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Azmi YA, Renaldo J, Andhika DP. Endoscopic combined intrarenal surgery for successful removal of an encrusted ureteral stent and multiple renal stones in solitary kidney: A case report. Int J Surg Case Rep 2024; 115:109324. [PMID: 38308996 PMCID: PMC10850768 DOI: 10.1016/j.ijscr.2024.109324] [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: 12/28/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Several endoscopic procedures have been performed to clear stones in the kidney. A potential technique called endoscopic combined intrarenal surgery (ECIRS) is a practical option for treating complex kidney stones. Hereby, we report a neglected double j (DJ) stent and recurrent multiple kidney stones treated by ECIRS. CASE PRESENTATION A 56-year-old female complained of right flank pain one week ago, which worsened within one day before hospital admission. She underwent DJ stent insertion one year ago because of residual stones after right percutaneous nephrolitothomy (PCNL) but was lost to follow-up. There was a history of left nephrectomy, leaving the patient with only a right kidney. A x-ray kidney ureter bladder (KUB) evaluation showed multiple irregular radiopaque shadows. A computed tomography (CT) scan detected numerous stones in the right kidney. The patient underwent ECIRS to remove the DJ stent and clear multiple stones in the right kidney. Following the surgery, the patient was discharged from the hospital on the fourth postoperative day with no complications and residual stone. CLINICAL DISCUSSIONS ECIRS is a technique that combines a simultaneous antero-retrograde approach to the kidney and aims to resolve nephrolithiasis in one step and with one access. The ECIRS procedure could be considered in cases of complex multiple stone nephrolithiasis. ECIRS could widen the operative vision, thus helping to clear difficult kidney stones. CONCLUSIONS The ECIRS technique could provide successful and safe management of recurrent multiple kidney stones and encrusted, neglected DJ stents in a solitary kidney patient.
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Affiliation(s)
- Yufi Aulia Azmi
- Department of Urology, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Johan Renaldo
- Department of Urology, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Dimas Panca Andhika
- Department of Urology, Faculty of Medicine Universitas Airlangga - Universitas Airlangga Academic Hospital, Surabaya, Indonesia
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Zaza MMA, Tawfeek AM, Salem TAEM, Soliman MIS, Hassan Ali M. Risk factors of stone residual after retrograde intrarenal surgery: A prospective cohort study. Urologia 2024:3915603231222083. [PMID: 38193436 DOI: 10.1177/03915603231222083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND Complete removal of renal stones is crucial for optimal patient outcomes, but recent studies have reported residual stones after retrograde intrarenal surgery (RIRS). This study aimed to identify the associated risk factors to improve patient management and treatment selection. METHODS This cohort study was conducted over 18 months at two hospitals and recruited adult patients with renal stones less than 3 cm. Preoperative assessment included medical history, physical examination, laboratory tests, and radiological imaging. Intraoperative and postoperative data collection and follow-up were conducted to evaluate surgical success and potential complications. RESULTS A total of 100 patients were included, with a mean age of 45.3 ± 10.7 years and a mean BMI of 26.2 ± 1.4 kg/m2. Approximately 19% of the patients had residual stones after the RIRS procedure. The RUSS score showed good diagnostic performance with an AUC of 0.843, and the optimal cut point was ⩾2.0 with a sensitivity of 52.6% and specificity of 95.1%. Independent predictors of residual stones were multiple sites (OR = 24.98; p = 0.002), multiple stones (OR = 13.62, p = 0.002), stone size of 21-30 mm (OR = 4.91, p = 0.038), lower calyx site (OR = 4.85, p = 0.033), and surgeon experience of fewer than 50 cases (OR = 6.82, p = 0.020). CONCLUSIONS This study identifies several factors associated with residual stones after RIRS for renal stones, including stone size, location, number, and surgeon experience. The study suggests that the RUSS score can be used as a reliable tool for predicting the likelihood of residual stones, which can help clinicians in patient selection and treatment planning.
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Han DS, Johnson JP, Schulster ML, Shah O. Indications for and results of renal autotransplantation. Curr Opin Nephrol Hypertens 2023; 32:183-192. [PMID: 36683544 DOI: 10.1097/mnh.0000000000000860] [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: 01/24/2023]
Abstract
PURPOSE OF REVIEW To understand the indications and outcomes of renal autotransplantation, and when to consider this unique procedure for patients. RECENT FINDINGS Renal autotransplantation confers acceptably low rates of graft failure and prevents need for long-term dialysis. Renal autotransplantation remains an important management strategy in very select patients for complex renovascular disease, ureteral stricture disease, ureteral trauma, upper urinary tract urothelial carcinoma, renal cell carcinoma, and Loin-Pain Hematuria Syndrome. With advancements in minimally invasive procedures, the application of renal autotransplantation for refractory stone disease is rare but exists. Robot-assisted laparoscopic renal autotransplantation demonstrates reproducible graft success and complication rates with improved perioperative outcomes (ex. hospital length of stay) - though comparative studies are lacking. Patients would benefit from a multidisciplinary approach from renal transplant surgeons, vascular surgeons, urologists, nephrologists, dieticians, pain management providers, social workers, and psychiatrists. SUMMARY In experienced hands, renal autotransplantation is a reasonable treatment approach for complex and refractory renal vascular disease, Loin-Pain Hematuria Syndrome, ureteral strictures and trauma, upper urinary tract malignancy, and stone disease in highly select patients.
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Affiliation(s)
- David S Han
- Columbia University Irving Medical Center, Department of Urology
| | - Jeffrey P Johnson
- Weill Cornell Medical College, Department of Urology, New York, New York, USA
| | | | - Ojas Shah
- Columbia University Irving Medical Center, Department of Urology
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Singal R, Dhar S. Retroperitoneal laparoscopic pyelolithotomy in renal pelvic stone versus open surgery - a comparative study. ACTA ACUST UNITED AC 2018; 91:85-91. [PMID: 29440956 PMCID: PMC5808274 DOI: 10.15386/cjmed-732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/30/2017] [Indexed: 11/23/2022]
Abstract
Background The introduction of endourological procedures such as percutaneous nephrolithotomy and ureterorenoscopy have led to a revolution in the the management of urinary stone disease. The indications for open stone surgery have been narrowed significantly, making it a second- or third-line treatment option. Aims and Objectives To study the safety and efficacy of retroperitoneal laparoscopic pyelolithotomy in retroperitoneal renal stone. We compared the results of laparoscopic and open surgery in terms of easy accessibility, operative period, renal injuries, and early recovery. Methods This prospective study was conducted on renal pelvic stone cases from January 2009 to February 2016 in Suchkhand Hospital, Agra, India. The study included a total of 1700 cases with the diagnosis of solitary renal pelvic stones. In group A - 850 cases - retroperitoneal laparoscopic pyelolithotomy was performed, while group B - 850 cases - underwent open pyelolithotomy. Results The mean operative time was less in group B than group A (74.83 min vs. 94.43 min) which was significant (p<0.001). The blood loss was less in the laparoscopic group than in the open group (63 mL vs. 103mL). There were statistically significant differences in the post-operative pain scores, and postoperative complications compared to group B (p<0.001). The mean hospital stay was less in group A (p<0.03), which was significant. Conclusion Laparoscopic surgery reduces analgesic requirements, hospital stay, and blood loss. The disadvantages include the reduced working space, the cost of equipment and the availability of a trained surgeon.
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Affiliation(s)
- Rikki Singal
- Surgery Department, MM University, Mullana, India
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Hasan R, Gribbin C, Hutton R, Amer T, Little B, Meddings R. A successful case of a laparoscopic extraction with closure of the diverticulum for an anteriorly placed calculus in an infundibular diverticulum. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415814553651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- R Hasan
- Urology department, University Hospital Ayr, South Ayrshire, UK
| | - C Gribbin
- Urology department, University Hospital Ayr, South Ayrshire, UK
| | - R Hutton
- Urology department, University Hospital Ayr, South Ayrshire, UK
| | - T Amer
- Urology department, University Hospital Ayr, South Ayrshire, UK
| | - B Little
- Urology department, University Hospital Ayr, South Ayrshire, UK
| | - R Meddings
- Urology department, University Hospital Ayr, South Ayrshire, UK
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Gandhi HR, Thomas A, Nair B, Pooleri G. Laparoscopic pyelolithotomy: An emerging tool for complex staghorn nephrolithiasis in high-risk patients. Arab J Urol 2015; 13:139-45. [PMID: 26413336 PMCID: PMC4561920 DOI: 10.1016/j.aju.2014.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 10/23/2014] [Accepted: 10/26/2014] [Indexed: 11/27/2022] Open
Abstract
Objectives To evaluate the effectiveness of laparoscopic pyelolithotomy (LP) for staghorn stones (>3–4 cm) in patients with chronic liver disease or coronary artery disease. Patients and methods In all, 49 patients underwent LP; they were divided into four groups, with stones in group 1 in the renal pelvis only, in group 2 in the renal pelvis and one calyx, in group 3 in the renal pelvis and two calyces, and in group 4, in the renal pelvis and more than two calyces. Patient demography, stone characteristics, surgical outcomes and complications were evaluated. Results The mean stone-free rate in one session was 90% among all groups. The mean (SD) stone size was 4.27 (1.72) cm. The stone-free rate decreased with greater stone burden, but the operative time, estimated blood loss and need for ancillary procedures increased with stone burden. No blood transfusion was required and one patient each in groups 2 and 4 had a urine leak. Conclusion LP provides acceptable results in complex cases for managing renal stone disease with a larger stone burden in high-risk situations.
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Affiliation(s)
- Himesh Ramesh Gandhi
- Department of Urology and Renal Transplantation, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Appu Thomas
- Department of Urology and Renal Transplantation, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Balagopal Nair
- Department of Urology and Renal Transplantation, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Ginilkumar Pooleri
- Department of Urology and Renal Transplantation, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Lunardi P, Timsit MO, Roumiguie M, Dariane C, N'Guyen K, Beauval JB, Leroux S. [Single procedure treatment of complex nephrolithiasis: about a modern series of anatrophic nephrolithotomy]. Prog Urol 2014; 25:90-5. [PMID: 25453356 DOI: 10.1016/j.purol.2014.09.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 09/19/2014] [Accepted: 09/24/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE Advances in endourology have significantly reduced indications of open surgery in the treatment of staghorn calculi. However, in our experience, open surgery is still the treatment of choice in some cases. This study presents the results of a series of selected patients and discusses the results in terms of efficacy and morbidity. MATERIALS A cohort of 26 patients underwent anatrophic nephrolithotomy by lombotomy to treat a complex staghorn calculus. RESULTS The mean stone size was 68,5mm, 70% were complete staghorn calculi. The operative time was 100minutes. Blood loss was 225mL, with a postoperative transfusion rate of 15.4%. The hospital stay was 8.4 days. The stone free rate following the procedure was 92%. The creatinine clearance (MDRD) at 3 months was improved from 5.9mL/min/m(2) on average over the entire series. CONCLUSION There are clearly still indications for open surgery in staghorn stones management, with good results in this contemporary series on both stone removal and nephronic preservation. Yet, it appears that this technique is no longer taught. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- P Lunardi
- Département d'urologie, d'andrologie et de transplantation rénale, CHU Rangueil, 1, avenue J.-Pouilhès, 31059 Toulouse, France.
| | - M O Timsit
- Service d'urologie, HEGP-Necker, Paris-XV, 149, rue de Sèvres, 75015 Paris, France
| | - M Roumiguie
- Département d'urologie, d'andrologie et de transplantation rénale, CHU Rangueil, 1, avenue J.-Pouilhès, 31059 Toulouse, France
| | - C Dariane
- Service d'urologie, HEGP-Necker, Paris-XV, 149, rue de Sèvres, 75015 Paris, France
| | - K N'Guyen
- Service d'urologie, centre hospitalier de Polynésie française, Tahiti, Polynésie française
| | - J B Beauval
- Département d'urologie, d'andrologie et de transplantation rénale, CHU Rangueil, 1, avenue J.-Pouilhès, 31059 Toulouse, France
| | - S Leroux
- Service d'urologie, centre hospitalier de Polynésie française, Tahiti, Polynésie française
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Abstract
PURPOSE OF REVIEW While most renal and ureteral stones can be efficiently managed using endourologic techniques, the use of laparoscopy for the management of urolithiasis is increasing. The application of laparoscopy for stone removal will further reduce the need for open stone surgery. RECENT FINDINGS Laparoscopic ureterolithotomy, pyelolithotomy, and anatrophic nephrolithotomy are highly successful techniques with regard to their one-session, high stone-free rates. These procedures could be considered as the preferred approaches when endourologic procedures are not available or have failed. Laparoscopic stone surgery (LSS) in patients with urinary tract anomalies offers a reliable minimally invasive procedure as an alternative to a complex endourologic technique. SUMMARY Although laparoscopy still has a limited role in the urologist's armamentarium for the surgical management of urolithiasis, it can further reduce the need for open stone surgery in complex circumstances. LSS duplicates its open counterpart and offers a high one-session, stone-free rate in most patients with a lower morbidity and quicker convalescence. More comparative studies are needed to define the role and indications of LSS in relation to endourologic and open techniques, especially in complex circumstances.
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Postoperative Complications Leading to Death after Coagulum Pyelolithotomy in a Tetraplegic Patient: Can We Prevent Prolonged Ileus, Recurrent Intestinal Obstruction due to Adhesions Requiring Laparotomies, Chest Infection Warranting Tracheostomy, and Mechanical Ventilation? Case Rep Urol 2013; 2013:682316. [PMID: 23533931 PMCID: PMC3600272 DOI: 10.1155/2013/682316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 02/12/2013] [Indexed: 11/25/2022] Open
Abstract
A 22-year-old male sustained C-6 tetraplegia in 1992. In 1993, intravenous pyelography revealed normal kidneys. Suprapubic cystostomy was performed. He underwent open cystolithotomy in 2004 and 2008. In 2009, computed tomography revealed bilateral renal calculi. Coagulum pyelolithotomy of left kidney was performed. Pleura and peritoneum were opened. Peritoneum could not be closed. Following surgery, he developed pulmonary atelectasis; he required tracheostomy and mechanical ventilation. He did not tolerate nasogastric feeding. CT of abdomen revealed bilateral renal calculi and features of proximal small bowel obstruction. Laparotomy revealed small bowel obstruction due to dense inflammatory adhesions involving multiple small bowel loops which protruded through the defect in sigmoid mesocolon and fixed posteriorly over the area of previous intervention. All adhesions were divided. The wide defect in mesocolon was not closed. In 2010, this patient again developed vomiting and distension of abdomen. Laparotomy revealed multiple adhesions. He developed chest infection and required ventilatory support again. He developed pressure sores and depression. Later abdominal symptoms recurred. This patient's general condition deteriorated and he expired in 2011.
Conclusion. Risk of postoperative complications could have been reduced if minimally invasive surgery had been performed instead of open surgery to remove stones from left kidney. Suprapubic cystostomy predisposed to repeated occurrence of stones in urinary bladder and kidneys. Spinal cord physicians should try to establish intermittent catheterisation regime in tetraplegic patients.
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Lee JW, Cho SY, Yeon JS, Jeong MY, Son H, Jeong H, Kim HH, Lee SB. Laparoscopic pyelolithotomy: comparison of surgical outcomes in relation to stone distribution within the kidney. J Endourol 2013; 27:592-7. [PMID: 23234358 DOI: 10.1089/end.2012.0570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
UNLABELLED Abstract Purpose: To evaluate surgical outcomes of laparoscopic pyelolithotomy (LP) in relation to stone distribution within the kidney. METHODS Between August 2008 and February 2012, 77 patients underwent LP as first-line treatment for renal stone(s). Cases were classified into four groups, depending on stone location: Group I (located in only renal pelvis), Group II (located only in renal calyx), Group III (located in renal pelvis and in one calyx), and Group IV (located in renal pelvis and in multiple calyces). Patient and stone characteristics, surgical outcomes, and complications were evaluated. RESULTS Sixty-seven (81.8%) cases were stone-free after LP for large renal stones. Stone-free rates in a single session significantly decreased with greater stone dispersion (p<0.001). Mean hospital stay in group IV was significantly longer than in other groups (p=0.038). However, there were no significant differences in mean operation times (p=0.214), mean change in serum hemoglobin (p=0.709), postoperative analgesics usages (p=0.153), and number of analgesics used on an as-needed basis (p=0.079). There were no complications of grade IIIb or of greater severity. One patient in group II received blood transfusion, and 1 in group III required percutaneous drainage due to perirenal urine collection. CONCLUSIONS LP is an effective and safe modality for managing renal stones diseases. Distribution of stone burden, and total stone burden, is an important predictor of surgical outcome of LP in renal stone diseases.
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Affiliation(s)
- Jeong Woo Lee
- Department of Urology, Seoul National University College of Medicine, Seoul, Republic of Korea
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