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Bouchalakis A, Somani BK, Lima E, Rassweiler-Seyfried MC, Mamoulakis C, Tokas T. Navigation systems and 3D imaging in percutaneous nephrolithotripsy: improving outcomes and safety. Curr Opin Urol 2024; 34:105-109. [PMID: 37889519 DOI: 10.1097/mou.0000000000001136] [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: 10/28/2023]
Abstract
PURPOSE OF REVIEW Percutaneous nephrolithotripsy (PCNL) is the first-line management option for large kidney stones (>2 cm). It remains, however, a demanding procedure with considerable morbidity. The present narrative review summarizes recent knowledge from original research studies investigating navigation systems/three-dimensional (3D) imaging in PCNL, particularly on publications during the past 12-18 months. RECENT FINDINGS Navigation systems and 3D imaging are primarily used for preoperative planning, with few intra-operative applications. Patient management and residents' training could benefit from their use. SUMMARY Navigation systems and 3D imaging technology have emerged as a potential game-changer in PCNL. Even though available evidence is currently scarce/inconclusive, the safety/efficacy of navigation systems and 3D dimensional imaging use in PCNL appears promising. This advanced technology offers precise anatomical mapping, improved visualization, and surgical accuracy. Enabling a comprehensive preoperative evaluation and improving guidance, navigation systems, and 3D imaging technology may improve the safety and efficacy of PCNL. With continuous technological evolution, it is expected that improvements/innovations will offer further aid in such demanding procedures. Familiarization and cost reduction are necessary for widespread application, while larger-scale prospective studies and well designed randomized controlled trials are still needed.
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Affiliation(s)
- Athanasios Bouchalakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Estevao Lima
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho
- ICVS/3B's-PT, Government Associate Laboratory, Braga/Guimarães
- Deparment of Urology, Hospital of Braga, Braga, Portugal
| | | | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Theodoros Tokas
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
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Janssen M, Siemer S. [Intervention planning in modern renal surgery]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:1133-1143. [PMID: 37698657 DOI: 10.1007/s00120-023-02188-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Three-dimensional (3D) reconstruction in renal surgery offers significant benefits in planning of the operation itself, in patient education and training fellows. OBJECTIVE The goal was to study the possible application and use of 3D reconstruction in modern renal surgery. METHODS A literature search in PubMed using keywords "3D" and "renal surgery" within the last 10 years of publication was performed. RESULTS The search revealed 655 articles among them 53 reviews. Relevant for this article were 120 articles which included 14 reviews. The publication statistics showed a strong increase in the last 10 years which may reflect the increasing application and demand for 3D technology in the field of renal surgery. Especially in robot-assisted minimally invasive surgery applications, the use of 3D technology was studied more often. The technical standards are not yet uniform and 3D printing in complex renal surgery remains cost- and time-intensive. Nevertheless, the results of the pioneering clinical studies showed positive results, and 3D technology can be used not only in planning the operation, but in patient education and also the training of fellows and staff. A limitation to more complex cases seems to be sensible for this is still a costly tool. To identify complex cases in renal surgery, the established renometric scoring systems should be used more broadly in daily practice to identify patients who would profit most from this technique. CONCLUSION In complex renal surgery, 3D reconstruction and modelling is rational; furthermore, it can be useful in patient education and in training of fellows.
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Affiliation(s)
- M Janssen
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland.
| | - S Siemer
- Klinik für Urologie und Kinderurologie, Universitätskliniken des Saarlandes, Homburg/Saar, Deutschland
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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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Halawani A, Koo KC, Wong VKF, Chew BH. Preoperative patient optimization for endourological procedures: the current best clinical practice. Curr Opin Urol 2023; 33:122-128. [PMID: 36354124 DOI: 10.1097/mou.0000000000001060] [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: 11/11/2022]
Abstract
PURPOSE OF REVIEW Despite technological advancements in endourological surgery, there is room for improvement in preoperative patient optimization strategies. This review updates recent best clinical practices that can be implemented for optimal surgical outcomes. RECENT FINDINGS Outcome and complication predictions using novel scoring systems and techniques have shown to assist clinical decision-making and patient counseling. Innovative preoperative simulation and localization methods for percutaneous nephrolithotomy have been evaluated to minimize puncture-associated adverse events. Novel antibiotic prophylaxis strategies and further recognition of risk factors that attribute to postoperative infections have shown the potential to minimize perioperative morbidity. Accumulating data on the roles of preoperative stenting and selective oral alpha-blockers adds evidence to the current paradigm of preventive measures for ureteral injury. SUMMARY Ample tools and technologies exist that can be utilized preoperatively to improve surgical outcomes. The combination of these innovations, along with validation in larger-scale studies, presents the cornerstone of future urolithiasis management.
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Affiliation(s)
- Abdulghafour Halawani
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Kyo Chul Koo
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
- Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Victor K F Wong
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ben H Chew
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
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Azal W, de Salles LC, di Domenico B, Miyaoka R, Reis LO. Will the advances in retrograde intrarenal surgery extinguish percutaneous nephrolithotomy for stones larger than 2 cm? Int Braz J Urol 2022; 49:143-149. [PMID: 36512462 PMCID: PMC9881800 DOI: 10.1590/s1677-5538.ibju.2022.0533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 10/26/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Wilmar Azal
- Universidade Estadual de CampinasCampinasSPBrasilUniversidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Lukas Costa de Salles
- Universidade Estadual de CampinasCampinasSPBrasilUniversidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Bruno di Domenico
- Universidade Estadual de CampinasCampinasSPBrasilUniversidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Ricardo Miyaoka
- Universidade Estadual de CampinasCampinasSPBrasilUniversidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Leonardo O. Reis
- Universidade Estadual de CampinasCampinasSPBrasilUniversidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil,Pontifícia Universidade Católica de CampinasCampinasSPBrasilUroScience, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brasil,Leonardo Oliveira Reis, MD, MSc, PhD, Universidade Estadual de Campinas (Unicamp), R. John Boyd Dunlop, s/n Campinas, SP, 13060-904, Brasil. E-mail:
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Nourian SMA, Bahrami M. Open surgery versus percutaneous nephrolithotomy for management of staghorn calculi. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2022; 10:271-276. [PMID: 36051615 PMCID: PMC9428571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND For urologists, treating staghorn stones remains a difficult challenge. Various studies have evaluated the results of percutaneous nephrolithotomy (PCNL) and open surgery in different populations but these results were controversial. Here, we aimed to compare and evaluate the results of open surgery and PCNL in the treatment of staghorn stones. METHODS This retrospective descriptive study was performed to compare the results of open surgery and PCNL in the treatment of staghorn stones in 2013-2021. A total of 360 participants were studied among the population. Demographic data of patients including age, gender, and comorbidities were obtained. We assessed variables including type of stone, serum creatinine, degree of hydronephrosis, and urine culture before the operation. All participants in our study were informed of the two surgical alternatives. RESULTS The mean length of hospital stay in PCNL patients was 3.88 ± 1.76 and in open surgery patients was 5.858 ± 2.12 (P = 0.003). In 30 patients (13.9%) in the PCNL group and 27 patients (18.8%) in the open surgery group, bleeding necessitating blood transfusion was the only intraoperative complication. 309 patients (85%) had no residual stones at the time of discharge from the hospital, which was 81.9% (177 cases) in patients treated with PCNL and 91.6% (132 patients) in the open surgery group (P > 0.05). CONCLUSION Staghorn calculi can be managed effectively with open surgery or PCNL. Given the reduced postoperative complication rate and higher stone-free rate, we believe open surgery is better technique for complicated staghorn stones with a high burden.
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Affiliation(s)
| | - Mahshid Bahrami
- Assistant Professor, Department of Radiology, Isfahan University of Medical SciencesIsfahan, Iran
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Abstract
PURPOSE OF REVIEW Radiological imaging techniques and applications are constantly advancing. This review will examine modern imaging techniques in the diagnosis of urolithiasis and applications for surgical planning. RECENT FINDINGS The diagnosis of urolithiasis may be done via plain film X-ray, ultrasound (US), or contrast tomography (CT) scan. US should be applied in the workup of flank pain in emergency rooms and may reduce unnecessary radiation exposure. Low dose and ultra-low-dose CT remain the diagnostic standard for most populations but remain underutilized. Single and dual-energy CT provide three-dimensional imaging that can predict stone-specific parameters that help clinicians predict stone passage likelihood, identify ideal management techniques, and possibly reduce complications. Machine learning has been increasingly applied to 3-D imaging to support clinicians in these prognostications and treatment selection. SUMMARY The diagnosis and management of urolithiasis are increasingly personalized. Patient and stone characteristics will support clinicians in treatment decision, surgical planning, and counseling.
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Durutović O, Filipović A, Milićević K, Somani B, Emiliani E, Skolarikos A, Janković MM. 3D Imaging Segmentation and 3D Rendering Process for a Precise Puncture Strategy During PCNL – a Pilot Study. Front Surg 2022; 9:891596. [PMID: 35592119 PMCID: PMC9110964 DOI: 10.3389/fsurg.2022.891596] [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: 03/07/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Percutaneous nephrolithotomy (PCNL) is frequently used as the first-line treatment of large and complex stones. The key point for successful complex stone removal with minimal risk of complications is to establish the most appropriate access route. Understanding the three-dimensional (3D) relationship of kidney stones and renal collecting systems is crucial for planning and creating an optimal access route. By using a 3D volume segmentation tool a more accurate approach to the renal collecting system and stone treatment could be planned. The objective of this study was assessing the impact of 3D software in getting the desired access.
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Affiliation(s)
- Otaš Durutović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Urology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Aleksandar Filipović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Belgrade, Serbia
- Correspondence: Aleksandar Filipović
| | - Katarina Milićević
- Laboratory for Biomedical Instrumentation and Technologies, Department of Signals and Systems, University of Belgrade, School of Electrical Engineering, Belgrade, Serbia
| | - Bhaskar Somani
- Faculty of Medicine, University Hospital Southampton, Southampton, United Kingdom
| | - Esteban Emiliani
- Department of Urology, Fundacion Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Andreas Skolarikos
- National and Kapodistrian University of Athens, 2nd Department of Urology, Sismanoglio Hospital, Athens, Greece
| | - Milica M. Janković
- Laboratory for Biomedical Instrumentation and Technologies, Department of Signals and Systems, University of Belgrade, School of Electrical Engineering, Belgrade, Serbia
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