Current trends of percutaneous nephrolithotomy in a developing country

Predictive factors for success after supine percutaneous nephrolithotomy: an analysis of 961 patients

OBJECTIVE:

The aim of this study was to evaluate the predictive factors for success following percutaneous nephrolithotomy in the supine position.

METHODS:

Patients who underwent percutaneous nephrolithotomy in the supine position from June 2011 to October 2018 were evaluated. Age, sex, body mass index, the American Society of Anesthesiologists physical status classification, hemoglobin level, number of previous surgeries, stone size, and the Guy’s Stone Score were analyzed. Success was considered if no fragments were observed on the computed tomography scan on the first postoperative day. Univariate and multivariate analyses were performed to determine significant parameters.

RESULTS:

We evaluated 961 patients; of them, 483 (50.2%) underwent previous stone-related surgery, and 499 (51.9%) had Guy’s Stone Score 3 or 4. The overall success rate in a single procedure was 40.7%, and complication rate was 13.7%. The univariate analysis showed that the maximum diameter of the stone (25.10±10 mm; p<0.001), previous percutaneous nephrolithotomy (OR 0.52; p<0.001), number of previous percutaneous nephrolithotomy (OR 0.15; p<0.001), the Guy’s Stone Score (OR 0.28; p<0.001), and the number of tracts (OR 0.32; p<0.001) were significant. In the multivariate analysis, the number of previous percutaneous nephrolithotomy (OR 0.54; p<0.001) and the Guy’s Stone Score (OR 0.25; p<0.001) were statically significant.

CONCLUSIONS:

Guy’s Stone Score and the number of previous percutaneous nephrolithotomy are predictors of success with the supine position. Complex cases and with previous percutaneous interventions may require technical improvements to achieve higher stone-free rates.

Current Trends in Percutaneous Nephrolithotomy in China: A Spot Survey

OBJECTIVE

To describe trends in the procedure of percutaneous nephrolithotomy (PCNL) in China to identify training needs.

METHODS

A spot survey with 36 questions, which revealed demographic data, patterns of PCNL practice, and opinions regarding specific clinical cases, was administered to Chinese urologists during the 17th National Urological Urolithiasis Symposium held in Dandong in 2018.

RESULTS

Out of 400 participants, 221 responses to the survey were received. PCNL was performed by 80.5% of the participants, and 70.2% of them were senior clinicians. It was found that 91% used the prone decubitus in training programs and 27.6% the modified supine, and 46.6% were apprenticeship trained for PCNL, while 5.6% trained during their residency. The prone position was the preferred decubitus, even for obese patients. All of the urologists established their own access, 93.7% used ultrasonography guidance alone, 70.7% used ultrasonic and/or pneumatic lithotripters, and 29.2% used laser. When exiting the kidney, 73.8% placed a nephrostomy tube whereas 26.2% used the tubeless technique. For postoperative follow-up, 51.3% used computed tomography (CT) or ultrasonography plus kidney-ureter-bladder (KUB) to monitor the results of procedures, while 45% used KUB alone. Colonic injury was reported by 8.9%. Average hospital stays of >3 days were reported for 81.2% of procedures.

CONCLUSION

Chinese urologists obtain their own access during PCNL, with ultrasonic guidance in most cases, and almost a half of them are apprenticeship trained. They prefer the prone position, use fascial dilators, and place a nephrostomy tube when exiting the kidney. Most urologists follow the official management guidelines in special cases. Skilled use of urological ultrasound examination, flexible nephroscopy, postoperative CT, tubeless procedures in selected patients, and urology residency training are recommended for PCNL practice.

Current scenario of endourological treatment of kidney stones in brazil: results of a national survey

Objective:

To elucidate the current scenario of endourology in Brazil for the treatment of urinary lithiasis, with an emphasis on regional differences and the reasons why certain techniques are still underutilized.

Materials and Methods:

An electronic questionnaire was sent by email to the 4,745 members of the Brazilian Urological Society (BSU) in 2016 to collect information on the 3 main endourological procedures used in the treatment of nephrolithiasis: Semi-rigid ureteroscopy (URS), Flexible ureteroscopy (F-URS) and percutaneous nephrolithotripsy (PCNL).

Results:

A total of 1,267 urologists answered the questionnaire. It was observed that the vast majority perform URS (95.6%), while 80.2% perform F-URS and only 72.1% perform PCNL. Regarding the surgical volume, most perform up to 10 procedures per month (73.4% to 88.2%) and the main impediment was the lack of patients with the pathology (42.1% to 67.7%). The lack of equipment or hospital infrastructure was one of the main limiting factors for rigid (23%) and flexible (38.1%) URS, mainly in the North and Northeast regions of the country. Regarding PCNL, most of them reported lack of practical experience in the method (29.9%). Finally, most urologists expressed interest in taking courses in endourology.

Conclusion:

Ureteroscopy, rigid or flexible, is already well established in the country, requiring the direction of more resources for its practice, especially in less developed regions. Regarding PCNL a significant part of Brazilian urologists still lack practical experience in this procedure, emphasizing the need for greater investment in teaching this technique.

Techniques - Ultrasound-guided percutaneous nephrolithotomy: How we do it

Ultrasonography has emerged as an alternative to fluoroscopy for image-guided percutaneous nephrolithotomy (PCNL) in many countries. Compared to fluoroscopy-guided PCNL (F-PCNL), ultrasound-guided PCNL (US-PCNL) is easier to learn and reduces radiation exposure to patients and providers. Despite these advantages, uptake of ultrasound-guided PCNL (US-PCNL) in Canada has been almost nonexistent, largely because it is not incorporated into urologists' training. In this article, we seek to familiarize Canadian urologists with this approach by describing our step-by-step technique for US-PCNL. Additionally, we provide keys to successful implementation of this technique.