A comparison of Amplatz dilators and metal dilators for tract dilatation in mini-percutaneous nephrolithotomy

Comparative study between a new screwed Amplatz sheath and the ordinary one in percutaneous nephrolithotomy

Objective

The objective of the article is to compare the results of using new screwed Amplatz sheath with results of the conventional Amplatz sheath regarding success and complications during percutaneous nephrolithotomy.

Methods

100 patients aged more than 18 years with renal calculi more than 2 cm with guy's score 1 from December 2018 till July 2020 were randomly stratified by closed envelope in group A (50 patients) with using conventional sheath and group B (50 patients) with new screwed sheath. We exclude morbid obese patients and patients with contraindication for PNL.

Results

There were no significant differences between both groups regarding patients demographic and stone demographic. Operative time and fluoroscopy time were significantly lower in group B rather than group A. Tract stability was in favor of group B as no tract loss recorded while in group A, 5 cases were recorded. In overall complications there were no significant differences between both groups. Bleeding was higher in group A (14%) than in group B (4%), but it was not statistically significant. Success rates were 78% for group A and 88% for group B but it was not statistically significant.

Conclusion

The screwed Amplatz sheath had showed less operative and fluoroscopy time. Also it enables urologists to have stable PNL tract. So it may be a promising tool to make PNL easier with higher success rate and lower complications.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00345-021-03806-2.

Mini PCNL Over Standard PCNL: What Makes it Better?

The incidence of small- and medium-size renal stones is rising. Stone clearance, bleeding, urine leak, and infectious complications are major concerns for urologists. They can choose the best technique from a list of armamentarium available. Minimally invasive approach like percutaneous nephrolithotomy (PCNL) has significantly influenced renal stone management since 1976. Miniaturization of the instruments innovate more effective and safer alternatives for urolithasis management. The outcome of mini-PCNL is explored and compared with standard PCNL in this review. Original research articles were reviewed using a systematic approach (keyword electronic database search). Duplicates were excluded in each step and 19 original articles out of 156 hits were analyzed. Mini-PCNL has significantly less bleeding complications and hospital stay. There were no significant difference in stone free rate between mini-PCNL and standard PCNL. The stone-free rate and complications rates were less dependent on the technique of puncture, tract dilatation, and energy used to fragment stones. The total operative time became slightly longer in mini-PCNL attributed to the sheath size and stone fragments retrieval. We found that mini-PCNL is as effective as standard PCNL with fewer complications. Stone burden is the key factor responsible for overall stone-free rate. However, the recommendation is limited by quality of study and the sample sizes.

Assessing Cost-Effectiveness of New Technologies in Stone Management

Diagnosis, treatment, and follow-up are all influential in determining the overall cost to the health care system for kidney stones. New innovations in the field of nephrolithiasis have been abundant, including disposable ureteroscopes, ultrasound-guided approaches to percutaneous nephrolithotomy, and advanced laser lithotripters. Identifying cost-effective treatment strategies encourages practitioners to be thoughtful about providing value-based high-quality care and remains on important principle in the treatment of urinary stone disease.

Updates in endourological management of urolithiasis

Urinary stone disease, or urolithiasis, is a very common disease with increasing prevalence and incidence. With the advancement of endoscopic techniques, the treatment outcomes of ureteroscopy (or transureteral lithotripsy) and percutaneous nephrolithotomy are continuously improving. In recent years, there have been many new developments in the field, including new endoscopy design, more effective auxiliary tools, improvement in treatment protocols, introduction of robotic technology, combining both ureteroscopy and percutaneous nephrolithotomy (endoscopic combined intrarenal surgery or transureteral lithotripsy-assisted percutaneous nephrolithotomy), improvement in laser technology, and so on. All these new inputs will further improve the treatment efficacy and safety of the procedures, thus benefiting our patients. In the present review, we briefly go through the main steps of ureteroscopy and percutaneous nephrolithotomy, with a concise description and application of these new advances.

Characterizing the Association Between Toll-like Receptor Subtypes and Nephrolithiasis With Renal Inflammation in an Animal Model

OBJECTIVE

To show experimentally induced renal stone disease and to evaluate secondary inflammatory responses in vivo, and to characterize changes in the expression of Toll-like receptor (TLR) subtypes in this model.

METHODS

Twenty 5- to 6-week-old male Wistar rats were divided into control and hyperoxaluria groups (n = 10 per group) and were supplied with normal water or 1% ethylene glycol, respectively, for 16 weeks. The animals were then placed in metabolic cages, and urine was collected for a 24-hour urine oxalate level evaluation. Following sacrifice, rats were subjected to bilateral nephrectomy and both kidneys were histopathologically evaluated. A 1-mm³ biopsy section from the right kidney of each rat was subjected to real-time polymerase chain reaction of the TLR expression.

RESULTS

At the end of week 16, the hyperoxaluria group had a higher mean 24-hour urine oxalate level (1.91) than the control group (0.29) (P <.05) and a remarkably increased deposition of renal CaOx crystals (15/20) than the control group (0/20) (P <.05), which was universally accompanied by inflammation (15/15). Twelve and no rats in the hyperoxaluria and control groups, respectively, had macroscopically visible renal pelvic stones (P <.05). Quantitative real-time polymerase chain reaction revealed significant decreases in the expression of several TLRs, particularly TLR11 and TLR7. Decreases in TLR1, TLR3, and TLR6 expressions and an increase in the TLR2 expression did not differ significantly between the groups.

CONCLUSION

We believe that is the first evaluation of TLR expression associated with renal stone formation in an animal model of inflammation. These results might lead to novel TLR-based treatments for nephrolithiasis and related inflammatory renal damage.