Contemporary practice of percutaneous nephrolithotomy: review of practice in a single region of the UK

Massive haemothorax from percutaneous nephrolithotomy requiring video-assisted thoracoscopic surgery: A case report

INTRODUCTION

Massive haemothorax can occur following percutaneous nephrolithotomy (PCNL), which is a significant adverse event and a life-threatening condition.

PRESENTATION OF CASE

A 65-year-old male who presented with a full right staghorn stone was treated with PCNL. Two days later, he developed massive haemothorax and conservative management with intercostal drainage failed. The patient successfully underwent video-assisted thoracoscopic surgical decortication (VATSD).

DISCUSSION

PCNL is the mainstay procedure for complex renal stones. Because it is aggressive, it can also have serious complications. Tube thoracostomy drainage is the initial approach for managing haemothorax. However, retained haemothorax still occurs and can cause additional complications. VATSD is frequently applied in the modern era because of its good visualization and reduced morbidity compared with conventional thoracotomy.

CONCLUSION

VATSD is a safe and effective surgical technique that can be easily applied to manage retained haemothorax as a result of PCNL.

The impact of nephrostomy balloon inflation volume on post percutaneous nephrolithotomy hemorrhage

Introduction

the study aims to match different volumes of nephrostomy balloon inflation to point out the foremost effective volume size of post percutaneous nephrolithotomy (PCNL) bleeding control.

Methods

we have retrospectively reviewed “560” medical records of patients who underwent percutaneous nephrolithotomy between (the years 2017 and 2018) at Prince Hussein Urology Center. The Patients were divided into two teams, group-1 (a number of 280 patients) with nephrostomy balloon inflated concerning three ml and group-2 (a number of 280 patients) the balloon inflated concerning one ml. The preoperative and postoperative hematocrit, the operation duration, the stone size, the postoperative pain severity, the transfusion rate and the duration of hematuria between the two groups were compared during hospitalization.

Results

regarding patients with ages (between 18 and 68 years); the preoperative hematocrit (mean values ± SDs) was (40.35% ± 3.57) vs (39.95% ± 3.43) for groups-1 and 2, respectively; the p value=0.066. The postoperative hematocrit was (37.91% ± 3.96) vs (34.38 ± 2.78), respectively; the p value was (0.008); the blood transfusion rate was 11.2% vs 13.4% (the p value was 0.039), respectively. The Postoperative pain score was (4.93 ± 1.44) vs (3.89 ± 1.45) (the p value was 0.012), respectively.

Conclusion

increasing the nephrostomy balloon volume to a “3cc” competes for a task to decrease bleeding which was found to be as a secure and considerable effective procedure-related factor. However, the disadvantage of this technique resulted in increasing the postoperative pain in patients undergoing such a procedure.

Blood transfusion, embolisation and nephrectomy after percutaneous nephrolithotomy (PCNL)

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Percutaneous treatment for renal stone disease is associated with a risk of significant morbidity. Our large UK series provides contemporary data on the risk of vascular complications and admission to the Intensive Care Unit (ICU) after PCNL. When compared with recent international databases, these data support the current evidence that better outcomes can be achieved in centres performing large numbers of procedures. These data add to the debate for the centralisation of specialist stone surgery.

OBJECTIVE

To audit the outcome of percutaneous nephrolithotomy (PCNL) at a UK stone centre over a 10-year period, and provide patients with understandable contemporary data on blood loss and vascular risk.

PATIENTS AND METHODS

A single centre retrospective analysis of all PCNLs undertaken between April 2000 and December 2010. The association between transfusion and patient age, operative duration and positive preoperative mid-stream urine (MSU) sample was subject to statistical analysis.

RESULTS

Data on 568 patients was analysed. 21 were paediatric cases with a mean (range) age of 8 (2-16) years; 547 were adult cases with a mean (range) age of 55 (17-84) years. 3.8% of adult patients (21/547) received a blood transfusion; mean age 60 years (55 years in those not transfused) with a mean operative duration of 119 min (103 min in those not transfused). 23.8% of patients transfused had a confirmed preoperative urinary tract infection compared with 16.1% of those not transfused. Seven patients underwent angiography, with five having selective arterial embolisation (0.9%). There were no deaths in this series although one patient (0.2%) required an urgent nephrectomy due to cardiovascular instability from bleeding.

CONCLUSIONS

Large UK series that provides contemporary data for consent on vascular risk at PCNL. The risk of transfusion is associated with increased patient age, operative duration and the presence of a positive preoperative MSU sample. Data compares favourably with other large published series, and supports the argument for centralisation of percutaneous stone management.

The effect of American Society of Anesthesiology scores on percutaneous nephrolithotomy outcomes

INTRODUCTION

To evaluate the effect of American Society of Anesthesiology (ASA) scores on percutaneous nephrolithotomy (PNL) outcomes.

MATERIALS AND METHODS

The records of 186 consecutive patients undergoing PNL procedures from 2006 to 2011 at a single institution were evaluated. Patients were divided into a low-risk group with a preoperative ASA of I or II and a high-risk group with ASA of III or IV. Postoperative complications were classified according to the modified Clavien classification system.

RESULTS AND CONCLUSIONS

There were 140 cases in the low-risk and 46 cases in the high-risk groups. The mean operative time was 72 min (40-120 min) and 86 min (55-125 min) and the complication rates were 17.8 and 19.5% for the low- and high-risk groups, respectively. The average duration of nephrostomy tube drainage was 3.3 ± 1 and 4.2 ± 1.5 days for the low- and high-risk groups, respectively. Stone-free rates were 85 and 82% for the low- and high-risk groups, respectively. PNL can be safely performed in the ASA high-risk patient population.

MINI PCNL in a pediatric population

PURPOSE

We report our initial experience of MINI percutaneous nephrolithotomy (PCNL) in a pediatric population using a miniature nephroscope through a 16F metal access sheath.

METHODS

All pediatric patients who underwent PCNL from August 2007 to September 2010 using a 14F miniature nephroscope through a 16F metal access sheath for renal stone extraction were evaluated. Patients' demographic details, procedural information, and posttreatment outcomes were prospectively documented.

RESULTS

A total of 23 MINI PCNLs were performed on 23 kidneys of 12 patients whose ages ranged from 1.6 to 14.6 years. The median stone burden was 3.44 cm(2), and there were 11 "Staghorn" stones. The procedure was primary via a single puncture in 19 kidneys and secondary using a preexisting nephrostomy tract in 4 kidneys. Access was successful in all primary and two secondary cases, for a total of success rate of 91.3 %. Stones were fragmented using a Holmium laser and/or lithoclast, and fragments were irrigated or sequentially removed by various stone grasping devices. The mean procedural X-ray screening time and total stone extraction period were 4.5 and 109.4 min, respectively. The primary stone free rate was 83.6 %, which increased to 90.5 % after treating the residual fragments. Postoperative hydrothorax developed in one patient, which required a chest drain. Symptoms of chest infection and positive urine culture were detected in one and two patients, respectively.

CONCLUSIONS

Our initial experience supports previous reports that MINI PCNL is safe and effective for the management of renal stones in children.

An Audit of Percutaneous Nephrolithotomy in the United Kingdom

We report a retrospective audit of percutanoeus nephrolithotomy (PCNL) in the United Kingdom. Questionnaires were sent to centres performing PCNL throughout the UK and data was obtained on 681 procedures from 30 centres. A variety of practice is demonstrated. Complication rates were comparable to previously published data and stone free rates were lower. Our data would also appear to support the view that urologist access for PCNL is both safe and effective in the UK.