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Irani D, Haghpanah A, Rasekhi A, Kamran H, Rahmanian M, Hosseini MM, Dejman B, Kiani S. Predictive factors of delayed bleeding after percutaneous nephrolithotomy requiring angioembolization. BJUI COMPASS 2024; 5:76-83. [PMID: 38179029 PMCID: PMC10764173 DOI: 10.1002/bco2.272] [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: 03/14/2023] [Revised: 06/04/2023] [Accepted: 06/19/2023] [Indexed: 01/06/2024] Open
Abstract
Objectives To investigate the predictive factors of delayed post-percutaneous nephrolithotomy (PCNL) haemorrhage because of arteriovenous fistula (AVF) or pseudoaneurysm (PA) and compare the factors between AVF and PA. Patients and methods This is a case-control study with a case-to-control ratio of 1:3. Out of 5077 patients who underwent PCNL from April 2015 to April 2018 in three different teaching hospitals, 113 had post-PCNL haemorrhages because of AVF and/or PA. Seventy-two patients met the inclusion criteria and entered the study as cases, while 216 patients without any postoperative complications were selected as controls. Results Of all 72 studied patients with complications after PCNL, 35 (48.6%) had AVF, and the rest had PA. The regression model revealed that a history of diabetes (odds ratio [OR]: 2.799, 95% confidence interval [CI]: 1.392-5.630, p-value = 0.004) and renal anomalies (OR: 2.929, 95% CI: 1.108-7.744, p-value = 0.03) were associated with developing delayed post-PCNL haemorrhage. However, no differences were seen between AVF and PA regarding selected variables (p-value > 0.05). Conclusion History of diabetes and renal anomalies were predictive factors for delayed post-PCNL haemorrhage, but no predictive factors were found to differentiate PA and AVF from one another.
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Affiliation(s)
- Dariush Irani
- Endourology Ward, Department of UrologyShiraz University of Medical SciencesShirazIran
| | - Abdolreza Haghpanah
- Endourology Ward, Department of UrologyShiraz University of Medical SciencesShirazIran
- Laparoscopy Research CenterShiraz University of Medical SciencesShirazIran
| | - Alireza Rasekhi
- Department of RadiologyShiraz University of Medical SciencesShirazIran
| | - Hooman Kamran
- Laparoscopy Research CenterShiraz University of Medical SciencesShirazIran
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Mahdi Rahmanian
- Medical School, MPH DepartmentShiraz University of Medical SciencesShirazIran
| | | | - Behnam Dejman
- Department of UrologyShiraz University of Medical SciencesShirazIran
| | - Sajad Kiani
- Department of UrologyShiraz University of Medical SciencesShirazIran
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Abdeldaeim HM, El Gebaly O, Said M, Zahran AR, Abouyoussif T. Mini percutaneous nephrolithotomy versus retrograde flexible ureterorenoscopy in the treatment of renal calculi in anomalous kidneys. Arch Ital Urol Androl 2021; 93:167-172. [PMID: 34286550 DOI: 10.4081/aiua.2021.2.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/21/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To report our single center experience in comparing mini-percutaneous nephrolithotomy versus flexible ureterorenoscopy for management of renal stones up to 2 cm in anomalous kidneys. MATERIALS AND METHODS Records of the last 30 patients with stones less than 2 cm in anomalous kidney treated by mini-percutaneous nephrolithotomy were reviewed and compared to last 30 patients treated by flexible ureterorenoscopy. RESULTS Mean stone size was significantly higher in the minipercutaneous nephrolithotomy group (17.90 mm) than in flexible ureterorenoscopy group (14.97mm) (p < 0.001). Mean operative time (80.33 min vs 56.43 min) and fluoroscopy exposure time (4.49 min vs 0.84 min) were significantly higher in the mini-percutaneous nephrolithotomy group than in the flexible ureterorenoscopy group (p < 0.001). The mean post-operative drop in hemoglobin concentration was significantly higher in the mini-percutaneous nephrolithotomy group (0.47 gm versus 0.2 gm) (p < 0.001). Stone free rate after 12 weeks follow up was not statistically significant between the 2 groups (90% in minipercutaneous nephrolithotomy vs 80% in flexible ureterorenoscopy) (FEp = 0.472). CONCLUSIONS Both modalities were found to be safe and effective for treatment of stones less than 2 cm in anomalous kidneys.
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Affiliation(s)
| | - Omar El Gebaly
- Department of Urology, Alexandria University, Alexandria.
| | - Mostafa Said
- Department of Urology, Alexandria University, Alexandria.
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Astolfi RH, Freschi G, Berti FF, Gattas N, Molina WR, Meller A. Flexible ureterorenoscopy in position or fusion anomaly: Is it feasible? Rev Assoc Med Bras (1992) 2017; 63:685-688. [PMID: 28977105 DOI: 10.1590/1806-9282.63.08.685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/21/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the results of flexible ureterorenoscopy (F-URS) with holmium laser in the treatment of kidney stones with ectopic and fusion anomalies (horseshoe kidney and rotation anomalies). METHOD We reviewed data from 13 patients with fusion and ectopic renal anomalies that underwent F-URS from April 2011 to April 2017. We analyzed demographic and clinical data (age, gender, BMI, anatomical abnormality, location and dimension of the renal calculi) and perioperative data (method of treatment, stone-free rate, number of days with DJ catheter and perioperative complications). RESULTS The mean stone size was 12.23 +/- 5.43 mm (range 6-22mm), located in the inferior (58.33%) and middle (16.76%) calyceal units, renal pelvis (16.67%) and multiple locations (8.33%). All 13 patients were treated with Ho-Yag laser, using dusting technique (25%), fragmentation and extraction of the calculi (58.33%) and mixed technique (16.67%). We did not have any severe perioperative complication. After 90 days, nine patients (75%) were considered stone free. CONCLUSION Our data suggest that F-URS is a safe and feasible choice for the treatment of kidney stones in patients with renal ectopic and fusion anomalies.
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Affiliation(s)
- Rafael Haddad Astolfi
- MD, Urology Resident at Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | | | | | - Nelson Gattas
- MD, Lecturer of Urology, Unifesp, São Paulo, SP, Brazil
| | - Wilson Rica Molina
- Associate Professor, University of Colorado, and Head of the Endourology Department, Denver Health Medical Center, University of Colorado, Denver, CO, USA
| | - Alex Meller
- MD, Assistant Physician, Urology Division, Unifesp, São Paulo, SP, Brazil
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Khadgi S, Shrestha B, Ibrahim H, Shrestha S, ElSheemy MS, Al-Kandari AM. Mini-percutaneous nephrolithotomy for stones in anomalous-kidneys: a prospective study. Urolithiasis 2016; 45:407-414. [DOI: 10.1007/s00240-016-0926-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 09/27/2016] [Indexed: 11/30/2022]
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Ozgor F, Kucuktopcu O, Ucpinar B, Sarilar O, Erbin A, Yanaral F, Sahan M, Binbay M. The effects of previous open renal stone surgery types on PNL outcomes. Can Urol Assoc J 2016; 10:E246-E250. [PMID: 28255416 DOI: 10.5489/cuaj.3687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Our aim was to demonstrate the effect of insicion of renal parenchyma during open renal stone surgery (ORSS) on percutaneous nephrolithotomy (PNL) outcomes. METHODS Patients with history of ORSS who underwent PNL operation between June 2005 and June 2015 were analyzed retrospectively. Patients were divided into two groups according to their type of previous ORSS. Patients who had a history of ORSS with parenchymal insicion, such as radial nephrotomies, anatrophic nephrolithotomy, lower pole resection, and partial nephrectomy, were included in Group 1. Other patients with a history of open pyelolithotomy were enrolled in Group 2. Preoperative characteristics, perioperative data, stone-free status, and complications were compared between the groups. Stone-free status was defined as complete clearance of stone(s) or presence of residual fragments smaller than 4 mm. The retrospective nature of our study, different experience level of surgeons, and lack of the evaluation of anesthetic agents and cost of procedures were limitations of our study. RESULTS 123 and 111 patients were enrolled in Groups 1 and 2, respectively. Preoperative characteristics were similar between groups. In Group 1, the mean operative time was statistically longer than in Group 2 (p=0.013). Stone-free status was significantly higher in Group 2 than in Group 1 (p=0.027). Complication rates were similar between groups. Hemorrhage requiring blood transfusion was the most common complication in both groups (10.5% vs. 9.9%). CONCLUSIONS Our study demonstrated that a history of previous ORSS with parenchymal insicion significantly reduces the success rates of PNL procedure.
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Affiliation(s)
- Faruk Ozgor
- Haseki Training and Research Hospital, Istanbul, Turkey
| | | | - Burak Ucpinar
- Haseki Training and Research Hospital, Istanbul, Turkey
| | - Omer Sarilar
- Haseki Training and Research Hospital, Istanbul, Turkey
| | - Akif Erbin
- Haseki Training and Research Hospital, Istanbul, Turkey
| | - Fatih Yanaral
- Haseki Training and Research Hospital, Istanbul, Turkey
| | - Murat Sahan
- Haseki Training and Research Hospital, Istanbul, Turkey
| | - Murat Binbay
- Haseki Training and Research Hospital, Istanbul, Turkey
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Effects of dilatation types during percutaneous nephrolithotomy for less radiation exposure: a matched-pair pilot study. Wien Klin Wochenschr 2015; 128:53-8. [DOI: 10.1007/s00508-015-0711-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 01/19/2015] [Indexed: 10/23/2022]
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Gok A, Polat H, Cift A, Yucel MO, Gok B, Sirik M, Benlioglu C, Kalyenci B. The hounsfield unit value calculated with the aid of non-contrast computed tomography and its effect on the outcome of percutaneous nephrolithotomy. Urolithiasis 2015; 43:277-81. [PMID: 25820292 DOI: 10.1007/s00240-015-0766-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 03/18/2015] [Indexed: 11/25/2022]
Abstract
To evaluate the effect of the Hounsfield unit (HU) value, calculated with the aid of non-contrast computed tomography, on the outcome of percutaneous nephrolithotomy (PCNL). Data for 83 patients evaluated in our clinic between November 2011 and February 2014 that had similar stone sizes, localizations, and radio opacities were retrospectively reviewed. The patients were grouped according to their HU value, in a low HU group (HU ≤ 1000) or a high HU group (HU > 1000). The two groups were compared based on their PCNL success rates, complications, duration of surgery, duration of fluoroscopy, and decrease in the hematocrit. There were no significant differences in terms of mean age, female-male ratio, or mean body mass index between the two groups (p > 0.05). The stone size and stone surface area did not differ significantly between the groups (p = 0.820 and p = 0.394, respectively). The unsuccessful PCNL rate and the prevalence of complications did not differ significantly between the two groups (p > 0.05). The duration of surgery, duration of fluoroscopy, and decrease in the hematocrit were significantly greater in the high HU group compared to the low HU group (p < 0.001). Calculating the HU value using this imaging method may predict cases with longer surgery durations, longer fluoroscopy durations, and greater decreases in hematocrite levels, but this value is not related to the success rate of PCNL.
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Affiliation(s)
- Alper Gok
- Department of Urology, Faculty of Medicine, Adıyaman University, Adıyaman, Turkey,
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Resorlu B, Karakan T, Kilinc MF, Kabar M, Doluoglu OG. Laparoscopic-assisted percutaneous nephrolithotomy in malrotated and ectopic pelvic kidneys: calyceal or direct pelvic access? Ren Fail 2015; 37:742-3. [PMID: 25687388 DOI: 10.3109/0886022x.2015.1012982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Berkan Resorlu
- Department of Urology Ankara Training and Research Hospital Ankara , Turkey
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Outcomes of retrograde flexible ureteroscopy and laser lithotripsy for stone disease in patients with anomalous kidneys. Urolithiasis 2014; 43:77-82. [PMID: 25161087 DOI: 10.1007/s00240-014-0713-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 08/11/2014] [Indexed: 12/12/2022]
Abstract
Due to the presence of structural and anatomical differences that accompany anomalous kidneys, currently available endourological modalities such as SWL and PNL may be insufficient, or additional laparoscopic assistance may be required. The present study aims to evaluate the efficacy and safety of retrograde flexible ureterorenoscopic stone treatment in patients with kidney anomalies. Over the last 3 years, 25 patients with renal stones in anomalous kidneys were consecutively treated by flexible ureterorenoscopy and holmium:YAG laser lithotripsy. Among the 25 patients, fiberoptic or digital flexible ureterorenoscopies were performed for the management of horseshoe kidneys (n = 3), cross-fused ectopic kidney (n = 1), renal ectopies [n = 13; associated with pelvic (n = 6) or lumbar kidneys (n = 7)], renal malrotations (n = 4), and duplicate ureters (n = 4). For lithotripsy, 200 or 273 µm probes were used, and for stone retraction 1.3-1.9 Fr ZeroTip baskets were used. Success was defined as the complete absence of stones as evaluated with a CT scan 1 month after the operation. The mean patient age was 39.4 ± 15.75 years, and the mean stone size was 194.64 ± 103.93 mm(2) (range 50-393). Complete stone clearance was achieved in 16 patients (64%) after a single session. Seven of the patients with residual stones underwent a second session and the remaining three patients were subsequently treated with SWL. The overall complete clearance rate was 88% (22 patients) with ancillary procedures. There were no serious postoperative complications except for one case (4%) of urosepsis. Flexible ureterorenoscopy with holmium laser lithotripsy is a safe option for the treatment of renal stones in anomalous kidneys with satisfactory success rates.
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Oğuz U, Balci M, Atis G, Bozkurt OF, Tuncel A, Halis F, Aslan Y, Yildirim IO, Senocak C, Yordam M, Atan A, Caskurlu T, Unsal A. Retrograde intrarenal surgery in patients with isolated anomaly of kidney rotation. Urolithiasis 2013; 42:141-7. [PMID: 24253539 DOI: 10.1007/s00240-013-0625-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 11/06/2013] [Indexed: 11/30/2022]
Abstract
The purpose of the study was to investigate feasibility of retrograde intrarenal surgery (RIRS) in patients with isolated anomaly of kidney rotation with kidney stones. We retrospectively reviewed the medical records of patients who underwent RIRS due to kidney stones in three referral hospitals. Twenty-four patients who had kidney rotation were included in this study. The patients with horseshoe kidney or pelvic kidney were not included in the study. The patients were evaluated for final success 1 month after surgery. Success was defined as stone-free or fragment smaller than 3 mm. Mean age of patients was 39.5 years (1-71 years) and male/female ratio was 3:1. Mean stone size was 13.46 mm (5-30 mm). Twelve (50 %) patients had the operation on the right side and other 12 (50 %) patients had on the left side. Eighteen (75 %) patients were stone-free after single procedure. And stone-free rate increased to 83.3 % after additional treatment procedures. When we compared the successful and failed procedures, gender, stone side and size, preoperative hydronephrosis, access sheet usage, ureteral double-J stent insertion were not statistically significant in two groups. We did not confront major complication. RIRS seems to be an effective and safe treatment option for renal stones in patients with isolated anomaly of kidney rotation.
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Affiliation(s)
- Ural Oğuz
- Department of Urology, Kecioren Training and Research Hospital, Ankara, Turkey,
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El-Nahas AR, Shokeir AA. Minimally Invasive Treatment of Calculi in Renal Anomalies. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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