1
|
Lu Z, Yang W, He W. Learning curve of ultrasound-guided percutaneous nephrolithotripsy in the treatment of complex renal calculi. J Int Med Res 2024; 52:3000605241239026. [PMID: 38534089 PMCID: PMC10981248 DOI: 10.1177/03000605241239026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/26/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVE This study was performed to investigate the learning curve of ultrasound-guided percutaneous nephrolithotripsy (PCNL) for the treatment of complex renal calculi. METHODS Seventy-two patients with complex renal stones who underwent ultrasound-guided PCNL by the same operator from November 2016 to September 2020 were retrospectively analyzed. The learning curve of PCNL for complex renal stones was analyzed using multifactorial cumulative sum (CUSUM) analysis and best-fit curves. RESULTS The CUSUM best-fit curve peaked at Case 36, which represented the minimum number of cumulative cases required to cross the learning curve for this surgical procedure. Accordingly, the learning curve was divided into a learning improvement period (36 cases) and a proficiency phase (36 cases). Compared with the learning improvement period, the proficiency phase was characterized by a shorter puncture time and operation time, a smaller drop in the hemoglobin level, and a lower postoperative complication rate. CONCLUSION The learning curve of PCNL for the treatment of complex renal calculi can be divided into a learning improvement period and a proficiency phase, and the minimum cumulative number of cases is 36.
Collapse
Affiliation(s)
- Zhaoxiang Lu
- Zhaoxiang Lu, Department of Urology, the Chao Hu Hospital of Anhui Medical University, No. 64 Chaohu North Road, Chaohu, Hefei 238000, China.
| | | | - Wei He
- Department of Urology, the Chao Hu Hospital of Anhui Medical University, Hefei, China
| |
Collapse
|
2
|
Lotan P, Goldberg H, Nevo A, Darawsha AE, Gefen S, Criederman G, Rubinstein R, Herzberg H, Holland R, Lifshitz D, Golomb D. Post-operative pain following percutaneous nephrolithotripsy- clinical correlates. Urologia 2023; 90:503-509. [PMID: 36326155 DOI: 10.1177/03915603221130899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVES Management of postoperative pain following percutaneous nephrolithotripsy (PCNL) is a significant goal. We sought to identify risk factors and clinical correlates of postoperative pain in order to improve perioperative management and patient satisfaction. MATERIALS AND METHODS A single-center, retrospective analysis, from a prospectively maintained database, of all consecutive patients who underwent PCNL for renal calculi between January 2011 and August 2018. Postoperative pain was assessed using the visual analog scale (VAS) and analgesic use. We considered VAS score above 4 as meaningful. Pain management was standardized according to patirnt reported VAS scores. Multivariable logistic regression was performed to identify risk factors and clinical correlates. RESULTS A total of 496 patients were analyzed. Younger age was associated with VAS above 4 on the operative day and the first postoperative following PCNL (p = 0.003 and p < 0.001, respectively). Female gender was associated with VAS above 4 in the first 2 days following the operation (p < 0.001). CONCLUSIONS Younger age and female gender would most likely benefit from pre-emptive improved pain management protocols following PCNL.
Collapse
Affiliation(s)
- Paz Lotan
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Hanan Goldberg
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Amihay Nevo
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | | | - Sheizaf Gefen
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | | | - Roy Rubinstein
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Haim Herzberg
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Ronen Holland
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - David Lifshitz
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Dor Golomb
- Department of Urology, Assuta Ashdod University Hospital, Ashdod, Israel
| |
Collapse
|
3
|
Mykoniatis I, Pyrgidis N, Tzelves L, Pietropaolo A, Juliebø-Jones P, De Coninck V, Hameed BMZ, Chaloupka M, Schulz GB, Stief C, Kallidonis P, Somani BK, Skolarikos A. Assessment of single-probe dual-energy lithotripters in percutaneous nephrolithotomy: a systematic review and meta-analysis of preclinical and clinical studies. World J Urol 2023; 41:551-565. [PMID: 36656331 DOI: 10.1007/s00345-023-04278-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To evaluate the safety and efficacy of single-probe dual-energy (SPDE) lithotripters in patients undergoing percutaneous nephrolithotripsy (PCNL) through a systematic review and meta-analysis. METHODS We searched PubMed, Cochrane Library, Scopus and Embase databases until July 2022 for any preclinical or clinical studies, exploring the safety and efficacy of different SPDE lithotripters in patients undergoing PCNL. We performed a meta-analysis to compare stone-free rate, bleeding, or other complications and mean operative time between SPDE lithotripters and other lithotripters (PROSPERO: CRD42021285631). RESULTS We included 16 studies (six preclinical, seven observational and three randomized with 625 participants) in the systematic review and four in the meta-analysis. Preclinical studies suggest that SPDE lithotripters are safe and effective for the management of renal stones. Among clinical studies, four studies assessed Trilogy with no comparative arm, two compared Trilogy or ShockPulse with a dual-probe dual-energy lithotripter, two compared Trilogy with a laser, one compared ShockPulse with a pneumatic lithotripter, and one directly compared Trilogy with ShockPulse. Comparing SPDE lithotripters to other lithotripters, no significant differences were demonstrated in stone free rate (OR 1.13, 95% CI 0.53-2.38, I2 = 0%), postoperative blood transfusion (OR 1.33, 95% CI 0.34-5.19, I2 = 0%), embolization (OR 0.45, 95% CI 0.02-12.06), operative time (WMD: 2.82 min, 95% CI -7.31-12.95, I2 = 78%) and postoperative complications based on the Clavien-Dindo classification. CONCLUSIONS SPDE lithotripters represent a promising treatment modality for patients requiring PCNL. Despite the initial encouraging findings of preclinical and isolated clinical studies, it seems that Trilogy or ShockPulse provide similar efficiency compared to older generation devices.
Collapse
Affiliation(s)
- Ioannis Mykoniatis
- First Department of Urology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands
| | - Nikolaos Pyrgidis
- Department of Urology, University Hospital, LMU Munich, Munich-Marchioninistr. 15, 81377, Munich, Germany
| | - Lazaros Tzelves
- Second Department of Urology, Sismanoglio Hospital, Sismanogliou 37, Athens, Greece.,University College of London Hospitals NHS Foundation Trust, London, UK.,Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands
| | - Amelia Pietropaolo
- Department of Urology, University of Hospital Southampton NHS Trust, Southampton, UK.,Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands
| | - Vincent De Coninck
- Department of Urology, AZ Klina, Brasschaat, Belgium.,Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands
| | - Belthangady M Zeeshan Hameed
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India.,Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands
| | - Michael Chaloupka
- Department of Urology, University Hospital, LMU Munich, Munich-Marchioninistr. 15, 81377, Munich, Germany
| | - Gerald Bastian Schulz
- Department of Urology, University Hospital, LMU Munich, Munich-Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital, LMU Munich, Munich-Marchioninistr. 15, 81377, Munich, Germany
| | | | - Bhaskar K Somani
- Department of Urology, University of Hospital Southampton NHS Trust, Southampton, UK
| | - Andreas Skolarikos
- Second Department of Urology, Sismanoglio Hospital, Sismanogliou 37, Athens, Greece.
| |
Collapse
|
4
|
Sugino F, Nakane K, Kawase M, Iinuma K, Kawase K, Koie T. Endoscopic combined intrarenal surgery for renal allograft lithiasis using "sheath-connection technique": A case report. Urol Case Rep 2023; 47:102331. [PMID: 36718209 PMCID: PMC9883172 DOI: 10.1016/j.eucr.2023.102331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
A 66-year-old man was diagnosed with renal allograft lithiasis. Although retrograde intrarenal surgery was attempted, a ureteral access sheath (UAS) was difficult to insert. Subsequently, we planned the endoscopic combined intrarenal surgery (ECIRS) using the "Sheath-connection technique." We indwelled the two UAS anterogradely and retrogradely, unified them at the bladder and the junction of the two UAS was passed through the ureterovesical junction. We successfully performed ECIRS.
Collapse
|
5
|
Abushamma F, Ito H, Aboumarzouk O, Timoney A, Collin N, Keeley FX. Calyceal Diverticula Disease: Diagnosis and Management Options in the Era of Non-Contrast CT Scan. Urol Int 2021; 106:688-692. [PMID: 34515232 DOI: 10.1159/000518051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/22/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Calyceal diverticula (CD) are traditionally diagnosed by contrast studies. However, non-contrast CT is the standard imaging modality for kidney stones. Therefore, we aimed to determine if the lack of contrast imaging affected outcomes of the management of symptomatic CD with stone. MATERIALS AND METHODS This is a retrospective study of patients diagnosed with CD with intracalyceal stone from 2000 to 2017 analyzing demographics, clinical data, and success of different treatment options. The timing of CD diagnosis is correlated to the success of the first treatment. RESULTS Forty-eight patients were found. CD was diagnosed prior to intervention in 20 (42%) cases and intraoperatively during flexible ureteroscopy in 17 (35%) and 11 (23%) cases were diagnosed after failed intervention, mainly ESWL. We found that the success rate of treatment was highly affected by the timing and modality of diagnosis. Preoperative diagnosis of CD was associated with 69% success rate of the first intervention. In contrast, there was a 0% success rate of first treatment if CD was not diagnosed with contrast imaging. Furthermore, univariate analysis showed no significant association between sociodemographics and clinical variables and success treatment (p > 0.05). CONCLUSIONS The delay in diagnosing CD with stone contributes significantly to the success rate and the number of treatments.
Collapse
Affiliation(s)
- Faris Abushamma
- Department of Medicine, Faculty of medicine and health Sciences, An-Najah National University, Nablus, Palestine.,Department of Urology, An-Najah National University Hospital, Nablus, Palestine.,Bristol Urological Institute, North Bristol NHS Trust, Bristol, United Kingdom
| | - Hiroki Ito
- Department of Urology, Yokosuka Kyosai Hospital, Kanagawa, Japan
| | - Omar Aboumarzouk
- Surgical Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Anthony Timoney
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, United Kingdom
| | - Neil Collin
- Interventional Radiology Department, Southmead Hospital, Bristol, United Kingdom
| | - Francis X Keeley
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, United Kingdom
| |
Collapse
|
6
|
Li Q, Wan L, Liu S, Li M, Chen L, Hou Z, Zhang W. Clinical efficacy of enhanced recovery after surgery in percutaneous nephrolithotripsy: a randomized controlled trial. BMC Urol 2020; 20:162. [PMID: 33081762 PMCID: PMC7574411 DOI: 10.1186/s12894-020-00728-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/24/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To evaluate the feasibility, safety, applied value and efficacy of enhanced recovery after surgery (ERAS) for PCNL for the treatment of renal calculi. Although the ERAS is applied for many urological diseases, its application in percutaneous nephrolithotripsy (PCNL) is still limited. METHODS This was a prospective study of patients admitted to hospital January and December 2018 and who were only diagnosed with renal calculi and excepted for serious or uncontrollable basic diseases and patients with multiple operation history and medication history. Patients were randomized 1:1 to the ERAS and traditional operation groups starting on the day before operation and end on the day of discharge. Each group was 118 cases. The stone clearance rate, visual analogue scale (VAS) pain score, the occurrence of perirenal hematoma and effusion, the incidence of extravasation of urine, the incidence of fever, bleeding and blood transfusion, and postoperative hospital stay were observed. RESULTS The stone clearance rates were similar between the two groups (ERAS: 93.2% (109/117) vs. traditional: 89.8% (106/118), P = 0.800). The operation time was similar in the two groups (ERAS: 54 ± 12 vs. traditional: 58 ± 11 min, P = 0.656). VAS pain score that was 0.79 ± 0.76 in the ERAS group at 4 h after surgery and was significantly lower than 2.79 ± 0.98 in the traditional group (P < 0.0001). The total complication rate was 15 cases in the ERAS group and 22 cases in the traditional group (P = 0.573). There were no difference in costs (21,348 ± 2404 vs. 21,597 ± 2293 RMB, P = 0.529). CONCLUSIONS ERAS perioperative management in PCNL was feasible, was without additional complications, and had well economic and social benefits. It is worth of clinical promotion and application.
Collapse
Affiliation(s)
- Qing Li
- Department of Urology, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, 510900, China.
| | - Li Wan
- Department of Urology, The First Affiliated Hospital of University of South China, Hengyang, 421001, China
| | - Shucheng Liu
- Department of Urology, The First Affiliated Hospital of University of South China, Hengyang, 421001, China
| | - Mingyong Li
- Department of Urology, The First Affiliated Hospital of University of South China, Hengyang, 421001, China
| | - Libo Chen
- Department of Urology, The First Affiliated Hospital of University of South China, Hengyang, 421001, China
| | - Zhengwu Hou
- Department of Urology, The First Affiliated Hospital of University of South China, Hengyang, 421001, China
| | - Wang Zhang
- Department of Urology, The First Affiliated Hospital of University of South China, Hengyang, 421001, China
| |
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW Equipment used in endourology is constantly evolving due to increasing incidence of urolithiasis. Suctioning has been used mainly in PCNL in conjunction with ultrasonic and ballistic devices for stone removal. Recently technological advances permitted the use of suctioning in more endourological techniques. This review aims to summarize the literature regarding these advancements and analyze the upcoming results. RECENT FINDINGS Several centers have conducted experimental and clinical studies on suctioning use during PCNL, mPCNL, and ureteroscopy and concluded that it is an effective and safe adjustment that improves stone-free rates and limits complication rates after these procedures. Suctioning use during common endourological procedures led to improved safety and efficacy among several indications. Due to the observational nature and small sample size of many studies, larger RCTs are needed to make safe conclusions.
Collapse
Affiliation(s)
- Lazaros Tzelves
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleion Hospital, Athens, Greece
| | - Andreas Skolarikos
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleion Hospital, Athens, Greece.
| |
Collapse
|
8
|
Enikeev D, Taratkin M, Klimov R, Alyaev Y, Rapoport L, Gazimiev M, Korolev D, Ali S, Akopyan G, Tsarichenko D, Markovina I, Ventimiglia E, Goryacheva E, Okhunov Z, Jefferson FA, Glybochko P, Traxer O. Thulium-fiber laser for lithotripsy: first clinical experience in percutaneous nephrolithotomy. World J Urol 2020; 38:3069-3074. [PMID: 32108256 DOI: 10.1007/s00345-020-03134-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/09/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of thulium-fiber laser (TFL) in laser lithotripsy during percutaneous nephrolithotomy (PCNL). METHODS Patients with stones < 30 mm were prospectively recruited to undergo PCNL using TFL "FiberLase" (NTO IRE-Polus, Russia). Stone size, stone density, operative time, and "laser on" time (LOT) were recorded. Study included only cases managed with fragmentation. Stone-free rate and residual fragments were determined on postoperative computer tomography. Complications were classified using the Clavien-Dindo grade. Stone retropulsion and endoscopic visibility were assessed based on surgeons' feedback using a questionnaire. RESULTS A total of 120 patients were included in the study with a mean age of 52 (± 1.8) years; of these 77 (56%) were males. Mean stone size was 12.5 (± 8.8) mm with a mean density of 1019 (± 375) HU. Mean operative time was 23.4 (± 17.9) min and mean LOT was 5.0 (± 5.7) min. Most used settings were of 0.8 J/25-30 W/31-38 Hz (fragmentation). The mean total energy for stone ablation was 3.6 (± 4.3) kJ. Overall stone-free rate was 85%. The overall complication rate was 17%. Surgeons reported stone retropulsion that interfered with surgery in 2 (1.7%) cases insignificant retropulsion was noted in 16 (10.8%) cases. Poor visualization was reported in three (2.5%) cases and minor difficulties with visibility in four (3.3%) cases. CONCLUSIONS TFL is a safe and effective modality for lithotripsy during PCNL and results in minimal retropulsion.
Collapse
Affiliation(s)
- Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St., Moscow, 119991, Russian Federation.
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St., Moscow, 119991, Russian Federation
| | - Roman Klimov
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St., Moscow, 119991, Russian Federation
| | - Yuriy Alyaev
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St., Moscow, 119991, Russian Federation
| | - Leonid Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St., Moscow, 119991, Russian Federation
| | - Magomed Gazimiev
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St., Moscow, 119991, Russian Federation
| | - Dmitry Korolev
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St., Moscow, 119991, Russian Federation
| | - Stanislav Ali
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St., Moscow, 119991, Russian Federation
| | - Gagik Akopyan
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St., Moscow, 119991, Russian Federation
| | - Dmitry Tsarichenko
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St., Moscow, 119991, Russian Federation
| | - Irina Markovina
- Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia
| | - Eugenio Ventimiglia
- GRC #20 Lithiase Urinaire, Hôpital Tenon, Sorbonne University, Paris, France
| | | | | | - Francis A Jefferson
- Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia
| | - Petr Glybochko
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St., Moscow, 119991, Russian Federation
| | - Olivier Traxer
- GRC #20 Lithiase Urinaire, Hôpital Tenon, Sorbonne University, Paris, France
| |
Collapse
|
9
|
Moen T, Ferrero A, McCollough C. Robustness of Textural Features to Predict Stone Fragility Across Computed Tomography Acquisition and Reconstruction Parameters. Acad Radiol 2019; 26:885-892. [PMID: 30287145 DOI: 10.1016/j.acra.2018.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/06/2018] [Accepted: 08/10/2018] [Indexed: 11/27/2022]
Abstract
RATIONALE AND OBJECTIVES Previous studies have demonstrated that quantitative relationships exist between stone fragility at lithotripsy and morphological features extracted from computed tomography (CT) scans. The goal of this study was to determine if variations in scanner model, patient size, radiation dose, or reconstruction parameters impact the accuracy of the prediction of renal stone fragility in an in vitro model. MATERIALS AND METHODS Sixty-seven kidney stones were scanned using routine single and dual energy stone protocols, mimicking average, and large patient habitus. Low dose scans were also performed. Each scan was reconstructed with routine protocol parameters, and with thinner (0.6 mm) or thicker (3 mm) images, two different reconstruction kernels, and iterative reconstruction at two strengths. Fragility of each stone was measured in a controlled ex vivo experiment. A single predictive model was developed from a reference CT protocol configuration and applied to data from each CT acquisition and reconstruction parameter tested to obtain estimated stone comminution times. RESULTS None of the investigated protocols showed a significant variation in the accuracy of stone fragility classification, except for the ones with the most aggressive iterative reconstruction and/or with thicker images. In these protocols, a number of stone fragility assessments changed from fragile to hard (or vice versa), compared to their ground truth measurement. CONCLUSION Prediction accuracy of stone fragility models developed from CT data is robust to expected variations in CT stone protocols used for quantification tasks. This finding facilitates their future adoption to different clinical practices.
Collapse
|
10
|
Fernández Alcalde Á, Ruiz Hernández M, Gómez dos Santos V, Sánchez Guerrero C, Diaz Pérez D, Arias Fúnez F, Laso García I, Duque Ruiz G, Burgos Revilla F. Comparison between percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of 2 and 3cm renal lithiasis. Actas Urol Esp 2019; 43:111-117. [PMID: 30528533 DOI: 10.1016/j.acuro.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/21/2018] [Accepted: 08/31/2018] [Indexed: 10/27/2022]
Abstract
CONTEXT AND OBJECTIVES The first-line treatment for >2cm lithiasis is percutaneous nephrolithotomy (PNL), leaving flexible ureteroscopy (fURS) as a second option. In the present review, the stone-free rate and the complications of both techniques were evaluated in the treatment of 2-3cm stones. MATERIAL AND METHODS Systematic review of studies that compared both techniques. Studies that were not comparative, as well as those carried out in the pediatric population or with <2cm or>3cm stones, were excluded. Two researchers independently performed the investigation, obtaining 5 studies that made up a total of 815 patients: 252 belonged to the fURS group and 563 to the PNL group. Four studies were retrospective, and one was non-randomized prospective. RESULTS Stone-free rate ranged between 47.0% and 95.0% for the fURS and between 87.0% and 100% for the PNL. The complication rate was 8.8-29.0% in the fURS and 11.9-27.0% in the PNL. fURS required a greater number of procedures, and had a lower decrease in haemoglobin and creatinine rise compared to PNL. CONCLUSIONS The stone-free rate was higher for PNL, although the fURS could reach comparable results at the expense of performing several procedures. Both techniques have a similar frequency of complications, but the PNL has more postsurgical analytical alterations.
Collapse
|
11
|
Li MM, Yang HM, Liu XM, Qi HG, Weng GB. Retrograde intrarenal surgery vs miniaturized percutaneous nephrolithotomy to treat lower pole renal stones 1.5-2.5 cm in diameter. World J Clin Cases 2018; 6:931-935. [PMID: 30568948 PMCID: PMC6288504 DOI: 10.12998/wjcc.v6.i15.931] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/01/2018] [Accepted: 11/07/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To compare the outcomes of retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mini-PCNL) in treating lower pole (LP) renal stones with a diameter of 1.5-2.5 cm.
METHODS A total of 216 patients who underwent mini-PCNL (n = 103) or RIRS n = 113) for LP stones with a diameter of 1.5-2.5 cm were enrolled between December 2015 and April 2017 at the Urology Department of Ningbo Urology and Nephrology Hospital.
RESULTS Significant differences were found in the hospital stay (9.39 ± 4.01 vs 14.08 ± 5.26, P < 0.0001) and hospitalization costs (2624.5 ± 513.36 vs 3255.2 ± 976.5, P < 0.0001) between the RIRS and mini-PCNL groups. The mean operation time was not significantly different between the RIRS group (56.48 ± 24.77) and the mini-PCNL group (60.04 ± 30.38, P = 0.345). The stone-free rates at the first postoperative day (RIRS vs mini-PCNL: 90.2% vs 93.2%, P = 0.822) and the second month postoperatively (RIRS vs mini-PCNL: 93.8% vs 95.1%, P = 0.986) were not significantly different.
CONCLUSION RIRS and mini-PCNL are both safe and effective methods for treating LP stones with a diameter of 1.5-2.5 cm. RIRS can be considered as an alternative to PCNL for the treatment for LP stones of 1.5-2.5 cm.
Collapse
Affiliation(s)
- Mao-Mao Li
- Department of Urologic Surgery, Ningbo Urology and Nephrology Hospital, Ningbo 315100, Zhejiang Province, China
| | - Hou-Meng Yang
- Department of Urologic Surgery, Ningbo Urology and Nephrology Hospital, Ningbo 315100, Zhejiang Province, China
| | - Xiao-Ming Liu
- Department of Urologic Surgery, Ningbo Urology and Nephrology Hospital, Ningbo 315100, Zhejiang Province, China
| | - Hong-Gang Qi
- Department of Urologic Surgery, Ningbo Urology and Nephrology Hospital, Ningbo 315100, Zhejiang Province, China
| | - Guo-Bin Weng
- Department of Urologic Surgery, Ningbo Urology and Nephrology Hospital, Ningbo 315100, Zhejiang Province, China
| |
Collapse
|
12
|
Bai FD, Wu HF, Wen JM, Zhang N, Zheng YC, Chen JM, Du CJ. [Clinical analysis for preset double J tube in percutaneous nephrolithotripsy]. Zhonghua Yi Xue Za Zhi 2018; 98:454-456. [PMID: 29429259 DOI: 10.3760/cma.j.iss.0376-2491.2018.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the clinical application and effect of preseting Double-J ureteric stent in percutaneous nephrolithotripsy. Method: 74 cases of renal calculi treated with PCNL in our hospital during June 2014 to February 2017 were retrospectively analyzed. Of 74 cases, 54 was male, 20 was female. All cases were aged 27 to 78, the mean age was (49.5±12.3) years old. The diameter of the stone was 20 to 59 mm, and the mean diameter was of (29.4±4.3) mm.Our Surgical methods was first putingFr6 double J tube in abnormal ureteral in advance in lithotomy position, then indwellingthree-way Foley catheter and clipping drainage port, perfusingirrigation port with 3 000 ml saline from 60-80 cm height.Perfusingsaline through irrigation port in prone position, we produce artificial hydronephrosis, then indwelling channel Fr20 through B ultrasound guided percutaneous nephrostomy, and removing renal calculi using holmium laser lithotripsy. Results: All patients were successfully completed percutaneous nephrostomy and indwell Fr20 channel, mean channel set up time (8.0 ±2.0) min, mean operation time (79±46) min, mean decline of hemoglobin (17.0±4.0) g/L, mean serum creatinine increased(3.1±1.1) μmol/L, one-stage stone-free rates 81.1%, complication rate 8.1% (1 case injured pleura and suffered from pneumothorax, 1 case suffered from massive hemorrhage of renal arteriovenous fistula after operation, 4 cases suffered postoperative fever). Conclusion: Advance in percutaneous nephrolithotripsy indwelling double J tube is a safe and feasible method, which is advantageous to the percutaneous renal puncture and the establishment of channels, and can avoid the blindness of along the line of indwelling double J.
Collapse
Affiliation(s)
- F D Bai
- Department of Urology, the Second Affiliated of Zhejiang University School of Medicine, Hangzhou 310009, China
| | | | | | | | | | | | | |
Collapse
|
13
|
Sohail N, Albodour A, Abdelrahman K. Laparoscopic Assisted Transmesocolonic Percutaneous Nephrolithotripsy in Ectopic Iliac Kidney. Urol Case Rep 2016; 7:48-50. [PMID: 27335792 PMCID: PMC4909502 DOI: 10.1016/j.eucr.2016.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 04/11/2016] [Indexed: 11/03/2022] Open
Abstract
We report a case of 15-year old female who presented with recurrent lower abdominal pain treated three times with ESWL previously. She was diagnosed as having right ectopic kidney with a 4 cm renal stone in renal pelvis and involving lower and mid calyx. She was treated successfully with laparoscopic assisted transmesocolonic percutaneous nephrolithotripsy. Procedure resulted in complete stone clearance without any perioperative or post operative complication. Patient stayed in hospital for 72 h with no drains or stents after day 5, post operatively.
Collapse
Affiliation(s)
- N Sohail
- Alkhor Hospital Urology section, Hamad Medical Corporation, Qatar
| | - A Albodour
- Alkhor Hospital Urology section, Hamad Medical Corporation, Qatar
| | - K Abdelrahman
- Alkhor Hospital Urology section, Hamad Medical Corporation, Qatar
| |
Collapse
|
14
|
Kallidonis P, Kyriazis I, Vasilas M, Panagopoulos V, Georgiopoulos I, Ozsoy M, Stolzenburg JU, Seitz C, Liatsikos E. Modular training for percutaneous nephrolithotripsy: The safe way to go. Arab J Urol 2015; 13:270-6. [PMID: 26609446 PMCID: PMC4656800 DOI: 10.1016/j.aju.2015.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 07/12/2015] [Accepted: 07/22/2015] [Indexed: 12/31/2022] Open
Abstract
Objectives should be describe a modular training scheme (MTS) which aims to provide training in percutaneous nephrolithotripsy (PCNL) and ensure the safety of the patients. Subjects and methods Two trainees with no experience in PCNL attended the MTS under the supervision of an experienced mentor. The MTS included five modules, comprising an initial animal laboratory course (using pigs), to acquire basic skills (Module 1), and Modules 2–5 included making the puncture, tract dilatation, single-stone and large-stone management in clinical cases, respectively. Each participant progressed from one module to the next under constant mentoring and evaluation by the mentor. When the trainees completed the MTS they proceeded to perform 60 PCNL procedures independently while the mentor performed 25 for comparison purposes. A global rating scale was used for the objective evaluation of the trainees. Peri-operative variables were recorded and statistically compared as appropriate. Statistical significance was defined as P < 0.05. Results One pig and 16 patients, and two pigs and 22 patients, were necessary to complete the MTS by each subject. There were no significant differences among the characteristics of the independently performed operations. The duration of surgery and fluoroscopy achieved a plateau similar to those of the mentor after ≈ 30 patients. The decrease in haemoglobin level, stone-free and complication rates in the patients were similar among the two trainees and the mentor. The complication rate of the trainees and the mentor never exceeded 13.3%. Conclusion The MTS successfully combined animal and stepwise clinical training based on a standardised technique and objective evaluation.
Collapse
Affiliation(s)
| | - Iason Kyriazis
- Department of Urology, University of Patras, Patras, Greece
| | | | | | | | - Mehmet Ozsoy
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | | | - Christian Seitz
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | | |
Collapse
|
15
|
Abreu LDADS, Camilo-Silva DG, Fiedler G, Corguinha GB, Paiva MM, Pereira-Correia JA, Muller VJF. Review on renal recovery after anatrophic nephrolithotomy: Are we really healing our patients? World J Nephrol 2015; 4:105-110. [PMID: 25664252 PMCID: PMC4317620 DOI: 10.5527/wjn.v4.i1.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 10/02/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
The main goals for urinary stone treatment are to preserve renal function, reduce or avoid complications related to calculi, and to render the patient free of calculi as soon as possible. Anatrophic nephrolithotomy (ANL) is a valid and useful alternative for conventional staghorn calculi excision. Although excellent stone free rates can be achieved with ANL there are some drawbacks that may be of concern. Morbidity related to intraoperative and postoperative complications is one of them. Another, great concern is the possibility of reduction on renal function related to the procedure itself. This may be related to nephron injury during nephrotomy and parenchymal closure or to ischemic injury. In this review we assess functional results after anatrophic nephrolithotomy.
Collapse
|
16
|
Al-Otaibi KM. Retrograde upper-pole calyceal access for percutaneous nephrolithotripsy of stones in the lower-pole calyx. Arab J Urol 2012; 10:353-7. [PMID: 26558049 PMCID: PMC4442947 DOI: 10.1016/j.aju.2012.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 08/09/2012] [Accepted: 08/10/2012] [Indexed: 11/19/2022] Open
Abstract
Objective To present the results of upper calyceal access during percutaneous nephrolithotripsy (PCNL) for stones in the lower calyx, as PCNL is considered the most effective minimally invasive surgery for managing lower calyceal stones, with percutaneous access either directly to the lower calyx or through an upper or middle calyx. Patients and methods The study included 76 patients with single (51) and multiple (25) stones in the lower calyx, and stones in the lower calyx plus renal pelvis (six) and associated pelvi-ureteric junction obstruction (PUJO, five). They were managed by PCNL using retrograde access through the upper-pole calyx in addition to laser endopyelotomy for the PUJO. Results The mean duration required for establishing the retrograde nephrostomy tract was 14.4 min, and for completing the procedure was 40 min. The mean fluoroscopy exposure time was 3.2 min. Access from the upper calyx allowed easy and rapid advancement of the nephroscope to the lower calyx. The stones varied in size, at 10–25 mm. Stones were cleared completely in 70 of the 76 patients (92%); the stone-free rate was 100%. The residual stone fragments (2–4 mm) in the remaining six patients (8%) were considered insignificant. Complications were minor in four patients (5%), and included pleural effusion in two, bleeding in one and an arteriovenous fistula in one. Conclusions Upper-pole calyceal access for PCNL provides easy and effective clearance of stones in the lower calyx. This access should be considered for PCNL of single or multiple stones in the lower calyx.
Collapse
Affiliation(s)
- Khalid M Al-Otaibi
- Department of Urology, University of Dammam, Dammam, Kingdom of Saudi Arabia
| |
Collapse
|