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Fernández Baltar C, Martínez Corral ME, Pérez Fentes D. Predicting and Avoiding Complications in Percutaneous Nephrolithotomy in the Era of Personalized Medicine: A Scoping Review. J Pers Med 2024; 14:962. [PMID: 39338216 PMCID: PMC11432793 DOI: 10.3390/jpm14090962] [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: 07/16/2024] [Revised: 08/30/2024] [Accepted: 09/04/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Percutaneous nephrolithotomy (PCNL) is associated with a wide range of complications. This review aims to explore how recent technological advancements and personalized medicine can help prevent or predict these complications. METHODS A scoping review was conducted according to the PRISMA-SCR guidelines and registered on the Open Science Framework in April 2024. A literature search was performed on PUBMED, Web of Science, and Scopus databases. This review focused on predictive AI models, 3D surgical models, intrasurgical image guidance, and biomarkers. Articles meeting the following criteria were included: publication between 2019 and 2024, written in English, involving human participants, and discussing technological advancements or personalized medicine in the context of complications in PCNL. RESULTS Of the 11,098 articles searched, 35 new studies were included. We identified a few articles on predictive AI models. Several studies demonstrated that 3D presurgical models and virtual models could enhance surgical planning and reduce complications. New intrasurgical image and guidance systems showed the potential in reducing bleeding and radiation exposure. Finally, several biomarkers were identified as predictors of sepsis and other complications. CONCLUSION This scoping review highlights the potential of emerging technologies in reducing and predicting PCNL complications. However, larger prospective studies are required for validation.
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Affiliation(s)
| | - María Elena Martínez Corral
- Department of Urology, University Hospital Complex of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (M.E.M.C.); (D.P.F.)
| | - Daniel Pérez Fentes
- Department of Urology, University Hospital Complex of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (M.E.M.C.); (D.P.F.)
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Wang L, Li KP, Yin S, Yang L, Zhu PY. Contrast-enhanced ultrasound versus conventional ultrasound-guided percutaneous nephrolithotomy in patients with a non-dilated collecting system: results of a pooled analysis of randomized controlled trials. BMC Urol 2023; 23:93. [PMID: 37173693 PMCID: PMC10182632 DOI: 10.1186/s12894-023-01269-8] [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: 01/31/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Contrast-enhanced ultrasound in percutaneous nephrolithotomy (CEUS-PCNL) is an economical and practical technique for the treatment of patients with renal stones without significant collecting system dilatation. The aim of this systematic review is to compare the safety and efficacy of CEUS-PCNL and conventional ultrasound (US)-guided (US-PCNL) treatment of patients with renal calculi without significant hydronephrosis. METHODS This review was conducted with strict adherence to the PRISMA guidelines. Comparative studies on CEUS-PCNL and US-PCNL published in PubMed, SinoMed, Google Scholar, Embase, and Web of science until March 1, 2023, were systematically searched. RevMan 5.1 software was used for meta-analysis. Pooled odds ratios (ORs), weight mean differences (WMDs) and standard mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using the fixed-effects or random-effects model. Publication bias was evaluated using funnel plots. RESULTS Four randomized controlled trials involving 334 patients (168 with CEUS-guided PCNL and 166 with US-guided PCNL) were identified. There was no statistically significant difference between CEUS-guided PCNL and US-guided PCNL in terms of the operation time (SMD: - 0.14; 95% CI - 0.35 to 0.08; p = 0.21), minor complications (p = 0.48), major complications (p = 0.28) and overall complications (p = 0.25). However, CEUS-guided PCNL had a higher stone-free rate (OR: 2.22; 95% CI 1.2 to 4.12; p = 0.01), higher success rate of single-needle punctures (OR:3.29; 95% CI 1.82 to 5.95; p < 0.0001), shorter puncture time (SMD: - 1.35; 95% CI - 1.9 to - 0.79; p < 0.00001), shorter hospital stay (SMD: - 0.34; 95% CI - 0.55 to - 0.12; p = 0.002) and lesser hemoglobin loss (SMD: - 0.83; 95% CI - 1.06 to - 0.61; p < 0.00001) as compared with conventional US-guided PCNL. CONCLUSIONS According to almost all pooled data, CEUS-guided PCNL is superior to US-guided PCNL in terms of the perioperative outcomes. However, many rigorous clinical randomized controlled studies are required to obtain more accurate results. Registration The study protocol was registered with PROSPERO (CRD42022367060).
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Affiliation(s)
- Li Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Kun-Peng Li
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Shan Yin
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Lin Yang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ping-Yu Zhu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
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Tatanis V, Cracco CM, Liatsikos E. Advances in percutaneous renal puncture: a comprehensive review of the literature. Curr Opin Urol 2023; 33:116-121. [PMID: 36305308 DOI: 10.1097/mou.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW Percutaneous nephrolithotomy (PCNL) constitutes the gold standard procedure for patients suffering from more than 2 cm renal stones. The puncture is a very critical step of PCNL, affecting manoeuvrability of the nephroscope, possibility to remove stone fragments, risk of bleeding and radiation exposure. The aim of the current review was to discuss the advances in percutaneous renal puncture. RECENT FINDINGS Following technological evolution in medicine, there was a consistent development in the puncture techniques, aiming at the improvement of its efficacy and safety. The use of specific agents can improve ultrasonic guidance, making the challenging step of gaining access to the kidney easier for the experienced surgeon and more accessible for the resident urologist. Future developments in the electromagnetic and three-dimensional (3D) technology may establish a high level of accuracy with decreased rates of related complications, even in the hands of beginners. SUMMARY The advances in percutaneous puncture can lead to improved safety and accuracy of this procedure decreasing the radiation exposure and the complication rate.
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Affiliation(s)
| | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece
- Department of Urology, Medical University of Vienna, Vienna, Austria
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Ma Y, Li P, Xiang L, Wen J, Jin X. Comparison of Contrast-Enhanced Ultrasound vs Conventional Ultrasound-Guided Percutaneous Nephrolithotomy in Nondilated Collecting System: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Endourol 2023; 37:264-272. [PMID: 36205577 DOI: 10.1089/end.2022.0360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: It has been demonstrated that ultrasound (US)-guided renal collecting system access during percutaneous nephrolithotomy (PCNL) is efficient and secure. The puncture success rate fell to 82%, and the total complication rate rose to 15% in kidneys with nondilated collecting systems. Contrast-enhanced ultrasonography (CEUS) has been used in PCNL techniques to address this issue. Methods: We did this meta-analysis following the preferred reporting criteria for systematic reviews and meta-analysis to combine the data of published studies to compare the CEUS-guided PCNL and the standard US-guided PCNL (PRISMA). For relevant literature, we searched PubMed, Embase, Web of Science, CKNI, and the Cochrane Library. The final inclusion date for this meta-analysis was May 1, 2022, and three randomized controlled trials (RCTs) were finally included. RevMan V5.4.1 was used in this work. Standard mean difference (SMD) with a 95% confidence interval (CI) was utilized as the major estimate in the synthesis of continuous data, while odds ratio (OR) with a 95% CI was synthesized as the main estimate in the synthesis of discontinuous data. Results: We found that compared with traditional US-guided PCNL, CEUS-guided PCNL could offer more benefits in terms of single-needle success rate (OR: 3.02, 95% CI: 1.62 to 5.61, p = 0.0005), shorter puncture time (SMD: -1.33, 95% CI: -2.06 to -0.60, p = 0.0004), shorter hospital stays (SMD: -0.37, 95% CI: -0.60 to -0.13, p = 0.002), and a better stone clearance rate (OR: 2.32, 95% CI: 1.15 to 4.68. p = 0.02). Although the PCNL complication rate after surgery was not significantly reduced by the CEUS technique (overall complication: OR = 0.70, 95% CI: 0.37 to 1.30, p = 0.25. Grade 1/2 complication: OR = 0.79, 95% CI: 0.41 to 1.53, p = 0.48; Grade 3/4 complication: OR = 0.44, 95% CI: 0.10 to 1.98, p = 0.28), it could reduce hemoglobin dropping compared with conventional US-guided PCNL (SMD: -0.82, 95% CI: -1.06 to -0.58, p < 0.001). Conclusion: The CEUS-guided PCNL technique is superior to the US-guided PCNL, according to almost all synthesized data. Additional randomized studies are still required.
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Affiliation(s)
- Yucheng Ma
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Puhan Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liyuan Xiang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jun Wen
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xi Jin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Liu ZQ, Xie J, Zhao CB, Liu YF, Li ZS, Guo JN, Jiang HT, Xiao KF. Feasibility of contrast-enhanced ultrasound and flank position during percutaneous nephrolithotomy in patients with no apparent hydronephrosis: a randomized controlled trial. World J Urol 2022; 40:1043-1048. [PMID: 35061058 PMCID: PMC8994732 DOI: 10.1007/s00345-022-03933-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Zeng-Qin Liu
- Department of Urology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
- Shenzhen Engineering and Technology Center of Minimally Invasive Urology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Jing Xie
- Department of Urology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
- Shenzhen Engineering and Technology Center of Minimally Invasive Urology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Chu-Biao Zhao
- Department of Urology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
- Shenzhen Engineering and Technology Center of Minimally Invasive Urology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Yan-Feng Liu
- Department of Urology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
- Shenzhen Engineering and Technology Center of Minimally Invasive Urology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Zai-Shang Li
- Department of Urology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
- Shenzhen Engineering and Technology Center of Minimally Invasive Urology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Ji-Nan Guo
- Department of Urology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
- Shenzhen Engineering and Technology Center of Minimally Invasive Urology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Hong-Tao Jiang
- Department of Urology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
- Shenzhen Engineering and Technology Center of Minimally Invasive Urology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Ke-Feng Xiao
- Department of Urology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China.
- Shenzhen Engineering and Technology Center of Minimally Invasive Urology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China.
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