Percutaneous extraction of renal stones: experience in 100 patients

Endourologic management of stone-bearing excluded calices: contrasting case reports

Calculi in a noncommunicating or excluded calix may be associated with infection, pain, and focal renal damage. Some authors have recommended removal of these calculi and reestablishment of the pelvicaliceal communication, either by dilation of the infundibulum or creation of a neoinfundibulum, in order to prevent recurrent stone formation and infection. Herein, we report two patients with stones in a completely excluded calix, one after repeated courses of shockwave lithotripsy for a staghorn calculus and the other after recurrent pyelonephritis. The combined approach is especially helpful if the examiner is in doubt about the anatomy (true calix v caliceal diverticulum) or if a natural infundibulum cannot be identified by antegrade endoscopy.

Complications attributable to the formation of the track in patients undergoing percutaneous nephrolithotomy

Reported complication rates of percutaneous nephrolithotomy vary considerably. In our own experience of 110 percutaneous nephrolithotomies performed by an experienced interventional radiologist, the complication rate for the entire procedure was 3.6%, and for the formation of the nephrostomy track 0.9%. This compares favourably with the reports from the major centres. Radiation dose to the operator was monitored and our results confirm that with meticulous attention to technique, dosages may be kept very low. We conclude that prior training in interventional techniques is a major factor in reducing both the morbidity associated with percutaneous nephrolithotomy and the radiation dose to the operator.

Unusual tubular calcification of a nephrostomy tract

Unusual tubular calcification occurred in the nephrostomy tract of a 30-year-old male, 6 months after percutaneous nephrostolithotomy. To our knowledge, this phenomena has not been previously reported. The main radiologic differential diagnoses are focal dystrophic calcification and vascular calcification. The etiology is unknown but may have been related to the patients' tendency to form renal calculi. The temporal sequence of events and the location of the nephrostomy catheter which correlated with the calcification suggests the correct diagnosis.

Percutaneous nephrolithotomy in the dog. An experimental study

Percutaneous nephrostomies (PN) were created with teflon fascial dilators under fluoroscopic guidance, to implant stones bilaterally into the renal pelves of five dogs weighing 7 to 35 kg. Between one and seven stones of 0.25 to 1.00 cm diameter were implanted into each renal pelvis. Two to 4 weeks later, PN tracts were recreated, and the implanted renal stones were successfully removed under fluoroscopic and endoscopic visualization. Results of gross and histopathologic evaluation of the kidneys 2, 7, 14, 30, and 90 days after stone removal showed minimal, localized renal parenchymal trauma. Complications, although infrequent, included proximal ureteral tears and hemorrhage. Difficulty was encountered in maneuvering equipment around large or numerous stones. Canine percutaneous nephrolithotomy was successful despite great variation in kidney size, as well as variations in the number, size, and shape of stones in the upper urinary tract.

Percutaneous nephrolithotomy: analysis of 500 consecutive cases

The first 500 patients who underwent percutaneous stone removal at our hospital and who have been evaluated for at least 8 months were reviewed. Comparison of the first 100 patients with the entire series showed a sharp improvement in the success rate as the radiologic and urologic team gained experience. The success rate for simple pelvicaliceal stones was 98% in the entire series (vs. 89% in the first 100 cases) and 87% for staghorn calculi. The most common complication was bleeding, with 12% of the patients requiring transfusion. Other complications include infection (0.6%), retained stone fragments (4%), and ureteropelvic junction stricture (1%). There was 1 death, an obese diabetic woman who suffered a myocardial infarction. Successful stone extraction requires a properly placed nephrostomy tract, and radiologic and urologic expertise. The advent of extracorporeal shock-wave lithotripsy will not abolish the need for nephrostolithotomy.