The Surgical Technique of Mini Percutaneous Nephrolithotomy

The influence of perioperative nursing intervention in patients with ureteral calculi treated with URSL and its correlation to adverse event incidence: A retrospective study

To evaluate the effectiveness of perioperative nursing intervention in patients undergoing ureteroscopic lithotripsy (URSL) for ureteral stones and its implications for the incidence of adverse events, a total of 144 patients with ureteral stones admitted to our hospital from January 2021 to December 2022 were selected for retrospective analysis. They were divided into 2 groups based on their different nursing methods, with 72 patients in each group. The control group (CG) received routine nursing intervention, while the study group (SD) received refined perioperative nursing intervention. The surgical situation, effective stone removal rate, postoperative pain, inflammatory factors, stress response, and incidence of adverse events were compared between the 2 groups. In comparison with the CG, the SD demonstrated a significant reduction in gastrointestinal recovery time, urinary catheter removal time, and hospitalization duration, all presenting statistically significant disparities (P < .05). Notably, the SD exhibited a one-time stone removal rate significantly superior to that of the CG (P < .05). Similarly, the postoperative pain index was significantly lower in the SD (P < .05). Pre- and post-surgical serotonin (5-HT) levels in the SD were markedly lower than in the CG (P < .05). Postoperative levels of Interleukin-10 (IL-10), C-reactive protein (CRP), and white blood cells (WBC) were elevated in both groups, and gradually declined as the patients recovered. However, postoperative levels of IL-10, CRP, and WBC were significantly lower in the SD (P < .05). The SD also showed significantly lower levels of malondialdehyde and higher levels of superoxide dismutase (P < .05). Postoperative levels of cortisol, adrenocorticotropic hormone, and norepinephrine were elevated and progressively returned to normal over time, and were significantly lower in the study group (P < .05). Furthermore, the SD experienced a significant reduction in adverse event incidence compared with the CG (P < .05). Implementing refined perioperative nursing interventions for patients undergoing URSL can effectively decrease the incidence of adverse events, diminish the surgical stimulation of inflammation markers and oxidative stress indicators, and foster patient recovery.

Pediatric Mini-Percutaneous Nephrolithotomy Using Self-Retained Screwed Amplatz Sheath vs Ordinary Sheath

Objective: To evaluate the use of a new 16F mini-screwed sheath in pediatrics in comparison to a 16F ordinary Amplatz sheath. Methods: Sixty-seven patients <18 years with renal calculi between 1 and 2 cm who was a candidate for mini-percutaneous nephrolithotomy (mini-perc) between January 2019 and September 2021 were randomized by closed envelope in group A (34 patients) using new mini-screwed sheath and group B (33 patients) with ordinary mini-sheath. Patients with contraindications for percutaneous nephrolithotomy were excluded. Results: No significant difference was present between both groups according to patients and stone demographics. There was no significant difference between both groups regarding puncture site and number. The mean operative time was 51.25 ± 2.15 minutes and 52.35 ± 3.45 minutes in groups A and B, respectively. The fluoroscopy time was significantly lower in group A (2.1 ± 0.85 minutes) than in group B (2.9 ± 1.05 minutes). Tract loss was 18.2% in group B while 0% in group A. Although bleeding was less in group A, it was nonsignificant. The stone-free rate was (94.11%) and (90.9%) in group A and group B, respectively. Conclusion: Screwed sheath enables the urologist to have a stable track during pediatric mini-perc surgery despite the thin abdominal wall in the pediatric. The screw sheath provides significantly lower fluoroscopy time and decreases the need for nephrostomy tube insertion when compared with ordinary sheath in mini-perc renal surgery.

The High Risk Factors and Preventive Measures of Percutaneous Nephrolithotomy under the Guidance of B-Ultrasound in the Treatment of Postoperative Renal Calculi

Objective

The aim of this study is to explore and analyze the high risk factors and preventive measures of percutaneous nephrolithotomy under the guidance of B-ultrasound in the treatment of postoperative renal calculi.

Methods

The clinical data of 220 patients with renal calculi admitted to our hospital from 2018 to October 2021 were retrospectively analyzed. All patients were treated with percutaneous nephrolithotomy n = 36) and nonbleeding group (n = 184), comparing the personal data, disease-related data, surgical operation related data of the two groups of patients, single factor and logistic multifactor regression analysis to explore the influence of B-guided percutaneous. Nephrolithotomy is a high-risk factor for postoperative bleeding in patients with kidney stones, and preventive measures are based on high-risk factors.

Results

There was no significant difference in the proportion of patients with different genders, whether they had renal surgery, whether they had hypertension, and those with postoperative hepatic insufficiency in the hemorrhagic group and the nonbleeding group (p > 0.05). There was no significant difference in age and body mass index between the bleeding group and the nonbleeding group (p > 0.05). The proportion of patients with diabetes in the bleeding group was higher than that in the nonbleeding group, and the difference between the groups was statistically significant (p < 0.05). Compared with the nonbleeding group, the bleeding group had a higher proportion of patients with calculus diameter ≥2 cm. The proportion of patients with staghorn calculi in the bleeding group was higher than that in the nonbleeding group. The difference between the groups was statistically significant (p < 0.05). There was no significant difference in the proportion of patients with hemorrhage, single or multiple renal stones, and ureteral stones in the hemorrhage group compared with the nonbleeding group (p > 0.05). Compared with the nonbleeding group, the proportion of patients with bleeding in the first stage was higher, and the proportion of patients with operation time >90 min was higher. The difference between the groups was statistically significant (p < 0.05). There was no significant difference in the proportion of patients in the bleeding group compared with the nonbleeding group (p > 0.05). Using Logic multifactorial regression analysis, independent risk factors for bleeding after percutaneous nephrolithotomy under ultrasound-guided bovery include diabetes mellitus, stone diameter, staghorn kidney stones, surgical timing, and staging surgery (p < 0.05).

Conclusion

The independent high-risk factors affecting bleeding after percutaneous nephrolithotomy guided by B-ultrasound include diabetes, stone diameter, staghorn type kidney stones, operation time, and staged surgery. According to this, effective preventive measures can effectively reduce the operation and the occurrence of postbleeding.

Impact of Cluster Nursing on Nursing on VAS Score and Urinary Function of Patients after Percutaneous Nephrolithotomy with Pneumatic Lithotripsy (PCNL)

Objective. To explore the effects of cluster nursing on VAS score and urinary system function of patients after percutaneous nephrolithotomy with pneumatic lithotripsy (PCNL). Methods. November 2019-January 2019, 114 patients with PCNL who received treatment in our hospital were selected and randomly divided into two groups: the control group and the study group. The study group received cluster nursing, and the control group received routine nursing. Compare the Barthel index (BI), between two groups, SAS score, complications rate, surgical outcomes, pain scores, quality of life scores, knowledge awareness rate, and satisfaction rate were compared. Results. There were no significant variations in Bi and SAS scores before the nursing ( $P>0.05$ ). The BI ratings were clearly higher after nursing, whereas the SAS and pain levels were considerably lower, however, the research group altered more dramatically ( $P0.05$ ). The study group’s incidence of complications was lower ( $P0.05$ ) than the control group’s; the study group’s hospitalization cost was lower, and the hospitalization and lower bed activity were shorter ( $P0.05$ ); after the nursing, the organised quality score was significantly higher in both groups, but the research group changed more dramatically ( $P0.05$ ). Compared with the control group, the knowledge of the research team was higher ( $P<0.05$ ); after the nursing, both group satisfaction scores were obviously high, but the study group changes more significantly ( $P<0.05$ ). Conclusion. After PCNL treatment, the patient receives cluster therapy, improving the patient’s anxiety, reducing the degree of pain, and improving the quality of life in patients, and the patient satisfaction is high. Therefore, cluster nursing is worthy of extensive application in the postoperative care of patients with PCNL.