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Cui D, Chen G, Luo J, Ma Q, Wang G, Yang Z, Ye L. Comparison of percutaneous nephrolithotripsy combined with retrograde intrarenal surgery and multi-tract percutaneous nephrolithotripsy for octopus stone: A propensity score-matching study. Medicine (Baltimore) 2024; 103:e38311. [PMID: 39259108 PMCID: PMC11142782 DOI: 10.1097/md.0000000000038311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/16/2024] [Accepted: 04/29/2024] [Indexed: 09/12/2024] Open
Abstract
To compared the effectiveness and safety of single standard mini percutaneous nephrolithotripsy (SM-PCNL) combined with retrograde intrarenal surgery (RIRS) and multiple standard mini percutaneous nephrolithotomy (MSM-PCNL) in the treatment of octopus stone of 2 to 4 cm. The clinical data of SM-PCNL combined with RIRS and MSM-PCNL for octopus stone with a 2 to 4 cm diameter from October 2019 to December 2022 were analyzed retrospectively, and propensity score matching was used to screen patients. The matched patients were paired, and the operation time, complications, postoperative pain, tubeless rate, stone-free rate (SFR), and postoperative hospital stay were further compared between the 2 groups. 88 patients underwent SM-PCNL combined with RIRS (combined group), and 143 patients underwent MSM-PCNL (multiple channel group). After matching analysis, there were 49 patients in each group, and there was no significant difference in the general preoperative data between the 2 groups. The perioperative complications and stone-free rate were no statistical difference. In postoperative pain (4.00 ± 0.74 vs 5.00 ± 0.74, P = .00), tubeless rate (44.90% vs 20.41%, P = .01), hemoglobin drop (9.38 ± 7.48 vs 14.22 ± 7.69, P = .01), postoperative hospital stay (3.37 ± 1.09 vs 5.08 ± 1.29, P = .00), the combined group was significantly better than the multiple channel group. Regarding operation time, the combined group was more than the multiple channel group (103.27 ± 27.61 vs 78.39 ± 19.31, P = .000). For octopus stone with a diameter of 2 to 4 cm, the effectiveness and safety of SM-PCNL combined with RIRS were similar to those of MSM-PCNL The surgeon should carefully evaluate the patient's physical condition, stone characteristics, and expectations before the operation and assist the patient in choosing an appropriate plan.
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Affiliation(s)
- Deheng Cui
- Department of Urology, The Second Hospital of Longyan, Longyan, Fujian, China
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Guoqiang Chen
- Department of Urology, The Second Hospital of Longyan, Longyan, Fujian, China
| | - Jianbin Luo
- Department of Urology, The Second Hospital of Longyan, Longyan, Fujian, China
| | - Qinghong Ma
- Department of Urology, The Second Hospital of Longyan, Longyan, Fujian, China
| | - Guangzhi Wang
- Department of Urology, The Second Hospital of Longyan, Longyan, Fujian, China
| | - Zesong Yang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Liefu Ye
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou, Fujian, China
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Cui D, Ma Q, Xie S, Wang G, Li G, Chen G. Comparison of the effectiveness of two adjustable negative pressure ureteral access sheaths combined with flex ureteroscopy for ≤ 2 cm renal stones. Sci Rep 2024; 14:4745. [PMID: 38413652 PMCID: PMC10899199 DOI: 10.1038/s41598-024-55333-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/22/2024] [Indexed: 02/29/2024] Open
Abstract
To compare the safety and effectiveness of the combination of intelligent intrarenal pressure control platforms (IPCP) and flexible ureteral access sheath (FUAS) combined with retrograde intrarenal surgery (RIRS) for the treatment of renal stones less than 2 cm. We retrospectively collected 383 patients with renal stones who underwent RIRS in our department from June 2022 to October 2023. Inclusion criteria: stone length or the sum of multiple stone lengths ≤ 2 cm. Finally, 99 cases were included and divided into an IPCP group (n = 40) and FUAS group (n = 59) based on surgical methods. The main endpoint was the stone-free rate (SFR) at third months after surgery, with no residual stones or stone fragments less than 2 mm defined as stone clearance. The secondary endpoints were surgical time and perioperative complications, including fever, sepsis, septic shock, and perirenal hematoma. There was no statistically significant difference in general information between the two groups, including age, gender, body mass index, comorbidities, stone side, stone location, stone length, urine bacterial culture, and hydronephrosis. The operation time for IPCP group and FUAS group was 56.83 ± 21.33 vs 55.47 ± 19.69 min (p = 0.747). The SFR of IPCP group and FUAS group on the first postoperative day was 75.00% vs 91.50% (p = 0.024). The SFR was 90.00% vs 94.90% in the third month (p = 0.349).In IPCP group, there were 11 cases with stones located in the lower renal calyces and 17 cases in FUAS group. The SFR of the two groups on the first day and third months after surgery were 45.50% vs 88.20% (p = 0.014) and 63.60% vs 94.10% (p = 0.040), respectively, with statistical differences. For kidney stones ≤ 2 cm, there was no difference in SFR and the incidence of infection-related complications between IPCP and FUAS combined with RIRS, both of which were superior to T-RIRS. For lower renal caliceal stones, FUAS has a higher SFR compared to IPCP.
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Affiliation(s)
- Deheng Cui
- Department of Urology, The Second Hospital of Longyan, Longyan, 364000, Fujian, China
| | - Qinghong Ma
- Department of Urology, The Second Hospital of Longyan, Longyan, 364000, Fujian, China
| | - Shengbiao Xie
- Department of Urology, The Second Hospital of Longyan, Longyan, 364000, Fujian, China
| | - Guangzhi Wang
- Department of Urology, The Second Hospital of Longyan, Longyan, 364000, Fujian, China
| | - Guanghai Li
- Department of Urology, The Second Hospital of Longyan, Longyan, 364000, Fujian, China.
| | - Guoqiang Chen
- Department of Urology, The Second Hospital of Longyan, Longyan, 364000, Fujian, China.
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De Stefano V, Castellani D, Somani BK, Giulioni C, Cormio A, Galosi AB, Sarica K, Glover X, da Silva RD, Tanidir Y, Gadzhiev N, Pirola GM, Mulawkar PM, Teoh JYC, Monga M, Herrmann TRW, Gauhar V. Suction in Percutaneous Nephrolithotripsy: Evolution, Development, and Outcomes from Experimental and Clinical studies. Results from a Systematic Review. Eur Urol Focus 2024; 10:154-168. [PMID: 37442721 DOI: 10.1016/j.euf.2023.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/02/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
CONTEXT Controversy exists regarding the therapeutic benefit of suction use during percutaneous nephrolithotripsy (PCNL). OBJECTIVE To review and highlight the options available in the use of suction for PCNL, and to discuss their strengths and limitations. EVIDENCE ACQUISITION A systematic literature search was performed using Scopus, EMBASE, and PubMed. Thirty four studies were included. There was one ex vivo study. Among clinical studies, 24 used a vacuum/suctioning sheath and nine a handpiece suction device/direct-in-scope suction. The suction technique was employed in standard, mini-PCNL, supermini-PCNL, and enhanced supermini‑PCNL techniques. EVIDENCE SYNTHESIS Handpiece suction devices demonstrated better safety and efficiency in treating large stones than nonsuction PCNL and in a much shorter time. Trilogy and ShockPulse-SE were equally effective, safe, and versatile for standard PCNL and mini-PCNL. The heavier handpiece makes Trilogy less ergonomically friendly. Laser suction handpiece devices can potentiate laser lithotripsy by allowing for better laser control with simultaneous suction of small fragments and dust. Integrated suction-based sheaths are available in reusable and disposable forms for mini-PCNL only. Mini-PCNL with suction reported superior outcomes for operative time and stone-free rate to mini-PCNL. This also helped minimize infectious complications by a combination of intrarenal pressure reduction and faster aspiration of irrigation fluid reducing the risk of sepsis, enhance intraoperative vision, and improve lithotripsy efficiency, which makes it a very attractive evolution for PCNL. CONCLUSIONS Suction devices in PCNL are reforming the way PCNL is being done. Adding suction to mini-PCNL reduces infectious complications and improves the stone-free rate. Our review shows that despite the limited evidence, suction techniques appear to improve PCNL outcomes. PATIENT SUMMARY In this review, we looked at the intra- and perioperative outcomes of percutaneous nephrolithotripsy (PCNL) with the addition of suction. With better stone fragmentation and fewer postoperative infections, this technology is very useful particularly for mini-PCNL.
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Affiliation(s)
- Virgilio De Stefano
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy.
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Bhaskar K Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Carlo Giulioni
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Angelo Cormio
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Kemal Sarica
- Department of Urology, Dr. Lutfi Kirdar Kartal Research and Training Hospital, Istanbul, Turkey
| | - Xavier Glover
- Urology, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | | | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Petersburg, Russia
| | | | - Prashant Motiram Mulawkar
- Department of Urology, Tirthankar Super Speciality Hospital, Akola, India; Professor of Urology, GMC & SSH, Akola, India; University of Edinburgh, Edinburgh, UK
| | - Jeremy Yuen-Chun Teoh
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Manoj Monga
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Thomas R W Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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Pathak N, Agrawal S, Parikh A, Shete N, Singh A, Ganpule A, Sabnis R, Desai M. A randomized controlled trial comparing infectious complications using mini perc with and without suction for renal stones less than 3 cm in size. Urolithiasis 2023; 52:6. [PMID: 37991587 DOI: 10.1007/s00240-023-01487-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/28/2023] [Indexed: 11/23/2023]
Abstract
The purpose was to do a study to compare infectious complications in patients operated for MiniPerc or Minimally invasive Percutaneous Nephrolithotomy (MPCNL) using MIP and MPCNL with suction using Shah Superperc sheath for medium-sized renal stones less than 3 cm in size. The primary objective of this study is to compare the infectious complications and the secondary objectives are to compare stone-free rates, complication rates and operative times. A prospective randomized controlled trial with patients having proximal ureteral and renal stones of 10-30 mm size and planned for MPCNL done at a single institute. A total of 80 consecutively admitted patients with written informed consent were included for randomization with 40 patients in each arm of MPCNL and suction MPCNL. The median age in MPCNL and suction MPCNL arms were 48 and 49 years, the median stone size of 15.45 and 16.7 cm, the Median stone volume of 1576.2 vs 1752 mm3, and the median stone density of 1258 and 1250 Hu, the median hospital stay of 3 days in both arms were comparable. Infectious complications were comparable in both arms. Operative time was significantly less in the suction MPCNL group (26.5 min-IQR 17-34.8) than in the MPCNL group (34.8 min-IQR 20-45), p = 0.021 and stone-free rates (SFR), were more in Suction MPCNL arm 97.5% than in MPCNL 87.5%, p = 0.04. Overall, the complication rates were comparable in both arms. Suction MPCNL procedure resulted in shorter operating times and more SFR than conventional MPCNL with comparable complication rates.
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Affiliation(s)
- Niramya Pathak
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Sahil Agrawal
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Aditya Parikh
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Nitiraj Shete
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Abhishek Singh
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Arvind Ganpule
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Ravindra Sabnis
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
| | - Mahesh Desai
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
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Mihaľová M, Šupčíková N, Kovalčíková AG, Breza J, Tóthová Ľ, Celec P, Breza J. Dynamics of Urinary Extracellular DNA in Urosepsis. Biomolecules 2023; 13:1008. [PMID: 37371588 DOI: 10.3390/biom13061008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Extracellular DNA (ecDNA) is a promising candidate marker for the early diagnosis and monitoring of urinary tract infections (UTIs). The aim of our study is to describe the dynamics of ecDNA in the plasma and urine of patients with urosepsis as well as in a mouse model of UTI. Samples of blood and urine were collected from adult patients with UTIs and obstructive uropathy (n = 36) during the first 3 days at the hospital and during a follow-up. Bacterial burden and urinary ecDNA were evaluated in a mouse UTI model (n = 26) at baseline; 24, 48, and 72 h after UTI induction; and 7 days after UTI induction. The plasma ecDNA did not change during urosepsis, but the plasma DNase activity increased significantly at the follow-up. The urinary ecDNA decreased significantly during hospitalization and remained low until the follow-up (90% lower vs. admission). No change was seen in the urinary DNase activity. C-reactive protein (CRP) and procalcitonin are positively correlated with plasma and urinary ecDNA. A UTI caused sepsis in 23% of mice. The urinary ecDNA decreased by three-fold and remained low until day 7 post-infection. Urinary bacterial burden is correlated with urinary ecDNA. Urinary ecDNA is a potential non-invasive marker for monitoring the effects of treatment during urosepsis and is related to UTI progression in the experimental animal model.
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Affiliation(s)
- Michaela Mihaľová
- Department of Urology, Faculty of Medicine, University Hospital Bratislava and Comenius University, 83305 Bratislava, Slovakia
| | - Nadja Šupčíková
- Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University, 81108 Bratislava, Slovakia
| | - Alexandra Gaál Kovalčíková
- Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University, 81108 Bratislava, Slovakia
- Department of Paediatrics, Faculty of Medicine, National Institute of Children's Diseases, Comenius University in Bratislava, 83340 Bratislava, Slovakia
| | - Ján Breza
- Department of Pediatric Urology, Faculty of Medicine, Comenius University and National Institute of Children's Diseases, 83101 Bratislava, Slovakia
| | - Ľubomíra Tóthová
- Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University, 81108 Bratislava, Slovakia
| | - Peter Celec
- Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University, 81108 Bratislava, Slovakia
- Institute of Pathophysiology, Faculty of Medicine, Comenius University in Bratislava, 81108 Bratislava, Slovakia
| | - Ján Breza
- Department of Urology, Faculty of Medicine, University Hospital Bratislava and Comenius University, 83305 Bratislava, Slovakia
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Cauni VM, Dragutescu M, Mihai B, Gorecki GP, Ples L, Sima RM, Persu C. Mini-Perc for Renal Stones-A Single Center Experience and Literature Review. Diagnostics (Basel) 2023; 13:1083. [PMID: 36980392 PMCID: PMC10047343 DOI: 10.3390/diagnostics13061083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/15/2023] Open
Abstract
AIM The aim of this study was to analyze the outcomes of miniaturized nephrolithotomy (mini-perc) in the management of renal stones with a diameter smaller than 20 mm. MATERIALS AND METHODS We retrospectively reviewed the records of 102 patients who underwent mini-perc between March 2015 and March 2020 in our department. The primary objective was the stone-free rate, but we also analyzed the retreatment rate, complications, hospital stay, operative time and reduction in hemoglobin level. All these patients had this technique as their first-line treatment, in a prone position, using a 16 Fr sheath size. Data were compared to a series of patients from the literature, treated with conventional PCNL. RESULTS The patients had calculus limited to either a single calyx or just extending to the renal pelvis, and stone size was less than 20 mm in its maximal dimension. The intrarenal stone location was in the upper calyx in 7 cases, middle calyx in 20 cases and lower calyx in 46 cases, and there were 29 patients with renal pelvis stone. The male to female ratio was 1.5:1, and the median age was 48.4 years. The average stone size was 17.4 mm in diameter (ranging between 9 and 20 mm) and all cases underwent Ho-YaG laser lithotripsy, ballistic energy and combined ultrasonic and ballistic lithotripsy. At the end of the procedure, an antegrade double J stent was placed under fluoroscopy for a maximum of 2 weeks in 42 cases, while 9 cases needed a nephrostomy tube 12-14 F. A total of 51 cases were totally tubeless. Our median operative time was 61 min (ranging from 35 to 75 min). The median hospitalization stay was 3.8 days. The stone free rate was 90.1% after one procedure, only nine (8.8%) cases needed a "second look" flexible ureteroscopy, and the final stone-free rate was 98% (absence of detectable calculi on ultrasound, KUB or non-contrast CT scan). The overall complication rate was 6.86% (Clavien classification I-57.14%; II-28.5%; III-14.2%), while no Clavien IV or V complications were reported. No patient required a blood transfusion, and mean hemoglobin loss was 0.81 mg/dL. Overall, our results are better than similar data for conventional PCNL in the literature. CONCLUSIONS The "mini-perc" technique is an effective procedure for the treatment of the renal lithiasis that is less or equal to 2 cm. The results demonstrated that this minimally invasive technique is associated with a higher stone-free rate and minimal complications.
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Affiliation(s)
- Victor-Mihail Cauni
- Department of Urology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Mihai Dragutescu
- Department of Urology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Bogdan Mihai
- Department of Urology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Gabriel-Petre Gorecki
- Department of Anesthesia and Intensive Care, CF2 Clinical Hospital, 011464 Bucharest, Romania
- Faculty of Medicine, Titu Maiorescu University, 031593 Bucharest, Romania
| | - Liana Ples
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- “Bucur” Maternity, Saint John Hospital, 012361 Bucharest, Romania
| | - Romina-Marina Sima
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- “Bucur” Maternity, Saint John Hospital, 012361 Bucharest, Romania
| | - Cristian Persu
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Xu XJ, Zhang J, Li M, Hou JQ. Clinical study on the minimally invasive percutaneous nephrolithotomy treatment of upper urinary calculi. World J Clin Cases 2022; 10:1198-1205. [PMID: 35211553 PMCID: PMC8855199 DOI: 10.12998/wjcc.v10.i4.1198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/02/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Upper urinary tract stones are very common in my country, with an incidence of 1% to 5% in the North and an even higher incidence of 5% to 10% in the south. The incidence rate in the south is higher than that in the north, mainly due to the water quality, climate and eating habits of the region. From the perspective of sex, incidence is more likely in males than females. In the high-incidence population, young adults are most prone to stones. Men in the age range of 25 to 40 years are more likely to have stones.
AIM To observe the therapeutic effect of minimally invasive percutaneous nephrolithotomy (mPCNL) on upper urinary tract stones and its influence on the renal function of patients.
METHODS Patients with upper urinary tract stones who were treated in our hospital from February 2017 to March 2018 were selected as research subjects and were divided into the PCNL group and the mPCNL group according to the random number table method. The general conditions of the two groups of patients were observed during the perioperative period, and the differences in stone clearance, pain, renal function indicators and complication rates were compared between the two groups to determine which were statistically significant (P < 0.05).
RESULTS The operation time of the mPCNL group was longer than that of the PCNL group (t = -34.392, P < 0.001), and the intraoperative blood loss of the mPCNL group was more than that of the PCNL group (t = 34.090, P < 0.001). There was no difference in renal function indices between the two groups of patients before treatment, and there was no difference in the levels of serum creatinine, β2 microglobulin or retinol binding protein in the mPCNL group after treatment. The visual analog scale score of patients in the mPCNL group was lower than that of the PCNL group (t = 12.191, P < 0.001), and there was no significant difference in the stone clearance rate between the two groups (χ2 value = 1.013, P = 0.314). There was no significant difference in the incidence of urine extravasation, dyspnea and peripheral organ damage between the two groups (χ2 value = 1.053, P = 0.305). At 1 mo after treatment and 3 mo after treatment, the quality of life of the mPCNL group was lower than that of the PCNL group, and the Qmax level of the mPCNL group was higher than that of the PCNL group.
CONCLUSION mPCNL has a good therapeutic effect on upper urinary tract stones, with a high stone clearance rate without causing kidney damage or increasing the incidence of complications, and thus has good application value.
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Affiliation(s)
- Xiao-Jian Xu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Jun Zhang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Miao Li
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Jian-Quan Hou
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
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Deepak H, Shah A, Upadhye M, Goud N, Shah A. Stone clearance rate and postoperative recovery of mini percutaneous nephrolithotomy: A single-institute study. JOURNAL OF MARINE MEDICAL SOCIETY 2022. [DOI: 10.4103/jmms.jmms_66_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lievore E, Zanetti SP, Fulgheri I, Turetti M, Silvani C, Bebi C, Ripa F, Lucignani G, Pozzi E, Rocchini L, De Lorenzis E, Albo G, Longo F, Salonia A, Montanari E, Boeri L. Cost analysis between mini-percutaneous nephrolithotomy with and without vacuum-assisted access sheath. World J Urol 2021; 40:201-211. [PMID: 34432135 PMCID: PMC8813798 DOI: 10.1007/s00345-021-03811-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose To perform a cost analysis between vacuum-assisted percutaneous nephrolithotomy (vmPCNL) and minimally invasive PCNL (MIP) and explore potential predictors of costs associated with the procedures. Methods We analyzed data from 225 patients who underwent vmPCNL or MIP at a single tertiary referral academic center between January 2016 and December 2020. We collected patients’ demographics, peri-and postoperative data and detailed expense records. After propensity score matching, 108 (66.7%) vmPCNL and 54 (33.3%) MIP procedures were analyzed. Descriptive statistics assessed differences in clinical and operative parameters. Univariable and multivariable linear regression models tested the association between clinical variables and costs. Results Operative time (OT) was shorter for vmPCNL, and the use of additional instruments to complete litholapaxy was more frequent in MIP (all p ≤ 0.01). Length of stay (LOS) was longer for MIP patients (p = 0.03) and the stone-free (SF) rate was higher after vmPCNL (p = 0.04). The overall instrumentation cost was higher for vmPCNL (p < 0.001), but total procedural costs were equivalent (p = 0.9). However, the overall cost for the hospitalization was higher for MIP than vmPCNL (p = 0.01). Univariable linear regression revealed that patient’s comorbidities, OT, any postoperative complication and LOS were associated with hospitalization costs (all p < 0.001). Multivariable linear regression analysis revealed that LOS and OT were associated with hospitalization costs (all p < 0.001), after accounting for vmPCNL procedure, patients’ comorbidities, and complications. Conclusion vmPCNL may represent a valid option due to clinical and economic benefits. Shorter OT, the lower need for disposable equipment and the lower complication rate reduced procedural and hospitalization costs. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03811-5.
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Affiliation(s)
- Elena Lievore
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Stefano Paolo Zanetti
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Irene Fulgheri
- Department of Radiology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Turetti
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Carlo Silvani
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Carolina Bebi
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Francesco Ripa
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Gianpaolo Lucignani
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Lorenzo Rocchini
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Elisa De Lorenzis
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giancarlo Albo
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Fabrizio Longo
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Boeri
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.
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10
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Abstract
PURPOSE OF REVIEW The armamentarium of percutaneous nephrolithotomy (PCNL) and the strategy to perform the procedure is constantly evolving. The innovation and development in techniques lead to further miniaturization in PCNL devices and change the lithotripsy and stone removal strategy. Suctioning in PCNL offers urologist a new conception in renal stone management. The present review evaluates the latest results on efficacy, safety and feasibility of suctioning PCNL techniques. RECENT FINDINGS Recent literature reported the outcomes of different suctioning PCNL techniques. Most of these studies demonstrated good efficacy when comparing conventional PCNL. Suctioning PCNL improving the lithotripsy efficiency to enhance the stone-free rate (SFR) and reducing renal pelvic pressure to attenuate postoperative infectious complications. The advantage of suction also helps overcome the limitation of potentially higher intrarenal pressure and prolonged operative time in Mini-PCNL. SUMMARY PCNL with suctioning represents a valuable new tool in the armamentarium of modern endourologists. This innovative approach can offer improved safety and efficacy with lower complications rates and higher cost effectiveness than the traditional PCNL technique.
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11
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Abstract
PURPOSE OF REVIEW Equipment used in endourology is constantly evolving due to increasing incidence of urolithiasis. Suctioning has been used mainly in PCNL in conjunction with ultrasonic and ballistic devices for stone removal. Recently technological advances permitted the use of suctioning in more endourological techniques. This review aims to summarize the literature regarding these advancements and analyze the upcoming results. RECENT FINDINGS Several centers have conducted experimental and clinical studies on suctioning use during PCNL, mPCNL, and ureteroscopy and concluded that it is an effective and safe adjustment that improves stone-free rates and limits complication rates after these procedures. Suctioning use during common endourological procedures led to improved safety and efficacy among several indications. Due to the observational nature and small sample size of many studies, larger RCTs are needed to make safe conclusions.
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Affiliation(s)
- Lazaros Tzelves
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleion Hospital, Athens, Greece
| | - Andreas Skolarikos
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleion Hospital, Athens, Greece.
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12
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Bai Y, Liu Q, Gu J, Zhang X, Hu S. Analysis of Urinary Pathogen Cultures and Drug Sensitivity in Patients with Urinary Stones for Five Consecutive Years in Xiangya Hospital, China. Infect Drug Resist 2020; 13:1357-1363. [PMID: 32494167 PMCID: PMC7227811 DOI: 10.2147/idr.s241036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/23/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To analyze pathogen distribution and drug sensitivity in patients with urinary calculi and thereby gain insight into the most appropriate antibacterial drugs for perioperative therapy. Materials and Methods From January 2014 to December 2018, the results of mid-stream urine pathogen culture and drug sensitivity tests were evaluated retrospectively for 353 patients with urinary calculi. SPSS software version 23.0 was used to analyze the data. Results A total of 353 strains of pathogens were isolated from urine culture. Among these, 278 (79%) strains belonged to the top 10 most frequently isolated pathogens, comprising 209 (75.2%) Gram-negative bacilli and 69 (24.8%) Gram-positive cocci. Escherichia coli was the most frequently isolated pathogen overall and the most frequently isolated Gram-negative bacillus, and Enterococcus faecalis was the most frequently isolated Gram-positive coccus. Drug sensitivity levels were effectively unchanged for less commonly used drugs, whereas drug resistance rates remained high for commonly used drugs such as ampicillin trihydrate, ampicillin/sulbactam, cefazolin, ceftriaxone, aztreonam, levofloxacin and ciprofloxacin. Conclusion E. coli and E. faecalis remain the most common Gram-negative bacillus and Gram-positive coccus uropathogens, respectively, in patients with urinary calculi. Mid-stream urine pathogen culture and drug sensitivity tests should be used to select appropriate antibacterial drugs before treatment, particularly for perioperative patients with urinary calculi.
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Affiliation(s)
- Yao Bai
- Xiangya International Medical Center, Department of Geriatrics Urology, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China.,Medizinische Klinik and Poliklinik IV, Klinikum Der Universität München, Munich, Germany
| | - Qingxia Liu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Jie Gu
- Xiangya International Medical Center, Department of Geriatrics Urology, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China.,Martini-Klinik Prostate Cancer Center, Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Xiaobo Zhang
- Xiangya International Medical Center, Department of Geriatrics Urology, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Sheng Hu
- Xiangya International Medical Center, Department of Geriatrics Urology, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
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13
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Suctioning versus traditional minimally invasive percutaneous nephrolithotomy to treat renal staghorn calculi: A case-matched comparative study. Int J Surg 2019; 72:85-90. [DOI: 10.1016/j.ijsu.2019.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/25/2019] [Accepted: 10/23/2019] [Indexed: 12/23/2022]
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14
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Jiang Y, Li J, Zhang Y, Hu X, Zhang X, Shang X, Gong S, Yu R. Clinical Situations of Bacteriology and Prognosis in Patients with Urosepsis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3080827. [PMID: 30881985 PMCID: PMC6381567 DOI: 10.1155/2019/3080827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/13/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Urosepsis and septic shock are a critical situation leading to a mortality rate up to 30% in patients with obstructive diseases of the urinary tract. AIM To analyze the bacterial distribution and drug resistance of pathogenic bacteria in patients with urosepsis and to provide a basis for the rational application of antibacterial drugs in clinical practice. METHODS A retrospective analysis of 94 hospitalized patients with urosepsis for 6 years was performed. The strain composition, resistance characteristics, and the antibiogram of common bacteria from positive blood and midstream urine culture were analyzed. RESULTS A total of 87 strains were isolated, including 65 strains (74.71%) of Gram-negative bacilli, 14 strains (16.09%) of Gram-positive cocci, and 8 strains (9.20%) of fungi. The Gram-negative bacilli included 42 strains of Escherichia coli (E. coli) (64.62%), among which 34 strains (80.95%) were producing ESBLs, and 14 strains (21.84%) of Klebsiella pneumoniae (K. pneumoniae), among which nine strains (64.29%) were producing ESBLs. The most common pathogenic bacteria, ESBL+ E. coli and K. pneumoniae strains, showed sensitivity towards imipenem, ertapenem, piperacillin/tazobactam, amikacin, and cefotetan, but were highly resistant to quinolones. The cure rate of urosepsis was 88.30%, and the susceptibility rate of septic shock was 45.47%. SIGNIFICANCE Gram-negative bacterial infections are the main cause of urosepsis. The mild patient group showed more E. coli (ESBL-) infections, and the number of ESBL producing E. coli isolated from the mild group showed higher drug resistance rates for aztreonam and levofloxacin compared with isolates from the severe group.
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Affiliation(s)
- Ying Jiang
- Department of Surgical Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Clinical Teaching Hospital Affiliated to the Fujian Medical University, Fuzhou, Fujian, China
| | - Jun Li
- Department of Surgical Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Clinical Teaching Hospital Affiliated to the Fujian Medical University, Fuzhou, Fujian, China
| | - Yingrui Zhang
- Department of Surgical Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Clinical Teaching Hospital Affiliated to the Fujian Medical University, Fuzhou, Fujian, China
| | - Xinlan Hu
- Microbiology Department of Fujian Provincial Hospital, Fujian Provincial Clinical Teaching Hospital Affiliated to the Fujian Medical University, Fuzhou, Fujian, China
| | - Xiaoguang Zhang
- Department of Surgical Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Clinical Teaching Hospital Affiliated to the Fujian Medical University, Fuzhou, Fujian, China
| | - Xiuling Shang
- Department of Surgical Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Clinical Teaching Hospital Affiliated to the Fujian Medical University, Fuzhou, Fujian, China
| | - Shurong Gong
- Department of Surgical Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Clinical Teaching Hospital Affiliated to the Fujian Medical University, Fuzhou, Fujian, China
| | - Rongguo Yu
- Department of Surgical Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Clinical Teaching Hospital Affiliated to the Fujian Medical University, Fuzhou, Fujian, China
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15
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Hennessey DB, Kinnear NK, Troy A, Angus D, Bolton DM, Webb DR. Mini PCNL for renal calculi: does size matter? BJU Int 2017; 119 Suppl 5:39-46. [PMID: 28544299 DOI: 10.1111/bju.13839] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the minimally invasive percutaneous nephrolithotomy (MIP) system for renal calculi. PATIENTS AND METHODS Consecutive patients undergoing mini-percutaneous nephrolithotomy (mPCNL) procedures with the MIP system were enrolled. Patient position, American Society of Anesthesiologists classification, puncture location, stone clearance, postoperative drainage and complications were recorded, and features unique to MIP were noted. RESULTS In all, 30 patients underwent 32 mPCNL procedures. The mean stone size was 17 (10.75-21.25) mm and the mean number of stones was 1 (1-2). The median stone clearance rate was 96.5 (95-100)%. The complication rate was 9.3%. No patient required a transfusion. In addition to these outcomes, we noted that the MIP system has many advantages over conventional PCNL (cPCNL). It is easy to learn and can be performed in both supine and prone positions. It is safe for supracostal puncture, provides excellent access to nearly all calyces and upper ureter, has multiple stone treatment options, can be used as an adjunct to cPCNL, and can be performed as a tubeless procedure. CONCLUSION Our experience with the MIP system has shown several advantages over cPCNL. mPCNL with the MIP system has several features that suggest it should be considered as an alternative or adjunct to cPCNL, ureteroscopy and extracorporeal shockwave lithotripsy.
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Affiliation(s)
| | - Ned K Kinnear
- Department of Urology, Austin Health, Heidelberg, Vic., Australia
| | - Andrew Troy
- Department of Urology, Austin Health, Heidelberg, Vic., Australia.,Epworth Freemasons Hospital, East Melbourne, Vic., Australia
| | - David Angus
- Department of Urology, Austin Health, Heidelberg, Vic., Australia.,Warringal Private Hospital, Heidelberg, Vic., Australia
| | - Damien M Bolton
- Department of Urology, Austin Health, Heidelberg, Vic., Australia.,Warringal Private Hospital, Heidelberg, Vic., Australia
| | - David R Webb
- Department of Urology, Austin Health, Heidelberg, Vic., Australia.,Epworth Freemasons Hospital, East Melbourne, Vic., Australia
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