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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 -
Clinical Journal of the American... Jul 2015Cystinuria is a rare inherited renal stone disease. Mutations in the amino acid exchanger System b(0,+), the two subunits of which are encoded by SLC3A1 and SLC7A9,...
BACKGROUND AND OBJECTIVES
Cystinuria is a rare inherited renal stone disease. Mutations in the amino acid exchanger System b(0,+), the two subunits of which are encoded by SLC3A1 and SLC7A9, predominantly underlie this disease. The work analyzed the epidemiology of cystinuria and the influence of mutations in these two genes on disease severity in a United Kingdom cohort.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
Prevalent patients were studied from 2012 to 2014 in the northeast and southwest of the United Kingdom. Clinical phenotypes were defined, and genetic analysis of SLC3A1 and SLC7A9 combining Sanger sequencing and multiplex ligation probe-dependent amplification was performed.
RESULTS
In total, 76 patients (42 men and 34 women) were studied. All subjects had proven cystine stones. Median age of presentation (first stone episode) was 24 years old, but 21% of patients presented after 40 years old. Patients had varied clinical courses, with 37% of patients having ≥10 stone episodes; 70% had evidence of CKD, and 9% had reached ESRD as a result of cystinuria and its complications. Patients with cystinuria received a variety of different therapies, with no obvious treatment consensus. Notably, 20% of patients had staghorn calculi, with associated impaired renal function in 80% of these patients. Genetic analysis revealed that biallelic mutations were present in either SLC3A1 (n=27) or SLC7A9 (n=20); 22 patients had only one mutated allele detected (SLC3A1 in five patients and SLC7A9 in 17 patients). In total, 37 different mutant variant alleles were identified, including 12 novel mutations; 22% of mutations were caused by large gene rearrangements. No genotype-phenotype association was detected in this cohort.
CONCLUSIONS
Patients with cystinuria in the United Kingdom often present atypically with staghorn calculi at ≥40 years old and commonly develop significant renal impairment. There is no association of clinical course with genotype. Treatments directed toward reducing stone burden need to be rationalized and developed to optimize patient care.
Topics: Adolescent; Adult; Age of Onset; Amino Acid Transport Systems, Basic; Amino Acid Transport Systems, Neutral; Child; Child, Preschool; Cystinuria; DNA Mutational Analysis; Disease Progression; Female; Gene Frequency; Genetic Predisposition to Disease; Humans; Kidney Calculi; Kidney Failure, Chronic; Male; Middle Aged; Multiplex Polymerase Chain Reaction; Mutation; Phenotype; Prevalence; Registries; Renal Insufficiency, Chronic; Retrospective Studies; Severity of Illness Index; United Kingdom; Young Adult
PubMed: 25964309
DOI: 10.2215/CJN.10981114 -
Jornal Brasileiro de Nefrologia 2023
Topics: Humans; Staghorn Calculi; Kidney Calculi
PubMed: 37930143
DOI: 10.1590/2175-8239-JBN-2023-0072en -
International Journal of Urology :... May 2004To elucidate the factors contributing to staghorn stone formation in patients.
PURPOSE
To elucidate the factors contributing to staghorn stone formation in patients.
MATERIALS AND METHODS
The records of 82 patients (44 men and 38 women) with complete staghorn calculi were reviewed retrospectively for clinical presentation, metabolic disturbances and anatomical abnormalities.
RESULTS
There were 79 unilateral and three bilateral cases. The patient performance of the activities of daily life was assessed with the modified Rankin scale (MRS) and it was found that 69 patients were functionally independent (84.1%, MRS 0-1) and 10 patients had a severe disability (12.2%, MRS 4-5). Seven patients had chronic indwelling catheters (8.5%). A positive urine culture was found in 24.4% of patients. Analysis of stone composition revealed magnesium ammonium phosphate and mixed calcium oxalate-phosphate were the most frequently identified types of stone (32.1% and 22.2%, respectively). Urinary pH was low in patients with uric acid stones (mean 5.4). Hyperuricemia, cystinuria and hypercalciuria were found in 14.6%, 2.4% and 37.8%, respectively. Hypercalciuria was found more frequently in calcium-stone cases. Eleven patients (13.4%) showed structural abnormalities of the kidney.
CONCLUSIONS
Our data show that the patients with severe disability, urinary tract infection and hypercalciuria could be recognized more frequently in staghorn calculi compared with common urolithiasis. However, in Western countries, the frequency of both urinary tract infection and struvite stones is much higher than in our data. Other Japanese authors have also reported the low frequency of struvite stones in staghorn calculi, suggesting that various factors other than urinary tract infection possibly contribute to the formation of staghorn calculi in Japan.
Topics: Activities of Daily Living; Adult; Aged; Calcium; Calcium Oxalate; Calcium Phosphates; Catheters, Indwelling; Cystinuria; Female; Humans; Hydrogen-Ion Concentration; Hyperuricemia; Kidney; Kidney Calculi; Magnesium Compounds; Male; Middle Aged; Phosphates; Retrospective Studies; Struvite; Uric Acid; Urinary Tract Infections; Urine
PubMed: 15147542
DOI: 10.1111/j.1442-2042.2004.00800.x -
Journal of Research in Medical Sciences... 2024The objective is to evaluate the prevalence of acute kidney injury (AKI) as an early complication of the percutaneous nephrolithotomy (PCNL) procedure.
BACKGROUND
The objective is to evaluate the prevalence of acute kidney injury (AKI) as an early complication of the percutaneous nephrolithotomy (PCNL) procedure.
MATERIALS AND METHODS
From May 2022 to October 2022, we conducted a retrospective study on patients undergoing PCNL procedures in two of the tertiary medical centers affiliated with Isfahan University of Medical Sciences. Patients' baseline characteristics, laboratory values, perioperative data, and stone features were documented. AKI was defined either as a ≥0.3 mg/dL increase in the serum creatinine level within 2 days, or a ≥1.5-fold increase in baseline serum creatinine level within 7 days after the operation. Laboratory values were measured 1 day before PCNL and daily thereafter until discharge. Patients were followed 1 week later to detect all of the possible cases of AKI.
RESULTS
The final analysis was performed on 347 individuals. AKI developed in 16 (4.61%) cases. The two groups were comparable regarding age ( = 0.887), gender ( = 0.566), and underlying comorbidities including diabetes mellitus ( = 0.577) and hypertension ( = 0.383). The mean body mass index (BMI) ( < 0.001) and both frequency and severity of hydronephrosis ( < 0.001) were significantly different. A higher mean PCNL duration ( < 0.001), period of hospitalization ( < 0.001), and blood loss volume ( < 0.001) were observed in those who developed AKI. Overall, 56.3% (9) of patients in the AKI group and 2.7% (9) in the non-AKI group required the establishment of more than one access tract, during the procedure ( < 0.001). A lower preoperative hemoglobin level was observed in the AKI group ( < 0.001). Those with AKI had significantly larger stones (3.08 ± 0.46 vs. 2.41 ± 0.23 cm, < 0.001) and higher Hounsfield units ( < 0.001). In addition, in the AKI group, most of the calculi (81.3%, 13) were of staghorn type, whereas in the non-AKI group, calculi were most frequently located in the middle calyx (30.2%, 100), ( < 0.001).
CONCLUSION
The prevalence of post-PCNL AKI is approximately 4.61%. The mean BMI, preoperative hemoglobin level, PCNL duration, intraoperative blood loss volume, and hospitalization period were significantly higher among patients who developed AKI. Those with AKI had significantly larger stones with higher Hounsfield units and more frequently of staghorn type. The two groups were not statistically different regarding age, gender, and presence of comorbidities (hypertension and diabetes mellitus).
PubMed: 38808219
DOI: 10.4103/jrms.jrms_317_23 -
Urology Journal Aug 2019Staghorn stones can cause damage to the kidneys and are considered as the one of the main cause of renal failure. If they are identified during the initial stages of...
BACKGROUND
Staghorn stones can cause damage to the kidneys and are considered as the one of the main cause of renal failure. If they are identified during the initial stages of diagnosis, kidney damage can be prevented. Screening can lead to a better diagnosis. Before the screening, it is necessary to calculate the cost-effectiveness of screening.
METHODS
Using the possibility calculations of staghorn stones in the society and different age groups as well as a decision tree model, the screening costs and effectiveness were calculated against no screening. Effectiveness was determined based on the number of prevented cases of renal failure. Ultimately, the incremental cost-effectiveness ration (ICER) was calculated and compared with the World Health Organization (WHO) method based on the gross domestic product (GDP) per capita and subgroup analysis was done for different age groups. In addition, the robustness of results was examined by sensitivity analysis.
RESULTS
The results of decision tree showed that in the screening group, the expected cost was 8815997 USD and the expected effectiveness was 358 and in the no-screening group, the expected cost was 3954214 USD and the expected effectiveness was 258. Based on the results of the study, screening compared with no screening would increase the cost by 4861783 USD and effectiveness would increase by 100 people. The incremental cost-effectiveness ratio (ICER) showed that for each unit of increase in effectiveness of screening compared with no screening, would lead to an increase the cost by 48618 USD. The results also indicated that screening 30-70-year-old people compared with other age groups (20-70 and 25-70) if done every two years, could reduce the mean costs per preventing each case of renal failure. Conclusion: If screening staghorn stones are done every two years for 30-70-year-old individuals, it would be cost effective considering WHO method and 3026 USD could be saved in the health care system per each person.
Topics: Adult; Aged; Cost-Benefit Analysis; Cross-Sectional Studies; Humans; Mass Screening; Staghorn Calculi; Young Adult
PubMed: 30604409
DOI: 10.22037/uj.v0i0.4425 -
BMC Urology Jun 2022Staghorn stones require surgical treatment to prevent serious complications. Multitract percutaneous nephrolithotomy (PNL) causes great renal parenchymal injury and...
Comparison of mini endoscopic combined intrarenal surgery and multitract minimally invasive percutaneous nephrolithotomy specifically for kidney staghorn stones: a single-centre experience.
BACKGROUND
Staghorn stones require surgical treatment to prevent serious complications. Multitract percutaneous nephrolithotomy (PNL) causes great renal parenchymal injury and blood loss. One-stage endoscopic combined intrarenal surgery (ECIRS) entails the combined use of antegrade nephroscope and retrograde flexible ureteroscope to clear the staghorn stone, which may overcome the limitations of multitract PNL. We aimed to compare the perioperative outcomes of mini ECIRS and multitract minimally invasive PNL in staghorn stone management.
METHODS
This was a retrospective single-center study of patients with staghorn stones who underwent ECIRS (n = 17) or multitract minimally invasive PNL (n = 17) between January 2018 and September 2021.
RESULTS
There was a significant between-group difference with respect to Guy's stone score. Stone size, stone burden (ECIRS group, 21.41 cm; multitract minimally invasive PNL group, 20.88 cm [P = 0.94]), and degree of hydronephrosis were comparable in the two groups. There was no significant between-group difference with respect to one-step or final stone-free rates. The mean operative time was also not significantly different between the groups (ECIRS group, 140 min; multitract minimally invasive PNL group, 183 min [P = 0.63]). ECIRS was associated with significantly lesser postoperative pain (visual analog scale; ECIRS group: 0; multitract minimally invasive PNL group: 2.7 [P < 0.001]). Hemoglobin loss, postoperative blood transfusion rate, complications, and length of hospital stay were comparable in the two groups.
CONCLUSION
Both mini ECIRS and multitract minimally invasive PNL were effective and safe for the management of renal staghorn stones with comparable operation time and stone-free rate, and complications. ECIRS was associated with less severe postoperative pain.
Topics: Humans; Kidney; Kidney Calculi; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Pain, Postoperative; Retrospective Studies; Staghorn Calculi; Treatment Outcome; Ureteroscopy
PubMed: 35773639
DOI: 10.1186/s12894-022-01030-7 -
American Journal of Clinical and... 2021To clarify the existing relationships between the characteristics of the patients and calculi and the rate of complications associated with contemporary percutaneous...
PURPOSE
To clarify the existing relationships between the characteristics of the patients and calculi and the rate of complications associated with contemporary percutaneous nephrolithotomy (PCNL).
METHODS
Retrospective cohort study of 126 consecutive patients who underwent PCNL at the academic medical center of the State Hospital of Sumaré-University of Campinas from 2016 to 2019. This study examined the correlation of pre-existing comorbidities and calculi characteristics with the incidence of postoperative complications.
RESULTS
72 (57.14%) needed complementary procedure for the residual stone fragments (defined as fragments size >3 mm). Complications occurred in 28 patients (22.22%). Of the patients who did not present any complications (n=98, 77.77%), 61 (62.24%) stayed in the hospital for 1-3 days. The length of hospital stays significantly correlated with higher grade of complication (P=0.018). Grade III staghorn calculi demonstrated a greater number of residual stone fragments (P<0.001). In this group of staghorn calculi (n=27, 21.42%), 24 (88.88%) presented with residual stone fragments after the PCNL procedure (P<0.001).
CONCLUSIONS
PCNL complications are related to longer hospital stay and calculus complexity is directly related to the rate of residual stone fragments, especially in cases of grade III staghorn calculi.
PubMed: 34993269
DOI: No ID Found -
Journal of the National Medical... Aug 1990The author presents a case of spontaneous nephrocutaneous fistula associated with a complete staghorn calculus in a nonfunctioning kidney. A renal scan, an intravenous...
The author presents a case of spontaneous nephrocutaneous fistula associated with a complete staghorn calculus in a nonfunctioning kidney. A renal scan, an intravenous pyelogram, and a right retrograde pyelogram confirmed the need for a nephrectomy. The procedure and results are described here.
Topics: Aged; Female; Fistula; Humans; Kidney Calculi; Kidney Diseases; Kidney Failure, Chronic; Nephrectomy; Skin Diseases
PubMed: 2395179
DOI: No ID Found -
Journal of Postgraduate Medicine 2022Unilateral acquired diaphragmatic paresis is a known complication of thoracic surgeries. Direct mechanical injury to the phrenic nerve during surgery results in this...
Unilateral acquired diaphragmatic paresis is a known complication of thoracic surgeries. Direct mechanical injury to the phrenic nerve during surgery results in this complication. However its occurrence post-percutaneous nephrolithotomy (PCNL) has not been described. We report a 43-year-old man who underwent prone PCNL for endourological management of left complete staghorn calculus. Access via the 10 left intercostal space, under fluoroscopy, was carried out to remove the calculus. Post-operative, the routine chest radiograph revealed left hemidiaphragmatic blunting. Computerized tomography of the chest confirmed left hemidiaphragmatic elevation, suggesting unilateral diaphragmatic paresis. He did not have any respiratory symptoms, was managed conservatively with chest physiotherapy and incentive spirometry and responded extremely well. The absence of reported cases of diaphragmatic paresis post PCNL lends to a dearth in knowledge regarding recognition and management. This case report aims to acquaint urologists with this rare complication associated with supracostal PCNL and provide a rational management plan.
Topics: Adult; Digestive System Diseases; Fluoroscopy; Humans; Kidney Calculi; Male; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Paresis
PubMed: 34708699
DOI: 10.4103/jpgm.JPGM_13_21