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Ito WE, Prokop DJ, Whiles BB, Sardiu ME, Smith H, Neff DA, Duchene DA, Molina WR. Impact of Renal Access Angle and Speed of Nephroscope Retrieval Movements on the Vortex Effect. Urology 2024; 183:50-56. [PMID: 37951359 DOI: 10.1016/j.urology.2023.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/05/2023] [Accepted: 10/31/2023] [Indexed: 11/13/2023]
Abstract
OBJECTIVE To analyze the influence of different renal access angles (AAs) and nephroscope retrieval speeds on the efficacy of the vortex effect (VE) in mini-percutaneous nephrolithotomy (mini-PCNL). This study aimed to understand the poorly understood physical components of the VE. MATERIALS AND METHODS A Pexiglas™ (KUS®) model was built based on the dimensions of a 15/16 F mini-PCNL set (Karl Storz). The flow rate was continuous via an automatic pump and calibrated to achieve hydrodynamic equivalence to the real equipment. One experiment consisted of manually retrieving all 30 stone phantoms (3 mm diameter) utilizing only the VE. Cumulative time to retrieve all stones was measured. An accelerometer recorded instant speeds of the nephroscope every 0.08 seconds (s), and 3 experiments were performed at each angle (0°, 45°, and 90°). A logistic regression model was built utilizing maximum speeds and access angles to predict the effectiveness of the VE. RESULTS Mean cumulative time for complete stone retrieval was 28.1 seconds at 0° vs 116.5 seconds at 45° vs 101.4 seconds at 90° (P < .01). We noted significantly higher speeds at 0° compared to 45° and 90° (P < .01); however, differences in average and maximum speed between 45° and 90° were not statistically significant (P = .21 and P = .25, respectively). The regression model demonstrated a negative association between increasing maximum speed and VE's effectiveness (OR 0.547, CI 95% 0.350-0.855, P < .01). When controlling for maximum speed, the 0° angle had significantly higher chances of achieving at least a partially effective VE. CONCLUSION Increasing the renal access angle or nephroscope extraction speed negatively impacts the effectiveness of the VE. This significantly increased procedure time in the laboratory model, suggesting that the VE is less effective at higher sheath angles.
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Affiliation(s)
- Willian E Ito
- Department of Urology, The University of Kansas Health System, Kansas City, KS
| | - Dillon J Prokop
- The University of Kansas School of Medicine, Kansas City, KS
| | - Bristol B Whiles
- Department of Urology, The University of Kansas Health System, Kansas City, KS
| | - Mihaela E Sardiu
- Department of Biostatistics and Data Science, The University of Kansas Health System, Kansas City, KS
| | - Holly Smith
- Department of Biostatistics and Data Science, The University of Kansas Health System, Kansas City, KS
| | - Donald A Neff
- Department of Urology, The University of Kansas Health System, Kansas City, KS
| | - David A Duchene
- Department of Urology, The University of Kansas Health System, Kansas City, KS
| | - Wilson R Molina
- Department of Urology, The University of Kansas Health System, Kansas City, KS.
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Zhang Z, Xie T, Li F, Wang X, Liu F, Jiang B, Zou X, Zhang G, Yuan Y, Xiao R, Wu G, Qian B. Comparison of traditional and novel tip-flexible suctioning ureteral access sheath combined with flexible ureteroscope to treat unilateral renal calculi. World J Urol 2023; 41:3619-3627. [PMID: 37821778 PMCID: PMC10693513 DOI: 10.1007/s00345-023-04648-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES To compare the safety and efficacy of novel tip-flexible suctioning ureteral access sheath (NTFS-UAS) and traditional ureteral access sheath (T-UAS) combined with flexible ureteroscope for treating unilateral renal calculi. MATERIALS AND METHODS The clinical data of 214 patients with unilateral renal calculi treated by NTFS-UAS (n = 102) and T-UAS (n = 112) combined with flexible ureteroscope from August 2021 to April 2022 were analyzed retrospectively. Demographic characteristics, stone-related parameters, operative time, stone-free rates (SFR), hospitalization time and complication rate (CR) were analyzed. RESULT No significant difference was observed between the two groups in terms of demographic characteristics, stone-related parameters, intraoperative CR, and hospitalization time. The operative time of NTFS-UAS group was significantly shorter than T-UAS group (55.25 ± 11.42 min vs. 59.36 ± 15.59 min; P = 0.028). The NTFS-UAS group obtained significantly higher SFR on 1 day postoperatively (86.3% vs. 75.0%; P = 0.038), and higher SFR on 30 days postoperatively than T-UAS group (91.2% vs. 81.3%; P = 0.037). The hemoglobin loss of NTFS-UAS group (- 0.54 ± 0.69 g/dl) was significantly lower than T-UAS group (- 0.83 ± 0.66 g/dl; P = 0.002). There was a significantly lower incidence of overall CR (11.8% vs. 22.3%; P = 0.041), and infectious CR (8.8% vs. 18.8%; P = 0.037) in the NTFS-UAS group. CONCLUSION Compared to T-UAS combined with flexible ureteroscope for treating unilateral renal calculi, NTFS-UAS had superiority in higher SFR on 1 day and 30 days postoperatively. Shorter operation time, lower hemoglobin loss, lower incidences of overall and infectious CR were observed in NTFS-UAS group. REGISTRATION NUMBER AND DATE ChiCTR2300070210; April 5, 2023.
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Affiliation(s)
- Zhaolin Zhang
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China
| | - Tianpeng Xie
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China
| | - Fangzhi Li
- First Clinical Medical College, Gannan Medical University, Ganzhou, 341000, Jiang Xi, China
| | - Xiaoning Wang
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China.
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China.
| | - Folin Liu
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China
| | - Bo Jiang
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China
| | - Xiaofeng Zou
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China
| | - Guoxi Zhang
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China
| | - Yuanhu Yuan
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China
| | - Rihai Xiao
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China
| | - Gengqing Wu
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China
| | - Biao Qian
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China
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Kwok JL, De Coninck V, Ventimiglia E, Panthier F, Corrales M, Sierra A, Emiliani E, Talso M, Miernik A, Kronenberg P, Enikeev D, Somani B, Ghani KR, Traxer O, Keller EX. Laser Ablation Efficiency, Laser Ablation Speed, and Laser Energy Consumption During Lithotripsy: What Are They and How Are They Defined? A Systematic Review and Proposal for a Standardized Terminology. Eur Urol Focus 2023:S2405-4569(23)00222-5. [PMID: 37940392 DOI: 10.1016/j.euf.2023.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/18/2023] [Accepted: 10/04/2023] [Indexed: 11/10/2023]
Abstract
CONTEXT Laser performance for lithotripsy is currently reported using units of measurement such as J/mm3, mm3/J, mm3/s, s/mm3, and mm3/min. However, there are no current standardized definitions or terminology for these metrics. This may lead to confusion when assessing and comparing different laser systems. OBJECTIVE The primary objective was to summarize outcome values and corresponding terminology from studies on laser lithotripsy performance using stone volume in relation to time or energy. The secondary objective was to propose a standardized terminology for reporting laser performance metrics. EVIDENCE ACQUISITION A systematic review of the literature was conducted using the search string ("j*/mm3" OR "mm3/j*" OR "mm3/s*" OR "s*/mm3" OR "mm3/min*" OR "min*/mm3" AND "lithotripsy") on Scopus, Web of Science, Embase, and PubMed databases. Study selection, data extraction, and quality assessment were performed independently by two authors. EVIDENCE SYNTHESIS A total of 28 studies were included, covering holmium:yttrium-aluminum-garnet (Ho:YAG), MOSES, and thulium fiber laser (TFL) technologies. Laser energy consumption values reported for the studies ranged from 2.0 - 43.5 J/mm3in vitro and from 2.7 - 47.8 J/mm3in vivo, translating to laser ablation efficiency of 0.023 - 0.500 mm3/J and 0.021 - 0.370 mm3/J, respectively. Laser ablation speeds ranged from 0.3 - 8.5 mm3/s in vivo, translating to lasing time consumption of 0.12 - 3.33 s/mm3. Laser efficacy ranged from 4.35 - 51.7 mm3/min in vivo. There was high heterogeneity for the terminology used to describe laser performance for the same metrics. CONCLUSIONS The range of laser performance metric values relating stone volume to energy or time is wide, with corresponding differing terminology. We propose a standardized terminology for future studies on laser lithotripsy, including laser ablation efficiency (mm3/J), laser ablation speed (mm3/s), and laser energy consumption (J/mm3). Laser efficacy (mm3/min) is proposed as a broader term that is based on the total operative time, encompassing the whole technique using the laser. PATIENT SUMMARY We reviewed studies to identify the units and terms used for laser performance when treating urinary stones. The review revealed a wide range of differing units, outcomes, and terms. Therefore, we propose a standardized terminology for future studies on laser stone treatment.
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Affiliation(s)
- Jia-Lun Kwok
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vincent De Coninck
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France; Young Academic Urologists (YAU) Endourology and Urolithiasis Working Group, Arnhem, The Netherlands; Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Eugenio Ventimiglia
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France; Young Academic Urologists (YAU) Endourology and Urolithiasis Working Group, Arnhem, The Netherlands; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Frédéric Panthier
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France; Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020 Paris, France
| | - Mariela Corrales
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France; Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020 Paris, France
| | - Alba Sierra
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France; Young Academic Urologists (YAU) Endourology and Urolithiasis Working Group, Arnhem, The Netherlands; Urology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Esteban Emiliani
- Young Academic Urologists (YAU) Endourology and Urolithiasis Working Group, Arnhem, The Netherlands; Department of Urology, Fundación Puigvert. Autonomous University of Barcelona, Barcelona, Spain; Progress in Endourology, Technology and Research Association (PETRA), Paris, France
| | - Michele Talso
- Young Academic Urologists (YAU) Endourology and Urolithiasis Working Group, Arnhem, The Netherlands; Progress in Endourology, Technology and Research Association (PETRA), Paris, France; Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Peter Kronenberg
- Progress in Endourology, Technology and Research Association (PETRA), Paris, France; Department of Urology, Hospital CUF Descobertas, Lisbon, Portugal
| | - Dmitry Enikeev
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Bhaskar Somani
- Progress in Endourology, Technology and Research Association (PETRA), Paris, France; Department of Urology, University Hospital Southampton, Southampton, UK
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Olivier Traxer
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France; Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020 Paris, France; Progress in Endourology, Technology and Research Association (PETRA), Paris, France
| | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France; Young Academic Urologists (YAU) Endourology and Urolithiasis Working Group, Arnhem, The Netherlands.
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Panthier F, Abid N, Hoznek A, Traxer O, Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Laser - utilization and settings. Prog Urol 2023; 33:825-842. [PMID: 37918982 DOI: 10.1016/j.purol.2023.08.008] [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: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
Endocorporeal lithotripsy has progressed thanks to the development of lasers. Two laser sources are currently available: Holmium:YAG (Ho:YAG) and more recently Thulium Fiber Laser (TFL). The settings generally used are dusting, fragmentation, and "pop-corning". These are the first recommendations on laser use for stone management and their settings. Settings must be modulated and can be changed during the treatment according to the expected and obtained effects, the location and stone type that is treated. METHODOLOGY: These recommendations have been developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether or not the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis [EAU Guidelines on urolithiasis. 2022]) and their adaptability to the French context.
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Affiliation(s)
- F Panthier
- GRC lithiase, AP-HP, Sorbonne université, Paris, France; Laboratoire PIMM, arts et métiers Paris Tech, Paris, France
| | - N Abid
- Department of Urology and Transplantation Surgery, Hospices Civils de Lyon, Edouard-Herriot Hospital, Lyon, France
| | - A Hoznek
- Service d'urologie, hôpital Henri-Mondor, AP-HP, université Paris Est Créteil, Paris, France
| | - O Traxer
- GRC lithiase, AP-HP, Sorbonne université, Paris, France; Laboratoire PIMM, arts et métiers Paris Tech, Paris, France
| | - P Meria
- Service d'urologie, hôpital Saint-Louis, AP-HP, centre université Paris Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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5
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Ito WE, Prokop DJ, Ito MC, Whiles BB, Neff DA, Duchene DA, Molina WR. The Vortex Effect in Minimally Invasive Percutaneous Nephrolithotomy. Urology 2023; 180:74-80. [PMID: 37482100 DOI: 10.1016/j.urology.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/19/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To describe the physical principles of the vortex effect to better understand its applicability in minimally invasive percutaneous nephrolithotomy (MIP) procedures. METHODS Two acrylic phantom models were built based on the cross-sectional area (CSA) ratio of a MIP nephroscope and access sheaths (15/16F and 21/22F MIP-M, Karl Storz). The nephroscope phantom was 10 mm in diameter. The access sheaths had diameters of 14 mm (CSA ratio: 0.69) and 20 mm (CSA ratio: 0.30). The models were adapted to generate hydrolysis, and hydrogen bubbles enhanced flow visualization on a green laser background. After calibration, the experimental flow rate was set to 12.0 mL/s. Three 30-second trials assessing the flow were performed with each model. Computational fluid dynamic simulations were completed to determine the speed and pressure profiles. RESULTS In both models, as the incoming fluid from the nephroscope phantom attempted to move toward the collecting system, a stagnation point was demonstrated. No fluid entered the collecting system phantom. Utilizing the 14 mm sheath, we observed a random generation of several vortices and a pressure gradient (PG) of 114.4 N/m2 between the nephroscope's tip and stagnation point. In contrast, examining the 20 mm sheath revealed a significantly smaller PG (19.4 N/m2) and no noticeable vortices were noted. CONCLUSION The speed of the fluid and equipment geometry regulate the PG and the vortices field, which are responsible for the production of the vortex effect. Considering the same flow rate, a higher ratio between the CSA of the nephroscope and access sheath results in improved efficacy of the vortex effect.
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Affiliation(s)
- Willian E Ito
- Department of Urology, The University of Kansas Health System, Kansas City, KS
| | - Dillon J Prokop
- The University of Kansas School of Medicine, Kansas City, KS
| | - Mario C Ito
- State University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Bristol B Whiles
- Department of Urology, The University of Kansas Health System, Kansas City, KS
| | - Donald A Neff
- Department of Urology, The University of Kansas Health System, Kansas City, KS
| | - David A Duchene
- Department of Urology, The University of Kansas Health System, Kansas City, KS
| | - Wilson R Molina
- Department of Urology, The University of Kansas Health System, Kansas City, KS.
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Chen Y, Cheng X, Yang H, Deng W, Chen L, Wang G, Zhou X. Optimal placement of flexible ureteral access sheath in retrograde intrarenal surgery. Urolithiasis 2023; 51:106. [PMID: 37592131 PMCID: PMC10435627 DOI: 10.1007/s00240-023-01469-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023]
Abstract
This study aims to explore the optimal location of flexible ureteral access sheath (f-UAS) in retrograde intrarenal lithotripsy (RIRS). RIRS model was built by AutoCAD 2011 software, and imported COMSOL 5.6 software to computer simulation. An RIRS model was constructed in vitro to analyze the distribution pattern of stone fragments and compare the weight of stone fragments carried out by the irrigation fluid when the f-UAS is in different positions. Computer simulation showed that the highest flow of irrigation fluid was in the channel of flexible ureteroscopy (f-URS) and in the lumen of f-UAS. From the f-URS to the renal collection system and then to the f-UAS, the velocity of irrigation fluid changes gradually from high-flow to low-flow and then to high-flow. When the f-URS and the f-UAS are at the same level, the irrigation fluid is always at a state of high flow during the process from f-URS to f-UAS. When the f-URS and the f-UAS are at the same level, it can increase the local intrarenal pressure (IRP) at the front of f-URS. The stone fragments are mainly sediment in the low-flow region of irrigation fluid. More stone fragments could follow the irrigation fluid out of the body when the tip of f-URS and the tip of f-UAS are at the same level (P < 0.001). The f-UAS should be brought closer to the stone in RIRS. And more stone fragments can be taken out of the body by the effect of irrigation fluid.
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Affiliation(s)
- Yujun Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Xiaofeng Cheng
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Heng Yang
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Wen Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Luyao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Gongxian Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China.
| | - Xiaochen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China.
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7
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Schmanke K, Ito W, Prokop D, Kannady B, Sardiu M, Whiles B, Neff D, Duchene D, Molina W. Optimizing stone harvesting in miniaturized-PCNL: a critical examination of renal access angles, technology, and the role they play in operative efficiency. World J Urol 2023; 41:1943-1949. [PMID: 37277509 DOI: 10.1007/s00345-023-04436-6] [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: 12/23/2022] [Accepted: 05/12/2023] [Indexed: 06/07/2023] Open
Abstract
PURPOSE Stone retrieval can be a laborious aspect of percutaneous nephrolithotomy (PCNL). A unique phenomenon of mini-PCNL is the vortex-effect (VE), a hydrodynamic form of stone retrieval. Additionally, the vacuum-assisted sheath (VAS) was recently developed as a new tool for stone extraction. The purpose of our study is to investigate the impact of renal access angle (as a surrogate for patient positioning) on stone retrieval efficiency and compare the efficiency among methods of stone retrieval. METHODS A kidney model was filled with 3 mm artificial stones. Access to the mid-calyx was obtained using a 15Fr sheath. Stones were retrieved over three minutes at angles of 0°, 25°, and 75° utilizing the VE, VAS, and basket. Stones were weighed for comparison of stones/retraction and stones/minute. Trials were repeated three times at each angle. RESULTS Renal access angle of 0° was associated with increased stone retrieval for both the VE and VAS (p < 0.05). The VE was the most effective method for stones retrieved per individual retraction at an angle of 0° (p < 0.005), although when analyzed as stones retrieved per minute, the VE and VAS were no longer statistically different (p = 0.08). At 75°, none of the methods were statistically different, regardless if analyzed as stones per retraction or per minute (p = 0.20-0.40). CONCLUSIONS Renal access angle of 0° is more efficient for stone retrieval than a steep upward angle. There is no difference in stone retrieval efficiency between the VE and VAS methods, although both are superior to the basket at lower sheath angles.
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Affiliation(s)
- Kenneth Schmanke
- Department of Urology, The University of Kansas Health System, 3901 Rainbow Boulevard, Mail Stop #3016, Kansas City, KS, USA
| | - Willian Ito
- Department of Urology, The University of Kansas Health System, 3901 Rainbow Boulevard, Mail Stop #3016, Kansas City, KS, USA
| | - Dillon Prokop
- School of Medicine, The University of Kansas, Kansas City, KS, USA
| | - Brandon Kannady
- School of Medicine, The University of Kansas, Kansas City, KS, USA
| | - Mihaela Sardiu
- Department of Biostatistics and Data Science, University of Kansas, Kansas City, KS, USA
| | - Bristol Whiles
- Department of Urology, The University of Kansas Health System, 3901 Rainbow Boulevard, Mail Stop #3016, Kansas City, KS, USA
| | - Donald Neff
- Department of Urology, The University of Kansas Health System, 3901 Rainbow Boulevard, Mail Stop #3016, Kansas City, KS, USA
| | - David Duchene
- Department of Urology, The University of Kansas Health System, 3901 Rainbow Boulevard, Mail Stop #3016, Kansas City, KS, USA
| | - Wilson Molina
- Department of Urology, The University of Kansas Health System, 3901 Rainbow Boulevard, Mail Stop #3016, Kansas City, KS, USA.
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Mishra DK, Agrawal MS, Shah M, Naganathan K, Hameed Z, Gauhar V. Ambulatory Minimally Invasive Endoscopic Combined Intrarenal Surgery in Management of Large Impacted Proximal Ureteral Calculi: A Feasibility Study at a Tertiary Referral Center. J Endourol 2023; 37:251-256. [PMID: 36401507 DOI: 10.1089/end.2022.0234] [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: 11/21/2022] Open
Abstract
Aim: To conduct a comparative, nonrandomized study to assess the feasibility of mini-Endoscopic Combined Intrarenal Surgery (ECIRS) using supine Mini-percutaneous nephrolithotomy (PCNL) access (16F) in Galdakao-Modified Supine Valdivia position for managing proximal large-volume impacted ureteral calculi as ambulatory day-care surgery vis-a-vis standalone ureteroscopy (URS) with push-back PCNL, if needed. The primary aim was to study the outcomes and stone-free rates (SFRs). Secondary aim was to compare the intraoperative and short-term postoperative complications. Materials and Methods: Data of 60 patients undergoing ECIRS (Group 1) from January 2016 to December 2019 were collected prospectively in a nonrandomized fashion from a single center after Ethics Committee approval. A matched-paired analysis was performed with retrospectively collated data of 60 patients undergoing standard URS/pushback PCNL (Group 2) using analysis of variance, Fisher's exact test, and Chi-square test. p < 0.05 was considered statistically significant. Outcomes and Results: Group 1 patients had a significantly shorter procedure time vs Group 2 (42.1 ± 11.2 minutes vs 52.1 ± 13.7 minutes; p < 0.001). Group 1 (59/60) patients had an overall single stage SFR of 98.3%, which was significantly higher than single-stage SFR of 83% in Group 2 (50/60) (p < 0.002). Group 2 patients had a higher incidence of fever (10 vs 4, p = 0.01). However, there were no cases of sepsis in either group. Rest of the complications were comparable for both, as the need for ancillary procedures was significantly higher in Group 2 (10% vs 1.7%, p < 0.001). Patients were discharged on the same day in both groups. Conclusions: The findings of our study suggest that, in large and impacted proximal ureteric stones, combined minimally invasive endoscopic approach offers the best option to render the patient stone free by a single intervention. With better intra- and postoperative outcomes and safety profile, Mini-ECIRS may be considered as an ambulatory procedure in this setting.
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Affiliation(s)
- Dilip K Mishra
- Department of Urology, Pushpanjali Hospital and Research Center Pvt Ltd, Agra, India
| | - Madhu Sudan Agrawal
- Department of Urology, Rainbow Hospital, Agra, India
- Urology Division, Department of Surgery, S.N. Medical College, Agra, India
| | - Milap Shah
- Department of Urology, Max Superspecialty Hospital, New Delhi, India
| | | | - Zeeshan Hameed
- Department of Urology, Father Muller Medical College, Mangalore, India
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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9
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Liu YY, Chen YT, Luo HL, Shen YC, Chen CH, Chuang YC, Huang KW, Wang HJ. Totally X-ray-Free Ultrasound-Guided Mini-Percutaneous Nephrolithotomy in Galdakao-Modified Supine Valdivia Position: A Novel Combined Surgery. J Clin Med 2022; 11:jcm11226644. [PMID: 36431120 PMCID: PMC9694234 DOI: 10.3390/jcm11226644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/01/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
We introduced a novel surgery that combines ultrasound guidance, miniaturization and Galdakao-modified supine Valdivia (GMSV) position in percutaneous nephrolithotomy (PCNL) and evaluated the safety and efficacy. This retrospective, single-center study retrospectively reviewed 150 patients who underwent ultrasound-guided mini-PCNL in the GMSV position from November 2019 to March 2022. All perioperative parameters were collected. Stone-free status was defined as no residual stones or clinically insignificant residual fragments (CIRF) <0.4 cm on postoperative day one. Among the 150 patients, the mean age was 56.96 years. The mean stone size was 3.19 cm (427 mm2). The mean S.T.O.N.E. score was 7.61, including 36 patients (24%) with scores ≥9. The mean operative time was 66.22 min, and the success rate of renal access creation in the first attempt was 88.7%. One hundred and forty (93.3%) patients were stone free. The mean decrease in Hemoglobin was 1.04 g/dL, and no patient needed a blood transfusion. Complications included transient hematuria (n = 13, 8.7%), bladder blood clot retention (n = 2, 1.3%), fever (n = 15, 10%) and sepsis (n = 2, 1.3%). Totally X-ray-free ultrasound-guided mini-PCNL in the GMSV position is feasible, safe and effective for patients with upper urinary tract stones, indicating the synergistic and complementary effects of the three novel techniques.
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Affiliation(s)
- Yi-Yang Liu
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
- Department of Electrical Engineering, National Kaohsiung University of Science and Technology, Kaohsiung 80778, Taiwan
| | - Yen-Ta Chen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Hao-Lun Luo
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Yuan-Chi Shen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Chien-Hsu Chen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Yao-Chi Chuang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Ko-Wei Huang
- Department of Electrical Engineering, National Kaohsiung University of Science and Technology, Kaohsiung 80778, Taiwan
| | - Hung-Jen Wang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
- Correspondence:
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10
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Adamou C, Goulimi E, Pagonis K, Peteinaris A, Tsaturyan A, Vagionis A, Lattarulo M, Giannitsas K, Liatsikos E, Kallidonis P. Comparison between standard, mini and ultra-mini percutaneous nephrolithotomy for single renal stones: a prospective study. World J Urol 2022; 40:2543-2548. [PMID: 35900584 DOI: 10.1007/s00345-022-04107-y] [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: 03/21/2022] [Accepted: 07/15/2022] [Indexed: 08/30/2023] Open
Abstract
PURPOSE Based on the current trend of miniaturization of instruments used in percutaneous nephrolithotomy (PCNL), it is necessary to compare different PCNL modalities regarding their access sheath size used. Thus, the safety and efficacy among standard, mini and ultra-mini PCNL (s-PCNL, m-PCNL, um-PCNL) were compared. METHODS We performed a prospective, non-randomized trial between January 2018 and July 2020. Patients with stones classified as Guy's stone score grade I were included. The set-up for s-PCNL and m-PCNL included a 30 Fr and 22 Fr percutaneous tract, respectively. In both set-ups, an ultrasonic/ballistic lithotripter was utilized. In the case of um-PCNL, a 12 Fr percutaneous tract was established. A high-power laser was used for lithotripsy. Hemoglobin drop, complication rate, length of hospital stay (LOS), stone-free rate (SFR) and operation time were evaluated. RESULTS A total of 84 patients, 28 patients per method, were evaluated. Hemoglobin drop was higher in the s-PCNL group when compared to m-PCNL (p = 0.008) and um-PCNL groups (p < 0.001), while um-PCNL group had the slightest hemoglobin drop. LOS was similar between s-PCNL group and m-PCNL group, but um-PCNL group required shorter hospital stay than the other two modalities (p < 0.001). The complication and transfusion rates as well as SFR did not differ between groups. Operation time in the um-PCNL set-up was longer compared to s-PCNL (p < 0.001) and m-PCNL (p = 0.011), whereas s-PCNL and m-PCNL did not differ significantly. CONCLUSION m-PCNL showed less hemoglobin drop, but similar operation time and SFR when compared to s-PCNL. um-PCNL showed even less hemoglobin drop, but the operation time was longer compared to the two other modalities.
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Affiliation(s)
| | - Evangelia Goulimi
- Department of Urology, University Hospital of Patras, Patras, Greece
| | | | | | - Arman Tsaturyan
- Department of Urology, University Hospital of Patras, Patras, Greece
| | | | - Marco Lattarulo
- Department of Urology, University Hospital of Patras, Patras, Greece
| | | | - Evangelos Liatsikos
- Department of Urology, University Hospital of Patras, Patras, Greece.,Department of Urology, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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11
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Chen ZH, Lee KH, Tseng WH, Su CC, Hsieh KL, Lim CY, Huang SK. Comparison of mini endoscopic combined intrarenal surgery and multitract minimally invasive percutaneous nephrolithotomy specifically for kidney staghorn stones: a single-centre experience. BMC Urol 2022; 22:93. [PMID: 35773639 PMCID: PMC9248084 DOI: 10.1186/s12894-022-01030-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Staghorn stones require surgical treatment to prevent serious complications. Multitract percutaneous nephrolithotomy (PNL) causes great renal parenchymal injury and blood loss. One-stage endoscopic combined intrarenal surgery (ECIRS) entails the combined use of antegrade nephroscope and retrograde flexible ureteroscope to clear the staghorn stone, which may overcome the limitations of multitract PNL. We aimed to compare the perioperative outcomes of mini ECIRS and multitract minimally invasive PNL in staghorn stone management. METHODS This was a retrospective single-center study of patients with staghorn stones who underwent ECIRS (n = 17) or multitract minimally invasive PNL (n = 17) between January 2018 and September 2021. RESULTS There was a significant between-group difference with respect to Guy's stone score. Stone size, stone burden (ECIRS group, 21.41 cm3; multitract minimally invasive PNL group, 20.88 cm3 [P = 0.94]), and degree of hydronephrosis were comparable in the two groups. There was no significant between-group difference with respect to one-step or final stone-free rates. The mean operative time was also not significantly different between the groups (ECIRS group, 140 min; multitract minimally invasive PNL group, 183 min [P = 0.63]). ECIRS was associated with significantly lesser postoperative pain (visual analog scale; ECIRS group: 0; multitract minimally invasive PNL group: 2.7 [P < 0.001]). Hemoglobin loss, postoperative blood transfusion rate, complications, and length of hospital stay were comparable in the two groups. CONCLUSION Both mini ECIRS and multitract minimally invasive PNL were effective and safe for the management of renal staghorn stones with comparable operation time and stone-free rate, and complications. ECIRS was associated with less severe postoperative pain.
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Affiliation(s)
- Zhi-Hao Chen
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004 Taiwan, R.O.C
| | - Kau-Han Lee
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004 Taiwan, R.O.C
| | - Wen-Hsin Tseng
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004 Taiwan, R.O.C
| | - Chia-Cheng Su
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004 Taiwan, R.O.C
| | - Kun-Lin Hsieh
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004 Taiwan, R.O.C
| | - Chye-Yang Lim
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004 Taiwan, R.O.C
| | - Steven K. Huang
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004 Taiwan, R.O.C
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12
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Mykoniatis I, Pietropaolo A, Pyrgidis N, Tishukov M, Anastasiadis A, Jones P, Keller EX, Talso M, Tailly T, Kalidonis P. Mini percutaneous nephrolithotomy versus standard percutaneous nephrolithotomy for the management of renal stones over 2 cm: a systematic review and meta-analysis of randomized controlled trials. Minerva Urol Nephrol 2022; 74:409-417. [PMID: 35147386 DOI: 10.23736/s2724-6051.22.04678-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Standard percutaneous nephrolithotomy (sPCNL) is recommended for renal stones over 2cm. Mini percutaneous nephrolithotomy (mPCNL) has also emerged as a promising technique in this setting. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the safety and efficacy of sPCNL to mPCNL for the management of renal stones over 2cm. EVIDENCE ACQUISITION We systematically searched PubMed, Cochrane Library and Scopus databases until April 2021 and sources of grey literature for relevant RCTs. We performed a meta-analysis of odds ratios (ORs) to compare bleeding or other complications and stone-free rate (SFR) between sPCNL and mPCNL. Similarly, we undertook a metaanalysis of weighted mean differences for the mean operative and hospitalization time between the two techniques (PROSPERO: CRD42021241860). EVIDENCE SYNTHESIS Pooled data from 8 RCTs (2535 patients) were available for analysis. sPCNL was associated with a higher hemoglobin drop (0.59g/dl, 95%CI: 0.4-0.77, I2=93%), higher likelihood of postoperative blood transfusion (OR: 2.58, 95%CI: 1.03-6.45, I2=30%) and longer hospital stay (0.75 days, 95%CI: 0.45-1.05, I2=73%) compared to mPCNL. No significant differences were demonstrated in SFR (OR: 0.92, 95%CI: 0.74-1.16, I2=0%) and mean operative time (4.05 minutes, 95%CI: -9.45-1.37, I2=91%) after sPCNL versus mPCNL. Similarly, no significant differences were observed for postoperative fever, pain and Clavien-Dindo complications. CONCLUSIONS mPCNL represents a safe and effective technique and may be also recommended as a first-line treatment modality for well-selected patients with renal stones over 2cm. Still, further high-quality RCTs on the field are mandatory, since the overall level of evidence is low.
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Affiliation(s)
- Ioannis Mykoniatis
- Department of Urology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece - g_mikoniatis @hotmail.com
| | - Amelia Pietropaolo
- Department of Urology, University of Hospital Southampton NHS Trust, Southampton, UK
| | - Nikolaos Pyrgidis
- Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany
| | - Maksim Tishukov
- Department of Urology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Anastasiadis
- Department of Urology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Patrick Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Etienne X Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michele Talso
- Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Thomas Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
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13
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Mishra DK, Bhatt S, Palaniappan S, Reddy TV, Rajenthiran V, Sreeranga Y, Agrawal MS. Mini versus ultra-mini percutaneous nephrolithotomy in a paediatric population. Asian J Urol 2022; 9:75-80. [PMID: 35198400 PMCID: PMC8841280 DOI: 10.1016/j.ajur.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 12/06/2020] [Accepted: 03/01/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate whether there would be a difference in outcome when the smaller ultra-mini 12 Fr sheath was used instead of the mini 16 Fr sheath for percutaneous nephrolithotomy (PCNL) in paediatric patients for stones less than 25 mm. METHODS This was a prospective cohort study of patients who underwent PCNL in our hospital in a 2-year period from July 2016 to June 2018 by a single surgeon. PCNL was performed in a prone position and tract was dilated to the respective size using single step dilatation. Laser was used to fragment the stone. Stone-free outcome was defined as absence of stone fragment at 3 months on kidney, ureter, and bladder X-ray. RESULTS There were 40 patients in each group. Mean stone size was comparable between the two groups (14.5 mm vs. 15.0 mm). The procedure was completed faster in the 16 Fr group compared to 12 Fr group (24.5 min vs. 34.6 min). Stone clearance was highly successful in both groups (97.5% vs. 95.0%). There was no difference in complications between the two groups. The decrease in hemoglobin was minimal in both groups (0.2 g/dL vs. 0.3 g/dL). CONCLUSION We found that the success rates were similar in both mini PCNL and the smaller ultra-mini PCNL groups. No significant difference in bleeding was noted in our pilot study, however, operative time was longer in the ultra-mini group as compared to the mini sheath group.
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Affiliation(s)
- Dilip K. Mishra
- Department of Urology, Global Rainbow Hospital, Agra, Uttar Pradesh, India
| | - Sonia Bhatt
- Department of Pediatrics, F H Medical College, Agra, Uttar Pradesh, India
| | - Sundaram Palaniappan
- Department of Urology, Global Rainbow Hospital, Agra, Uttar Pradesh, India
- Department of Urology, Sengkang General Hospital, Singapore
| | | | | | - Y.L. Sreeranga
- Department of Urology, Global Rainbow Hospital, Agra, Uttar Pradesh, India
| | - Madhu S. Agrawal
- Department of Urology, Global Rainbow Hospital, Agra, Uttar Pradesh, India
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14
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Ghazi A, Sharma N. Ultrasound guided dual tract supine PCNL with simultaneous use of two different energy sources by two urologists working in unison-an innovative approach in staghorn calculus. Urol Case Rep 2021; 40:101869. [PMID: 34660204 PMCID: PMC8503850 DOI: 10.1016/j.eucr.2021.101869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/16/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022] Open
Abstract
Complete staghorn renal calculi are surgical challenge requiring multi-tract or staged PCNL. We report a case of supine PCNL where complete stone clearance was achieved with dual tracts (24 Fr/lower pole and 16Fr/upper pole) through which two surgeons operated simultaneously using two different energy sources (pneumatic/ultrasound lithotripter through 24Fr and Thulium Fiber laser through 16Fr). Strong water currents generated by dual-tract irrigation augmented the mini-PCNL venturi effect facilitating stone fragment evacuation. This is first reported case of two surgeons operating simultaneously using two different energy sources, in supine position in a limited space on a complete staghorn stone.
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Affiliation(s)
- Ahmed Ghazi
- Department of Urology, University of Rochester Medical Center, 158 Sawgrass Dr, Floor 2. Rochester, New York, 14620-4648, USA
| | - Nitin Sharma
- Clinical Fellow Urology, Department of Urology, University of Rochester Medical Center, 610 Elmwood Ave, Rochester, NY, 14642, USA
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15
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Wu ZH, Liu TZ, Wang XH, Wang YZ, Zheng H, Zhang YG. Double-sheath vacuum suction versus vacuum-assisted sheath minimally invasive percutaneous nephrolithotomy for management of large renal stones: single-center experience. World J Urol 2021; 39:4255-4260. [PMID: 34032912 DOI: 10.1007/s00345-021-03731-4] [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: 01/16/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To compare double-sheath vacuum suction minimally invasive percutaneous nephrolithotomy (DS-mini-PCNL) with vacuum-assisted mini-PCNL (VS-mini-PCNL) and to better define the potential benefits of DS-mini-PCNL. METHODS Between July 2019 and May 2020, 117 patients with large radiopaque renal stones underwent mini-PCNL. Of these, 63 underwent DS-mini-PCNL and 54 underwent VS-mini-PCNL. For VS-mini-PCNL, a F20 Y-shaped sheath was used and the oblique arm of the sheath was connected to the vacuum suction. For DS-mini-PCNL, the oblique arm of a F20 Y-shaped sheath (the outer sheath) and a F16 Y-shaped sheath (the inner sheath) was connected to the perfusion inflow and the vacuum suction, respectively. A 550-μm holmium-YAG laser was used for stone fragmentation. RESULTS Compared with VS-mini-PCNL group, DS-mini-PCNL group had significantly shorter operative time (35.78 ± 7.77 min vs. 44.56 ± 13.19 min; P = 0.000) and significantly lower fever rate (1.6% vs. 11.1%; P = 0.048). It was not significantly different between the two groups despite the higher initial stone-free rate seen for DS-mini-PCNL group relative to VS-mini-PCNL group (87.7% vs. 81.5%, P = 0.346). Auxiliary procedure rates were 4.8% (three patients) in DS-mini-PCNL group and 16.7% (nine patients) in VS-mini-PCNL group, with a significant difference (P = 0.034). The difference in the final stone-free rate between the two groups was rendered insignificant (93.8% vs. 89.1%, P = 0.510). CONCLUSIONS DS-mini-PCNL is a safe and effective modality for large renal stones, which could increase the efficiency of stone extraction and decrease infectious complications compared with VS-mini-PCNL.
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Affiliation(s)
- Zhong-Hua Wu
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China
| | - Tong-Zu Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China.
| | - Xing-Huan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China.
| | - Yong-Zhi Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China
| | - Hang Zheng
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China
| | - Yin-Gao Zhang
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China
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16
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DiBianco JM, Ghani KR. Precision Stone Surgery: Current Status of Miniaturized Percutaneous Nephrolithotomy. Curr Urol Rep 2021; 22:24. [PMID: 33576896 DOI: 10.1007/s11934-021-01042-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Innovations in lasers and surgical technology have led to a renewed interest in the miniaturization of percutaneous nephrolithotomy (PCNL). We review the different approaches and evidence on the efficacy of mini-PCNL. RECENT FINDINGS Mini-PCNL encompasses a range of techniques using tract sizes from 4.8 to 22 F to treat renal stones. The most common device uses irrigation to passively extract stones out of the sheath. Super-mini-PCNL incorporates active suction. Ultra- and micro-techniques reduce the tract to smaller diameters. Laser fragmentation is the main lithotripsy modality. Studies demonstrate an association with reduced complications, hospital stay, and increased tubeless rate. Drawbacks include longer operative times while stone-free rates for larger stones may be sub-optimal. Mini-PCNL has advantages of less trauma and the avoidance of nephrostomy tubes. Ambulatory surgery is feasible in select patients. Advances in laser lithotripsy and active suction have the potential to improve stone clearance and treat larger stones.
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Affiliation(s)
- John M DiBianco
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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17
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Paediatric cystolitholapaxy using mini PCNL-kit through the Mitrofanoff stoma. Ann Med Surg (Lond) 2021; 62:88-91. [PMID: 33505678 PMCID: PMC7815490 DOI: 10.1016/j.amsu.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/09/2021] [Accepted: 01/09/2021] [Indexed: 11/30/2022] Open
Abstract
Bladder stones are a common complication after augmentation cystoplasty and urinary diversion. However, the treatment of recurrent cystolithiasis in neuropathic children remains a real challenge for urologists and open procedures may be associated with significant morbidity. Currently, mini-invasive management options are available in the therapeutic armamentarium. Herein, we reported a case of Mitrofanoff cystolitholapaxy using a mini PCNL-kit, in a 14-year-old patient with the history of neurogenic bladder due to myelomeningocele managed by bladder augmentation. This technique has been previously described but we have added a unique modification using Nelaton catheter for carefully dilating the Mitrofanoff stoma before inserting an Amplatz sheeth and we report tips and tricks to guarantee a stone free status with one single procedure. Using high energy Holmium laser, this approach is safe and effective even with large stone burden. The treatment of cystolithiasis in neuropathic patients with a bladder-neck closure represents a surgical challenge. Open cystolithotomy is a good option to treat large stone burdens or multiple calculi. For recurrent stones, endoscopic treatment via a catheterizable channel is an effective option, especially for patients with a closed bladder neck and low-burden stone. Dilating the channel is the key step. Using serially Nelaton catheter (10-16Fr) is a good trick to preserve the integrity of the Mitrofanoff stoma.
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18
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Perkutane Nephrolithotomie. Urolithiasis 2021. [DOI: 10.1007/978-3-662-62454-8_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Acute kidney injury following supine mini-PNL versus retrograde intrarenal surgery in patients with renal stones < 3 cm: a prospective comparative study. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00052-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The purpose of the current study was to prospectively compare mini-PNL and RIRS for development of acute kidney injury (AKI), success, and complication rates in a cohort of patients with kidney stones less than 3 cm.
Methods
In this prospective study, data of 60 consecutive patients underwent mini-PNL (n = 31) or RIRS (n = 29) was investigated. Urinary NGAL levels were measured preoperatively and at postoperative 6th hour to evaluate AKI. Success and complication rates were also compared.
Results
The mean stone size was significantly higher in the mini-PNL group (24.6 mm vs. 18.2 mm, p = 0.02). The mean postoperative NGAL levels were 45.6 ± 12.4 and 48.1 ± 13.6 for the mini-PNL and RIRS groups, respectively. The increase was statistically significant for both groups (p: 0.01). The difference between the two groups for mean postoperative NGAL measurements was not statistically significant (p = 0.47). The SFR was significantly higher in the mini-PNL group (96.7% vs. 79.3%, p = 0.04). The complication rates were similar for the two groups (p = 0.99). The mean duration of operation was 48.2 ± 22.5 min in the mini-PNL group and 62.6 ± 18.1 min in the RIRS group (p = 0.03). The median duration of hospitalization was 1 day for both groups.
Conclusions
In patients with renal stones < 3 cm in diameter, mini-PNL in supine position provides higher SFR and shorter operative times with similar rates of complications and AKI when compared with RIRS. Mini-PNL should be considered as the primary treatment option together with RIRS for renal stones and should not be ruled out for being a more invasive option.
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20
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Mykoniatis I, Sarafidis P, Memmos D, Anastasiadis A, Dimitriadis G, Hatzichristou D. Are endourological procedures for nephrolithiasis treatment associated with renal injury? A review of potential mechanisms and novel diagnostic indexes. Clin Kidney J 2020; 13:531-541. [PMID: 32905259 PMCID: PMC7467591 DOI: 10.1093/ckj/sfaa020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/07/2020] [Indexed: 12/23/2022] Open
Abstract
Nephrolithiasis is one of the most common urological conditions with a huge socio-economic impact. About 50% of recurrent stone-formers have just one lifetime recurrence and >10% of patients present with a high recurrent disease requiring subsequent and sometimes multiple surgical interventions. The advent of new technology has made endourological procedures the pinnacle of stone treatment, including procedures like percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery and miniaturized PCNL procedures. Researchers have primarily focused on comparisons with respect to stone-free rates, procedure parameters and post-operative complications. However, the effect of these three procedures on renal function or indexes of renal injury has not been sufficiently examined. This was only reported in a few studies as a secondary objective with the use of common and not the appropriate and detailed renal parameters. This review presents current literature regarding the use of novel and highly predictive biomarkers for diagnosing acute kidney injury, discusses potential mechanisms through which endourological procedures for renal stone treatment may affect renal function and proposes areas with open questions where future research efforts in the field should focus.
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Affiliation(s)
- Ioannis Mykoniatis
- First Department of Urology, G. Gennimatas Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Memmos
- First Department of Urology, G. Gennimatas Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Anastasiadis
- First Department of Urology, G. Gennimatas Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Dimitriadis
- First Department of Urology, G. Gennimatas Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Hatzichristou
- First Department of Urology, G. Gennimatas Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Axelsson TA, Cracco C, Desai M, Hasan MN, Knoll T, Montanari E, Pérez-Fentes D, Straub M, Thomas K, Williams JC, Brehmer M, Osther PJS. Consultation on kidney stones, Copenhagen 2019: lithotripsy in percutaneous nephrolithotomy. World J Urol 2020; 39:1663-1670. [PMID: 32728884 PMCID: PMC8217030 DOI: 10.1007/s00345-020-03383-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/22/2020] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To evaluate the balance between existing evidence and expert opinions on the safety and efficacy of new technological improvements in lithotripsy techniques for percutaneous nephrolithotomy (PCNL). METHODS A scoping review approach was applied to search literature in Pubmed, Embase, and Web of Science. Consensus by key opinion leaders was reached at a 2-day meeting entitled "Consultation on Kidney Stones: Aspects of Intracorporeal Lithotripsy" held in Copenhagen, Denmark, in September 2019. RESULTS New-generation dual-mode single-probe lithotripsy devices have shown favourable results compared with use of ballistic or ultrasonic lithotripters only. However, ballistic and ultrasonic lithotripters are also highly effective and safe and have been the backbone of PCNL for many years. Compared with standard PCNL, it seems that mini PCNL is associated with fewer bleeding complications and shorter hospital admissions, but also with longer operating room (OR) time and higher intrarenal pressure. Use of laser lithotripsy combined with suction in mini PCNL is a promising alternative that may improve such PCNL by shortening OR times. Furthermore, supine PCNL is a good alternative, especially in cases with complex renal stones and large proximal ureteric stones; in addition, it facilitates endoscopic combined intrarenal surgery (ECIRS). CONCLUSION Recent technological improvements in PCNL techniques are promising, but there is a lack of high-level evidence on safety and efficacy. Different techniques suit different types of stones and patients. The evolution of diverse methods has given urologists the possibility of a personalized stone approach, in other words, the right approach for the right patient.
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Affiliation(s)
- Tomas Andri Axelsson
- Division of Urology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Solna, Sweden
| | - Cecilia Cracco
- Department of Urology, Cottolengo Hospital of Torino, Turin, Italy
| | - Mahesh Desai
- Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Mudhar Nazar Hasan
- Division of Urology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Solna, Sweden
| | - Thomas Knoll
- Department of Urology, Klinikum Sindelfingen-Boeblingen, University of Tübingen, Sindelfingen, Germany
| | - Emanuele Montanari
- Urological Dept. at Fondazione Ca Granda-Ospedale Maggiore Policlinico of Milan, University of Milan, Milan, Italy
| | - Daniel Pérez-Fentes
- Department of Urology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Michael Straub
- Department of Urology, University Hospital Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Kay Thomas
- Stone Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - James C Williams
- Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marianne Brehmer
- Division of Urology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Solna, Sweden
| | - Palle J S Osther
- Urological Research Center, Department of Urology, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark.
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Safety and efficacy of a single middle calyx access (MCA) in mini-PCNL. Urolithiasis 2019; 48:541-546. [PMID: 31822953 DOI: 10.1007/s00240-019-01176-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/03/2019] [Indexed: 12/23/2022]
Abstract
To compare outcomes of a single middle calyx access (MCA) with a single upper or lower calyceal access in mini-PCNL. From May 2015 through August 2018, patients' files who underwent a single renal access mini-PCNL were retrospectively reviewed. All patients underwent fluoroscopic-guided access (16-20 F) in the prone position. They were categorized into group 1 (MCA) and group 2 (either upper or lower calyceal access). Compared preoperative items included stone location, size, number and complexity (according to Guy's score). The compared outcome parameters were complication and stone-free rates. The study comprised 512 consecutive patients, 374 patients in group 1 and 138 in group 2. A single MCA was utilized to access 95% of proximal ureteral calculi, 89% for ureteropelvic junction stones, and 84% for stones present in the pelvicalyceal system and ureter. MCA was used in 89% of complete staghorn stones and 73% of multiple stones. the Stone-free rates (93% vs 90.6%, P = 0.350) and the complications rates (8% vs 7.2%, P = 0.772) were comparable between group 1 and 2 despite that MCA was used for most cases with complex stones. Complications severity were also comparable (P = 0.579). Mini-PCNL performed through a single MCA is effective and safe. This access can be used for the treatment of renal and upper ureteral calculi of different complexities and locations.
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Pressure matters 2: intrarenal pressure ranges during upper-tract endourological procedures. World J Urol 2018; 37:133-142. [PMID: 29915944 DOI: 10.1007/s00345-018-2379-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/12/2018] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To perform a review on the latest evidence related to intrarenal pressures (IRPs) generated during upper-tract endourology, and present different tools to maintain decreased values, to decrease complication rates. METHODS A literature search was performed using PubMed, restricted to original English-written articles, including animal, artificial model and human studies. Different keywords were: percutaneous nephrolithotomy, PCNL, ureteroscopy, URS, RIRS, irrigation flow, irrigation pressure, intrarenal pressure, intrapelvic pressure and renal-pelvic pressure. RESULTS IRPs reported during retrograde intrarenal surgery (RIRS), PCNL, miniPCNL, and microPCNL range 40.8-199.35, 3-40.8, 10-45 and 15.37-41.21 cm H2O, respectively. By utilizing ureteral access sheaths (UASs) IRPs usually remain lower than 30 cm H2O at an irrigation pressure (IP) of ≤ 100 cm H2O but could increase to > 40 cm H2O at an IP of 200 cm H2O. By utilizing the minimally invasive PCNL system, IRPs remain low at 20 cm H2O even at high IPs. Utilizing endoluminal isoproterenol during RIRS, could reduce IRP increases with a rate of 27-107%, and maintain low IRPs values, usually below 50 cm H2O. CONCLUSIONS Increased IRP values have been reported during RIRS and UASs constitute the most efficient tool for decreasing them. IRPs during mini-PCNL can be decreased utilizing the vacuum-cleaner and purging effects but might remain uncontrolled during micro- and ultra-mini PCNL. Intraluminal pharmacological treatment could play a role in IRP decrease, with isoproterenol being the most studied agent.
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Wei C, Zhang Y, Pokhrel G, Liu X, Gan J, Yu X, Ye Z, Wang S. Research progress of percutaneous nephrolithotomy. Int Urol Nephrol 2018; 50:807-817. [PMID: 29556901 DOI: 10.1007/s11255-018-1847-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/12/2018] [Indexed: 12/29/2022]
Abstract
Percutaneous nephrolithotomy (PCNL) is generally accepted as the gold standard treatment for the treatment of large kidney stones (> 2 cm). For nearly 40 years, with the continuous progress of technology and the constant updating of ideas, PCNL has made great progress. In this review, we discuss the current research progress, recent advancement and hot spot of the whole process of PCNL including anesthesia, position, puncture, dilation, lithotripsy approaches, perfusate, tube placement, hospitalization time, drug, treatment of residual stones, prognosis judgment and operation evaluation by summarizing the related research in this article.
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Affiliation(s)
- Chao Wei
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Yucong Zhang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Gaurab Pokhrel
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Xiaming Liu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Jiahua Gan
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Xiao Yu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China.
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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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Gadzhiev N, Sergei B, Grigoryev V, Okhunov Z, Ganpule A, Pisarev A, Iskakov Y, Petrov S. Evaluation of the effect of Bernoulli maneuver on operative time during mini-percutaneous nephrolithotomy: A prospective randomized study. Investig Clin Urol 2017; 58:179-185. [PMID: 28480343 PMCID: PMC5419106 DOI: 10.4111/icu.2017.58.3.179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/10/2017] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate the effect of 'Bernoulli maneuver' (bringing the access sheath to horizontal plane) on operative time and stone free rates in patients undergoing mini-percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS All consecutive patients with a solitary kidney stone undergoing a mini-PCNL between 2015 and 2016 were included into this study. Patients were randomized either to standard prone or control (C) group patients or to tilted prone with 'Bernoulli maneuver' group (B) patients. Pre-, intra-, and postoperative characteristics of these 2 groups were recorded and analyzed. RESULTS A total of 67 patients were included in the study. Of these, 40 patients were randomized to group C and 27 to group B. The mean (95% confidence limits) stone size (mm) in group C and B was 14 (13, 15) and 13 (11, 14), respectively (p=0.26). Nephroscopy time was shorter in Bernoulli group (35 minutes vs. 23 minutes, p=1.5·10-5, and Bayes factor BF10=2,340, and Cohen standardized effect size dst=1.2). The difference made it up 12 minutes (with 95% confidence interval from 8 to 18 minutes). There were no statistically significant differences between groups regarding white blood cell, creatinine level and stone-free status defined by computed tomography on the first postoperative day. CONCLUSIONS In our study the 'Bernoulli maneuver' led to a shorter nephroscopy time in mini-PCNL. This maneuver can significantly reduce nephroscopy time and save significant amount of operative time, especially in tertiary referral centers with high-volume mini-PCNL procedures.
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Affiliation(s)
- Nariman Gadzhiev
- The Federal State Institute of Public Health 'The Nikiforov Russian Center of Emergency and Radiation Medicine', Saint-Petersburg, Russia
| | - Brovkin Sergei
- The Federal State Institute of Public Health 'The Nikiforov Russian Center of Emergency and Radiation Medicine', Saint-Petersburg, Russia
| | - Vladislav Grigoryev
- The Federal State Institute of Public Health 'The Nikiforov Russian Center of Emergency and Radiation Medicine', Saint-Petersburg, Russia
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, CA, USA
| | | | - Aleksei Pisarev
- The Saint-Petersburg State University clinic, Saint-Petersburg, Russia
| | | | - Sergei Petrov
- The Federal State Institute of Public Health 'The Nikiforov Russian Center of Emergency and Radiation Medicine', Saint-Petersburg, Russia
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Kwon O, Park J, Cho MC, Son H, Jeong H, Cho SY. Feasibility of single-session endoscopic combined intrarenal surgery for ipsilateral large renal stones and retrograde intrarenal surgery for contralateral renal stones: Initial experience. Int J Urol 2017; 24:377-382. [DOI: 10.1111/iju.13313] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/16/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Ohseong Kwon
- Department of Urology; Hallym University Kangnam Sacred Heart Hospital; Seoul Korea
| | - Juhyun Park
- Department of Urology; SMG-SNU Boramae Medical Center; Seoul Korea
| | - Min Chul Cho
- Department of Urology; SMG-SNU Boramae Medical Center; Seoul Korea
| | - Hwancheol Son
- Department of Urology; SMG-SNU Boramae Medical Center; Seoul Korea
| | - Hyeon Jeong
- Department of Urology; SMG-SNU Boramae Medical Center; Seoul Korea
| | - Sung Yong Cho
- Department of Urology; SMG-SNU Boramae Medical Center; Seoul Korea
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Ruhayel Y, Tepeler A, Dabestani S, MacLennan S, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, Türk C, Yuan Y, Knoll T. Tract Sizes in Miniaturized Percutaneous Nephrolithotomy: A Systematic Review from the European Association of Urology Urolithiasis Guidelines Panel. Eur Urol 2017; 72:220-235. [PMID: 28237786 DOI: 10.1016/j.eururo.2017.01.046] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/30/2017] [Indexed: 12/15/2022]
Abstract
CONTEXT Miniaturized instruments for percutaneous nephrolithotomy (PNL), utilizing tracts sized ≤22 Fr, have been developed in an effort to reduce the morbidity and increase the efficiency of stone removal compared with standard PNL (>22 Fr). OBJECTIVE We systematically reviewed all available evidence on the efficacy and safety of miniaturized PNL for removing renal calculi. EVIDENCE ACQUISITION The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Since it was not possible to perform a meta-analysis, the data were summarized in a narrative synthesis. EVIDENCE SYNTHESIS After screening 2945 abstracts, 18 studies were included (two randomized controlled trials [RCTs], six nonrandomized comparative studies, and 10 case series). Thirteen studies were full-text articles and five were only available as congress abstracts. The size of tracts used in miniaturized procedures ranged from 22 Fr to 4.8 Fr. The largest mean stone size treated using small instruments was 980mm2. Stone-free rates were comparable in miniaturized and standard PNL procedures. Procedures performed with small instruments tended to be associated with significantly lower blood loss, while the procedure duration tended to be significantly longer. Other complications were not notably different between PNL types. Study designs and populations were heterogeneous. Study limitations included selection and outcome reporting bias, as well as a lack of information on relevant confounding factors. CONCLUSIONS The studies suggest that miniaturized PNL is at least as efficacious and safe as standard PNL for the removal of renal calculi. However, the quality of the evidence was poor, drawn mainly from small studies, the majority of which were single-arm case series, and only two of which were RCTs. Furthermore, the tract sizes used and types of stones treated were heterogeneous. Hence, the risks of bias and confounding were high, highlighting the need for more reliable data from RCTs. PATIENT SUMMARY Removing kidney stones via percutaneous nephrolithotomy (PNL) using smaller sized instruments (mini-PNL) appears to be as effective and safe as using larger (traditional) instruments, but more clinical research is needed.
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Affiliation(s)
- Yasir Ruhayel
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | | | - Saeed Dabestani
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | | | - Aleš Petřík
- Department of Urology, Region Hospital, České Budějovice, Czech Republic; Department of Urology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Kemal Sarica
- Department of Urology, Dr. Lutfi Kirdar Kartal Research and Training Hospital, Istanbul, Turkey
| | - Christian Seitz
- Department of Urology, Medical University Vienna, Vienna, Austria
| | - Andreas Skolarikos
- Second Department of Urology, Sismanoglio Hospital, Athens Medical School, Athens, Greece
| | - Michael Straub
- Department of Urology, Technical University Munich, Munich, Germany
| | - Christian Türk
- Department of Urology, Hospital of the Sisters of Charity, Vienna, Austria
| | - Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Thomas Knoll
- Department of Urology, Sindelfingen-Boeblingen Medical Center, University of Tübingen, Sindelfingen, Germany.
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Proietti S, Giusti G, Desai M, Ganpule AP. A Critical Review of Miniaturised Percutaneous Nephrolithotomy: Is Smaller Better? Eur Urol Focus 2017; 3:56-61. [DOI: 10.1016/j.euf.2017.05.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/25/2017] [Accepted: 05/03/2017] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW Miniaturized percutaneous nephrolithotomy (PCNL) procedures have reached big popularity in the past years. Following the idea that decreasing the diameter of the instruments would decrease the complication rate instruments with outer diameter down to 4,8 Fr was established. In this review, we want to take a critical insight of the most popular miniaturized procedures, regarding the key advantages and disadvantages of the miniaturized instruments. RECENT FINDINGS For all techniques displayed, a number of studies are available to support their effectivity in the given range of indication. Naturally, the body of evidence for M-sized instruments is largest, as it exists in the armamentarium since long, whereas studies comparing small or extrasmall and extraextrasmall to standard or among each other are rare. However, large studies comparing miniaturized procedures with conventional PCNL in randomized controlled fashion are still lacking, too. SUMMARY Miniaturization and attending developments such as ultrasonographic-guided puncture, single step dilatation of the tract, low irrigation pressure in open systems and a tubeless procedure lead to lower complication rates in PCNL. All of the established procedures have their own range of indication with regard to size and location of the stone. They amplified the possibility of a customized therapy for each patient.
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Häcker A, Bachmann A, Herrmann T, Homberg R, Klein J, Leyh H, Miernik A, Netsch C, Olbert P, Rassweiler J, Schoenthaler M, Sievert KD, Westphal J, Gross AJ. Operative Technik der perkutanen Steintherapie. Urologe A 2016; 55:1375-1386. [DOI: 10.1007/s00120-016-0229-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mager R, Balzereit C, Hüsch T, Herrmann T, Nicklas A, Nagele U, Haferkamp A, Schilling D. Clearance of Stone Fragments and Stone Dust by Continuous Flow Hydrodynamics in Percutaneous Renal Surgery: An In Vitro Study. J Endourol 2015; 30:441-6. [PMID: 26671579 DOI: 10.1089/end.2015.0572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To investigate the capacity of stone clearance in common percutaneous nephrolithotomy (PCNL) systems achieved solely by hydrodynamic effects in an in vitro setting. METHODS A watertight cylindrical cast with a caliceal void served as an in vitro model. Various instruments for percutaneous renal surgery working with both continuous flow (fCF) and open Rutner sidearm (fCO) were tested. The model was loaded with standardized artificial stone material (2 mm in diameter) to examine stone removal by the vacuum cleaner effect and with sand (0.1-0.5 mm in diameter) to measure the washout effect caused by irrigation backflow. The association between washout of gravel and irrigation pressure was analyzed using ANOVA. Regression analysis was performed to assess the influence of the instruments' hydrodynamic characteristics-effective cross section of the outflow and irrigation flow volume. RESULTS Provoking the vacuum cleaner effect removal of stones was only effective in fCF but not in fCO instruments. Depending on irrigation pressure, the volumetric flow rate and effective cross section of the outflow clearance of sand could be observed in various medium- and large-sized fCF and fCO instruments, whereas in small-sized systems, clearance effects were negligible. Regression analysis showed clearance of stone dust strongly associated with an instrument's volumetric flow rate. CONCLUSIONS This in vitro study demonstrated that the application of medium- and large-sized fCF PCNL systems removes both "insignificant" stones and dust solely by hydrodynamic effects. Further studies have to show if these effects also occur in the in vivo situation.
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Affiliation(s)
- Rene Mager
- 1 Department of Urology and Pediatric Urology, University Hospital Frankfurt , Frankfurt, Germany
| | | | - Tanja Hüsch
- 1 Department of Urology and Pediatric Urology, University Hospital Frankfurt , Frankfurt, Germany
| | - Thomas Herrmann
- 3 Department of Urology and Urologic Oncology, Hannover Medical School , Hannover, Germany
| | - Andre Nicklas
- 4 Department of Urology and Andrology, General Hospital Hall , Hall in Tyrol, Austria
| | - Udo Nagele
- 4 Department of Urology and Andrology, General Hospital Hall , Hall in Tyrol, Austria
| | - Axel Haferkamp
- 1 Department of Urology and Pediatric Urology, University Hospital Frankfurt , Frankfurt, Germany
| | - David Schilling
- 1 Department of Urology and Pediatric Urology, University Hospital Frankfurt , Frankfurt, Germany
- 5 Department of Urology, Isarkliniken Munich , Munich, Germany
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Hein S, Miernik A, Wilhelm K, Adams F, Schlager D, Herrmann TRW, Rassweiler JJ, Schoenthaler M. Clinical significance of residual fragments in 2015: impact, detection, and how to avoid them. World J Urol 2015; 34:771-8. [PMID: 26497824 DOI: 10.1007/s00345-015-1713-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/12/2015] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Residual fragments are common after stone treatment. Little is known about clinical outcomes relevant to the patient. This comprehensive review of the literature highlights the impact of residual fragments, modes of detection, and treatment strategies to avoid residual fragments in shock wave therapy, ureteroscopy, and percutaneous nephrolithotomy. METHODS A comprehensive review of current literature was performed using PubMed(®), MEDLINE(®), Embase™, Ovid(®), Google Scholar™, and the Cochrane Library. Publications relevant to the subject were retrieved and critically appraised. RESULTS Residual fragments after treatment for urinary stones have a significant impact on a patient's well-being and future course. (Ultra-) low-dose non-contrast computed tomography detects small residuals most reliably. In shock wave lithotripsy, adherence to basic principles helps to improve results. Various techniques and devices facilitate complete stone clearance in conventional and miniaturized percutaneous nephrolithotomy and (flexible) ureteroscopy. Promising new technologies in shock waves, lasers, and robotics (and potentially microrobotics) are on the horizon. CONCLUSIONS Residual fragments are relevant to patients. Contemporary treatment of urolithiasis should aim at complete stone clearance.
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Affiliation(s)
- Simon Hein
- Department of Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
| | - Konrad Wilhelm
- Department of Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Fabian Adams
- Department of Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Daniel Schlager
- Department of Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Thomas R W Herrmann
- Department of Urology and Urooncology, Hannover Medical School (MHH), Carl Neuberg Str. 1, 30625, Hannover, Germany
| | - Jens J Rassweiler
- Department of Urology and Pediatric Urology, SLK Kliniken Heilbronn, University of Heidelberg, Am Gesundbrunnen 20 - 26, 74078, Heilbronn, Germany
| | - Martin Schoenthaler
- Department of Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
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Nagele U, Traxer O. No matter which way: IS 10 or 11/12 FRENCH access the rising new standard in kidney stone surgery 2015? World J Urol 2015; 34:449-50. [PMID: 26049864 DOI: 10.1007/s00345-015-1609-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/28/2015] [Indexed: 11/26/2022] Open
Affiliation(s)
- Udo Nagele
- Department of Urology and Andrology, General Hospital Hall i.T., Milser Str. 10, 6060, Hall in Tirol, Austria.
| | - Olivier Traxer
- Department of Urology, Tenon University Hospital, Marie Curie University, Paris, France
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Nagele U, Nicklas A. Vacuum cleaner effect, purging effect, active and passive wash out: a new terminology in hydrodynamic stone retrival is arising--Does it affect our endourologic routine? World J Urol 2015; 34:143-4. [PMID: 26002252 DOI: 10.1007/s00345-015-1575-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 04/23/2015] [Indexed: 12/22/2022] Open
Affiliation(s)
- Udo Nagele
- Department of Urology and Andrology, General Hospital Hall i.T., Milser Str. 10, 6060, Hall in Tirol, Austria.
| | - Andre Nicklas
- Department of Urology and Andrology, General Hospital Hall i.T., Milser Str. 10, 6060, Hall in Tirol, Austria
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