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Fernández Baltar C, Gude Sampedro F, Pérez Fentes D. Does success in percutaneous nephrolithotomy depend only on stone size? Analysis of the predictive capacity for success and complications of the current nephrolithometry scoring systems and their relationship with the stone surface. Actas Urol Esp 2024:S2173-5786(24)00070-2. [PMID: 38735437 DOI: 10.1016/j.acuroe.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/18/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE To analyze the predictive capacity of the nephrolithometry scoring systems (GSS, STONE, CROES and S-ReSC) and stone surface regarding success and complications following percutaneous nephrolithotomy (PCNL). METHODS We studied 392 patients who had undergone PCNL in our center. Only patients with a non-contrast CT (n = 240) were finally included for analysis. The predictive capacities for success and complications of the different scoring systems were evaluated using ROC curves and their area under the curve (AUC). RESULTS Regarding success, the S-ReSC system had the highest predictive capacity with an AUC of 0.681 (95% CI 0.610-0.751), followed by the CROES with 0.667 (95% CI 0.595-0.738), the STONE with 0.654 (95% CI 0.579-0.728) and finally the GSS with 0.626 (95% CI 0.555-0.698). The stone surface as a single variable had an AUC of 0.641 (95% CI 0.565-0.718). As for complications, the S-ReSC had the highest AUC with 0.664 (95% CI 0.57-0.758), followed by STONE with 0.663 (95% CI 0.572-0.755), GSS with 0.626 (95% CI 0.555).-0.698) and CROES with 0.614 (95% CI 0.518-0.7). The stone surface alone had an AUC of 0.616 (95% CI 0.522-0.715). CONCLUSION The nephrolithometry scales analyzed show a moderate predictive capacity for success and complications in patients undergoing PCNL in our center. Moreover, stone surface as an independent variable demonstrates moderate predictive capacity for both outcomes.
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Affiliation(s)
- C Fernández Baltar
- Complejo Hospitalario Universitario de Pontevedra, Servicio de Urología, Pontevedra, Spain.
| | - F Gude Sampedro
- Complejo Universitario de Santiago de Compostela, Unidad de Epidemiología, Santiago de Compostela, Spain
| | - D Pérez Fentes
- Complejo Universitario de Santiago de Compostela, Servicio de Urología, Santiago de Compostela, Spain
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2
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Edison E, Mazzon G, Arumuham V, Choong S. Prevention of complications in endourological management of stones: What are the basic measures needed before, during, and after interventions? Asian J Urol 2024; 11:180-190. [PMID: 38680580 PMCID: PMC11053336 DOI: 10.1016/j.ajur.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/17/2023] [Indexed: 05/01/2024] Open
Abstract
Objective This narrative review aims to describe measures to minimise the risk of complications during percutaneous nephrolithotomy (PCNL), ureteroscopy, and retrograde intrarenal surgery. Methods A literature search was conducted from the PubMed/PMC database for papers published within the last 10 years (January 2012 to December 2022). Search terms included "ureteroscopy", "retrograde intrarenal surgery", "PCNL", "percutaneous nephrolithotomy", "complications", "sepsis", "infection", "bleed", "haemorrhage", and "hemorrhage". Key papers were identified and included meta-analyses, systematic reviews, guidelines, and primary research. The references of these papers were searched to identify any further relevant papers not included above. Results The evidence is assimilated with the opinions of the authors to provide recommendations. Best practice pathways for patient care in the pre-operative, intra-operative, and post-operative periods are described, including the identification and management of residual stones. Key complications (sepsis and stent issues) that are relevant for any endourological procedure are then be discussed. Operation-specific considerations are then explored. Key measures for PCNL include optimising access to minimise the chance of bleeding or visceral injury. The role of endoscopic combined intrarenal surgery in this regard is discussed. Key measures for ureteroscopy and retrograde intrarenal surgery include planning and technique to minimise the risk of ureteric injury. The role of anaesthetic assessment is discussed. The importance of specific comorbidities on each step of the pathway is highlighted as examples. Conclusion This review demonstrates that the principles of meticulous planning, interdisciplinary teamworking, and good operative technique can minimise the risk of complications in endourology.
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Affiliation(s)
- Eric Edison
- Department of Urology, University College Hospital London, London, UK
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Vimoshan Arumuham
- Department of Urology, University College Hospital London, London, UK
| | - Simon Choong
- Department of Urology, University College Hospital London, London, UK
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3
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Kallidonis P, Spinos T, Tatanis V, Skarimpa A, Vrettos T, Katsakiori P, Liatsikos E. Nonpapillary Prone Endoscopic Combined Intrarenal Surgery (ECIRS): Five-Year Experience and Outcomes from a High-Volume Center. J Clin Med 2024; 13:621. [PMID: 38276127 PMCID: PMC10816857 DOI: 10.3390/jcm13020621] [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: 12/23/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Endoscopic combined intrarenal surgery (ECIRS) provides simultaneous retrograde and percutaneous access to the upper urinary tract. The purpose of this study is to present revised data, tips and tricks, and technique modifications arising from our five-year experience with ECIRS. The data of 62 patients who underwent nonpapillary prone ECIRS from January 2019 to November 2023 were prospectively collected. All cases were performed in the prone position. Inclusion criteria were complex stone cases with stones in multiple calyces requiring either multiple accesses or multiple sessions to achieve stone-free status. Patients' mean age was 54.4 ± 12.39 years, while the mean stone size was 39.03 ± 13.93 mm. The mean operative time was 51.23 ± 17.75 min. Primary and final stone-free rates were 83.8% and 90.3%, respectively. In total, nine patients presented with postoperative complications, which were all Grade II ones. The holmium-YAG laser type during retrograde lithotripsy was associated with significantly shorter operative times compared to the thulium fiber laser. Nonpapillary prone ECIRS is a feasible, safe, and efficient approach for patients with specific stone and anatomy characteristics. The implementation of more, higher-evidence studies is of utmost importance so that safer conclusions can be drawn.
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Affiliation(s)
- Panagiotis Kallidonis
- Department of Urology, University of Patras Hospital, 26504 Patras, Greece; (T.S.); (V.T.); (A.S.); (P.K.); (E.L.)
| | - Theodoros Spinos
- Department of Urology, University of Patras Hospital, 26504 Patras, Greece; (T.S.); (V.T.); (A.S.); (P.K.); (E.L.)
| | - Vasileios Tatanis
- Department of Urology, University of Patras Hospital, 26504 Patras, Greece; (T.S.); (V.T.); (A.S.); (P.K.); (E.L.)
| | - Anna Skarimpa
- Department of Urology, University of Patras Hospital, 26504 Patras, Greece; (T.S.); (V.T.); (A.S.); (P.K.); (E.L.)
| | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, 26504 Patras, Greece;
| | - Paraskevi Katsakiori
- Department of Urology, University of Patras Hospital, 26504 Patras, Greece; (T.S.); (V.T.); (A.S.); (P.K.); (E.L.)
| | - Evangelos Liatsikos
- Department of Urology, University of Patras Hospital, 26504 Patras, Greece; (T.S.); (V.T.); (A.S.); (P.K.); (E.L.)
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
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4
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Kallidonis P, Peteinaris A, Tatanis V, Vagionis A, Faitatziadis S, Liatsikos E. Percutaneous nephrolithotomy non-papillary puncture trends. A review of the literature. Actas Urol Esp 2024; 48:52-56. [PMID: 37330051 DOI: 10.1016/j.acuroe.2023.06.003] [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: 02/24/2023] [Accepted: 04/19/2023] [Indexed: 06/19/2023]
Abstract
Percutaneous nephrolithotomy (PCNL) is the gold standard of treatment for large renal calculi. Papillary puncture is the mainstay of treatment for large renal calculi, but the non-papillary has been introduced and gained some interest. The aim of this study is the investigation of trends of non-papillary access for PCNL over the years. A review of the literature took place and 13 publications were included in the study. Two experimental studies investigating the feasibility of non-papillary access were found. Five cohort prospective and 2 retrospective studies for non-papillary access and 4 comparative studies between papillary and non-papillary access were included. Non papillary access is a technique that has been proved as a safe and efficient solution that keeps up with the latest endoscopic trends. A wider use of this method could be expected in the future.
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Affiliation(s)
- P Kallidonis
- Servicio de Urología, Hospital Universitario de Rion, Patras, Greece.
| | - A Peteinaris
- Servicio de Urología, Hospital Universitario de Rion, Patras, Greece
| | - V Tatanis
- Servicio de Urología, Hospital Universitario de Rion, Patras, Greece
| | - A Vagionis
- Servicio de Urología, Hospital Universitario de Rion, Patras, Greece
| | - S Faitatziadis
- Servicio de Urología, Hospital Universitario de Rion, Patras, Greece
| | - E Liatsikos
- Servicio de Urología, Hospital Universitario de Rion, Patras, Greece; Hospital Universitario de Viena, Viena, Austria
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5
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Tsaturyan A, Peteinaris A, Adamou C, Pagonis K, Musheghyan L, Natsos A, Vrettos T, Liatsikos E, Kallidonis P. Percutaneous antegrade management of large proximal ureteral stones using non-papillary puncture. Asian J Urol 2024; 11:110-114. [PMID: 38312817 PMCID: PMC10837659 DOI: 10.1016/j.ajur.2022.01.006] [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: 10/05/2021] [Accepted: 01/17/2022] [Indexed: 10/16/2022] Open
Abstract
Objective To evaluate the feasibility and the safety of medial non-papillary percutaneous nephrolithotomy (npPCNL) for the management of large proximal ureteral stones. Methods We evaluated prospectively collected data of 37 patients with large proximal ureteral stones more than 1.5 cm in diameter treated by prone npPCNL. Depending on stone size, in-toto stone removal or lithotripsy using the Lithoclast® Trilogy (EMS Medical, Nyon, Switzerland) was performed. Perioperative parameters including operative time (from start of puncture to the skin suturing), stone extraction time (from the first insertion of the nephroscope to the extraction of all stone fragments), and the stone-free rate were evaluated. Results Twenty-one males and 16 females underwent npPCNL for the management of large upper ureteral calculi. The median age and stone size of treated patients were 58 (interquartile range [IQR]: 51-69) years and 19.3 (IQR: 18.0-22.0) mm, respectively. The median operative time and stone extraction time were 25 (IQR: 21-29) min and 8 (IQR: 7-10) min, respectively. One case (2.7%) of postoperative bleeding and two cases (5.4%) of prolonged fever were managed conservatively. The stone-free rate at a 1-month follow-up was 94.6%. Conclusion The npPCNL provides a straight route to the ureteropelvic junction and proximal ureter. Approaching from a dilated portion of the ureter under low irrigation pressure with larger diameter instruments results in effective and safe stone extraction within a few minutes.
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Affiliation(s)
| | | | | | | | - Lusine Musheghyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | | | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece
- Department of Urology, Medical University of Vienna, Vienna, Austria
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Zeng T, Wu W, Zhang L, Zhang S, Huang Y, He Z, Chang Z, Zhong W, Zeng G, Wu W. Superselective renal arterial embolization for severe postpercutaneous nephrolithotomy haemorrhage: clinical characteristics and risk factors for initial failure. World J Urol 2023:10.1007/s00345-023-04391-2. [PMID: 37029797 DOI: 10.1007/s00345-023-04391-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/28/2023] [Indexed: 04/09/2023] Open
Abstract
OBJECTIVE To identify the clinical characteristics of patients who underwent superselective renal arterial embolization (SRAE) after percutaneous nephrolithotomy (PCNL) and to explore the risk factors for failed initial SRAE after PCNL. MATERIALS AND METHODS Patients who underwent SRAE for severe haemorrhage following PCNL between January 2014 and December 2020 were included in the study. The clinical data of those patients and the parameters and characteristics of the perioperative PCNL and SRAE procedures were collected and analysed. RESULTS A total of 243 patients were included in this study. A total of 139 patients (57.2%) had a pseudoaneurysm, 25 (10.3%) had an arteriovenous fistula, 50 (20.6%) patients had both a pseudoaneurysm and an arteriovenous fistula, and 29 (11.9%) had an arterial laceration. In 177 patients with single percutaneous access, 125 (70.6%) patients exhibited nontract haemorrhage, and 55 (31.1%) patients exhibited multiple bleeding sites. In 66 patients with multiple percutaneous access, 44 (66.7%) patients exhibited nontract haemorrhage, and 32 (48.5%) patients exhibited multiple bleeding sites. The decrease in Hb before SRAE was 41.4 ± 19.8 g/L. The mean time between PCNL surgery and initial SRAE was 6.4 ± 4.9 days. Serum creatinine was increased after the SRAE procedure. Initial SRAE was successful in 229 (94.2%) patients and failed in 14 (5.8%) patients. Multivariate regression demonstrated that hydronephrosis < 20 mm, total ultrasonographic guidance, solitary kidney, previous ipsilateral renal surgery, PCNL duration > 90 min and multiple bleeding sites were potential risk factors for initial embolization failure. CONCLUSION Percutaneous access was not the most important reason for post-PCNL severe haemorrhage. SRAE is effective for the treatment of severe haemorrhage following PCNL; however, several factors have an impact on the success of initial SRAE. Additionally, the SRAE procedure may affect renal function.
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Affiliation(s)
- Tao Zeng
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China
| | - Weizhou Wu
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China
- Department of Urology, Maoming People's Hospital, Maoming, Guangdong, China
| | - Liangwei Zhang
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China
- Department of Urology, People's Hospital of Yingde City, Qingyuan, Guangdong, China
| | - Shike Zhang
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China
- Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yapeng Huang
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China
| | - Zhican He
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China
- Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhenglin Chang
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China
| | - Wen Zhong
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China
| | - Guohua Zeng
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
- Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
| | - Wenqi Wu
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
- Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
- Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
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7
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Tsaturyan A, Adamou C, Pantazis L, Kalogeropoulou C, Tzelepi V, Apostolopoulos D, Pagonis K, Peteinaris A, Natsos A, Vrettos T, Al-Aown A, Liatsikos E, Kallidonis P. The effect of percutaneous tract dilation technique on renal parenchymal trauma: An experimental in vivo study on a porcine model. Urol Ann 2023; 15:191-196. [PMID: 37304519 PMCID: PMC10252767 DOI: 10.4103/ua.ua_25_22] [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: 02/04/2022] [Accepted: 09/28/2022] [Indexed: 06/13/2023] Open
Abstract
Purpose The purpose of this study was to evaluate renal parenchymal trauma of two-step dilation compared to the conventional Amplatz gradual dilation during percutaneous nephrolithotomy on a porcine model. Materials and Methods A nonpapillary percutaneous access tract was established under fluoroscopic guidance in both kidneys of four female pigs. On the right kidney of each pig, gradual dilation was performed using an Amplatz dilator set with a gradual dilation to 30 Fr, whereas on the left, a two-step dilation was utilized using only 16 Fr and 30 Fr dilators. Two of the animals were euthanized immediately after the procedure and the remaining two 1 month later. The pigs that were kept alive underwent a contrast-enhanced computed tomography immediately, 15, and 30 days postoperatively. A dimercaptosuccinic acid (DMSA) scintigraphy and single-photon emission computed tomography-computed tomography (CT) were also performed after the last CT and afterward, the pigs were sacrificed. All kidneys were harvested for pathohistological examination. Results The follow-up radiologic imaging showed similar parenchymal damage caused by the compared dilation techniques and an expected reduction in scar size in the later scans. No scar was identified by DMSA in any kidney. Gross and microscopic examinations conducted both on the kidneys that were harvested immediately after the procedure and the ones from the animals that were left to heal, revealed no significant differences in tissue damage, grade of fibrosis, or inflammation depending on the dilation method. Conclusions Our study showed no inferior outcomes caused by two-step dilation compared to gradual dilation regarding renal parenchymal damage following a nonpapillary puncture. In fact, postoperative imaging findings suggested a trend toward better healing and less scar tissue when the two-step method was used.
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Affiliation(s)
- Arman Tsaturyan
- Department of Urology and ICU University Hospital of Patras, Patras, Greece
| | | | - Lampros Pantazis
- Department of Urology and ICU University Hospital of Patras, Patras, Greece
| | | | - Vasiliki Tzelepi
- Department of Pathology and ICU University Hospital of Patras, Patras, Greece
| | | | | | - Angelis Peteinaris
- Department of Urology and ICU University Hospital of Patras, Patras, Greece
| | - Anastasios Natsos
- Department of Urology and ICU University Hospital of Patras, Patras, Greece
| | - Theofanis Vrettos
- Department of Anesthesiology and ICU University Hospital of Patras, Patras, Greece
| | - Abdulrahman Al-Aown
- Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | - Evangelos Liatsikos
- Department of Urology and ICU University Hospital of Patras, Patras, Greece
- Department of Urology, Medical University of Vienna, Vienna, Austria
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8
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Tatanis V, Cracco CM, Liatsikos E. Advances in percutaneous renal puncture: a comprehensive review of the literature. Curr Opin Urol 2023; 33:116-121. [PMID: 36305308 DOI: 10.1097/mou.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW Percutaneous nephrolithotomy (PCNL) constitutes the gold standard procedure for patients suffering from more than 2 cm renal stones. The puncture is a very critical step of PCNL, affecting manoeuvrability of the nephroscope, possibility to remove stone fragments, risk of bleeding and radiation exposure. The aim of the current review was to discuss the advances in percutaneous renal puncture. RECENT FINDINGS Following technological evolution in medicine, there was a consistent development in the puncture techniques, aiming at the improvement of its efficacy and safety. The use of specific agents can improve ultrasonic guidance, making the challenging step of gaining access to the kidney easier for the experienced surgeon and more accessible for the resident urologist. Future developments in the electromagnetic and three-dimensional (3D) technology may establish a high level of accuracy with decreased rates of related complications, even in the hands of beginners. SUMMARY The advances in percutaneous puncture can lead to improved safety and accuracy of this procedure decreasing the radiation exposure and the complication rate.
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Affiliation(s)
| | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece
- Department of Urology, Medical University of Vienna, Vienna, Austria
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9
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Tsaturyan A, Faitatziadis S, Peteinaris A, Adamou C, Pagonis K, Natsos A, Vrettos T, Liatsikos E, Kallidonis P. Non-papillary prone percutaneous nephrolithotomy for renal abnormalities: single-institution experience. World J Urol 2023; 41:581-587. [PMID: 36547678 DOI: 10.1007/s00345-022-04254-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of non-papillary prone PCNL for the treatment of patients with renal abnormalities. METHODS An observational retrospective cohort study including PCNL cases of patients with renal abnormalities was performed. The following inclusion criteria were applied: renal stones > 1.5 cm with maximal diameter, anatomical malformations of affected kidney (malrotated kidneys, horseshoe kidneys and kidneys with complete duplicated systems, medullary sponge kidney), patients treated with standard (30Fr) PCNL or mini-PCNL (22Fr). The lithotripsy was performed using the Lithoclast Master or the Lithoclast® Trilogy (EMS Medical, Nyon, Switzerland). RESULTS Overall, 57 patients, 35 males, and 22 females with any renal malformation underwent non-papillary prone PCNL. Our study included 25 patients with horseshoe kidneys, 21 with malrotated kidneys, 9 with kidneys with duplicated pelvicalyceal systems and 2 with medullary sponge kidneys. The mean cumulative stone size was 36 ± 1.4 mm and most of the stones were in the lower calyceal group (36.9%) and in the pelvis (27.2%). The stone-free rate (SFR) was 84.2% and the mean hospitalization time was 2.7 ± 0.7 days. In total, postoperative complications were developed in six patients (10.5%), half of them presenting fever and the other half requiring blood transfusion (Grade II). CONCLUSION The PCNL is the method of choice for treating large stones in anomalous kidneys. The generally accepted panacea that only a papillary puncture is safe is questioned by our results. Based on our experience, a non-papillary puncture proved to be a safe and effective procedure.
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Affiliation(s)
- Arman Tsaturyan
- Department of Urology, University of Patras Medical School, 26500, Rio, Patras, Greece.
| | - Solon Faitatziadis
- Department of Urology, University of Patras Medical School, 26500, Rio, Patras, Greece
| | - Angelis Peteinaris
- Department of Urology, University of Patras Medical School, 26500, Rio, Patras, Greece
| | - Constantinos Adamou
- Department of Urology, University of Patras Medical School, 26500, Rio, Patras, Greece
| | - Konstantinos Pagonis
- Department of Urology, University of Patras Medical School, 26500, Rio, Patras, Greece
| | - Anastasios Natsos
- Department of Urology, University of Patras Medical School, 26500, Rio, Patras, Greece
| | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | - Evangelos Liatsikos
- Department of Urology, University of Patras Medical School, 26500, Rio, Patras, Greece.,Department of Urology, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Panagiotis Kallidonis
- Department of Urology, University of Patras Medical School, 26500, Rio, Patras, Greece
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10
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Kashi AH, Basiri A, Voshtasbi A, Ghead MA, Dadpour M, Nazempour F, Najafi D, Sotoudeh M, Narouie B. Comparing the outcomes of papillary and non-papillary access in percutaneous nephrolithotomy. World J Urol 2023; 41:537-542. [PMID: 36527469 DOI: 10.1007/s00345-022-04256-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Some publications have recently been released on the safety of non-papillary access (NPA) in percutaneous nephrolithotomy (PCNL) by a Greek group. The purpose of this study was to prospectively examine the outcome of NPA during two years in a referral center. METHODS This prospective cohort study was conducted on PCNL operations performed from January 2020 to April 2022 in Labbafinejad Hospital. In cases in which obtaining papillary access (PA) was not obtainable after several attempts and NPA was obtained, or in cases in whom after entry to the pyelocalyceal system, a NPA was observed, the cases were categorized in the NPA group (n = 67). The control group (PA) was composed of patients who had undergone PCNL with papillary access with similar stone bulk (n = 67). The primary endpoints of interest were hemoglobin drop and transfusion frequency. The secondary endpoint included: stone free rate (SFR), operation duration, and complications. RESULTS A total of 134 patients were enrolled during the study period which included 33 female patients (25%). The mean ± SD age of patients was 49.6 ± 13.2 years. The frequency of transfusion and residual stones was not different between NPA and PA groups: 6 (9%) versus 8 (11%), P = 0.29; and 16 (24%) versus 12 (18%), P = 0.26. Likewise, the operation time (87.6 ± 25.8 versus 90.2 ± 22.6 min, P = 0.45), and the frequency of intraoperative and postoperative complications were not different between the NPA and PA groups. CONCLUSION The results of this prospective study did not reveal a higher frequency of residual stones, transfusion, or complications in the NPA group. Nevertheless, our study is not powered enough to reveal complications of low frequency including delayed bleeding.
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Affiliation(s)
- Amir Hossein Kashi
- Department of Urology, Urology and Nephrology Research Center(UNRC), Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Abbas Basiri
- Department of Urology, Urology and Nephrology Research Center(UNRC), Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Alborz Voshtasbi
- Department of Urology, Urology and Nephrology Research Center(UNRC), Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Mohammad Ali Ghead
- Department of Urology, Urology and Nephrology Research Center(UNRC), Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Mehdi Dadpour
- Department of Urology, Urology and Nephrology Research Center(UNRC), Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Farzad Nazempour
- Department of Urology, Urology and Nephrology Research Center(UNRC), Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Darya Najafi
- Department of Urology, Urology and Nephrology Research Center(UNRC), Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Mehdi Sotoudeh
- Department of Urology, Urology and Nephrology Research Center(UNRC), Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Behzad Narouie
- Department of Urology, Zahedan University of Medical Sciences, Zahedan, Iran.
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11
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Tsaturyan A, Vrettos T, Ballesta Martinez B, Liourdi D, Lattarulo M, Liatsikos E, Kallidonis P. Position-related anesthesiologic considerations and surgical outcomes of prone percutaneous nephrolithotomy: a review of the current literature. Minerva Urol Nephrol 2022; 74:695-702. [PMID: 35622348 DOI: 10.23736/s2724-6051.22.04787-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The aim of the current study was to perform a critical review of existing literature and report the potential morbidity of patient positioning during urological surgeries as well as evaluate the surgical outcomes and anesthesiologic benefits and risks of prone percutaneous nephrolithotomy (PCNL). A narrative review of the current literature has been performed. Articles related to position-related injuries and complications under general anesthesia in prone positions were selected, studied, and considered for the current review. We found that under general anesthesia, the prone position improved the oxygenation of patients and increased the elimination of carbon dioxide. A potential risk for position-related anesthesiologic side effects was reported for longer spine surgeries in a prone position. The injuries and position-related side effects were extremely rare following prone PCNL since the mean duration of the procedure was significantly shorter than that of spine surgery. In conclusion, the prone PCNL remains the most often utilized and preferred approach globally with well-established success and complication rates. Clinical outcomes of prone PCNL do not demonstrate an increased rate of anesthesiologic complications compared to the supine approach. Standardization of turnover of the position, and reduction of the operative time warrant a faster and complication-free recovery.
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Affiliation(s)
| | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | | | - Despoina Liourdi
- Department of Urology, University of Patras, Patras, Greece.,Department of Internal Medicine, Ag. Andreas General Hospital of Patras, Patras, Greece
| | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece - .,Department of Urology, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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12
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Kyriazis I, Kallidonis P, Kyrkopoulou E, Spinos T, Liatsikos E. Hands on wet lab and live surgery training in PCNL: Any impact to surgical skills of attending surgeons? Arch Ital Urol Androl 2022; 94:300-304. [DOI: 10.4081/aiua.2022.3.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/23/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives: The clinical value and efficiency of hands-on training courses in percutaneous nephrolithotomy (PCNL) remains undocumented. During the last 9 years, a two-day international intensive hands-on training course in fluoroscopic guided prone PCNL is taking place in our department on a monthly basis. Course includes wet lab training in the porcine model and live surgery training. In this work we report the outcomes of a survey send to course participants questioning the impact of the course to their clinical practice.Materials and methods: A survey consisting of 26 questions was distributed online to a total of 91 trainees that had completed the course. Comparison of pre and post course surgical practices was performed using the "N-1" Chi-squared test.Results: A total of 64 trainees responded to our online survey with 55.6% and 41.3% reporting a modest or major impact to their practice accordingly. Notable changes in puncture and dilation technique were evidenced while a uniform reduction in puncture and operative times was documented. 79.4% responded that the course increased the safety of their procedure, 73% that it reduced operating times, 39.7% that increased their stone free rates, 23.8% that reduced their complications and 23.8% that induced to change their instrumentation with respect of that they were using in the past. Subgroup analysis including only well experienced surgeons revealed a similar impact to their practice.Conclusions: In the proper setting, an intensive hands-on PCNL course can have a significant impact on attending physicians. Participation to such events even for experienced surgeons should be encouraged.
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13
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Nasseh H, Mokhtari G, Ghasemi S, Biazar G, Kazemnezhad Leyli E, Gholamjani Moghaddam K. Risk Factors for Intra-operative Bleeding in Percutaneous Nephrolithotomy in an Academic Center: A Retrospective Study. Anesth Pain Med 2022; 12:e126974. [PMID: 36937085 PMCID: PMC10016121 DOI: 10.5812/aapm-126974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/04/2022] [Accepted: 08/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background Percutaneous nephrolithotomy (PNL) is the treatment of choice for renal stones as a safe, effective, and minimally invasive method. However, bleeding remains a major concern in the procedure. Objectives This study aimed to investigate the risk factors of bleeding in PNL. Methods This retrospective descriptive cross-sectional study was conducted in the Urology department of Razi hospital. The data of patients with urinary calculi staghorn type who underwent PNL in a prone position under general anesthesia were recorded. A checklist including patients' demographics, surgical characteristics, and outcomes was filled out for each patient. Results The data from 151 complete files were gathered. The mean age of the cases was 47.89 ± 12.41 years. The mean hemoglobin (Hb) drop was 1.92 ± 1.56 mg/dL. At least 1 mg/dL Hb drop was observed in all cases. The highest Hb drop was 3 mg/dL.). There was no significant relationship between stone bulk, age, BMI, GFR, surgery duration, and the number of tracts, and Hb drop during PNL (P > 0.05). But there was a positive correlation between Urinary Tract Infection (UTI) history (P = 0.01) and transfusion (P = 0.0001) and Hb drop during PNL. Also, the history of open kidney surgery (P = 0.031), nephrostomy insertion (P = 0.003), and extracorporeal shock wave lithotripsy therapy (ESWL) (P = 0.041) were correlated with the increased risk of Hb drop. Conclusions Urinary tract infection, history of open surgery, nephrostomy implantation, and ESWL were significantly associated with more bleeding in PNL.
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Affiliation(s)
- Hamidreza Nasseh
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Gholamreza Mokhtari
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Samira Ghasemi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gelareh Biazar
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding Author: Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences, 4144654839, Rasht, Iran. Tel: +98-1333369328,
| | - Ehsan Kazemnezhad Leyli
- Guilan Road Trauma Research Center, Biostatistics Department, Guilan University of Medical Sciences, Rasht, Iran
| | - Keivan Gholamjani Moghaddam
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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14
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Widyokirono DR, Kloping YP, Hidayatullah F, Rahman ZA, Ng ACF, Hakim L. Endoscopic Combined Intrarenal Surgery vs Percutaneous Nephrolithotomy for Large and Complex Renal Stone: A Systematic Review and Meta-Analysis. J Endourol 2022; 36:865-876. [PMID: 35152754 DOI: 10.1089/end.2021.0761] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Managing complex and large renal stones with percutaneous nephrolithotomy (PCNL) is difficult because of the likelihood of residual stones and multiple access. Endoscopic combined intrarenal surgery (ECIRS) is introduced as an improvement to the procedure to manage stones in one session. The objective of this systematic review and meta-analysis is to compare the efficacy and safety between ECIRS and PCNL for treating large and complex renal stones. Materials and Methods: We conducted a systematic review in the Embase, Scopus, and MEDLINE databases based on the 2020 Preferred Reporting Items for Systematic Review and Meta-Analyses guideline. Eligible studies comprised both randomized and nonrandomized studies comparing ECIRS and PCNL. Results: A total of five nonrandomized studies and one randomized controlled trial were included. The analysis was divided into two subgroups based on the PCNL type, a conventional PCNL (cPCNL) and a mini-PCNL (mPCNL). The one-step stone-free rate (SFR) of ECIRS were significantly higher compared with both the cPCNL (odds ratio [OR] 5.14, 95% confidence interval [CI] 2.54 to 10.4, p < 0.001) and mPCNL (OR 4.27, 95% CI 2.57-7.1, p < 0.001). There were no significant differences in mean operative time and hemoglobin drop between both groups (p > 0.05). The use of auxiliary procedures was significantly higher in both PCNL groups compared with the ECIRS group (OR 0.19, 95% CI 0.13-0.30, p < 0.001). The overall complication rate of ECIRS was lower compared with PCNL (OR 0.43, 95% CI 0.21-0.85, p = 0.02), especially urosepsis, in which the incidence was lower compared with cPCNL (OR 0.14, 95% CI 0.02-0.78, p = 0.02), but not mPCNL (p > 0.05). Conclusion: ECIRS is an effective and safe treatment particularly for large and complex nephrolithiasis, with significantly higher one-step SFR, a lower necessity for auxiliary procedures, and a lower complication rate compared with PCNL.
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Affiliation(s)
- Dyah Ratih Widyokirono
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
- Department of Urology, Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Yudhistira Pradnyan Kloping
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
- Department of Urology, Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Furqan Hidayatullah
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
- Department of Urology, Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Zakaria Aulia Rahman
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
- Department of Urology, Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Anthony Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Lukman Hakim
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
- Department of Urology, Universitas Airlangga Teaching Hospital, Surabaya, East Java, Indonesia
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15
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Lin F, Li B, Rao T, Ruan Y, Yu W, Cheng F, Larré S. Presence of a Novel Anatomical Structure May Cause Bleeding When Using the Calyx Access in Mini-Percutaneous Nephrolithotomy. Front Surg 2022; 9:942147. [PMID: 35800114 PMCID: PMC9253458 DOI: 10.3389/fsurg.2022.942147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background Fused renal pyramid (FRP) is a kidney anatomical structure which was first identified by us. The vascular anatomy of FRP exhibits different from that of the normal renal pyramid (NRP), manifested by the distribution of the ectopic interlobar arteries in FRP. In this study, we analyzed the effect of FRPs on bleeding when using calyx access in mini-percutaneous nephrolithotomy (PCNL). Patients and Methods Overall, 633 patients who underwent ultrasound-guided single-tract mini-PCNL were divided into two groups according to the puncture method used: in group A, puncture was performed through the axial direction of the renal calyx, the line from the apex of the fornix to the center of the neck plane under B-mode ultrasound guidance; and in group B, Doppler ultrasound-guided axillary puncture through calyces corresponding to NRPs when the plane of renal column blood vessels on both sides was selected or calyx puncture through the hypovascular area of the FRPs. Relevant demographic and clinical data were retrospectively analyzed. Results The two groups exhibited similar baseline characteristics. No significant differences were found in hemoglobin reduction, puncture site, tract size, postoperative creatinine level, or stone-free rate between the two groups (P > 0.05). Blood transfusion and embolization rates in group B were significantly lower than those in group A (P = 0.03 and 0.045, respectively). No differences were found between the two groups in terms of persistent pain, hydrothorax, fever, subcapsular hematoma, and urosepsis (P > 0.05). The overall complication rate was not significantly different between the two groups (P = 0.505). Conclusions FRP is a non-negligible anatomical structure that may cause hemorrhage when using calyx access. Doppler ultrasound can identify ectopic blood vessels in FRPs to reduce bleeding during calyx access in mini-PCNL procedures.
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Affiliation(s)
- Fangyou Lin
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bojun Li
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ting Rao
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yuan Ruan
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Weimin Yu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
- Correspondence: Fan Cheng Weimin Yu
| | - Fan Cheng
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
- Correspondence: Fan Cheng Weimin Yu
| | - Stéphane Larré
- Department of Urology, Robert Debré Teaching Hospital, University of Reims, Reims, France
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16
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Liu ZQ, Xie J, Zhao CB, Liu YF, Li ZS, Guo JN, Jiang HT, Xiao KF. Feasibility of contrast-enhanced ultrasound and flank position during percutaneous nephrolithotomy in patients with no apparent hydronephrosis: a randomized controlled trial. World J Urol 2022; 40:1043-1048. [PMID: 35061058 PMCID: PMC8994732 DOI: 10.1007/s00345-022-03933-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To investigate the puncture accuracy and feasibility of contrast-enhanced ultrasound (CEUS) guided percutaneous nephrolithotomy (PCNL) in flank position for patients with no apparent hydronephrosis. Methods Between May 2018 and June 2020, 72 kidney stone patients with no or mild hydronephrosis were randomized into two groups: a CEUS-guided PCNL group and a conventional ultrasound (US)-guided group. Patients’ demographics and perioperative outcomes were compared, including the success rate of puncture via calyceal fornix, the success rate of a single-needle puncture, puncture time, operative time, postoperative hemoglobin loss, stone-free rate, incidence of complications and postoperative stay. Results The success rate of puncture via calyceal fornix for CEUS-guided group was significantly higher than that for conventional US-guided group (86.1 vs. 47.2%, p = 0.002). Patients performed with CEUS-guided PCNL required shorter renal puncture time than those guided with conventional US (36.5 s vs. 61.0 s, p < 0.001). The median postoperative hemoglobin loss in the CEUS-guided group was significantly lower than that in conventional US-guided group (2.5 vs. 14.5 g/L, p < 0.01). There was no statistically significant difference in the success rate of a single-needle puncture, operative time, stone-free rate, incidence of complications and postoperative stay between the two groups. Conclusion CEUS guidance facilitates identification of the renal calyx fornix, and benefits more precise renal puncture and less hemoglobin loss in PCNL. CEUS-guided PCNL in flank position is a feasible approach to the treatment of kidney stone patients with no apparent hydronephrosis.
Trial registration number: ChiCTR1800015417. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-022-03933-4.
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Affiliation(s)
- Zeng-Qin Liu
- Department of Urology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
- Shenzhen Engineering and Technology Center of Minimally Invasive Urology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Jing Xie
- Department of Urology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
- Shenzhen Engineering and Technology Center of Minimally Invasive Urology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Chu-Biao Zhao
- Department of Urology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
- Shenzhen Engineering and Technology Center of Minimally Invasive Urology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Yan-Feng Liu
- Department of Urology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
- Shenzhen Engineering and Technology Center of Minimally Invasive Urology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Zai-Shang Li
- Department of Urology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
- Shenzhen Engineering and Technology Center of Minimally Invasive Urology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Ji-Nan Guo
- Department of Urology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
- Shenzhen Engineering and Technology Center of Minimally Invasive Urology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Hong-Tao Jiang
- Department of Urology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
- Shenzhen Engineering and Technology Center of Minimally Invasive Urology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China
| | - Ke-Feng Xiao
- Department of Urology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China.
- Shenzhen Engineering and Technology Center of Minimally Invasive Urology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China.
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17
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Kallidonis P, Tsaturyan A, Faria-Costa G, Ballesta Martinez B, Peteinaris A, Adamou C, Pagonis K, Natsos A, Vrettos T, Liatsikos E. Nonpapillary prone endoscopic combined intrarenal surgery: effectiveness, safety and tips, and tricks. World J Urol 2022; 40:3067-3074. [PMID: 36251056 PMCID: PMC9712319 DOI: 10.1007/s00345-022-04178-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/01/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of nonpapillary prone endoscopic combined intrarenal surgery (ECIRS) and provide practical tips and tricks for the successful accomplishment of the procedure respecting the anatomical particularities. MATERIAL AND METHODS This study is an analysis of a prospectively collected database including all cases of ECIRS performed between January 2019 and December 2021 in a high-volume tertiary center. All patients underwent the procedure in prone-split leg position. A nonpapillary renal puncture was performed. The used access sheaths were 22Fr or 30Fr. Lithotripsy was performed anterogradely with a dual-energy lithotripter with incorporated suction and retrogradely with holmium Yttrium-Aluminum-Garnet laser. RESULTS A total of 33 patients were included. The initial stone-free rate (SFR) was 84.8% and the final SFR was 90.9%. The median stone size was 35 mm and 60% of patients had staghorn calculi. The prevalence of renal abnormalities was 21.3%, including 3 cases of horseshoe kidney, 2 cases of malrotation and 2 cases with complete duplicated systems. The median operative time was 47 min. The median hospital stay was 3 days and median hemoglobin loss was 1.2 gr/dL. Overall, the complication rate was 9.1%, all being Grade II complications (n = 2 fever and n = 1 transient bleeding). CONCLUSIONS Nonpapillary prone ECIRS is an effective and safe procedure. Standardization of the procedure is critical to achieve good outcomes. Patients who benefit the most are probably the ones where additional punctures can be avoided using this technique, namely patients with renal abnormalities, incrusted ureteral stents and staghorn stones.
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Affiliation(s)
- Panagiotis Kallidonis
- Department of Urology, University of Patras Medical School, University of Patras, 26500 Rio, Patras, Greece
| | - Arman Tsaturyan
- Department of Urology, University of Patras Medical School, University of Patras, 26500 Rio, Patras, Greece
| | - Gabriel Faria-Costa
- Department of Urology, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal ,Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Begona Ballesta Martinez
- Department of Urology, University of Patras Medical School, University of Patras, 26500 Rio, Patras, Greece
| | - Angelis Peteinaris
- Department of Urology, University of Patras Medical School, University of Patras, 26500 Rio, Patras, Greece
| | - Constantinos Adamou
- Department of Urology, University of Patras Medical School, University of Patras, 26500 Rio, Patras, Greece
| | - Konstantinos Pagonis
- Department of Urology, University of Patras Medical School, University of Patras, 26500 Rio, Patras, Greece
| | - Anastasios Natsos
- Department of Urology, University of Patras Medical School, University of Patras, 26500 Rio, Patras, Greece
| | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | - Evangelos Liatsikos
- Department of Urology, University of Patras Medical School, University of Patras, 26500 Rio, Patras, Greece ,Department of Urology, Medical University of Vienna, Vienna, Austria
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18
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Shi Y, Yang X, Mathis BJ, Li W. Can Color Doppler Ultrasound Challenge the Paradigm in Percutaneous Nephrolithotomy? J Endourol 2021; 36:373-380. [PMID: 34569266 DOI: 10.1089/end.2021.0368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Compare color Doppler (Color) ultrasound-guided puncture to common type-B (Type-B) ultrasound-guided puncture in reducing the incidence of hemorrhagic complications of percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS A total of 348 patients who received PCNL from September 2017 to December 2018 were divided into Color (231 cases) and Type-B groups (117 cases). The avascular area of the target fornix was pinpointed in the Color group while the middle of the target fornix was the default puncture point in the Type-B group. Tract bleeding, nephrostomy tract creation time, operation time, postoperative hemoglobin (Hb) values and serum creatinine (Scr) concentrations, and stone-free rates were analyzed. RESULTS Color Doppler imaging revealed that 35.1% of the cases in the Color group (81/231) had variable artery positioning in the target fornix. Tract bleeding and postoperative Hb reduction in the Color group were significantly lower than the Type-B group (10.8% vs 24.8%, P=0.0007, and 4.87±8.58 vs 7.70±8.90 g/L, P=0.0044, respectively). The postoperative hospitalization of the Color group was also shortened (8.3±5.9 vs 9.7±3.0 d, P<0.0001). Although working channel creation took longer in this group (4.2±0.3 vs 3.6±0.2 min, P<0.0001), there were no significant differences in the total operation time between the two groups (39.2±15.2 vs 36.4±16.5 min, P=0.1097) or postoperative Scr and stone-free rates. CONCLUSION Vascular variation of the fornix is very common. Consistent puncture of the avascular area of the target fornix significantly lowered tract bleeding and postoperative Hb decrease compared to traditional procedures. Color Doppler ultrasound-guided puncture is thus useful to reduce the incidence of severe hemorrhagic complications of PCNL.
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Affiliation(s)
- Ying Shi
- Wuhan Union Hospital, 36630, Urology, Wuhan, Hubei , China;
| | - Xiong Yang
- Wuhan Union Hospital, 36630, Urology, Wuhan, Hubei , China;
| | - Bryan James Mathis
- University of Tsukuba Hospital, 68320, International Medical Center, Tsukuba, Ibaraki, Japan;
| | - Wencheng Li
- Wuhan Union Hospital, 36630, Urology, Wuhan, Hubei , China;
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19
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Checcucci E, Amparore D, Volpi G, Piramide F, De Cillis S, Piana A, Alessio P, Verri P, Piscitello S, Carbonaro B, Meziere J, Zamengo D, Tsaturyan A, Cacciamani G, Rivas JG, De Luca S, Manfredi M, Fiori C, Liatsikos E, Porpiglia F. Percutaneous puncture during PCNL: new perspective for the future with virtual imaging guidance. World J Urol 2021; 40:639-650. [PMID: 34468886 DOI: 10.1007/s00345-021-03820-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/19/2021] [Indexed: 12/21/2022] Open
Abstract
CONTEXT Large and complex renal stones are usually treated with percutaneous nephrolithotomy (PCNL). One of the crucial steps in this procedure is the access to the collecting system with the percutaneous puncture and this maneuver leads to a risk of vascular and neighboring organs' injury. In the last years, the application of virtual image-guided surgery has gained wide diffusion even in this specific field. OBJECTIVES To provide a short overview of the most recent evidence on current applications of virtual imaging guidance for PCNL. EVIDENCE ACQUISITION A non-systematic review of the literature was performed. Medline, PubMed, the Cochrane Database and Embase were screened for studies regarding the use virtual imaging guidance for PCNL. EVIDENCE SYNTHESIS 3D virtual navigation technology for PCNL was first used in urology with the purpose of surgical training and surgical planning; subsequently, the field of surgical navigation with different modalities (from cognitive to augmented reality or mixed reality) had been explored. Finally, anecdotal preliminary experiences explored the potential application of artificial intelligence guidance for percutaneous puncture. CONCLUSION Nowadays, many experiences proved the potential benefit of virtual guidance for surgical simulation and training. Focusing on surgery, this tool revealed to be useful both for surgical planning, allowed to achieve a better surgical performance, and for surgical navigation by using augmented reality and mixed reality systems aimed to assist the surgeon in real time during the intervention.
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Affiliation(s)
- E Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142, km 3,95, 10060, Candiolo, Turin, Italy.
- Uro-Technology and SoMe Working Group of the Young Academic Urologists (YAU) Working Party of the European Association of Urology (EAU), Arnhem, The Netherlands.
- Department of Oncology, Division of Urology, University of Turin, Turin, Italy.
| | - D Amparore
- Department of Oncology, Division of Urology, University of Turin, Turin, Italy
| | - G Volpi
- Department of Oncology, Division of Urology, University of Turin, Turin, Italy
| | - F Piramide
- Department of Oncology, Division of Urology, University of Turin, Turin, Italy
| | - S De Cillis
- Department of Oncology, Division of Urology, University of Turin, Turin, Italy
| | - A Piana
- Department of Oncology, Division of Urology, University of Turin, Turin, Italy
| | - P Alessio
- Department of Oncology, Division of Urology, University of Turin, Turin, Italy
| | - P Verri
- Department of Oncology, Division of Urology, University of Turin, Turin, Italy
| | - S Piscitello
- Department of Oncology, Division of Urology, University of Turin, Turin, Italy
| | - B Carbonaro
- Department of Oncology, Division of Urology, University of Turin, Turin, Italy
| | - J Meziere
- Department of Oncology, Division of Urology, University of Turin, Turin, Italy
| | - D Zamengo
- Department of Oncology, Division of Urology, University of Turin, Turin, Italy
| | - A Tsaturyan
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - G Cacciamani
- USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Juan Gomez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - S De Luca
- Department of Oncology, Division of Urology, University of Turin, Turin, Italy
| | - M Manfredi
- Department of Oncology, Division of Urology, University of Turin, Turin, Italy
| | - C Fiori
- Department of Oncology, Division of Urology, University of Turin, Turin, Italy
| | - E Liatsikos
- Department of Urology, University Hospital of Patras, Patras, Greece
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - F Porpiglia
- Department of Oncology, Division of Urology, University of Turin, Turin, Italy
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Poudyal S. Current insights on haemorrhagic complications in percutaneous nephrolithotomy. Asian J Urol 2021; 9:81-93. [PMID: 35198401 PMCID: PMC8841251 DOI: 10.1016/j.ajur.2021.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/10/2020] [Accepted: 12/11/2020] [Indexed: 01/07/2023] Open
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Tsaturyan A, Bellin A, Barbuto S, Zampakis P, Ntzanis E, Lattarulo M, Kalogeropoulou C, Liatsikos E, Kallidonis P. Technical aspects to maximize the hyperaccuracy three-dimensional (HA3D ™) computed tomography reconstruction for kidney stones surgery: a pilot study. Urolithiasis 2021; 49:559-566. [PMID: 33811497 DOI: 10.1007/s00240-021-01262-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/27/2021] [Indexed: 12/24/2022]
Abstract
The aim of the current prospective pilot study was to describe a hyperaccuracy three-dimensional (HA3D™) model reconstruction technique, specifically developed to maximize the visualization of the renal collecting system's anatomy, and its relationship with the stones, vessels and renal parenchyma, and to compare the HA3D™ virtual models with the intraoperative findings. The image acquisition was performed using a CT scanner (Toshiba, Aquilion Prime) and included the unenhanced, arterial, venous and excretory phases. The DICOM format CT images were processed by MEDICS Srl ( www.medics3d.com , Turin, Italy). In total, study included three patients with renal stone scheduled for non-papillary prone percutaneous nephrolithotomy (PCNL). The median age and BMI were 51 (range 49-54) and 25.5 (range 25.0-32.7), respectively. The median stone size was 1170 mm2 (range 830-1520) and median stone density was 1130 HU (range 600-1340). In all cases, the quality of the CT images acquired with our protocol was adequate to perform the HA3D™ reconstruction. Median operative and puncture time were 39.4 (range 35.2-44.0) and 1.9 (range 1.8-2.1) mins, respectively. The success rate for the first attempt of the percutaneous puncture was 100%, and only one PCNL tract was sufficient to complete the surgery. All three patients were stone-free on the third postoperative day. A dedicated imaging acquisition protocol and a tailored 3D model reconstruction process specifically developed for kidney stones treatment allow obtaining HA3D™ highly relevant models to greatly match intraoperative findings during PCNL with the potential of minimizing bleeding and organ injury complications.
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Affiliation(s)
- Arman Tsaturyan
- Department of Urology, University Hospital of Patras, Patras, Greece.
| | - Andrea Bellin
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Simona Barbuto
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Peter Zampakis
- Department of Radiology, University Hospital of Patras, Patras, Greece
| | | | - Marco Lattarulo
- Department of Urology, University Hospital of Patras, Patras, Greece
| | | | - Evangelos Liatsikos
- Department of Urology, University Hospital of Patras, Patras, Greece
- Department of Urology, Medical University of Vienna, Vienna, Austria
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Kallidonis P, Vagionis A, Vrettos T, Adamou K, Pagonis K, Ntasiotis P, Callas GA, Tanaseskou L, Al Aown AM, Liatsikos E. Non papillary mini-percutaneous nephrolithotomy: early experience. World J Urol 2021; 39:1241-1246. [PMID: 32472276 DOI: 10.1007/s00345-020-03267-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 05/16/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This study aims to evaluate the non-papillary puncture for mini-PCNL in terms of safety and efficacy. METHODS A total number of 32 patients were subjected to mini-PCNL by the performance of non-papillary punctures over 6 months. One-step track dilation to 22 Fr took place in all cases. An 18 Fr nephroscope (Slender, Karl Storz GmbH, Germany) and an ultrasound lithotripter (Lithoclast Master, EMS S.A, Switzerland) with 9.9 Fr probe was used. Demographics and perioperative data are prospectively collected from an institutional board-approved database and the presented data were retrospectively collected. RESULTS The average cumulative stone size was 23.53 ± 6.6 mm. Mean operative time was 44.6 ± 13.44 min and primary stone-free rate after PCNL was 96% and 85.7% for single and multiple access, respectively. Second access was performed in seven cases, all of which had multiple stones. Mean hemoglobin drop was 1.23 ± 0.88 gr/dL. The patients stayed 2.56 ± 0.98 days in the hospital. Overall complication rate was 9.37%, without encountering any severe bleeding complication. CONCLUSION Using non-papillary access for mini-PCNL did not result in significant blood loss and need for transfusions. The respective data were directly comparable to contemporary literature and the safety of mini-PCNL by a non-papillary approach could be advocated.
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Affiliation(s)
- P Kallidonis
- Department of Urology, University Hospital of Patras, Patras, Greece.
| | - A Vagionis
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - T Vrettos
- Department of Anesthesiology and ICU, University Hospital of Patras, Patras, Greece
| | - K Adamou
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - K Pagonis
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - P Ntasiotis
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - G A Callas
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - L Tanaseskou
- Department of Anesthesiology and ICU, University Hospital of Patras, Patras, Greece
| | - A M Al Aown
- Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, Kingdom of Saudi Arabia
| | - E Liatsikos
- Department of Urology, University Hospital of Patras, Patras, Greece
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Irani D, Haghpanah A, Hosseini MM, Malekmakan L, Ashraf MA, Raeisi Shahraki H. Complications and surgical results of stone-directed antegrade pyelography compared to the retrograde pyelographic access method in percutaneous nephrolithotomy using ‘bull’s eye’ technique: A randomized clinical trial. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415821993729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: This study aimed to evaluate the differences in outcomes and complications in stone-directed antegrade pyelography using the ‘bull’s eye’ technique in patients with renal stones versus the conventional method of percutaneous nephrolithotomy (PCNL). Although conventional PCNL access using retrograde pyelography is useful, it is time-consuming and may cause postoperative discomfort. Herein, we report our experience in the application of this new technique. Methods: Between January 2017 and June 2018, 100 patients participated in this randomized clinical trial. Stone-directed antegrade pyelography using the ‘bull’s eye’ technique under fluoroscopic guidance was used for percutaneous access in the intervention group. The second group, consisting of those who had undergone conventional PCNL using retrograde pyelography and ‘bull’s eye’ technique in the same period, were considered as the controls. Pre- and postoperative laboratory examinations, surgical results and complications were recorded and compared between the two groups. Results: A single calyceal puncture in partial staghorn and staghorn stone patients was sufficient in 72.2% of the antegrade group and in 78.9% of the retrograde group ( p=0.69). The double-puncture technique was necessary for 71.9% of renal pelvis stones in the antegrade group and for 9.4% in the retrograde group ( p<0.001). The antegrade approach reduced the mean operative time and analgesic requirement significantly ( p<0.001). No statistically significant difference, however, was found between the two groups regarding stone migration to the ureter, radiation time and postoperative complications. Conclusions: The stone-directed antegrade approach using the ‘bull’s eye’ technique is a safe and accurate method in PCNL access in patients with radiopaque and semi-opaque renal stones.
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Affiliation(s)
- Dariush Irani
- Division of Urology, Shiraz University of Medical Sciences, Shahid Faghihi Medical Centre, Iran
- Shiraz Nephro-Urology Research Centre, Shiraz University of Medical Sciences, Iran
| | - Abdolreza Haghpanah
- Division of Urology, Shiraz University of Medical Sciences, Shahid Faghihi Medical Centre, Iran
- Shiraz Nephro-Urology Research Centre, Shiraz University of Medical Sciences, Iran
| | - Mohammad Mehdi Hosseini
- Division of Urology, Shiraz University of Medical Sciences, Shahid Faghihi Medical Centre, Iran
- Shiraz Nephro-Urology Research Centre, Shiraz University of Medical Sciences, Iran
| | - Leila Malekmakan
- Shiraz Nephro-Urology Research Centre, Shiraz University of Medical Sciences, Iran
| | - Mohammad Ali Ashraf
- Shiraz Nephro-Urology Research Centre, Shiraz University of Medical Sciences, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Iran
| | - Hadi Raeisi Shahraki
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Iran
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Kallidonis P, Vagionis A, Lattarulo M, Adamou C, Tsaturyan A, Liourdi D, Vrettos T, Simeone C, Liatsikos E. Non-papillary percutaneous nephrolithotomy for treatment of staghorn stones. Minerva Urol Nephrol 2020; 73:649-654. [PMID: 33256363 DOI: 10.23736/s2724-6051.20.04124-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the non-papillary puncture for Percutaneous Nephrolithotomy (PCNL) for the treatment of staghorn stones in terms of safety and efficacy. METHODS Data of 53 patients undergoing PCNL for staghorn stones were retrospectively collected from January 2015 to December 2019. A non-papillary puncture was performed with a two- step track dilation technique up to 30Fr. A 26 Fr semirigid nephroscope and an ultrasonic lithotripter with integrated suction (Swiss Lithoclast master, EMS S.A, Nyon, Switzerland) were used for the treatment. Demographics and perioperative data were retrospectively gathered from an institutional board approved database. RESULTS The average stone size was 60.1±16.1 mm. Mean operative time was 54.57±14.83 minutes, while mean time using fluoroscopy was 2.67±1.02 minutes. Mean number of accesses was 1.2 (a total of 64 accesses). Flexible nephroscope was never used. Primary stone-free rate after PCNL was 81.1% (43 patients). Mean hemoglobin drop was 1.6±1.86 gr/dL. Overall patient stay was 3.94±0.82 days, while overall complication rate was 20.7% (11 patients), with only one patient requiring blood transfusion due to pseudoaneurysm. CONCLUSIONS The use of non-papillary access for PCNL in the treatment of staghorn stones resulted in promising results in terms of stone-free rate, operating time, complication rate, hemoglobin drop and reduced the number of percutaneous tracts. These parameters of the current investigation were directly comparable to current literature. The safety and efficacy of a non-papillary approach for the treatment of staghorn stones could be advocated.
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Affiliation(s)
- Panagiotis Kallidonis
- School of Medicine, Department of Urology, University Hospital of Patras, Patras, Greece -
| | - Athanasios Vagionis
- School of Medicine, Department of Urology, University Hospital of Patras, Patras, Greece
| | - Marco Lattarulo
- School of Medicine, Department of Urology, University Hospital of Patras, Patras, Greece.,Unit of Urology, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Constantinos Adamou
- School of Medicine, Department of Urology, University Hospital of Patras, Patras, Greece
| | - Arman Tsaturyan
- School of Medicine, Department of Urology, University Hospital of Patras, Patras, Greece
| | - Despoina Liourdi
- Department of Internal Medicine, Ag. Andreas Hospital, Patras, Greece
| | - Theofanis Vrettos
- Department of Anesthesiology and Intensive Care, University Hospital of Patras, Patras, Greece
| | - Claudio Simeone
- Unit of Urology, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Evangelos Liatsikos
- School of Medicine, Department of Urology, University Hospital of Patras, Patras, Greece
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Mini-PCNL with vacuum effect: A case series. UROLOGY VIDEO JOURNAL 2020. [DOI: 10.1016/j.urolvj.2020.100076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Cracco CM, Scoffone CM. Endoscopic combined intrarenal surgery (ECIRS) - Tips and tricks to improve outcomes: A systematic review. Turk J Urol 2020; 46:S46-S57. [PMID: 32877638 PMCID: PMC7731958 DOI: 10.5152/tud.2020.20282] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study aimed at assessing current efficacy and safety of endoscopic combined intrarenal surgery (ECIRS) for the treatment of large and/or complex urolithiasis and identifying relevant tips and tricks able to improve its outcomes, mainly deriving from the adjunct of retrograde flexible ureteroscopy to the traditional antegrade approach of percutaneous nephrolithotomy (PNL). MATERIAL AND METHODS A systematic review was conducted using relevant databases (Ovid Medline, PubMed, Scopus, and Web of Sciences), employing "ECIRS" as the search term in all cases, and then adding "endoscopic combined intrarenal surgery" and "flexible ureteroscopy AND percutaneous nephrolithotomy" as search terms for PubMed and Scopus. Original articles and systematic reviews were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Additionally, the reference lists of the selected publications were checked manually. RESULTS A total of 14 studies were selected for analysis: two systematic reviews, one randomized controlled trial, five nonrandomized comparative studies, three prospective case series, and three retrospective case series. ECIRS achieves high stone-free rates and rather low/low Clavien-Dindo grade complication rates, confirming the role of retrograde ureteroscopy in the maximization of its efficacy and safety. A narrative synthesis of the most recognized tips and tricks of ECIRS is provided. CONCLUSION The contribution of retrograde flexible ureteroscopy during PNL is essential. It plays a dual role, both diagnostic and active, allowing tailoring of the procedure to the patient, urolithiasis, and anatomy of the collecting system and optimization of the PNL efficacy and safety. This is ECIRS: an updated, complete, and versatile version of PNL.
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Rassweiler-Seyfried MC, Lima E, Ritter M, Klein JT, Michel MS. [Navigation systems for the percutaneous access to the kidney]. Urologe A 2020; 59:1017-1025. [PMID: 32533201 DOI: 10.1007/s00120-020-01250-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Percutaneous access to the renal pelvis still remains the most difficult step before nephrolitholapaxy (PCNL). New imaging techniques, such as 3D imaging and various navigation instruments such as electromagnetic, sonographic, CT-controlled and marker-based/iPAD try to simplify this step and reduce complications. OBJECTIVES In this review, various new techniques for puncturing the renal collecting system are presented and their advantages and disadvantages are evaluated. MATERIALS AND METHODS A systematic literature search was carried out in MEDLINE, whereby only puncture techniques that have already been evaluated in clinical studies were included. RESULTS Five different navigation methods for puncturing the renal pelvis before PCNL were found. CONCLUSION Intraoperative navigation can be useful when puncturing the collecting system. The combination of ultrasound and fluoroscopy currently remains the gold standard. However, there is still a need for further, primarily clinical, prospective studies to determine which new imaging technology and navigation systems will prevail and thus facilitate the access route to the kidney, especially in the case of special anatomical conditions.
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Affiliation(s)
- M-C Rassweiler-Seyfried
- Klinik für Urologie und Urochirurgie, Universitätsmedzin Mannheim, Theodor-Kutzer-Ufter 1-3, 68161, Mannheim, Deutschland.
| | - E Lima
- Department of Urology - Hospital of Braga, University of Minho, Campus de Gualtar, 4709-057, Braga, Portugal
| | - M Ritter
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - J-T Klein
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - M-S Michel
- Klinik für Urologie und Urochirurgie, Universitätsmedzin Mannheim, Theodor-Kutzer-Ufter 1-3, 68161, Mannheim, Deutschland
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Kallidonis P, Tsaturyan A, Lattarulo M, Liatsikos E. Minimally invasive percutaneous nephrolithotomy (PCNL): Techniques and outcomes. Turk J Urol 2020; 46:S58-S63. [PMID: 32525477 DOI: 10.5152/tud.2020.20161] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/15/2020] [Indexed: 02/03/2023]
Abstract
Minimally invasive percutaneous nephrolithotomy (PCNL) was introduced to decrease the morbidity of the standard PCNL (sPCNL). Thereafter, many modifications and techniques have been presented with the introduction of different miniaturized PCNL (mPCNL) techniques, such as micro-PCNL and ultra-mini-PCNL (UMP). As of present, none of the techniques has displaced the sPCNL. Nonetheless, mini-PCNL has continuously widening indications and has been proposed to have significant advantages over sPCNL. In the current review, each technique is presented while discussing the advantages and disadvantages of each approach. A comprehensive review of the current literature has been performed. Articles related to the topic were retrieved and critically analyzed. Less peri-operative bleeding and shorter hospital stay were the most important advantages advocated for mini-PCNL. Although the performance of mini-PCNL is safe, the utilization of micro-PCNL and UMP should be done with caution.
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Affiliation(s)
| | - Arman Tsaturyan
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - Marco Lattarulo
- Department of Urology, University Hospital of Patras, Patras, Greece
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Kim HY, Lee KW, Lee DS. Critical causes in severe bleeding requiring angioembolization after percutaneous nephrolithotomy. BMC Urol 2020; 20:22. [PMID: 32160888 PMCID: PMC7066775 DOI: 10.1186/s12894-020-00594-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/02/2020] [Indexed: 12/23/2022] Open
Abstract
Background To identify the risk factors for severe bleeding requiring angioembolization among patients who received transfusions after PCNL, particularly those who underwent anatomically incorrect renal puncture. Methods A total of 53 patients, who received transfusions after PCNL and simultaneously had a postoperative CT scan performed between November 2009 and May 2019 at two teaching hospitals, were retrospectively reviewed. The patients were divided into two groups: those who underwent angioembolization and those who did not. Patient, stone and procedural factors were compared between the two groups. Puncture correctness was evaluated using postoperative CT scans. Puncture was defined as being a correct puncture if the fornix or papilla of the posterior calyx was punctured and the trajectory of the tract was within 20 degrees posterior to the frontal plane of the kidney (i.e., within Brödel’s line). Results 21 patients underwent angioembolization after PCNL. Incorrect puncture was seen in 14/21 (66.7%) patients who underwent angioembolization after PCNL, whereas it was seen in 11/32 (34.4%) patients who did not undergo angioembolization (p = 0.021). On multivariable regression analysis, puncture correctness was found to be the only significant factor, with an OR of 3.818, 95% CI of 1.192–12.231 and p value of 0.024. Conclusions Incorrect renal puncture was related to severe bleeding requiring angioembolization after PCNL. Our results emphasize the importance of the basic principle of renal puncture for PCNL.
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Affiliation(s)
- Hee Youn Kim
- Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, 16247, Republic of Korea
| | - Kyu Won Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Dong Sup Lee
- Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, 16247, Republic of Korea.
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Zhang B, Xie H, Hu Y, Liu C. The visual percutaneous nephrolithotomy versus the conventional percutaneous nephrolithotomy in treatment for renal stone. MINERVA UROL NEFROL 2019; 71:627-635. [DOI: 10.23736/s0393-2249.19.03465-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Nguyen DD, Luo JW, Tailly T, Bhojani N. Percutaneous Nephrolithotomy Access: A Systematic Review of Intraoperative Assistive Technologies. J Endourol 2019; 33:358-368. [DOI: 10.1089/end.2019.0085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
| | - Jack W. Luo
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Thomas Tailly
- Urology Department, University Hospital Ghent, Ghent, Belgium
| | - Naeem Bhojani
- Division of Urology, University of Montreal Health Center (CHUM), Montreal, Canada
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The Analysis of Risk Factors for Hemorrhage Associated with Minimally Invasive Percutaneous Nephrolithotomy. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8619460. [PMID: 30834279 PMCID: PMC6374806 DOI: 10.1155/2019/8619460] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 12/14/2018] [Accepted: 01/03/2019] [Indexed: 11/29/2022]
Abstract
Objective This study investigated the risk factors for bleeding during minimally invasive percutaneous nephrolithotomy, so as to prevent the occurrence of bleeding and improve the surgical effect. Patients and Methods The data of 396 patients who underwent percutaneous nephrolithotomy by an experienced surgeon between May 2014 and December 2017 were retrospectively analyzed. To identify the risk factors for bleeding during percutaneous nephrolithotomy, each group was stratified according to the decrease in median hemoglobin. Age, gender, body mass index, stone size, operation time, stone type, degree of hydronephrosis, number of accesses, puncture guidance, underlying disease (diabetes; hypertension), and previous surgical history were evaluated. Univariate analysis was performed to calculate the potential factors. In order to determine the independence of each factor, we finally selected stone size, staghorn stone, degree of hydronephrosis, and operation time. Multivariate logistic regression analysis was used to identify the risk factors for bleeding during minimally invasive percutaneous nephrolithotomy. Results A total of 396 patients were successfully treated with percutaneous nephrolithotomy. The univariate analysis demonstrated that the potential risk factors for bleeding during percutaneous nephrolithotomy included stone size, type of stone, operative time, and degree of hydronephrosis. According to the previous studies, stone size, staghorn stone, degree of hydronephrosis, and operation time were ultimately selected. Multivariate logistic regression analysis was used to identify the risk factors for bleeding during percutaneous nephrolithotomy. According to the outcome of logistic regression analysis, stone size, staghorn stone, operation time, and degree of hydronephrosis were the risk factors for bleeding during minimally invasive percutaneous nephrolithotomy. Conclusions Percutaneous nephrolithotomy is an effective method for the treatment of upper urinary calculi with few complications. According to the results achieved by an experienced surgeon, the size of stone, staghorn stone, operation time, and degree of hydronephrosis were associated with the bleeding during minimally invasive percutaneous nephrolithotomy.
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Kallidonis P, Liatsikos E. Response to Omar re: Papillary vs Nonpapillary Puncture in Percutaneous Nephrolithotomy: A Prospective Randomized Trial (From: Omar M. J Endourol 2019;33:173; DOI: 10.1089/end.2018.0444). J Endourol 2019; 33:174. [PMID: 30688524 DOI: 10.1089/end.2018.29050.kal] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sabler IM, Katafigiotis I, Sfoungaristos S, Lorber A, Leotsakos I, Yutkin V, Hidas G, Gofrit ON, Duvdevani M. Is emergency percutaneous antegrade drainage of the upper urinary tract useful for future percutaneous nephrolithotomy access? Investig Clin Urol 2018; 60:29-34. [PMID: 30637358 PMCID: PMC6318205 DOI: 10.4111/icu.2019.60.1.29] [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] [Received: 09/30/2018] [Accepted: 12/13/2018] [Indexed: 12/05/2022] Open
Abstract
Purpose To compare percutaneous nephrolithotomy (PCNL) operations between patients with a preoperative nephrostomy tube and patients that the renal access was obtained at the time of the surgery. Materials and Methods We retrospectively evaluated PCNL cases. Patients were divided into two groups. Group 1 – a non-nephrostomy tube (percutaneous nephrostomy, PCN) group and Group 2 – patients with a PCN placed before the procedure. All preoperatively placed PCN's were performed in emergency situations by interventional radiologists (IR). Complications were classified according to the Clavien-Dindo classification. We compared stone characteristics, operation time, complications, efficacy and PCN usability at surgery. Results Five hundred twenty-seven patients who were submitted to PCNL for renal stones were included in the study. In 73 patients (13.9%) the PCNs were placed before the surgery. Patients and stone characteristics, mean operative time (p=0.830), complications (p=0.859) and stone-free rates (93.0%) were similar between the groups. There was a trend toward higher complication rates in Group 1, but the difference was not statistically significant. Only 21 (29.0%) of preoperatively placed PCNs were used during PCNL for establishing a tract. The reasons for not using PCN tract were: pelvic or infundibular insertion (30.0%) and suboptimal anatomic location (70.0%). Conclusions Preoperative emergency inserted PCNs by IR usage rates were low during PCNL. Its placement neither affects the incidence of complications nor affects the operation time and outcomes. As such, when emergency renal drainage is indicated, the need for a future definitive PCNL should not influence the decision about the modality of renal drainage.
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Affiliation(s)
- Itay M Sabler
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ioannis Katafigiotis
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Athens Stone Clinic, Athens, Greece
| | - Stavros Sfoungaristos
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Athens Stone Clinic, Athens, Greece
| | - Amitay Lorber
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ioannis Leotsakos
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Vladimir Yutkin
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Guy Hidas
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Li JK, Teoh JY, Ng CF. Updates in endourological management of urolithiasis. Int J Urol 2018; 26:172-183. [PMID: 30575154 DOI: 10.1111/iju.13885] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/21/2018] [Indexed: 12/23/2022]
Abstract
Urinary stone disease, or urolithiasis, is a very common disease with increasing prevalence and incidence. With the advancement of endoscopic techniques, the treatment outcomes of ureteroscopy (or transureteral lithotripsy) and percutaneous nephrolithotomy are continuously improving. In recent years, there have been many new developments in the field, including new endoscopy design, more effective auxiliary tools, improvement in treatment protocols, introduction of robotic technology, combining both ureteroscopy and percutaneous nephrolithotomy (endoscopic combined intrarenal surgery or transureteral lithotripsy-assisted percutaneous nephrolithotomy), improvement in laser technology, and so on. All these new inputs will further improve the treatment efficacy and safety of the procedures, thus benefiting our patients. In the present review, we briefly go through the main steps of ureteroscopy and percutaneous nephrolithotomy, with a concise description and application of these new advances.
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Affiliation(s)
- Joseph Km Li
- S. H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jeremy Yc Teoh
- S. H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chi-Fai Ng
- S. H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
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Lin F, Yu W, Rao T, Ning J, Ruan Y, Xia Y, Ye P, Lu J, Cheng F, Larré S. The Anatomic Structure of a Fused Renal Pyramid and Its Clinical Significance in the Establishment of Percutaneous Renal Access. Urology 2018; 124:38-45. [PMID: 30445123 DOI: 10.1016/j.urology.2018.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/25/2018] [Accepted: 11/02/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the clinical significance of the fused renal pyramid (FRP) in establishing percutaneous renal access, and the anatomic basis for avoiding vascular injury caused by puncturing through this renal pyramid with the aim of achieving accurate puncture in percutaneous nephrolithotomy. MATERIALS AND METHODS Sixty-two cadaveric kidneys and 105 porcine kidneys were selected for the assessment of regional anatomy, to explore the anatomic structure of the FRP and determine its frequency. Then, we compared the effects of 4 different puncture paths on the occurrence of renal vascular injury when respectively punctured through the normal renal pyramid (group A), the centerline of one side pyramid of the FRP (group B), the center of the entire FRP (group C) and the renal column (group D). RESULTS The incidence of FRP in human kidneys is not low. The artery in the kidney can be divided into 6 grades. The grade IV branch-interlobar artery courses through the FRP. There was significant difference in the degree of arterial injury between the group A and C (P = .003), while no significant difference between the group A and B (P = .151). There was significant difference in the proportion of interlolar artery injury between group A and C (P <.001), while no significant difference between group A and B (P = .239). CONCLUSION It is necessary to carefully identify and bypass the FRP when establishing a percutaneous renal access. If unavoidable, the puncture path should be on the centerline of one side pyramid of the FRP.
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Affiliation(s)
- Fangyou Lin
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Weimin Yu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Ting Rao
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jinzhuo Ning
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yuan Ruan
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yuqi Xia
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Peng Ye
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jingxiao Lu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Fan Cheng
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
| | - Stéphane Larré
- Department of Urology, Robert Debré Teaching Hospital, University of Reims, Reims, France
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Papillary puncture: still a good practice. World J Urol 2018; 37:573-574. [PMID: 30315359 DOI: 10.1007/s00345-018-2527-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 10/10/2018] [Indexed: 10/28/2022] Open
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Kallidonis P, Kalogeropoulou C, Kyriazis I, Apostolopoulos D, Kitrou P, Kotsiris D, Ntasiotis P, Liatsikos E. Percutaneous Nephrolithotomy Puncture and Tract Dilation: Evidence on the Safety of Approaches to the Infundibulum of the Middle Renal Calyx. Urology 2017. [PMID: 28629676 DOI: 10.1016/j.urology.2017.05.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the anatomical relations of the papillary, infundibular, and pelvic approach to percutaneous nephrolithotomy and evaluate the amount of vascularization at the respective sites. MATERIALS AND METHODS 99mTc-dimercaptosuccinic acid single-photon emission computed tomography/computed tomography (SPECT/CT) renal scintigraphies or computed tomography perfusion (CTP) was performed in 40 patients (prone n = 20 or supine position n = 20). The angle of approach (AoA) for access tracts and the respective regions of interest to the mid-calyceal papilla and infundibulum as well as renal pelvis were designed and compared. RESULTS The design of access tracts aiming to the renal pelvis, papilla, and infundibulum of the renal calyx was impossible for the nondilated collecting systems as all these tracts were in close vicinity. In both SPECT/CT and CTP, there was no statistical difference between the AoA for infundibular or pelvic access in comparison with the papillary puncture in either prone or supine position regardless of the degree of dilation of the system. The comparison of the measurements in the regions of interest showed that there was no difference in blood supply between the infundibular and pelvic access in comparison with the papillary approach in both positions regardless of the degree of collecting system dilation. CONCLUSION The use of SPECT/CT and CTP showed that the punctures to the mid-calyceal renal papilla-fornix and infundibulum as well as the renal pelvis at the same level have similar AoA. The sites of the parenchyma involved in the tract dilation of the respective approaches are not related to significant differences in terms of vascularization.
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Affiliation(s)
| | | | - Iason Kyriazis
- Department of Urology, University of Patras, Patras, Greece
| | | | | | | | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece; Department of Urology, Medical University of Vienna, Vienna, Austria
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