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Ding M, Zhu K, Zhang W, Huang H, Duan B, Zheng J, Wang H, Wang T, Bai P, Bin C. Comparing Balloon Dilation to Non-Balloon Dilation for Access in Ultrasound-Guided Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis. Int Braz J Urol 2024; 50:7-19. [PMID: 38166218 PMCID: PMC10947654 DOI: 10.1590/s1677-5538.ibju.2023.0373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/30/2023] [Indexed: 01/04/2024] Open
Abstract
PURPOSE This study aims to evaluate the safety and efficacy of ultrasound-guided balloon dilation compared to non-balloon dilation for percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS A systematic review and meta-analysis were conducted by searching PubMed, EMBASE, and the Cochrane Library. Results were filtered using predefined inclusion and exclusion criteria as described and meta-analysis was performed using Review Manager 5.4 software. RESULTS A total of six studies involving 1189 patients who underwent PCNL were included. The meta-analysis results demonstrated that compared to non-balloon dilation, balloon dilation was associated with reduced haemoglobin drop [mean difference (MD) = -0.26, 95% CI = -0.40 ~ -0.12, P = 0.0002], decreased transfusion rate [odds ratio (OR) = 0.47, 95% CI = 0.24 ~ 0.92, P = 0.03], shorter tract establishment time (MD = -1.30, 95% CI = -1.87 ~ -0.72, P < 0.0001) and shorter operation time (MD = -5.23, 95% CI = -10.19 ~ -0.27, P = 0.04). CONCLUSIONS Overall, ultrasound-guided balloon dilatation offered several advantages in PCNL procedures. It facilitated faster access establishment, as evidenced by shorter access creation time. Additionally, it reduced the risk of kidney injury by minimizing postoperative haemoglobin drop and decreasing the need for transfusions. Moreover, it enhanced the efficiency of surgery by reducing the operation time. However, it is important to note that the quality of some included studies was subpar, as they did not adequately control for confounding factors that may affect the outcomes. Therefore, further research is necessary to validate and strengthen these findings.
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Affiliation(s)
- Meixuan Ding
- Fujian Medical UniversityThe School of Clinical MedicineFuzhouChinaThe School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Kai Zhu
- Fujian Medical UniversityThe School of Clinical MedicineFuzhouChinaThe School of Clinical Medicine, Fujian Medical University, Fuzhou, China
- Xiamen UniversitySchool of MedicineThe First Affiliated Hospital of Xiamen UniversityXiamenChinaThe Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Wenzhao Zhang
- Fujian Medical UniversityThe School of Clinical MedicineFuzhouChinaThe School of Clinical Medicine, Fujian Medical University, Fuzhou, China
- Xiamen UniversitySchool of MedicineWomen and Children's HospitalXiamenChinaDepartment of Pediatric Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Haichao Huang
- Xiamen UniversitySchool of MedicineThe First Affiliated Hospital of Xiamen UniversityXiamenChinaThe Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Bo Duan
- Xiamen UniversitySchool of MedicineThe First Affiliated Hospital of Xiamen UniversityXiamenChinaThe Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jiaxin Zheng
- Xiamen UniversitySchool of MedicineThe First Affiliated Hospital of Xiamen UniversityXiamenChinaThe Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Huiqiang Wang
- Xiamen UniversitySchool of MedicineThe First Affiliated Hospital of Xiamen UniversityXiamenChinaThe Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Tao Wang
- Xiamen UniversitySchool of MedicineThe First Affiliated Hospital of Xiamen UniversityXiamenChinaThe Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Peide Bai
- Xiamen UniversitySchool of MedicineThe First Affiliated Hospital of Xiamen UniversityXiamenChinaThe Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Chen Bin
- Fujian Medical UniversityThe School of Clinical MedicineFuzhouChinaThe School of Clinical Medicine, Fujian Medical University, Fuzhou, China
- Xiamen UniversitySchool of MedicineThe First Affiliated Hospital of Xiamen UniversityXiamenChinaThe Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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Marchini GS, Lima FS, Campos MEC, Maroccolo MVO, Reggio E, Mazzucchi E, Nahas WC, Santos LS, Hota T. Modified biplanar (0-90°) endoscopic-guided puncture technique for percutaneous nephrolithtomy: refinement with endoscopic combined intrarrenal surgery to reduce fluoroscopy and operative time. Int Braz J Urol 2023; 49:785-786. [PMID: 37624662 PMCID: PMC10947630 DOI: 10.1590/s1677-5538.ibju.2023.0346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION We aim to publish our innovative modified biplanar 0-90 endoscopic guided puncture technique for percutaneous nephrolithotomy in supine recorded with a GoPro® camera for standardization of the technique. It solves drawbacks of the fluoroscopic technique, i.e., in kidneys with complex anatomy, it may be challenging to distinguish calyces as they are often superposed, and it does not allow for all benefits of a combined endoscopic approach (1, 2). Our technique shortens puncture and fluoroscopic time and is easy to teach and reproduce. METHODS A 77-year-old female patient had previous double J insertion due to an obstructing stone in the right distal ureter. She managed to pass the distal stone but remained with the double J and a 20mm stone (1300HU) in the right renal pelvis. The shared decision was for the actual standard of care (3, 4) endoscopic combined intrarenal surgery (ECIRS). The MiniECIRS started with flexible ureteroscopy and a posterior calix which gave direct access to the stone was chosen. The tip of the flexible scope was used to mark point A with the C-arm in the 0-degree position and line B in the 90-degree position. Puncture was fast and the MiniECIRS was uneventful with a single mid-pole access guided by the flexible scope. The surgeon had a Full-HD GoPro® camera mounted on his head, controlled by the surgical staff. All essential surgical steps were recorded. RESULTS The quality of the recorded movie was graded as excellent, and the camera did not cause any discomfort to the surgeon. Operative and X-Ray time were 120minutes and 2minutes (7.64mGy). Hemoglobin drop was 0.8g/dL. The post-operative day-1 computed tomography scan was stone-free. The patient was discharged 24h after surgery. Kidney stent was left with a string and removed after 5days. The patient remained asymptomatic and metabolic evaluation revealed a calcium oxalate stone, low urinary volume and hypocitraturia which were treated with potassium citrate and hydration. CONCLUSION The Modified Biplanar (0-90 degree) Endoscopic-Guided Puncture Technique for Percutaneous Nephrolithotomy joins the reproducibility of the same technique under fluoroscopy with advantages regarding safety and efficiency of ECIRS.
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Affiliation(s)
- Giovanni Scala Marchini
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSão PauloSPBrasilSeção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil;
- Hospital do Idoso Zilda ArnsCuritibaPRBrasilEndouroexperts - Hospital do Idoso Zilda Arns, Curitiba, PR, Brasil
| | - Fábio Sepúlveda Lima
- Hospital do Idoso Zilda ArnsCuritibaPRBrasilEndouroexperts - Hospital do Idoso Zilda Arns, Curitiba, PR, Brasil
| | | | | | - Ernesto Reggio
- Hospital do Idoso Zilda ArnsCuritibaPRBrasilEndouroexperts - Hospital do Idoso Zilda Arns, Curitiba, PR, Brasil
| | - Eduardo Mazzucchi
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSão PauloSPBrasilSeção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil;
| | - William Carlos Nahas
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSão PauloSPBrasilSeção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil;
| | - Luiz Sérgio Santos
- Hospital do Idoso Zilda ArnsCuritibaPRBrasilEndouroexperts - Hospital do Idoso Zilda Arns, Curitiba, PR, Brasil
| | - Thiago Hota
- Hospital do Idoso Zilda ArnsCuritibaPRBrasilEndouroexperts - Hospital do Idoso Zilda Arns, Curitiba, PR, Brasil
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Xie F, Deng S, Fei K, Xu H, Zhang H. Nomogram to predict the risk of adverse outcomes in patients with residual stones following percutaneous nephrolithotomy. Int Braz J Urol 2023; 49:599-607. [PMID: 37390125 PMCID: PMC10482460 DOI: 10.1590/s1677-5538.ibju.2023.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/28/2023] [Indexed: 07/02/2023] Open
Abstract
PURPOSE To investigate the risk factors associated with adverse outcomes in patients with residual stones after percutaneous nephrolithotomy (PCNL) and to establish a nomogram to predict the probability of adverse outcomes based on these risk factors. METHODS We conducted a retrospective review of 233 patients who underwent PCNL for upper urinary tract calculi and had postoperative residual stones. The patients were divided into two groups according to whether adverse outcomes occurred, and the risk factors for adverse outcomes were explored by univariate and multivariate analyses. Finally, we created a nomogram for predicting the risk of adverse outcomes in patients with residual stones after PCNL. RESULTS In this study, adverse outcomes occurred in 125 (53.6%) patients. Multivariate logistic regression analysis indicated that the independent risk factors for adverse outcomes were the diameter of the postoperative residual stones (P < 0.001), a positive urine culture (P = 0.022), and previous stone surgery (P = 0.004). The above independent risk factors were used as variables to construct the nomogram. The nomogram model was internally validated. The calculated concordance index was 0.772. The Hosmer-Lemeshow goodness-of-fit test was performed (P > 0.05). The area under the ROC curve of this model was 0.772. CONCLUSIONS Larger diameter of residual stones, positive urine culture, and previous stone surgery were significant predictors associated with adverse outcomes in patients with residual stones after PCNL. Our nomogram could help to assess the risk of adverse outcomes quickly and effectively in patients with residual stones after PCNL.
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Affiliation(s)
- Feng Xie
- University of South ChinaThe First Affiliated HospitalHengyang Medical SchoolHengyangHunanChinaDepartment of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
- The First Hospital of ChangshaEmergency DepartmentChangshaHunanChinaEmergency Department, The First Hospital of Changsha, Changsha, Hunan, China
| | - Shidong Deng
- University of South ChinaThe First Affiliated HospitalHengyang Medical SchoolHengyangHunanChinaDepartment of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Kuilin Fei
- Central South UniversityXiangya HospitalDepartment of ObstetricsChangshaHunanChinaDepartment of Obstetrics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hanfeng Xu
- University of South ChinaThe First Affiliated HospitalHengyang Medical SchoolHengyangHunanChinaDepartment of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Huihui Zhang
- University of South ChinaThe First Affiliated HospitalHengyang Medical SchoolHengyangHunanChinaDepartment of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
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Mazzon G, Choong S, Celia A. Stone-scoring systems for predicting complications in percutaneous nephrolithotomy: A systematic review of the literature. Asian J Urol 2023. [PMID: 37538152 PMCID: PMC10394284 DOI: 10.1016/j.ajur.2023.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Objective Percutaneous nephrolithotomy is a treatment of choice for larger stones of the upper urinary tract. Currently, several nephrolithometric nomograms for prediction of post-operative surgical outcomes have been proposed, although uncertainties still exist regarding their roles in the estimation of complications. Methods We conducted a systematic review on PubMed and Web of Sciences databases including English studies with at least 100 cases and published between January 2010 and December 2021. We identified original articles evaluating correlations between the Guy's stone score, the stone size (S), tract length (T), obstruction (O), number of involved calices (N), and essence or stone density (E) (S.T.O.N.E.), Clinical Research Office of the Endourological Society (CROES), and Seoul National University Renal Stone Complexity (S-ReSC) scores and post-operative complications in adult patients. We also included newly designed nomograms for prediction of specific complications. Results After an initial search of 549 abstracts, we finally included a total of 18 papers. Of them, 11 investigated traditional nephrolithometric nomograms, while seven newly designed nomograms were used to predict specific complications. Overall, 7316 patients have been involved. In total, 14 out of 18 papers are derived from retrospective single-center studies. Guy's stone score obtained correlation with complications in five, S.T.O.N.E. nephrolithometry score in four, while CROES score and S-ReSC score in three and two, respectively. None of the studies investigated minimally invasive percutaneous nephrolithotomy (PCNL) and all cases have been conducted in prone position. Considering newly designed nomograms, none of them is currently externally validated; five of them predict post-operative infections; the remaining two have been designed for thromboembolic events and urinary leakage. Conclusion This review presents all nomograms currently available in the PCNL field and highlights a certain number of concerns. Published data have appeared contradictory; more recent tools for prediction of post-operative complications are frequently based on small retrospective cohorts and lack external validations. Heterogeneity among studies has also been noticed. More rigorous validations are advisable in the future, involving larger prospective patients' series and with the comparison of different tools.
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Favorito LA. International Brazilian Journal of Urology reaches the highest impact factor in its history (3,050) and changes level in this current management. Int Braz J Urol 2022; 48:739-741. [PMID: 35838501 PMCID: PMC9388177 DOI: 10.1590/s1677-5538.ibju.2022.05.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Luciano A Favorito
- Unidade de Pesquisa Urogenital - Universidade Estadual do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil.,Serviço de Urologia, Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil
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