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Archivos Espanoles de Urologia Jan 2017Miniaturized percutaneous nephrolithotomy (mini-PCNL) has increased in popularity in recent years and is now widely used to overcome the therapeutic gap between... (Review)
Review
Miniaturized percutaneous nephrolithotomy (mini-PCNL) has increased in popularity in recent years and is now widely used to overcome the therapeutic gap between conventional PCNL and less-invasive procedures such as shock wave lithotripsy (SWL) or flexible ureterorenoscopy (URS) for the treatment of renal stones. However, despite its minimally invasive nature, the superiority in terms of safety, as well as the similar efficacy of mini-PCNL compared to conventional procedures, is still under debate. The aim of this chapter is to present one of the most recent advancements in terms of mini-PCNL: the Karl Storz "minimally invasive PCNL" (MIP). A literature search for original and review articles either published or e-published up to December 2016 was performed using Google and the PubMed database. Keywords included: minimally invasive PCNL; MIP. The retrieved articles were gathered and examined. The complete MIP set is composed of different sized rigid metallic fiber-optic nephroscopes and different sized metallic operating sheaths, according to which the MIP is categorized into extra-small (XS), small (S), medium (M) and large (L). Dilation can be performed either in one-step or with a progressive technique, as needed. The reusable devices of the MIP and vacuum cleaner efect make PCNL with this set a cheap procedure. The possibility to shift from a small to a larger instrument within the same set (Matrioska technique) makes MIP a very versatile technique suitable for the treatment of almost any stone. Studies in the literature have shown that MIP is equally effective, with comparable rates of post-operative complications, as conventional PCNL, independently from stone size. MIP does not represent a new technique, but rather a combination of the last ten years of PCNL improvements in a single system that can transversally cover all available techniques in the panorama of percutaneous stone treatment.
Topics: Equipment Design; Humans; Kidney Calculi; Minimally Invasive Surgical Procedures; Nephrostomy, Percutaneous
PubMed: 28221157
DOI: No ID Found -
Tidsskrift For Den Norske Laegeforening... Mar 2012
Topics: Aged, 80 and over; Diagnosis, Differential; Female; Humans; Nephrostomy, Percutaneous; Pyonephrosis; Ultrasonography
PubMed: 22398770
DOI: 10.4045/tidsskr.11.1491 -
The Pan African Medical Journal 2018Giant urinary bladder stone is defined as a stone with a weight higher than 100 g. It is rare in women, accounting for approximately 2%. Its occurrence in the urinary...
Giant urinary bladder stone is defined as a stone with a weight higher than 100 g. It is rare in women, accounting for approximately 2%. Its occurrence in the urinary bladder does not exceed 5% of the whole of the urinary tract. In women, the occurrence of urinary bladder stone is often secondary to a predisposing factor including intravesical foreign body, neurogenic bladder, repeated urinary infections, a history of surgery treating stress urinary incontinence. Therefore, there are some patients with a bladder stones without any obvious cause, such as primary idiopathic stone. We here report the case of a 31-year old patient with giant urinary bladder stone affecting the superior part of the urinary tract causing acute renal failure. The patient initially underwent bilateral nephrostomies to drain the superior part of the urinary tract; then giant urinary bladder stone was removed by open cystolithotomy. Etiological assessment didn't show any obvious cause.
Topics: Acute Kidney Injury; Adult; Female; Humans; Nephrotomy; Urinary Bladder Calculi
PubMed: 29632626
DOI: 10.11604/pamj.2018.29.4.14308 -
JSLS : Journal of the Society of... 2014Percutaneous nephrolithotomy is the most complicated stone surgery technique to learn. The steep learning curve is related mainly to obtaining precise renal access by...
INTRODUCTION
Percutaneous nephrolithotomy is the most complicated stone surgery technique to learn. The steep learning curve is related mainly to obtaining precise renal access by puncturing the targeted calyx. A minimally misaligned puncture may lead to torrential bleeding, failure of the surgery, and complications. Renal puncture can take a long time, and the increased fluoroscopic time is a hazard for the patient and surgeon.
METHODS
To aid in renal puncture and overcome the learning curve associated with learning the renal puncture technique, we designed a kidney access device (KAD), which helps align the 3-dimensional targeted calyx under fluoroscopy for precise needle placement. The KAD allows access to calyces at all angles. A 3-step puncture technique was formulated for puncturing the kidney using the KAD in a porcine model (with comparable renal size and anatomy with humans). To evaluate the practicality of the KAD and its possible advantages and limitations, the KAD was used to puncture 3 targeted calyces of bilateral kidneys in 4 pigs. Guidewires were inserted into the renal collecting system through the placed needle.
RESULTS
Mean time per puncture was 4 ± 2 minutes (n = 24). Necropsy showed no retroperitoneal hematoma, visceral organ injury, or active bleeding from kidneys in any of the pigs. Kidneys were dissected and precise intrarenal placements of guidewires in relation to targeted calyces were noted at all 24 sites.
CONCLUSIONS
The KAD with the 3-step technique aids in the safe and accurate renal puncture, even in novice hands, while drastically reducing operative and fluoroscopy time. The KAD may also be used to access other organs and has potential applications in minimally invasive surgery.
Topics: Animals; Disease Models, Animal; Equipment Design; Fluoroscopy; Kidney Calculi; Kidney Calices; Nephrostomy, Percutaneous; Swine
PubMed: 25489217
DOI: 10.4293/JSLS.2014.00219 -
International Journal of Surgery... Dec 2016Technical innovations in all aspects of percutaneous nephrolithotomy have changed the field considerably. The current review is aimed at reporting on the most recent... (Review)
Review
Technical innovations in all aspects of percutaneous nephrolithotomy have changed the field considerably. The current review is aimed at reporting on the most recent advancements in the field of percutaneous nephrolithotomy. Improvements in CT imaging and the possibility of 3D rendering have dethroned the intravenous pyelogram as gold standard for pre-operative imaging. Where gaining access in the lower pole in prone position with telescopic metal dilators, placing a 30F tract used to be standard, the plethora of alternatives provides the trained surgeon with a large armamentarium to tackle any obstacle. Novel lithotripters appear more efficient than their predecessors and with tubeless PCNL gaining some momentum, ambulatory PCNL is slowly but surely becoming feasible rather than fictional.
Topics: Clinical Competence; Humans; Kidney Calculi; Nephrostomy, Percutaneous; Surgeons; Surgery, Computer-Assisted
PubMed: 27826048
DOI: 10.1016/j.ijsu.2016.11.007 -
Urolithiasis Oct 2022We aimed to perform a systematic review of randomized trials to summarize the evidence on the safety and stone-free rate after Tubeless percutaneous nephrolithotomy... (Meta-Analysis)
Meta-Analysis Review
We aimed to perform a systematic review of randomized trials to summarize the evidence on the safety and stone-free rate after Tubeless percutaneous nephrolithotomy (PCNL) (ureteral stent/catheter, no nephrostomy) compared to Standard PCNL (nephrostomy, with/without ureteral stent/catheter) to evaluate if the tubeless approach is better. The inverse variance of the mean difference with a random effect, 95% Confidence Interval (CI), and p values was used for continuous variables. Categorical variables were assessed using Cochran-Mantel-Haenszel method with the random effect model, and reported as Risk Ratio (RR), 95% CI, and p values. Statistical significance was set at p < 0.05 and a 95% CI. 26 studies were included. Mean operative time was significantly shorter in the Tubeless group (MD-5.18 min, 95% CI - 6.56, - 3.80, p < 0.00001). Mean postoperative length of stay was also significantly shorter in the Tubeless group (MD-1.10 day, 95% CI - 1.48, - 0.71, p < 0.00001). Incidence of blood transfusion, angioembolization for bleeding control, pain score at the first postoperative day, the number of patients requiring postoperative pain medication, fever, urinary infections, sepsis, perirenal fluid collection, pleural breach, hospital readmission, and SFR did not differ between the two groups. Incidence of postoperative urinary fistula was significantly lower in the Tubeless group (RR 0.18, 95% CI 0.07, 0.47, p = 0.0005). This systematic review shows that tubeless PCNL can be safely performed and the standout benefits are shorter operative time and hospital stay, and a lower rate of postoperative urinary fistula.
Topics: Humans; Kidney Calculi; Length of Stay; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Postoperative Complications; Randomized Controlled Trials as Topic; Treatment Outcome; Urinary Fistula
PubMed: 35674819
DOI: 10.1007/s00240-022-01337-y -
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 -
Minerva Urology and Nephrology Dec 2022
Topics: Humans; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Kidney Calculi
PubMed: 36286403
DOI: 10.23736/S2724-6051.22.05126-6 -
International Journal of Surgery... Dec 2016Percutaneous nephrolithotomy (PCNL) is the preferred treatment of choice for renal calculi. PCNL has evolved remarkably since the eighties when it was first described. (Review)
Review
INTRODUCTION
Percutaneous nephrolithotomy (PCNL) is the preferred treatment of choice for renal calculi. PCNL has evolved remarkably since the eighties when it was first described.
APPROACH
Approach might be by either supine or prone and the access is made with the help of either fluoroscopy or ultrasound. Recently endoscopy guided puncture has also been described.
MINIATURIZATION
Traditionally the tract size for PCNL used to be 30Fr. Even though the stone clearance rate was good there were complications such as bleeding With the advent of excellent optics and advances in stone fragmentation the tract size has reduced to a great extent which has reduced the complications without compromising the stone clearance.
COMPLICATIONS
The complications related to access might be injury to pleura, and other visceral organs. The other complications are bleeding, infection and incomplete stone clearance.
CONCLUSION
PCNL has emerged as most efficient procedure among these approaches to stone removal, though not devoid of complications and requirement for skills. The drive for minimal invasive approach should not compromise stone clearance, latter being the core principle of endourology. In skilled hands PCNL is the answer to stone questions we as urologist face day to day. though which form of PCNL is to be chosen depends on surgeons skill level and discretion.
Topics: Humans; Kidney Calculi; Miniaturization; Nephrostomy, Percutaneous
PubMed: 27856356
DOI: 10.1016/j.ijsu.2016.11.028 -
Hinyokika Kiyo. Acta Urologica Japonica Aug 2015We assessed our initial experience with tubeless percutaneous nephrolithotomy (PCNL). Between February 2011 and December 2013, we performed 155 tubeless PCNL and 54...
We assessed our initial experience with tubeless percutaneous nephrolithotomy (PCNL). Between February 2011 and December 2013, we performed 155 tubeless PCNL and 54 standard PCNL in which nephrostomy tubes were used postoperatively. Tubeless PCNL was performed when the presence of residual fragments, bleeding, and extravasation were excluded intraoperatively. The incidence of complications, hospital stay duration, analgesic requirements, visual analog scale score, decrease in hemoglobin levels, and stone-free rates were compared between the two groups. The mean hospital stay after tubeless PCNL was shorter (5.1 days) than that after standard PCNL (6.8 days, P<0.05). Transient fever was seen in 20 patients (13.8%) in the tubeless PCNL group and 12 patients (25.5%) in the standard PCNL group. Tubeless PCNL is a safe and effective procedure, and hospital stay is shorter with tubeless PCNL than with standard PCNL.
Topics: Female; Humans; Kidney Calculi; Length of Stay; Male; Middle Aged; Nephrostomy, Percutaneous; Postoperative Complications
PubMed: 26411652
DOI: No ID Found