Computer tomography urography assisted real-time ultrasound-guided percutaneous nephrolithotomy on renal calculus

This study aimed to assess the role of pre-designed route on computer tomography urography (CTU) in the ultrasound-guided percutaneous nephrolithotomy (PCNL) for renal calculus.From August 2013 to May 2016, a total of 100 patients diagnosed with complex renal calculus in our hospital were randomly divided into CTU group and control group (without CTU assistance). CTU was used to design a rational route for puncturing in CTU group. Ultrasound was used in both groups to establish a working trace in the operation areas. Patients' perioperative parameters and postoperative complications were recorded.All operations were successfully performed, without transferring to open surgery. Time of channel establishment in CTU group (6.5 ± 4.3 minutes) was shorter than the control group (10.0 ± 6.7 minutes) (P = .002). In addition, there was shorter operation time, lower rates of blood transfusion, secondary operation, and less establishing channels. The incidence of postoperative complications including residual stones, sepsis, severe hemorrhage, and perirenal hematoma was lower in CTU group than in control group.Pre-designing puncture route on CTU images would improve the puncturing accuracy, lessen establishing channels as well as improve the security in the ultrasound-guided PCNL for complex renal calculus, but at the cost of increased radiation exposure.

Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of low-risk upper tract urothelial carcinoma

INTRODUCTION

The conservative management of upper tract urothelial carcinoma (UTUC) has historically been offered to patients with imperative indications. The recent International Consultation on Urologic Diseases (ICUD) publication on UTUC stratified treatment allocations based on high- and low-risk groups. This report updates the conservative management of the low-risk group.

METHODS

The ICUD for low-risk UTUC working group performed a thorough review of the literature with an assessment of the level of evidence and grade of recommendation for a variety of published studies in this disease space. We update these publications and provide a summary of that original report.

RESULTS

There are no prospective randomized controlled studies to support surgical management guidelines. A risk-stratified approach based on clinical, endoscopic, and biopsy assessment allows selection of patients who could benefit from kidney-preserving procedures with oncological outcomes potentially similar to radical nephroureterectomy with bladder cuff excision, with the added benefit of renal function preservation. These treatments are aided by the development of high-definition flexible digital URS, multi-biopsies with the aid of access sheaths and other tools, and promising developments in the use of adjuvant topical therapy.

CONCLUSIONS

Recent developments in imaging, minimally invasive techniques, multimodality approaches, and adjuvant topical regimens and bladder cancer prevention raise the hope for improved risk stratification and may greatly improve the endoscopic treatment for low-risk UTUC.

Profile of metabolic and infectious stone-formers in a contemporary PCNL cohort

INTRODUCTION

To identify factors associated with stone composition in patients undergoing percutaneous nephrolithotomy (PCNL).

MATERIAL AND METHODS

A retrospective analysis of patients who underwent PCNL at two academic institutions between 2002 and 2014. Stone composition, stone characteristics based on non-contrast computer tomography (NCCT), patient demographics, and the S.T.O.N.E nephrolithometry scores were compared. Stones were characterized as either infection or metabolic. Metabolic stones were classified as calcium phosphate-containing and all others.

RESULTS

A total of 192 renal units underwent PCNL. Retrieved stones were found to be 75% (144) metabolic and 25% (48) infection by stone analysis. Of the metabolic stones, 51% (73) were phosphate-containing calculi. Overall, infection stones were found to have a significantly higher S.T.O.N.E nephrolithometry score than metabolic stones (9.2 versus 8.1, p < 0.001). Average Hounsfield units (HU) were significantly lower in infection stones (765 versus 899, p < 0.05). Sixty-three percent of patients with infection stones were female as compared to 46% of patients with metabolic stones. Patients with phosphate-containing stones in the metabolic group were significantly more likely to be female (56% versus 35%, p < 0.01), younger (mean 49 versus 60 years of age, p < 0.02), and have lower BMI's (30 versus 32, p < 0.02) compared with other metabolic stones.

CONCLUSIONS

Patient demographics including age, sex and BMI differ between patients with phosphate and non-phosphate containing metabolic stones. Higher S.T.O.N.E nephrolithometry scores were found in infection stones. These findings may serve as useful tools in the identification of stone compositions that are being seen more frequently in large and complicated stones undergoing PCNL.

A Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy for Management of Renal Stones ?2 CM

PURPOSE

In this retrospective study, we aimed to compare the outcomes in patients who have been treated withpercutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS) on renal stones &ge; 2 cm size.

MATERIALS AND METHODS

We evaluated patients who underwent PNL or RIRS for renal stones &ge; 2 cm size betweenNovember 2011 and November 2014. Stone size, operation, fluoroscopy and hospitalization time, success rates,stone-free rates and complication rates were compared in both groups. Patients were followed for three months.

RESULTS

254 patients were in the PNL Group. 185 patients were in the RIRS Group. The mean age was 46.88 and48.04 years in PNL and RIRS groups, respectively.The patient and stone characteristics (age, gender, Body Mass Index, kidney anomaly, SWL history and stoneradioopacity) were similar between two groups.The mean stone size preoperatively was significantly larger in patients who were treated with PNL (26.33mm.vs24.04mm.; P = .006). In the RIRS group, the mean stone number was significantly higher than PNL group (P &lt;.001).The mean operative, fluoroscopy and hospitalization time were significantly higher in PNL group (P &lt; .001). Thestone-free rate was 93.3% for the PNL group and 73.5% for the RIRS group after first procedure (P &lt; .001). Nomajor complication (Clavien III-V) occurred in the RIRS group.

CONCLUSION

Although the primary treatment method for renal stones &ge; 2cm size is PNL, serious complicationscan be seen. Therefore, RIRS can be an alternative treatment option in the management of renal stones &ge;2 cm size.

[Current results of RIRS and comparison with PCNL.]

OBJECTIVES

The objective of this article is to show the current situation regarding two surgical techniques for the treatment of renal lithiasis, RIRS (Retrograde intrarenal surgery) and PCNL (Percutaneous nephrolithotomy), specially concerning the larger size stones. We perform a literature review on the topic and add the experience with both techniques at our center. Besides, we also analyze the role of RIRS in comparison with the percutaneous techniques in smaller size lithiasis.

METHODS

We review the results obtained in the literature and our experience. We offer our opinion in reference to the indications of RIRS in these cases based on such review and our experience.

RESULTS/CONCLUSIONS

RIRS is a safe and effective technique, with a similar success rate to PCNL if one assumes the possibility of retreatment in stones >2cm. Its low complication rate, fast postoperative recovery and short hospital stay make this technique a therapeutic alternative to PCNL in this type of patients. Compared with percutaneous techniques less invasive than classical 24 to 30 Ch. accesses (miniperc or microperc), RIRS offers a higher stone free rate. If we also consider that RIRS is associated with shorter hospital stay and lower bleeding risk, even without significant differences in the global complication rate we could consider RIRS as the first line endourological treatment in stones <2cm.

[Staged retrograde flexible ureteroscopic lithotripsy versus miniaturized percutaneous nephrolithotomy for renal stones of 2-4 cm in diameter: a randomized controlled trial]

OBJECTIVE

To compare the efficacy and safety of staged retrograde flexible ureteroscopic lithotripsy (FURS) and miniaturized percutaneous nephrolithotomy (m-PCNL) for treatment of renal stones of 2-4 cm in diameter.

METHODS

This randomized controlled trial was conducted in 70 patients with renal stones of 2-4 cm in diameter admitted in our hospital between January 2013 and December 2015. The patients were randomized to receive staged FURS (35 cases) or m-PCNL (35 cases), and the total treatment time, total hospital stay after procedure, total medical cost, treatment success, decrease in hemoglobin level and complications were compared between the two groups.

RESULTS

The treatment success rate was 100% in both groups, but the complete stone-free rate was significantly lowered in FURS group than m-PCNL group (65.71% vs 94.29%, P<0.01). The average decrease in hemoglobin level was 3.37∓1.56 g/L in FURS group and 11.93∓2.24 g/L in m-PCNL group (P<0.01). The overall complication rates in the two groups were 6.25% and 9.37%, respectively (P>0.05). Minor complications (grade I by Clavien-Dindo classification) occurred in one case in FURS group (fever) and two cases in m-PCNL group (self-limiting hematuria); major complications (grade II) occurred in one case in FURS group (steinstrase) and one case in m-PCNL group (blood transfusion). In staged FURS and m-PCNL groups, the mean total treatment time was 4.06∓1.11 vs 1.26∓0.47 weeks (P<0.01), the mean hospital stay after procedure was 3.66∓1.29 vs 5.13∓0.43 days (P<0.01), and the mean total medical cost was 54 291.00 RMB ∓6149.00 vs 23 482.00 RMB ∓2317.00 (P<0.01), respectively.

CONCLUSION

FURS is safe and effective for treatment of renal stones of 2-4 cm in diameter, and a staged procedure is necessary to achieve a stone-free status for large calculi. Both sophisticated equipment and rich surgical experience are essential to ensure treatment success.

Infected hydronephrosis: can we reduce patient suffering and costs?

OBJECTIVE

To investigate the correlation among clinical parameters, risk factors, outcomes and costs in the context of patients with infected hydronephrosis.

METHODS

This retrospective, multi-centric study was conducted in three Romanian academic urology departments, and comprised data of patients with infected hydronephrosis treated between July 2013 and July 2014. Based on per-patient hospitalisation costs, the participants were divided into three groups: group A: cost less than 500 euros), group B: between 500 and 1,000 euros, and group C: over 1,000 euros). Differences between clinical parameters, comorbidities, type of procedure, admission to intensive care unit, length of hospital stay and costs were analysed.

RESULTS

Of the 175 patients, 49(28%) were in group A, 95(54.3%) in group B and 31(17.7%) in group C. The relevant parameters influencing outcomes and costs were age (p=0.001), neoplasical aetiology (p=0.001), leukocytosis (p=0.001), renal insufficiency (p=0.001), and moment of the intervention (p=0.005). Diabetes did not influence the costs (p=0.36). JJ stent insertion was tolerated at least the same as percutaneous nephrostomy, and with the same efficiency.

CONCLUSIONS

In order to avoid patient suffering and to reduce costs linked to the treatment of infected hydronephrosis, the patient-general practitioner-specialist collaboration is of the utmost importance. Symptoms, signs, paraclinical features and empirical use of antibiotics may all lead to a delay in proper management, thus making the hospitalisation longer and the costs significantly higher.

[Logistic regression analysis of risk factors of serious complications related with double-J ureteral stenting following percutaneous nephrolithotomy]

OBJECTIVE

To investigate the risk factors of the serious complications related with double-J ureteral stent placement following percutaneous nephrolithotomy (PCNL).

METHODS

Clinical data were reviewed for 272 patients treated with PCNL and indwelling double-J stents between January, 2014 and April, 2016. The risk factors of serious complications were identified using univariate and multivariate logistic regression analysis.

RESULTS

Serious complications of double-J ureteral stenting occurred in 63 patients (23.1%). Univariate and multivariate logistic regression analysis indicated that the ureter abnormalities (β=1.735, P=0.000, OR=5.670), stent indwelling duration (β=1.206, P=0.028, OR=3.340), gender (β=0.895, P=0.016, OR=2.446), preoperative urinary tract infection (β=0.849, P=0.020 , OR=2.338) and stent size (β=0.847, P=0.011, OR=2.333) were all risk factors of serious complications related with the procedure.

CONCLUSION

Male patients are exposed to a higher risk of serious complications following PCNL. Effective management of urinary tract infection and choice of appropriate stent size in cases of ureteral abnormalities help to reduce these complications. The double-J stent should be withdrawn as soon as possible in patients with good postoperative recovery.

[Flexible ureterorenoscopy vs percutaneous nephrolithotomy for renal stone management: Retrospective study]

PURPOSE

The aim of this study was to evaluate the efficacy and tolerance of renal stone fragmentation by flexible ureterorenoscopy (URS), compared to percutaneous nephrolithotomy (PCNL).

MATERIAL AND METHODS

Patients treated between 1998 and 2010 by URS and PCNL for intrarenal stone were reviewed. Patients' and stones' characteristics were analyzed. The preoperative parameters were reported as well as the procedure's efficiency and its complications. Success was defined by the absence of residual lithiasis visualized on renal imaging at 6 months of follow-up.

RESULTS

Among 531 patients included, there were 159 PCNL and 372 URS. The mean duration of hospitalization after PCNL was 8±4.6 days and 3±1.7 days after URS. The mean stones' size was higher in the PCNL group (19.9±7.5mm) than for the URS group (9.7±5.6mm; P<0.0001). The stone-free rate was significantly better in the PCNL group for stones measuring between 10 and 20mm (P<0.0001) and for stones of more than 20mm (P=0.017). Postoperative complications were significantly more frequent (27 %) and more severe (8.8 % vs Clavien III and IV) in the PCNL, than in the URS group, respectively (P=0.0001).

CONCLUSION

PCNL is a successful technique for renal stone fragmentation. However, URS seemed more tolerated despite a lower stone-free rate.

LEVEL OF EVIDENCE

4.

The evolution of urolithiasis assessment and management in the new millennium

INTRODUCTION

The aim of this review was to identify trends and developments in basic research, epidemiology, diagnosis, conservative and surgical management of urinary stone disease, and to demonstrate the evolution of urolithiasis management in the new millennium.

EVIDENCE ACQUISITION

We performed a literature search on Medline according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement up to December 2015 using the following key words: urolithiasis prevalence, recurrent urinary stone, metabolic syndrome and urolithiasis, urinary stone/urolithiasis metabolic evaluation, shockwave lithotripsy, ureterorenoscopy, percutaneous nephrolithotomy/nephrolitholapaxy. The key words were chosen following consensus as the single most appropriate and descriptive terms that would yield maximal relevant results in a single search for each section. We then segregated only relevant articles in the English language of the highest quality evidence (systematic review/meta-analysis, prospective cohorts and prospective randomized trials, levels of evidence: 1A and 1B, respectively) as well as experimental research. The initial relevance screening was based on title and abstract, whereas further filtering included full text screening. The evidence is subsequently presented and discussed on each relevant section, preceded by seminal references that are used as a basis for comparison to formulate our conclusions.

EVIDENCE SYNTHESIS

By using the key word "urolithiasis prevalence" we identified initially 1581 relevant articles. Following exclusion of duplicates and relevance screening, 154 articles were included for data extraction (9.77%). Of note, 31 articles focused on the pediatric population. By using the key words "metabolic syndrome and urolithiasis" we identified initially 127 relevant articles. Following exclusion of duplicates and relevance screening, 23 articles were included for data extraction (18.11%). It must be noted that the majority of studies are reviews, experimental models and prospective cohorts. By using the key words "urolithiasis metabolic evaluation" we identified initially 262 relevant articles. Following exclusion of duplicates and relevance screening, 179 articles were included for data extraction (68.32%). It must be noted that the majority of studies are reviews, experimental models and prospective cohorts. By using the key word "shockwave lithotripsy" we identified initially 695 relevant articles. Following exclusion of duplicates and relevance screening, 90 articles were included for data extraction (12.94%). By using the key word "ureterorenoscopy" we identified initially 2609 relevant articles. Following exclusion of duplicates and relevance screening, 186 articles were included for data extraction (7.12%). By using the key word "percutaneous nephrolithotomy" we identified initially 695 relevant articles. Following exclusion of duplicates and relevance screening, 381 articles were included for data extraction (10.42%).

CONCLUSIONS

The management of urolithiasis has evolved greatly and in multiple directions in the past fifteen years. There is a definite compartmentalization of basic research, innovation and development focusing on distinct stages of the disease, from epidemiologic features to pathophysiology, medical and surgical aspects. Patients enjoy better delivery of care, having ever more effective options to deal with their condition. The multidisciplinary approach provides more reliable solutions and will continue to drive the development of better preventative and treatment strategies in the future.

[Risk factor analysis of systemic inflammatory response syndrome in type 2 diabetics after percutaneous nephrolithotomy]

OBJECTIVE

To evaluate the risk factors of systemic inflammatory response syndrome (SIRS) in the patients with type 2 diabetes diagnosed with kidney stone after percutaneous nephrolithotomy (PCNL).

METHODS

In this study, 461 patients with type 2 diabetes who received PCNL in Peking University People's Hospital from June 2006 to December 2015 were reviewed. There were 281 males and 180 females with an average age of 57 years were included, of whom, 137 were diagnosed with SIRS after PCNL. The demographic data, clinical features, and test results were compared between the patients with SIRS and without SIRS, trying to identify the correlation between their clinical characters and the occurrence of SIRS.

RESULTS

The SIRS was significantly correlated with the patients' preoperative white blood cell counting (×10⁹/L) [7.76 (4.00-17.96) vs. 6.31 (2.00-17.40), P<0.001], preoperational blood glucose level (mmol/L) [7.30 (3.08-19.90) vs. 6.40 (3.42-16.78), P<0.001], operative time (min) [75 (20-270) vs. 60 (20-200), P<0.001], length of stay (d) [12 (2-46) vs. 11 (3-29), P=0.019], staghorn stones [38.8% (33/85) vs. 27.7% (104/376), P=0.042], and preoperational urinary tract infection [36.8% (50/136) vs. 26.6% (81/304), P=0.032]. There was no significant correlation between the SIRS and the patients' age, body mass index, preoperative hemoglobin level, preoperative serum creatinine, and transfusion. In multivariate analysis, abnormal preoperative white blood cell counting (OR=3.194, 95% CI: 1.531-6.666, P=0.002), operative time longer than 60 min (OR=1.635, 95% CI: 1.088-2.456, P=0.018), and preoperational blood glucose level higher than normal 7.1 mmol/L were significantly correlated with the presence of SIRS.

CONCLUSION

The high level of preoperational blood glucose, abnormal preoperative white blood cell counting, and long operative time were significantly correlated with the presence of SIRS in patients with type 2 diabetes after PCNL.

Paravertebral block for surgical anesthesia of percutaneous nephrolithotomy: Care-compliant 3 case reports

BACKGROUND

Paravertebral block is often used to provide postoperative analgesia after renal surgery. In this case-series report, we present our experience with 3 patients in whom percutaneous nephrolithotomy was performed successfully under ultrasound-guided 3-segment lumbar-thoracic paravertebral block.

CASE SUMMARY

Three patients were scheduled for percutaneous nephrolithotomy. All 3 patients were high-risk cases for both general and neuraxial anesthesia. After due deliberation and with the consent of patient and his family, ultrasound-guided paravertebral block was performed. Seven to 10 mL of 0.5% ropivacaine was injected at T10/T11, T11/T12, and T12/L1 paravertebral place, respectively. Sensory loss to pinprick from T8 to L2 was achieved in all 3 patients 20 min after administration of block. Surgical procedures for all 3 patients were successful, and none of the patients complained of pain during the operation.

CONCLUSIONS

Ultrasound-guided multilevel paravertebral block may be an attractive option for anesthetic management of percutaneous nephrolithotomy in clinical practice.

Outcome of Percutaneous Nephrolithotomy in Patients with Spinal Cord Neuropathy

PURPOSE

To investigate technical problems, complications and stone clearance rate in patients with spinal neuropathy who had undergone percutaneous nephrolithotomy.

MATERIALS AND METHODS

This cross-sectional study was done between 2004 and 2013 on 29 patients with both spinal cord neuropathy and kidney stones who were chosen for percutaneous nephrolithotomy in Sanandaj city, Iran. The data were obtained from patients' medical records and were documented in a researcher-made checklist. Absolute and relative frequency, mean and standard deviation were calculated.

RESULTS

A total of 43 percutaneous nephrolithotomies were performed on 32 kidneys. In 51.7% the right kidney, in 37.9% the left kidney and in three patients (10.3%) both kidneys were involved. There were 24 patients (82.8%) with spinal cord injury. Five patients (17.2%) had spina bifida. The mean of operation time was 129.7 minutes and the mean of hospital stay was 8.3 &plusmn; 3.1 days. The mean of kidney stone size was 35.7 &plusmn; 6.1 mm (25 to 45 mm). In 58.5% of the patients, surgery lasted more than two hours. Stone clearance rates were 53.1% and 78.1% after the first and second percutaneous nephrolithotomy.

CONCLUSION

Although patients with spinal cord injury have problems in terms of surgery and complications, percutaneous nephrolithotomy is an appropriate and safe treatment method for their kidney stones. Pre-operative counseling with a radiologist and an anesthesiologist is recommended.&nbsp.

A method for estimating DMSA SPECT renal function for assessing the effect of percutaneous nephrolithotripsy on the treated pole

BACKGROUND

The aim of this study was to develop a method for estimating DMSA SPECT renal function on each renal pole in order to evaluate the effect of percutaneous nephrolithotripsy by focusing the measurements on the region through which the percutaneous approach is performed.

METHODS

Twenty patients undergoing percutaneous nephrolithotripsy between November 2010 and June 2012 were included in this study. Both Planar and SPECT-DMSA studies were carried out before and after nephrolithotripsy. The effect of percutaneous nephrolithotripsy was evaluated by estimating the total renal function and the regional renal function of each renal pole. Despite PCNL has been previously reported as a minimally invasive technique, our results showed regional renal function decreases in the treated pole in most patients, affecting the total renal function in a few of them.

RESULTS

A quantification method was used for estimating the SPECT DMSA renal function of the upper, interpolar and lower renal poles. Our results confirmed that total renal function was preserved after nephrolithotripsy. Nevertheless, the proposed method showed that the regional renal function of the treated pole decreased in most patients (15 of 20 patients), allowing us to find differences in patients who had not shown changes in the total renal function obtained from conventional quantification methods.

CONCLUSION

A method for estimating the SPECT DMSA renal function focused on the treated pole enabled us to show for the first time that nephrolithotripsy can lead to a renal parenchymal damage restricted to the treated pole.

Salvage Percutaneous Nephrolithotomy: Analysis of Outcomes following Initial Treatment Failure

PURPOSE

Percutaneous nephrolithotomy has high potential for morbidity or failure. There are limited data regarding risk factors for failure and to our knowledge no published reports of surgical outcomes in patients with prior failed attempts at percutaneous stone removal.

MATERIALS AND METHODS

We identified patients referred to 3 medical centers after prior failed attempts at percutaneous nephrolithotomy. A retrospective chart review was performed to analyze reasons for initial failure and outcomes of salvage percutaneous nephrolithotomy. Outcomes were compared to those in a prospectively maintained database of more than 1,200 patients treated with a primary procedure.

RESULTS

Salvage percutaneous nephrolithotomy was performed in 31 patients. Unsuitable access to the stone was the reason for failure in 80% of cases. Other reasons included infection, bleeding and inadequate instrument availability in 6.5% of cases each. Compared to patients who underwent primary percutaneous nephrolithotomy those treated with salvage were more likely to have staghorn calculi (61.3% vs 31.4%, p <0.01) and a larger maximum stone diameter (3.7 vs 2.5 cm, p <0.01), and require a secondary procedure (65.5% vs 42.1%, p <0.01). There was no significant difference between the cohorts in the remaining demographics or perioperative outcomes. All patients were deemed completely stone free except one who elected observation for a 3 mm nonobstructing fragment.

CONCLUSIONS

Despite the more challenging nature and prior unsuccessful attempts at treatment, the outcomes of salvage percutaneous nephrolithotomy were no different from those of primary percutaneous nephrolithotomy when performed by experienced surgeons.

Comparison of laparoscopic stone surgery and percutaneous nephrolithotomy in the management of large upper urinary stones: a meta-analysis

For the treatment of large upper urinary stones percutaneous nephrolithotomy (PCNL) is generally considered the first choice, and Laparoscopic Stone Surgery (LSS) is an alternative. We aim to compare the efficiency and safety of PCNL with LSS, as far as the management of large upper urinary stones is concerned. A systematic search from Pubmed, Web of Science, Wiley Online Library and Elsevier was performed up to August 1, 2015 for the relevant published studies. After data extraction and quality assessment, meta-analysis was performed using the RevMan 5.3 software. 15 eligible trials evaluating LSS vs. PCNL were identified including 6 prospective and 9 retrospective studies with 473 patients undergoing LSS and 523 patients undergoing PCNL. Although LSS led to longer operative time (p = 0.01) and higher open conversion rate (p = 0.02), patients might benefit from significantly fewer overall complications (p = 0.03), especially lower bleeding rate (p = 0.02), smaller drop in hemoglobin level (p < 0.001), less need of blood transfusion (p = 0.01). The stone free rate was also higher for LSS compared with PCNL (p < 0.001) with less secondary/complementary procedure (p = 0.006). There was no significant difference in other demographic parameters between the two groups. Our data suggests that LSS turns out to be a safe and feasible alternative to PCNL for large upper urinary stones with less bleeding and higher stone free rate. Because of the inherent limitations of the included studies, further large sample prospective, multi-centric studies and randomized control trials should be undertaken to confirm our findings.

Staff lens doses in interventional urology. A comparison with interventional radiology, cardiology and vascular surgery values

The purpose of this work is to evaluate radiation doses to the lens of urologists during interventional procedures and to compare them with values measured during interventional radiology, cardiology and vascular surgery. The measurements were carried out in a surgical theatre using a mobile C-arm system and electronic occupational dosimeters (worn over the lead apron). Patient and staff dose measurements were collected in a sample of 34 urology interventions (nephrolithotomies). The same dosimetry system was used in other medical specialties for comparison purposes. Median and 3rd quartile values for urology procedures were: patient doses 30 and 40 Gy cm(2); personal dose equivalent Hp(10) over the apron (μSv/procedure): 393 and 848 (for urologists); 21 and 39 (for nurses). Median values of over apron dose per procedure for urologists resulted 18.7 times higher than those measured for radiologists and cardiologists working with proper protection (using ceiling suspended screens) in catheterisation laboratories, and 4.2 times higher than the values measured for vascular surgeons at the same hospital. Comparison with passive dosimeters worn near the eyes suggests that dosimeters worn over the apron could be a reasonable conservative estimate for ocular doses for interventional urology. Authors recommend that at least the main surgeon uses protective eyewear during interventional urology procedures.