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Yilmaz M, Sahin Y. Comparative Study of Prone Position Variations for Percutaneous Nephrolithotomy. Res Rep Urol 2023; 15:233-241. [PMID: 37383942 PMCID: PMC10296540 DOI: 10.2147/rru.s415426] [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: 04/26/2023] [Accepted: 06/05/2023] [Indexed: 06/30/2023] Open
Abstract
Objective In this comparative study, we evaluated the results of flat prone and prone hip flexed percutaneous nephrolithotomy in terms of efficacy and safety to contribute to the optimal prone percutaneous nephrolithotomy position. Materials and Methods Data of the patients who underwent percutaneous nephrolithotomy operations in a flat-prone or prone hip flexed positions due to renal pelvis and/or ≥2 Calix filling stones between January 2016 and January 2022 were collected retrospectively. Demographic data of the patient groups in different prone positions as well as clinical findings, stone characteristics and operative data were analyzed. The groups were also compared in terms of post-operative findings and complications. Results The average age and CROES scores of patients included in the study were 47.15±15.6 years and 221.76±62.49, respectively. There was no statistically significant difference between the two groups in terms of patient demographic data, stone-free status and complication rates. Operation Room Time (ORT) (min) in flat prone PCNL group was shorter in average (100.57±32.74 min vs 92.32±28.75 min, p = 0.041) and duration with nephrostomy (days) and hospitalization (days) parameters were statistically significantly shorter in prone hip flexed PCNL (respectively, p < 0.001; p = 0.005). Conclusion Flat-prone PCNL provides significantly shorter ORT. However, the time with nephrostomy and hospitalization with the prone hip flexed PCNL were shorter than flat-prone position. The findings will guide the optimal prone PCNL position.
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Affiliation(s)
- Mehmet Yilmaz
- Department of Urology, University of Health Sciences Bağcılar Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Sahin
- Department of Urology, University of Health Sciences Bağcılar Training and Research Hospital, Istanbul, Turkey
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Grosso AA, Sessa F, Campi R, Viola L, Polverino P, Crisci A, Salvi M, Liatsikos E, Feu OA, DI Maida F, Tellini R, Traxer O, Cocci A, Mari A, Fiori C, Porpiglia F, Carini M, Tuccio A, Minervini A. Intraoperative and postoperative surgical complications after ureteroscopy, retrograde intrarenal surgery, and percutaneous nephrolithotomy: a systematic review. Minerva Urol Nephrol 2021; 73:309-332. [PMID: 33887891 DOI: 10.23736/s2724-6051.21.04294-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Retrograde ureteroscopy (URS), intra-renal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) represent routine interventions for the treatment of ureteral and renal stones, although at times associated with serious adverse events. Of note, the evidence on perioperative complications after these procedures remains sparse and controversial. Moreover, there is a lack of standardized reporting of adverse events using uniform systems. The aim of the present study was to systematically review of the available evidence on URS/RIRS and PCNL for the surgical treatment of urinary stone, assessing the incidence of intra- and postoperative events, classified according to the modified Clavien-Dindo scale. EVIDENCE ACQUISITION A systematic review of the literature was performed according to PRISMA recommendations and was conducted on intra- and postoperative complications, as well as on their management, following URS, RIRS and PCNL procedures, particularly focusing on major events. EVIDENCE SYNTHESIS Overall, 26 studies (13 on URS/RIRS and 11 on PCNL) met the inclusion criteria and were evaluated. The highest intraoperative complication rate was 11.5% and 8.5% for RIRS and PCNL, respectively. Major complication rate following URS/RIRS and PCNL ranged between 0.3-31.7% and 2-17.1%, respectively. The most frequent adverse events were obstructive pyelonephritis or urinary leakage requiring the placement of a double J stent or a drainage. Among PCNLs series, life-threatening adverse events have also been reported, including bleeding requiring renal angioembolization and urothorax. CONCLUSIONS Despite the inclusion of series using a standardized reporting system, the complication rate after URS/RIRS/PCNL remains extensively heterogeneous in the literature; in addition, a non-negligible proportion of studies did not characterize the adverse events nor report the actual management strategy to solve them. Future research is needed to standardize the classification and reporting of surgical complications after endourological procedures (taking into consideration the surgeon's experience and skills), aiming to improve patient counseling and potentially the strategy for their prevention.
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Affiliation(s)
- Antonio A Grosso
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Francesco Sessa
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Riccardo Campi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy -
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Lorenzo Viola
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Paolo Polverino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Alfonso Crisci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Matteo Salvi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | | | | | - Fabrizio DI Maida
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Riccardo Tellini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Olivier Traxer
- Service of Urology, Sorbonne University, Paris, France
- Tenon Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Andrea Cocci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Marco Carini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Agostino Tuccio
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
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Ibrahim A, Wollin D, Preminger G, Andonian S. Technique of Percutaneous Nephrolithotomy. J Endourol 2018; 32:S17-S27. [DOI: 10.1089/end.2018.0047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Ahmed Ibrahim
- Division of Urology, Department of Surgery, McGill University, Montreal, Canada
| | - Daniel Wollin
- Division of Urology, Department of Surgery, Duke University, Durham, North Carolina
| | - Glenn Preminger
- Division of Urology, Department of Surgery, Duke University, Durham, North Carolina
| | - Sero Andonian
- Division of Urology, Department of Surgery, McGill University, Montreal, Canada
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4
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Tailly T, Denstedt J. Innovations in percutaneous nephrolithotomy. Int J Surg 2016; 36:665-672. [DOI: 10.1016/j.ijsu.2016.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/02/2016] [Indexed: 12/26/2022]
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Fan D, Song L, Xie D, Hu M, Peng Z, Liao X, Liu T, Du C, Zhu L, Yao L, Huang J, Yang Z, Guo S, Qin W, Zhong J, Ye Z. A comparison of supracostal and infracostal access approaches in treating renal and upper ureteral stones using MPCNL with the aid of a patented system. BMC Urol 2015; 15:102. [PMID: 26463527 PMCID: PMC4603905 DOI: 10.1186/s12894-015-0097-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 10/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are still disagreements on which is a better approach to choose to establish percutaneous tract for percutaneous nephrolitotomy (PCNL), between supracostal and infracostal approaches. The aim of this study is to investigate the safety, efficacy and practicability of minimally invasive PCNL (MPCNL) with the aid of a patented system either through supracostal or through infracostal access. METHODS A retrospective study was carried out for 83 patients with renal or upper ureteral stones. Under the guidance of B ultrasound or C-arm, these patients were treated by MPCNL through either 12th rib infracostal (Group 1, 43 cases) or supracostal (Group 2, 40 cases) access approach. These 2 groups were compared for total number of percutaneous tracts, average time in establishing a given percutaneous tract, the number of percutaneous tract used for each case, the average stone clearance time, the clearance rate of all stones by one surgery, and the amount of bleeding using a single percutaneous tract. RESULTS There was a significantly smaller total number of percutaneous tracts needed, a smaller number of cases that needed two percutaneous tracts to clear stones completely, a shorter average time in establishing a percutaneous tract, and a smaller average amount of bleeding in infracostal access group. At the same time, there were a significantly larger number of cases in which stones were cleared completely using a single percutaneous tract and a higher renal stone clearance rate by one surgery. CONCLUSION There were several advantages of infracostal access. These included accuracy in establishing a percutaneous tract, safety, quickness, convenience and flexibility in moving the patented sheath, and higher renal and upper ureteral stone clearance rate by one surgery.
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Affiliation(s)
- Difu Fan
- Department of Urology, The Affiliated Ganzhou City People's Hospital of Nanchang University, Ganzhou, Jiangxi, 341000, China.
| | - Leming Song
- Department of Urology, The Affiliated Ganzhou City People's Hospital of Nanchang University, Ganzhou, Jiangxi, 341000, China.
| | - Donghua Xie
- Department of Urology, The Affiliated Ganzhou City People's Hospital of Nanchang University, Ganzhou, Jiangxi, 341000, China.
| | - Min Hu
- Department of Urology, The Affiliated Ganzhou City People's Hospital of Nanchang University, Ganzhou, Jiangxi, 341000, China.
| | - Zuofeng Peng
- Department of Urology, The Affiliated Ganzhou City People's Hospital of Nanchang University, Ganzhou, Jiangxi, 341000, China.
| | - Xiaohui Liao
- Dermatology Institute of Gan County, Jiangxi, 341100, China.
| | - Tairong Liu
- Department of Urology, The Affiliated Ganzhou City People's Hospital of Nanchang University, Ganzhou, Jiangxi, 341000, China.
| | - Chuance Du
- Department of Urology, The Affiliated Ganzhou City People's Hospital of Nanchang University, Ganzhou, Jiangxi, 341000, China.
| | - Lunfeng Zhu
- Department of Urology, The Affiliated Ganzhou City People's Hospital of Nanchang University, Ganzhou, Jiangxi, 341000, China.
| | - Lei Yao
- Department of Urology, The Affiliated Ganzhou City People's Hospital of Nanchang University, Ganzhou, Jiangxi, 341000, China.
| | - Jianrong Huang
- Department of Urology, The Affiliated Ganzhou City People's Hospital of Nanchang University, Ganzhou, Jiangxi, 341000, China.
| | - Zhongsheng Yang
- Department of Urology, The Affiliated Ganzhou City People's Hospital of Nanchang University, Ganzhou, Jiangxi, 341000, China.
| | - Shulin Guo
- Department of Urology, The Affiliated Ganzhou City People's Hospital of Nanchang University, Ganzhou, Jiangxi, 341000, China.
| | - Wen Qin
- Department of Urology, The Affiliated Ganzhou City People's Hospital of Nanchang University, Ganzhou, Jiangxi, 341000, China.
| | - Jiuqing Zhong
- Department of Urology, The Affiliated Ganzhou City People's Hospital of Nanchang University, Ganzhou, Jiangxi, 341000, China.
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
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6
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Abbott JE, DiMatteo AD, Fazio E, Deem SG, Sobh AK, DePolo A, Davalos JG. High Supracostal Percutaneous Nephrolithotomy Access: Assessing Safety in Access above the Eleventh Rib after Performing Preoperative Planning with Computed Tomography. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/oju.2015.54005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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7
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Abstract
Accurate reporting of complications is an essential component to critical appraisal and innovation in surgery and specifically with percutaneous nephrolithotomy (PCNL). We review the evolution of complication reporting for PCNL and suggest future directions for innovation. A selective review was carried out using Pubmed. Key search terms and their combinations included percutaneous, anatrophic, nephrolithotomy, PCNL, complications, Clavien, Martin score, bleeding, bowel injury, perforation, fever, sepsis. The references from relevant papers and reviews as well as AUA and EAU guidelines were also scanned for inclusion. PCNL has become the procedure of choice for large renal stones owing to decreased morbidity over alternative procedures. Both common and rare complications have been described in large case series, small randomized controlled trials, and case reports in an unstandardized form. Although these reports have provided an informative starting point, a standardized complication reporting methodology is necessary to enable appropriate comparisons between institutions, time periods, or innovations in technique. The Clavien-Dindo grading system has become widely accepted in urology and has facilitated the study of PCNL complications. Future research should focus on adaptions of this system to render it more comprehensive and applicable to PCNL.
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Affiliation(s)
- Philippe D Voilette
- Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - John D Denstedt
- Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
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8
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Lantz AG, Pace KT, Honey RJD. Flank bulge following supracostal percutaneous nephrolithotomy: A report of 2 cases. Can Urol Assoc J 2013; 7:E547-9. [PMID: 24032069 DOI: 10.5489/cuaj.176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Damage to intercostal nerves during surgical procedures has been associated with a postoperative flank bulge, due to denervation of the anterolateral abdominal wall musculature. This complication has not been reported following percutaneous nephrolithotomy (PCNL). We are aware of 3 cases, but have details on 2 cases of postoperative flank bulge following supracostal PCNL which are reported here. We also suggest how this complication could potentially be minimized.
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Affiliation(s)
- Andrea G Lantz
- Department of Urology, Dalhousie University, Halifax, NS
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9
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Nouralizadeh A, Ziaee SAM, Hosseini Sharifi SH, Basiri A, Tabibi A, Sharifiaghdas F, Kilani H, Gharaei B, Roodneshin F, Soltani MH. Comparison of Percutaneous Nephrolithotomy Under Spinal Versus General Anesthesia: A Randomized Clinical Trial. J Endourol 2013; 27:974-8. [DOI: 10.1089/end.2013.0145] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Akbar Nouralizadeh
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, I.R. Iran
| | - Seyed Amir Mohsen Ziaee
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, I.R. Iran
| | - Seyed Hossein Hosseini Sharifi
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, I.R. Iran
| | - Abbas Basiri
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, I.R. Iran
| | - Ali Tabibi
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, I.R. Iran
| | - Farzaneh Sharifiaghdas
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, I.R. Iran
| | - Hossein Kilani
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, I.R. Iran
| | - Babak Gharaei
- Anesthesiology Department of Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, I.R. Iran
| | - Fatemeh Roodneshin
- Anesthesiology Department of Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, I.R. Iran
| | - Mohammad Hossein Soltani
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, I.R. Iran
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Abstract
PURPOSE OF REVIEW The evolution of percutaneous renal stone surgery has recently seen an increasing number undergoing surgery in the supine position rather than just the classical prone technique. Several advantages have been proposed with the supine approach, including benefits for anaesthesia (cardiovascular and airway), the patient (reduced transfer-related injuries), and surgeon (combined retrograde and antegrade surgery, and ergonomics). As the supine technique and variations have now been practised for several years, it is timely to review whether it has been adopted universally and what factors may lead to preference for one approach over another. RECENT FINDINGS There have been several retrospective reports, but only two prospective randomized trials published in the literature, comparing the techniques. There have also been recent attempts at establishing national and international databases for percutaneous nephrolithotomy (PCNL) surgery to try and describe the practice patterns for this surgery, and also the factors that influence the decision to adopt a particular position. Although there appear to be no clear overall benefits for one position over another, and practice is likely to remain fairly surgeon-specific, there are some cases in which the supine PCNL may be preferable (e.g. in obese patients). SUMMARY Along with the development of centres offering this surgical technical variation, endourology training programmes will increasingly offer exposure to supine PCNL, which may then affect the global practice patterns.
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11
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Rodrigues PL, Rodrigues NF, Fonseca J, Lima E, Vilaça JL. Kidney Targeting and Puncturing During Percutaneous Nephrolithotomy: Recent Advances and Future Perspectives. J Endourol 2013; 27:826-34. [DOI: 10.1089/end.2012.0740] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Pedro L. Rodrigues
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Algoritmi Center, School of Engineering, University of Minho, Guimarães, Portugal
- DIGARC – Polytechnic Institute of Cávado and Ave, Barcelos, Portugal
| | - Nuno F. Rodrigues
- DIGARC – Polytechnic Institute of Cávado and Ave, Barcelos, Portugal
- HASLab/INESC TEC, University of Minho, Braga, Portugal
| | - Jaime Fonseca
- Algoritmi Center, School of Engineering, University of Minho, Guimarães, Portugal
| | - Estevão Lima
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Department of Urology, Hospital of Braga, Braga, Portugal
| | - João L. Vilaça
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
- DIGARC – Polytechnic Institute of Cávado and Ave, Barcelos, Portugal
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12
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Abstract
Percutaneous renal access is a common procedure in urologic practice. The main indications are drainage of an obstructed and hydronephrotic kidney and antegrade renal access prior to percutaneous renal surgeries such as percutaneous nephrolithotomy (PCNL) and percutaneous endopyelotomy (EP). The contraindications for this technique are patients with history of allergy to topical or local anesthesia and patients with coagulopathy. The creation of a percutaneous tract into the renal collecting system is one of the important steps for percutaneous renal access. This step usually requires imaging. The advantages and disadvantages of each modality of image guidance are controversial. We performed a structured review using the terms: Percutaneous nephrostomy, guidance, fluoroscopy, ultrasonography, computed tomography (CT) scan, and magnetic resonance imaging (MRI). The outcomes are discussed.
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Affiliation(s)
- Bannakij Lojanapiwat
- Division of Urology, Department of Surgery, Chiangmai University, Thailand
- For correspondence: Dr. Bannakij Lojanapiwat, Division of Urology, Department of Surgery, Faculty of Medicine, Chiangmai University, Thailand. E-mail:
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13
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El-Karamany T. A supracostal approach for percutaneous nephrolithotomy of staghorn calculi: A prospective study and review of previous reports. Arab J Urol 2012; 10:358-66. [PMID: 26558050 PMCID: PMC4442912 DOI: 10.1016/j.aju.2012.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 08/09/2012] [Accepted: 08/10/2012] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To evaluate a supracostal approach for percutaneous nephrolithotomy (PCNL) of staghorn calculi through a prospective study and review of previously reported cases. METHODS From June 2009 to November 2011, 40 patients with staghorn calculi were scheduled for supracostal S-PCNL in a prospective study. Of the 40 renal units, 16 (40%) had a complete staghorn and 24 (60%) had a partial staghorn calculus. Perioperative complications were stratified according to the modified Clavien system. Univariate and multiple logistic regression analyses were used to determine statistically significant variables affecting the stone-free rate and development of complications. RESULTS In all, 57 tracts were established in the 40 renal units; 23 (58%) renal units were approached through one supracostal upper pole calyx, while 13 (33%) and four (10%) required a second middle- or lower-pole puncture, respectively. Overall, 78% of patients were rendered stone-free or had clinically insignificant residual fragments with PCNL monotherapy, and this increased to 88% with auxiliary procedures. In the logistic regression analysis, a complete staghorn stone was the only independent variable for residual stones (P = 0.005). There was an overall complication rate of 38%. Independent variables with an influence on complications were staghorn stone burden (P = 0.007), and operative duration (P = 0.045). CONCLUSIONS The supracostal upper calyceal approach provides optimum access for the percutaneous removal of staghorn stones. Appropriate attention to the technique and to monitoring before and after surgery can detect thoracic complications, and these can be managed easily with intercostal chest tube drainage, with no serious morbidity.
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14
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Abstract
Percutaneous nephrolithotomy (PCNL) is the most morbid of the minimally invasive surgeical procedures for stone removal. Over the last 2 decades, refinements in technique and new technology have improved the efficacy and the efficiency of the procedure. Although PCNL has long been the procedure of choice for large and complex stones, it is increasingly being used for moderate stone burdens because of its high stone-free rates and because of the limitations of shock wave lithotripsy and ureteroscopy. The article reviews advances in the technique and technology applied to percutaneous access, tract dilation, stone visualization, stone fragmentation, stone clearance, and postoperative management.
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Current world literature. Curr Opin Urol 2012; 22:160-5. [PMID: 22297787 DOI: 10.1097/mou.0b013e328350f678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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ECIRS (Endoscopic Combined Intrarenal Surgery) in the Galdakao-modified supine Valdivia position: a new life for percutaneous surgery? World J Urol 2011; 29:821-7. [PMID: 22057344 DOI: 10.1007/s00345-011-0790-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 10/18/2011] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Percutaneous nephrolithotomy (PNL) is still the gold-standard treatment for large and/or complex renal stones. Evolution in the endoscopic instrumentation and innovation in the surgical skills improved its success rate and reduced perioperative morbidity. ECIRS (Endoscopic Combined IntraRenal Surgery) is a new way of affording PNL in a modified supine position, approaching antero-retrogradely to the renal cavities, and exploiting the full array of endourologic equipment. ECIRS summarizes the main issues recently debated about PNL. METHODS The recent literature regarding supine PNL and ECIRS has been reviewed, namely about patient positioning, synergy between operators, procedures, instrumentation, accessories and diagnostic tools, step-by-step standardization along with versatility of the surgical sequence, minimization of radiation exposure, broadening to particular and/or complex patients, limitation of post-operative renal damage. RESULTS Supine PNL and ECIRS are not superior to prone PNL in terms of urological results, but guarantee undeniable anesthesiological and management advantages for both patient and operators. In particular, ECIRS requires from the surgeon a permanent mental attitude to synergy, standardized surgical steps, versatility and adherence to the ongoing clinical requirements. ECIRS can be performed also in particular cases, irrespective to age or body habitus. The use of flexible endoscopes during ECIRS contributes to minimizing radiation exposure, hemorrhagic risk and post-PNL renal damage. CONCLUSIONS ECIRS may be considered an evolution of the PNL procedure. Its proposal has the merit of having triggered the critical analysis of the various PNL steps and of patient positioning, and of having transformed the old static PNL into an updated approach.
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Affiliation(s)
- Darren Beiko
- Associate Professor, Department of Urology, Queen's University, Kingston, ON
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