Ultrasound for kidney access in percutaneous nephrolithotomy: a contemporary review

Nowadays percutaneous nephrolithotomy (PCNL) is the standard of care for renal staghorn calculus or large (>20 mm) pelvic or caliceal stones, as well as for the failure of other treatment options. This review aims to evaluate the contemporary use of ultrasound imaging in PCNL, by comparing it to conventional fluoroscopy, reviewing data regarding the complication and success rate of nephrostomy tract creation and stone free rate (SFR), as well as data concerning the learning curve for these procedures and cost indicators. The evidence acquired shows that the ultrasound guided access (USGA) is a comparable method with the classic fluoroscopic guided access (FGA), with a similar safety profile, with a significant reduction in radiation exposure, up to radiation free complete PCNL. USGA PCNL seems to lead to decreased bleeding and need for transfusion, especially when the Doppler mode is used, and also to a slightly higher SFR than conventional FGA PCNL. USGA PCNL reduces the overall costs of the procedure by about 30% and can be safely learnt and performed by urologists. For an experienced endourologist, familiar withFGA PCNL, the learning curve for shifting to USGA PCNL is of approximately 20 procedures.

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Modified supine percutaneous nephrolithotomy with combined fluoroscopy and ultrasound-guided renal puncture: Initial single-surgeon experience at a UK teaching hospital

Journal of Clinical Urology ◽

10.1177/2051415817704127 ◽

2017 ◽

Vol 10 (6) ◽

pp. 535-540

Author(s):

N Nkwam ◽

MA Khan

Keyword(s):

Percutaneous Nephrolithotomy ◽

Ultrasound Guidance ◽

Plain Film ◽

Ultrasound Guided ◽

Visceral Injury ◽

Stone Free Rate ◽

Surgeon Experience ◽

Clavien Grade ◽

Low Incidence ◽

Free Rate

Objective: The purpose of this article is to report the outcomes of our initial experience of performing percutaneous nephrolithotomy in the supine position using ultrasound guidance in addition to fluoroscopy for renal access. Patients and methods: The first 34 consecutive modified supine percutaneous nephrolithotomy cases performed by a single consultant urologist inserting their own percutaneous tracts using ultrasound-guidance and fluoroscopy were evaluated. Operative data was collected prospectively over a 10-month period including any complications. The stone-free rate was evaluated three months post-operatively with a plain film or non-contrast computed tomography of the kidneys, ureters and bladder. Results: Renal access was achieved in all 34 cases. Mean age was 57 years (19–82) with 14 males and 20 females. Mean stone size 37.2 mm (20–72 mm). Overall stone-free rate was 85.3% at a mean follow up of 11.2 months. There was one Clavien Grade I, and three Clavien Grade II complications of post-operative fever requiring treatment with intravenous antibiotics. No patients developed urosepsis, required blood transfusion or sustained any visceral injury. Median in-patient stay was one night (1–4). Conclusion: Modified supine percutaneous nephrolithotomy with combined fluoroscopy and ultrasound-guided renal access has a low incidence of complications allowing for short hospital stay.

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The Safety and Efficacy of Mini Percutaneous Nephrolithotomy During Learning Curve

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v18i2.21355 ◽

2019 ◽

Vol 18 (2) ◽

pp. 42-47

Author(s):

Bikash Bikram Thapa ◽

Bina Basnet ◽

Bikash Bahadur Rayamajhi ◽

Narayan Thapa ◽

Bharat Bhadur Bhandari

Keyword(s):

Learning Curve ◽

Percutaneous Nephrolithotomy ◽

Renal Stone ◽

Operative Time ◽

Medium Size ◽

Stone Size ◽

Access Sheath ◽

Stone Free Rate ◽

The Mean ◽

Free Rate

Introduction: Since its introduction in 1976, percutaneous renal stone surgery has undergone several modifications. Reduction in size of access sheath was one of them which was first reported by Jackman in 1998. The miniaturisation of access sheath in Mini-Percutaneous Nephrolithotomy surgery has significantly reduced the intervention related morbidity with similar outcome as of standard Percutaneous Nephrolithotomy. Methods: This is a prospective cohort study where a single surgeon without previous experience of independent PCNL surgery performed Mini PCNL under controlled condition for renal stone sized 10 to 30 mm. The outcome was measured in terms of stone free rate and postoperative complications. The association of stone free rate and drop in haemoglobin level with different preoperative and operative variables were calculated with Pearson’s correlation test and p value <0.05 was considered significant. Results: Mini PCNL was performed in total of 63 renal units. The mean age was 37.8 ± 9.9 years with male: female ratio of 1.8:1. The average stone size was 16.8 ± 2.9 mm. The mean operative time was 55.2 ± 19.0 (30-110) minutes. The stone free rate was 98.2 ± 3.6 %. The mean drop in haemoglobin was 1.3 ± 0.8 and blood transfusion rate was 4.7%. The average hospital stay was 2.6 ± 1.3 days. The grade I complications was 15.8% and grade II and III was 7.9% each. Stone free rate was significantly associated with stone number (r = -0.47, p = 0.004). Similarly fall in haemoglobin was associated with total operative time (r = 0.49, p = 0.003). The stone size, hardness of stone (HU) and size of access sheath had no significant association with stone free rate and fall in haemoglobin. Conclusions: Mini PCNL is as effective as standard PCNL with higher safety margin in small and medium size stone (10 to 30 mm) during learning curve of endo-urology procedure.

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Multitract percutaneous nephrolithotomy in the management of staghorn stones

African Journal of Urology ◽

10.1186/s12301-020-00086-x ◽

2020 ◽

Vol 26 (1) ◽

Author(s):

Aso Omer Rashid ◽

Sarwar Noori Mahmood ◽

Aram Karim Amin ◽

Rawa Bapir ◽

Noor Buchholz

Keyword(s):

Percutaneous Nephrolithotomy ◽

Renal Unit ◽

First Line ◽

Combination Treatments ◽

Stone Free Rate ◽

Staghorn Calculus ◽

Grade Ii ◽

Patient Stone ◽

Free Rate ◽

Staghorn Stones

Abstract Background Staghorn stones are difficult to manage with a risk of significant renal impairment and urosepsis. Percutaneous nephrolithotomy is the first-line treatment for staghorn stones. Often, multiple access tracts are needed to render the patient stone-free. PCNL has been combined with SWL, flexible URS (ECIRS), and mini-PCNL to access residual fragments without the need of additional tracts. However, in a country with limited access to technology and a restraint on resources, multitract PCNL still is the preferred option. The aim of this study was to assess the safety and efficacy of multitract PCNL in such an environment. Methods We analyzed data on sixty-five patients with staghorn calculus who underwent multitract PCNL for a staghorn calculus. Data included demographics, stone parameters, intraoperative parameters, complications and clinical outcomes. Hb-drop and creatinine changes were assessed pre- and post-OP. Complications were graded according to the modified Clavien-Dindo classification. Results In a total of 65 patients [47 males (72%)], 154 percutaneous access tracts were used in 66 renal units. The number of tracts varied between 2 and 4 in a single renal unit. The stone-free rate was 85%. 20% of patients developed grade I, 14% grade II, and 3% grade III b complications. There were no grade IV and V complications. Conclusion Multitract PCNL is safe and efficient, with a good stone-free rate and an acceptable complication rate. When auxiliary combination treatments are not available, multitract standard PCNL remains an option.

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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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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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Non-contrast computed tomography for percutaneous nephrolithotomy: Are complications and stone-free rate related to Hounsfield parameters? Results of a cross-sectional study

European Urology Supplements ◽

10.1016/s1569-9056(18)31879-7 ◽

2018 ◽

Vol 17 (2) ◽

pp. e1495

Author(s):

A. Gallioli ◽

E. De Lorenzis ◽

L. Boeri ◽

M. Fontana ◽

S.P. Zanetti ◽

...

Keyword(s):

Computed Tomography ◽

Percutaneous Nephrolithotomy ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Stone Free Rate ◽

Free Rate

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MP22-01 REARRANGEMENT OF THE GUY'S STONE SCORE IMPROVES PREDICTION OF STONE FREE RATE AFTER PERCUTANEOUS NEPHROLITHOTOMY.

The Journal of Urology ◽

10.1016/j.juro.2016.02.689 ◽

2016 ◽

Vol 195 (4S) ◽

Author(s):

Jorge Moreno-Palacios ◽

Efraín Maldonado-Alcaraz ◽

Enrique Garcia-Peña ◽

Juan Ramon Torres-Anguiano ◽

Eduardo Serrano-Brambila ◽

...

Keyword(s):

Percutaneous Nephrolithotomy ◽

Stone Free Rate ◽

Free Rate

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Prediction of the stone free rate by using the guy's stone score after percutaneous nephrolithotomy

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v45i3.44652 ◽

2019 ◽

Vol 45 (3) ◽

pp. 197-200

Author(s):

Mohammad Shafikul Islam ◽

Muhammad Hossain ◽

Md. Saiful Islam ◽

AKM Khurshidul Alam ◽

Md. Habibur Rahman Dulal ◽

...

Keyword(s):

Percutaneous Nephrolithotomy ◽

Renal Stone ◽

Normal Body Mass Index ◽

Patient Counseling ◽

Residual Stone ◽

Female Ratio ◽

Stone Free Rate ◽

Grade Ii ◽

Free Rate ◽

Grade Iii

Background: Urolithiasis is one of the common diseases of the urinary system, with an incidence of approximately 5-10% among the general population. Among the minimally invasive surgeries, percutaneous nephrolithotomy (PCNL) is the gold standard therapy for large and/or complex renal stones. Objective: The study was carried out to predict the stone-free rate after PCNL by using the Guy's stone score. Methods: This prospective cross-sectional study was conducted in the Department of Urology, Bangabandhu Sheikh Mujib Medical University, (BSMMU), Dhaka from February 2016 to January 2017. The patients with renal stone attending the outpatient department who met the criteria of standard PCNL. Results: Atotal of 52 patients with renal stone were included in this study. The mean age was to be found 45.3±14.0 with range of 18 to 73 years. Male to female ratio was 3.3:1. Almost three fourth (74.5%) patients had normal body mass index. All patients had normal anatomy. More than half 27 of the (51.9%) patients had found grade I, 10 (19.2%) Grade II, 11(21.2%) Grade III and 4 (7.7%) Grade IV. Nearly two third 34 (65.4%) patients were found total stone cleared and 18(34.6%) had residual stone. Cleared stone was found 23(85.2%) in grade I, 7(70.0%) grade II, 3(27.3%) in grade III and 1(25.0%) in grade IV. Conclusion: Based on the study findings, it may be concluded that higher the GSS less the stone free rate.It will help in better patient counseling preoperatively, and to predict the need for ancillary treatment.

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Percutaneous nephrolithotomy of staghorn renal stones in pediatric patients using adult-sized instrument

Urologia Journal ◽

10.1177/0391560319858488 ◽

2019 ◽

Vol 86 (4) ◽

pp. 211-215

Author(s):

Akbar Nouralizadeh ◽

Hamid Pakmanesh ◽

Abbas Basiri ◽

Mohammad Hadi Radfar ◽

Behzad Narouie ◽

...

Keyword(s):

Percutaneous Nephrolithotomy ◽

Pediatric Patients ◽

Renal Stones ◽

Adult Size ◽

Efficacy And Safety ◽

Double J Stent ◽

Stone Free Rate ◽

The Mean ◽

Free Rate ◽

Free Status

Introduction: In this study, we aimed to evaluate the safety and efficacy of the percutaneous nephrolithotomy procedure performed with adult-sized instruments in pediatric cases with staghorn kidney stone. Methods: We retrospectively evaluated the efficacy and safety of 94 percutaneous nephrolithotomy procedures performed during 15 years in a single center for 82 pediatric patients with staghorn calculi using adult-sized instruments (24-Fr nephroscope). Stone free status was defined as complete clearance of the stones or the presence of insignificant residual stones of <3 mm in diameter. Results: The mean age was 108 ± 53 months (range, 14–180 months). There were 39 patients (48%) with complete staghorn stones and 43 cases (52%) with partial staghorn. We fulfilled 91.4% of operations through a single access. The stone free rate was 86.6% after one percutaneous nephrolithotomy session. In total, seven patients referred for shock wave lithotripsy and four cases were scheduled for the second percutaneous nephrolithotomy session. Fever occurred in 18 patients (21%) and bleeding requiring transfusion in four children (5%). Prolonged leakage from nephrostomy site requiring anesthesia for double J stent placement occurred in one patient. No grade IV or V Clavien complication occurred. Conclusion: The success rate and complications of percutaneous nephrolithotomy with adult-size instruments in pediatric patients are acceptable.

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