Review on renal recovery after anatrophic nephrolithotomy: Are we really healing our patients?

Clinical comparison of lateral supine position mini-percutaneous nephrolithotomy and anatrophic nephrolithotomy in the treatment of complete staghorn renal calculi

BACKGROUND

At present, the guidelines for urology recommend percutaneous nephrolithotomy (PCNL) as the preferred treatment for staghorn renal calculi (SRC). However, for complete SRC, it has been questioned by clinicians and patients due to high residual stone rate, complications, repeated hospitalizations and high treatment cost. Anatrophic nephrolithotomy (ANL) is a traditional and classic method for the treatment of SRC. Due to its high trauma and high technical requirements, it is difficult to carry out in primary hospitals, and gradually replaced by PCNL. The purpose of this study is to compare the efficacy of PCNL and ANL in the treatment of complete SRC.

METHODS

Overall, 238 patients with complete SRC were divided into mini-PCNL in lateral supine position group, (n = 190) and ANL group (n = 94) according to treatment for a retrospective cohort study. The calculi parameters, renal function index, comorbidities of calculi, surgical complications, length and frequency of hospitalization, treatment costs, results of postoperative satisfaction survey were compared between the two groups.

RESULTS

The risk of the residual stone rate after mini-PCNL in lateral supine position was 239 times (OR = 238.667, P < 0.0001), the number of residual stone 1.3 times (OR = 1.326, P < 0.0001), the amount of residual stone 2.2 times (OR = 2.224, P < 0.0001) that of ANL. The risk of the cost of initial treatment after mini-PCNL in lateral supine position was 3.3 times (OR = 3.273, P < 0.0001), the total cost of treatment 4 times (OR = 4.051, P < 0.0001), the total length of hospital stays 1.4 times (OR = 1.44, P < 0.0001) that of ANL, the incidence of postoperative renal atrophy was 2.2 times (OR = 2.171, P = 0.008) higher in the ANL than in the mini-PCNL in lateral supine position. Glomerular filtration rate (GFR) reduction after ANL was 1.4 times (OR = 1.381, P = 0.037) greater than that after mini-PCNL in lateral supine position at 24-month follow-up. The risk of the overall satisfaction of ANL was 58 times (OR = 57.857, P < 0.0001) higher than that of mini-PCNL in lateral supine position, the number of branches of staghorn greater than 8 is a high risk factor for the occurrence of residual stone after mini-PCNL in lateral supine position (OR = 353.137, P < 0.0001).

CONCLUSION

Although the risk of renal atrophy and decreased GFR after ANL is higher than that of mini-PCNL in lateral supine position, the efficacy of traditional ANL in the treatment of complete SRC was generally superior to that of mini-PCNL in lateral supine position. Moreover, number of branches of staghorn greater than 8 are the preferred ANL for complete SRC.

TRIAL REGISTRATION

ChiCTR2100047462. The trial was registered in the Chinese Clinical Trial Registry; registration date: 19/06/2021.

Is percutaneous nephrolithotripsy feasible in ipsilateral lumbar incisional hernia? A report of two patients

Incisional hernia refers to an abdominal wall defect at the site of a previous surgical incision. In this paper, we describe two patients who previously underwent open kidney stone surgery several years ago and had the ipsilateral recurrent stones. They were both managed by a mini percutaneous nephrolithotripsy (PCNL) to treat kidney stones. Case 1 was a 50-year-old female with right recurrent staghorn stones after 5 years of open surgery and required two PCNL procedures to achieve stone-free status. Case 2 was a 74-year-old male with significant comorbidities who had a right 27 mm recurrent kidney stone after 10 years of open nephrolithotomy. Both patients experienced no postoperative complications after PCNL. These cases show that in cases of lumbar incisional scar hernias, mini PCNL with ultrasound guidance and proper patient positioning can be an optimal approach for kidney stone treatment.

Ciprofloxacin infusion versus third generation cephalosporin as a surgical prophylaxis for percutaneous nephrolithotomy: a randomized study

Introduction

Percutaneous nephrolithotomy (PCNL) is considered a clean-contaminated surgical procedure. The American Urological Association has recommended different preoperative antimicrobial prophylaxis for various urological procedures to prevent surgical site infections, postoperative fever, and possible sepsis. The European Association of Urology (EAU) antibiotic guidelines endorse giving either a second or third-generation cephalosporin, trimethoprim-sulfamethoxazole, fluoroquinolone or aminopenicillin with a β-lactamase inhibitor. The aim of the present study is to prospectively compare two different protocols of antibiotic prophylaxis in PCNL.

Material and methods

Successfully consented patients with sterile urine preoperatively who were awaiting percutaneous nephrolithotomy were randomized into two groups. The first group (n = 41) was given a single dose of 200 mg ciprofloxacin infusion, while group two (n = 43) was given 2 mg of cefotaxime divided into 2 doses; during induction of anesthesia and 12 hours later. The occurrence of perioperative infection-related events would be compared in both groups.

Results

Both groups had similar age, sex, Body Mass Index, and stone composition. No statistical difference was found regarding stone size, stone culture, irrigation fluid volume, operative time and urine pelvis culture result in both groups (Table 2). Two patients (5%) developed postoperative fever in the 1^st group compared to 12 patients (28%) in the second group (p = 0.02).

Conclusions

A prophylactic regimen consisting of a single dose ciprofloxacin infusion during induction of surgery showed a higher efficacy as a preoperative antibacterial preparation, compared to cefotaxime, in protection against postoperative fever in patients undergoing PCNL.

Long-term effects of anatrophic nephrolithotomy on selective renal function

To evaluate the long-term changes of selective renal function after anatrophic nephrolithotomy (ANL). A retrospective study was conducted for patients who underwent ANL between January 1995 and December 2016. Inclusion criteria were availability of preoperative and follow-up (1 year or more) radio-isotopic renal scans. Stone-free status was evaluated after 1 month with KUB and ultrasonography or NCCT. Renal isotope scans using 99mTc MAG3 were performed to measure the changes in selective function of the affected kidney (GFR%). Eligible patients were classified into two groups, group 1 patients with stable or improved function and group 2 patients with deteriorated function (> 5% decrease in GFR%). Univariate and multivariate analyses were performed to determine risk factors for deterioration of renal function. The cutoff value for any significant variable was determined using ROC curve. The study included 50 patients with mean age 43.8 + 13.9 years. Complications developed in 26 patients (52%), and stone-free status was documented in 42 patients (84%). After a median follow-up of 2.7 years (range 1-11), mean GFR% of all cases significantly decreased from preoperative value of 52.7% + SD 20 to 45.4% + SD 25% during follow-up (P < 0.001). Deterioration of GFR% was documented in 21 kidneys (42%). Cold ischemia time with a cutoff value 50 min was the independent risk factor (RR 3.986, 95% CI 1.069-14.869, P 0.039). The results of this study support limiting ANL to a selected group of patients and taking all the possible efforts to minimize cold ischemia time below 50 min.