Nephrostolithotomy: percutaneous techniques for urinary calculus removal. 1982

Percutaneous extraction of big kidney stone without fragmentation: The novel technique in percutaneous nephrolithotomy (EN BLOC PCNL)

PCNL is gold standard treatment of pelvis stone more than 2 cm. Since 1970 that PCNL was introduced, multiple methods including mini PCNL, Lap assisted PCNL etc. were used to increase the efficacy and decrease the complications of PCNL in different patients. We describe a new method of PCNL for the first time for extracting 7 cm renal stone without fragmentation, and we called it EN BLOC PCNL. Our technique had no complication and caused lower operative time.

The Comparison Study of Flexible Ureteroscopic Suctioning Lithotripsy With Intelligent Pressure Control Versus Minimally Invasive Percutaneous Suctioning Nephrolithotomy in Treating Renal Calculi of 2 to 3 cm in Size

Purpose. To compare the efficacy and safety of flexible ureteroscopic suctioning lithotripsy (FURS) using patented designed intelligent irrigation and suctioning intraluminal pressure-control platform and integrated pressure-measuring suctioning ureteral access sheath versus minimally invasive suctioning percutaneous nephrolithotomy (MPCNL) in treating renal calculi at 2 to 3 cm in size. Methods. Ninety-one patients who met the criteria were included in the study. Among these, 46 patients underwent transurethral flexible ureteroscopic lithotripsy and the other 45 patients underwent MPCNL. We retrospectively analyzed the clinical data for the 2 groups and parameters including stone clearance rate, complication rate, average operative time, average postoperative hospitalization duration, and average postoperative hemoglobin level decrease were compared. Results. The hospitalization time for the FURS group was 3.53 ± 1.25 days, which was statistically shorter than that of the MPCNL group, which was 6.54 ± 2.36 days. There was significantly more patients needing pain medication postoperatively in the MPCNL group with statistical difference between the 2 groups ( P = .015). Also, there was more significant hemoglobin level drop in the MPCNL group with statistical difference between the 2 groups. However, there were no statistical differences between the 2 groups on average operative time and stone clearance rate. Conclusion. Both the operative methods are safe and efficacious in treating solitary renal calculus at 2 to 3 cm in size. However, FURS has more advantages including shorter hospital stay, less complication, and less bleeding.

A Novel Method for Repositioning Suboptimally Preoperatively Placed Nephrostomy Tubes for Percutaneous Nephrolithotomy Without Renal Repuncture

Objective: Nephrostomy tubes (NTs) inserted in emergency settings by interventional radiologists are frequently unsuitable for subsequent percutaneous nephrolithotomy (PCNL). We report a novel method of adjusting these NTs to be used as PCNL tracts and avoid renal repuncture. Patients and Methods: A retrospective search of 981 consecutive PCNLs performed in our institution between 2002 and 2017 identified all patients with preoperatively inserted NTs. The NTs unsuitable for PCNL were adjusted by a novel approach in which a 5-mm incision was made at the ideal puncture location (IPL) as indicated under fluoroscopic guidance. The preinserted NT was removed after passing a guidewire into the kidney. A dissector clamp was introduced through the entry wound of the removed NTs to bluntly dissect a retroperitoneal tunnel and pull out the distal tip of guidewire through the IPL, while its proximal segment was maintained in the kidney. The newly positioned guidewire was used for PCNL tract preparation without repuncturing the kidney. Results: The NTs were located in the mid calix, lower calix, and renal pelvis in 6 (26%), 13 (57%), and 4 (17%) cases, respectively. The NT was suitable for PCNL in 5 (22%) cases, a new renal access was performed in 3 (13%), and the novel adjustment approach was used in 15 (65%), all successfully. The place of entry was moved an average of 6 cm (range 47) and the angle between the tract axis and the calix axis was reduced by 65° in average. The procedure was done uneventfully in an average of 4 minutes. Conclusions: The novel method of adjusting preoperatively inserted NTs for PCNL by repositioning their original entry location to the IPL offers the possibility of avoiding kidney repuncture. It is feasible, safe, and easy to implement, and it spares potential morbidity related to additional puncturing of the kidney.

Prone Versus Supine Percutaneous Nephrolithotomy: What Is Your Position?

PURPOSE OF REVIEW

Percutaneous nephrolithotomy (PCNL) is the gold standard surgical procedure for treating large, complex renal stones. Due to its challenging nature, PCNL has undergone many modifications in surgical technique, instruments, and also in patient positioning. Since the first inception of PCNL, prone position has been traditionally used. However, alternative positions have been proposed and assessed over the years. This is a comprehensive review on the latest developments related to positioning in the practice of PCNL.

RECENT FINDINGS

The prone position and its modifications are the most widely used positions for PCNL, but with the introduction of various supine positions, the optimal position has been up for debate. Recent meta-analysis has shown a superior stone-free rate in the prone position and comparable complication rates to the supine position. The advantage of ease of access to the urethra for simultaneous retrograde techniques in the supine position is also possible with modifications in the prone position such as the split-leg technique. Modern-day PCNL has transformed from an operation traditionally undertaken in the prone position to a procedure in which a prone or supine position may be employed; however, published data have not shown significant superiority of either approach.

The modern history and evolution of percutaneous nephrolithotomy

INTRODUCTION

Serendipity, innovative physicians, evolving techniques for renal access, and improvements in equipment and radiology led to the evolution of percutaneous nephrolithotomy (PCNL).

METHODS

We searched urology texts and the literature for sources pertaining to the history and development of PCNL.

RESULTS

In 1941, Rupel and Brown performed the first nephroscopy when a rigid cystoscope was passed into the kidney following open surgery. Willard Goodwin, in 1955, while trying to perform a renal arteriogram, placed a needle into the collecting system of a hydronephrotic kidney and performed the first antegrade nephrostogram. He left a tube to drain the kidney, thereby placing the first nephrostomy tube. By 1976, Fernström and Johansson were the first to describe a technique for extracting renal calculi through a percutaneous nephrostomy under radiological control. In 1978, Arthur Smith, would describe the first antegrade stent placement when he introduced a Gibbons stent through a percutaneous nephrostomy in a patient with a reimplanted ureter. Dr. Smith would coin the term "endourology" to describe closed, controlled manipulation of the genitourinary tract. His collaboration with Kurt Amplatz, an interventional radiologist and medical inventor, would lead to numerous innovations that would further advance PCNL. In the 1980s the process of renal access and tract dilation was improved upon and the use of a rigid cystoscope was replaced by offset nephroscopes with a large straight working channel. Radiographic innovations, including improvements in fluoroscopy would further aid in renal access. The development of various lithotripsy devices and the introduction of the holmium laser improved the efficiency of stone fragmentation and clearance. The increased clinical experience and utilization of PCNL would lead to the characterization of stone-free rates and complications for the procedure.

CONCLUSION

Serendipity, innovations in renal access, optics, radiology, and improvements in lithotripsy all contributed to the modern day PCNL.