scholarly journals A Novel Technique of Ultra-Mini-Percutaneous Nephrolithotomy: Introduction and an Initial Experience for Treatment of Upper Urinary Calculi Less Than 2 cm

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Janak Desai ◽  
Guohua Zeng ◽  
Zhijian Zhao ◽  
Wen Zhong ◽  
Wenzhong Chen ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Urinary Calculi ◽  
Renal Stones ◽  
Laser Lithotripsy ◽  
Complication Rates ◽  
Modified Technique ◽  
Average Operative Time ◽  
Grade Ii ◽  
The Mean ◽  
Metal Sheath

Objectives. To describe our novel modified technique of ultra-mini-percutaneous nephrolithotomy (UMP) using of a novel 6 Fr mininephroscope through an 11–13 Fr metal sheath to perform holmium: YAG laser lithotripsy.Methods. The medical records of 36 patients with moderate-sized (<20 mm) kidney stones treated with UMP from April to July 2012 were retrospectively reviewed. Patients were assessed at the 1st day and 1st month postoperatively by KUB and US to assess stone-free status.Results. The mean stone size was 14.9 ± 4.1 mm (rang: 6–20). The average operative time was 59.8 ± 15.9 (30–90) min. The stone-free rate at postoperative 1st day and 1st month was 88.9% and 97.2%. The mean hospital stay was 3.0 ± 0.9 (2–5) days. Complications were noted in 6 (16.7%) cases according to the Clavien classification, including sepsis in 2 (5.6%) cases (grade II), urinary extravasations in 1 (2.8%) case (grade IIIa), and fever in 3 (8.3%) cases (grade II). No patients needed blood transfusion.Conclusions. UMP is technically feasible, safe, and efficacious for moderate-sized renal stones with an advantage of high stone-free rates and low complication rates. However, due to the limits of its current unexplored indications, UMP is therefore a supplement to, not a substitute for, the standard mini-PCNL technology.

scholarly journals Safety and efficacy of Chinese minimally invasive percutaneous nephrolithotomy in the management of renal stones ≤ 2 cm: a single-center experience

2019 ◽  
Vol 25 (1) ◽  
Author(s):  
Elsayed M. Salih ◽  
Ibrahim Elsotohi ◽  
Hisham Elhelaly ◽  
Mohamed Elsalhy ◽  
Mourad M. Mourad
Keyword(s):  
Minimally Invasive ◽  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Renal Stones ◽  
Stone Size ◽  
Intraoperative Complication ◽  
Safety And Efficacy ◽  
Single Center Experience ◽  
Minimally Invasive Percutaneous Nephrolithotomy ◽  
The Mean

Abstract Background The goal for using smaller caliber instruments in PNL was to reduce the access-related complications and to decrease morbidity. The objective of this study was to evaluate the safety and efficacy of Chinese minimally invasive percutaneous nephrolithotomy (MIPNL) in the treatment of renal stones ≤ 20 mm. Results Sixty-seven patients completed the study protocol. The mean age was 41.10 ± 13.99 years (range 18–68 years). There were 43 (64%) male and 24 (36%) females. The mean stone size was ranged from 78.5 to 439.6 mm2 (mean ± SD 172.48 ± 69.54 mm2). The overall SFR was (82%). Twelve (18%) needed post-MIPNL auxiliary procedure, in the form of second MIPNL in 3 (4.5%) cases, SWL in 7 (10%), and RIRS in 2 (3%) cases. The intraoperative complication was present in four patients (5%) include bleeding necessitate blood transfusion in one patient (1.5%) and renal collecting system perforation 3 (4.5%). The postoperative complication was urine leakage 5 (7.5) and fever in 6 (9%) of patients. Conclusion Chinese MIPNL is safe and effective method for treatment of renal stone ≤ 20 mm size with satisfactory SFR and low complication rate when SWL failed or contraindicated. It is considered a feasible treatment alternative to standard PNL, in the absence of flexible URS or miniature nephroscope.

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

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.

scholarly journals Providing Several Skills to Treat Complex Infectious Stones of Solitary Kidney in a Patient Failed to Undergo Percutaneous Nephrolithotomy: A Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Dechao Feng ◽  
Wuran Wei
Keyword(s):  
Cost Effectiveness ◽  
Percutaneous Nephrolithotomy ◽  
Renal Stones ◽  
Solitary Kidney ◽  
Laser Lithotripsy ◽  
High Frequency Oscillation ◽  
Flexible Ureteroscopy ◽  
Renal Deterioration ◽  
Holmium Laser Lithotripsy ◽  
Staghorn Stones

Conservative treatment is closely associated with renal deterioration for patients with renal staghorn stones. It is well-recognized that percutaneous nephrolithotomy (PCNL) is recommended as the first-line treatment of renal stones larger than 2 cm due to its higher stone clearance and cost-effectiveness when compared with other treatment alternatives, such as shockwave lithotripsy and flexible ureteroscopy (FURS). Besides, our findings indicated that miniaturized PCNL could be served as an alternative to PCNL with a higher stone-free rate and a lower hemorrhage risk. Despite the higher cost-effectiveness of PCNL, the management of staghorn stones are still controversial in some special situations, such as a solitary kidney. Herein, we present a case with complex infectious stones of a right-sided solitary kidney, complaining of persistent pain in the right waist. The rarity of this case is that it is difficult to encounter these cotton-like staghorn stones which are clinically resistant to holmium laser lithotripsy, and the particularity is that the patient with solitary kidney failed to undergo PCNL. We found that the combination of intermittently high-frequency oscillation and flexible ureteroscopy forceps might contribute to treat the complex infectious stones in a patient with solitary kidney. Our surgical experience might be beneficial to such patients undergoing flexible ureteroscopy in clinical practice.

scholarly journals Comparison of intracorporeal and extracorporeal urinary diversions after laparoscopic radical cystectomy in females with bladder cancer

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Liyuan Wu ◽  
Feiya Yang ◽  
Liming Song ◽  
Zejun Xiao ◽  
Sujun Han ◽  
...  
Keyword(s):  
Complication Rates ◽  
Lymph Node Yield ◽  
Operative Outcomes ◽  
Clavien Grade ◽  
Hospital Stays ◽  
Grade Ii ◽  
The Mean ◽  
Estimated Glomerular Filtration Rates ◽  
Node Yield

Abstract Purpose To compare the peri-operative outcomes of females undergoing laparoscopic intracorporeal urinary diversions (ICUD) and extracorporeal urinary diversions (ECUD) after laparoscopic radical cystectomies (LRC). Patients and methods Thirty-eight females who underwent LRCs and urinary diversions from February 2008 to October 2018 were divided into two groups: the ECUD group (19 patients) and the ICUD group (19 patients). We retrospectively analysed the patients in terms of patients’ demographics, peri-operative outcomes, and oncological follow-ups. Results There were significant differences in the mean operative times between ECUDs and ICUDs (364.6 vs. 297.1 min, p = 0.007), transfusion rates (37% vs. 5%, p = 0.042), time to flatus (5 vs. 3 days, p = 0.020), time to ambulation (2 vs. 1 days, p = 0.022), and duration of postoperative hospital stays (22 vs. 13 days, p = 0.002). The mean lymph node yield was 12.9 in the ECUD group and 18.6 in the ICUD group (p = 0.140). Seven out of 19 patients (37%) in the ECUD group and 6 out of 19 patients (32%) in the ICUD group had positive lymph nodes (p > 0.9). Two out of 19 ECUD patients (11%) and 4 of 19 ICUD patients (21%) had positive surgical margins (p = 0.660). Although there were no differences in major complications at 30 days and in all complications at 90 days, the Clavien grade II complications were significantly different at 30 days (ECUD 8, ICUD 2; p = 0.026). The mean follow-up times were 48.7 months (ECUD group) and 26.4 months (ICUD group). There were no statistically significant differences in estimated glomerular filtration rates postoperatively (p = 0.516). Seven patients had disease metastases (ECUD 2 out of 19, ICUD 5 out of 19; p = 0.405) and 5 died (ECUD 3 out of 19, ICUD 2 out of 19; p > 0.9). Conclusions ICUDs benefit females by having smaller incisions, faster recoveries, and decreased complication rates.

scholarly journals Acute kidney injury following supine mini-PNL versus retrograde intrarenal surgery in patients with renal stones < 3 cm: a prospective comparative study

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Metin Yığman ◽  
Semih Tangal ◽  
Tuba Candar ◽  
Mehmet İlker Gökçe
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Renal Stones ◽  
Primary Treatment ◽  
Study Data ◽  
Complication Rates ◽  
Duration Of Hospitalization ◽  
Prospective Comparative Study ◽  
The Mean ◽  
The Difference

Abstract Background The purpose of the current study was to prospectively compare mini-PNL and RIRS for development of acute kidney injury (AKI), success, and complication rates in a cohort of patients with kidney stones less than 3 cm. Methods In this prospective study, data of 60 consecutive patients underwent mini-PNL (n = 31) or RIRS (n = 29) was investigated. Urinary NGAL levels were measured preoperatively and at postoperative 6th hour to evaluate AKI. Success and complication rates were also compared. Results The mean stone size was significantly higher in the mini-PNL group (24.6 mm vs. 18.2 mm, p = 0.02). The mean postoperative NGAL levels were 45.6 ± 12.4 and 48.1 ± 13.6 for the mini-PNL and RIRS groups, respectively. The increase was statistically significant for both groups (p: 0.01). The difference between the two groups for mean postoperative NGAL measurements was not statistically significant (p = 0.47). The SFR was significantly higher in the mini-PNL group (96.7% vs. 79.3%, p = 0.04). The complication rates were similar for the two groups (p = 0.99). The mean duration of operation was 48.2 ± 22.5 min in the mini-PNL group and 62.6 ± 18.1 min in the RIRS group (p = 0.03). The median duration of hospitalization was 1 day for both groups. Conclusions In patients with renal stones < 3 cm in diameter, mini-PNL in supine position provides higher SFR and shorter operative times with similar rates of complications and AKI when compared with RIRS. Mini-PNL should be considered as the primary treatment option together with RIRS for renal stones and should not be ruled out for being a more invasive option.

scholarly journals Safety and Efficacy of Percutaneous Nephrolithotomy in The Treatment of Renal Stones in Children

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A M A Badran ◽  
Y M Kotb ◽  
M K A Tolba
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Stones ◽  
Urinary Stone ◽  
Stone Disease ◽  
Age Group ◽  
Intraoperative Blood Loss ◽  
Urinary Stone Disease ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract Background the incidence of urinary stone disease has been increased due to the change in dietary habits, lifestyle factors and obesity. The prevalence of urinary stone disease was reported as 11.1% in the adult population, while the prevalence in children varies with age, it is approximately 2-3%. Open surgery was the only surgical treatment option in the past, now most pediatric urinary stones can be treated effectively by other procedures as extracorporial shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS) and laparoscopy. Aim of the Study to assess the safety and efficacy of percutaneous nephrolithotomy in the treatment of renal stones more than 15 mm in children aged 2-14 years old. Patients and Methods our study included 40 patients (28 males and 12 females) with a mean age (8.35 ± 3.69) with a range (2 to 14 years) managed by PCNL in 2 groups: Group A (Preschool age group): included 18 patients, 12 males (67%) and 6 females (33%) aged (2-6 years) managed by mini PCNL.Group B (School age group): included 22 patients, 16 male (73%) and 6 females (27%) aged (7-14 years) managed by standard PCNL. Results Success rate was nearly similar in both groups, it was 88.9% in group A and 95.5% in group B. Regarding the mean operative time it was 72.22 ± 12.63 in group A and 70.00 ± 15.74 in group B. Regarding the intraoperative blood loss it was more significant in group B with the mean intraoperative blood loss as 76.67 ± 15.34 in group A and 116.36 ± 22.79 in group B. Postoperative pain was more in group B than in group A, so 6 patients (33.3%) postoperative weak opiate analgesia in group A for less than 24 hours, while 16 patients (72.7%) needed postoperative weak opiate analgesia in group B. Hospital stay was 2.44 ± 0.51 in group A and 2.91 ± 1.02 in group B. Conclusion PCNL is a safe and effective procedure for management of renal stones in children, with accepted stone clearance rates and postoperative morbidity in addition to short hospital stay.

scholarly journals Percutaneous nephrolithotomy assisted by LithoClast master in one-phase treatment for staghorn renal stones with refractory infections

2020 ◽  
Author(s):  
Hai-Xiao Tang ◽  
Di Wu ◽  
Bo-Wen Shi ◽  
Ze-Hao Dai ◽  
Yun-Teng Huang
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Medical Center ◽  
Operation Time ◽  
Renal Stones ◽  
Efficacy And Safety ◽  
Medical Systems ◽  
Two Phase ◽  
Reactive Protein ◽  
Fifth Generation ◽  
Grade Ii

Abstract Background: Infectious staghorn renal stones are usually treated with one-phase for percutaneous puncture and drainage, and then two-phase for percutaneous nephrolithotomy (PCNL). The objective of the study was to evaluate the efficacy and safety of PCNL assisted by LithoClast master (the fifth-generation Electro Medical Systems, EMS) in one-phase treatment for staghorn renal stones with refractory infections.Methods: From September 2017 to September 2019, 80 patients with staghorn renal stones who underwent one-phase for PCNL combined with the fifth-generation EMS in our hospital were retrospectively analyzed. According to whether patients with staghorn renal stones were complicated with refractory infections or not before operation, they were divided into A group (48 cases with refractory infections) and B group (32 cases without infections). In A group, refractory infections were properly controlled with sensitive antibiotics before operation. The efficacy and safety of treatment for two groups were compared.Results: Before taking sensitive antibiotics in A group, there was statistical difference in the location of stones between the two groups (P＜0.05), while there were no statistical significances in other general clinical data between the two groups (P＞0.05). Although there were statistical differences in the increase rate of white blood cell count, C-reactive protein, procalcitonin on the first day after operation between the two groups (P＜0.05), there were no statistical differences in operation time, hospitalization time, hemoglobin, stone-free rate, Clavien-Dindo grade I complications, Clavien-Dindo grade II and above complications between the two groups (P＞0.05). Conclusions: For staghorn renal stones with refractory infections, based on the application of sensitive antibiotics before operation to properly control refractory infections, PCNL assisted by the fifth-generation EMS in one-phase can efficiently remove staghorn renal stones, without increasing the risk of postoperative complications. In the medical center with mature technical conditions and rich experience, staghorn renal stones with refractory infections can be selected carefully to carry out one-phase operation.

scholarly journals Retrograde Intrarenal Surgery vs. Miniaturised Percutaneous Nephrolithotomy to Treat Lower Pole Renal Stone < 2 cms Diameter in Western Part of Odisha

2021 ◽  
Vol 8 (19) ◽  
pp. 1347-1351
Author(s):  
Ashok Kumar Nayak ◽  
Sanjay Kumar Mahapatra ◽  
Braja Mohan Mishra ◽  
Dipti Ranjan Dhar ◽  
Biswajit Sahu
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Operating Time ◽  
Operation Time ◽  
Renal Stones ◽  
Analysis Data ◽  
Lower Pole ◽  
Medical Sciences ◽  
Retrograde Intrarenal Surgery ◽  
The Mean

BACKGROUND We wanted to compare the outcomes of retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mini-PCNL) in treating lower pole (LP) renal stones with a diameter of < 2 cm in terms of safety, efficacy, and stonefree rate (SFR). METHODS In a retrospective analysis data of 39 patients who underwent mini-PCNL (N = 19) or RIRS (N = 20) for LP stones with a diameter of < 2 cm were reviewed between November 2018 and November 2020 at the Department of Urology in Veer Surendra Sai Institute of Medical Sciences and Research (VSSIMSAR), Odisha. The mean age, sex, stone size, operating time, complications, hospital stay, and SFR were compared between the groups. The success of the procedure was defined as the absence of residual stones or small residuals of size 3mm or less on computed tomography at 12 weeks postoperatively. RESULTS Significant differences were found in the hospital stay duration in hours (103.3 ± 11.7 vs. 145.2 ± 16.4, P < 0.028) between the RIRS and mini - PCNL groups. The mean operation time (in minutes) was also significantly different between the RIRS group (82.5 ± 3.44) and mini PCNL group (86.21 ± 5.90, P = 0.021). The stonefree rates in the postoperative period at three months (RIRS vs. mini - PCNL: 95 % vs. 94 %, P = 0.47) were not significantly different. CONCLUSIONS RIRS and mini-PCNL are both safe and effective methods for treating LP stones with a diameter of < 2 cm. RIRS can be considered as a less invasive alternative to PCNL for the treatment of LP stones of < 2 cm with reasonable SFR with shorter hospital stay. KEYWORDS Retrograde Intrarenal Surgery, Percutaneous Nephrolithotripsy, Lower Pole Kidney Stones, Miniaturized Percutaneous Nephrolithotomy

scholarly journals A retrospective study comparing super-mini percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of 20–30 mm renal stones in obese patients

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e8532
Author(s):  
Chen Xu ◽  
Rijin Song ◽  
Pei Lu ◽  
Minjun Jiang ◽  
Guohua Zeng ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Demographic Data ◽  
Operation Time ◽  
Renal Stones ◽  
Flexible Ureteroscopy ◽  
Complication Rates ◽  
Obese Patients ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Stone Characteristics

Objective This study aimed to compare the efficacy and safety of Super-mini percutaneous nephrolithotomy (SMP) and flexible ureteroscopy (F-URS) in the treatment of 20–30 mm renal stones in obese patients. Methods We conducted a retrospective analysis of outcomes of patients who underwent SMP and F-URS to treat 20–30 mm renal stones from August 2017 to September 2018. Patients with BMI >30 kg/m2 were enrolled into this study. Forty-eight patients underwent SMP, while 104 patients underwent F-URS by the same surgeon. The patients’ demographic data, stone characteristics, perioperative parameters and outcomes, complications, stone-free rate (SFR) and overall costs were retrospectively assessed. Results No significant differences were found between the two groups in terms of age, gender, BMI, operation side, stone size, number, locations, stone compositions and CT value. The mean operation time was significantly shorter in the SMP group (p < 0.001), while the F-URS group had significantly shorter postoperative stays (p < 0.001) and lower complication rates (p < 0.001). Both groups had similar SFR at a 3-month follow-up (p = 0.190), while the SMP group achieved significant higher SFR 3 days after the operation (p < 0.001). The SMP group had a significantly lower overall cost and fewer stage-2 procedures than the F-URS group. Conclusion SMP and F-URS are equally effective in obese patients with 20–30 mm renal stones. However, F-URS offers the advantage of a lower complication rate, while SMP performed better in terms of operation time, tubeless rate, stage-2 procedures and overall costs.

scholarly journals Effect of Renal Function on Success and Complications of Percutaneous Nephrolithotomy

2021 ◽  
pp. 68-73
Author(s):  
Serkan Yarimoglu ◽  
Mehmet Erhan Aydin ◽  
Murat Sahan ◽  
Omer Koras ◽  
Onur Erdemoglu ◽  
...  
Keyword(s):  
Renal Function ◽  
Glomerular Filtration ◽  
Percutaneous Nephrolithotomy ◽  
Kidney Stones ◽  
Complication Rates ◽  
Number Of Patients ◽  
Group 3 ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Objective: In this study, we aimed to compare the success and complication rates of percutaneous nephrolithotomy (PCNL) according to preoperative glomerular filtration rates (GFR) of patients who underwent PCNLdue to kidney stones. Material and Methods: Between January 2012 and December 2016, 794 patients who underwent PCNL due to kidney Stones were evaluated retrospectively. Preoperative GFR values of patients were calculated according to Cockcroft –Gault formula. The patients with preoperative GFR values>90 ml/min, 60-90 ml/min, 30-60 ml/min were respectively defined as group-1, group-2 and group-3. Preoperative and perioperative values, Stone free rates and complication rates were compared between the groups. Postoperatively , <4 mm residual stone was identified as success. Results: There were 466 patients in Group-1, 259 in Group-2 and 67 patients in Group-3. The mean preoperative GFR values of the patients were 118.53 ml/min, 77.76 ml/min and 48.52 ml/min, respectively in group-1, group-2 and group-3 (p <0.001).The mean age of the patients was 62.8±11.47, 51.86±11.10, and60.31±12.7, respectively, in group-1, group-2 and group-3 (p<0.001).The mean Stone burden of the patients were 497.34±518.60 mm2, 517.6±493.8 mm2and 711.06±679.07 mm2, respectively, in group-1, group-2 and group-3 (p=0.013). The number of patients identified with success after surgery was 355 (86.2%), 195 (76.1%) and 50 (74.6%) in group-1, group-2 and group-3, respectively (p = 0.542). The number of patients who develop complications was 114 (%24.65), 57 (%22) and 11 (%16.4) in group-1, group-2 and group-3, respectively (p=0.310). Conclusion: Preoperative GFR valuesare not lonely sufficient to predict success and complications after PCNL. Keywords: Percutaneous nephrolithotomy, renal function, renal stone, glomerular filtration rates

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