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Abstract
RATIONALE Ureteral obstruction of the graft kidney is a common complication of kidney transplantation. However, ureteral obstruction caused by inguinal hernia has rarely been reported. We present a rare case of ureteral obstruction with allograft dysfunction caused by an inguinal hernia. PATIENT CONCERNS A 76-year-old man, who was a renal transplant recipient, presented with bilateral pitting oedema, reduced urine output, and right inguinal hernia. DIAGNOSES Abdominal computed tomography revealed severe hydroureteronephrosis of the kidney allograft. A right inguinal hernia with ureteral incarceration was observed. INTERVENTIONS The patient underwent graft percutaneous nephrostomy, followed by antegrade insertion of a double-J tube (DJ). Gradual improvement was observed in his renal function. Right inguinal herniorrhaphy was performed 5 days later. OUTCOMES The renal function returned to normal after percutaneous nephrostomy and insertion of the DJ. A right inguinal direct-type hernia with ureter adhesion to the hernial sac was observed during the surgery. The posterior wall defect was repaired by the McVay technique. The DJ was removed after 1 month. The patient's renal function remained stable at 6-month follow-up. LESSONS The orientation of the graft kidney has a significant influence on the location of the ureter. Upward orientation of the hilum will result in superficial location of the ureter, rendering it close to the hernial sac and susceptible to incarceration. The transplant surgeon should be aware of such a presentation of graft dysfunction with inguinal hernia to prevent a delay in the diagnosis and graft loss.
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Affiliation(s)
- Tian-You Chang
- Department of Urology, China Medical University Hospital
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University Hospital
- School of Medicine, College of Chinese Medicine, China Medical University
| | - Ping-Chin Lai
- The Kidney Institute and Division of Nephrology, China Medical University Hospital
| | - Wei-Ching Lin
- Department of Radiology, China Medical University Hospital
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
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Jiang L, Zheng Z. [Study and Analysis on the Test of Representative Products for Percutaneous Renal Puncture Device]. Zhongguo Yi Liao Qi Xie Za Zhi 2019; 43:214-216. [PMID: 31184082 DOI: 10.3969/j.issn.1671-7104.2019.03.015] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Percutaneous renal puncture device has very important clinical value. Qualified percutaneous renal puncture device is one of the important ways to evaluate its safety and efficacy, and it is also an important prerequisite for the device to be marketed in China. When manufactuers test the product, the selection of representative products is suggested from the aspects of performance parameter, structure, material and production process.
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Affiliation(s)
- Lujie Jiang
- Center for Certification & Evaluation, SHFDA, Shanghai, 200020
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3
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Liu Y, Wu K, Lai H, Zeng Z, Zhang B. Clinical application of fluoroscopic guided percutaneous antegrade ureteral stents placement for the treatment of malignant ureteral obstruction. J Xray Sci Technol 2019; 27:453-460. [PMID: 30909269 DOI: 10.3233/xst-180466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the clinical efficacy and safety of fluoroscopic guided percutaneous antegrade ureteral stents placement used for treatment of malignant ureteral obstruction. METHODS Between April 2016 and March 2018, fluoroscopic guided percutaneous ureteral stents was performed in 25 patients, including 7 patients (28%) with bilateral obstruction. The most common cancer diagnoses were cervical cancer (28%), rectal cancer (24%) and colon cancer (16%) among these patients. Clinical data were retrospectively analyzed with respect to the efficacy, safety and outcome of this treatment method. RESULTS Percutaneous antegrade placement of ureteral stents was performed in all cases, including 12 ureters that failed in the initial retrograde ureteral stents placement. The median stent patency time for the antegrade ureteral stents were 10.4 (95% CI: 8.3-12.6) months. The primary complications included mild flank pain and discomfort (44%), hematuria (44%), urinary tract infection (8%), bladder irritation symptoms (4%), and arterial bleeding (4%). CONCLUSION Fluoroscopic guided percutaneous ureteral stents placement is a safe, efficient procedure and has a high success rate in patients with malignant ureteral obstruction.
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Affiliation(s)
- Yang Liu
- Department of Radiology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ketong Wu
- Department of Radiology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haiyang Lai
- Department of Radiology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhaofei Zeng
- Department of Radiology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bo Zhang
- Department of Radiology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Carlos EC, Wollin DA, Winship BB, Jiang R, Radvak D, Chew BH, Gustafson MR, Simmons WN, Zhong P, Preminger GM, Lipkin ME. In Vitro Comparison of a Novel Single Probe Dual-Energy Lithotripter to Current Devices. J Endourol 2018; 32:534-540. [PMID: 29649900 DOI: 10.1089/end.2018.0143] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 11/12/2022] Open
Abstract
PURPOSE The LithoClast Trilogy is a novel single probe, dual-energy lithotripter with ultrasonic (US) vibration and electromagnetic impact forces. ShockPulse and LithoClast Select are existing lithotripters that also use a combination of US and mechanical impact energies. We compared the efficacy and tip motion of these devices in an in vitro setting. MATERIALS AND METHODS Begostones, in the ratio 15:3, were used in all trials. Test groups were Trilogy, ShockPulse, Select ultrasound (US) only, and Select ultrasound with pneumatic (USP). For clearance testing, a single investigator facile with each lithotripter fragmented 10 stones per device. For drill testing, a hands-free apparatus with a submerged balance was used to apply 1 or 2 lbs of pressure on a stone in contact with the device tip. High-speed photography was used to assess Trilogy and ShockPulse's probe tip motion. RESULTS Select-USP was slowest and Trilogy fastest on clearance testing (p < 0.01). On 1 lbs drill testing, Select-US was slowest (p = 0.001). At 2 lbs, ShockPulse was faster than Select US (p = 0.027), but did not significantly outpace Trilogy nor Select-USP. At either weight, there was no significant difference between Trilogy and ShockPulse. During its US function, Trilogy's maximum downward tip displacement was 0.041 mm relative to 0.0025 mm with ShockPulse. Trilogy had 0.25 mm of maximum downward displacement during its impactor function while ShockPulse had 0.01 mm. CONCLUSIONS Single probe dual-energy devices, such as Trilogy and ShockPulse, represent the next generation of lithotripters. Trilogy more efficiently cleared stone than currently available devices, which could be explained by its larger probe diameter and greater downward tip displacement during both US and impactor functions.
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Affiliation(s)
- Evan C Carlos
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Daniel A Wollin
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Brenton B Winship
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Ruiyang Jiang
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Daniela Radvak
- 2 Department of Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - Ben H Chew
- 3 Department of Urologic Sciences, University of British Columbia , Vancouver, Canada
- 4 Endourology Disease Group for Excellence (EDGE) Research Consortium
| | - Michael R Gustafson
- 2 Department of Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - W Neal Simmons
- 2 Department of Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - Pei Zhong
- 2 Department of Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - Glenn M Preminger
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Michael E Lipkin
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
- 4 Endourology Disease Group for Excellence (EDGE) Research Consortium
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Critchlow WA, Stern KL, Jameson JJ, Kriegshauser JS. Retained Nephrostomy String Causing Severe Flank Pain and Hematuria. J Vasc Interv Radiol 2017; 28:1308-1310. [PMID: 28841947 DOI: 10.1016/j.jvir.2017.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/07/2017] [Accepted: 04/08/2017] [Indexed: 11/16/2022] Open
Affiliation(s)
- William A Critchlow
- Department of Urology, Mayo Clinic Hospital, 5777 E Mayo Boulevard, Phoenix, AZ 85054
| | - Karen L Stern
- Department of Urology, Mayo Clinic Hospital, 5777 E Mayo Boulevard, Phoenix, AZ 85054
| | - Jason J Jameson
- Department of Urology, Mayo Clinic Hospital, 5777 E Mayo Boulevard, Phoenix, AZ 85054
| | - J Scott Kriegshauser
- Department of Radiology, Mayo Clinic Hospital, 5777 E Mayo Boulevard, Phoenix, AZ 85054
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Ching KC, Shlansky-Goldberg RD, Trerotola SO. A Durable Percutaneous U-Tube Nephrostomy for Management of a Recurrently Displaced Locking Loop Catheter. J Vasc Interv Radiol 2017; 28:475-477. [PMID: 28231929 DOI: 10.1016/j.jvir.2016.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/24/2016] [Accepted: 10/25/2016] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kevin C Ching
- Department of Radiology, Division of Interventional Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Richard D Shlansky-Goldberg
- Department of Radiology, Division of Interventional Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Scott O Trerotola
- Department of Radiology, Division of Interventional Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
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Zhao Z, Tuerxu A, Liu Y, Wu W, Simayi A, Zhong W, Chen W, Batuer A, Zeng G. Super-mini PCNL (SMP): Material, indications, technique, advantages and results. ARCH ESP UROL 2017; 70:211-216. [PMID: 28221155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To introduce an emerging technique termed 'super-mini- percutaneous nephrolithotomy' (SMP) and describe its application in practice. METHODS We described the technique of SMP in the treatment of renal stones with emphasis on the material, indications, technique procedure, advantages, and results. RESULTS SMP refers to a 7 Ch. nephroscope placed through a 10-14 Ch. metal access sheath with functions of both irrigation and suction-evacuation, to achieve stone fragmentation via laser or pneumatic lithotripsy. We reported our experience of this technique in 342 cases including 231 adults and 111 children. The mean stone size was 2.3 ± 0.9 cm resulted in 54.3 ± 27.7 min of mean operative time in adults, as well as 39.4 ± 26.2 min for stone size of 1.4 ± 0.5cm in children. In parallel, the initial stone-free rate (SFR) was 89.2% and 90.0% followed with a 94.4% and 95.5% of final SFR at 3 months in adults and children, respectively. No transfusions were needed in all patients. Tubeless was achieved in 93.9% and 100%of patients in adults and children respectively. The mean hospital stay was 2.3 ± 0.8 d and 2.7 ± 1.5 d respectively. CONCLUSIONS SMP are suited for stones less than 2.5 cm in size. It is also suited for special situations such as pediatric moderate-sized stones, previously failed SWL or RIRS approaches. It has advantages of a shorter operative time and hospital stays, with a largely reduction use of drainage catheter after procedure. The indications of the SMP may also compete with those of SWL and RIRS.
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Affiliation(s)
- Zhijian Zhao
- Department of Urology, Minimally Invasive Surgery Center. The First Affiliated Hospital of Guangzhou Medical University and Guangdong Key Laboratory of Urology. China
| | - Aierken Tuerxu
- Department of Urology. The First People's Hospital of Kashi. Kashi Xinjiang. China
| | - Yongda Liu
- Department of Urology, Minimally Invasive Surgery Center. The First Affiliated Hospital of Guangzhou Medical University and Guangdong Key Laboratory of Urology. China
| | - Wenqi Wu
- Department of Urology, Minimally Invasive Surgery Center. The First Affiliated Hospital of Guangzhou Medical University and Guangdong Key Laboratory of Urology. China
| | - Abulizi Simayi
- Department of Urology. People's Hospital of Xinjiang Uyghur Autonomous Region. China
| | - Wen Zhong
- Department of Urology, Minimally Invasive Surgery Center. The First Affiliated Hospital of Guangzhou Medical University and Guangdong Key Laboratory of Urology. China
| | - Wenzhong Chen
- Department of Urology, Minimally Invasive Surgery Center. The First Affiliated Hospital of Guangzhou Medical University and Guangdong Key Laboratory of Urology. China
| | - Abudukahaer Batuer
- Department of Urology. The First People's Hospital of Kashi. Kashi Xinjiang. China
| | - Guohua Zeng
- Department of Urology, Minimally Invasive Surgery Center. The First Affiliated Hospital of Guangzhou Medical University and Guangdong Key Laboratory of Urology. China
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8
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Desai JD. Ultra-mini PNL (UMP): Material, indications, technique, advantages and results. ARCH ESP UROL 2017; 70:196-201. [PMID: 28221153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Stone disease has afflicted mankind since centuries; records from ancient civilisations of India and Egypt have shown stones in human bodies. The scientific mind of humans has always made smart endeavours to remove the kidney stones. From large instruments made like the beaks of different animals and birds in 600 BC (Indian civilisation) to extremely sophisticated and miniaturised endoscopic intruments of today the human race has travelled a long way. The theme has always been to remove the stones with minimal morbidity and mortality and with minimum pain to the patient. The article takes you through the journey of instruments used in 600 BC until today. The story of instrumentation is a symbiosis of the medical minds along with engineering advances. The story of miniaturisation could not have moved further without the development of lasers, fiberoptics and sophisticated cameras. As the field stands today, we remove more complex stones by larger endoscopic intervention and smaller stones by miniaturised instruments. The article discusses all the merits and shortcomings of various techniques: from open surgery to standard PCNL to Mini PCNL to Ultra- Mini PCNL to Micro-PCNL.
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Zanetti SP, Boeri L, Gallioli A, Talso M, Montanari E. Minimally invasive PCNL-MIP. ARCH ESP UROL 2017; 70:226-234. [PMID: 28221157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Miniaturized percutaneous nephrolithotomy (mini-PCNL) has increased in popularity in recent years and is now widely used to overcome the therapeutic gap between conventional PCNL and less-invasive procedures such as shock wave lithotripsy (SWL) or flexible ureterorenoscopy (URS) for the treatment of renal stones. However, despite its minimally invasive nature, the superiority in terms of safety, as well as the similar efficacy of mini-PCNL compared to conventional procedures, is still under debate. The aim of this chapter is to present one of the most recent advancements in terms of mini-PCNL: the Karl Storz "minimally invasive PCNL" (MIP). A literature search for original and review articles either published or e-published up to December 2016 was performed using Google and the PubMed database. Keywords included: minimally invasive PCNL; MIP. The retrieved articles were gathered and examined. The complete MIP set is composed of different sized rigid metallic fiber-optic nephroscopes and different sized metallic operating sheaths, according to which the MIP is categorized into extra-small (XS), small (S), medium (M) and large (L). Dilation can be performed either in one-step or with a progressive technique, as needed. The reusable devices of the MIP and vacuum cleaner efect make PCNL with this set a cheap procedure. The possibility to shift from a small to a larger instrument within the same set (Matrioska technique) makes MIP a very versatile technique suitable for the treatment of almost any stone. Studies in the literature have shown that MIP is equally effective, with comparable rates of post-operative complications, as conventional PCNL, independently from stone size. MIP does not represent a new technique, but rather a combination of the last ten years of PCNL improvements in a single system that can transversally cover all available techniques in the panorama of percutaneous stone treatment.
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Affiliation(s)
- Stefano Paolo Zanetti
- Department of Urology. IRCCS Ca' Granda Ospedale Maggiore Policlinico. Università degli Studi di Milano. Italy
| | - Luca Boeri
- Department of Urology. IRCCS Ca' Granda Ospedale Maggiore Policlinico. Università degli Studi di Milano. Italy
| | - Andrea Gallioli
- Department of Urology. IRCCS Ca' Granda Ospedale Maggiore Policlinico. Università degli Studi di Milano. Italy
| | - Michele Talso
- Department of Urology. IRCCS Ca' Granda Ospedale Maggiore Policlinico. Università degli Studi di Milano. Italy
| | - Emanuele Montanari
- Department of Urology. IRCCS Ca' Granda Ospedale Maggiore Policlinico. Università degli Studi di Milano. Italy
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Cepeda M, Amón JH. [MicroPerc: Fashion or reality.]. ARCH ESP UROL 2017; 70:217-225. [PMID: 28221156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Miniaturization in percutaneous surgery has seen its zenith in microperc. Technological advances have enabled us to treat renal lithiasis through a 4.8 Ch. caliper percutaneous access. According to published literature, the technique is reproducible and when applied to small and medium size renal lithiasis has a high success rate keepin a low complication rate. Its main advantage is the absence of tract dilatation, diminishing the bleeding risk inherent to percutaneous access, postoperative pain and hospital stay. Nevertheless, it presents a series of technical limitations: low maneuverability and versatility, impossible extraction of significant fragments, limited vision and high intrarenal pressure. Does microperc have a place among proven techniques such as SWL, flexible ureteroscopy or minipercutaneous surgery? In our article we try to answer this question by reviewing the available literature, and review all technical features, advantages and limitations of the procedure at the same time.
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Affiliation(s)
- Marcos Cepeda
- Servicio de Urología. Hospital Universitario Río Hortega. Valladolid. España
| | - José H Amón
- Servicio de Urología. Hospital Universitario Río Hortega. Valladolid. España
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Abstract
Minimally invasive endoscopic procedures are often employed for the surgical removal of kidney stones. Traditionally, large stones are removed by (standard) percutaneous nephrolithotomy (SPCNL). Although effective for the clearance of large stone burdens, SPCNL is associated with significant morbidity. Therefore, in an effort to reduce this morbidity, while preserving efficacy, mini-PCNL (MPCNL) with a smaller tract size (<20 French) was developed. Several studies suggest that MPCNL has a comparable stone-free rate to SPCNL. However, the question of lower morbidity with MPCNL remains unanswered. In this review, we describe the equipment, indications, and efficacy of MPCNL with particular attention to its value over traditional minimally invasive stone removal techniques.
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Affiliation(s)
- Sasha C Druskin
- Department of Urology, Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Justin B Ziemba
- Department of Urology, Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
- Johns Hopkins School of Medicine, Brady Urological Institute, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
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Tabibi A, Abedi AR, Radfar MH, Kamranmanesh MR, Karami H, Arab D, Pakmanesh H. Percutaneous Nephrolithotomy Using Split Amplatz Sheath: A Randomized Clinical Trial. Urol J 2016; 13:2750-2753. [PMID: 27576880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/10/2016] [Accepted: 07/24/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE To compare the outcome of percutaneous nephrolithotomy (PCNL) using split or intact Amplatz sheath. MATERIALS AND METHODS Seventy two patients who underwent PCNL were randomly divided into two groups; PCNL using intact (group 1) and split (group 2) Amplatz sheath. Preoperative data, operative time, largest extracted stone size, fluoroscopy and lithotripsy time, and serum biochemistry tests before and after PCNL were evaluated. RESULTS Preoperative features and stone size were not significantly different between the groups. There were no significant differences in complications and postoperative changes in hemoglobin and serum electrolytes. Stone free rate in group 2 (88.1%) was insignificantly higher than group 1 (83.3%) (p = .05), but in staghorn stones and stones larger than 1000 mm2, stone free rate in group 2 was significantly higher than group 1 (82% vs. 72%). The mean extracted stone size in group 2 (150 ± 49) was significantly larger than group 1 (40 ± 16 mm2) (p < .005). The mean operative, lithotripsy and fluoroscopy times were significantly longer in group 1. CONCLUSION Using split Amplatz sheath in PCNL facilitates extraction of larger stone fragments which could contribute to shorter fluoroscopy, lithotripsy and operative times. .
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Affiliation(s)
- Ali Tabibi
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran,Iran
| | - Amir Reza Abedi
- Urology and Nephrology Research Center, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hadi Radfar
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran,Iran
| | - Mohammad Reza Kamranmanesh
- Anesthesiology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences
| | | | - Davood Arab
- Semnan University of Medical Sciences, Semnan, Iran
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Penbegul N, Utangac MM, Daggulli M, Dede O, Bozkurt Y, Bodakci MN, Atar M. A novel drainage technique during micropercutaneous nephrolithotomy in pediatric patients: double angiocath. J Pediatr Surg 2016; 51:1051-3. [PMID: 27041228 DOI: 10.1016/j.jpedsurg.2016.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/16/2016] [Accepted: 03/04/2016] [Indexed: 11/17/2022]
Abstract
Micropercutaneous nephrolithotomy (microperc) is a recently introduced percutaneous nephrolithotomy (PNL) technique that has the smallest tract size. The absence of an amplatz sheath during the microperc technique is a fundamental difference that distinguishes it from all other types of PNL (standard, mini, ultramini). Increasing of the intrarenal pelvic pressure (IPP) was demonstrated by the authors in adult patients but this problem may be even more serious in pediatric patients. Previously, the authors defined the use of a 14 gauge angiocath needle and sheath (microsheath) during microperc surgery for pediatric patient to reduce the IPP. In this novel technique, a second angiocath is used to access the renal collecting system to drain fluid during surgery. This technique is more effective in reducing IPP during microperc, especially in pediatric patients.
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Affiliation(s)
- Necmettin Penbegul
- Dicle University School of Medicine, Department of Urology, 21280 Diyarbakir, Turkey.
| | - Mehmet Mazhar Utangac
- Dicle University School of Medicine, Department of Urology, 21280 Diyarbakir, Turkey
| | - Mansur Daggulli
- Dicle University School of Medicine, Department of Urology, 21280 Diyarbakir, Turkey
| | - Onur Dede
- Dicle University School of Medicine, Department of Urology, 21280 Diyarbakir, Turkey
| | - Yasar Bozkurt
- Dicle University School of Medicine, Department of Urology, 21280 Diyarbakir, Turkey
| | - Mehmet Nuri Bodakci
- Dicle University School of Medicine, Department of Urology, 21280 Diyarbakir, Turkey
| | - Murat Atar
- Dicle University School of Medicine, Department of Urology, 21280 Diyarbakir, Turkey
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Arslan MS, Zeytun H, Basuguy E, Arslan S, Aydogdu B, Okur MH. The Outcome of Percutaneous Nephrolithotomy Using Intravenous Catheter for Obtaining Percutaneous Access as a Treatment for Renal Stone Disease in Children: A Pilot Study. Urol J 2016; 13:2502-2508. [PMID: 26945654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE Using percutaneous nephrolithotomy (PNL), it is easy to reach stones in various parts of the kidney via a single access tract. In the current study, we set out to demonstrate that the intravenous catheter is a safe way to gain renal access, and that PNL is safe in children. MATERIALS AND METHODS We retrospectively reviewed the medical records of patients who underwent PNL as a treatment for renal stone disease at our center between September 2013 and December 2014. There were no specific exclusion criteria. We used 14 gauge intravenous catheter for renal access in all cases. RESULTS Eleven of the 32 patients (34.4%) were female and 21 (65.6%) were male. The mean ± SD patient age was 4.7 ± 3.71 years (9 months-16 years). Six patients (18.7%) were infants less than 1 year of age. Fifteen of the stones (46.8%) were located in the right kidney, and 17 of the stones (53.1%) were located in the left kidney. The average stone size was 13.9 ± 4.8 mm (range, 12-28). The average duration of operation was 69.7 ± 10.4 minutes (range, 50-110), and the average duration of fluoroscopy was 2.21 ± 1.06 minutes (range, 1-6). There were complications in 5 of the cases (15.6%). CONCLUSION The access and dilatation stages are quite important. We propose that the intravenous catheter is a safe and inexpensive tool for renal access in PNL in pediatric age group patients.
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Affiliation(s)
- Mehmet Serif Arslan
- Departments of Pediatric Urology and Pediatric Surgery, University of Dicle, Sur, Diyarbakir 21210, Turkey.
| | - Hikmet Zeytun
- Departments of Pediatric Urology and Pediatric Surgery, University of Dicle, Sur, Diyarbakir 21210, Turkey
| | - Erol Basuguy
- Departments of Pediatric Urology and Pediatric Surgery, University of Dicle, Sur, Diyarbakir 21210, Turkey
| | - Serkan Arslan
- Departments of Pediatric Urology and Pediatric Surgery, University of Dicle, Sur, Diyarbakir 21210, Turkey
| | - Bahattin Aydogdu
- Departments of Pediatric Urology and Pediatric Surgery, University of Dicle, Sur, Diyarbakir 21210, Turkey
| | - Mehmet Hanifi Okur
- Departments of Pediatric Urology and Pediatric Surgery, University of Dicle, Sur, Diyarbakir 21210, Turkey
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15
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D'Arcy FT, Lawrentschuk N, Manecksha RP, Webb DR. Renal track creation for percutaneous nephrolithotomy: the history and relevance of single stage dilation. Can J Urol 2015; 22:7978-7983. [PMID: 26432968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PCNL) was described in the 1980s and revolutionized the treatment of stone disease. The crucial component to this surgery is satisfactory track creation. We examine how the development and production in the 1980s of a single stage dilator (SSD) subsequently modified for pediatric PCNL has become the ideal access tool for mini percutaneous nephrolithotomy (mPCNL) today. MATERIALS AND METHODS The conception, production, scientific and clinical development of the original SSD is described. The pitfalls of track dilation in general according to method of dilation are also discussed and outlined. RESULTS This study provides evidence clarifying commonly held misconceptions about the origin of SSD which is the mainstay of the mPCNL technique. CONCLUSIONS Percutaneous renal surgery continues to evolve. In less than 40 years stone surgery has transformed from a morbid open operation to a number of minimally invasive, routine techniques. The SSD has been an innovation that has played a crucial role in this change.
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Affiliation(s)
- Frank T D'Arcy
- University of Melbourne, Department of Surgery, Austin Health, Melbourne, Victoria, Australia
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Ramón de Fata F, Hauner K, Andrés G, Angulo JC, Straub M. Miniperc and retrograde intrarenal surgery: when and how? Actas Urol Esp 2015; 39:442-50. [PMID: 25670477 DOI: 10.1016/j.acuro.2014.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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] [Received: 09/14/2014] [Revised: 09/16/2014] [Accepted: 09/17/2014] [Indexed: 01/30/2023]
Abstract
CONTEXT Extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL) are consolidated procedures for the treatment of kidney stones; however, their primary weak points are the lower efficacy of ESWL, especially for lower calyx stones, and the morbidity of PCNL resulting from the creation and dilation of the percutaneous trajectory. The increasing miniaturization of percutaneous surgery instrumentation and the development of retrograde intrarenal surgery (RIRS) are recent innovations. ACQUISITION OF EVIDENCE A structured nonsystematic review was conducted through a literature search of articles published between 1997 and 2013, using the terms kidney stones, miniperc, mini-PCNL, RIRS and flexible ureteroscopy in the PubMed, Google Scholar and Scopus databases. SUMMARY OF THE EVIDENCE RIRS requires greater surgical time, several procedures for voluminous stones and higher hospital costs, due in part to the relative fragility of the instruments. On the other hand, miniperc requires a longer hospital stay, an increased need for postoperative analgesia and a greater reduction in hemoglobin levels, although these do not translate into an increased rate of transfusions. CONCLUSIONS The current treatment of kidney stones uses minimally invasive procedures such as miniperc and RIRS. The 2 procedures are equivalent in terms of efficacy (stone clearance) and are associated with minimal complications. Comparative prospective studies are necessary to determine the position of each of these techniques in the treatment of kidney stones. In our experience, the 2 techniques are complementary and should be part of the current urological therapeutic arsenal.
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Affiliation(s)
- F Ramón de Fata
- Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, España
| | - K Hauner
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Múnich, Alemania
| | - G Andrés
- Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, España
| | - J C Angulo
- Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, España.
| | - M Straub
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Múnich, Alemania
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Hadj-Moussa M, Nepple KG, Brown JA. Comparison of a single center, academic surgeon real-world experience with three percutaneous nephrolithotomy lithotripters. Can J Urol 2014; 21:7470-7474. [PMID: 25347373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION We compared a single surgeon, single-institution experience with the Wolf Ultrasonic Model #2167.05 (Richard Wolf Medical Instruments Co., Vernon Hills, IL, USA), Lithoclast Ultra (Boston Scientific, Natick, MA, USA), and CyberWand (Gyrus/ACMI, Southborough, MA, USA) lithotripters for percutaneous nephrolithotomy (PCNL). We assessed each lithotripter's performance and durability. MATERIALS AND METHODS We conducted a retrospective chart review on 70 sequential PCNLs. Treatments were split into three cohorts based on the type of lithotripter used, Wolf (August 2003 to February 2004), Lithoclast (March 2004 to November 2008), or CyberWand (December 2008 to October 2009). Operative time, repeat PCNL procedures, lithotripter efficacy, patient body mass index (BMI), and stone-free rates (defined as < 4 mm fragment on postoperative day one noncontrast CT scan) were compared. RESULTS Sixty-one patients underwent 70 PCNLs using the Wolf (12), Lithoclast (39) or CyberWand (19). The CyberWand cohort had higher rates of obesity (74% versus 53% for Lithoclast and 45% for Wolf) and staghorn calculi (68% versus 39% for Lithoclast and 36% for Wolf). Operative time were 151 minutes (75-384, Wolf), 190 (55-360, Lithoclast) and 200 (81-387, CyberWand) cohorts. Stone-free rates were 50% (Wolf), 49% (Lithoclast) and 37% (CyberWand). PCNL was repeated within 45 days following 6 (50%) Wolf, 7 (18%) Lithoclast and 1 (5%) CyberWand procedures. Lithotripter malfunction complicated 1 Wolf (8%), 5 (13%) Lithoclast and no CyberWand PCNLs. Intraoperative complications occurred during 1 (8%) Wolf, 9 (23%) Lithoclast, and 2 (11%) CyberWand cases. CONCLUSIONS Despite treating larger stones in more obese patients, the CyberWand lithotripter had a lower malfunction and need for repeat PCNL rates. These findings suggest that the CyberWand may be a more durable lithotripter. However, the overall efficacy of each lithotripter in performing PCNL was similar.
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Karakose A, Aydogdu O, Atesci YZ. Does the use of smaller Amplatz sheath size reduce complication rates in percutaneous nephrolithotomy? Urol J 2014; 11:1752-1756. [PMID: 25194070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 03/17/2014] [Accepted: 04/10/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE To evaluate the effect of Amplatz sheath size used in percutaneous nephrolithotomy (PCNL) on postoperative outcomes, bleeding and renal impairment rates. MATERIALS AND METHODS We retrospectively evaluated the records of 91 patients who had undergone PCNL. We divided the patients into 2 groups according to Amplatz sheath size (22 and 30 French [F]) used in the PCNL procedure. Groups were retrospectively compared in terms of pre- and postoperative hemoglobin and renal function, mean nephrostomy time, mean nephrostomy tube diameter, mean operative time, mean hospitalization time and mean scopy time. RESULTS Mean operative time, mean preoperative hemoglobin and serum creatinine values were similar in 2 groups. The mean stone diameter of patients in group 1 (22F) and group 2 (30F) were 38.47 ± 11.51 mm and 37.69 ± 12.33 mm, respectively. Pre- and postoperative hemoglobin (Hb) levels were 14.52 ± 1.5 g/dL and 13.51 ± 1.4 g/dL, respectively in group 1. Pre- and postoperative Hb level were 14.23 ± 1.6 g/dL and 10.73 ± 1.7 g/dL, respectively in group 2. There was a significant difference between the two groups in terms of mean scopy time (P = .023), postoperative Hb (P = .027), postoperative creatinine (P = .032), mean nephrostomy duration (P = .019), mean nephrostomy diameter (P = .028) and hospitalization time (P = .034). There was significant difference between the two groups in bleeding requiring blood transfusion (P = .023) and residual stone (P = .035). CONCLUSION The smaller the Amplatz sheath used in PCNL, the lower kidney hemorrhage and renal function impairment happens.
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Affiliation(s)
- Ayhan Karakose
- Department of Urology, Izmir University School of Medicine, Izmir,
| | - Ozgu Aydogdu
- Department of Urology, Izmir University School of Medicine, Izmir, Turkey
| | - Yusuf Ziya Atesci
- Department of Urology, Izmir University School of Medicine, Izmir, Turkey
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Lesovoĭ VN, Savenkov VI. [Microtranscutaneous nephrolithotripsy--new possibilities in treatment of patients, suffering urolithic disease]. Klin Khir 2014:70-72. [PMID: 25417295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The results of a new method of laser microtranscutaneous puncture nephrolithotripsy application in patients, suffering nephrolithiasis, including it, occuring on background of the ureteropelvic segment stricture and formation of hydronephrosis, were analyzed. The method application permits to lower significantly or eliminate the roentgen burden on patient and surgeon. The laser microtranscutaneous puncture nephrolithotripsy is less traumatic, than a standard transcutaneous puncture nephrolithotripsy and retroperitoneal endovideoscopic pyelolithotomy.
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20
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El Harrech Y, Abakka N, El Anzaoui J, Goundale O, Touiti D. One-shot dilation in modified supine position for percutaneous nephrolithotomy: experience from over 300 cases. Urol J 2014; 11:1575-1582. [PMID: 25015601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 04/20/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE To evaluate the feasibility, safety and efficacy of one-shot dilation (OSD) in modified supine position percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS A total of 320 PCNL in a total of 291 patients were performed between October 2008 and July 2011. There were no specific exclusion criteria. Patients with kidney anomalies or solitary kidney, with history of renal surgery or extracorporeal shockwave lithotripsy (SWL), those with staghorn calculi or needing more than one access, were eligible for inclusion. Data collected included patient demographics and stone characteristics, access time, radiation exposure, total operating time, preoperative and postoperative hemoglobin concentrations, tract dilatation failures, complications and transfusions. RESULTS Mean stone size was 38 mm (16-110 mm). The mean time access was 2.1 min (range 0.7-6.2 min). Tract dilatation fluoroscopy time was 25 ± 17 sec. The targeted calix could be entered with a success rate of 97.81%. The mean hemoglobin decrease was -1.17 g/dL ± 0.84. There were no visceral, pleural, collecting systems or vascular injuries. Major complications included, transfusion in 4 (1.25%) patients, pseudoaneurysm with persistent bleeding necessitating nephrectomy in 1 (0.3%) patient and two deaths (0.62%) after surgery. There was no significant difference in successful access and complications between patients with and without previous open surgery and in those with or without staghorn stones (P > .05). CONCLUSION The use of one shot and modified supine position combines the advantages of these both methods including less radiation exposure and shorter access and operative time. The one shot dilation is safe, easy to learn, cost effective and offers a potential alternative to the standard devices particularly in developing countries.
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Affiliation(s)
- Youness El Harrech
- Department of Urology, Military Hospital Avicenna, Marrakech, Morocco. youness.elharrech@ gmail.com
| | - Najib Abakka
- Department of Urology, Military Hospital Avicenna, Marrakech, Morocco
| | - Jihad El Anzaoui
- Department of Urology, Military Hospital Avicenna, Marrakech, Morocco
| | - Omar Goundale
- Department of Urology, Military Hospital Avicenna, Marrakech, Morocco
| | - Driss Touiti
- Department of Urology, Military Hospital Avicenna, Marrakech, Morocco
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21
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Sheehan M. Monolateral purple urine bag syndrome in a patient with bilateral nephrostomy tubes. Urol Nurs 2014; 34:135-138. [PMID: 25112022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Purple urine bag syndrome (PUBS) is a constellation of findings resulting in purple discoloration of the urine and/or urine drainage bag(s) occurring in patients with long-term urinary indwelling catheters. Other causative factors may include constipation, female gender, the presence of bacteria containing sulphatase and phosphatase enzymes, and alkaline urine. While the contributing factors for PUBS are linked with high morbidity, PUBS itself is a benign condition. A case study of monolateral PUBS in a patient with bilateral nephrostomy tubes (NTs) is presented.
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22
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Llanes González L, Pérez Fentes DA, Palmero Martí JL. [Micropercutaneous nephrolithotomy (micro-PNL or microperc): a new tool in the treatment of renal lithiasis]. ARCH ESP UROL 2014; 67:225-230. [PMID: 24840586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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23
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Gonen M, Basaran B. Tubeless percutaneous nephrolithotomy: spinal versus general anesthesia. Urol J 2014; 11:1211-1215. [PMID: 24595926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 03/12/2013] [Indexed: 06/03/2023]
Abstract
PURPOSE Tubeless percutaneous nephrolithotomy (PCNL) with double-J stenting is a good option for large kidney calculi without increasing blood loss. In many centers tubeless PCNL is performed under general anesthesia. In the present study we evaluated the impact of spinal anesthesia in patients undergoing tubeless PCNL. MATERIAL AND METHODS Between February 2011 and February 2012, forty six patients with kidney calculi were treated with tubeless PCNL. Of these patients 26 were treated under spinal anesthesia (group 1) and remaining 20 were treated under general anesthesia (group 2). Groups were compared according to patient demographics, stone size, access number, operative time, presence of supracostal access, analgesic requirement, length of hospital stay, and complications. RESULTS There were not any statistically significant differences between groups in terms of patient demographics, mean stone size, mean access number, operative time, presence of supracostal access, and length of hospital stay. However, the analgesic requirement was significantly less in group 1 (53 ± 39 mg vs. 111 ± 46 mg, intravenous tramadol in groups 1 and 2, respectively P < .001). CONCLUSION Tubeless PCNL under spinal anesthesia is a good alternative for general anesthesia in adult patients. Spinal anesthesia decreases analgesic requirement in patients that were performed tubeless PCNL compared to general anesthesia.
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Affiliation(s)
- Murat Gonen
- Department of Urology, Baskent University, Konya, Turkey.
| | - Betul Basaran
- Department of Anesthesiology, Baskent University, Konya, Turkey
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Goktug HNG, Yesıl S, Ozturk U, Tuygun C, Imamoglu MA. Totally tubeless percutaneous nephrolithotomy: selecting for success in children. ADV CLIN EXP MED 2013; 22:565-570. [PMID: 23986217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The placement of a nephrostomy tube or internal ureteral stent after PCNL has been considered standard practice. OBJECTIVES To investigate the inclusion criteria for totally tubeless PCNL in pediatric cases. MATERIAL AND METHODS A total of 27 children who underwent PCNL included in the study: Twelve of the 27 patients who underwent totally tubeless PCNL (group 1; tubeless and stentless), and the remaining 15 patients underwent Standard PCNL (group 2; tube with or without stent). Whether or not to perform totally tubeless technique was decided intraoperatively. The length of hospitalization, drop in hemoglobin level, the operation time, stone burden and the fluoroscopy time of group 1 and 2 were compared statistically. Also stone free and complication rates were evaluated in both groups. RESULTS The mean age was 5 years and 9.5 years in group 1 and 2, respectively (p = 0.01). The mean operative time was 15.83 min in group 1, and 48.6 min in group 2 (p = 0.0001). The mean change in hemoglobin levels between preoperative and postoperative measurements was -1.83 mg/dl for group 1, and -5.2 mg/dl for group 2 (p = 0.0001). No blood transfusion was needed during or after the operation in any cases for group 1. The mean length of hospital stay was 1.83 day in group 1 and 5.53 day in group 2 (p = 0.001). Stone free rate for group 1 was 100% (12/12) and 93.3% (14/15) for group 2. There were no major operative or postoperative complications in both groups. CONCLUSIONS Provided an optimal patient selection, the success and safety rates of PCNL's performed via totally tubeless technique are similar to those.
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Affiliation(s)
- Hasan Nedim Goksel Goktug
- Department of Urology, Ministry of Health, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
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Tepeler A, Sarica K. Standard, mini, ultra-mini, and micro percutaneous nephrolithotomy: what is next? A novel labeling system for percutaneous nephrolithotomy according to the size of the access sheath used during procedure. Urolithiasis 2013; 41:367-8. [PMID: 23736743 DOI: 10.1007/s00240-013-0578-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 05/25/2013] [Indexed: 11/26/2022]
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26
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Kochetov AG, Sitnikov NV, Gvasaliia BR, Sidorov OV, Ponomarev VK, Borshevetskiĭ AA, Pavlov DV. [Combinative methods of treatment of patients with complicated urolithiasis]. Voen Med Zh 2013; 334:36-41. [PMID: 24000622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The authors showed that urolithiasis is the second disease after inflammatory nonspecific kidney and urinary tract diseases and has a tendency to increase. 3-5% of patients suffer this disease, and 30-40% of all patients of urology in-patients department suffer nephrolithiasis. Introduction into clinical practice of modern minimally invasive treatment methods changed the paradigm of treatment of urolithiasis, especially coral type nephrolithiasis - cause of 15-50% of all renal calculi. The authors presented results of combinative treatment of 183 patients with different complicated forms of urolithiasis. The technique of percutaneous nephrolithotripsy (in supine position) was modified. It helped to reduce complications, time of surgery and radiation exposure. The effectiveness of simultaneous contact ureterolithotripsy and percutaneous nephrolithotripsy in patients with renal or ureters calculi, and simultaneous litholysis and distance lithotripsy in patients with metabolic disorders is shown. Combinative methods of treatment of complicated forms of urolithiasis are based on modern minimally invasive technologies and are very effective.
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Lin CW, Yen TH, Cheng CL, Huang HH, Kang RJ, Gueng MK, Lin YC, Tyan YS, Tsao TF. In vivo and in vitro sonographic diagnosis of an encrusted nephrostomy catheter with color doppler twinkling artifact. J Clin Ultrasound 2013; 41:175-177. [PMID: 22323278 DOI: 10.1002/jcu.21893] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 12/28/2011] [Indexed: 05/31/2023]
Abstract
Encrustation is one of the most common complications that may develop with the use of a nephrostomy catheter. We used the color Doppler twinkling artifact to detect encrustation and obstruction of a nephrostomy catheter in vivo. This was confirmed by in vitro scanning of the catheter after analyzing the radiogram. Color Doppler twinkling artifact may provide useful information on the management of nephrostomy catheters.
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Affiliation(s)
- Ching-Wen Lin
- Department of Medical Imaging, Chung Shan Medical University Hospital, No. 110, Section 1, Chien-Kuo N Road, Taichung City 402, Taiwan
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Rosenzweig B, Mor Y, Zilberman DE, Rimon U, Garniek A. Bagless nephron-ephroureterostomy for bilateral ureteral obstruction: a simple modification to improve patients' quality of life. J Vasc Interv Radiol 2013; 24:295-6. [PMID: 23369563 DOI: 10.1016/j.jvir.2012.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/06/2012] [Accepted: 10/09/2012] [Indexed: 11/16/2022] Open
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Wang J, Zhou DQ, He M, Li WG, Pang X, Yu XX, Jiang B. One-phase treatment for calculous pyonephrosis by percutaneous nephrolithotomy assisted by EMS LithoClast master. Chin Med J (Engl) 2013; 126:1584-1586. [PMID: 23595399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Affiliation(s)
- Jian Wang
- Department of Urology, 303th Hospital of People's Liberation Army, Nanning, Guangxi 530021, China
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Bahu R, Chaftari AM, Hachem RY, Ahrar K, Shomali W, El Zakhem A, Jiang Y, AlShuaibi M, Raad II. Nephrostomy tube related pyelonephritis in patients with cancer: epidemiology, infection rate and risk factors. J Urol 2012; 189:130-5. [PMID: 23164390 DOI: 10.1016/j.juro.2012.08.094] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 08/02/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE Nephrostomy tube placement is often necessary to avert acute renal failure in patients with cancer with obstructive uropathy or in patients with ureteral leak. However, there have been limited published studies on the rate and risk of nephrostomy tube related pyelonephritis in patients with cancer. Therefore, in this study we determined rates of nephrostomy tube related pyelonephritis and predisposing risk factors in patients with cancer. MATERIALS AND METHODS We retrospectively reviewed patients who underwent nephrostomy tube placement between September 1, 2009 and September 16, 2010 at MD Anderson Cancer Center. Patients were followed for 90 days. The primary outcome assessed was the development of nephrostomy tube related pyelonephritis and the secondary outcome was the development of asymptomatic bacteriuria. We also determined risk factors associated with pyelonephritis. RESULTS Of the 200 patients analyzed 38 (19%) had pyelonephritis and 15 (7.5%) had asymptomatic bacteriuria. Of the nephrostomy tube related infections 34 cases (89%) were with the primary nephrostomy tube. Subsequently 4 of the patients who underwent nephrostomy tube exchange had an episode of pyelonephritis. Pyelonephritis developed within the first month in 19 (10%) patients. Prior urinary tract infection and neutropenia were found to be significant risk factors for pyelonephritis (p = 0.047 and 0.03, respectively). CONCLUSIONS The placement of nephrostomy tubes in patients with cancer is associated with a significant rate of pyelonephritis. Neutropenia and history of urinary tract infection were significant risk factors for pyelonephritis. This finding warrants further investigation into preventive strategies to reduce the infection rate.
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Affiliation(s)
- Ramez Bahu
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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Veeratterapillay R, Shaw MBK, Williams R, Haslam P, Lall A, De la Hunt M, Hasan ST, Thomas DJ. Safety and efficacy of percutaneous nephrolithotomy for the treatment of paediatric urolithiasis. Ann R Coll Surg Engl 2012; 94:588-92. [PMID: 23131231 PMCID: PMC3954287 DOI: 10.1308/003588412x13373405387014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2012] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Paediatric percutaneous nephrolithotomy (PCNL) has revolutionised the treatment of paediatric nephrolithiasis. Paediatric PCNL has been performed using both adult and paediatric instruments. Stone clearance rates and complications vary according to the technique used and surgeon experience. We present our experience with PCNL using adult instruments and a 28Fr access tract for large renal calculi in children under 18 years. METHODS All patients undergoing PCNL at our institution between 2000 and 2009 were reviewed. Demographics, surgical details and post-operative follow-up information were obtained to identify stone clearance rates and complications. RESULTS PCNL was performed in 32 renal units in 31 patients (mean age: 10.8 years). The mean stone diameter was 19mm (range: 5-40mm). Twenty-six cases required single puncture and six required multiple tracts. Overall, 11 staghorn stones, 10 multiple calyceal stones and 11 single stones were treated. Twenty-seven patients (84%) were completely stone free following initial PCNL. Two cases had extracorporeal shock wave lithotripsy for residual fragments, giving an overall stone free rate of 91% following treatment. There was no significant bleeding or sepsis encountered either during the operation or in the post-operative setting. No patient required or received a blood transfusion. CONCLUSIONS Paediatric PCNL can be performed safely with minimal morbidity using adult instruments for large stone burden, enabling rapid and complete stone clearance.
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Affiliation(s)
- R Veeratterapillay
- Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne NE7 7DN, UK.
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Lai D, He Y, Dai Y, Li X. Combined minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery for staghorn calculi in patients with solitary kidney. PLoS One 2012; 7:e48435. [PMID: 23119016 PMCID: PMC3484138 DOI: 10.1371/journal.pone.0048435] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 09/25/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND To present our experience with simultaneous combined minimally invasive percutaneous nephrolithotomy (MPCNL) and retrograde intrarenal surgery (RIRS) to manage patients with staghorn calculi in solitary kidney, and evaluate the safety, efficiency and feasibility of this approach. METHODOLOGY/PRINCIPAL FINDINGS The study included 20 patients with staghorn calculi in solitary kidney. Demographic characteristics, stone location and surface area were recorded. After informed consent, the patients underwent one stage MPCNL firstly. Combined second stage MPCNL and RIRS simultaneously were performed at postoperative 5-7 days. Operative parameters, stone-free rate (SFR), stone analyses and complications were evaluated. Serum creatinine (Scr), glomerular filtration rate (GFR) and chronic kidney disease (CKD) were measured preoperatively, postoperatively at 1 month, and each follow-up visit. All patients had staghorn stones involving multiple calyces. The mean stone burden was 1099.9 ± 843.95 mm(2). All patients had only one percutaneous access tract. The mean whole operative duration was 154.37 ± 32.45 min. The mean blood loss was 64 (12-140) ml. The final SFR was 90%. During the 1-month follow-up study period, four patients improved in CKD stage. Two patients who had CKD (stage 5) still needed dialysis postoperatively. Mean Scr of the rest patients preoperatively was 187.16 ± 94.12 compared to 140.99 ± 57.92 umol/L by the end of 1-month follow-up period (p = 0.019). The same findings were observed in GFR in that preoperatively it was 43.80 ± 24.74 ml/min and by the end of the 1-month follow-up it was 49.55 ± 21.18 ml/min (p = 0.05). CONCLUSIONS/SIGNIFICANCE Combined MPCNL and RIRS management effectively decrease the number and size of percutaneous access tracts, which is safe, feasible, and efficient for managing staghorn calculi in solitary kidney with satisfactory SFR and reducing blood loss, potential morbidity associated with multiple tracts. The approach did not adversely affect renal function at both short-term and long-term follow-up.
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Affiliation(s)
- Dehui Lai
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yongzhong He
- Department of Urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuping Dai
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xun Li
- Department of Urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Samad L, Zaidi Z. Tubed vs tubeless PCNL in children. J PAK MED ASSOC 2012; 62:892-896. [PMID: 23139970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To compare post-operative outcomes between tubeless and conventional large-bore nephrostomy tube drainage following percutaneous nephrolithotomy in children. METHODS The study comprised 54 patients under 14 years of age who were undergoing percutaneous nephrolithotomy at 60 renal units and met the inclusion criteria. They were randomised to placement of a 16F nephrostomy tube (Group A, 30 renal units) or tubeless drainage (Group B, 30 renal units) at the end of the procedure. Patient age, number and position of stones, operating time, change in haemoglobin, post-operative analgesia requirement, length of hospital stay and post-operative complications were compared between the two groups, using SPSS version 17 and t test. RESULTS Group A had 28 patients, while Group B had 26. The mean age in Group A was 7.2 +/- 3.2 years, and in Group B it was 6.3 +/- 3.6 years (age range 3-13 years and 1-13 years respectively). The mean size of stone was 28.6 +/- 16.7mm and 20.4 +/- 9.3mm; mean change in Hb was 0.78 +/- 0.69mg/dl and 0.63 +/- 0.54mg/dl; and the mean operating time was 54 +/- 20.7 minutes versus 66.9 +/- 22.9 minutes in the two groups respectively. There was significantly less requirement for post-operative pethidine in Group B versus Group A (p=0.01). The postoperative clearance and complications were comparable between the two groups, while the duration of hospital stay was significantly shorter in Group B compared to Group A (p=0.007). CONCLUSION Tubeless percutaneous nephrolithotomy in children is safe and effective. Post-operative analgesia requirement is less and hospital stay is shortened compared to the conventional nephrostomy placement after percutaneous nephrolithotomy.
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Affiliation(s)
- Lubna Samad
- Department of Urology, The Indus Hospital, Korangi, Karachi
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Lu Y, Ping JG, Zhao XJ, Hu LK, Pu JX. Randomized prospective trial of tubeless versus conventional minimally invasive percutaneous nephrolithotomy. World J Urol 2012; 31:1303-7. [PMID: 22903789 DOI: 10.1007/s00345-012-0921-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 07/24/2012] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of minimally invasive percutaneous nephrolithotomy (mPCNL) without nephrostomy drainage tubes. METHODS We prospectively enrolled 32 eligible patients with kidney stones at our hospital. Patients were randomly assigned to a conventional mPCNL group (ureteric Double-J stents and nephrostomy drainage tubes) or a tubeless mPCNL group (ureteric catheter but no drainage tubes). A single experienced surgeon performed all operations. RESULTS At baseline, the two groups had similar age, maximum stone diameter, and gender distribution. There were no significant differences in operation time, presence of postoperative fever, stone clearance, and level of postoperative serum hemoglobin. However, the tubeless mPCNL group had significantly shorter hospital stays (3 vs. 4 days, p = 0.032) and significantly less back pain (5 patients vs. 14 patients, p = 0.003) than the conventional mPCNL group. CONCLUSIONS No significant differences were found between conventional and tubeless mPCNL in safety issues and stone clearance rate. However, patients treated with tubeless mPCNL had shorter hospitalization stays and were less likely to experience back pain.
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Affiliation(s)
- Yong Lu
- Department of Urology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, People's Republic of China,
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Xu GN, Zhao W, Xia HB, Meng JC, Xie L, Xia SJ. [Research and animal experiment of a remote-control locating device under the radiographic guidance for percutaneous nephrolithotomy]. Zhonghua Yi Xue Za Zhi 2012; 92:2002-2004. [PMID: 22944279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To introduce an independently developed remote-control locating device under the radiographic guidance for percutaneous nephrolithotomy (PCNL) and conduct small-scale animal experiment to test its application effect. METHODS Five experimental minipigs were selected. And an animal model of nephrolithotomy was established by implanting stones from outside the body. This locating device for PCNL was used to locate before puncture under the radiographic guidance and then begin puncturing to the target stone following the located angle. RESULTS Four pigs achieved single puncture after localization. During the puncture process, no obvious hemorrhage occurred. The average time from starting locating to finishing puncture was 20.7 min, the average time of locating 15.6 min and the average time of puncture 5.1 min. CONCLUSIONS This remote-control type of locating device can improve the accuracy and safety of puncture and minimize the radioactive exposure to operators. Thus it has an excellent perspective of further development and clinical application.
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Affiliation(s)
- Guang-nian Xu
- Department of Urology, Shanghai First People's Hospital, Shanghai, China
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Shergill IS, Abdulmajed MI, Moussa SA, Rix GH. The 3-finger technique in establishing percutaneous renal access: a new and simple method for junior trainees. J Surg Educ 2012; 69:550-553. [PMID: 22677596 DOI: 10.1016/j.jsurg.2012.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 02/11/2012] [Accepted: 03/17/2012] [Indexed: 06/01/2023]
Abstract
INTRODUCTION AND OBJECTIVES Urology trainees may lack experience in gaining renal access during percutaneous nephrolithomy (PCNL). Establishing the correct depth of initial percutaneous needle insertion is one of the major obstacles. As such, we have identified an easy technique, which can be performed, to establish correct depth adjustment allowing easier access. MATERIALS AND METHODS An initial attempt is made to insert the percutaneous needle into the desired posterior calyx in the antero-posterior (AP) plane. If the needle does not traverse into the desired calyx immediately, it is concluded that the needle track must be too shallow or too deep. The C-arm is then rotated 20 to 30 degrees from the vertical, in the axial plane, towards the operating surgeon and, using the image intensifier, very careful note is made of the end of the needle in this plane, compared with the end of the needle initially in the AP plane, to see if it has moved "medially" or "laterally." The 3-finger technique is then performed by the surgeon, to establish if the needle path is too deep or too shallow. This technique is currently being performed by trainees under direct consultant supervision with 13 successful cases so far. RESULTS The 3-finger technique has been successfully used to demonstrate and teach PCNL access to urology trainees. In all 13 cases, percutaneous renal access was achieved successfully by trainees without immediate or late complications. Also, positive and encouraging feedbacks were received from those trainees, and all expressed willingness to continue using the same new technique in the future. CONCLUSIONS Our new technique is cheap, safe, easy to learn and use, and of particular benefit to junior trainees who are beginning to perform PCNL access.
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Affiliation(s)
- Iqbal S Shergill
- Department of Urology, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, North Wales, United Kingdom
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Mandal S, Goel A, Gupta DK. Re: Jens J. Rassweiler, Michael Müller, Markus Fangerau, et al. iPad-assisted percutaneous access to the kidney using marker-based navigation: initial clinical experience. Eur Urol 2012;61:628-31. Eur Urol 2012; 61:e57; author reply e58. [PMID: 22464309 DOI: 10.1016/j.eururo.2012.03.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 03/14/2012] [Indexed: 11/28/2022]
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Etemadian M, Maghsoudi R, Shadpour P, Mokhtari MR, Rezaeimehr B, Shati M. Pediatric percutaneous nephrolithotomy using adult sized instruments: our experience. Urol J 2012; 9:465-471. [PMID: 22641489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of pediatric percutaneous nephrolithotomy (PCNL) using adult sized instruments in the management of pediatric urolithiasis. MATERIALS AND METHODS We retrospectively reviewed the medical records of 38 children younger than 15 years who had undergone 45 PCNLs with adult sized instruments in our center between August 2007 and February 2010. RESULTS There were 26 boys and 12 girls, with a mean age of 8.4 ± 4.24 years (range, 12 months to 13 years). Twelve patients had complete staghorn stone. Mean stone burden was 2.93 ± 0.89 cm. The tract was dilated between 26 and 30F. Standard PCNL was performed in 8 patients and tubeless PCNL in the next 37 subjects. Simultaneous transurethral lithotripsy was done in 9 patients. Stone clearance rate was 67%. Mean pre and postoperative hemoglobin levels were 12.67 ± 1.7 and 11.39 ± 1.6 g/dL, respectively. Mean hospitalization was 3.5 ± 1.1 days. Eight subjects had postoperative fever beyond day 1. Blood transfusion was required in only one patient. In one patient (3 years old) with a staghorn stone, hyponatremia and seizure occurred, which were treated conservatively without any adverse sequela. There was a significant difference in hospital stay between tubeless and standard PCNL groups (P < .02). CONCLUSION We concluded that PCNL using adult sized instruments was relatively safe in children, with a clearance rate of 67%. We suggest prospective randomized studies to compare mini-perc and adult sized instruments use in pediatric PCNL.
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Affiliation(s)
- Masoud Etemadian
- Hasheminejad Clinical Research Development Center (HCRDC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Rassweiler JJ, Müller M, Fangerau M, Klein J, Goezen AS, Pereira P, Meinzer HP, Teber D. iPad-assisted percutaneous access to the kidney using marker-based navigation: initial clinical experience. Eur Urol 2011; 61:628-31. [PMID: 22209052 DOI: 10.1016/j.eururo.2011.12.024] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 12/13/2011] [Indexed: 11/17/2022]
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Chen L, Li JX, Yang B, Hu WG, Huang XB, Wang XF. [Impacts of different nephrostomy tubes and their fixation ways on patients with nephrolithiasis complicated with renal insufficiency after percutaneous nephrolithotomy]. Beijing Da Xue Xue Bao Yi Xue Ban 2011; 43:878-881. [PMID: 22178838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To investigate impacts of different nephrostomy tubes and their fixation ways on patients with nephrolithiasis complicated with renal insufficiency after percutaneous nephrolithotomy. METHODS A total of 72 renal insufficiency patients were enrolled in this study, who were randomized into three groups with 24 patients in each group according to nephrostomy tube diameter and its fixation way: Group I, i.e. stretch group with 14 Fr silicon tube (Urovision)with balloon; Group II, i.e. not strech group with 14 Fr silicon tube (Urovision) with balloon; Group III, i.e. not strech group with 20Fr latex tube without balloon. The data collected included preoperative serum cretinine, hemoglobin value, midstream urine culture, stone volume, and operative time, and number of operative tract. It was also recorded that the change of hemoglobin between preoperation and 24 h or 72 h postoperation, presence of postoperative extravasation, systemic inflammatory respose syndrome, narcotic usage and blood transfusion. RESULTS There were no statistically significant differences among the three groups in terms of the incidence of postooperative extravasation (P=0.301), SIRS(P=0.099) and narcotic usage (P=0.898). In the aspects of the change of hemoglobin between preoperation and 24 h or 72 h postoperation, there were significant differences between group I and group II (P=0.001, P=0.009) or group III (P=0.021, P=0.003). No difference was found between groups II and III (P=0.989, P=0.962). In the aspect of blood transfusion cases, group I (1 case) < group III (6 cases) < group II (10 cases). The number of patients needing blood transfusion in group I was significantly lower than that in group II (P=0.002), but the differences between group III and group I (P=0.102) or group II (P=0.221) were not statistically significant. CONCLUSION It is worth recommending indwelling 14 Fr silicon nephrostomy tube with balloon oppressing the operative tracts, because it could reduce blood loss 24 h and 72 h after operation in patients with nephrolithiasis complicated with renal insufficiency.
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Affiliation(s)
- Liang Chen
- Department of Urology, Peking University People's Hospital, Beijing 100044, China
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Knoll T, Jessen JP, Honeck P, Wendt-Nordahl G. Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10-30 mm size. World J Urol 2011; 29:755-9. [PMID: 22037633 DOI: 10.1007/s00345-011-0784-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 10/06/2011] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The value of flexible ureterorenoscopy (fURS) and miniaturized PNL (mPNL) for larger renal calculi is under discussion. This non-randomized prospective study aimed to evaluate fURS and mPNL for solitary renal stones of 10-30 mm size. MATERIALS AND METHODS fURS was carried out in 21 patients with last generation 7.5F endoscopes. Ureteral access sheaths were used in 19 patients. For mPNL, an 18F modified Amplatz sheath with a 14F nephroscope were used (n = 25). The procedure was performed either tubeless with an antegrade stent or a nephrostomy. Outcome and complications of both procedures were assessed. RESULTS Patients' demographics and stone sizes were comparable (18 ± 5 vs. 19 ± 4 mm, P = 0.08). Patients in the fURS group had a higher mean BMI (31 vs. 27, P < 0.05). Total OR time was significantly longer for fURS (106 ± 51 vs. 59 ± 19 min., P < 0.001). More patients were stone-free after one single percutaneous treatment, while 2nd-stage treatments with fURS were common (total procedures 1.04 vs. 1.52, P < 0.001; immediate stone-free rate (SFR) 96% vs. 71.5%, P < 0.001). SFR after 4 weeks was 100% (mPNL) and 85.8% (fURS) (P < 0.01). Minor complications as classified by Clavien I or II occurred in 16 and 23.8%, mPNL and fURS, respectively, P = 0.13). No major complications (Clavien III-V) occured in both groups. CONCLUSIONS Our series supports both the concept of either percutaneous or retrograde endoscopic treatment for renal calculi with both modalities offering excellent safety. However, while for fURS, a significantly higher rate of 2nd-stage procedures was necessary, and mPNL led to faster and higher SFR without increasing complication rate.
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Affiliation(s)
- Thomas Knoll
- Department of Urology, Klinikum Sindelfingen-Boeblingen Medical Center, University of Tübingen, Arthur-Gruber-Str. 70, 71065, Sindelfingen, Germany.
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Li JY, Cui Z, Gao XF, Jiang JY, Jing TL, Shi L, Peng YH, Sun YH. Re: Markus J. Bader, Christian Gratzke, Michael Seitz, et al. The "all-seeing needle": initial results of an optical puncture system confirming access in percutaneous nephrolithotomy. Eur Urol 2011;59:1054-9. Eur Urol 2011; 60:e42-3; author reply e44. [PMID: 21855210 DOI: 10.1016/j.eururo.2011.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Accepted: 07/15/2011] [Indexed: 11/16/2022]
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Resorlu B, Kara C, Ozyuvali E, Unsal A. Percutaneous nephrolithotomy in hypertensive patients with different sizes of instruments. Acta Chir Belg 2011; 111:228-231. [PMID: 21954739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The risk of major complications, especially hemorrhage, is significantly elevated during surgery in hypertensive patients. To determine whether percutaneous nephrolithotomy (PCNL) can be safely performed in the hypertensive patients using different sized instruments. METHODS We reviewed the records of 602 patients undergoing PCNL at our institution and identified 53 who were on antihypertensive therapy at the time of surgery. Patients were categorized into three groups according to size of devices used in surgery : those 24 F percutaneous tract with 22 F nephroscope (Group 1, n = 12 [22.7%]; 26 F percutaneous tract with 24 F nephroscope (Group 2, n = 19 [35.8%]) and 30 F percutaneous tract with 26 F nephroscope (Group 3, n = 22 [41.5%]). We compared the groups with regard to baseline characteristics, intraoperative parameters, stone-free and complication rates, and the length of hospitalization. RESULTS There were no differences between the three groups in age, gender, weight and stone laterality. Fluoroscopy time, access to the collecting system and mean operative time for per cm2 stone did not differ between the groups. Hemoglobin decrease, postoperative hospital stay and blood transfusion rate was higher in group 3. Stones were completely cleared in 83.3%, 84.2% and 81.3% of patients, which increased to 91.6%, 89.5%, and 90.1% with adjunctive therapy in the group 1,2 and 3, respectively. CONCLUSIONS PCNL with smaller devices is a safe and effective method in hypertensive patients. It has significantly a shorter hospital stay and less bleeding rates compared to classical PCNL.
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Affiliation(s)
- B Resorlu
- Kecioren Training and Research Hospital, Department of Urology, Ankara, Turkey.
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Bader MJ, Gratzke C, Seitz M, Sharma R, Stief CG, Desai M. The "all-seeing needle": initial results of an optical puncture system confirming access in percutaneous nephrolithotomy. Eur Urol 2011; 59:1054-9. [PMID: 21477921 DOI: 10.1016/j.eururo.2011.03.026] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 03/16/2011] [Indexed: 12/26/2022]
Abstract
BACKGROUND In percutaneous nephrolithotomy (PNL), the best possible way to access the collecting system is still a matter of debate. There is little possibility of correcting a suboptimal access. OBJECTIVE To describe our initial experience using a micro-optical system through a specific puncture needle to confirm the quality of the chosen access prior to dilatation of the operating tract. DESIGN, SETTING AND PARTICIPANTS Micro-optics of 0.9- and 0.6-mm diameter were used. The micro-optic with integrated light lead was inserted through the working sheath of the puncture needle. The modified needle had a 1.6-mm (4.85-Fr) outer diameter. The optical fiber was connected via a zoom ocular and light adapter to a standard endoscopic camera system. For sufficient intraoperative sight, an irrigation system was connected. INTERVENTION The optical puncture needle was used in 15 patients for renal access prior to standard PNL procedures. MEASUREMENTS The optical assessment included determination of the distortion, resolution, angle, and field of view. The irrigation flow was assessed in an ex vivo setting, with the puncture stylet or the needle shaft either empty or with a 0.018-in guidewire inserted. RESULTS AND LIMITATIONS In all cases, visualization of the punctured kidney calyces was successful and the presence of the target calculi could be confirmed prior to guidewire placement and tract dilation. The 0.9-mm optic was found to be significantly superior in all optical parameters in contrast to the 0.6-mm optic. No significant complications were observed. CONCLUSIONS The optical puncture needle for PNL appears to be most helpful for confirming the optimal percutaneous access to the kidney prior to dilation of the nephrostomy tract, improving the safety of the technique.
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Affiliation(s)
- Markus J Bader
- Department of Urology, Ludwig Maximilians Universität München, Campus Grosshadern, Munich, Germany
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Etemadian M, Soleimani MJ, Haghighi R, Zeighami MR, Najimi N. Does bleeding during percutaneous nephrolithotomy necessitate keeping the nephrostomy tube? A randomized controlled clinical trial. Urol J 2011; 8:21-26. [PMID: 21404198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE To compare outcomes in two groups of patients with kept and discarded nephrostomy tube after percutaneous nephrolithotomy (PCNL) complicated with bleeding. MATERIALS AND METHODS Two hundred patients who had undergone PCNL complicated with hemorrhage were recruited in this study. Patients were randomly allocated to two groups: group A, who underwent tubeless PCNL and tract port was packed for 3 to 4 minutes after removing Amplatz sheath, and group B, for whom a 24-F nephrostomy tube was left in place at the end of the procedure. Patients were followed up for 3 months to check if bleeding occurred. RESULTS The mean operation time was 68 ± 4.3 minutes in group A and 74 ± 5.6 minutes in group B (P = .098). The mean stone size was similar in groups A and B (36.26 ± 5.3 mm versus 35.35 ± 5.85 mm; P = .613). The mean hemoglobin drop was 3.65 ± 1.20 g/dL in group A and 3.13 ± 1.06 g/dL in group B. There was no significant difference between the mean of stone free rate in groups A and B (92.58% ± 5.97 versus 89.60% ± 8.3; P = .210). Patients in group A experienced a significantly less duration of hospitalization than group B (2.42 ± 0.84 days versus 3.70 ± 0.80 days; P < .001). CONCLUSION In the absence of clear indication, nephrostomy tube insertion after PCNL does not seem to be beneficial, and its removal does not pose patients at any additional risk.
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Affiliation(s)
- Masoud Etemadian
- Department of Urology, Hasheminejad Kidney Center, Tehran University of Medical Sciences, Tehran, Iran.
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Yang B, Li JX, Hu WG, Huang XB, Wang XF. [Standard-tract percutaneous nephrolithotomy accessed by two-step dilation for 3052 patients]. Beijing Da Xue Xue Bao Yi Xue Ban 2010; 42:447-450. [PMID: 20721261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To evaluate the efficacy and morbidity of 24F-tract percutaneous nephrolithotomy (PNL) accessed by two-step dilation. METHODS A total of 3052 patients with 3 366 kidneys or upper ureter calculi underwent 24F-tract PNL accessed by two-step dilation between Aug., 2003 and Jan., 2008, including 108 patients with solitary kidney, 68 with kidney cysts, 44 with horseshoe kidney, 26 with vertebral column deformity, 24 with medullary sponge kidney and 1 transplanted kidney. Stone burdens were (47.2+/-35.6) mm in length. RESULTS 99.4% of 3740 operations were successful in one-session access,in which 3348 PNLs were accessed by single tract (89.5%), 366 by double tracts (9.7%) and 26 by triple tracts (0.7%). The mean operating time was (68.4+/-30.9) min, the mean first accessing time were (17.6+/-11.1) min. and the mean calculi-dealing time were (35.0+/-55.3) min. The stone-free rate after one session operation was 100% for single calculus and 72.3% for multiple or staghorn calculi. of all the kidneys, 374 (11.1%) accepted another PNL to remove the residual calculi, and the last stone-free rate of PNL was 88.6%. During and after operation, 52 cases (1.4%) needed transfusion, 12 (0.3%) underwent selective embolization of renal artery and 1 (0.03%) accepted nephrectomy for bleeding control. No injury of organs occurred except for 3 cases with pneumatothorax and 19 (0.5%) with urinary extravazation. No septic shock occurred. CONCLUSION 24F-tract PNL accessed by two-step dilation wtih ultrasound-guided puncture is effective and safe.
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Affiliation(s)
- Bo Yang
- Department of Urology, Peking University People's Hospital, Beijing 100034, China
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Unsal A, Resorlu B, Kara C, Bozkurt OF, Ozyuvali E. Safety and efficacy of percutaneous nephrolithotomy in infants, preschool age, and older children with different sizes of instruments. Urology 2010; 76:247-52. [PMID: 20022089 DOI: 10.1016/j.urology.2009.08.087] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 07/31/2009] [Accepted: 08/22/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare the morbidity and success rates among different age groups of children undergoing percutaneous nephrolithotomy (PCNL) using adult- or pediatric-sized devices. PCNL for renal stones in children may present problems because of small size, mobility of the pediatric kidney, and the small size of the collecting system. METHODS Patients were categorized into 2 age groups: those < or =7 years old at the time of PCNL (group 1, n = 17 [38.6%]), and those 8-16 years old (group 2, n = 27 [61.4%]). Group 2 children were further divided into subgroups according to the use of pediatric- (group 2a, n = 12 [27.3%]) or adult-sized devices (group 2 b, n = 15 [34.1%]). RESULTS Mean patient age was 4.1, 11.7, and 13.2 years in groups 1, 2a, and 2b, respectively. Fluoroscopy time, time to access the collecting system, operative time, and average postoperative hospital stay did not differ between the groups. However, hemoglobin decrease, bleeding during surgery, and blood transfusion rate was higher in group 2b. Stones were completely cleared in 82.4%, 83.3%, and 81.3% patients, and these percentages increased to 94.1%, 91.7%, and 93.7% with adjunctive shock wave lithotripsy and ureterorenoscopy in groups 1, 2a, and 2b, respectively. CONCLUSIONS Endourologic intervention in children usually requires instruments specific for preschool age; however, in older children with dilated collecting system, the use of adult instruments and techniques may achieve equal results.
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Affiliation(s)
- Ali Unsal
- Department of Urology, Kecioren Training and Research Hospital, Ankara, Turkey
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Noble MJ. Editorial comment. Urology 2010; 76:252-3; author reply 253. [PMID: 20599123 DOI: 10.1016/j.urology.2009.09.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 09/28/2009] [Accepted: 09/29/2009] [Indexed: 11/19/2022]
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