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Luo Z, Li J, Xiao B. Laparoscopy-assisted ultrasound-guiding percutaneous nephrolithotomy for the treatment of stones in pelvic ectopic kidney: A case report. Urol Case Rep 2024; 53:102654. [PMID: 38261945 PMCID: PMC10797536 DOI: 10.1016/j.eucr.2024.102654] [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: 11/23/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024] Open
Abstract
Background Pelvic ectopic kidney is a kind of congenital malformations of urinary system due to the failure of ascent from the pelvis to the abdomen during development. Case presentation A 39-year-old man was referred to the urology department of our hospital for abdominal pain for half a month. Radiographic studies revealed stones in pelvic ectopic left kidney. Laparoscopy-assisted ultrasound-guiding percutaneous nephrolithotomy (PCNL) was performed. Postoperative plain film revealed that the patient achieved a stone-free status. Conclusions Laparoscopy-assisted ultrasound-guiding PCNL is a safe alternative for the treatment of stones in pelvic ectopic kidney with a high stone-free clearance.
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Affiliation(s)
- Zhichao Luo
- Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jianxing Li
- Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Bo Xiao
- Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Zhang H, Chen Y, Liu P, Zhang L, Cao J. Evaluation of the safety and efficiency of color Doppler ultrasound-guided percutaneous nephrolithotomy in clinical practice: results from a retrospective study. Ren Fail 2023; 45:2275714. [PMID: 37929948 PMCID: PMC10629412 DOI: 10.1080/0886022x.2023.2275714] [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: 08/04/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023] Open
Abstract
This study evaluated the clinical value of color Doppler ultrasound-guided percutaneous nephrolithotomy (PCNL) in avoiding bleeding caused by punctured blood vessels. Herein, we retrospectively included patients who underwent color Doppler ultrasound-guided PCNL or PCNL using the conventional channel technique from August 2018 to August 2022. The clinical characteristics of patients during surgery, complications, and hospital stay were recorded and compared. Overall, 228 patients were enrolled, with 126 patients (age, 47.6 ± 13.2 years; men: 57.14%) in the color Doppler ultrasound-guided PCNL group and 102 patients (age, 46.6 ± 12.3 years) in the B-mode ultrasound-guided puncture group. The total operation time (63.5 ± 15.5 vs. 61.3 ± 16.3 min, p = .5236) and stone clearance rate (86.50% vs. 83.33%, p = .7139) were similar between the two groups. However, the puncture time for the color Doppler ultrasound-guided PCNL group was longer than that for the B-mode ultrasound-guided puncture group (5.1 ± 2.3 vs. 2.6 ± 1.6 min, p = .0019). Moreover, the length of postoperative hospital stay in the color Doppler ultrasound-guided PCNL group reduced significantly by ∼1 day compared with that in the B-mode ultrasound-guided puncture group (4.5 ± 1.6 vs. 5.6 ± 2.1 days, p = .0087). The blood transfusion rate (1.58% vs. 4.9%, p = .0399), sedation-related adverse event rate (0.79% vs. 2.9%, p = .0332), perineal hematoma incidence (0% vs. 2.94%, p < .0001), and serum decreased hemoglobin levels (12.2 ± 9.7 vs. 23.5 ± 10.1 g/L, p < .001) after color Doppler ultrasound-guided PCNL were significantly lower than those after B-mode ultrasound-guided puncture. The stone clearance rate was similar between the two groups, with a similar operation time. Moreover, color Doppler ultrasound-guided PCNL shortened the postoperative hospital stay and decreased Hb levels, blood transfusion rate, and perineal hematoma incidence.
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Affiliation(s)
- He Zhang
- Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
| | - Yuangui Chen
- Department of Urology, Naval Speciality Medical Center, Shanghai, China
| | - Peng Liu
- Department of Urology, Shanghai 411 Hospital, Shanghai, China
| | - Lin Zhang
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jianwei Cao
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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Polanco Pujol L, Bueno Chomon G, Caño Velasco J, Rodríguez Fernández E, Diez-Cordero JM, Hernández Cavieres J, Blaha I, Hernández Fernández C. Laparoscopic pyelolithotomy in pelvic ectopic kidney: Case report and literature review. Actas Urol Esp 2021; 45:419-426. [PMID: 34147427 DOI: 10.1016/j.acuroe.2020.09.007] [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: 08/12/2020] [Accepted: 09/17/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Pelvic kidney is a rare congenital anomaly. The ectopic kidney is more susceptible to developing lithiasis. The management of this type of lithiasis is a challenge. The objective of this paper was to conduct a review of available literature on the treatment of stone in ectopic kidney. MATERIAL AND METHODS Description of a case of transperitoneal laparoscopic pyelolithotomy for the treatment of inferior calyceal lithiasis in a right pelvic kidney. A literature review was performed by using Pubmed. The following terms and combination terms were searched: "pelvic ectopic kidney", "ureterorenoscopy", "extracorporeal lithotripsy", "PCNL", "pyelolithotomy". We incluyed original articles, meta-analysis, review and case reports. RESULTS 130 articles were excluded by title or duplication. 62 abstracts articles and them 50 full text articles were evaluated. Stone free rate were 75% (SLW), 85% (URSf), 85%-90% (PCNL) and 100% (laparoscopic pyelolithotomy). The literature on treatment on pelvic kidney is poor. CONCLUSION Factors such stone size, density and location, and upper urinary tract abnormalities, influence the choice of therapeutic approach (retrograde, percutaneous and/or laparoscopic/robotic). Laparoscopic pyelolithotomy is a safe and minimally invasive treatment option for large kidney stones with unfavorable anatomy for the endoscopic approach.
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Affiliation(s)
- Lucia Polanco Pujol
- Departamento de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Gonzalo Bueno Chomon
- Departamento de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jorge Caño Velasco
- Departamento de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | - Igor Blaha
- Departamento de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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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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Polanco L, Bueno G, Caño J, Rodríguez E, Diez-Cordero J, Hernández J, Blaha I, Hernández C. Laparoscopic pyelolithotomy in pelvic ectopic kidney: Case report and literature review. Actas Urol Esp 2021. [PMID: 33676772 DOI: 10.1016/j.acuro.2020.09.011] [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: 10/22/2022]
Abstract
INTRODUCTION Pelvic kidney is a rare congenital anomaly. The ectopic kidney is more susceptible to developing lithiasis. The management of this type of lithiasis is a challenge. The objective of this paper was to conduct a review of available literature on the treatment of stone in ectopic kidney. MATERIAL AND METHODS Description of a case of transperitoneal laparoscopic pyelolithotomy for the treatment of inferior calyceal lithiasis in a right pelvic kidney. A literature review was performed by using Pubmed. The following terms and combination terms were searched: «pelvic ectopic kidney», «ureterorenoscopy», «extracorporeal lithotripsy», «PCNL», «pyelolithotomy». We included original articles, meta-analysis, review and case reports. RESULTS 130 articles were excluded by title or duplication. 62 abstracts articles and them 50 full text articles were evaluated. Stone free rate were 75% (SLW), 85% (URSf), 85-90% (PCNL) and 100% (laparoscopic pyelolithotomy). The literature on treatment on pelvic kidney is poor. CONCLUSION Factors such stone size, density and location, and upper urinary tract abnormalities, influence the choice of therapeutic approach (retrograde, percutaneous and/or laparoscopic/robotic). Laparoscopic pyelolithotomy is a safe and minimally invasive treatment option for large kidney stones with unfavorable anatomy for the endoscopic approach.
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6
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Abt D. Steinleiden bei anatomischen Besonderheiten. Urolithiasis 2021. [DOI: 10.1007/978-3-662-62454-8_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Salvi M, Muto G, Tuccio A, Grosso AA, Mari A, Crisci A, Carini M, Minervini A. Active treatment of renal stones in pelvic ectopic kidney: systematic review of literature. MINERVA UROL NEFROL 2020; 72:691-697. [DOI: 10.23736/s0393-2249.20.03792-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Yerkes EB, Baum M, Chu DI. Chronic kidney disease and upper tract concerns after congenital and acquired urinary tract abnormalities: considerations for transition of care in teens and young adults. World J Urol 2020; 39:1003-1011. [PMID: 32514671 DOI: 10.1007/s00345-020-03273-1] [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: 09/15/2019] [Accepted: 05/22/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To emphasize the burden that chronic kidney disease (CKD) and its complications place on overall health and well-being over the lifetime in individuals with congenital and acquired urinary tract abnormalities. METHODS Topic-based literature review was performed and professional opinion was obtained to describe the scope of medical challenges faced by both teens and adults and their health care providers in the context of congenital and acquired urinary tract abnormalities. RESULTS Challenges include accurate assessment of glomerular filtration rate; engaging for consistent surveillance of blood pressure, proteinuria, and medical complications of CKD that increase the risk of progression to end-stage renal disease and affect general health; achieving early referral to nephrology for better outcomes; managing renal complications within the unique limitations of lower urinary tract function; treating upper tract urolithiasis in the atypical urinary tract; and preparing for successful renal transplant. CONCLUSION In individuals with congenital or acquired abnormalities of the urinary tract, there is an inherent risk of CKD with its associated morbidity and increased mortality risk. Interplay between the upper and lower urinary tract impacts CKD progression. Collaborative management between urology and nephrology is highly recommended to address the unique challenges for each individual over the lifetime.
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Affiliation(s)
- Elizabeth B Yerkes
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue #24, Chicago, IL, 60611, USA.
| | | | - David I Chu
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Wang C, Jin L, Zhao X, Li G, Xue B. Minimally invasive treatment of an ectopic kidney stone: a case report and literature review. J Int Med Res 2019; 47:4544-4550. [PMID: 31378109 PMCID: PMC6753573 DOI: 10.1177/0300060519865845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
An ectopic pelvic kidney is a rare congenital anomaly with a high incidence of
complications such as reflux, hydronephrosis, nephrolithiasis, and even renal
failure. We herein report a case of transperitoneal laparoscopic pyelolithotomy
for treatment of a left pelvic kidney stone and discuss various surgical
procedures based on the published literature. A 64-year-old woman presented to
our hospital with generalized weakness and occasional nonspecific waist pain in
October 2017. Computed tomography showed a 2.6-cm renal pelvis stone located in
the left ectopic pelvic kidney with severe hydronephrosis. The patient underwent
transperitoneal laparoscopic pyelolithotomy and was discharged 7 days after
surgery. Various treatment procedures are available for ectopic kidney stones.
Proper preoperative assessment and selection of the most suitable surgical
procedure play critical roles in successful treatment.
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Affiliation(s)
- Chenglu Wang
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Lu Jin
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Xinyang Zhao
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Guobin Li
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Boxin Xue
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
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Singh AG, Jairath A, Balaji SS, Tak G, Ganpule AP, Vijayakumar M, Sabnis RB, Desai MR. Changing trends in the endourological management of urolithiasis in anomalous kidneys. BJU Int 2018; 123:318-327. [PMID: 30281895 DOI: 10.1111/bju.14575] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To present our single-centre experience of urolithiasis management in anomalous kidneys, highlighting the need for an algorithm-based approach in deciding the appropriate treatment method for each type. PATIENTS AND METHODS We retrospectively reviewed the data of all the patients who presented to our renal unit with urolithiasis in an anomalous kidney between January 1990 and July 2014. The peri-operative characteristics of all the patients, along with management approach, were studied. RESULTS Percutaneous nephrolithotomy (PCNL) was the most common surgical technique used, followed by flexible ureterorenoscopy (URS). Pain was the most common presentation in these patients. The overall stone clearance rate associated with PCNL and flexible URS was 85.8% in cases of anomalous kidneys in this series. The stone clearance rates in ectopic kidneys, horseshoe kidneys, malrotated kidneys and autosomal dominant polycystic kidneys associated with PCNL and flexible URS were similar: 86%, 88%, 76% and 83%, respectively, and 81.2%, 80%, 92% and 100%, respectively . Based on our results, we developed a stone management algorithm. CONCLUSION The management of renal calculi in patients with renal anomalies may vary based on the stone size, location, density, pelvicalyceal system anatomy and drainage. An algorithm-based approach could help surgeons decide the appropriate treatment in this population.
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Affiliation(s)
- Abhishek G Singh
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Ankush Jairath
- Department of Urology, Astha Hospital, Ludhiana, Punjab, India
| | - Sudharshan S Balaji
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Gopal Tak
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Arvind P Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | | | - Ravindra B Sabnis
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Mahesh R Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
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Patwardhan SK, Shelke UR, Patil BP, Pamecha YR. Laparoscopic assisted percutaneous nephrolithotomy in chronic kidney disease patients with ectopic pelvic kidney. Urol Ann 2017; 9:257-260. [PMID: 28794593 PMCID: PMC5532894 DOI: 10.4103/ua.ua_16_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: Patients with deranged renal functions have a number of associated factors which can impair healing of wound and increase postoperative morbidity. This study was conducted to assess the problems while managing ectopic pelvic kidney calculi using laparoscopic approach for percutaneous nephrolithotomy (PCNL) in chronic kidney disease patients. Subjects and Methods: Patients with calculi in ectopic kidney with increased serum creatinine level secondary to obstruction were included in the study. Initially, obstruction was relieved. Patients later underwent laparoscopic-assisted PCNL. Patients were monitored postoperatively. Results: Three patients with large renal calculi in ectopic pelvic kidney had presented in 2 years. Laparoscopic-assisted PCNL was done to remove the stone. Patients had persistent urine leak post-operatively. Mean duration for removal of nephrostomy tube and drain removal were 4.67 days and 6.67 days, respectively. These patients also had paralytic ileus for prolonged duration. Conclusion: Although laparoscopic assisted PCNL is an option in the management of patients with stone disease in ectopic pelvic kidney, prolonged time for healing of tract may increase postoperative morbidity in these patients with impaired renal function.
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Affiliation(s)
- Sujata K Patwardhan
- Department of Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Umesh Ravikant Shelke
- Department of Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Bhushan P Patil
- Department of Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Yash R Pamecha
- Department of Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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12
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He Z, Zhang C, Zeng G. Minimally invasive percutaneous nephrolithotomy guided by ultrasonography to treat upper urinary tract calculi complicated with severe spinal deformity. Int Braz J Urol 2016; 42:960-966. [PMID: 27509373 PMCID: PMC5066892 DOI: 10.1590/s1677-5538.ibju.2015.0408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/06/2015] [Indexed: 12/12/2022] Open
Abstract
Objective: To report our experience of minimally invasive percutaneous nephrolithotomy(MPCNL) in managing upper urinary tract calculi complicated with severe spinal deformity. Materials and Methods: Between August 2001 to December 2012, 16 upper urinary calculi in 13 patients with severe spinal deformity were treated by MPCNL. Preoperative investigation of the respiratory function, evaluation of anatomy by intravenous urography (IVU) and CT scan, and preoperative kidney ultrasonagraphy with simulation of the percutaneous puncture were performed in all patients. The percutaneous puncture was guided by ultrasonography. Results: A total of 19 MPCNL procedures were performed in 16 kidneys, with an average 1.2 procedures in each kidney. Three kidneys needed two sessions of MPCNL, and 2 kidneys needed combined treatment with retrograde flexible ureterscopic lithotripsy. All procedures were successfully completed with no major complications during or after surgery. The mean (range) operative duration was 67 (20-150) min and the mean postoperative haemoglobin drop was 1.0 (0.2-3.1) g/dL. Complete stone-free status was achieved in 14 kidneys. At a mean follow-up of 48(3-86) months, recurrence of small lower calyx stone was detected in one patient. Recurrent UTI was documented by urine culture in two patients and managed with sensitive antibiotics. Conclusion: PCNL for patients with severe spinal deformities is challenging. Ultrasonography-assisted puncture can allow safe and successfully establishment of PCN tract through a narrow safety margin of puncture and avoid the injury to the adjacent organs. However, the operation should be performed in tertiary centers with significant expertise in managing complex urolithiasis.
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Affiliation(s)
- Zhaohui He
- Department of Urology, Minimally Invasive Surgery Center, the first affiliated Hospital of Guangzhou Medical University. Guangdong Key laboratory of Urology Guangzhou, China
| | - Caixia Zhang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, China
| | - Guohua Zeng
- Department of Urology, Minimally Invasive Surgery Center, the first affiliated Hospital of Guangzhou Medical University. Guangdong Key laboratory of Urology Guangzhou, China
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Khadgi S, Shrestha B, Ibrahim H, Shrestha S, ElSheemy MS, Al-Kandari AM. Mini-percutaneous nephrolithotomy for stones in anomalous-kidneys: a prospective study. Urolithiasis 2016; 45:407-414. [DOI: 10.1007/s00240-016-0926-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 09/27/2016] [Indexed: 11/30/2022]
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Soylemez H, Penbegül N, Utangac MM, Dede O, Çakmakçı S, Hatipoglu NK. Laparoscopy assisted percutaneous stone surgery can be performed in multiple ways for pelvic ectopic kidneys. Urolithiasis 2015; 44:345-52. [DOI: 10.1007/s00240-015-0829-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/10/2015] [Indexed: 12/15/2022]
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Violette PD, Dion M, Tailly T, Denstedt JD, Razvi H. Percutaneous Nephrolithotomy in Patients with Urinary Tract Abnormalities. J Endourol 2014; 28:1448-54. [DOI: 10.1089/end.2014.0239] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Philippe D. Violette
- Department of Surgery, Division of Urology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Marie Dion
- Department of Surgery, Division of Urology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Thomas Tailly
- Department of Surgery, Division of Urology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - John D. Denstedt
- Department of Surgery, Division of Urology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Hassan Razvi
- Department of Surgery, Division of Urology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Otaño N, Jairath A, Mishra S, Ganpule A, Sabnis R, Desai M. Percutaneous nephrolithotomy in pelvic kidneys: is the ultrasound-guided puncture safe? Urology 2014; 85:55-8. [PMID: 25440823 DOI: 10.1016/j.urology.2014.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 07/06/2014] [Accepted: 08/18/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To demonstrate our experience with the use of ultrasound (USG) for puncture guidance while performing percutaneous nephrolithotomy in ectopic pelvic kidneys. METHODS From January 1990 to December 2013, we have performed percutaneous nephrolithotomy in 26 patients with USG-guided punctures. The stones were solitary in 15 patients (58%) and multiple in 11 patients (42%). The mean stone size was 22 mm (range, 10-50 mm), including 3 staghorn calculi. All procedures were performed in an oblique-supine position, and the intraoperative complications as the postoperative outcome were reviewed. RESULTS The mean operative time was 93 minutes, achieving complete stone clearance in 22 (88%) of the patients. One of the patients had urine leakage after removing nephrostomy, needing postoperative double J stenting. One patient had significant intraoperative bleeding requiring staging of the procedure and blood transfusion. No bowel injuries were identified. Mean hospitalization time was 5.6 days. CONCLUSION USG-guided puncture is a safe and effective approach to the collecting system even in renal anomalies like in pelvic ectopic kidneys when performed in experienced hands.
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Affiliation(s)
- Natalia Otaño
- Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
| | - Ankush Jairath
- Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | | | - Arvind Ganpule
- Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | | | - Mahesh Desai
- Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
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Bozkurt OF, Tepeler A, Sninsky B, Ozyuvali E, Ziypak T, Atis G, Daggulli M, Resorlu B, Caskurlu T, Unsal A. Flexible ureterorenoscopy for the treatment of kidney stone within pelvic ectopic kidney. Urology 2014; 84:1285-9. [PMID: 25288574 DOI: 10.1016/j.urology.2014.07.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 06/03/2014] [Accepted: 07/22/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To present the outcomes of flexible ureterorenoscopy (F-URS) and laser lithotripsy for the treatment of calculi within pelvic ectopic kidney (PEK). PATIENTS AND METHODS We retrospectively reviewed the medical records of 26 patients with calculi in PEK treated with F-URS in 5 referral hospitals between 2010 and 2013. Patient demographics and stone characteristics (age, sex, body mass index, stone size, location, history of shock wave lithotripsy or kidney surgery), and perioperative measures (duration of operation, fluoroscopic imaging, and hospitalization and success and complication rates) were reviewed. RESULTS A total of 26 patients with mean age of 41.1 ± 15.8 years (7-72 years) were included in the study. The mean stone size was 17.0 ± 5.1 mm (10-28 mm). The mean procedure and fluoroscopy times were calculated as 52.1 ± 27.7 minutes (30-120 minutes) and 54.8 ± 48.9 seconds (10-180 seconds), respectively. The mean length of hospital stay was 2.7 ± 1.8 days (1-9 days). Treatment was deemed successful in 22 patients (84.6%). Ureteroscopy failed in 4 patients (15.4%) due to impaired passage of fragments (n = 3) or inability to reach the stone secondary to the location in an isolated lower calyx (n = 1). Minor postoperative complications were observed in 5 patients (19.2%; persistent hematuria [n = 1], fever [n = 1], renal colic [n = 2], and urinary tract infection [n = 1]). No severe complications or mortality occurred. CONCLUSION Our results suggest that F-URS is a safe and effective minimally invasive treatment modality for small- and medium-sized stones in PEK.
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Affiliation(s)
- Omer Faruk Bozkurt
- Department of Urology, Kecioren Teaching and Research Hospital, Ankara, Turkey
| | - Abdulkadir Tepeler
- Department of Urology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey; Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI.
| | - Brian Sninsky
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Ekrem Ozyuvali
- Department of Urology, Kecioren Teaching and Research Hospital, Ankara, Turkey
| | - Tevfik Ziypak
- Department of Urology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Gokhan Atis
- Department of Urology, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
| | - Mansur Daggulli
- Department of Urology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Berkan Resorlu
- Department of Urology, Kecioren Teaching and Research Hospital, Ankara, Turkey
| | - Turhan Caskurlu
- Department of Urology, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
| | - Ali Unsal
- Department of Urology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Violette P, Dion M, Tailly T, Denstedt JD, Razvi H. Percutaneous Nephrolithotomy in Patients with Urinary Tract Abnormalities. J Endourol 2014. [DOI: 10.1089/end.2014.0239.ecc14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ganesamoni R, Sabnis RB, Mishra S, Desai MR. Microperc for the management of renal calculi in pelvic ectopic kidneys. Indian J Urol 2013; 29:257-9. [PMID: 24082451 PMCID: PMC3783710 DOI: 10.4103/0970-1591.117267] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Management of stone disease in an ectopic kidney is challenging. Laparoscopy or ultrasound guided percutaneous nephrolithotomy and retrograde intra-renal surgery are the preferred techniques for these stones. We performed ultrasound guided microperc using a 16 G needle for the management of renal calculi in pelvic ectopic kidneys in two patients. There was no intraoperative or post-operative complication. Both patients had complete stone clearance and were discharged on the first post-operative day. Ultrasound guided microperc is a safe and effective option for the management of small renal calculi in pelvic ectopic kidneys.
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Affiliation(s)
- Raguram Ganesamoni
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
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Penbegul N, Hatipoglu NK, Bodakci MN, Atar M, Bozkurt Y, Sancaktutar AA, Tepeler A. Role of Ultrasonography in Percutaneous Renal Access in Patients With Renal Anatomic Abnormalities. Urology 2013; 81:938-42. [DOI: 10.1016/j.urology.2013.01.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 01/05/2013] [Accepted: 01/22/2013] [Indexed: 11/15/2022]
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Abstract
Stones in abnormal situations present a management conundrum to the urologist. Many of these situations are relatively rare and literature is scanty on the appropriate management. We review the current literature on the management of stones in the setting of pregnancy, calyceal diverticulum, urinary diversions, pelvic kidneys, transplant kidneys, autosomal dominant polycystic kidney disease, horseshoe kidneys, and other renal anomalies. The aims of treatment are complete stone-free status. The modality of treatment should be individualized to the size and location of stone and type of abnormal situation confronted.
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Affiliation(s)
- Yung K Tan
- Department of Urology, Columbia University Medical Center, New York, NY 10032, USA
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22
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Desai MR, Ganpule AP. Percutaneous Nephrolithotomy (PCNL). Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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El-Nahas AR, Shokeir AA. Minimally Invasive Treatment of Calculi in Renal Anomalies. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Zaidi Z, Alam Z. Endourological Approaches to Renal and Ureteric Calculi in Children. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rais-Bahrami S, Friedlander JI, Duty BD, Okeke Z, Smith AD. Difficulties with access in percutaneous renal surgery. Ther Adv Urol 2011; 3:59-68. [PMID: 21869906 DOI: 10.1177/1756287211400661] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Percutaneous renal surgery provides a minimally invasive approach to the kidney for stone extraction in a number of different clinical scenarios. Certain clinical cases present inherent challenges to percutaneous access to the kidney. Herein, we present scenarios in which obtaining and/or maintaining percutaneous access is difficult along with techniques to overcome the challenges commonly encountered. Also, complications associated with these challenging percutaneous renal surgeries are discussed.
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Affiliation(s)
- Soroush Rais-Bahrami
- North Shore Long Island Jewish Health System, The Arthur Smith Institute for Urology, 450 Lakeville Road, New Hyde Park, NY 11040, USA
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Osther PJ, Razvi H, Liatsikos E, Averch T, Crisci A, Garcia JL, Mandal A, de la Rosette, on behalf of the CRO J. Percutaneous Nephrolithotomy Among Patients with Renal Anomalies: Patient Characteristics and Outcomes; a Subgroup Analysis of the Clinical Research Office of the Endourological Society Global Percutaneous Nephrolithotomy Study. J Endourol 2011; 25:1627-32. [DOI: 10.1089/end.2011.0146] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Palle Jörn Osther
- Department of Urology, Fredericia Hospital, University of Southern Denmark, Fredericia, Denmark
| | - Hassan Razvi
- Division of Urology, The University of Western Ontario, London, Ontario, Canada
| | | | - Timothy Averch
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alfonso Crisci
- Department of Urology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Juan Lòpez Garcia
- Department of Urology, Complejo, Hospitalario Donostia, San Sebastian, Guipuzkoa, Spain
| | - Arup Mandal
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Desai MR, Sharma R, Mishra S, Sabnis RB, Stief C, Bader M. Single-step percutaneous nephrolithotomy (microperc): the initial clinical report. J Urol 2011; 186:140-5. [PMID: 21575966 DOI: 10.1016/j.juro.2011.03.029] [Citation(s) in RCA: 175] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Indexed: 12/17/2022]
Abstract
PURPOSE To our knowledge we report the first technical feasibility and safety study of 1-step percutaneous nephrolithotomy using the previously described 4.85Fr all-seeing needle (PolyDiagnost, Pfaffenhofen, Germany). We defined microperc as modified percutaneous nephrolithotomy in which renal access and percutaneous nephrolithotomy are done in 1 step using the all-seeing needle. MATERIALS AND METHODS Microperc was performed in 10 cases using the 4.85Fr all-seeing needle to achieve collecting system access under direct vision. Percutaneous nephrolithotomy was done through the same 16 gauge needle sheath with a 3-way connector allowing irrigation, and passage of a flexible telescope and a 200 μm holmium:YAG laser fiber. We prospectively analyzed preoperative, intraoperative and postoperative parameters. RESULTS Mean calculous size was 14.3 mm. Two of the 10 patients were of pediatric age, and 1 each had an ectopic pelvic kidney, chronic kidney disease and obesity. Microperc was feasible in all cases with mean ± SD surgeon visual analog score for access of 3.1 ± 1.2, a mean 1.4 ± 1.0 gm/dl hemoglobin decrease and a mean hospital stay of 2.3 ± 1.2 days. The stone-free rate at 1 month was 88.9%. In 1 patient intraoperative bleeding obscured vision, requiring conversion to mini percutaneous nephrolithotomy. There were no postoperative complications and no auxiliary procedures were required. CONCLUSIONS Microperc is technically feasible, safe and efficacious for small volume renal calculous disease. Further clinical studies and direct comparison with available modalities are required to define the place of microperc in the treatment of nonbulky renal urolithiasis.
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Affiliation(s)
- Mahesh R Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Gujarat, India.
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Bader MJ, Gratzke C, Seitz M, Sharma R, Stief CG, Desai M. The "all-seeing needle": initial results of an optical puncture system confirming access in percutaneous nephrolithotomy. Eur Urol 2011; 59:1054-9. [PMID: 21477921 DOI: 10.1016/j.eururo.2011.03.026] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 03/16/2011] [Indexed: 12/26/2022]
Abstract
BACKGROUND In percutaneous nephrolithotomy (PNL), the best possible way to access the collecting system is still a matter of debate. There is little possibility of correcting a suboptimal access. OBJECTIVE To describe our initial experience using a micro-optical system through a specific puncture needle to confirm the quality of the chosen access prior to dilatation of the operating tract. DESIGN, SETTING AND PARTICIPANTS Micro-optics of 0.9- and 0.6-mm diameter were used. The micro-optic with integrated light lead was inserted through the working sheath of the puncture needle. The modified needle had a 1.6-mm (4.85-Fr) outer diameter. The optical fiber was connected via a zoom ocular and light adapter to a standard endoscopic camera system. For sufficient intraoperative sight, an irrigation system was connected. INTERVENTION The optical puncture needle was used in 15 patients for renal access prior to standard PNL procedures. MEASUREMENTS The optical assessment included determination of the distortion, resolution, angle, and field of view. The irrigation flow was assessed in an ex vivo setting, with the puncture stylet or the needle shaft either empty or with a 0.018-in guidewire inserted. RESULTS AND LIMITATIONS In all cases, visualization of the punctured kidney calyces was successful and the presence of the target calculi could be confirmed prior to guidewire placement and tract dilation. The 0.9-mm optic was found to be significantly superior in all optical parameters in contrast to the 0.6-mm optic. No significant complications were observed. CONCLUSIONS The optical puncture needle for PNL appears to be most helpful for confirming the optimal percutaneous access to the kidney prior to dilation of the nephrostomy tract, improving the safety of the technique.
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Affiliation(s)
- Markus J Bader
- Department of Urology, Ludwig Maximilians Universität München, Campus Grosshadern, Munich, Germany
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Lu MH, Pu XY, Gao X, Zhou XF, Qiu JG, Si-Tu J. A Comparative Study of Clinical Value of Single B-Mode Ultrasound Guidance and B-Mode Combined With Color Doppler Ultrasound Guidance in Mini-invasive Percutaneous Nephrolithotomy to Decrease Hemorrhagic Complications. Urology 2010; 76:815-20. [DOI: 10.1016/j.urology.2009.08.091] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Revised: 07/27/2009] [Accepted: 08/26/2009] [Indexed: 10/19/2022]
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Karami H, Rezaei A, Mohammadhosseini M, Javanmard B, Mazloomfard M, Lotfi B. Ultrasonography-Guided Percutaneous Nephrolithotomy in the Flank Position Versus Fluoroscopy-Guided Percutaneous Nephrolithotomy in the Prone Position: A Comparative Study. J Endourol 2010; 24:1357-61. [DOI: 10.1089/end.2009.0099] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hossein Karami
- Urology and Nephrology Research Center (UNRC), Shohada Medical Center, Shahid Beheshti University, M.C. (SBMU), Tehran, Islamic Republic of Iran
| | - Alireza Rezaei
- Urology and Nephrology Research Center (UNRC), Shohada Medical Center, Shahid Beheshti University, M.C. (SBMU), Tehran, Islamic Republic of Iran
| | - Mojtaba Mohammadhosseini
- Urology and Nephrology Research Center (UNRC), Shohada Medical Center, Shahid Beheshti University, M.C. (SBMU), Tehran, Islamic Republic of Iran
| | - Babak Javanmard
- Urology and Nephrology Research Center (UNRC), Shohada Medical Center, Shahid Beheshti University, M.C. (SBMU), Tehran, Islamic Republic of Iran
| | - Mohsen Mazloomfard
- Urology and Nephrology Research Center (UNRC), Shohada Medical Center, Shahid Beheshti University, M.C. (SBMU), Tehran, Islamic Republic of Iran
| | - Behzad Lotfi
- Urology and Nephrology Research Center (UNRC), Shohada Medical Center, Shahid Beheshti University, M.C. (SBMU), Tehran, Islamic Republic of Iran
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Status quo of percutaneous nephrolithotomy in children. ACTA ACUST UNITED AC 2010; 38:1-5. [PMID: 19921165 DOI: 10.1007/s00240-009-0240-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 11/04/2009] [Indexed: 12/26/2022]
Abstract
Paediatric nephrolithiasis is quite challenging in terms of management because of the smaller size of the urinary tract and the bigger risk for stone recurrence. Children bear a higher risk of metabolic and infectious causes of stone disease and a longer lifetime risk for recurrence, especially in cases of residual fragments. Complete stone clearance should become the absolute objective and clinically insignificant residual fragments should be avoided. Nowadays, percutaneous nephrolithotomy (PCNL) arises as a logical first-line treatment option for considerable paediatric nephrolithiasis as miniaturization of endoscopes and advances in energy sources for stone fragmentation have facilitated stone-free rates. In this review we present the evolution of PCNL in children and we demonstrate its safety and efficacy. As appropriate instruments are available and relevant surgical experience is accumulating, age should no longer exist as a limiting factor for performing PCNL.
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Extraperitoneal laparoscopy-assisted percutaneous nephrolithotomy in a patient with osteogenesis imperfecta. ACTA ACUST UNITED AC 2010; 39:73-6. [PMID: 20229321 DOI: 10.1007/s00240-010-0263-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Accepted: 02/16/2010] [Indexed: 10/19/2022]
Abstract
Osteogenesis imperfecta (OI) patients represent a challenge to all physicians, as they do for anesthetists and urologists, when they develop symptomatic stones in the urinary tract. We recently treated an OI patient with renal pelvic stone by extraperitoneal laparoscopy-assisted percutaneous nephrolithotomy (PCNL). To our knowledge, this combined treatment modality has not been reported previously in OI. An 18-year-old paraplegic girl with OI presented to our urology department because of right-sided flank pain. She pointed out that she had right kidney stone for the previous 2 years, and because of risks of general anesthesia and surgical procedures, surveillance was recommended. Intravenous pyelography was performed and an 11.9-mm stone at the pelvis of the right kidney and grade 1-2 hydronephrosis at the same side with normal kidney functions and severe left-sided scoliosis were detected. After explanation of risks of the treatment modality and general anesthesia to the patient, extraperitoneal laparoscopy-assisted PCNL was performed. No complications occurred due to general anesthesia or surgical procedure. The operation time was 95 min and no blood transfusion was required. The nephrostomy tube and retroperitoneal drain were removed 2 and 3 days after the procedure, respectively. The patient was doing well at a follow-up of 6 months. Extraperitoneal laparoscopy-assisted PCNL approach may decrease the risk of surgery as an alternative treatment modality for OI patients. Such cases should be operated on at centers with significant experience in the field of endourology, where all the equipment and specialized personnel are readily available.
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Basiri A, Mohammadi Sichani M, Hosseini SR, Moradi Vadjargah A, Shakhssalim N, Kashi AH, Kamranmanesh M, Nasseh H. X-ray-free percutaneous nephrolithotomy in supine position with ultrasound guidance. World J Urol 2009; 28:239-44. [PMID: 19641923 DOI: 10.1007/s00345-009-0451-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 07/07/2009] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Supine percutaneous nephrolithotomy (PCNL) has numerous benefits compared to the prone position, including lower anesthesia risk, shorter operating time, and better ergonomic position for the surgeon. It is also comparable to prone position regarding vascular and bowel injuries. This study was conducted to add some more benefits by omitting X-ray in PCNL in a supine position. METHODS Nineteen consecutive adult patients underwent ultrasound-guided PCNL in supine position. All patients were placed under ultrasound guidance in supine position. The tract was dilated over a guidewire in a single shot technique under ultrasound guidance from anterior abdominal wall. Once the procedure ended, residual stone was controlled using ultrasound with anterior abdominal wall window. Residual stones less than 5 mm were considered insignificant. No X-ray was used in any setting of the procedure. RESULTS The pelvicaliceal system could be successfully approached in all patients. The posterior calices were the most common sites of entry. Mean (range) of operation time was 111 (70-180) min. Mean + or - SD hemoglobin before PCNL was 14.0 + or - 2.2 mg/dl, and after the procedure it was 12.3 + or - 1.6 mg/dl. Only one patient required blood transfusion. Mean + or - SD creatinine before PCNL was 1.03 + or - 0.24 mg/dl, and after the procedure it was 1.11 + or - 0.22 mg/dl. None of the patients suffered visceral injury. The total stone-free rate was 84%. CONCLUSIONS Even in our first report with limited experience, it seems that the efficacy of PCNL with ultrasonography in supine position is comparable to PCNL in prone position with fluoroscopy with no more complications.
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Affiliation(s)
- Abbas Basiri
- Department of Urology, Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University, M.C. (SBMU), No.101, Boostan 9th St., Pasdaran Ave., P.O. Box 1666677951, Tehran, Iran.
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Affiliation(s)
- Vincent G Bird
- Department of Urology, Miller School of Medicine, University of Miami, Dominion Tower, Miami, FL 33136, USA.
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Lasers in percutaneous renal procedures. World J Urol 2009; 28:135-42. [PMID: 19488759 DOI: 10.1007/s00345-009-0423-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Accepted: 05/10/2009] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Since the invention of lasers in 1960, they have been increasingly used in medicine. In this review paper, the types of lasers used in urology, in addition to their applications to percutaneous renal surgery will be reviewed. Specifically, use of lasers in the percutaneous management of renal stones, upper tract transitional cell carcinoma and stricture will be reviewed. MATERIALS AND METHODS Pubmed was searched for citations since 1966. The following terms were used: "lasers", "calculi", "endopyelotomy", and "transitional cell carcinoma". RESULTS Due to its minimal depth of penetration, holmium laser has proven to be safe and efficacious. It is currently the primary energy source for flexible instrumentation, and also has demonstrated efficacy in percutaneous lithotripsy (faster than ultrasonic lithotripsy and safer than electrohydraulic lithotripsy). Holmium laser been used for antegrade endopyelotomy and percutaneous resection of upper tract transitional cell carcinoma. CONCLUSIONS Holmium laser is safer than other lasers and has become the gold standard for laser lithotripsy for flexible instrumentation. It has been used successfully in the percutaneous management of renal stones, ureteropelvic junction obstruction, and upper tract transitional cell carcinoma. Holmium laser is an alternative energy source to conventional lithotripters and electrocautery for endopyelotomy and resection of upper tract transitional cell carcinoma.
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Totally Ultrasonography-Guided Percutaneous Nephrolithotomy in the Flank Position. J Endourol 2008; 22:1453-7. [DOI: 10.1089/end.2007.0391] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mousavi-Bahar SH, Amir-Zargar MA, Gholamrezaie HR. Laparoscopic assisted percutaneous nephrolithotomy in ectopic pelvic kidneys. Int J Urol 2008; 15:276-8. [PMID: 18304232 DOI: 10.1111/j.1442-2042.2007.01985.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Three patients underwent laparoscopic assisted percutaneous nephrolithotomy (PNL). A kidneys, ureter and bladder (KUB), and intravenous pyelogram (IVP) of the first patient showed a 3 cm calculus in a right side ectopic pelvic kidney overlying on the sacrum. The second patient had bilateral ectopic kidneys. The right kidney was located in the true pelvis without calculi and the left kidney was located in the iliac cavity with a 2.5 cm calculus in the renal pelvis. The third one had a 4 cm stone in the infundibulum of the upper calyx of the left pelvic ectopic kidney. All of them had a history of failed shock wave lithotripsy after two sessions. Then the patients were scheduled for laparoscopic assisted percutaneous removal of calculi. Under fluoroscopic control the best access route was located and the kidney was punctured. A 24F nephroscope was introduced and all calculi were disintegrated and removed. Operating time was 150, 120 and 110 min in cases 1, 2 and 3, respectively. Complete stone clearance was documented with a plain X-ray KUB film and ultrasonography. Finally the patients underwent IVP three months following the operation. They were all well and there were no early or late complications.
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Cinman NM, Okeke Z, Smith AD. Pelvic kidney: associated diseases and treatment. J Endourol 2007; 21:836-42. [PMID: 17867938 DOI: 10.1089/end.2007.9945] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The incidence of pelvic kidney has been approximated at between 1 in 2200 and 1 in 3000. The ectopic kidney is thought to be no more susceptible to disease than the normally positioned kidney, except for the development of calculi and hydronephrosis. Because of the greater risk of injuring aberrant vessels or overlying abdominal viscera and nerves, the pelvic kidney presents special treatment challenges. Alternative approaches to treating nephrolithiasis may yield better outcomes. The tortuous ureter often associated with a pelvic kidney hinders deflection of the flexible ureteroscope, potentially limiting access. Laparoscopy-guided intervention permits visual exposure of the kidney, enhancing safe puncture and tract placement integral to percutaneous nephrolithotomy. Laparoscopy-assisted anterior retrograde percutaneous nephroscopy involves percutaneous access using a Hunter-Hawkins retrograde nephrostomy needle with adjunctive laparoscopy to permit viewing and manipulation of overlying bowel. Ureteropelvic junction (UPJ) obstruction has been reported to occur in 22% to 37% of ectopic kidneys. Endoscopic incision presents difficulties beyond those of anatomically normal kidneys. The laparoscopic approach provides good surgical exposure, and operative times are comparable to those of laparoscopic pyeloplasty in anatomically normal kidneys. To date, only a handful of cases of malignancy in a pelvic kidney have been described. Like a nonfunctioning anatomically normal kidney, a nonfunctional pelvic kidney may require primary removal. There are a few reports of laparoscopic pelvic nephrectomy. Additional studies are needed to compare the various treatments for disease of the pelvic kidney in order to decide which options have the most beneficial outcomes.
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Affiliation(s)
- Nadya M Cinman
- Department of Urology, North-Shore Long Island Jewish Medical Center, New Hyde Park, New York 11040-1496, USA
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Combination of Laparoscopy and Nephroscopy for Treatment of Stones in Pelvic Ectopic Kidneys. J Endourol 2007; 21:1131-6. [DOI: 10.1089/end.2007.9930] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Desai M, Grover R, Manohar T, Ganpule A. Simultaneous bilateral percutaneous nephrolithotomy: a single-center experience. J Endourol 2007; 21:508-14. [PMID: 17523904 DOI: 10.1089/end.2006.0401] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of simultaneous bilateral percutaneous nephrolithotomy (SBPCNL) for bilateral renal calculus disease. PATIENTS AND METHODS A retrospective study was conducted from June 1996 to February 2006 involving 38 male and 7 female patients with a mean age of 44 years (range 5-73 years) with 90 affected renal units who underwent SBPCNL under general anesthesia. Those patients with established nephrostomy tracts were excluded from the study group. RESULTS The average duration of the procedure was 107 +/- 43 minutes (range 60-220 minutes). The average drop in hemoglobin was 2 +/- 1.2 g/dL (range 0.3-5.6 g/dL), with 3 patients (7%) requiring blood transfusion. In 87% of patients, a single stage was performed on both sides, while 13% required two stages on one side. A single tract was on both sides utilized in 78%, while 22% of the patients required two tracts on one side. None required two tracts on both sides or more than one stage on both sides. The stone-clearance rate was 96%. The average hospital stay was 6 days. Complications consisted of renal-pelvic perforation in two patients and transient pyrexia in five. Three patients had persistent urine leak on one side, of which two stopped spontaneously and one necessitated ureteral stenting. CONCLUSION Simultaneous bilateral PCNL is a safe procedure and can be used effectively in adults as well as in children. In addition to being cost effective, it involves only a single anesthesia with a shorter hospital stay and faster convalescence. However, patients with a large stone burden or complex pelvicaliceal anatomy should not be selected for SBPCNL.
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Affiliation(s)
- Mahesh Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India.
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Abstract
This article reviews the most common renal anomalies and the management of patients with calculus disease in anomalous kidneys. The emphasis is on minimally invasive techniques to achieve a stone-free status with minimal morbidity.
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Affiliation(s)
- Mantu Gupta
- Columbia University School of Medicine, College of Physicians & Surgeons, 11th Floor Department of Urology, 161 Fort Washington Avenue, New York, NY 10032, USA.
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Mosavi-Bahar SH, Amirzargar MA, Rahnavardi M, Moghaddam SMH, Babbolhavaeji H, Amirhasani S. Percutaneous Nephrolithotomy in Patients with Kidney Malformations. J Endourol 2007; 21:520-4. [PMID: 17523906 DOI: 10.1089/end.2006.0349] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Percutaneous nephrolithotomy (PCNL) for complex calculi within malformed kidneys can be challenging because of the abnormal anatomy. We present our 7-year experience with PCNL in such patients. PATIENTS AND METHODS We performed PCNL on 16 patients with complex calculi and anomalous kidneys, including 7 with horseshoe kidneys, 5 with rotation anomalies, 3 with ectopic kidneys, and 1 with a small kidney. After appropriate preoperative evaluation, the procedure was performed by choosing either anterior or posterior approaches depending on the kidney anomaly. When required, ultrasonography, laparoscopy, or both were used, as well as fluoroscopy to control the procedures. RESULTS A single-stage PCNL resulted in complete clearance in 13 patients (81%). A second-look procedure, alone or followed by shockwave lithotripsy, conferred stone clearance in one patient with a malrotated kidney and two with staghorn calculi in horseshoe kidneys. More than one tract was needed in two patients. The procedure was guided by laparoscopy in two patients with calculi in ectopic left kidneys. Serious complications were not encountered. CONCLUSION Patients with malformed kidneys and complex calculi can be managed safely and effectively with PCNL when they are properly selected and appropriately assessed before operation.
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Stein RJ, Desai MM. Management of urolithiasis in the congenitally abnormal kidney (horseshoe and ectopic). Curr Opin Urol 2007; 17:125-31. [PMID: 17285023 DOI: 10.1097/mou.0b013e328028fe20] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Urolithiasis in horseshoe and ectopic kidneys presents unique challenges in the decision-making and technical aspects of stone treatment. Specific renal anatomy, stone size and associated conditions such as ureteropelvic junction obstruction are factors that may influence treatment. Detailed review of imaging is important to ensure efficient stone treatment and minimize complications. RECENT FINDINGS Widespread use of extracorporeal shockwave lithotripsy for calculi in congenitally abnormal kidneys is now giving way to stone-size and anatomy-appropriate therapeutic decision making. Multiple modalities including shockwave lithotripsy, ureteroscopy, percutaneous nephrolithotomy and laparoscopy are being employed in this group of patients. SUMMARY Treatment decisions for stones in horseshoe and ectopic kidneys can be challenging, and must be made on an individual basis taking into account multiple variables.
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Affiliation(s)
- Robert J Stein
- Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Manohar T, Jain P, Desai M. Supine Percutaneous Nephrolithotomy: Effective Approach to High-Risk and Morbidly Obese Patients. J Endourol 2007; 21:44-9. [PMID: 17263606 DOI: 10.1089/end.2006.0212] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE There are various concerns regarding percutaneous nephrolithotomy (PCNL) in the prone position, especially in the morbidly obese and patients with compromised cardiopulmonary status and stature deformity. We present our experience with supine PCNL with special reference to its technique, indications, advantages, and disadvantages. PATIENTS AND METHODS A series of 62 patients underwent PCNL in the supine position, 57 under general anesthesia and 5 with epidural anesthesia. Their average age was 48 +/- 14.16 years, and the average bulk of the stone was 316 +/- 275 mm2, with 11% of the patients having staghorn stones and 19 both renal and upperureteral stones. The average body mass index was 24.28 +/- 4.69, and 11% of the patients were morbidly obese. Nearly all patients (93%) had an anesthesia risk of ASA grade 3 or above. Two patients had hip ankylosis. All patients were placed in a modified dorsal lithotomy position with a 45 degrees tilt to the contralateral side. Under ultrasound guidance, the desired calix was punctured in or near the posterior axillary line. RESULTS The average hemoglobin drop was 1.62 +/- 1.03 gm/dL, but only 3% of the patients required blood transfusion. None of the patients suffered visceral injury. Nearly all (95%) of the patients were rendered free of stones by the initial PCNL with or without ureteroscopy. CONCLUSION Supine PCNL is an effective and safe procedure in high-risk and obese patients and allows simultaneous management of renal and ureteral stones.
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Affiliation(s)
- T Manohar
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
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Al-Tawheed AR, Al-Awadi KA, Kehinde EO, Abdul-Halim H, Hanafi AM, Ali Y. Treatment of calculi in kidneys with congenital anomalies: an assessment of the efficacy of lithotripsy. ACTA ACUST UNITED AC 2006; 34:291-8. [PMID: 16807722 DOI: 10.1007/s00240-006-0059-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Accepted: 05/15/2006] [Indexed: 11/27/2022]
Abstract
We studied the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in the treatment of stones in kidneys with congenital anomalies to determine factors that may affect the results. Patients found to have renal calculi in kidneys with different types of congenital anomalies were treated using ESWL. All patients were investigated by intravenous urography (IVU) to confirm the diagnosis. J stents were inserted prior to therapy in renal units with calculi exceeding 1.5 cm in diameter. Complications encountered and factors affecting success using this treatment modality were analysed. Twenty-five patients (18 males, 7 females) were studied between August 1988 and July 2005. There were nine patients with horseshoe kidneys, eight with ectopic kidneys, three with malrotated kidneys, two with duplex renal system, and one patient each with polycystic kidneys and hypoplastic kidney. The IVU showed 31 isolated calyceal or renal pelvic stones with mean stone burden of 1.44cc. All 25 patients were treated by lithotripsy. Twenty-four (77.4%) renal units (in 19 patients) were completely cleared of stones, 2 (6.5%) renal units (2 patients) were partially cleared of calculi and the procedures failed in 5 (16.1%) renal units (4 patients). Out of five renal units in which the procedures failed, open surgery was performed in three renal units and percutaneous nephrolithotomy (PCNL) was performed in two. None of the 25 patients developed any major complications. No significant adverse changes in renal function tests were observed at 3-month follow-up. The stone-free rate was influenced and reduced by stone size and location in the pelvi-calyceal system. Calculi in kidneys with congenital anomalies may be treated successfully by ESWL as a first-line therapy in the majority of patients. With position modifications, localization of stones may be facilitated and disintegrated. The outcome in patients so treated does not differ significantly from that in those with normal kidneys.
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Affiliation(s)
- Adel R Al-Tawheed
- Department of Surgery (Division of Urology), Mubarak Al-Kabeer Hospital, Safat, Kuwait
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Goel R, Yadav R, Gupta NP, Aron M. Laparoscopic Assisted Percutaneous Nephrolithotomy (PCNL) in Ectopic Kidneys: Two Different Techniques. Int Urol Nephrol 2006; 38:75-8. [PMID: 16502056 DOI: 10.1007/s11255-005-3611-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Two patients presented with calculi in ectopic kidneys. Complete clearance of calculi was achieved by laparoscopic assisted percutaneous nephrolithotomy (PCNL), by different but related techniques. In one patient with prior history of open pyelolithotomy, the anterior surface of the kidney was exposed by mobilizing the overlying sigmoid colon laparoscopically and the percutaneous tract was established into the desired calyx under combined laparoscopic and fluoroscopic control. In the second patient, the tract was established between the major mesenteric vessels without any mobilization of the bowel. Herein, we outline the nuances of these two related techniques, and the indications and contraindications for their use for laparoscopic assisted PCNL in ectopic kidneys.
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Affiliation(s)
- Rajiv Goel
- Department of Urology, All India Institute of Medical Sciences, 110 029, New Delhi, India
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Kukreja R, Desai M, Patel S, Bapat S, Desai M. Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol 2005; 18:715-22. [PMID: 15659890 DOI: 10.1089/end.2004.18.715] [Citation(s) in RCA: 306] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Bleeding is a major concern during percutaneous nephrolithotomy (PCNL), especially with the use of multiple tracts. This prospective study aimed to identify factors affecting blood loss during PCNL. PATIENTS AND METHODS Data were collected prospectively from 236 patients undergoing 301 PCNL procedures at our institute since June 2002. Blood loss was estimated by the postoperative drop in hemoglobin factored by the quantity of any blood transfusion. Various patient-related and intraoperative factors were assessed for association with total blood loss or blood transfusion requirement using stepwise multivariate regression analysis. RESULTS The average hemoglobin drop was 1.68 +/- 1.23 g/dL. Stepwise multivariate regression analysis showed that the occurrence of operative complications (P < 0.0001), mature nephrostomy tract (P < 0.0001), operative time (P < 0.0001), method of access guidance (fluoroscopy v ultrasound) (P = 0.0001), method of tract dilatation (P = 0.0001), multiple (> or =2) tracts (P = 0.003), size of the tract (P = 0.001), renal parenchymal thickness (P = 0.05), and diabetes (P = 0.05) were significant predictors of blood loss. The overall blood transfusion rate for all patients was 7.9%. Preoperative hemoglobin, multiple tracts, stone size, and total blood loss were significant in predicting perioperative blood transfusion requirement. Factors such as age, hypertension, renal insufficiency, urinary infection, the degree of hydronephrosis, stone bulk, and the function of the ipsilateral renal unit did not have any effect on the blood loss. Technical factors such as the operating surgeon and the calix of entry also did not affect the blood loss. CONCLUSIONS Diabetes, multiple-tract procedures, prolonged operative time, and the occurrence of intraoperative complications are associated with significantly increased blood loss. Atrophic parenchyma and past ipsilateral intervention are associated with reduced blood loss. On the basis of this evidence, maneuvers that may reduce blood loss and transfusion rate include ultrasound-guided access, use of Amplatz or balloon dilatation systems, reducing the operative time, and staging the procedure in cases of a large stone burden or intraoperative complications. Reducing the tract size in pediatric cases, nonhydronephrotic systems and those with a narrow infundibulum, and secondary tracts in a multiple-tract procedure may also reduce blood loss during PCNL.
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Affiliation(s)
- Rajesh Kukreja
- Department of Urology, Muljibhai Patel Urological Hospital Nadiad, Gujarat, India
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Aron M, Gupta NP, Goel R, Ansari MS. Laparoscopy-assisted Percutaneous Nephrolithotomy (PCNL) In Previously Operated Ectopic Pelvic Kidney. Surg Laparosc Endosc Percutan Tech 2005; 15:41-3. [PMID: 15714158 DOI: 10.1097/01.sle.0000148470.59299.6f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 35-year-old man with a left ectopic pelvic kidney and a prior history of open pyelolithotomy presented with recurrent multiple stones in the pelvic kidney. Complete clearance of calculi was achieved by laparoscopy-assisted PCNL (percutaneous nephrolithotomy). To the best of our knowledge this is the first report of laparoscopy-assisted PCNL in a previously operated ectopic pelvic kidney.
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Affiliation(s)
- Monish Aron
- Department of Urology, All India Institute of Medical Sciences, New Delhi 110 029, India.
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Fariña Pérez LA, Cambronero Santos J, Meijide Rico F, Zungri Telo ER. Pielolitotomía laparoscópica en riñón pelviano. Actas Urol Esp 2004; 28:620-3. [PMID: 15529932 DOI: 10.1016/s0210-4806(04)73146-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Pelvic renal ectopia bearing stones is a particularly rare case of complex calculi. Several percutaneous and laparoscopic procedures had been proposed in the last years to treat this challenge problem in a minimally invasive way. CLINICAL CASE We describe the procedure of laparoscopic pyelolithotomy under general anesthesia, using three port sites, in a male patient with symptomatic stones in a left pelvic kidney with normal function. Two stones were successfully removed, with the help of flexible nephroscopy through a port, and the pyelotomy was closed with intracorporeal suture. COMMENT Laparoscopic pyelolithotomy of a pelvic kidney is a minimally invasive technique that is not difficult to perform, making laparotomy unnecessary. Laparoscopic technique must be take into account when dealing with the infrequent complex stone patient candidate to an open stone surgery. A review of the Spanish bibliography shows this to be the second reported case of pelvic kidney calculi treated by laparoscopic pyelolithotomy.
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