scholarly journals Predictors of Success after Extracorporeal Shock Wave Lithotripsy (ESWL) for Renal Calculi Between 20—30 mm: A Multivariate Analysis Model

2006 ◽  
Vol 6 ◽  
pp. 2388-2395 ◽  
Author(s):  
Ahmed El-Assmy ◽  
Ahmed R. El-Nahas ◽  
Mohamed E. Abo-Elghar ◽  
Ibrahim Eraky ◽  
Mahmoud R. El-Kenawy ◽  
...  
Keyword(s):  
Surface Area ◽  
Renal Stones ◽  
Renal Calculi ◽  
Analysis Model ◽  
Stone Surface ◽  
Chi Square ◽  
Renal Anomalies ◽  
Extracorporeal Shock Wave ◽  
Stone Free Rate ◽  
Free Rate

The first-line management of renal stones between 20—30 mm remains controversial. The Extracorporeal Shock Wave Lithotripsy (ESWL) stone-free rates for such patient groups vary widely. The purpose of this study was to define factors that have a significant impact on the stone-free rate after ESWL in such controversial groups. Between January 1990 and January 2004, 594 patients with renal stones 20—30 mm in length underwent ESWL monotherapy. Stone surface area was measured for all stones. The results of treatment were evaluated after 3 months of follow-up. The stone-free rate was correlated with stone and patient characteristics using the Chi-square test; factors found to be significant were further analyzed using multivariate analysis.Repeat ESWL was needed in 56.9% of cases. Post-ESWL complications occurred in 5% of cases and post-ESWL secondary procedures were required in 5.9%. At 3-month follow-up, the overall stone-free rate was 77.2%. Using the Chi-square test, stone surface area, location, number, radiological renal picture, and congenital renal anomalies had a significant impact on the stone-free rate. Multivariate analysis excluded radiological renal picture from the logistic regression model while other factors maintained their statistically significant effect on success rate, indicating that they were independent predictors. A regression analysis model was designed to estimate the probability of stone-free status after ESWL. The sensitivity of the model was 97.4%, the specificity 90%, and the overall accuracy 95.6%.Stone surface area, location, number, and congenital renal anomalies are prognostic predictors determining stone clearance after ESWL of renal calculi of 20—30 mm. High probability of stone clearance is obtained with single stone ≤400 mm2 located in renal pelvis with no congenital anomalies. Our regression model can predict the probability of the success of ESWL in such controversial groups and can define patients who would need other treatment modality.

scholarly journals Flexible ureterorenoscopy in position or fusion anomaly: Is it feasible?

2017 ◽  
Vol 63 (8) ◽  
pp. 685-688 ◽  
Author(s):  
Rafael Haddad Astolfi ◽  
Gustavo Freschi ◽  
Fernando Figueiredo Berti ◽  
Nelson Gattas ◽  
Wilson Rica Molina Junior ◽  
...  
Keyword(s):  
Kidney Stones ◽  
Perioperative Complications ◽  
Horseshoe Kidney ◽  
Renal Calculi ◽  
Flexible Ureterorenoscopy ◽  
Renal Anomalies ◽  
Stone Free Rate ◽  
Perioperative Complication ◽  
The Mean ◽  
Free Rate

Summary Objective: To analyze the results of flexible ureterorenoscopy (F-URS) with holmium laser in the treatment of kidney stones with ectopic and fusion anomalies (horseshoe kidney and rotation anomalies). Method: We reviewed data from 13 patients with fusion and ectopic renal anomalies that underwent F-URS from April 2011 to April 2017. We analyzed demographic and clinical data (age, gender, BMI, anatomical abnormality, location and dimension of the renal calculi) and perioperative data (method of treatment, stone-free rate, number of days with DJ catheter and perioperative complications). Results: The mean stone size was 12.23 +/- 5.43 mm (range 6-22mm), located in the inferior (58.33%) and middle (16.76%) calyceal units, renal pelvis (16.67%) and multiple locations (8.33%). All 13 patients were treated with Ho-Yag laser, using dusting technique (25%), fragmentation and extraction of the calculi (58.33%) and mixed technique (16.67%). We did not have any severe perioperative complication. After 90 days, nine patients (75%) were considered stone free. Conclusion: Our data suggest that F-URS is a safe and feasible choice for the treatment of kidney stones in patients with renal ectopic and fusion anomalies.

scholarly journals Flexible ureteroscopy for renal stone without preoperative ureteral stenting shows good prognosis

PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e2728 ◽  
Author(s):  
Jiaqiao Zhang ◽  
Chuou Xu ◽  
Deng He ◽  
Yuchao Lu ◽  
Henglong Hu ◽  
...  
Keyword(s):  
Renal Stone ◽  
Operation Time ◽  
Renal Stones ◽  
Renal Calculi ◽  
Good Prognosis ◽  
Flexible Ureteroscopy ◽  
Stone Free Rate ◽  
Ureteral Stenting ◽  
Free Rate

Purpose To clarify the outcome of flexible ureteroscopy (fURS) for management of renal calculi without preoperative stenting. Methods A total of 171 patients who received 176 fURS procedures for unilateral renal stones were reviewed. All procedures were divided into two groups depending on whether they received ureteral stenting preoperatively. Baseline characteristics of patients, stone burden, operation time, stone-free rates, and complications were compared between both groups. Results Successful primary access to the renal pelvis was achieved in 104 of 114 (91.2%) patients without preoperative stenting, while all procedures with preoperative stenting (n = 62) were successfully performed. A total of 156 procedures were included for further data analysis (56 procedures in stenting group and 100 in non-stenting group). No significant differences was found regardless of a preoperative stent placement in terms of stone-free rate (73.2% with stenting vs. 71.0% without, P = 0.854), operative time (70.4 ± 32.8 with stenting vs. 70.2 ± 32.1 without, P = 0.969). Conclusions fURS for management of renal stone without preoperative ureteral stenting are associated with well outcome in short term follow-up. Our study may help patients and doctors to decide if an optional stent is placed or not.

scholarly journals ESWL EFFECTIVENESS FOR LOWER POLE KIDNEY STONES

2019 ◽  
Vol 26 (1) ◽  
Author(s):  
Riza Mazidu Sholihin ◽  
Soetojo Soetojo ◽  
Haviv Muris
Keyword(s):  
General Hospital ◽  
Kidney Stones ◽  
Clearance Rate ◽  
Kidney Stone ◽  
Lower Pole ◽  
Stone Size ◽  
Chi Square ◽  
Extracorporeal Shock Wave ◽  
Stone Free Rate ◽  
Free Rate

Objective: To describe the profile of lower pole kidney stone patients who underwent Extracorporeal Shock Wave Lithotripsy (ESWL) and the clearance rate of ESWL for lower pole kidney stones at Soetomo General Hospital from 2012 to 2016. Material & Methods: This research design was analytical retrospective, lower pole kidney stone patients who underwent ESWL in Soetomo General Hospital from 2012 to 2016 who fulfill inclusion criteria become samples in this research. Samples were divided into two group, stone size <15 mm and 15-20 mm. Results: Total samples in this study were 128, consist of 81 males and 47 females. The age average was 48 ± 11.124. The stone size average was 9.5 ± 4.5 mm consisted of 109 patients with stone size <15 mm and 19 patients with stone size 15-20 mm. There were 119 single lower pole kidney stones and 9 multiple ones. From all patients, 77 patients (60.2%) were stones free and the rest (39.8%) were not. Stone free rate for lower pole kidney stones was higher in stone size <15 mm compared with 15-20 mm, 65.2% and 31.5% respectively. Statistical analysis with Chi-square showed significant ESWL clearance rate difference between lower pole kidney stone size <15mm group and 15-20 mm (p<0.05). Conclusion: ESWL was a safe option for lower pole kidney stones with high success rate. There was significant relationship between stone size and stone clearance rate. ESWL was effective for lower pole kidney stones size <15 mm. 

scholarly journals Safety and efficacy of percutaneous nephrolithotomy for the treatment of paediatric urolithiasis

2012 ◽  
Vol 94 (8) ◽  
pp. 588-592 ◽  
Author(s):  
R Veeratterapillay ◽  
MBK Shaw ◽  
R Williams ◽  
P Haslam ◽  
A Lall ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Calculi ◽  
Clearance Rates ◽  
Stone Clearance ◽  
Extracorporeal Shock Wave ◽  
Stone Free Rate ◽  
Surgeon Experience ◽  
The Mean ◽  
Free Rate

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.

scholarly journals Mini-percutaneous nephrolithotomy in surgery of nephrolithiasis

2021 ◽  
pp. 44-52
Author(s):  
Аndriy Sahalevych ◽  
Roman Sergiychuk ◽  
Vladislav Ozhohin ◽  
Olexandr Vozianov ◽  
Andriy Khrapchuk ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Renal Stones ◽  
Renal Calculi ◽  
Stone Free Rate ◽  
Duration Of Surgery ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Tract Infections ◽  
Free Rate

Abstract. The present study aimed to assess the effectiveness and safety of mini-percutaneous nephrolithotomy (mPNL) in comparison with standard percutaneous nephrolithotomy (sPNL) for the treatment of complex nephrolithiasis. Methods. During the period from 2012 to 2020, 1021 patients with solitary (10.0-30.0 mm), staghorn and multiple renal calculi were retrospectively divided into two groups: sPNL (500 patients) and mPNL (521 patients). The groups were compared by the stone-free rate (%, SFR), the duration of the surgery, complications and hospital stay. Results. SPNL and mPNL were highly effective procedures for the treatment of nephrolithiasis. The mPNL group had longer operative times (81.0±15.5 vs 69.1±13.9 min, p<0.001) and higher frequency tubeless/totally tubeless procedures (41.1 vs 6.8%, p<0.001). mPNL showed a higher SFR (96.4 vs 91.8%, р=0.002 in patients with complete staghorn (90.1 vs 77.3%, p<0.05) and multiple kidney stones (89.5 vs 70.8%, p=0.03). Postoperative decrease in hemoglobin was lower in mPNL group 1.1±0.34 vs 2.1±0.26 g/dl (p<0.001). The incidence rate of urinary tract infections and postoperative hospital stay was lower in the mPNL group: 7.3 vs 13.2%, p=0.03 and 1.9±0.6 vs 4.3±2.4 days, р<0.001. Conclusions. MPNL is a safe and effective treatment for patients with complex renal stones with an improved stone-free rate and lower complication rate and shorter hospital stay. Smaller diameter tract in mPNL procedures was associated with a longer duration of surgery.

scholarly journals STONE-FREE RATE DIFFERENCES IN KIDNEY STONES PATIENTS WITH AND WITHOUT TAMSULOSIN AFTER ESWL

2011 ◽  
Vol 18 (2) ◽  
Author(s):  
Nindra Prasadja ◽  
Doddy M Soebadi ◽  
Wahjoe Djatisoesanto ◽  
Widodo J Pudjirahardjo
Keyword(s):  
Medical Therapy ◽  
Renal Stones ◽  
Controlled Study ◽  
Control Group ◽  
Study Group ◽  
Clearance Time ◽  
Extracorporeal Shock Wave ◽  
Stone Free Rate ◽  
Maximum Period ◽  
Free Rate

Objective: To determine whether the administration of tamsulosin, as adjunctive medical therapy, increases the efficacy of one session of extracorporeal shock wave lithotripsy (ESWL) to treat renal stones. Material & Method: A prospective randomized placebo controlled study enrolled 21 patients. They underwent a single ESWL session to treat solitary radiopaque renal stones 4 to 20 mm in diameter. After ESWL, the study group (11) received 0,4 mg tamsulosin daily and the control group (10) received placebo until stone clearance or a maximum period of 8 weeks. The primary endpoint was stone-free rate and parameters were stone size and clearance time. Results: The overall stone-free rate was better in the study group than in the control group (90,9% vs. 60,0%). The clearance time after 2, 4, 6 and 8 weeks was greater in the study group than in the control group (36,4%; 63,6%; 72,7% and 90,9% vs 30,0%; 50,0%; and 60,0% respectively) but statistically insignificant. Conclusion: Clinically, the results of our study have demonstrated that tamsulosin therapy, as an adjunctive medical therapy after ESWL, is more effective than lithotripsy alone for the treatment of patients with renal stones. Keywords: ESWL, tamsulosin, medical expulsive therapy, renal stones.

Shock-wave lithotripsy, ureterorenoscopy and percutaneous nephrolithotomy for 1–2 cm renal stones: A randomised pilot study

2020 ◽  
Vol 13 (6) ◽  
pp. 413-418
Author(s):  
Philip J McCahy ◽  
Matthew Hong ◽  
Eldho Paul ◽  
Ivor Berman ◽  
Shekib Shahbaz
Keyword(s):  
Shock Wave ◽  
Percutaneous Nephrolithotomy ◽  
Shock Wave Lithotripsy ◽  
Renal Stones ◽  
Level Of Evidence ◽  
Extracorporeal Shock Wave ◽  
Stone Free Rate ◽  
Computed Tomography Scanning ◽  
Significant Difference ◽  
Free Rate

Objectives: This study aimed to assess which of extracorporeal shock-wave lithotripsy (SWL), ureterorenoscopy (URS) or percutaneous nephrolithotomy (PCNL) offers the best stone-free rate (SFR) for 1–2 cm renal stones. Patients and methods: A total of 31 patients with renal stones between 1 and 2 cm were randomised to SWL, URS or PCNL. Repeat treatments or alternatives were performed until the patient was stone free or clinically in no further need of treatment. All patients were assessed with computed tomography scanning independently reviewed by a radiologist blinded to the treatment. Results: Overall, 10 well-matched patients were randomised to SWL, 11 to URS and 10 to PCNL. SFRs were 60% for SWL, 55% for URS and 80% for PCNL (no significant difference). The mean number of procedures required were 2.6 (range 1–7) for SWL, 2.5 (range 1–4) for URS and 1.3 (range 1–3) for PCNL ( p=0.072). There were no major complications, but 50% of SWL had minor complications compared with 9% for URS and 20% for PCNL. Conclusion: The results for SWL were disappointing for SFR, number of procedures and complications. In common with other recent studies, the SFR following URS was also poor. PCNL had the best results for SFR with the fewest procedures. We calculate that an adequately powered study will require 42 patients per arm. Level of evidence Level 2b

scholarly journals Mini percutaneous nephrolithotomy versus retrograde flexible ureterorenoscopy in the treatment of renal calculi in anomalous kidneys

2021 ◽  
Vol 93 (2) ◽  
pp. 167-172
Author(s):  
Hussein M. Abdeldaeim ◽  
Omar El Gebaly ◽  
Mostafa Said ◽  
Abdel Rahman Zahran ◽  
Tamer Abouyoussif
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Hemoglobin Concentration ◽  
Renal Stones ◽  
Renal Calculi ◽  
Flexible Ureterorenoscopy ◽  
Single Center Experience ◽  
Stone Free Rate ◽  
The Mean ◽  
Free Rate

Objectives: To report our single center experience in comparing mini-percutaneous nephrolithotomy versus flexible ureterorenoscopy for management of renal stones up to 2 cm in anomalous kidneys. Materials and methods: Records of the last 30 patients with stones less than 2 cm in anomalous kidney treated by mini-percutaneous nephrolithotomy were reviewed and compared to last 30 patients treated by flexible ureterorenoscopy. Results: Mean stone size was significantly higher in the minipercutaneous nephrolithotomy group (17.90 mm) than in flexible ureterorenoscopy group (14.97mm) (p < 0.001). Mean operative time (80.33 min vs 56.43 min) and fluoroscopy exposure time (4.49 min vs 0.84 min) were significantly higher in the mini-percutaneous nephrolithotomy group than in the flexible ureterorenoscopy group (p < 0.001). The mean post-operative drop in hemoglobin concentration was significantly higher in the mini-percutaneous nephrolithotomy group (0.47 gm versus 0.2 gm) (p < 0.001). Stone free rate after 12 weeks follow up was not statistically significant between the 2 groups (90% in minipercutaneous nephrolithotomy vs 80% in flexible ureterorenoscopy) (FEp = 0.472).Conclusions: Both modalities were found to be safe and effective for treatment of stones less than 2 cm in anomalous kidneys.

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

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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