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Tadayon N, Refaei M, Zarrintan S, Shahsavari S, Najari D, Sheikhzadeh M. Post-percutaneous nephrolithotomy pseudo aneurysm formation treated by coil embolization; A study of seven cases. J Cardiovasc Thorac Res 2024; 16:55-59. [PMID: 38584656 PMCID: PMC10997973 DOI: 10.34172/jcvtr.32905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 02/17/2024] [Indexed: 04/09/2024] Open
Abstract
Renal artery pseudoaneurysm is a rare complication of percutaneous nephrolithotomy (PCNL) with symptoms of flank pain and hematuria. Endovascular coil embolization has been proposed as a safe management option. We report Seven male patients, aged 36 to 65 years, with post-PCNL pseudoaneurysms presenting as gross hematuria. They all underwent CT angiography prior to endovascular intervention. The access was from common femoral artery in 6 cases and from left brachial artery in one case. Selective angiography of affected renal artery and branches were performed by suitable catheter. Coil embolization was performed by MicroNester and MReye coils (Cook, Inc.). Size of coils was selected based on angiography results. Completion angiography revealed embolized pseudoaneurysm in all cases. Gross and microscopic hematuria disappeared in all patients in the following days. Endovascular angioembolization with coil is an effective technique for managing post-PCNL pseudoaneurysms in renal artery and its branches.
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Affiliation(s)
- Niki Tadayon
- Clinical Research Developmental Unit of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meisam Refaei
- Department of General & Vascular Surgery, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Zarrintan
- Division of Vascular & Endovascular Surgery, University of California, San Diego,California,USA
| | - Saleh Shahsavari
- Department of Surgery, Shohada Tajrish Hospital,Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Doras Najari
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Sheikhzadeh
- Department of General & Vascular Surgery, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zhang LW, Fei X, Song Y. Renal pelvis mucosal artery hemorrhage after percutaneous nephrolithotomy: a rare case report and literature review. BMC Urol 2022; 22:100. [PMID: 35820877 PMCID: PMC9277858 DOI: 10.1186/s12894-022-01049-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Following a percutaneous nephrolithotomy (PCNL) procedure, the most common complications are considered to be intraoperative and postoperative bleeding. Many patients with postoperative bleeding can be treated conservatively, causing the perirenal hematoma to resolve spontaneously. The major causes of severe postoperative bleeding are pseudoaneurysms, arteriovenous fistula, and segmental arterial injury. Typically, the first choice of treatment to manage severe bleeding complications is selective angioembolization (SAE) because of the very high success rate associated with this procedure. CASE PRESENTATION This clinical case involves a 56-year-old man who underwent dual-channel PCNL treatment after diagnosing a left kidney staghorn stone and urinary tract infection. The operation was successful, with no apparent signs of bleeding. Tests revealed continued decreasing hemoglobin levels following the procedure. After the conservative treatment failed, renal angiography was performed immediately, indicating renal pelvis mucosal artery hemorrhage. In the three hours post-surgery, the SAE still failed to prevent bleeding. Further discussions led to formulating a new surgical plan using a nephroscope to enter the initial channel where hemostasis began. The hemostasis origin was found precisely in the mucosal artery next to the channel during the operation and was successfully controlled. CONCLUSIONS This case reveals there is poor communication and inadequate discussions about the potential failures of an SAE procedure. Swift clinical decision-making is imperative when dealing with high-level renal trauma to prevent delays in surgery that can threaten the safety of patients.
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Affiliation(s)
- Lv Wen Zhang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110000, China
| | - Xiang Fei
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110000, China.
| | - Yan Song
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110000, China.
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Khatami F, Gorji A, Khoshchehreh M, Mashhadi R, Pishkuhi MA, Khajavi A, Shabestari AN, Aghamir SMK. The correlation between promoter hypermethylation of VDR, CLDN, and CasR genes and recurrent stone formation. BMC Med Genomics 2022; 15:109. [PMID: 35546405 PMCID: PMC9092793 DOI: 10.1186/s12920-022-01265-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/09/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives Recurrent Kidney stone formation is a main medical problem imposing a significant burden on both healthcare and the economy worldwide. Environmental and genetic factors have been linked to a bigger risk of kidney stone formation. We aim to assess the role of methylation on recurrent stone formation in three target genes. Methods We aimed to check the association between promoter hypermethylation vitamin D receptor (VDR), calcium-sensing receptor (CaSR), and claudin 14 (CLDN14) genes in recurrent kidney stones. We enrolled 30 consecutive recurrent kidney stone formers (age 18–60 years) (cases) and 30 age and gender-matched controls.3. To identify promoter methylation, two target regions from each candidate gene were bisulfited after blood collection and DNA extraction. Methylation quantification was done through methylation-specific high resolution melting (MS-HRM). Results The mean age of the patients and controls (mean ± SD) was 49.58 ± 14.23 years and BMI 36.12 ± 2.72. The methylation status in all six target regions was meaningfully different between the stone-former group and controls when methylation was considered in three clusters of unmethylated, methylated, and hypermethylated. A higher effect in VDR and CLDN was observed compare to CasR (p-value < 0.001, and < 0.005 versus p-value < 0.256). Conclusions Methylation as an important epigenetic mechanism should be considered more in recurrent stone formations. Promoter hypermethylation of VRD and CLDN genes may have an essential role in recurrent kidney stones formations.
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Affiliation(s)
- Fatemeh Khatami
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Gorji
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Rahil Mashhadi
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahin Ahmadi Pishkuhi
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Science, Tehran, Iran
| | - Alireza Khajavi
- Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Namazi Shabestari
- Department of Geriatric Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Gorji Daroonkolaee A, Fakhr Yasseri A, Khatami F, Saatchi M, Moradi Tabriz H, Afsari R, Rakebi MM, Tehranipour E, Gholamnejad M, Mashhadi R, Aghamir SMK. Bacterial colonization in three different parts of double J stent. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221081399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Due to the extensive use of indwelling stents and catheters in urology, bacterial colonization on these materials is a significant cause of infections in this group of patients. This study aims to investigate and compare the bacterial colonization in urine and in the three zones of the double J (DJ) stent. Methods: Between August 2019 and May 2020, 67 patients (18–78 years old) who underwent DJ stenting were recruited in the study. Surgeries before stenting included transurethral lithotripsy (TUL), percutaneous nephrolithotomy (PCNL), or diagnostic ureteroscopy. Before stenting, sterile urine samples were collected, and urinary cultures were performed, and the same procedure was done after removal of the DJ stents. DJ stent cultures were also performed. Results: 61 patients were analyzed. The mean age of all patients was 53 ± 16 years. The mean time of DJ installation in all patients was 27.6 ± 6.7 days (14–43 days). In these three parts of the DJ, 70.5%, 67.2%, and 72.1% of patients were without a colony, respectively. The microorganism distribution is approximately the same in the lower and upperparts, and Escherichia coli has the highest frequency (11.5%). The odds ratio (OR) of contamination was significantly lower in men than in women, but overweight and diabetes were not associated. Conclusion: The severity and pattern of bacterial colonization are not significantly different in the proximal, distal, and middle parts of the DJ stent.
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Affiliation(s)
| | | | - Fatemeh Khatami
- Urology Research Center (URC), Tehran University of Medical Sciences, Iran
| | - Mohammad Saatchi
- Urology Research Center (URC), Tehran University of Medical Sciences, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Iran
| | - Hedieh Moradi Tabriz
- Department of Pathology, Sina Hospital, Tehran University of Medical Sciences, Iran
| | - Roohollah Afsari
- Urology Research Center (URC), Tehran University of Medical Sciences, Iran
| | | | - Elham Tehranipour
- Urology Research Center (URC), Tehran University of Medical Sciences, Iran
| | - Maryam Gholamnejad
- Urology Research Center (URC), Tehran University of Medical Sciences, Iran
| | - Rahil Mashhadi
- Urology Research Center (URC), Tehran University of Medical Sciences, Iran
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Imaging modalities and treatment of paediatric upper tract urolithiasis: A systematic review and update on behalf of the EAU urolithiasis guidelines panel. J Pediatr Urol 2020; 16:612-624. [PMID: 32739360 DOI: 10.1016/j.jpurol.2020.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prompt diagnosis and treatment of paediatric urolithiasis are required to avoid long term sequelae of renal damage. OBJECTIVE To systematically review the literature regarding the diagnostic imaging modalities and treatment approaches for paediatric urolithiasis. STUDY DESIGN PubMed, Science Direct, Scopus and Web of Science were systematically searched from January 1980-January 2019. 76 full-text articles were included. RESULTS Ultrasound and Kidney-Ureter-Bladder radiography are the baseline diagnostic examinations. Non-contrast Computed Tomography (CT) is the second line choice with high sensitivity (97-100%) and specificity (96-100%). Magnetic Resonance Urography accounts only for 2% of pediatric stone imaging studies. Expectant management for single, asymptomatic lower pole renal stones is an acceptable initial approach, especially in patients with non-struvite, non-cystine stones<7 mm. Limited studies exist on medical expulsive therapy as off-label treatment. Extracorporeal shock wave lithotripsy (SWL) is the first-line treatment with overall stone free rates (SFRs) of 70-90%, retreatment rates 4-50% and complication rates up to 15%. Semi-rigid ureteroscopy is effective with SFRs of 81-98%, re-treatment rates of 6.3-10% and complication rates of 1.9-23%. Flexible ureteroscopy has shown SFRs of 76-100%, retreatment rates of 0-19% and complication rates of 0-28%. SFRs after first and second-look percutaneous nephrolithotomy (PNL) are 70.1-97.3% and 84.6-97.5%, respectively with an overall complication rate of 20%. Open surgery is seldom used, while laparoscopy is effective for stones refractory to SWL and PNL. Limited data exist for robot-assisted management. CONCLUSIONS In the initial assessment of paediatric urolithiasis, US is recommended as first imaging modality, while non-contrast CT is the second option. SWL is recommended as first line treatment for renal stones <20 mm and for ureteral stones<10 mm. Ureteroscopy is a feasible alternative both for ureteral stones not amenable to SWL as well as for renal stones <20 mm (using flexible). PNL is recommended for renal stones >20 mm.
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Li Z, Wu A, Liu J, Huang S, Chen G, Wu Y, Chen X, Tan G. Risk factors for hemorrhage requiring embolization after percutaneous nephrolithotomy: a meta-analysis. Transl Androl Urol 2020; 9:210-217. [PMID: 32420126 PMCID: PMC7214970 DOI: 10.21037/tau.2020.01.10] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background The aim of this meta-analysis was to systematically review and identify the risk factors for severe hemorrhage after percutaneous nephrolithotomy (PCNL). Methods We searched the PubMed and EMBASE database for literature related to the risk factors of severe hemorrhage after PCNL requiring angiography and embolization through to September 2019. The necessary data for each eligible study were extracted by 2 independent reviewers. The Newcastle-Ottawa Scale (NOS) was used for assessing the methodological quality of the included studies. Statistical analyses were conducted using Comprehensive Meta-Analysis version 2 to identify whether there was a statistical association between risk factors and severe hemorrhage post-PCNL. Results The results of this meta-analysis showed that urinary tract infection (UTI) (OR =1.98, 95% CI, 1.21–3.26, P=0.007), diabetes mellitus (OR =4.07, 95% CI, 1.83–9.06, P=0.001), staghorn stone (OR =3.49, 95% CI, 1.25–9.76, P=0.017), and multiple tracts (OR =2.09, 95% CI, 1.33–3.28, P=0.001) were independent risk factors for severe hemorrhage post-PCNL, while hypertension (OR =1.18, 95% CI, 0.58–2.42, P=0.65) showed no significant statistical difference. Conclusions Urologists should focus on the above identified risk factors for severe hemorrhage post-PCNL, including UTI, diabetes mellitus, staghorn stone, and multiple tracts. More high-quality studies with larger sample sizes are needed to validate these conclusions.
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Affiliation(s)
- Zhiqin Li
- Department of Urology, Maoming People's Hospital, Maoming 525000, China
| | - Aiming Wu
- Department of Urology, Maoming People's Hospital, Maoming 525000, China
| | - Jianjun Liu
- Department of Urology, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China
| | - Shuitong Huang
- Department of Urology, Maoming People's Hospital, Maoming 525000, China
| | - Guangming Chen
- Department of Urology, Maoming People's Hospital, Maoming 525000, China
| | - Yonglu Wu
- Department of Urology, Maoming People's Hospital, Maoming 525000, China
| | - Xianxi Chen
- Department of Urology, Maoming People's Hospital, Maoming 525000, China
| | - Guobin Tan
- Department of Urology, Maoming People's Hospital, Maoming 525000, China
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Wollin DA, Preminger GM. Percutaneous nephrolithotomy: complications and how to deal with them. Urolithiasis 2017; 46:87-97. [PMID: 29149365 DOI: 10.1007/s00240-017-1022-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/11/2017] [Indexed: 11/29/2022]
Abstract
Percutaneous nephrolithotomy is a common surgical treatment for large and complex stones within the intrarenal collecting system. A wide variety of complications can result from this procedure, including bleeding, injury to surrounding structures, infection, positioning-related injuries, thromboembolic disease, and even death. Knowledge of the different types of complications can be useful in order to prevent, diagnose, and treat these problems if they occur. This review describes the diversity of complications with the goal of improving their avoidance and treatment.
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Affiliation(s)
- Daniel A Wollin
- Comprehensive Kidney Stone Center, Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, 40 Duke Medicine Circle, Room 1573, White Zone, Durham, NC, 27710, USA.
| | - Glenn M Preminger
- Comprehensive Kidney Stone Center, Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, 40 Duke Medicine Circle, Room 1573, White Zone, Durham, NC, 27710, USA
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Aghamir SMK, Mohseni MG, Hosseini SR, Salavati A, Ganjali H, Fallah MA, Rezaei H, Modaresi SS. Totally tubeless percutaneous nephrolithotomy is feasible in morbidly obese patients. Turk J Urol 2017; 43:162-164. [PMID: 28717540 DOI: 10.5152/tud.2017.03185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 09/20/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Regarding technical difficulties that obese body habitus might impose to percutaneous nephrolithotomy (PNL) success and higher risk of peri-operative complications in this group of patients, we decided to retrospectively gather data from our patients during past 8 years to determine the stone free and complication rates. MATERIAL AND METHODS Between January 2007-December 2015, seventy-eight obese patients with body mass index over 35 who had indication for PNL including stones larger than 2 cm in pelvi-calyceal system or smaller extracorporeal shock wave lithotripsy (ESWL) resistant stones or who were not a fit candidate for ESWL due to increased skin to target distance, with no contraindication of PNL (including bleeding diathesis, inability to be positioned in prone) were enrolled. They were randomly assigned to group 1 (standard PNL with nephrostomy and ureteral stent) or group 2 (totally tubeless PNL with no ureteral stent and no nephrostomy). The outcomes were compared. RESULTS The transfusion rate, operation time, and the hemoglobin drop were same across the groups (p>0.05). Total analgesic use was equivalent of 33.8 vs. 14.7 mgs of morphine sulfate (18-77 mg) and was significantly lower in total tubeless group (p=0.001). Return to normal activity was described as total number of in-patient and outpatient days from time of admission to the point which the patients returns to normal life activity such as going to job or school and was 19.4 vs. 9.3 days (6-30 days, p=0.001). CONCLUSION Totally tubeless PNL in obese subjects would have lower analgesic use and return to normal activity versus standard PNL. Totally tubeless PNL is recommended for obese patients.
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Affiliation(s)
| | | | | | - Alborz Salavati
- Department of Urology, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ganjali
- Department of Urology, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hamed Rezaei
- Department of Urology, Tehran University of Medical Sciences, Tehran, Iran
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