamethoxazole.
CONCLUSION
Stones composed of sulfamethoxazole or its metabolites are rare but have known associated risk factors that should be considered when prescribing this antibiotic. This case report illustrates additional risk factors for consideration, including pre-existing urinary calculi that may serve as a nidus for sulfamethoxazole deposition, and reviews treatment and prevention methods.
Topics: Anti-Infective Agents; Female; Humans; Kidney Calculi; Middle Aged; Sulfamethoxazole
PubMed: 34535099
DOI: 10.1186/s12894-021-00894-5 -
PloS One 2012To present our experience with simultaneous combined minimally invasive percutaneous nephrolithotomy (MPCNL) and retrograde intrarenal surgery (RIRS) to manage patients...
BACKGROUND
To present our experience with simultaneous combined minimally invasive percutaneous nephrolithotomy (MPCNL) and retrograde intrarenal surgery (RIRS) to manage patients with staghorn calculi in solitary kidney, and evaluate the safety, efficiency and feasibility of this approach.
METHODOLOGY/PRINCIPAL FINDINGS
The study included 20 patients with staghorn calculi in solitary kidney. Demographic characteristics, stone location and surface area were recorded. After informed consent, the patients underwent one stage MPCNL firstly. Combined second stage MPCNL and RIRS simultaneously were performed at postoperative 5-7 days. Operative parameters, stone-free rate (SFR), stone analyses and complications were evaluated. Serum creatinine (Scr), glomerular filtration rate (GFR) and chronic kidney disease (CKD) were measured preoperatively, postoperatively at 1 month, and each follow-up visit. All patients had staghorn stones involving multiple calyces. The mean stone burden was 1099.9 ± 843.95 mm(2). All patients had only one percutaneous access tract. The mean whole operative duration was 154.37 ± 32.45 min. The mean blood loss was 64 (12-140) ml. The final SFR was 90%. During the 1-month follow-up study period, four patients improved in CKD stage. Two patients who had CKD (stage 5) still needed dialysis postoperatively. Mean Scr of the rest patients preoperatively was 187.16 ± 94.12 compared to 140.99 ± 57.92 umol/L by the end of 1-month follow-up period (p = 0.019). The same findings were observed in GFR in that preoperatively it was 43.80 ± 24.74 ml/min and by the end of the 1-month follow-up it was 49.55 ± 21.18 ml/min (p = 0.05).
CONCLUSIONS/SIGNIFICANCE
Combined MPCNL and RIRS management effectively decrease the number and size of percutaneous access tracts, which is safe, feasible, and efficient for managing staghorn calculi in solitary kidney with satisfactory SFR and reducing blood loss, potential morbidity associated with multiple tracts. The approach did not adversely affect renal function at both short-term and long-term follow-up.
Topics: Adult; Aged; Creatinine; Female; Glomerular Filtration Rate; Humans; Kidney Calculi; Lithotripsy; Male; Middle Aged; Nephrostomy, Percutaneous; Young Adult
PubMed: 23119016
DOI: 10.1371/journal.pone.0048435 -
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