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Karkin K, Aydamirov M, Aksay B, Kaplan E, Gürlen G, Altunkol A, Ortaoğlu F, Akgün ÖF, Vuruşkan E, Gürbüz ZG. Comparison of two percutaneous nephrolithotomy methods for the treatment of pediatric kidney stones: mini-percutaneous nephrolithotomy and standard percutaneous nephrolithotomy. Arch Ital Urol Androl 2024; 96:12369. [PMID: 38713072 DOI: 10.4081/aiua.2024.12369] [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: 02/08/2024] [Accepted: 02/17/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVE In this study, the aim was to compare the results of mini and standard percutaneous nephrolithotomy (PCNL) for the treatment of pediatric kidney stones. MATERIALS AND METHODS Data for 128 patients < 18 years of age who underwent mini and standard PCNL due to pediatric kidney stones were retrospectively examined. Patients were divided into two groups: mini-PCNL (16-20 Fr) and standard PCNL (26 Fr). Surgery time, number of punctures to the pelvicalyceal system, hospital stay, postoperative hemoglobin drop, complications and stone-free status (SFR) were compared between the groups. Additional surgical intervention (double-J stent, ureterorenoscopy, secondary PCNL) performed after the surgery was recorded. The absence of residual stones or < 3 mm residual stones on kidney, ureter and bladder radiography (KUB) and ultrasonography (USG) performed in the third postoperative month were accepted as success criteria. RESULTS There were 32 (43.8%) patients in the mini-PCNL group and 41 (56.2%) patients in the standard PCNL group. The mean age was 9.3 ± 4.1 years in the mini-PCNL group and 10.1 ± 5.4 years in the standard PCNL group. Mean stone size in the mini-PCNL group was 2.1 ± 1.2; while for standard PCNL it was 2.3 ± 1.4. The mean surgery time was statistically significantly higher in the mini-PCNL group (p = 0.005). There was no difference between the groups in terms of intraoperative double J stent use, postoperative complications and SFR. A double J stent was inserted in two patients in the mini-PCNL group and in one patient in the standard PCNL group due to urine leakage from the nephrostomy tract in the postoperative period. Although the postoperative hemoglobin drop was found to be significantly higher in standard PCNL (p = 0.001), hematuria and blood transfusion rates were low in both groups. Mean hospital stay was shorter in the mini-PCNL group compared to standard PCNL (3.6 ± 1.2 days vs. 2.5 ± 1.1; p = 0.018). CONCLUSIONS Although mini-PCNL has longer surgery time compared to standard PCNL, it should be preferred for the treatment of pediatric kidney stones due to advantages such as similar success and complication rates to standard PCNL, short hospital stay and less postoperative hemoglobin drop.
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Affiliation(s)
- Kadir Karkin
- Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana.
| | - Mubariz Aydamirov
- Bas¸kent University, Alanya Application and Research Center, Alanya.
| | - Buğra Aksay
- Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana.
| | - Eyüp Kaplan
- Abdulkadir Yüksel State Hospital Urology Clinic, Gaziantep.
| | - Güçlü Gürlen
- Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana.
| | - Adem Altunkol
- Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana.
| | - Ferhat Ortaoğlu
- Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana.
| | - Ömer Faruk Akgün
- Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana.
| | - Ediz Vuruşkan
- Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana.
| | - Zafer Gökhan Gürbüz
- Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana.
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Massella V, Pietropaolo A, Gauhar V, Emiliani E, Somani BK. Has fluoroless endourology (URS and PCNL) come of age? Evidence from a comprehensive literature review. Actas Urol Esp 2024; 48:2-10. [PMID: 37330050 DOI: 10.1016/j.acuroe.2023.06.002] [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: 02/23/2023] [Revised: 04/04/2023] [Accepted: 04/21/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Radiation via the use of imaging is a key tool in management of kidney stones. Simple measures are largely taken by the endourologists to implement the 'As Low As Reasonably Achievable' (ALARA) principle, including the use of fluoroless technique. We performed a scoping literature review to investigate the success and safety of fluoroless ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) procedures for the treatment of KSD. METHODS A literature review was performed searching bibliographic databases PubMed, EMBASE and Cochrane library, and 14 full papers were included in the review in accordance with the PRISMA guidelines. RESULTS Of the 2535 total procedures analysed, 823 were fluoroless URS vs. 556 fluoroscopic URS; and 734 fluoroless PCNL vs. 277 fluoroscopic PCNL. The SFR for fluoroless vs. fluoroscopic guided URS was 85.3% and 77%, respectively (p=0.2), while for fluoroless PCNL vs. fluoroscopic group was 83.8% and 84.6%, respectively (p=0.9). The overall Clavien-Dindo I/II and III/IV complications for fluoroless and fluoroscopic guided procedures were 3.1% (n=71) and 8.5% (n=131), and 1.7% (n=23) and 3% (n=47) respectively. Only 5 studies reported a failure of the fluoroscopic approach with a total of 30 (1.3%) failed procedures. CONCLUSION The ALARA protocol has been implemented in endourology in numerous ways to protect both patients and healthcare workers during recent years. Fluoroless procedures for treatment of KSD are safe and effective with outcomes comparable to standard procedures and could become the new frontier of endourology in selected cases.
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Affiliation(s)
- V Massella
- Servicio de Urología, Hospital Universitario de Southampton, United Kingdom
| | - A Pietropaolo
- Servicio de Urología, Hospital Universitario de Southampton, United Kingdom
| | - V Gauhar
- Servicio de Urología, Hospital General Ng Teng Fong, Singapore
| | - E Emiliani
- Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - B K Somani
- Servicio de Urología, Hospital Universitario de Southampton, United Kingdom.
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Arabzadeh Bahri R, Maleki S, Shafiee A, Shobeiri P. Ultrasound versus fluoroscopy as imaging guidance for percutaneous nephrolithotomy: A systematic review and meta-analysis. PLoS One 2023; 18:e0276708. [PMID: 36862676 PMCID: PMC9980746 DOI: 10.1371/journal.pone.0276708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/15/2023] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVES To determine whether the outcomes of ultrasound-guided percutaneous nephrolithotomy (UG-PCNL), an alternative to traditional fluoroscopy-guided percutaneous nephrolithotomy (FG-PCNL), are comparable. METHODS A systematic search of PubMed, Embase, and the Cochrane Library was carried out to discover investigations comparing UG-PCNL to FG-PCNL, and accordingly, a meta-analysis of those studies was performed. The primary outcomes included the stone-free rate (SFR), overall complications based on Clavien-Dindo classification, duration of surgery, duration of patients' hospitalization, and hemoglobin (Hb) drop during the surgery. All statistical analyses and visualizations were implemented utilizing R software. RESULTS Nineteen studies, including eight randomized clinical trials (RCTs) and eleven observational cohorts, comprising 3016 patients (1521 UG-PCNL patients) and comparing UG-PCNL with FG-PCNL met the inclusion criteria of the current study. Considering SFR, overall complications, duration of surgery, duration of hospitalization, and Hb drop, our meta-analysis revealed no statistically significant difference between UG-PCNL and FG-PCNL patients, with p-values of 0.29, 0.47, 0.98, 0.28, and 0.42, respectively. Significant differences were discovered between UG-PCNL and FG-PCNL patients in terms of the length of time they were exposed to radiation (p-value< 0.0001). Moreover, FG-PCNL had shorter access time than UG-PCNL (p-value = 0.04). CONCLUSION UG-PCNL provides the advantage of requiring less radiation exposure while being just as efficient as FG-PCNL; thus, this study suggests prioritizing the use of UG-PCNL.
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Affiliation(s)
- Razman Arabzadeh Bahri
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- * E-mail:
| | - Saba Maleki
- School of Medicine, Guilan University of Medical Sciences (GUMS), Rasht, Guilan Province, Iran
| | - Arman Shafiee
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Parnian Shobeiri
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Eslahi A, Salehipour M, Ahmed F, Askarpour MR, Kiani S, Akrami F. Distal ureteral calculi in a patient with ileal conduit and urinary diversion treated via antegrade ureteroscopic lithotripsy: A case report. Clin Case Rep 2023; 11:e6987. [PMID: 36852115 PMCID: PMC9957996 DOI: 10.1002/ccr3.6987] [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: 11/22/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/26/2023] Open
Abstract
Ureteral calculi management in patients with urinary diversion is challenging for most urologists. The surgeon should consider the patient's diversion type, BMI, stone size and location, and his/her experience with the procedure. We report an 85-year-old ileal conduit diversion man presented with ureteral calculi and treated via antegrade ureteroscopic lithotripsy.
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Affiliation(s)
- Ali Eslahi
- Department of Urology, School of MedicineShiraz University of Medical SciencesShirazIran,Shiraz Geriatric Research CenterShiraz University of Medical SciencesShirazIran
| | - Mehdi Salehipour
- Department of Urology, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Faisal Ahmed
- Department of Urology, School of MedicineIbb University of Medical SciencesIbbYemen
| | | | - Sajad Kiani
- Department of Urology, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Firoozeh Akrami
- Department of Urology, School of MedicineShiraz University of Medical SciencesShirazIran
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Eslahi A, Salehipour M, Hosseini MM, Ahmed F, Hosseini SH, Ghafari S. Mini-percutaneous nephrolithotomy via ultrasound guidance in transplanted kidney: a report of two cases. Pan Afr Med J 2022; 41:333. [PMID: 35865850 PMCID: PMC9268309 DOI: 10.11604/pamj.2022.41.333.33169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Urolithiasis is a rare but familiar problem in transplanted kidney patients, with a prevalence rate between 0.23-6.3%. Minimally invasive percutaneous nephrolithotomy (mini-PCNL) is a revised technique that uses a miniature endoscope through a small access sheath and is associated with minor bleeding risk. Only a few cases of mini-PCNL via ultrasonography (US) guidance in transplanted kidneys have been published. We present a 23-year-old female and a 34-year-old man who presented with obstructive uropathy due to impacted stones in their transplanted kidneys. Firstly, the nephrostomy tube was inserted. Then, they underwent mini-PCNL via US guidance. Puncturing the pyelocaliceal system was achieved via a 3.5 MHz US probe. Procedures were performed with a one-shot dilatation technique and a 15-Fr rigid nephroscope. In conclusion, we suggest that if an experienced urologist performs it, the US-guided mini-PCNL is safe and effective in patients with transplanted kidneys.
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Affiliation(s)
- Ali Eslahi
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Salehipour
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mehdi Hosseini
- Shiraz Nephrology-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Faisal Ahmed
- Urology Research Center, Al-Thora General Hospital, Department of Urology, School of Medicine, Ibb University of Medical Since, Ibb, Yemen
| | - Seyed Hossein Hosseini
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sajad Ghafari
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Zhang H, Xu H, Fei K, Guo D, Duan Y. The safety and efficiency of a 1470 nm laser in obtaining tract hemostasis in tubeless percutaneous nephrolithotomy: a retrospective cross-sectional study. BMC Urol 2022; 22:94. [PMID: 35780099 PMCID: PMC9250247 DOI: 10.1186/s12894-022-01046-z] [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: 04/20/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022] Open
Abstract
Objective It is challenging to perform a tubeless percutaneous nephrolithotomy (PNL) in patients with tract bleeding. The present study was designed to study the safety and efficacy of the 1470 nm laser for hemostatic completion in tubeless PNL patients with tract bleeding. Patients and Methods Between January 2020 and October 2021, 120 patients were retrospectively included and divided into two groups. The hemostasis group included 60 patients receiving tubeless PNL, in which a 1470 nm laser was used to manage tract bleeding. The other group included 60 patients receiving tubeless PNL in which the hemostasis procedure was not performed, serving as the control group. The differences in the patients’ demographic characteristics, procedural information, and posttreatment outcomes between the two groups were statistically compared. Results The differences associated with sex, age, weight, body mass index, urine culture, stone burden, calyx of puncture, degree of hydronephrosis and comorbidities between the two groups were not statistically significant. Compared with the control group, the hemostasis group showed greatly reduced blood loss (0.61 ± 0.31 vs. 0.85 ± 0.46 g/dL) and decreased postoperative hospitalization duration (2.83 ± 0.81 vs. 4.45 ± 0.91 days). The differences in operative time, stone-free rate, Visual Analogue Score and postoperative complications between the two groups were not statistically significant. In the subgroup analysis, the obese patients and patients with moderate to severe hydronephrosis in the hemostasis group also showed a significantly less blood loss (0.51 ± 0.22 vs. 0.83 ± 0.48 g/dL; 0.54 ± 0.27 vs. 0.85 ± 0.47 g/dL, respectively) and shorter length of postoperative hospitalization (2.62 ± 0.51 vs. 4.47 ± 1.19 days; 2.97 ± 0.63 vs. 4.41 ± 0.91 days, respectively) than those in the control group. Conclusions Our results demonstrated that 1470 nm laser is a safe, feasible and effective method to obtain tract hemostasis in tubeless PNL.
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Affiliation(s)
- Huihui Zhang
- Department of Urology, Hengyang Medical School, The First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, 421001, Hunan, People's Republic of China.,Institute of Hospital Administration, University of South China, Hengyang, 421001, Hunan, People's Republic of China
| | - Hanfeng Xu
- Department of Urology, Hengyang Medical School, The First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, 421001, Hunan, People's Republic of China
| | - Kuilin Fei
- Department of Obstetrics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Dayong Guo
- Department of Urology, Hengyang Medical School, The First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, 421001, Hunan, People's Republic of China
| | - Youjun Duan
- Department of Urology, Hengyang Medical School, The First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, 421001, Hunan, People's Republic of China.
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Mahmoud MA, Shawki AS, Abdallah HM, Mostafa D, Elawady H, Samir M. Use of retrograde intrarenal surgery (RIRS) compared with mini-percutaneous nephrolithotomy (mini-PCNL) in pediatric kidney stones. World J Urol 2022; 40:3083-3089. [PMID: 36244014 PMCID: PMC9712365 DOI: 10.1007/s00345-022-04186-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/05/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE We aimed to compare the cost-effectiveness and safety of retrograde intrarenal surgery (RIRS) and mini-percutaneous nephrolithotomy (mini-PCNL) for pediatric kidney stones management. PATIENTS AND METHODS Ninety pediatric patients with single or multiple renal stones 1-3 cm in diameter were collected prospectively and equally divided into two groups to undergo RIRS or mini-PCNL. The groups were compared for fluoroscopy and operative time, postoperative hospital stay time, stone-free rate (SFR), need for auxiliary procedures, and cost as well as complications. RESULTS There were no differences found between RIRS and mini-PCNL groups with regard to operative time and postoperative DJ stent application, while the mean of fluoroscopy time and postoperative hospital stay was significantly shorter in the RIRS than in the mini-PCNL group. The SFR, auxiliary treatment on residual stones, and complications were comparable. In both groups, no major (Clavien IV-V) complications were observed. The mean cost of RIRS was $1210 and $733 for the mini-PCNL. CONCLUSIONS Both RIRS and mini-PCNL are effective and safe treatment modalities for pediatric renal stones 10-30 mm in size. However, mini-PCNL is more cost-effective making it a viable alternative to RIRS.
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Paraboschi I, Gnech M, De Marco EA, Minoli DG, Bebi C, Zanetti SP, Manzoni G, Montanari E, Berrettini A. Pediatric Urolithiasis: Current Surgical Strategies and Future Perspectives. Front Pediatr 2022; 10:886425. [PMID: 35757114 PMCID: PMC9218273 DOI: 10.3389/fped.2022.886425] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/16/2022] [Indexed: 12/23/2022] Open
Abstract
New technological innovations and cutting-edge techniques have led to important changes in the surgical management of pediatric urolithiasis. Miniaturized technologies and minimally invasive approaches have been increasingly used in children with urinary stones to minimize surgical complications and improve patient outcomes. Moreover, the new computer technologies of the digital era have been opening new horizons for the preoperative planning and surgical treatment of children with urinary calculi. Three-dimensional modeling reconstructions, virtual, augmented, and mixed reality are rapidly approaching the surgical practice, equipping surgeons with powerful instruments to enhance the real-time intraoperative visualization of normal and pathological structures. The broad range of possibilities offered by these technological innovations in the adult population finds increasing applications in pediatrics, offering a more detailed visualization of small anatomical structures. This review illustrates the most promising techniques and devices to enhance the surgical treatment of pediatric urolithiasis in children, aiming to favor an early adoption and to stimulate more research on this topic.
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Affiliation(s)
- Irene Paraboschi
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michele Gnech
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Erika Adalgisa De Marco
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Guido Minoli
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carolina Bebi
- Department of Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Stefano Paolo Zanetti
- Department of Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Gianantonio Manzoni
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Alfredo Berrettini
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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