Comparison stone-free rate and effects on quality of life of percutaneous nephrolithotomy and retrograde intrarenal surgery for treatment of renal pelvis stone (2–4 cm)

Abstract Background Urolithiasis has a well documented common occurrence in the general population. Percutaneous nephrolithotomy (PCNL), has prevailed over other more morbid procedures, like open surgeries in the management of such stones PNL in complex renal stones is a challenging procedure because it requires considerable experience in gaining percutaneous tracts, performing delicate and judicious intrarenal manipulations, mastering all techniques of intracorporeal stone disintegration, and weighing the benefits of complete stone clearance against the risks of complications. Aim of the Work GSS and Nephrolithometric Nomogram. Scoring system in predicting PCNL outcomes. The ability of the GSS and STONE score to correlate with the post-operative change in the quality of life. Patients and Methods In a non-randomized prospective study we evaluated the two scoring systems Guy’s and S.T.O.N.E. nephrolithometry scoring systems in predicting the success rate of PCNl and the quality of life. This study included 100 patients with renal stones who were scheduled for PCNL at El Demerdash University Hospitals and Nasser institute hospital in the period from April 2017 to October 2018. Results Our study included 100 patients (34 were female, 66 were male) with a mean age of 46.16 (range from 28 to 68). The mean GUY score was 1.57± 0.73 and the mean STONE score was 5.76± 1.19.the overall stone free rate was 89% with a complication rate of 18% with a mean stone burden <400 mm.GUY and STONE score were able to predict SFR and complications after PCNL. Conclusion Both GSS and S.T.O.N.E Nephrolithometry Score can be used to stratify the complexity of renal stone before PCNL to predict the stone clearance and complication. Both can be valuable tools for providing uniformity for comparison of outcome, proper planning of the surgery and preoperative counseling of the patient.

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Percutaneous-Based Management of Staghorn Calculi in Solitary Kidney: Combined Mini Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery

Urologia Internationalis ◽

10.1159/000360708 ◽

2014 ◽

Vol 94 (1) ◽

pp. 70-73 ◽

Cited By ~ 8

Author(s):

Wen Zhong ◽

Zhijian Zhao ◽

Liang Wang ◽

Sunil Swami ◽

Guohua Zeng

Keyword(s):

Percutaneous Nephrolithotomy ◽

Operation Time ◽

Solitary Kidney ◽

Retrograde Intrarenal Surgery ◽

Staghorn Calculi ◽

Combined Use ◽

Stone Free Rate ◽

Group 2 ◽

Free Rate ◽

Group 1

Introduction: Mini percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) are well-established techniques with little morbidity. The combined use of standard PCNL and the mini-PCNL or the RIRS technique was evaluated and compared to investigate their own role in the management of staghorn calculi in solitary kidney. Materials and Methods: 23 patients received combined standard PCNL and mini-PCNL (group 1), and 22 patients received combined standard PCNL and RIRS (group 2). The treatment results and complications were evaluated and compared. Results: The mean operation time was 128.8 ± 9.1 min in group 1 and 109.8 ± 10.7 min in group 2 (p < 0.001). The decrease in hemoglobin level in group 1 was significantly higher than that in group 2 (3.5 ± 0.6 vs. 2.1 ± 0.5 g/dl, p < 0.001). The final stone-free rate was significantly higher (p = 0.038) in group 2 (90.9%) than in group 1 (65.2%). Conclusions: Combined standard PCNL and RIRS technique can extract the majority of staghorn calculi quickly by PCNL with EMS Lithoclast, and RIRS used simultaneously can reduce the need for multiple tracts and therefore reduce blood loss and potential morbidity related to multiple tracts, shorten the operation time and achieve a high stone-free rate.

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Study of the safety and efficacy of minimally invasive percutaneous nephrolithotomy in the management of large and complex renal stone

International Surgery Journal ◽

10.18203/2349-2902.isj20200812 ◽

2020 ◽

Vol 7 (3) ◽

pp. 725

Author(s):

Rushabhkumar C. Somani ◽

Chirag K. Sangada

Keyword(s):

Minimally Invasive ◽

Percutaneous Nephrolithotomy ◽

Renal Pelvis ◽

Urinary Calculi ◽

P Value ◽

Safety And Efficacy ◽

Stone Free Rate ◽

Duration Of Surgery ◽

Minimally Invasive Percutaneous Nephrolithotomy ◽

Free Rate

Background: Nephrolithiasis is highly prevalent across all demographic groups in the india and beyond, and its incidence rates are rising. In addition to the morbidity of the acute event, stone disease often becomes a lifelong problem that requires preventative therapy to diminish ongoing morbidity. Objective of this study to evaluate the safety and efficacy of minimally invasive percutaneous nephrolithotomy (PCNL) in the management of large and complex renal stone.Methods: This retrospective study includes 75 renal calculi patients with 100 renal units with large and complicated stone >20 mm. Stones were classified into simple (isolated renal pelvis or isolated calyceal stones) or complex (partial or complete stag horn stones, renal pelvis stones with accompanying calyceal stones). Then various parameter like decrease haemoglobin, surgical complication, creatinine level, duration of surgery etc were compared between simple and complex stones patients by calculation p value using online student t test calculator. P value less than 0.01 considered as a difference of significance.Results: The mean stone size was 35.5±20.37 mm and mean operative duration was 60±35.3 min. In all, cases 60 (80%) were stone-free after the first procedure and another 10 needed an auxiliary procedure (5 second-look PCNL, 3 extracorporeal shockwave lithotripsy-ESWL, 2 ureterorenoscopy, and) to become stone-free, resulting in a 93.33% stone-free rate. Complications occurred in 9 procedures (12%).Conclusions: From this study, it would be concluded that Minimally invasive PCNL provided significantly higher stone-free rate and efficiency quotient for management of urinary calculi. Overall complications are usually observed in patients having intraoperative hypotension and increased intra operative time.

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Quality of life in patients with ureterolithiasis

Experimental and Сlinical Urology ◽

10.29188/2222-8543-2020-13-4-42-49 ◽

2020 ◽

Vol 13 (4) ◽

pp. 42-49

Author(s):

V.V. Protoschak ◽

◽

M.V. Paronnikov ◽

A.O. Kiselev ◽

◽

...

Keyword(s):

Quality Of Life ◽

Clinical Efficacy ◽

Early Postoperative Period ◽

Life Questionnaire ◽

Stone Size ◽

Sf 36 ◽

Stone Free Rate ◽

Before And After ◽

Free Rate

Introduction. In modern scientific literature it is becoming increasingly popular to study Quality of Life (QoL) index as an integral indicator of the entire therapeutic complex. QoL along with physical examination, laboratory and instrumental tests allows a doctor to fully assess patient’s condition. That is why the QoL researches has been recently become more and more widespread in the scientific papers. Aim. The aim of this study was to determine applicability of the Wisconsin Stone Quality of Life Questionnaire (WISQOL) and the SF-36 General Questionnaire for evaluating treatment outcomes and postoperative follow-up in patients with ureterolithiasis. Materials and methods. 123 patients with diagnosed urolithiasis (ureteral stone) were included in the study. Clinical efficacy of the shock wave lithotripsy (SWL) and contact (laser) ureterolithotripsy (CLT) was assessed after 1 week, 1 and 3 months using stone free rate (SFR). To analyze clinical factors influencing patients QoL, differences in the WISQOL and SF-36 total scores and scores before and after treatment were compared. At the third step, the dynamics of QoL indicators at different stages of treatment was analyzed. Results. The SFR at 1 week, 1 and 3 months after SWL and CLT were 47,1%, 58,8%, 72,5% and 6,4%, 84,7, 93,1% respectively. Gender, age, stone size and the Stone Free Rate achieved during treatment had a significant effect on QoL (p <0.05), while localization and density of a stone showed no effect. According to the WISQOL and SF-36 questionnaire, 1 week after CLT patients had lower levels of QoL, than after SWL (p < 0.05), but after 1 month the QoL for SWL and CLT reached the same levels and by 3 months became submaximal. Conclusions. Despite the higher rates of clinical efficacy, CLT showed lower QoL levels in the early postoperative period. Male sex, age up to 40 years, stone size more than 7 mm, and not achieved SFR during treatment contribute to lower QoL. To assess the dynamics of QoL levels in patients with ureterolithiasis, it is advisable to use the WISQOL.

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Does the Composition of the Stones Counts in Patients Who Underwent Percutaneous Nephrolithotomy?

Revista de Chimie ◽

10.37358/rc.19.3.7054 ◽

2019 ◽

Vol 70 (3) ◽

pp. 1023-1025

Author(s):

Ciprian Todea-Moga ◽

Orsolya Martha ◽

Ioan Scarneciu ◽

Camelia Cornelia Scarneciu ◽

Laurian Maxim ◽

...

Keyword(s):

Chemical Composition ◽

Postoperative Complications ◽

Percutaneous Nephrolithotomy ◽

Renal Pelvis ◽

Kidney Stones ◽

Average Length ◽

Intraoperative Complications ◽

Stone Free Rate ◽

Length Of Hospitalization ◽

Free Rate

The aim of this study is to highlight the importance of percutaneous nephrolithotomy (PCNL) in the treatment of kidney stones with different chemical composition. We included in this study 200 patients with kidney stones who underwent PCNL. In most of the cases the stones were composed by calcium, usually calcium oxalate followed by struvite and uric acid component. The stones were mostly localized in the renal pelvis (142), inferior calyx (46) and ureteropelvic junction (4) and 28 cases with staghorn stones. Intraoperative complications were: migrating fragments (22%), hemorrhage (12%), lesions of the renal pelvis and difficulties of percutaneous access or dilatation (6%). The postoperative complications were: bleeding (20%), obstruction caused by stone fragments (22.5%), hydronephrosis (18%), fistula (13%). The average length of hospitalization after PCNL was 5.58 +/- 2.69 days SD. Stone-free rate was: 77.5%. PCNL is a safe and effective method of treatment for large and complex stones. Intra and postoperative complications after PCNL are not influenced directly by the chemical composition of the stones. It is important to evaluate the chemical composition of the stones in order to establish the treatment management and to recommend a proper conservative treatment in order to prevent the recurrence of the disease.

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Comparison of the stone-free rates of mini-percutaneous nephrolithotomy, standard percutaneous nephrolithotomy, and retrograde intrarenal surgery for renal stones: A systematic review and network meta-analysis

10.21203/rs.3.rs-16120/v1 ◽

2020 ◽

Author(s):

Dong Hyuk Kang ◽

Kang Su Cho ◽

Doo Yong Chung ◽

Won Sik Jeong ◽

Hae Do Jung ◽

...

Keyword(s):

Systematic Review ◽

Percutaneous Nephrolithotomy ◽

Meta Analysis ◽

Renal Stones ◽

Research Quality ◽

Observational Research ◽

Success Rates ◽

Retrograde Intrarenal Surgery ◽

Stone Free Rate ◽

Free Rate

Abstract Background: Retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are performed to treat renal stones. PCNL is effective for kidney stones >2 cm but is invasive compared with RIRS. Miniature PCNL (mPCNL) has been used as an alternative treatment for conventional PCNL, and employs a miniature endoscope of 11–18 Fr. We conducted a systematic review of published studies regarding the RIRS, PCNL, and mPCNL treatment modalities, and performed a network meta-analysis of the success or stone-free rates.Methods: The data collected up to January 2016 were searched using PubMed and EMBASE, and references were searched electronically. Two researchers used data extraction formats to extract data on the stone-free or success rates, study design, number of subjects and characteristics, and treatments for renal stones (i.e., RIRS, PCNL, and mPCNL). To evaluate the quality of the studies, the Downs and Black checklist, which is an observational research quality evaluation tool, was used and analyzed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Results: Twenty-five studies were used to compare the stone-free or success rates of RIRS, PCNL, and mPCNL for renal stones. Six comparisons of PCNL and mPCNL, seven of mPCNL and RIRS, and 12 of RIRS and PCNL were analyzed. No difference in the stone-free rate was found between PCNL and mPCNL (OR: 0.95; 95% CI: 0.51–1.9) in network mata-analysis. Between RIRS and mPCNL, the stone-free rate of RIRS was lower than mPCNL (OR: 0.41; 95% CI: 0.021–0.82). Comparison of RIRS and PCNL revealed that RIRS was also lower than PCNL in terms of stone-free rate (OR: 0.43; 95% CI: 0.22–0.82). In the ranking analysis, rankogram showed that mPCNL was ranked as No. 1 and PCNL was ranked as No. 2. The P-score was 0.820 for mPCNL, 0.680 for PCNL and 0 for RIRS.Conclusions: PCNL and mPCNL showed higher success or stone-free rates than RIRS for the treatment of renal stones. However, PCNL and mPCNL showed no difference in the treatment outcome.

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Efficacy and safety of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for treatment of large renal stones: a meta-analysis

Journal of International Medical Research ◽

10.1177/0300060520983136 ◽

2021 ◽

Vol 49 (1) ◽

pp. 030006052098313

Author(s):

Tie Mao ◽

Na Wei ◽

Jing Yu ◽

Yinghui Lu

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Percutaneous Nephrolithotomy ◽

Meta Analysis ◽

Renal Stones ◽

Efficacy And Safety ◽

Complementary Treatment ◽

Laparoscopic Pyelolithotomy ◽

Stone Free Rate ◽

Free Rate

Background We aimed to compare the efficacy and safety of laparoscopic pyelolithotomy (LPL) versus percutaneous nephrolithotomy (PCNL) for treating renal stones larger than 2 cm. Methods We searched the PubMed, Embase, Web of Science, SinoMed, and Chinese National Knowledge Infrastructure databases for studies that compared the surgical outcomes of LPL and PCNL. We conducted a meta-analysis of the retrieved studies, expressed as weighted mean difference or risk ratios with 95% confidence intervals. Results We included 25 studies (1831 patients). LPL was associated with a significantly higher stone-free rate, lower rates of blood loss, complementary treatment, blood transfusion, and complications, and less reduction in hemoglobin level compared with PCNL. LPL and PCNL were similar in terms of duration of hospital stay, conversion rate, changes in glomerular filtration rate and creatinine level, and mean time of postoperative analgesia. However, LPL was associated with a longer operation time than PCNL. Conclusion LPL appears to be more effective and safer than PCNL in patients with large renal stones, by increasing the stone-free rate and reducing blood loss, complementary treatment, blood transfusion, and complications compared with PCNL. LPL may thus be a useful modality for treating patients with large renal stones.

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External validation of the R.I.R.S. scoring system to predict stone-free rate after retrograde intrarenal surgery

BMC Urology ◽

10.1186/s12894-021-00801-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Cong Wang ◽

ShouTong Wang ◽

Xuemei Wang ◽

Jun Lu

Keyword(s):

Scoring System ◽

Kidney Stone ◽

Medical Center ◽

External Validation ◽

Retrograde Intrarenal Surgery ◽

Stone Burden ◽

Stone Free Rate ◽

Stone Density ◽

Free Rate ◽

Free Status

Abstract Background The R.I.R.S. scoring system is defined as a novel and straightforward scoring system that uses the main parameters (kidney stone density, inferior pole stones, stone burden, and renal infundibular length) to identify most appropriate patients for retrograde intrarenal surgery (RIRS). We strived to evaluate the accuracy of the R.I.R.S. scoring system in predicting the stone-free rate (SFR) after RIRS. Methods In our medical center, we retrospectively analyzed charts of patients who had, between September 2018 and December 2019, been treated by RIRS for kidney stones. A total of 147 patients were enrolled in the study. Parameters were measured for each of the four specified variables. Results Stone-free status was achieved in 105 patients (71.43%), and 42 patients had one or more residual fragments (28.57%). Differences in stone characteristics, including renal infundibulopelvic angle, renal infundibular length, lower pole stone, kidney stone density, and stone burden were statistically significant in patients whether RIRS achieved stone-free status or not (P < 0.001, P: 0.005, P < 0.001, P < 0.001, P: 0.003, respectively). R.I.R.S. scores were significantly lower in patients treated successfully with RIRS than patients in which RIRS failed (P < 0.001). Binary logistic regression analyses revealed that R.I.R.S. scores were independent factors affecting RIRS success (P = 0.033). The area under the curve of the R.I.R.S. scoring system was 0.737. Conclusions Our study retrospectively validates that the R.I.R.S. scoring system is associated with SFR after RIRS in the treatment of renal stones, and can predict accurately.

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Impact of weight on stone-free rate during percutaneous nephrolithotomy

African Journal of Urology ◽

10.1186/s12301-020-00071-4 ◽

2020 ◽

Vol 26 (1) ◽

Author(s):

Abdrabuh M. Abdrabuh

Keyword(s):

Percutaneous Nephrolithotomy ◽

Operative Procedure ◽

World Health ◽

Fluoroscopy Time ◽

Morbidly Obese ◽

Obese Patients ◽

Co Morbidity ◽

Stone Free Rate ◽

Morbid Obese ◽

Free Rate

Abstract Background To assess Impact of weight on stone-free rate during percutaneous nephrolithotomy. Methods Hundred and twenty-three PNL procedures were done between January 2016 and July 2017. The patients were divided into four groups according to the World Health Organization (WHO) classification of body mass index (BMI): < 25 ((group 1, average)), 25–29.9 (group 2, overweight), 30–39.9 (group 3, obese), and ≥ 40 kg/m2 (group 4, morbidly obese). All groups were compared as regarding preoperative variables, intra-operative procedure and postoperative results. Results The non-obese groups were younger in age than obese and morbid obese groups (P = 0.005). The difference in BMI was statistically significant between non-obese and obese groups (P = 0.0001). Most of females gender were obese and morbid obese (P = 0.0001) and most of the obese patients had left-sided renal stone (P = 0.001). Most of overweight and obese groups had radiopaque stones (P = 0.02). There were no statistically significant differences between all groups as regarding co-morbidity, stone size, stone locations, and hydronephrosis grade. Operative time (P = 0.034), length of hospital stay (P value = 0.014) and fluoroscopy time (P = 0.0001) were statistically significant differences between all groups. Number of accesses, access site, postoperative hemoglobin drop, post- operative complications, fate of residual stones and stone-free rate were not statistically significant differences between all groups. BMI was correlated with mean fluoroscopy time and mean hospitalization duration in our study as the time of hospitalization and time of x-ray exposure increase with obesity. Conclusion PNL is a safe and effective procedure for obese patients. BMI do not predict clearance post PNL.

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