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Proietti S, Di Pietro S, Oo MM, Gisone S, Scalia R, Gaboardi F, Giusti G. Supine percutaneous nephrolithotomy in horseshoe kidney. Cent European J Urol 2024; 77:291-297. [PMID: 39345315 PMCID: PMC11428371 DOI: 10.5173/ceju.2024.8] [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: 01/07/2024] [Revised: 01/07/2024] [Accepted: 01/07/2024] [Indexed: 10/01/2024] Open
Abstract
Introduction Historically, percutaneous nephrolithotomy (PCNL) in horseshoe kidney (HSK) patients has been performed in the prone position. Nevertheless, thanks to the spread of the supine PCNL technique for patients with urinary stones and normal renal anatomy, some retrospective studies have already reported on supine PCNL and HSK, showing the effectiveness and safety of the procedure. Herein we report our experience with supine PCNL in a subset of patients with urolithiasis. Material and methods Prospective data were collected for all HSK patients who underwent supine PCNL at our institution from June 2016 to June 2023. Stone volume was reported as the volume of a single stone or the sum of the volumes of multiple stones on computed tomography (CT) images. Patients were reported to be stone-free if there were no stones on postoperative non-contrast CT (NCCT) exam. Peri-/postoperative complications were reported according to the Clavien-Dindo classification system. The primary endpoint of the study was stone-free rate (SFR) and the secondary endpoints were Clavien-Dindo complications Grade I or higher. Results A total of 35 patients met the inclusion criteria and were enrolled in the study. Forty-eight procedures were analyzed. SFR was 72.9% at 1-month follow-up. In 11 out of 48 procedures (22.9%) Clavien-Dindo Grade I-II complications were recorded. In one case Clavien-Dindo Grade IIIa complication was observed. Conclusions In this prospective study of 35 HSK patients who underwent 48 procedures, supine PCNL was safe and effective, with minimal morbidity.
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Affiliation(s)
- Silvia Proietti
- Department of Urology, European Training Centre of Endourology (ETCE), IRCCS San Raffaele Hospital, Milan, Italy
| | - Salvatore Di Pietro
- Department of Urology, European Training Centre of Endourology (ETCE), IRCCS San Raffaele Hospital, Milan, Italy
| | - Mon Mon Oo
- Department of Urology, European Training Centre of Endourology (ETCE), IRCCS San Raffaele Hospital, Milan, Italy
| | - Stefano Gisone
- Department of Urology, European Training Centre of Endourology (ETCE), IRCCS San Raffaele Hospital, Milan, Italy
| | - Riccardo Scalia
- Department of Urology, European Training Centre of Endourology (ETCE), IRCCS San Raffaele Hospital, Milan, Italy
| | - Franco Gaboardi
- Department of Urology, European Training Centre of Endourology (ETCE), IRCCS San Raffaele Hospital, Milan, Italy
| | - Guido Giusti
- Department of Urology, European Training Centre of Endourology (ETCE), IRCCS San Raffaele Hospital, Milan, Italy
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El Hayek KKR, Perrella R, Ferreira DB, Batagello CA, Mota PKV, Cohen DJ, Murta CB, Claro JFDA, Vicentini FC. Predictive factors for success after supine percutaneous nephrolithotomy: an analysis of 961 patients. Rev Assoc Med Bras (1992) 2022; 68:780-784. [PMID: 35766691 PMCID: PMC9575886 DOI: 10.1590/1806-9282.20211340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/05/2022] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
| | - Rodrigo Perrella
- Hospital de Transplantes Dr. Euryclides de Jesus Zerbini, Division of Urology - São Paulo (SP), Brazil
| | - Daniel Beltrame Ferreira
- Hospital de Transplantes Dr. Euryclides de Jesus Zerbini, Division of Urology - São Paulo (SP), Brazil
| | - Carlos Alfredo Batagello
- Hospital de Transplantes Dr. Euryclides de Jesus Zerbini, Division of Urology - São Paulo (SP), Brazil
| | | | - David Jacques Cohen
- Hospital de Transplantes Dr. Euryclides de Jesus Zerbini, Division of Urology - São Paulo (SP), Brazil
| | - Claudio Bovolenta Murta
- Hospital de Transplantes Dr. Euryclides de Jesus Zerbini, Division of Urology - São Paulo (SP), Brazil
| | | | - Fabio Carvalho Vicentini
- Hospital de Transplantes Dr. Euryclides de Jesus Zerbini, Division of Urology - São Paulo (SP), Brazil
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Choudhury S, Kasim A, Pal DK. Supine PCNL in autosomal dominant polycystic kidney disease. Urologia 2022; 90:123-129. [PMID: 35422167 DOI: 10.1177/03915603221091082] [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: 11/16/2022]
Abstract
AIMS AND OBJECTIVES Standard percutaneous nephrolithotomy (PCNL) has routinely been performed in prone position in autosomal dominant polycystic kidney disease (ADPKD) with nephrolithiasis. The objectives of our present study is to ensure optimum access to the renal collecting system, reducing operative time, and anesthetic morbidity during supine PCNL in ADPKD with nephrolithiasis. METHODS Seven patients were selected randomly. There were no preference for age, gender, size, location and laterality of stone, or BMI . All the patients fit into the AUA guideline criteria for management by percutaneous nephrolithotomy. Preoperative, perioperative, and follow up data were collected prospectively. RESULTS Seven patients underwent supine PCNL in approximately 2.5 year in modified supine position. There was no intraoperative, post operative, or on follow up complications in any patient. In all the patients stones were cleared completely in single sitting. CONCLUSIONS Supine PCNL in ADPKD with nephrolithiasis is an alternative with similar outcomes to the standard prone PCNL. It provides an additional benefit of performing the procedure in a single position, which is known to reduce total operating time, less anesthesia related complications, less neuromusculoskeletal injury, and reduce physical strain on operating.
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Affiliation(s)
- Sunirmal Choudhury
- Departmant of Urology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Atar Kasim
- Departmant of Urology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Dilip Kumar Pal
- Departmant of Urology, Institute of Postgraduate Medical Education and Research, Kolkata, India
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Pak YG, Yagudaev DM, Gallyamov EA. THE FUNCTIONAL STATE OF THE RENAL PARENCHYMA AFTER VARIOUS VIDEO ENDOSURGICAL METHODS OF TREATMENT OF PATIENTS WITH LARGE AND COMPLEX KIDNEY STONES. SURGICAL PRACTICE 2021. [DOI: 10.38181/2223-2427-2021-3-5-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The work is based on the analysis of literature data devoted to the problem of preserving the functional state of the kidneys with various video endoscopic methods of surgical treatment of large and complex kidney stones. The purpose of the review is to highlight the likelihood of deterioration in the functional state of the kidneys in the postoperative period. A detailed analysis of postoperative outcomes in various minimally invasive methods of treatment of patients with large and complex kidney stones was carried out, with an overview of the possibility of using dynamic nephroscintigraphy as a method of objectively assessing the functional state of the kidneys.
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Affiliation(s)
- Yu. G. Pak
- CUC «City multidisciplinary hospital No. 2»
| | | | - E. A. Gallyamov
- I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian
Federation
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Falahatkar R, Shahraki T, Falahatkar S, Esmaeili S, Mashouf P. Evaluating outcomes of complete supine percutaneous nephrolithotomy for staghorn vs multiple non-staghorn renal stones: a 10-year study. World J Urol 2021; 39:3071-3077. [PMID: 33403437 DOI: 10.1007/s00345-020-03563-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To evaluate the outcomes of complete supine percutaneous nephrolithotomy (csPCNL) for staghorn stones and multiple large non-staghorn stones. METHODS The records of 886 patients who underwent csPCNL from September 2009 to October 2019 were considered. Out of them, 201 cases met the eligibility criteria and they were divided into three groups: 63 cases of staghorn, 68 cases of multiple medium (20 mm < diameter ≤ 30 mm) non-staghorn and 70 cases of multiple large non-staghorn (> 30 mm) stones. Almost all outcomes and stone-related factors were analyzed. RESULTS There was not any significant difference regarding age, body mass index, history of urinary tract infection, transfusion rate, complication rate, pre and post-surgery serum creatinine, hemoglobin drop and total hospital stay between the three groups. Stone free rate was 98.5% in multiple medium group, 97.1% in multiple large group and 84.1% in staghorn group (P = 0.001). The operation duration was significantly shorter for the multiple medium group (P < 0.001) but it was not significantly different between the multiple large non-staghorn and staghorn group. CONCLUSION The results demonstrated that almost all outcomes were not significantly different between the three groups (especially between staghorn and larger non-staghorn ones). These findings reveal that surgeons could choose csPCNL for treatment of staghorn stones and multiple large non-staghorn stones and consider staghorn stones as challenging as multiple large (especially diameter > 30 mm) non-staghorn stones.
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Affiliation(s)
- Reza Falahatkar
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Tamkin Shahraki
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Siavash Falahatkar
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Samaneh Esmaeili
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Parham Mashouf
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Gupta S, Kasim A, Pal DK. Supine tubeless PCNL in horseshoe kidney (a series of cases). Urologia 2021; 89:559-563. [PMID: 34006150 DOI: 10.1177/03915603211015546] [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: 11/16/2022]
Abstract
OBJECTIVE Objective of this case series is accurate access to the respective calyx with stone in horseshoe kidney while performing percutaneous nephrolithotmy in supine position. Reducing operative time and anaesthetic morbidity while performing percutaneous nephrolithotomy in horseshoe kidney with nephrolithiasis in supine position. MATERIALS AND METHODS Four patient with one having bilateral renal calculi with horshoe kidney were selected randomly. There were no preference for age, gender; size, location and laterality of stone or BMI. All the patients fit into the AUA guideline criteria for management by percutaneous nephrolithotomy. Preoperative, perioperative and follow up data were collected. RESULTS Four patients with one having bilateral renal calculi underwent supine tubeless PCNL in 1 year in GMSV position. There was no intraoperative, post operative or on follow up complications in any patient. In all the patients stones were cleared completely in single setting. CONCLUSION Supine percutaneous nephrolithotomy in horseshoe kidney is an alternative to the standard prone percutaneous nephrolithotomy in the horseshoe kidney. It provides an additional benefit of performing the procedure in a single position, which is known to reduce total operating time, less anaesthesia related complications and less neuromusculoskeletal injury.
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Affiliation(s)
- Sandeep Gupta
- Department of Urology, Institute of Post Graduate Medical Education and Research & SSKM Hospital, WB, India
| | - Atar Kasim
- Department of Urology, Institute of Post Graduate Medical Education and Research & SSKM Hospital, WB, India
| | - Dilip Kumar Pal
- Department of Urology, Institute of Post Graduate Medical Education and Research & SSKM Hospital, WB, India
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Vicentini FC, Mazzucchi E, Gökçe Mİ, Sofer M, Tanidir Y, Sener TE, de Souza Melo PA, Eisner B, Batter TH, Chi T, Armas-Phan M, Scoffone CM, Cracco CM, Perez BOM, Angerri O, Emiliani E, Maugeri O, Stern K, Batagello CA, Monga M. Percutaneous Nephrolithotomy in Horseshoe Kidneys: Results of a Multicentric Study. J Endourol 2020; 35:979-984. [PMID: 32292038 DOI: 10.1089/end.2020.0128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective: To report the outcomes of percutaneous nephrolithotomy (PCNL) in horseshoe kidneys (HSK) in 12 institutions worldwide and evaluate the impact of patient position during operation. Methods: We carried out a retrospective analysis of PCNL procedures performed between 2008 and 2018 in patients with HSK. Pre-, peri-, and postoperative data were collected, and a subgroup analysis was performed according to patient position. Success was defined as an absence of >4-mm fragments. Values of p < 0.05 were considered significant. Results: We analyzed 106 procedures. The transfusion, complication, and immediate success rates (ISRs) were 3.8%, 17.5%, and 54.7%, respectively. The final success rate (FSR) increased to 72.4% after a mean of 0.24 secondary procedures. Logistic regression showed that higher body mass index (BMI) and stone size were significantly associated with residual fragments ≥4 mm. Sixty-seven patients (63.2%) were treated in prone and 39 (36.8%) in supine position. The prone group had a significantly higher BMI than the supine group (30.1 vs 27.7, p = 0.024). The transfusion, complication, and ISRs between the prone and supine groups were 4.5% vs 2.6% (p = 0.99), 16.9% vs 18.4% (p = 0.99), and 52.5% vs 69.2% (p = 0.151), respectively. Surgical time was significantly longer in the prone group (126.5 vs 100 minutes, p = 0.04). Upper pole was the preferred access in 80.3% of the prone group and 43.6% of the supine group (p < 0.001). The prone group had significantly more Clavien 2 complications than the supine (p = 0.013). The FSR in the prone and supine groups increased to 66.1% and 82.1% after 0.26 and 0.21 secondary procedures, respectively. No complications higher than Clavien 3 occurred. Conclusion: PCNL in patients with HSK is safe and effective with a low complication rate. Higher BMI and stone size negatively impacted outcomes. Supine PCNL may be an option for treating kidney stones in patients with HSK.
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Affiliation(s)
- Fabio Carvalho Vicentini
- Endourology Section, Clinics Hospital, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Endourology Section, Hospital Brigadeiro, Sao Paulo, Brazil
| | - Eduardo Mazzucchi
- Endourology Section, Clinics Hospital, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Mehmet İlker Gökçe
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Mario Sofer
- Endourology Section, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Tarik Emre Sener
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Brian Eisner
- Kidney Stone Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy Hunt Batter
- Kidney Stone Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas Chi
- Department of Urology, UCSF School of Medicine, San Francisco, California, USA
| | - Manuel Armas-Phan
- Department of Urology, UCSF School of Medicine, San Francisco, California, USA
| | | | | | | | - Oriol Angerri
- Department of Urology, Fundació Puigvert, UniversitatAutònoma de Barcelona, Barcelona, Spain
| | - Esteban Emiliani
- Department of Urology, Fundació Puigvert, UniversitatAutònoma de Barcelona, Barcelona, Spain
| | - Orazio Maugeri
- Department of Urology, Ospedale S Croce e Carle Cuneo, Cuneo, Italy
| | - Karen Stern
- Glickman Urological and Kidney Institute, Cleveland, Ohio, USA
| | | | - Manoj Monga
- Glickman Urological and Kidney Institute, Cleveland, Ohio, USA
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Supine versus prone position for percutaneous nephrolithotripsy: A meta-analysis of randomized controlled trials. Int J Surg 2019; 66:62-71. [PMID: 31034987 DOI: 10.1016/j.ijsu.2019.04.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/11/2019] [Accepted: 04/23/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To compare the safety and efficacy of percutaneous nephrolithotripsy (PCNL) in supine versus prone position for patients with renal or upper ureteral calculi. METHODS A systematic search of Pubmed, Embase and Cochrane Central Register of Controlled Trials was performed to identify all eligible studies. All included randomized controlled trials (RCTs) were evaluated based on the inclusion and exclusion criteria. After quality assessment and date extraction, a meta-analysis was performed using RevMan 5.3 software. RESULTS A total of 15 RCTs with 1474 patients were included in our meta-analysis. Pooled data showed that PCNL in supine position could significantly reduce the operative time [weighted mean difference (WMD) -12.02, 95% confidence interval (CI) -20.49 to -3.54, p = 0.005] and rate of fever [risk ratio (RR) 0.67, 95% CI 0.46 to 0.97, p = 0.03] compared to prone position. In addition, no significant differences could be found between groups in stone-free rate (p = 0.31), hospital stay (p = 0.59) and rate of overall complications (p = 0.11), mainly including urinary leakage (p = 0.83), pleural effusion (p = 0.74) and blood transfusion (p = 0.58). CONCLUSIONS The current study found comparable stone-free rate and significant lower rate of postoperative fever in supine PCNL compared with prone PCNL. PCNL in supine position could be a safe and efficient choice for patients with renal or upper ureteral calculi.
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