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Lubis AS, Anwar SL, Shofwan S, Makarim FR, Al Kautsar A, Wajiih WC. A new alternative to percutaneous nephrolithotomy: A case report. Int J Surg Case Rep 2024; 121:110008. [PMID: 38981298 PMCID: PMC11294692 DOI: 10.1016/j.ijscr.2024.110008] [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: 06/02/2024] [Revised: 06/29/2024] [Accepted: 07/04/2024] [Indexed: 07/11/2024] Open
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stone removal, involving a small incision in the back and insertion of a nephroscope to extract the stones. Recent advancements include super-mini PCNL, employing smaller instruments for less invasive access to the kidney. However, conventional PCNL often requires tract dilation, which can lead to potential complications. CASE PRESENTATION This case report presents the successful application of our surgical technique using the basic principles of PCNL with the aid of a pediatric trocar cystostomy and ultrasound guidance as a new alternative for super-mini PCNL, offering safer access with reduced bleeding risk and shorter recovery. The surgery was performed on a 55-year-old female with bilateral kidney stones, with the stone in the left kidney being larger than the one in the right kidney. The procedure was completed within 60 min without significant postoperative complications. DISCUSSION Our new alternative for PCNL offers benefits such as reduced invasiveness, shorter recovery time, decreased risk of complications, and minimal changes in postoperative hemoglobin levels. This new alternative can be performed in developing country hospitals that do not have the expensive PCNL equipment. CONCLUSION This new alternative of PCNL with pediatric trocar cystostomy proves to be effective and safe.
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Affiliation(s)
- Ahmad Sulaiman Lubis
- Department of Surgery, Faculty of Medicine, Universitas Islam Sultan Agung Semarang, Indonesia.
| | - Sumadi Lukman Anwar
- Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada, Indonesia
| | - Said Shofwan
- Department of Anesteshia, Faculty of Medicine, Universitas Islam Sultan Agung Semarang, Indonesia
| | - Fadhli Rizal Makarim
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Islam Sultan Agung Semarang, Indonesia
| | - Aqil Al Kautsar
- Graduate Medical Students, Faculty of Medicine, Universitas Islam Sultan Agung Semarang, Indonesia
| | - Wildan Chanieful Wajiih
- Graduate Medical Students, Faculty of Medicine, Universitas Islam Sultan Agung Semarang, Indonesia
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Chen W, Hu H, Yu G. Percutaneous nephrolithotomy or flexible ureteral lithotripsy, which one is better for patients with upper ureteral calculi of 1.5-2.0 cm in diameter. BMC Urol 2024; 24:98. [PMID: 38664721 PMCID: PMC11044355 DOI: 10.1186/s12894-024-01480-1] [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: 01/19/2024] [Accepted: 04/09/2024] [Indexed: 04/29/2024] Open
Abstract
PURPOSE First research to evaluate the clinical efficacy and safety of flexible ureteral lithotripsy (FURSL) and percutaneous nephrolithotomy (PCNL) in the treatment of the upper ureteral stone is between 1.5 cm and 2.0 cm in diameter since there is no consensus with such ureteral stone yet. METHODS From December 2018 to October 2022, 104 patients with calculi in the upper ureter received percutaneous nephrolithotomy (PCNL)or flexible ureteroscopic lithotripsy (FURSL) in our institution. The clinical data of the patients in the two groups were retrospectively searched. Stone removal rate, operation time, blood loss, postoperative pain score, postoperative inflammatory factor, postoperative complication rates and ureteral obstruction three months after the operation were compared between the two groups. RESULTS A total of 104 patients were included in the study. The stone clearance rate and the secondary surgery rate were 88.89% and 7.41% in the FURSL group, the figures were 97.96% and 2.0% in the PCNL group (p = 0.067, 0.497). Regarding ureteral obstruction three months after the operation, there were 2 patients in FURSL group and 0 patients in PCNL group(p = 0.497).Compared to patients in FURSL group, patients in the PCNL group had shorter operation time(PCNL 71.81 ± 18.94 min vs. FURSL 86.80 ± 22.49 min, p = 0.0004), fewer complications(PCNL 20.37% vs. FURSL 6.12%), and lower postoperative inflammatory factor(p = 0.0004), yet they got more hemoglobin drop (PCNL 13.14 ± 9.81 g/L vs. FURSL 4.77 ± 3.55 g/L, p < 0.0001), higher postoperative pain scores(p = 0.0017) in the first three postoperative days and longer hospital stay (PCNL 4.96 ± 1.21 days vs. FURSL 3.60 ± 0.83 days). CONCLUSION Both FURSL and PCNL were effective methods for treating upper ureteral stones of 1.5-2.0 cm in diameter given the extremely high stone clearance rate and a very low secondary surgery rate, as long as rare ureteral obstruction in medium-long term observation. Additionally, FURSL can effectively reduce surgical bleeding, postoperative pain, and hospital stay, while PCNL can decrease operation time, the risk of infection, and complications. Therefore, doctors could select suitable surgical treatment for those patients depending on their different clinical situations based on these findings.
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Affiliation(s)
- Wenpu Chen
- Department of Urology, Jinshan District Central Hospital affiliated to Shanghai University of Medicine & Health Sciences; Jinshan Branch of Shanghai Sixth People's Hospital, 147 Jiankang Road, Jinshan District, Shanghai, China
| | - Hengda Hu
- Department of Urology, Jinshan District Central Hospital affiliated to Shanghai University of Medicine & Health Sciences; Jinshan Branch of Shanghai Sixth People's Hospital, 147 Jiankang Road, Jinshan District, Shanghai, China
| | - Guofeng Yu
- Department of Urology, Jinshan District Central Hospital affiliated to Shanghai University of Medicine & Health Sciences; Jinshan Branch of Shanghai Sixth People's Hospital, 147 Jiankang Road, Jinshan District, Shanghai, China.
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Edison E, Mazzon G, Arumuham V, Choong S. Prevention of complications in endourological management of stones: What are the basic measures needed before, during, and after interventions? Asian J Urol 2024; 11:180-190. [PMID: 38680580 PMCID: PMC11053336 DOI: 10.1016/j.ajur.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/17/2023] [Indexed: 05/01/2024] Open
Abstract
Objective This narrative review aims to describe measures to minimise the risk of complications during percutaneous nephrolithotomy (PCNL), ureteroscopy, and retrograde intrarenal surgery. Methods A literature search was conducted from the PubMed/PMC database for papers published within the last 10 years (January 2012 to December 2022). Search terms included "ureteroscopy", "retrograde intrarenal surgery", "PCNL", "percutaneous nephrolithotomy", "complications", "sepsis", "infection", "bleed", "haemorrhage", and "hemorrhage". Key papers were identified and included meta-analyses, systematic reviews, guidelines, and primary research. The references of these papers were searched to identify any further relevant papers not included above. Results The evidence is assimilated with the opinions of the authors to provide recommendations. Best practice pathways for patient care in the pre-operative, intra-operative, and post-operative periods are described, including the identification and management of residual stones. Key complications (sepsis and stent issues) that are relevant for any endourological procedure are then be discussed. Operation-specific considerations are then explored. Key measures for PCNL include optimising access to minimise the chance of bleeding or visceral injury. The role of endoscopic combined intrarenal surgery in this regard is discussed. Key measures for ureteroscopy and retrograde intrarenal surgery include planning and technique to minimise the risk of ureteric injury. The role of anaesthetic assessment is discussed. The importance of specific comorbidities on each step of the pathway is highlighted as examples. Conclusion This review demonstrates that the principles of meticulous planning, interdisciplinary teamworking, and good operative technique can minimise the risk of complications in endourology.
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Affiliation(s)
- Eric Edison
- Department of Urology, University College Hospital London, London, UK
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Vimoshan Arumuham
- Department of Urology, University College Hospital London, London, UK
| | - Simon Choong
- Department of Urology, University College Hospital London, London, UK
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Chen YH, Li WM, Juan YS, Huang TY, Wang YC, Lee HY. A comparison of S.T.O.N.E nephrolithometry scoring system, Guy's stone score, and Seoul National University Renal Stone Complexity (S-ReSC) in predicting mini-PCNL stone-free rate. Urolithiasis 2024; 52:19. [PMID: 38180575 DOI: 10.1007/s00240-023-01499-3] [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: 09/12/2023] [Accepted: 10/24/2023] [Indexed: 01/06/2024]
Abstract
The main goal of the study is to evaluate the three stone scoring systems (S.T.O.N.E nephrolithometry scoring system (STONE), Guy's stone score (GSS) and Seoul National University Renal Stone Complexity (S-ReSC)) for the stone-free rate (SFR) of mini-PCNL. We retrospectively analyzed 72 patients who received mini-PCNL from February 2018 to October 2020. The SFR, complication rates, hospitalization days and recurrence rates were analyzed using three stone scoring systems. The result showed statistical significance in the association between scoring system and stone-free (STONE: OR 95%CI 0.409 (0.221-0.759), p = 0.0045; S-ReSC OR 95%CI 0.633 (0.401-0.999), p = 0.0497), but not GSS (OR 95%CI 0.776 (0.397-1.516), p = 0.4581). After adjusting the potential confounding factors, the area under curve (AUC) of STONE, GSS, and S-ReSC was 0.86, 0.78, and 0.81, respectively, and Akaike information criterion (AIC) of STONE, GSS, and S-ReSC was 64.65, 74.89, and 69.92, respectively. The accuracy rate of STONE, GSS, and S-ReSC was 0.81, 0.75, and 0.79, respectively. There was no statistically difference of predicting stone recurrence (p = 0.46, 0.53, 0.86), complications (p = 0.74, 0.51, 0.16) and hospitalization days (p = 0.77, 0.86, 0.87) in STONE, GSS, and S-ReSC, respectively. In conclusion, both the STONE and S-ReSC stone scoring systems are viable for predicting the SFR following mini-PCNL, especially after variable adjustment with the STONE system demonstrating superiority over S-ReSC.
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Affiliation(s)
- Yi-Hsuan Chen
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1St Road, Sanmin Dist., Kaohsiung, 80708, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Ming Li
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1St Road, Sanmin Dist., Kaohsiung, 80708, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan
- Department of Urology, Kaohsiung Medical University Gang-Shan Hospital, Kaohsiung, Taiwan
| | - Yung-Shun Juan
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1St Road, Sanmin Dist., Kaohsiung, 80708, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Yi Huang
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1St Road, Sanmin Dist., Kaohsiung, 80708, Taiwan
| | - Yen-Chun Wang
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1St Road, Sanmin Dist., Kaohsiung, 80708, Taiwan
| | - Hsiang-Ying Lee
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1St Road, Sanmin Dist., Kaohsiung, 80708, Taiwan.
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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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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Da Silva Ferreira D, Bhattu AS, Adam A. Miniaturizing the approach to upper tract renal calculi: Is smaller always better? A narrative review. Curr Urol 2023; 17:280-285. [PMID: 37994342 PMCID: PMC10662827 DOI: 10.1097/cu9.0000000000000210] [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: 11/10/2022] [Accepted: 03/14/2023] [Indexed: 11/24/2023] Open
Abstract
Newer modalities for treating upper tract urinary stones focus on maintaining and improving outcomes, reducing complications, and optimizing patient care. This narrative review aims to outline novel miniaturized endourological innovations for managing upper tract calculi.
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Affiliation(s)
| | - Amit Satish Bhattu
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ahmed Adam
- Division of Urology, University of the Witwatersrand, Johannesburg, South Africa
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Melchionna A, Choong S, Arumuham V, Mazzon G. Comment on: "Mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for the treatment of 10-20-mm kidney stones in patients with ileal conduit: a comparative study". Minerva Urol Nephrol 2023; 75:783-785. [PMID: 38126293 DOI: 10.23736/s2724-6051.23.05639-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Alberto Melchionna
- Institute of Urology, University College Hospitals of London, London, UK
| | - Simon Choong
- Institute of Urology, University College Hospitals of London, London, UK
| | - Vimoshan Arumuham
- Institute of Urology, University College Hospitals of London, London, UK
| | - Giorgio Mazzon
- Institute of Urology, University College Hospitals of London, London, UK -
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Juliebø-Jones P, Ulvik Ø, Beisland C, Somani BK. Paediatric percutaneous nephrolithotomy (P-PCNL) reporting checklist. Scand J Urol 2023; 58:115-119. [PMID: 37987596 DOI: 10.2340/sju.v58.13392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/06/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To develop a reporting checklist that serves to improve and standardise reporting in studies pertaining to paediatric percutaneous nephrolithotomy (PCNL). METHODS Based on findings from systematic review of literature, a draft list of items was formulated. By process of review and revisions, a finalised version was established and consensus achieved. RESULTS The finalised version of the checklist covers four main sections, which include the following areas: study details, pre-operative, operative and post-operative information. There are 18 further sub-items. Recommendations deemed to be of high importance to include are highlighted in bold. CONCLUSION This practical tool can aid clinicians and researchers when undertaking and reviewing studies on paediatric PCNL. This is highly relevant given the current heterogeneity that exists as well as debate in best practice patterns.
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Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway; EAU YAU Urolithiasis Group, Arnhem, The Netherlands.
| | - Øyvind Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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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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Kucukyangoz M, Gucuk A. Which position is more advantageous for percutaneous nephrolithotomy: supine or prone? Urolithiasis 2023; 51:102. [PMID: 37578662 DOI: 10.1007/s00240-023-01474-y] [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: 05/10/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
Percutaneous nephrolithotomy (PNL) can be performed in a number of different positions. Our aim was to evaluate the convenience and advantages of the supine position following the transition from the prone to the supine position. 94 patients undergoing supine PNL (Group-1) and 93 patients undergoing prone PNL (Group-2) were retrospectively reviewed and included in the study. Patients who underwent mini-PNL (mPNL) were selected from Group-1 and Group-2 and divided into Group-1A supine mPNL patients (77) and Group-2A prone mPNL patients (53). Demographic characteristics, operative data and post-operative parameters were compared between these groups. The operation time was 74.4 ± 21.9 min in Group-1A and 79.2 ± 19.8 min in Group-2A (p = 0.076). The median value of fluoroscopy time was 30 s in Group-1A and 40 s in Group-2A (p = 0.003). In Group-1A, 59 patients had no intraoperative double-J stent (DJS) insertion and 18 patients had DJS insertion, while in Group-2A, 24 patients had no DJS insertion and 29 patients had DJS insertion (p < 0.001). MPNL was performed in 81.9% of patients in the supine position and 57% in the prone position. This difference was statistically significant (p < 0.001). No significant difference was found with regard to the success rate and the complications of mPNL. Fluoroscopy time is shorter in the supine position. Moreover, the insertion rates of DJS are low. With increasing experience, we have found that our standard PNL (sPNL) rate is gradually decreasing and more mPNL is being performed.
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Affiliation(s)
| | - Adnan Gucuk
- Department of Urology, Private Acıbadem Hospital, Eskişehir, Turkey
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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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Ząbkowski T, Durma AD, Grabińska A, Michalczyk Ł, Saracyn M. Analysis of Nephrolithiasis Treatment in Highest Reference Hospital-Occurrence of Acromegaly in the Study Group. J Clin Med 2023; 12:3879. [PMID: 37373574 DOI: 10.3390/jcm12123879] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Urolithiasis is one of the most common diseases of the urinary system, the incidence of which is assumed to be up to 100,000 cases per million (10% of the population). The cause of it is dysregulation of renal urine excretion. Acromegaly is a very rare endocrine disorder that causes a somatotropic pituitary adenoma producing higher amounts of growth hormone. It occurs approximately in 80 cases per million (about 0.008% of the population). One of the acromegaly complications may be urolithiasis. METHODS Clinical and laboratory results of 2289 patients hospitalized for nephrolithiasis in the highest reference hospital were retrospectively analyzed, distinguishing a subgroup of patients with acromegaly. Statistical analysis was performed to compare the prevalence of the disease in the analyzed subgroup with the epidemiological results available in up-to-date literature. RESULTS The distribution of nephrolithiasis treatment was definitely in favor of non-invasive and minimally invasive treatment. The methods used were as follows: ESWL (61.82%), USRL (30.62%), RIRS (4.15%), PCNL (3.1%), and pyelolithotomy (0.31%). Such a distribution limited the potential complications of the procedures while maintaining the high effectiveness of the treatment. Among two thousand two hundred and eighty-nine patients with urolithiasis, two were diagnosed with acromegaly before the nephrological and urological treatment, and seven were diagnosed de novo. Patients with acromegaly required a higher percentage of open surgeries (including nephrectomy) and also had a higher rate of kidney stones recurrence. The concentration of IGF-1 in patients with newly diagnosed acromegaly was similar to those treated with somatostatin analogs (SSA) due to incomplete transsphenoidal pituitary surgery. CONCLUSIONS In the population of patients with urolithiasis requiring hospitalization and interventional treatment compared to the general population, the prevalence of acromegaly was almost 50-fold higher (p = 0.025). Acromegaly itself increases the risk of urolithiasis.
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Affiliation(s)
- Tomasz Ząbkowski
- Department of Urology, Military Institute of Medicine-National Research Institute, 02-637 Warsaw, Poland
| | - Adam Daniel Durma
- Department of Endocrinology and Radioisotope Therapy, Military Institute of Medicine-National Research Institute, 02-637 Warsaw, Poland
| | - Agnieszka Grabińska
- Department of Urology, Military Institute of Medicine-National Research Institute, 02-637 Warsaw, Poland
| | | | - Marek Saracyn
- Department of Endocrinology and Radioisotope Therapy, Military Institute of Medicine-National Research Institute, 02-637 Warsaw, Poland
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Chen W, Shi Z, Feng J, Liu C, Jiang T, Chen Q, He Y, Zhang H, Gao R, Mao H. Effects of severe hydronephrosis on surgical outcomes of minimally invasive percutaneous nephrolithotomy (MPCNL). Wideochir Inne Tech Maloinwazyjne 2023; 18:328-342. [PMID: 37680724 PMCID: PMC10481447 DOI: 10.5114/wiitm.2023.128055] [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: 04/25/2023] [Accepted: 05/07/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction The impact of severe hydronephrosis on the outcomes of minimally invasive percutaneous nephrolithotomy (MPCNL) remains controversial; it is still a subject well worth exploration. Aim To investigate the effects of severe hydronephrosis on surgical outcomes of MPCNL, especially on operative time (OT) and stone-free rate (SFR). Material and methods In total, 301 patients who underwent MPCNL were included in this study and divided into 4 groups according to the degree of hydronephrosis (nil, mild, moderate, and severe hydronephrosis, respectively). Univariate analyses and multivariate logistic analyses were used to determine the risk factors affecting OT and SFR. Results Patients with severe hydronephrosis had a longer OT (p < 0.001), a decreased SFR (p < 0.001), and a higher postoperative haemoglobin drop and blood transfusion rate compared to the other 3 cohorts (p = 0.011 and p = 0.043, respectively). Univariate analyses determined that severe hydronephrosis, calyx for access, stone location, stone type, stone size, and number of tracts significantly correlated with OT, while severe hydronephrosis, stone location, stone type, and stone size showed a strong association with SFR (all p < 0.05). Multivariate analyses further identified that severe hydronephrosis (OR = 3.496, p = 0.013), stone location (≥ 4 calyces: OR = 3.024, p = 0.017), stone type (staghorn: OR = 5.204, p = 0.002), and stone size (≥ 1600 mm2: OR = 12.669, p < 0.001; 800-1599 mm2: OR = 5.194, p < 0.001) were significant risk factors affecting OT, while SFR was independently influenced by stone type (staghorn: OR = 4.377, p = 0.039; multiple: OR = 3.778, p = 0.044), stone location (≥ 4 calyces: OR = 4.413, p = 0.020; 2-3 calyces: OR = 3.617, p = 0.034), and severe hydronephrosis (OR = 7.093, p = 0.001). Conclusions Severe hydronephrosis is a significant risk factor that can lead to longer OT and lower SFR, and correlates with increased risk of bleeding and blood transfusion rate in some cases during MPCNL. Accordingly, severe hydronephrosis is an influential factor that should not be ignored when performing MPCNL.
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Affiliation(s)
- Wenwei Chen
- Department of Urology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Urology, National Regional Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zhuxian Shi
- Department of Urology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Urology, National Regional Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jie Feng
- Department of Urology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Urology, National Regional Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Changyi Liu
- Department of Urology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Urology, National Regional Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Tao Jiang
- Department of Urology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Urology, National Regional Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Qin Chen
- Department of Urology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Urology, National Regional Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yanfeng He
- Department of Urology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Urology, National Regional Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Hua Zhang
- Department of Urology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Urology, National Regional Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Rui Gao
- Department of Urology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Urology, National Regional Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Houping Mao
- Department of Urology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Urology, National Regional Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Morozov A, Kalinin N, Androsov A, McFarland J, Scolarikos A, Saidian D, Gomez Rivas J, Somani B, Enikeev D, Glybochko P, Gazimiev M. A novel less-traumatic needle for kidney puncture: first clinical experience. Int Urol Nephrol 2023:10.1007/s11255-023-03584-3. [PMID: 37204679 DOI: 10.1007/s11255-023-03584-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/30/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION To decrease complication rate, we developed a novel MG needle for kidney puncture consisting of a pointed cannula, an atraumatic mandrin-bulb and a spring mechanism pushing the mandrin-bulb forward. AIM OF THE STUDY To assess efficacy and safety of kidney puncture during percutaneous nephrolithotomy (PCNL) using a novel less-traumatic MG needle within a clinical trial. MATERIALS AND METHODS We conducted a prospective randomized single-center study. In the experimental group, kidney puncture was performed with a novel MG needle while in the control group, standard Trocar or Chiba puncture needles were used. PRIMARY ENDPOINT hemoglobin drop. RESULTS A total of 67 patients were enrolled. Patients who underwent standard puncture (n = 33) had higher hemoglobin drop in the early postoperative period (p = 0.024). Although there was no statistical difference in overall complication rate between the two groups (p = 0.351), two severe Clavien-Dindo IIIa complications with urinoma occurred in patients from the control group. CONCLUSION Less-traumatic needle for kidney puncture may reduce hemoglobin drop and prevent the development of severe complications. At the same time, in terms of stone-free rate (SFR), the efficacy of PCNL remains the same regardless of the needle used for renal access.
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Affiliation(s)
- Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Nikita Kalinin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Jonathan McFarland
- Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Andreas Scolarikos
- 2-nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece
| | - Daniel Saidian
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Juan Gomez Rivas
- Department of Urology, Clinico San Carlos University Hospital, Madrid, Spain
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
| | - Petr Glybochko
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Magomed Gazimiev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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15
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Li H, Yin Y, Nie M. Efficacy and safety of super-mini percutaneous nephrolithotomy in the treatment of urinary calculi: a systematic review and meta-analysis. BMC Urol 2023; 23:87. [PMID: 37161340 PMCID: PMC10170803 DOI: 10.1186/s12894-023-01256-z] [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: 02/03/2023] [Accepted: 04/22/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Super-mini-percutaneous nephrolithotomy (SMP) is feasible and safe in adults and children with moderate-size renal calculi, but the use of SMP to remove larger calculi has yet to be determined. This study aimed to review the efficacy (stone-free rate, SFR) and safety of SMP in treating urinary calculi. METHODS PubMed, the Cochrane Library, and Embase were searched for eligible studies published up to May 2021. The primary outcome was the SFR. The secondary outcomes were the complications (using the Clavien-Dindo grading system), pain score, hospitalization days, and mean hemoglobin decline. All analyses were performed using the random-effects model. Nine studies (2433 patients with SMP and 2178 controls) were included. RESULTS SMP was not associated with an improved SFR in patients with calculi (RR = 1.05, 95%CI: 0.99-1.11). There were no differences in the occurrence of Clavien-Dindo I (RR = 0.95, 95%CI: 0.67-1.35) and Clavien-Dindo II (RR = 0.91, 95%CI: 0.58-1.42) complications between SMP and the control procedures. There were more Clavien-Dindo III complications with SMP than with the control procedures (RR = 0.71, 95%CI: 0.55-0.91), but none of the individual complications significantly differed between the two groups. Clavien-Dindo I fever appeared to be higher with SMP than with the control procedure (RR = 0.64, 95%CI: 0.50-0.83). CONCLUSION In terms of efficacy, there were no differences between SMP and other procedures in treating urinary calculi. Clavien-Dindo I fever and Clavien-Dindo III complications might be more frequent with SMP than other procedures.
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Affiliation(s)
- Han Li
- Urology of Chengdu First People's Hospital, Chengdu Integrated Traditional Chinese Medicine and Western Medicine Hospital, Chengdu, Sichuan, 610000, China
| | - Yong Yin
- Urology of Chengdu First People's Hospital, Chengdu Integrated Traditional Chinese Medicine and Western Medicine Hospital, Chengdu, Sichuan, 610000, China
| | - Ming Nie
- Urology of Chengdu First People's Hospital, Chengdu Integrated Traditional Chinese Medicine and Western Medicine Hospital, Chengdu, Sichuan, 610000, China.
- Urology of Chengdu First People's Hospital, Chengdu Integrated Traditional Chinese Medicine and Western Medicine Hospital, Chengdu City, Sichuan Province, 610000, China.
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Zhan CS, Zhang C, Wang JZ, Fan S, Zhao L, Shu HM, Hao ZY. Stone attenuation on computer tomography helps surgeons make decisions between miniaturized percutaneous nephrolithotomy or retrograde intrarenal surgery for lower pole stones: a retrospective study. Urolithiasis 2023; 51:77. [PMID: 37093335 DOI: 10.1007/s00240-023-01442-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 03/30/2023] [Indexed: 04/25/2023]
Abstract
A retrospective study was performed on 200 patients who underwent miniaturized percutaneous nephrolithotomy (mini-PCNL) or retrograde intrarenal surgery (RIRS) for 10-20 mm sized lower pole renal calculi to investigate the relationship between computed tomography (CT) attenuation of calculi and surgical outcomes. CT was used to examine the location, size, and CT attenuation values of the calculi. Additionally, the operation time, hospital stay, hemoglobin (Hb) reduction, stone-free rate (SFR), and complication rate were also meticulously documented and subjected to comparative analysis. Complications were assessed using the Clavien-Dindo grading system. We observed no significant differences in hospitalization data and follow-up outcomes, except for a longer hospital stay and higher Hb drops in patients receiving mini-PCNL. Statistical analysis revealed an association between CT attenuation and operation time. Compared with mini-PCNL, RIRS could reduce bleeding, hospital stay, surgery time, and complications for 10-20 mm sized lower pole kidney stones with CT values < 1000 HU. RIRS resulted in longer operation time and lower stone-free rates despite shorter hospital stays and less bleeding than mini-PCNL for stones with CT values > 1000 HU. Therefore, selecting an appropriate surgical method based on CT attenuation might improve outcomes. For patients with stone attenuation values < 1000 HU, RIRS is the recommended option. When stone attenuation values > 1000 HU, the surgical method should be chosen based on the patient's individual situation.
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Affiliation(s)
- Chang-Sheng Zhan
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Cheng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Jian-Zhong Wang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Song Fan
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Lei Zhao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Hong-Min Shu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zong-Yao Hao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
- Institute of Urology, Anhui Medical University, Hefei, China.
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China.
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Morozov A, Kalinin N, Androsov A, Gazimiev A, Lerner Y, Gomez Rivas J, Somani B, Enikeev D, Gazimiev M. A Novel and Less Traumatic Needle for Kidney Puncture: Development and Preclinical Study Results. J Endourol 2023; 37:93-98. [PMID: 36074948 DOI: 10.1089/end.2022.0371] [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: 01/10/2023] Open
Abstract
Abstract Introduction: A considerable proportion of percutaneous nephrolithotomy complications occurs during renal puncture. An option to decrease the complications rate is needle modification to make the procedure less traumatic. We aimed to evaluate the effectiveness of the novel MG needle in a preclinical study. Materials and Methods: We developed an original MG needle based on the Veress needle concept containing an atraumatic (blunt) mandrin connected through a spring to the cannula. The MG needle's properties were compared with those of the conventional Chiba and Trocar needles in two experiments. In the first experiment, we assessed the force required to puncture the model. In the second experiment, we punctured a porcine kidney and analyzed histology report after the puncture. Results: We performed a series of 30 punctures of polypropylene block by each needle. The force required to make a puncture with the Chiba needle (6.53 ± 0.87 N) was significantly lower compared with the MG needle (7.1 ± 1.07 N), p = 0.027. However, the MG needle turned out to be superior to the Trocar needle (8.71 ± 1.08 N), p = 0.001. A total of 15 specimens were obtained after three renal punctures were made with each needle. A microscopy of the specimen after puncture with the Chiba and Trocar needles showed small fragments of epithelium and erythrocytes inside the canal with uneven margins where the needle passed. A microscopy of the specimen after puncture with a novel MG needle showed a canal with even margins. No tissue fragments inside the canal were observed. Conclusion: The force required to puncture with the novel MG needle is comparable with conventional needles. According to preclinical experiments, histology report of porcine kidney indicates that renal puncture with an MG needle is less traumatic. It may reduce the risk of bleeding, and this should be proved during clinical trials.
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Affiliation(s)
- Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Nikita Kalinin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Artur Gazimiev
- Institute for Clinical Medicine, Sechenov University, Moscow, Russia
| | - Yulia Lerner
- Institute of Clinical Morphology and Digital Pathology, Sechenov University, Moscow, Russia
| | - Juan Gomez Rivas
- Department of Urology, Clinico San Carlos University Hospital, Madrid, Spain
| | - Bhaskar Somani
- University Hospital Southampton NHS Trust Southampton, University of Southampton, United Kingdom
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Magomed Gazimiev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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Sigdel B, Shrestha S, Maskey P. Predicting the outcome of mini percutaneous nephrolithotomy using STONE nephrolithometry score-a single-center experience. Urolithiasis 2022; 51:14. [PMID: 36495320 DOI: 10.1007/s00240-022-01379-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 11/02/2022] [Indexed: 12/13/2022]
Abstract
To predict stone-free and complication rates following mini-percutaneous nephrolithotomy (m-PCNL) using STONE nephrolithometry score, this prospective observational study was conducted in the Department of Surgery, Urology Unit, Patan Hospital. All the patients undergoing m-PCNL were included. The cases were performed in the prone position, a single tract less than 18 French was made, and pneumatic lithotripsy was done. Stone-free rates were assessed with plain X-ray kidney, ureter, and bladder (X-ray KUB) on the first post-operative day or at 15 days follow-up. Complications within 30 days were graded using modified Clavien grading. A total of 106 patients were included in the final analysis. The overall stone-free rate was 83%. Among the individual variables, only staghorn calculus was associated with residual stone (p = 0.007). Patients who were rendered stone-free had statistically significantly lower STONE scores than those with residual stone (p < 0.001). The complication rate was 23%, and the majority were Clavien grade I complications. A higher STONE score had a greater risk of having complications but was not statistically significant (p = 0.11). STONE nephrolithometry score can predict stone complexity pre-operatively and subsequent stone-free status and thus, helps in pre-operative surgical planning and counseling for possible outcomes following m-PCNL.
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Affiliation(s)
- Bidhan Sigdel
- Department of Surgery, Urology Unit, Patan Academy of Health Sciences, Patan Hospital, Lalitpur, Nepal.
| | - Samir Shrestha
- Department of Surgery, Urology Unit, Patan Academy of Health Sciences, Patan Hospital, Lalitpur, Nepal
| | - Pukar Maskey
- Department of Surgery, Urology Unit, Patan Academy of Health Sciences, Patan Hospital, Lalitpur, Nepal
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19
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In vitro renal calculi destruction by a high-frequency glow discharge plasma. Sci Rep 2022; 12:12637. [PMID: 35879389 PMCID: PMC9314433 DOI: 10.1038/s41598-022-16702-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/14/2022] [Indexed: 11/21/2022] Open
Abstract
Despite the progress made in the treatment of nephrolithiasis, the existing methods of renal calculi destruction are not ideal and have both advantages and disadvantages. Considering the process of high-frequency glow discharge formation on the surface of an electrode and in an electrolyte solution, we obtained the results on the destruction of renal calculi in vitro. It was shown that the destruction of kidney stones by glow discharge plasma was caused by several processes—the plasma induced effect of hydrated electrons and shock wave effect of the electrolyte stimulated by electrical breakdowns in the plasma. The plasma generation modes were configured by estimating the thickness of the vapor–gas layer in which the plasma burns. Thus, the average rate of contact destruction of renal calculi was measured depending on the plasma generator input power and time of plasma exposure. We conclude that the method of stone fragmentation by high-frequency electrolyte plasma is rather perspective and can be used in endoscopic urology for percutaneous and transurethral lithotripsy.
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Widyokirono DR, Kloping YP, Hidayatullah F, Rahman ZA, Ng ACF, Hakim L. Endoscopic Combined Intrarenal Surgery vs Percutaneous Nephrolithotomy for Large and Complex Renal Stone: A Systematic Review and Meta-Analysis. J Endourol 2022; 36:865-876. [PMID: 35152754 DOI: 10.1089/end.2021.0761] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Managing complex and large renal stones with percutaneous nephrolithotomy (PCNL) is difficult because of the likelihood of residual stones and multiple access. Endoscopic combined intrarenal surgery (ECIRS) is introduced as an improvement to the procedure to manage stones in one session. The objective of this systematic review and meta-analysis is to compare the efficacy and safety between ECIRS and PCNL for treating large and complex renal stones. Materials and Methods: We conducted a systematic review in the Embase, Scopus, and MEDLINE databases based on the 2020 Preferred Reporting Items for Systematic Review and Meta-Analyses guideline. Eligible studies comprised both randomized and nonrandomized studies comparing ECIRS and PCNL. Results: A total of five nonrandomized studies and one randomized controlled trial were included. The analysis was divided into two subgroups based on the PCNL type, a conventional PCNL (cPCNL) and a mini-PCNL (mPCNL). The one-step stone-free rate (SFR) of ECIRS were significantly higher compared with both the cPCNL (odds ratio [OR] 5.14, 95% confidence interval [CI] 2.54 to 10.4, p < 0.001) and mPCNL (OR 4.27, 95% CI 2.57-7.1, p < 0.001). There were no significant differences in mean operative time and hemoglobin drop between both groups (p > 0.05). The use of auxiliary procedures was significantly higher in both PCNL groups compared with the ECIRS group (OR 0.19, 95% CI 0.13-0.30, p < 0.001). The overall complication rate of ECIRS was lower compared with PCNL (OR 0.43, 95% CI 0.21-0.85, p = 0.02), especially urosepsis, in which the incidence was lower compared with cPCNL (OR 0.14, 95% CI 0.02-0.78, p = 0.02), but not mPCNL (p > 0.05). Conclusion: ECIRS is an effective and safe treatment particularly for large and complex nephrolithiasis, with significantly higher one-step SFR, a lower necessity for auxiliary procedures, and a lower complication rate compared with PCNL.
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Affiliation(s)
- Dyah Ratih Widyokirono
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
- Department of Urology, Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Yudhistira Pradnyan Kloping
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
- Department of Urology, Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Furqan Hidayatullah
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
- Department of Urology, Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Zakaria Aulia Rahman
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
- Department of Urology, Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Anthony Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Lukman Hakim
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
- Department of Urology, Universitas Airlangga Teaching Hospital, Surabaya, East Java, Indonesia
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21
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Soltani MH, Karimi A, Salimi M, Amini E. Feasibility, safety, and effectiveness of adult-sized instruments in pediatric percutaneous nephrolithotomy: A systematic review and meta-analysis. J Pediatr Urol 2022; 18:303-310. [PMID: 35534382 DOI: 10.1016/j.jpurol.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/25/2022] [Accepted: 04/15/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Little evidence exists regarding the benefits and disadvantages of adult-sized instruments for Percutaneous Nephrolithotomy (PCNL) in pediatric patients. This systematic review aims to clarify the safety and efficacy of this approach. MATERIALS AND METHODS We conducted a systematic literature review using databases of PubMed, Scopus, Embase, Web of Science, and Cochrane and included studies that evaluated PCNL in children. All identified records underwent two-phase title/abstract and full-text screening. Pediatric patients were defined as 17 years or younger, and adult-sized instruments as 24Fr and above. The primary outcomes were success (stone-free) rate and surgical complications obtained from studies comparing adult-sized and pediatric-sized instruments. RESULTS A total of 84 abstracts and 16 full text article were assessed till July 2021 and 6 studies were included. All studies were retrospective. Number of accesses (Odds ratio (OR), adult-sized to pediatric-sized: 0.96, 95% CI: 0.52-1.78, p = 0.89), initial stone-free rate (OR: 0.73, 95% CI: 0.42-1.27, p = 0.26), final stone-free rate (OR: 1.14, 95% CI: 0.38-3.44, p = 0.82), and residual stones (OR: 0.79, 95% CI: 0.42-1.49, p = 0.46) could be analyzed, none with significant differences. Overall complication rates did not differ significantly between the groups. However, one study reported more grade III/IV complications in the adult-sized instrument group. The adult-sized instrument group had a higher hemoglobin/hematocrit decrease in 3 studies. Duration of surgery, fluoroscopy time, length of hospital stay, times to nephrostomy tube removal, and transfusion rate could not be assessed in meta-analysis; however, they were comparable between the adult-sized and pediatric-sized groups. Studies also showed that adult-sized instruments are applicable in children younger than 3 years and those with staghorn calculi as well as in fluoroscopy-free ultrasound-guided PCNL. CONCLUSION Adult-sized instruments had comparable outcomes to the pediatric-sized ones and can be applied in pediatric PCNL when factors such as accessibility justify their use. The number and design of the studies restrict the reliability of the comparisons. Therefore, future studies with improved methodology may better reveal the impact of instruments on the outcome of PCNL in children.
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Affiliation(s)
- Mohamamd Hossein Soltani
- Shahid Labbafinejad Hospital, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirali Karimi
- Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maziar Salimi
- Shahid Labbafinejad Hospital, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Erfan Amini
- Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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22
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Lin CH, Lin YC, Chiang HC, Yan MY, Fang WY, Chen PH. Totally tubeless single access tract mini-percutaneous nephrolithotripsy in treatment of large burden > 2-cm and/or complex renal stones: a case series of 62 patients. BMC Urol 2022; 22:61. [PMID: 35429983 PMCID: PMC9013460 DOI: 10.1186/s12894-022-01012-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/07/2022] [Indexed: 01/23/2023] Open
Abstract
Background Limited literature has focused on the use of totally tubeless mini-percutaneous nephrolithotomy (PCNL) for the treatment of large renal stones. We present our findings of treating patients with large and/or complex renal stones using single renal access totally tubeless mini-PCNL. Methods From March 2018 to May 2021, 62 consecutive cases in which single tract totally tubeless mini-PCNL was used to treat complex renal stones were enrolled, all with calculi > 2 cm. All procedure of puncture and dilation were guided by fluoroscope. The complexity of stones was assessed according to the Guy’s Scoring System (GSS). The surgical duration, length of hospital stay, analgesia requirement, stone-free rate, and perioperative morbidity were assessed. Results The mean preoperative stone burden was 36.69 ± 19.76 mm (above 2 cm in all cases), mean surgical duration was 61.93 ± 40.84 min (range 15–180 min), and mean hematocrit reduction was 4.67 ± 2.83%. Postoperative Nalbuphine was used in 6 patients. The mean length of stay was 2.46 ± 1.19 days (range 2–8 days), and the postoperative stone-free rate was 83.9% (52/62), and 87.1% (54/62) after auxiliary ESWL. The overall complication rate was 14.5%, the majority of complications being postoperative transient fever. Conclusion For the treatment of large bursen > 2 cm and/or complex renal stones, totally tubeless single tract mini-PCNL ensures a feasible SFR, low morbidity and short hospital stay. According to the low complication rate in our study, the totally tubeless manner was not associated with an increased risk of postoperative morbidity, and patients benefited from decreased postoperative analgesics use.
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Juliebø-Jones P, Æsøy MS, Gjengstø P, Beisland C, Ulvik Ø. Ureteroscopy for stone disease in the paediatric population: lessons learned and outcomes in a Nordic setting. Ther Adv Urol 2022; 14:17562872221118727. [PMID: 36032655 PMCID: PMC9403456 DOI: 10.1177/17562872221118727] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/14/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction: Paediatric stone disease is rare in the Nordic communities. Still, the
condition can require surgical intervention in the form of ureteroscopy
(URS). Here, we report outcomes achieved at a regional (tertiary)
centre. Patients and methods: Retrospective analysis was performed of consecutive patients (<18 years of
age) undergoing URS for stone disease between 2010 and 2021. Outcomes of
interest included stone-free rate (SFR) determined using a definition of no
residual fragments ⩾ 3 mm on imaging and complications classified according
to Clavien–Dindo system. Results: In total, 23 patients underwent 47 URS procedures for a total of 31 stone
episodes. Mean age was 9 (range 1–17) years and male-to-female ratio was
6:17. Overall, 35% had at least one medical comorbidity. Ultrasound
determined preoperative stone status in 87%. Mean largest index and
cumulative stone sizes were 9 (range 3–40) and 12 (range 3–40) mm,
respectively. Overall, 32% had multiple stones. Lower pole was the commonest
stone location (39%). No patients underwent elective pre-operative stenting.
Ureteral access sheaths were not used in any cases. Access to upper urinary
tract at first procedure was successful in 94%. Initial and final SFR was
61% and 90%, respectively. No intra-operative complications were recorded.
Overall post-operative complication rate was 17.5%. Urinary tract infection
(CD II) was the commonest adverse event (12.5%). Conclusion: Paediatric URS can be delivered in the setting of a regional centre without
compromising outcomes. This includes when carried out by adult
endourologists, without routine pre-stenting and omitting use of ureteric
access sheath.
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Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
| | | | - Peder Gjengstø
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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24
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Desoky E, Sakr A, Elsayed ER, Ali MM. Ultra-mini-percutaneous nephrolithotomy in flank-free modified supine position versus prone position in treatment of pediatric renal pelvic and lower calyceal stones. J Endourol 2021; 36:610-614. [PMID: 34861776 DOI: 10.1089/end.2021.0557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To report the safety and efficacy of ultra-mini-percutaneous nephrolithotomy (UMPCNL) in flank free modified supine (FFMS) and prone positions in management of pediatric renal calculi. PATIENTS & METHODS This prospective randomized study included 55 pediatric patients with symptomatic renal stones and suitable for ultra-mini-percutaneous nephrolithotomy. They were randomized into two groups. Group A included 28 patients who were treated by UMPCNL in FFMS position (with a pad below the ipsilateral shoulder and buttocks, putting ipsilateral upper limb over the chest, and crossing the extended ipsilateral lower limb over the flexed contralateral one) and Group B included 27 patients treated by UMPCNL in the prone position. In both groups dilatation was done to 13 French sheath allowing the introduction of 6/7.5 French semi-rigid ureteroscope and fragmentation of stones by Ho:YAG laser with a 550-μm fiber laser lithotripter. RESULTS The operation time in FFMS position UMPCNL group was significantly shorter than prone position UMPCNL group (84.3±9.87 vs. 99.3±8.75) minutes with p=0.022. There was no significant difference between both groups in terms of stone free rate (89.3% vs. 88.9%), overall complication rate (including transient fever) (21.4% vs. 18.5%), post-operative pain (VAS score) (3.4±0.8 vs. 3.3±0.9), or hospital stay (3.53±0.8 vs. 4.1±1.1) days. CONCLUSION Both ultra-mini-percutaneous nephrolithotomy in FFMs and prone positions are feasible, safe and effective in treatment of pediatric renal stones with relatively shorter operative time in FFMS position.
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Affiliation(s)
- Esam Desoky
- Zagazig University, Urology, 42 Mostafa Foad St.-Manshiet Abaza, Zagazig, Egypt, 44511;
| | - Ahmed Sakr
- Zagazig University, urology, zagazig, Egypt;
| | - Ehab Raafat Elsayed
- Zagazig university hospital, Urology , Egypt -sharkia, Zagazig, Zagazig , Sharkia, Egypt, 44111;
| | - Maged M Ali
- Zagazig University Faculty of Human Medicine, 68865, urology, Al-Sharqia, Zagazig, Bahr street, Zagazig, Egypt, Zagazig, Egypt, 44519, EGYPT;
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25
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Jiang P, Brevik A, Clayman RV. The Life and Death of Percutaneous Stone Removal: "Looking Back-Looking Forward". Urol Clin North Am 2021; 49:119-128. [PMID: 34776046 DOI: 10.1016/j.ucl.2021.07.010] [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: 10/20/2022]
Abstract
Although percutaneous nephrolithotomy (PCNL) is less morbid than open surgery, it still carries risks of significant complications as well as injury to the renal parenchyma. Flexible ureteroscopic stone removal, although causes no appreciable damage to the renal parenchyma, has limitations, most notably, a lower stone-free rate than PCNL. Advances in our knowledge regarding ureteral physiology combined with technical developments applied to ureteral access sheath deployment and size may well propel retrograde intrarenal surgery to the forefront of kidney stone removal, regardless of stone size or location.
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Affiliation(s)
- Pengbo Jiang
- Department of Urology, University of California - Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868, USA.
| | - Andrew Brevik
- Department of Urology, University of California - Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868, USA
| | - Ralph V Clayman
- Department of Urology, University of California - Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868, USA
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26
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Lievore E, Zanetti SP, Fulgheri I, Turetti M, Silvani C, Bebi C, Ripa F, Lucignani G, Pozzi E, Rocchini L, De Lorenzis E, Albo G, Longo F, Salonia A, Montanari E, Boeri L. Cost analysis between mini-percutaneous nephrolithotomy with and without vacuum-assisted access sheath. World J Urol 2021; 40:201-211. [PMID: 34432135 PMCID: PMC8813798 DOI: 10.1007/s00345-021-03811-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose To perform a cost analysis between vacuum-assisted percutaneous nephrolithotomy (vmPCNL) and minimally invasive PCNL (MIP) and explore potential predictors of costs associated with the procedures. Methods We analyzed data from 225 patients who underwent vmPCNL or MIP at a single tertiary referral academic center between January 2016 and December 2020. We collected patients’ demographics, peri-and postoperative data and detailed expense records. After propensity score matching, 108 (66.7%) vmPCNL and 54 (33.3%) MIP procedures were analyzed. Descriptive statistics assessed differences in clinical and operative parameters. Univariable and multivariable linear regression models tested the association between clinical variables and costs. Results Operative time (OT) was shorter for vmPCNL, and the use of additional instruments to complete litholapaxy was more frequent in MIP (all p ≤ 0.01). Length of stay (LOS) was longer for MIP patients (p = 0.03) and the stone-free (SF) rate was higher after vmPCNL (p = 0.04). The overall instrumentation cost was higher for vmPCNL (p < 0.001), but total procedural costs were equivalent (p = 0.9). However, the overall cost for the hospitalization was higher for MIP than vmPCNL (p = 0.01). Univariable linear regression revealed that patient’s comorbidities, OT, any postoperative complication and LOS were associated with hospitalization costs (all p < 0.001). Multivariable linear regression analysis revealed that LOS and OT were associated with hospitalization costs (all p < 0.001), after accounting for vmPCNL procedure, patients’ comorbidities, and complications. Conclusion vmPCNL may represent a valid option due to clinical and economic benefits. Shorter OT, the lower need for disposable equipment and the lower complication rate reduced procedural and hospitalization costs. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03811-5.
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Affiliation(s)
- Elena Lievore
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Stefano Paolo Zanetti
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Irene Fulgheri
- Department of Radiology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Turetti
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Carlo Silvani
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Carolina Bebi
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Francesco Ripa
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Gianpaolo Lucignani
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Lorenzo Rocchini
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Elisa De Lorenzis
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giancarlo Albo
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Fabrizio Longo
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Boeri
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.
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27
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Ghazala SG, Saeed Ahmed SM, Mohammed AA. Can mini PCNL achieve the same results as RIRS? The initial single center experience. Ann Med Surg (Lond) 2021; 68:102632. [PMID: 34386224 PMCID: PMC8346359 DOI: 10.1016/j.amsu.2021.102632] [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: 06/13/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Urolithiasis is a prevalent disease worldwide with high recurrence rate, minimally invasive interventions have largely replaced open ones, namely PCNL and RIRS. Miniaturization, optical improvements, and modern laser types made these procedures safe and effective in the management of single renal stones.Aim of the study: Is to compare the effectiveness of mini PCNL with RIRS in the treatment of single renal stone of ≤25 mm. PATIENTS AND METHODS This prospective study that included 60 patients with single renal stones of ≤25 mm and were treated by either mini PCNL (group A) or RIRS (group B). The study was performed during the period from October 2020 to April 2021. RESULTS The mean operative time RIRS group was 43.6 ± 10.493, while for miniPCNL it was 36.6 ± 7.035 (P = 0.004). The stone free rate in RIRS and miniPCNL group was 70% and 90% respectively (P = 0.053). The need for JJ stent was higher in RIRS compared to miniPCNL group (70% vs. 40%) respectively (P = 0.02). The duration of hospital stay in miniPCNL was 38.2 h compared to 16.7 h for RIRS group (p = 0.0001). The rate of postoperative hemoglobin drop was higher in MiniPCNL compared to RIRS (P = 0.0001). There was no significant difference regarding complication rates between both groups. CONCLUSION Mini-PCNL FOR the treatment of renal stones sized ≤25 mm has high stone free rate, shorter operative time, less requirement for JJ stent and near similar post-operative pain and complications compared to RIRS.
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Affiliation(s)
| | | | - Ayad Ahmad Mohammed
- Department of Surgery, College of Medicine, University of Duhok, DUHOK, Kurdistan Region, Iraq
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28
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Yu W, Ruan Y, Xiong Z, Zhang Y, Rao T, Cheng F. The Outcomes of Minimally Invasive Percutaneous Nephrolithotomy with Different Access Sizes for the Single Renal Stone ≤25 mm: A Randomized Prospective Study. Urol Int 2021; 106:440-445. [PMID: 34198290 DOI: 10.1159/000516914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 04/16/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to provide a randomized controlled trial comparing the outcomes of different access sizes used in the solo ultrasonic-guided minimally invasive percutaneous nephrolithotomy (mini-PCNL). METHODS From January 2018 to December 2019, a total of 160 cases with single renal stones of <25 mm were randomized to undergo mini-PCNLs with Fr16, Fr18, Fr20, or Fr22 accesses. All accesses were established with the axis of the target calyx as the marker for puncture location and then expanded to the desired size. Hemoglobin reduction, operative time, stone-free rate, complications, etc., were all recorded and assessed. RESULTS The demographic data were similar, and there were no significantly intergroup differences in stone-free rate, complications, and hospital stay time. The hemoglobin reduction was comparable and was 0.9 ± 0.6, 0.9 ± 0.7, 1.0 ± 0.5, and 1.1 ± 0.7 g/dL for the groups Fr16, Fr18, Fr20, and Fr22, respectively. The operative time was 53.4 ± 14.5, 48.5 ± 15.2, 42.8 ± 13.3, and 43.3 ± 13.1 min for the 4 groups, which decreased significantly from group Fr16 to Fr20, but there was no significant difference between Fr20 and Fr22 groups. CONCLUSIONS The axis of target calyx is a reliable marker for establishment of percutaneous renal access under ultrasonic guidance. The surgical outcomes of different access sizes were comparable, but the operation time was significantly shortened with the increase of size. However, Fr22 was not more efficient than Fr20.
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Affiliation(s)
- Weimin Yu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China,
| | - Yuan Ruan
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhuang Xiong
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yunlong Zhang
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ting Rao
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Fan Cheng
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
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Tay YX, Kaur B. Competency-based education for training of diagnostic radiographers in percutaneous nephrolithotomy procedure in the operating theatre-an initial experience. J Med Imaging Radiat Sci 2021; 52:S8-S10. [PMID: 34183304 DOI: 10.1016/j.jmir.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/05/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Yi Xiang Tay
- Radiography Department, Division of Radiological Sciences, Singapore General Hospital, Singapore.
| | - Berinderjeet Kaur
- Mathematics & Mathematics Education AG, National Institute of Education, Nanyang Technological University, Singapore
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30
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Hosseini MM, Irani D, Altofeyli A, Eslahi A, Basiratnia M, Haghpanah A, Adib A, Ahmed F. Outcome of Mini-Percutaneous Nephrolithotomy in Patients Under the Age of 18: An Experience With 112 Cases. Front Surg 2021; 8:613812. [PMID: 34211997 PMCID: PMC8239139 DOI: 10.3389/fsurg.2021.613812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 05/10/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: Renal calculi are becoming more common among children. Although, extracorporeal shock wave lithotripsy (ESWL) is the first choice in this age group, minimal invasive surgeries, such as percutaneous nephrolithotomy (PCNL), are indicated for some patients. Recently, PCNL devices have become smaller in size with acceptable efficacy and lower complications. We evaluated the outcomes and complications of mini-PCNL (MPCNL) surgery in our referral training centers. Materials and Methods: Between September 2012 and January 2020, a total of 112 children under the age of 18, who had shown failure of ESWL, and/or their parents refused to do it, underwent MPCNL (15 Fr). The patients' profiles were reviewed for data collection including preoperative and stone data, operation information, and postoperative complications. Results: Of 112 patients, 69 were boys, and 43 were girls. Their mean age was 8.6 years (14 months to 18 years). Mean stone size was 20 mm (14–34 mm). Seventy-four cases had renal pelvic stone, 22 had pelvis and lower pole, and 16 had staghorn. The mean operation time was 65 min (35–100 min), and mean radiation time was 0.6 min (0.2–1.4 min). Low-grade fever was detected in 14 patients (12.5%). Four patients needed blood transfusion and two had increased creatinine, which improved with conservative management. One patient developed urosepsis that resolved with antibiotic therapy. None of the patients had kidney perforation or other organ injury or death. Early stone-free rate (SFR) after operation was 90.2% (101 patients). Six patients had residual fragment <5 mm, which passed spontaneously in 2 weeks after operation (total SFR 95.3%). Three patients underwent second-look nephroscopy, and ureteroscopy was done for two patients due to migrated stone fragments to the distal ureter. Conclusion: MPCNL is recommended as a safe alternative option for treatment of the nephrolithiasis in children with good outcome and acceptable complications.
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Affiliation(s)
- Mohammad Mehdi Hosseini
- Shiraz Nephrology-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Dariush Irani
- Department of Urology, Shaheed Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ala'a Altofeyli
- Department of Urology, Shaheed Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Eslahi
- Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mitra Basiratnia
- Shiraz Nephrology-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolreza Haghpanah
- Department of Urology, Shaheed Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Adib
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Faisal Ahmed
- Department of Urology, Urology Research Center, Al-Thora General Hospital, Ibb University of Medical Since, Ibb, Yemen
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31
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Zeng G, Zhong W, Pearle M, Choong S, Chew B, Skolarikos A, Liatsikos E, Pal SK, Lahme S, Durutovic O, Farahat Y, Khadgi S, Desai M, Chi T, Smith D, Hoznek A, Papatsoris A, Desai J, Mazzon G, Somani B, Eisner B, Scoffone CM, Nguyen D, Ferretti S, Giusti G, Saltirov I, Maroccolo MV, Gökce MI, Straub M, Bernardo N, Lantin PL, Saulat S, Gamal W, Denstedt J, Ye Z, Sarica K. European Association of Urology Section of Urolithiasis and International Alliance of Urolithiasis Joint Consensus on Percutaneous Nephrolithotomy. Eur Urol Focus 2021; 8:588-597. [PMID: 33741299 DOI: 10.1016/j.euf.2021.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/10/2020] [Accepted: 03/02/2021] [Indexed: 02/07/2023]
Abstract
CONTEXT Although percutaneous nephrolithotomy (PCNL) has been performed for decades and has gone through many refinements, there are still concerns regarding its more widespread utilization because of the long learning curve and the potential risk of severe complications. Many technical details are not included in the guidelines because of their nature and research protocol. OBJECTIVE To achieve an expert consensus viewpoint on PCNL indications, preoperative patient preparation, surgical strategy, management and prevention of severe complications, postoperative management, and follow-up. EVIDENCE ACQUISITION An international panel of experts from the Urolithiasis Section of the European Association of Urology, International Alliance of Urolithiasis, and other urology associations was enrolled, and a prospectively conducted study, incorporating literature review, discussion on research gaps (RGs), and questionnaires and following data analysis, was performed to reach a consensus on PCNL. EVIDENCE SYNTHESIS The expert panel consisted of 36 specialists in PCNL from 20 countries all around the world. A consensus on PCNL was developed. The expert panel was not as large as expected, and the discussion on RGs did not bring in more supportive evidence in the present consensus. CONCLUSIONS Adequate preoperative preparation, especially elimination of urinary tract infection prior to PCNL, accurate puncture with guidance of fluoroscopy and/or ultrasonography or a combination, keeping a low intrarenal pressure, and shortening of operation time during PCNL are important technical requirements to ensure safety and efficiency in PCNL. PATIENT SUMMARY Percutaneous nephrolithotomy (PCNL) has been a well-established procedure for the management of upper urinary tract stones. However, according to an expert panel consensus, core technical aspects, as well as the urologist's experience, are critical to the safety and effectiveness of PCNL.
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Affiliation(s)
- Guohua Zeng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wen Zhong
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Margaret Pearle
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Simon Choong
- Institute of Urology, University College Hospital, London, UK
| | - Ben Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Evangelos Liatsikos
- Department of Urology, University Hospital of Patras, University of Patras, Patras, Greece
| | | | - Sven Lahme
- Department of Urology, Siloah St. Trudpert Hospital, Pforzheim, Germany
| | - Otas Durutovic
- Department of Urology, Clinic of Urology, University of Belgrade, Belgrade, Serbia
| | - Yasser Farahat
- Department of Urology, Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates
| | - Sanjay Khadgi
- Department of Urology, Vayodha Hospital, Kathmandu, Nepal
| | - Mahesh Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Thomas Chi
- Department of Urology, University of California, San Francisco, CA, USA
| | - Daron Smith
- Institute of Urology, University College Hospital, London, UK
| | - Andras Hoznek
- Department of Urology, Mondor Hospital, Créteil, France
| | | | - Janak Desai
- Department of Urology, Samved Hospital, Ahmedabad, India
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Brian Eisner
- Deparment of Urology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Stefania Ferretti
- Department of Urology, Hospital and University of Parma, Parma, Italy
| | - Guido Giusti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | | | - Mehmet Ilker Gökce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Michael Straub
- Department of Urology, Technical University Munich, Munich, Germany
| | - Norberto Bernardo
- Department of Urology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | | | - Sherjeel Saulat
- Department of Urology, Sindh Institution of Urology and Transplantation, Karachi, Pakistan
| | - Wael Gamal
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | - John Denstedt
- Division of Urology, Western University, London, Ontario, Canada
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Kemal Sarica
- Department of Urology, Biruni University, Medical School, Istanbul, Turkey.
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El-Nahas AR, Khadgi S, Diab M, Al-Terki A. Definition and Unfavorable Risk Factors of Trifecta in Mini-Percutaneous Nephrolithotomy. J Endourol 2021; 35:1140-1145. [PMID: 33554728 DOI: 10.1089/end.2020.1192] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objectives: In performing mini-percutaneous nephrolithotomy (PCNL), we aimed at achieving the trifecta of stone-free status and no complications in a single treatment session. We analyzed our experience to determine negative predictors for achieving these three-fold goals. Patients and Methods: The data of all consecutive patients who underwent tubeless mini-PCNL between July 2015 and March 2020 in two hospitals were retrospectively reviewed. Stone-free was defined as no residual stones. Complications were recorded and graded according to modified Clavien classification. Patients were divided into two groups according to the outcome (trifecta and non-trifecta). Factors affecting the outcome were compared between both groups by using univariate and multivariate analyses to detect independent unfavorable risk factors. Results: The study included 944 patients with mean age 40.2 years (standard deviation: 13.6). The stone-free rate after one session of mini-PCNL was 90.7%. Auxiliary procedures were needed in 14 patients (1.5%). Complications were observed in 76 patients (8.1%). Trifecta was achieved in 792 patients (84%). Independent unfavorable risk factors in multivariate analysis were number of caliceal groups affected by the stones (relative risks were 1.95 to 2.27 and 5.7 for one, two, and three caliceal groups respectively) and number of percutaneous tracts (relative risk was 2.2). Stone size and complexity were not significant predictors of missing trifecta in multivariate analysis. Conclusions: Mini-PCNL can achieve a high rate of trifecta (84%) for different stone sizes and complexities. Stones distribution in multiple caliceal groups and multiple tracts are the independent unfavorable risk factor.
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Affiliation(s)
- Ahmed R El-Nahas
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.,Urology Unit, AL-Amiri Hospital, Kuwait, Kuwait
| | - Sanjay Khadgi
- Department of Urology, Vayodha Hospital, Kathmandu, Nepal
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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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Yang X, Huang P, Cao J, Cao Z, Nie Y. Application of Percutaneous Holmium Laser Lithotripsy in the Treatment of Bladder Calculi with Lower Urinary Tract Obstruction or Pelvic Joint Disease. Urol Int 2021; 105:581-586. [PMID: 33503623 DOI: 10.1159/000511746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 09/17/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim was to summarize the experience of percutaneous holmium laser lithotripsy in the treatment of bladder calculi with lower urinary tract obstruction or pelvic joint disease in our hospital, explore its efficacy and safety, and improve the minimally invasive surgical technique for bladder calculi. METHODS The clinical data of 61 patients with bladder calculi combined with lower urinary tract obstructive diseases, including urethral stricture, benign prostatic hyperplasia, and bladder neck contracture or pelvic joint diseases in our hospital from 2017 to 2019 were retrospectively analyzed. All patients with bladder stones measuring 1.5-9 cm were placed in supine or lithotomy position. B-scan was conducted to locate the puncture above the pubic symphysis, establishing a 16-30 Fr bladder channel, and Lumenis holmium laser lithotripsy was subsequently performed through a Li Xun Nephroscope. The crushed stones were flushed out through the percutaneous bladder channel or taken out with foreign body forceps. After surgery, the cystostomy tube was indwelled for 3 days. RESULTS All the 61 cases were operated successfully with an average lithotripsy time of 25 min, and there was no conversion to open surgery. Postoperative reexamination showed neither residual calculi nor complications such as severe infection, massive hemorrhage, and intestinal injury. CONCLUSION Percutaneous holmium laser lithotripsy is an improved minimally invasive surgical technique for the treatment of bladder calculi with the advantages of clear surgical field, high stone removal efficiency, less trauma, low-pressure bladder perfusion, and low incidence of accessory injury and infection. For patients with lower urinary tract obstructive disease resulting in obstruction of transurethral surgery and patients with pelvic joint disease resulting in difficult lithotomy position placement, this procedure is more advantageous than transurethral surgery. It is also suitable for bladder calculus with a long diameter >5 cm or multiple calculi.
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Affiliation(s)
- Xingguo Yang
- Department of Urology, Yiling Hospital, Yichang, China
| | - Pinxin Huang
- Department of Urology, Yiling Hospital, Yichang, China
| | - Jun Cao
- Department of Urology, Yiling Hospital, Yichang, China
| | - Zhixiu Cao
- Department of Urology, Wuhan No. 1 Hospital, Wuhan, China
| | - Yong Nie
- Department of Urology, Yiling Hospital, Yichang, China,
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A clinical experience of thulium fibre laser in miniperc to dust with suction: a new horizon. World J Urol 2020; 39:2727-2732. [PMID: 32960327 DOI: 10.1007/s00345-020-03458-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/10/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To report safety and efficacy of mini-PCNL with suction attached to sheath combined with high-power Thulium Fibre laser (TFL). The secondary aim was to evaluate optimal laser settings for maximum stone dusting. MATERIALS AND METHODS Prospective, single arm study was conducted from June 2019-December 2019 using miniPCNL with suction and TFL in 54 patients with renal stones < 3 cm. Stone fragments for each laser setting were independently retrieved and segregated according to size(< 1 mm,1-3 mm, > 3 mm) and weighed. Xray/CT scan imaging was performed in all patients within 48 h and 30 days to assess stone clearance. Optimal laser settings were evaluated for maximum dusting. RESULTS Mean stone size was 18.32 ± 6.37 mm, volume was 2337.75 ± 1996.84mm3 and stone density was 1300.55 ± 435.32 HU. Total operative time was 39.85 ± 20.52 min, laser time was 10.08 ± 7.41 min and stone fragmentation rate was 5.02 ± 3.93 mm3/s. The procedure was completely tubeless in 37.04%, nephrostomy tube in 37.04% and DJ stent placed in 25.92%. Postoperatively, three patients had urinary infection (Clavien 2). Complete stone clearance at 48 h was achieved in 35 (64.8%) cases. 19 patients (35.2%) who had residual fragments at 48 h, had 100% clearance at one month on CT/Xray KUB. CONCLUSIONS MiniPCNL using a nephrostomy sheath with suction along with high power Thulium Fibre Laser is safe and effective modality for lithotripsy. An initial laser setting of 0.2 J and 125-200 Hz was optimal for maximum dusting and simultaneous aspiration. Randomized comparative studies with other energy sources are being considered.
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