Development of a novel mesh model to define a new index "amount of stone" to evaluate calculus and predicting the lithotripsy time

OBJECTIVE

Develop a mesh model to define a new "index amount of stone" to evaluate calculus and predict lithotripsy time.

METHODS

The stones were divided into target units with diameter of 5 mm by the mesh from x, y and z directions, and the cross-sectional areas between units were calculated as amount of stone as a new index to evaluate calculus. Design a prospective study with 112 cases of percutaneous nephrolithotomy to verify the reliability of this index, and to compare the accuracy of the quantity, volume and maximum diameter of stones in predicting the time of lithotripsy.

RESULTS

Amount of stone (Q) is reliable. The lithotripsy time was significantly correlated with the amount of stone, volume and maximum diameter of the stone (p < 0.01). The three regression equations were valid. The linear fit in the amount group was larger than that in the volume group, and further larger than that in the maximum diameter group, with R2 values of 0.716, 0.661 and 0.471, respectively.

CONCLUSIONS

It is more accurate and convenient to use amount of stone to evaluate calculus, which can be used to predict the lithotripsy time.

Safety and efficacy of percutaneous nephrolithotripsy in comorbid patients: A 3 years prospective observational study

PURPOSE

To report the result of percutaneous nephrolithotripsy (PCNL) via standard nephrostomy tract in a single training institution. The perioperative complications in relation to the comorbid state are particularly assessed.

PATIENTS AND METHODS

A prospective interventional study between January 2019 to November 2022, included 210 patients scheduled for PCNL. The average age was 40.3 ± 11.8 years (range 18- 67 years). Patients were categorized into two groups. The first group comprised 146 cases (69 .5%) with no associated co-morbidities while the second group 64 (30.5%) had co-morbidities such as obesity in 4 cases (1.9%), hypertension (HTN) in 24 cases (11.4%) cases, diabetes mellitus (DM) in 17 (8.1%) cases, history of recurrent stone surgery in 11 (5.2%) cases and more than one in 8 cases (3.8%). Co-morbidities, stone burden, location of stone, time of surgery, stay in the hospital, further operations, and negative events were among the reported data. Complications and the stone-free rate were the main outcome indicators.

RESULTS

Intraoperative complications were reported in 40 (18.8%) patients (18 group 1 and 22 group 2) during PCNL. Bleeding occurred in 22 (10.5%) patients (9 group 1 and 13 group 2), blood transfusions were needed in 4 (1.9%) (2 group 1 and 2 group 2), extravasation was observed in 11 patients (5.2%) (6 group 1 and 5 group 2) and cardiac arrhythmia in 3 (1.4%) (1 group 1 and 2 group 2) patients. Postoperative complications occurred in 61 patients (29%) (24 group 1 and 37 group 2) in the form of fever in 10 patients (4.8 %) (3 group 1 and 7 group 2) and prolonged leakage in 50 patients (23.8%) (21 group 1 and 29 group 2). One patient of group 2 died from postoperative sepsis. Extravasation and postoperative leakage were higher in diabetic patients than in non-diabetics. Stonefree rate was 60.5% (127 of 210). Clinically significant residual fragments (CSRFs) found in 70 cases (33.3%) (33 group 1 and 37 group 2). In 13 cases (6.2%) (5 group 1 and 8 group 2), clinically insignificant residual fragments (CIRFs) were found. In 8 (3 group 1 and 5 group 2) of the 13 cases, spontaneous stone passage was observed within 4-6 weeks of surgery. Residual stones in three cases (1 group 1 and 2 group 2) were asymptomatic and 4 mm or less, whereas stones increased in two cases of group 2. Among all factors studied, stone burden was significantly correlated to both intraoperative and postoperative complications. The occurrence of postoperative fever increased with large stone burden.

CONCLUSIONS

PCNL is a therapeutic modality that is effective, feasible, and safe for a wide range of patients with concurrent medical issues. A steep curve is required to reduce intraoperative and postoperative complications.

Outcome of Mini-PCNL Under Loco-Regional Anesthesia: Outcomes of a Systematic Review

PURPOSE OF REVIEW

Miniaturized PCNL (mi-PCNL) for stone disease is performed under a general anesthesia. However, the role of loco-regional anesthesia in mi-PCNL and its outcomes are not well defined yet. Here, we review the outcomes and complications of loco-regional anesthesia for mi-PCNL. A Cochrane-style review was performed in accordance with the preferred reporting items for systematic reviews to evaluate the outcomes of loco-reginal anesthesia for URS in stone disease, including all English language articles from January 1980 and October 2021.

RECENT FINDINGS

Ten studies with a total of 1663 patients underwent mi-PCNL under loco-regional anesthesia. The stone-free rate (SFR) for mi-PCNL under neuro-axial anesthesia ranged between 88.3 and 93.6%, while it ranged between 85.7 and 93.3% for mi-PCNL under local anesthesia (LA). The conversion rate to another anesthesia modality was 0.5%. The complications ranged widely between 3.3 and 85.7%. The majority were Grade I-II complications and none of the patients had grade V complications. Our review shows that mi-PCNL under loco-regional anesthesia is feasible with good SFR and a low risk of major complications. The conversion to general anesthesia is needed in a small minority, with the procedure itself being well tolerated and a big step towards establishing an ambulatory pathway for these patients.

DIFFERENT APPROACHES TO MANAGING UROLITHIASIS IN KIDNEY TRANSPLANT PATIENTS - A CASE REPORT

Urolithiasis is a rare urologic complication after kidney transplantation, and its diagnosis and treatment can be challenging for clinicians. In our 52-year-old male patient, graft hydronephrosis was found six months after transplantation. The patient had recurrent urinary tract infections followed by macrohematuria and an increase in creatinine levels. Computerized tomography revealed a 13-mm diameter stone in the ureter of the transplanted kidney as the cause of obstruction. Percutaneous nephrostomy was placed in the graft to solve the obstruction. Initial endoscopic treatment with a retrograde approach failed. An antegrade approach through a previously placed nephrostomy was not successful either. By a repeated retrograde approach, laser lithotripsy was performed successfully. The patient has been monitored for six months and has stable graft function without hydronephrosis or stones. As in our patient's case, the diagnosis and treatment of urolithiasis in kidney transplant patients is challenging, and minimally invasive procedures are the treatment of choice.

Evolution and current applications of endoscopic combined intrarenal surgery: a scoping review from back to the future

PURPOSE OF REVIEW

To systematically review the evolution of techniques, technology, clinical utility, limitations and possible future applications of endoscopic combined intrarenal surgery (ECIRS) for ureteral and kidney stones.

RECENT FINDINGS

The literature search was performed on 18th January 2023 using PubMed, EMBASE and Scopus. 35 studies were included. Among them, six were reviews. Since its introduction in 2008, ECIRS has evolved and improved. ECIRS can be performed in different patient position, such as modified supine Valdivia position by Galdakao, prone position with split-leg and supine position with good outcomes. Instrument miniaturization has also been introduced in ECIRS making it doable in an ambulatory setting. ECIRS showed shorter operative time, lower complication rate, and retreatment compared with conventional PCNL. Operative outcomes of mini-ECIRS are better than mini-PCNL alone. ECIRS also showed good outcomes in impacted upper ureteric stones. Recently, some studies have explored the robotic-assisted kidney puncture in ECIRS that avoided multitrack surgery, especially in anomalous kidney and staghorn stones.

SUMMARY

ECIRS is ready for primetime in endourology and can be considered the next gold-standard for a personalized stone approach in complex kidney stones.

Mini-Percutaneous Nephrolithotomy Outcomes in the Obese Population: A Retrospective Review

Introduction and Objectives: Mini-percutaneous nephrolithotomy (PCNL) has gained popularity over the last decade due to its stone-free rate comparable to traditional PCNL but with decreased risk of complications. While the data on mini-PCNL has been favorable thus far, no study today has evaluated outcomes in obese patients. Methods: All patients undergoing mini-PCNL at our institution since we began its use in 2019 were included in this study. Mini-PCNL was defined as access sheath ≤22F in size. An obese group with body mass index (BMI) ≥30 was compared to a nonobese group with BMI <30. A patient was considered relatively stone free if residual fragments were <4 mm on follow-up CT with ≤3 mm cuts. Fisher exact test was used to compare dichotomous differences between variables, and t-test to compare continuous variables. Results: We identified 67 patients who underwent mini-PCNL during the study period with 33 patients in the obese group. Median BMI in the obese group was 36.4 kg/m2 compared to 25.05 kg/m2 in nonobese. There were no blood transfusions in either group during the study period. There was no statistical difference between the obese vs nonobese group for age, access sheath size, change in hemoglobin, same day discharge, percent relatively stone free, emergency department visit within 30 days, and median largest single stone diameter. There was a significant difference in the sum of all treated stone diameter in the obese group (median 15 mm) vs nonobese (median 18 mm, p = 0.02) (Table 1). Conclusion: Mini-PCNL appears to be equally safe and effective in obese and nonobese patients alike. While there was a statistically significantly higher amount of overall stone burden in the nonobese groups, the overall difference is not clinically significant. Further research is needed to validate our experience.

Pediatric Mini-Percutaneous Nephrolithotomy Using Self-Retained Screwed Amplatz Sheath vs Ordinary Sheath

Objective: To evaluate the use of a new 16F mini-screwed sheath in pediatrics in comparison to a 16F ordinary Amplatz sheath. Methods: Sixty-seven patients <18 years with renal calculi between 1 and 2 cm who was a candidate for mini-percutaneous nephrolithotomy (mini-perc) between January 2019 and September 2021 were randomized by closed envelope in group A (34 patients) using new mini-screwed sheath and group B (33 patients) with ordinary mini-sheath. Patients with contraindications for percutaneous nephrolithotomy were excluded. Results: No significant difference was present between both groups according to patients and stone demographics. There was no significant difference between both groups regarding puncture site and number. The mean operative time was 51.25 ± 2.15 minutes and 52.35 ± 3.45 minutes in groups A and B, respectively. The fluoroscopy time was significantly lower in group A (2.1 ± 0.85 minutes) than in group B (2.9 ± 1.05 minutes). Tract loss was 18.2% in group B while 0% in group A. Although bleeding was less in group A, it was nonsignificant. The stone-free rate was (94.11%) and (90.9%) in group A and group B, respectively. Conclusion: Screwed sheath enables the urologist to have a stable track during pediatric mini-perc surgery despite the thin abdominal wall in the pediatric. The screw sheath provides significantly lower fluoroscopy time and decreases the need for nephrostomy tube insertion when compared with ordinary sheath in mini-perc renal surgery.

Antegrade administration of mitomycin gel for upper tract urothelial carcinoma via percutaneous nephrostomy tube: a multi-institutional retrospective cohort study

OBJECTIVES

To assess the safety profile of antegrade mitomycin gel instillation through a percutaneous nephrostomy tube (PCNT) for upper tract urothelial carcinoma (UTUC) with the aim of decreasing morbidity associated with therapy.

PATIENTS AND METHODS

Patients undergoing antegrade administration of mitomycin gel via PCNT were retrospectively included for analysis from four tertiary referral centres between 2020 and 2022. The primary outcome was safety profile, as graded by Common Terminology Criteria for Adverse Events (v5.0). Post-therapy disease burden was assessed by primary disease evaluation (PDE) via ureteroscopy.

RESULTS

Thirty-two patients received at least one dose of mitomycin gel via PCNT for UTUC, 29 of whom completed induction and underwent PDE. Thirteen patients (41%) had residual tumour present prior to induction therapy. At a median of 15.0 months following first dose of induction therapy, ureteric stenosis occurred in three patients (9%), all of whom were treated without later recurrence or chronic stenosis. Other adverse events included fatigue (27%), flank pain (19%), urinary tract infection (12%), sepsis (8%) and haematuria (8%). No patients had impaired renal function during follow-up and there were no treatment-related deaths. Seventeen patients (59%) had no evidence of disease at PDE and have not experienced recurrence at a median follow-up of 13.0 months post induction.

CONCLUSIONS

Administration of mitomycin gel via a PCNT offers a low rate of ureteric stenosis, demonstrates a favourable safety profile, and is administered without general anaesthesia.

Calculus anuria: a urological emergency with an excellent outcome

Calculus anuria is a catastrophic condition with dire consequences if not treated promptly. The purpose of this study was to identify factors which influence the short-term outcome of patients with calculus anuria. A retrospective analysis was conducted from January 2016 to December 2021, in children up to the age of 18 years, who presented with calculus anuria and required emergency decompression at Sindh Institute of Urology and Transplantation, Pakistan. One hundred and twenty-five children were included. Majority were born to consanguineous parents and a few of them had positive family history of stone disease. Severe illness was found in 25 (20%) patients and among them 8 (32%) required hemodialysis. Decompression by double J stenting is the preferred intervention in our institute and was done in 106 (85%) children, followed by percutaneous nephrostomy tube in 10 (8%) successfully. A small number of patients, 9 (7%) required both procedures to relieve their obstruction. A significant number of patients, about 115 (92%), attained normal renal functions after intervention. No pertinent factors were identified, relating to incomplete renal recovery in nine (7%) of the patients who unfortunately progressed to chronic kidney disease.

Percutaneous nephrostomy for complex renal stones: Percutaneous renal access behind the stone versus renal calyx dilation

OBJECTIVE

To evaluate the technical success rate and complications associated with percutaneous nephrostomy (PCN) via percutaneous renal access behind the stone and renal calyx dilation in patients with complex renal stones.

MATERIALS AND METHODS

From January 2010 to February 2021, we identified 69 patients with 70 complex renal stones who underwent PCN. Complex renal stones were classified as simple (renal pelvis only) (27.1%, 19/70), borderline staghorn (8.6%, 6/70), partial staghorn (51.4%, 36/70), or complete staghorn (12.9%, 9/70). All PCNs were performed under ultrasound and fluoroscopic guidance using one of two renal-entry techniques: puncture behind the stone (56%, 39/70) or renal calyx dilation (44%, 31/70). Then, we retrospectively evaluated the technical success rates and complications associated with each renal entry access technique.

RESULTS

The overall technical success rate was 100%, and the complication rate was 20.0% (14/70). For those who underwent renal access behind the stone, the complication rate was 15.4% (6/39), and six patients (six PCNs) had transient gross hematuria. For those who underwent dilated renal calyx entry, the complication rate was 25.8% (8/31), and one patient had significant bleeding complications requiring transfusion. Furthermore, seven patients (seven PCNs) had transient gross hematuria. Overall, the complication rates did not differ between the technique groups (p = 0.279).

CONCLUSION

PCN for complex renal stones has a high technical success rate and an acceptable complication rate regardless of the specific technique. Renal entry behind the stone is as safe and feasible as approaching via a dilated renal calyx.

[Complications of retrograde intrarenal sugery in patients with low pole kidney stones]

A lot of patients with nephrolithiasis have calculi at low pole calyces. One of the best and safety operative options of such category is retrograde intrarenal surgery (RIRS). RIRS is wide spread in current clinical practice. But not rarely it corresponded with different grade complications. Current literature review is dedicated to predictors of complications due to RIRS in patients with low pole calculi.

Robot-assisted anatrophic nephrolithotomy for complete staghorn stone

To assess the efficacy and safety of robot-assisted anatrophic nephrolithotomy (RANL) as a choice of minimally invasive treatment for patients with complete staghorn stone. In a single-tertiary referral center retrospective study, 10 consecutive patients underwent RANL for complete staghorn stone. After dissection to the renal hilum and clamping of the renal vessels, an incision was made along the Brodel line and exposed the collecting system to extract the stone. Then, the collecting system and parenchyma were closed in layers. The outcomes included reduction of the stone burden, short- and long-term postoperative kidney function, and pain score. The average age of patients was 54.6 years and body mass index was 27.58 kg/m2. Mean warm ischemia time was 28.40 minutes, mean robotic console time was 137 minutes, and mean estimated blood loss was 83 mL. The mean length of stay was 5.4 days and there were no severe perioperative complications. Eight of 10 patients had >90% reduction in stone burden and 5 (50%) patients were completely stone-free. There was no significant decrease in postoperative estimated glomerular filtration rate compared with preoperative values after 1 month and 1 year. Our experience with RANL demonstrated efficacy and safety in the minimally invasive treatment of complete staghorn stone in short- and long-term follow-up periods.

An ex-vivo assessment of a new single probe triple modality (Trilogy) lithotripter

Introduction and objectives

This Swiss LithoClast^® Trilogy lithotrite is a new lithotrite for percutaneous nephrolithotomy (PCNL). It has four modifiable settings; impact, frequency, ultrasound and suction. We aim to determine the optimal device settings for the fastest stone clearance.

Materials and methods

Kidney stone phantoms were made with Begostone in a powder to water ratio (15:3–15:6). Complete stone clearance (seconds) was calculated and impact and frequency were adjusted and repeated N = 3. Intra renal pressure (IRP) was then measured in a porcine kidney model.

Results

Stone phantoms with physical properties similar to struvite were cleared best with 100% impact and frequency of 12 Hz. Both uric acid stone phantoms and calcium phosphate stone phantoms were cleared most efficiently with an impact of 30% and a frequency of 4 Hz. The mean time to clear uric acid stone phantoms was 83 s versus 217 s for calcium phosphate stone phantoms. Similarly, for calcium oxalate stone phantoms, an impact of 30% and a frequency of 4 Hz was associated with the fastest clearance time, mean 204 s. However, the differences between 4, 8 and 12 Hz were not statistically significant. At a suction level of 60% or higher, IRP became negative.

Conclusion

These results indicate that stone phantoms of hard kidney stones are cleared more efficiently at lower impact and frequency settings. With regard to suction, a setting of ≤ 50% appears to be the optimal setting.

Retrograde intrarenal surgery for impacted upper ureteral stone in a patient with advanced lumbar scoliosis and lower-extremity development defect: a case report

BACKGROUND

Today, retrograde intrarenal surgery is the most preferred and very successful treatment method for upper ureteral stones that do not spontaneously pass and/or do not benefit from extracorporeal wave lithotripsy. However, perioperative complications are more common in retrograde intrarenal surgery if the stone in the ureter is impacted. Moreover, urosepsis and renal dysfunction are detected more frequently in patients with impacted stones. Impacted stones, which are a risky stone group even in patients with normal vertebral anatomy, are a more challenging situation in patients with advanced vertebral scoliosis. It is difficult to achieve an operating position in these patients. In addition, the ureteral tracing is altered, curved, and tortuous, making it more difficult for the endoscope to advance through the ureter.

CASE PRESENTATION

In this case report, we present a 23-year-old Caucasian male patient with right concavity and severe scoliosis, lower-extremity developmental disorder, and urosepsis. To treat the urosepsis picture, first percutaneous nephrostomy drainage was provided and the urine was sterilized with appropriate antibiotics according to the culture/antibiogram. Then, we performed ureterolithotripsy with a flexureterorenoscope. Finally, we see that flexible ureterorenoscopic lithotripsy to the upper ureteral stone with impacted stones, which is a very challenging operation even in patients with normal vertebrae, could be successfully performed in our patient with advanced scoliosis deformity.

CONCLUSION

High stone-free and low complication rates can be obtained with flexible ureterorenoscopic retrograde intrarenal surgery in medium-sized impacted upper ureteral stones in patients with advanced scoliosis.

[Modern algorithm of diagnosis and treatment of acute gestational pyelonephritis in a large industrial city]

THE PURPOSE OF THE STUDY

to develop a modern algorithm for the diagnosis and treatment of acute gestational pyelonephritis in a large industrial city and to study the possibilities of phytotherapy as an integral part of this algorithm.

MATERIALS AND METHODS

The study consisted of two stages and included 629 patients treated over 12 years (2010-2021) in Perm city with a population of 1.1 million people. At the first stage, the developed algorithm for the diagnosis and treatment of acute gestational pyelonephritis in 440 pregnant women was tested. A city emergency center for patients with gestational pyelonephritis was created with 3 urologists and related specialists on duty around the clock, what accelerated hospitalization timelines by 2.1 times. The patients underwent a level 1 examination, which included ultrasound examination, urine bacteriology and other methods. Patients in serve condition underwent, a level 2 examination, which included magnetic resonance imaging (MRI), ultrasound Dopplerography (USDG) and extended laboratory tests.

RESULTS

During an urgent examination, acute purulent pyelonephritis was diagnosed in 27 (6.1%) patients who underwent 13 open surgeries (11 organ-preserving, 2 nephroectomies) and 14 minimally invasive (percutaneous nephrostomy, puncture of a kidney abscess) within 2-5 hours from the moment of hospitalization. Serve obstructive pyelonephritis was diagnosed in 286 patients, the passage of urine was restored by the installation of a stent or catheterization of the ureter. Conservative antibacterial therapy was performed in 127 patients with serous non-obstructive pyelonephritis. Positive results of treatment were observed in 439 (99.8%) patients: recovery in 95%, significant improvement in 4.8%, with a mortality rate of 0.2%. Bed-day decreased by 30.4%. At the second stage, a comparative randomized study was conducted during 4 years with 189 pregnant women with acute serous pyelonephritis enrolled. In the group 1 (n=94) patients received standard therapy according to the implemented algorithm, in the group 2 (n=95) patients had 60-day use of Canephron N. In the group 2, treatment results were better: recovery was achieved in 96.8% of patients, improvement in 3.2%, the number of pregnant women with leukocyturia and bacteriuria decreased 4.1 times, which prevented the occurrence of repeated attacks of acute pyelonephritis. Compared with standard therapy, Canephron N increased glomerular filtration by 12,3%, diuresis by 14.2%, increased urea excretion function of the kidneys, sanitized the urinary tract at an earlier timelines, reduced the number of premature births and the birth of dead and premature babies.

CONCLUSION

As a result of the development and implementation of an algorithm for the diagnosis and treatment of acute gestational pyelonephritis and creation of the treatment center for such patients, it was possible to reduce significantly the time of hospitalization and inpatient treatment and achieve good treatment results in 99.8% of patients. The inclusion of long-term phytotherapy with Canephron N in the treatment regimen increased the effectiveness of treatment, improved kidney function in patients, significantly reduced the number of pregnant women with leukocyturia and bacteriuria, and reduced the risk of a repeated attack of pyelonephritis.

Supine <em>versus</em> Prone Miniaturised Percutaneous Nephrolithotomy in Elderly Patients

OBJECTIVE

To compare the outcomes of mini-PCNL (miniaturised percutaneous nephrolithotomy) in prone and supine positions in elderly patients.

STUDY DESIGN

Cohort study.

PLACE AND DURATION OF STUDY

Department of Urology, University of Health Sciences, Turkey, between April 2017 and January 2021.

METHODOLOGY

Patients over 65 years of age were included in the study. All patients' comorbidities were recorded and charlson comorbidity index (CCI) score was calculated. The groups were compared in terms of perioperative values, stone-free rates and complication rates. Logistic regression analysis was used to evaluate risk factors for complication development. Postoperative complications were noted according to the Clavien scoring system (CSS).

RESULTS

There were 54 patients in the supine mini-PCNL group and 64 in the prone mini-PCNL group. The median ages were 67 in the prone and 66 in the supine group. CCI scores were similar in both groups (p = 0.735). Stone-free and total complication rates were not statistically different in the groups (p = 0.994 and p = 0.247, respectively). However, grade 1-2 complication rates were significantly higher in the prone group (p=0.020). CCI score and stone size were significantly associated with the development of complications (p = 0.018 and p = 0.034, respectively).

CONCLUSION

The present study is the first to compare the outcomes of mini-PCNL in prone and supine position in geriatric patients. Supine mini-PCNL is a potentially safer alternative treatment method for older patients with high CCI scores. Key Words: Percutaneous nephrolithotomy, Supine position, Elderly, Mini-PCNl, CCI score.

[Endoscopic marsupialization of parapelvic renal cysts]

INTRODUCTION

Parapelvic renal cysts are very common. Indications for surgical treatment are upper urine tract obstruction, pain and recurrent gross hematuria.

AIM

To analyze the efficiency and safety of endoscopic transurethral and percutaneous laser marsupialization of parapelvic renal cysts.

MATERIALS AND METHODS

A total of 9 patients were undergone to transurethral intrarenal marsupialization of parapelvic renal cysts from March 2016 to February 2021 (4 men, 5 women, aged 42-78 years). Another 2 patients (2 men, aged 46 and 52 years) were treated by percutaneous approach. The average size of the cyst according to contrast-enhanced multi-slice computed tomography (MSCT) was 3.1+/-1.8 cm. In two cases, papillary tumor of the pelvis was suspected. The anteroposterior diameter of the pelvis was 2.6+/-1.3 cm; 9 patients had pain in the loin area, while in 7 patients recurrent gross hematuria was also an indication for surgical treatment. For marsupialization, a holmium (Ho:YAG) laser Auriga XL (Boston Scientific, USA) was used in 4 patients, and in other cases (n=7) a procedure was performed using a thulium fiber laser (Tm Fiber) Fiberlase U1 (IRE-Polus, Russia). In 3 patients, to clarify the site of incision of the cyst, intraoperative ultrasound was used. In all cases, after draining the cyst, an internal stent was placed inside the cyst for a period of 4-6 weeks.

RESULTS

The duration of transurethral surgery was 26+/-11 minutes, while percutaneous marsupialization of the cyst, which was performed in combination with percutaneous nephrolithotomy, took 10 and 18 minutes, respectively. The average catheterization time was 12+/-8 hours. Nephrostomy tube was removed on the 2nd day. The length of stay was 4+/-2 days. Febrile fever was noted in 1 patient (9%), which required a change in antibiotic therapy. During ultrasound control at discharge, the dilatation of the collecting system was not detected in any cases, while the residual cavity was found in 2 patients (18%). Follow-up contrast-enhanced MSCT and ultrasound within 3-30 months in all patients (n=11) showed no dilatation of the collecting system. In 1 (9%) patient, the residual cavity was preserved with a decrease in size to 1.2 cm without signs of upper urinary tract obstruction; the initial diameter of the cyst in this patient was 4.9 cm. There was no recurrence of gross hematuria.

CONCLUSIONS

In our opinion, transurethral and percutaneous laser marsupialization of parapelvic renal cysts is an effective and safe method that allows definitive treatment for cysts up to 4 cm in size. If the cyst is larger than 4 cm, endoscopic removal should be balanced with the possibility of preserving the residual cavity. The most common complication of endoscopic treatment of intrarenal cysts is acute pyelonephritis with a rate of 9%.

Feasibility of contrast-enhanced ultrasound and flank position during percutaneous nephrolithotomy in patients with no apparent hydronephrosis: a randomized controlled trial

Purpose

To investigate the puncture accuracy and feasibility of contrast-enhanced ultrasound (CEUS) guided percutaneous nephrolithotomy (PCNL) in flank position for patients with no apparent hydronephrosis.

Methods

Between May 2018 and June 2020, 72 kidney stone patients with no or mild hydronephrosis were randomized into two groups: a CEUS-guided PCNL group and a conventional ultrasound (US)-guided group. Patients’ demographics and perioperative outcomes were compared, including the success rate of puncture via calyceal fornix, the success rate of a single-needle puncture, puncture time, operative time, postoperative hemoglobin loss, stone-free rate, incidence of complications and postoperative stay.

Results

The success rate of puncture via calyceal fornix for CEUS-guided group was significantly higher than that for conventional US-guided group (86.1 vs. 47.2%, p = 0.002). Patients performed with CEUS-guided PCNL required shorter renal puncture time than those guided with conventional US (36.5 s vs. 61.0 s, p < 0.001). The median postoperative hemoglobin loss in the CEUS-guided group was significantly lower than that in conventional US-guided group (2.5 vs. 14.5 g/L, p < 0.01). There was no statistically significant difference in the success rate of a single-needle puncture, operative time, stone-free rate, incidence of complications and postoperative stay between the two groups.

Conclusion

CEUS guidance facilitates identification of the renal calyx fornix, and benefits more precise renal puncture and less hemoglobin loss in PCNL. CEUS-guided PCNL in flank position is a feasible approach to the treatment of kidney stone patients with no apparent hydronephrosis.

Trial registration number: ChiCTR1800015417.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00345-022-03933-4.

RISK OF OCCURRENCE AND WAYS TO IMPROVE THE TREATMENT OF UROLITHIASIS IN PATIENTS WITH A SINGLE KIDNEY

OBJECTIVE

The aim: To summarize the state of the problem of urolithiasis in patients with a single kidney and consider current views on improving its treatment based on the analysis of world literature.

PATIENTS AND METHODS

Materials and methods: The study conducted a thorough analysis of modern scientific literature sources in the international scientometric database, which highlighted the development of urolithiasis in patients with a single kidney and the peculiarities of its treatment. The main ways to improve treatment are identified. A critical assessment of the achievements and shortcomings of various surgical treatments. The authors' own developments are presented in the article.

CONCLUSION

Conclusions: The topographic position of the kidney in the retroperitoneal space affects not only the occurrence of pathological processes in the kidney, but also the surgical strategy in the treatment of nephrolithiasis. Percutaneous nephrolithotomy is the main treatment for large (> 2 cm) or complex kidney stones. Patients with a single kidney are more prone to bleeding with PCNL treatment than patients with bilateral kidneys because they have an increased thickness of the renal parenchyma as a result of compensatory hypertrophy. RIRS is a reliable choice for patients with a single kidney who is contraindicated in PCNL.