scholarly journals A Major Complication in Micropercutaneous Nephrolithotomy: Upper Calyceal Perforation with Extrarenal Migration of Stone Fragments due to Increased Intrarenal Pelvic Pressure

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Fatih Akbulut ◽  
Burak Ucpinar ◽  
Metin Savun ◽  
Onur Kucuktopcu ◽  
Faruk Ozgor ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Pelvis ◽  
Laser System ◽  
Major Complication ◽  
Efficient Technique ◽  
Yag Laser ◽  
Stone Clearance ◽  
Micropercutaneous Nephrolithotomy ◽  
Effective Drainage ◽  
Pelvic Pressure

Micropercutaneous nephrolithotomy is a safe and efficient technique for appropriate sized stones. It is performed through a 4.85 Fr all-seeing needle and stones are fragmented into dust, without the need for tract dilatation, unlike other percutaneous nephrolithotomy types. Even though micropercutaneous nephrolithotomy has many advantages, increase in intrapelvic pressure during surgery may cause rare but serious complications. Herein we report a case of micropercutaneous nephrolithotomy in a 20-year-old woman with a 20 mm right renal pelvis stone and present an undesired outcome of this complication, upper calyceal perforation. Right lower calyceal access was performed with 4.85 Fr all-seeing needle and 2 cm renal pelvis stone was fragmented by 272 μm Holmium-Yag laser system. Upper calyceal perforation and infrahepatic accumulation of stone fragments were detected by fluoroscopy during the surgery. Postoperative imagings revealed perirenal urinoma, perirenal and infrahepatic stone fragments, and lower calyceal stone fragments inside the system. On second postoperative day, minipercutaneous nephrolithotomy and double J catheter insertion procedures were applied for effective drainage and stone clearance. Risk of calyceal perforation and urinoma formation, due to increased intrapelvic pressure during micropercutaneous nephrolithotomy, should be kept in mind.

MANAGEMENT OF BLADDER STONE WITH HOLMIUM-YAG LASER AT KARDINAH HOSPITAL TEGAL

2020 ◽  
Vol 27 (1) ◽  
pp. 1-4
Author(s):  
Fatan Abshari ◽  
Zulfikar Ali
Keyword(s):  
General Hospital ◽  
Laser Energy ◽  
Major Complication ◽  
Mucosal Injury ◽  
Cross Sectional Study ◽  
Stone Size ◽  
Cross Sectional ◽  
Yag Laser ◽  
Bladder Stones ◽  
Large Size

Objective: Transurethral lithotripsy using Holmium-YAG laser has been reported to be beneficial in breaking up bladder stones with large size (>4cm in diameter) with lower risk of mucosal injury and hematuria. The aim of this study is to evaluate the utilization of Holmium-YAG laser for the management of bladder stones at Kardinah General Hospital, Tegal. Material & Methods: This is a cross-sectional study conducted from January 2017 to March 2017. Patient’s demography, which included age, sex, length of surgery, stone size, and laser’s energy count were recorded. Results: We included 120 patients in this study. Mean of patients age in this study was 51.93 years old with age range were 41-85 years old. Most of the patients were male (109 vs 11) with a mean size of stone 25.09 ± 3.04 mm. Length of surgery ranges from 15 to 75 minutes and mean energy of the laser 28.99 ± 19.34 kJ. There was 100% stone’s clearance following surgery with no major complication occurred. Conclusion: Holmium-YAG laser is effective in managing bladder stones at Kardinah General Hospital particularly for large size stones. Length of surgery and energy of laser used depend on the stone size in which bigger stone size is associated with longer surgery time and bigger laser energy needed.

scholarly journals Stone Clearance by Computed Tomography after Percutaneous Nephrolithotomy: A Descriptive Cross-sectional Study

2020 ◽  
Vol 58 (228) ◽  
Author(s):  
Chitaranjan Shah ◽  
Robin Bahadur Basnet ◽  
Arvind Shah ◽  
Prakash Chhettri ◽  
Anup Chapagain ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Percutaneous Nephrolithotomy ◽  
Low Dose ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Residual Stone ◽  
Cross Sectional ◽  
Stone Clearance ◽  
Low Dose Computed Tomography ◽  
Residual Fragments

Introduction: Percutaneous nephrolithotomy has the highest stone free rate among other procedures with relatively higher complication rate. Post-operative imaging after stone surgeries has not been uniform. This study was done to study about the stone clearance by computed tomography after percutaneous nephrolithotomy. Methods: The descriptive cross-sectional study was conducted in the Department of Urology, Bir Hospital for six months duration. The patients undergoing percutaneous nephrolithotomy and those with intra-operative fluoroscopic clearance were evaluated with a low dose computed tomography after 48 hours to assess residual fragments its size and location. Patient’s demographics, stone characteristics and complications were compared between the stone free and with residual stone patients. Results: Out of 72 percutaneous nephrolithotomy performed, 40 patients were included in the study. Low dose computed tomography kidney, ureter and bladder after 48 hours of surgery detected residual fragments in 11 (27.5%) patients. The RFs size of <4mm were found in 7 (63.63%) of cases whereas RFs of >4mm were found in 4 (36.36%). The stone size was 352.47 ± 97.47 mm2 and 254.79 ± 172.68mm2 in group with residual fragments and stone free group respectively. Conclusions: Low dose computed tomography kidney, ureter and bladder done for assessment of stone clearance after 48 hours of percutaneous nephrolithomy detected residual in around one fourth of patients, however majority of them had residual fragments <4mm. Intra-operative fluoroscopic clearance may over estimate stone clearance after percutaneous nephrolithomy as about one third of patients still may have residual fragments of >4mm size.

Responses of primate spinothalamic tract neurons to renal pelvic distension

1989 ◽  
Vol 62 (3) ◽  
pp. 778-788 ◽  
Author(s):  
W. S. Ammons
Keyword(s):  
Renal Pelvis ◽  
Receptive Fields ◽  
Response Threshold ◽  
Spinothalamic Tract ◽  
Renal Nerve ◽  
C Fiber ◽  
The Right ◽  
Somatic Input ◽  
Increased Activity ◽  
Pelvic Pressure

1. Experiments were performed to examine responses of spinothalamic tract (STT) neurons to distension of the renal pelvis. Nineteen monkeys (Macaca fascicularis) were anesthetized with alpha-chloralose, paralyzed, and artificially ventilated. Fifty-four STT neurons in the T11-L2 segments were studied. Each cell was excited by renal nerve stimulation and had a somatic receptive field in the left flank and/or the abdomen. 2. Distension of the left renal pelvis to 50 mmHg for 20-30 s increased activity of 40 STT neurons. Two types of responses were observed. Six cells responded rapidly to the increase in renal pelvic pressure. Thereafter activity of these cells completely adapted. The other 34 cells also responded rapidly to the distension: however, the subsequent adaptation was not complete. Average activity before distension was 13 +/- 1 (SE) spikes/s. Distension increased activity to a peak of 42 +/- 3 spikes/s. Mean activity just before the end of the distension was 27 +/- 3 spikes/s. 3. The pelvic pressure-cell response relation was determined for 16 cells. Only one cell responded to a pressure of 20 mmHg. Three responded to 30 mmHg, and all others responded to 40 mmHg and higher. The average response threshold was 32 +/- 1 mmHg. Peak responses increased as distending pressure increased from 40-80 mmHg. Responses to a pressure of 100 mmHg were no greater than to 80 mmHg. Adapted levels of activity were also a function of distending pressure in the 40-80 mmHg range. 4. Probability of responses was unrelated to somatic input. However, cells with A delta- and C-fiber renal input were significantly more likely to respond to renal pelvic distension than cells with only A delta-renal input. Magnitude of responses to a pressure of 50 mmHg was not related to the type of renal input to the cells; however, among the cells tested at all pressures, cells with A delta- and C-fiber input had significantly greater responses to pressures of 80 and 100 mmHg. 5. Cells were studied in laminae I and IV-VII: responses were unrelated to laminar location. None of the 6 cells located in L2 responded to renal pelvic distension; 8 of 12 in L1 responded; 24 of 28 in T12 responded; and all 8 cells in T11 responded. 6. Stimulation of inhibitory receptive fields on the right hindlimb reduced activity of four cells to a significantly greater extent during pelvic distension than before pelvic distension.(ABSTRACT TRUNCATED AT 400 WORDS)

Continuous-wave and self-starting passively mode-locked broadband Cr4+:YAG laser system

1998 ◽  
Author(s):  
Yongmao Chang ◽  
Romain Maciejko ◽  
Richard Leonelli ◽  
Anthony S. Thorpe
Keyword(s):  
Continuous Wave ◽  
Laser System ◽  
Yag Laser

scholarly journals MP33-08 PREDICTING FACTORS FOR COMPLICATIONS AND STONE CLEARANCE FOLLOWING PEDIATRIC MINI-PERCUTANEOUS NEPHROLITHOTOMY

2016 ◽  
Vol 195 (4S) ◽  
Author(s):  
Mohammed ElSheemy ◽  
Ahmed Shouman ◽  
Kareem Daw ◽  
Ahmed Shoukry ◽  
Waseem Aboulela ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Stone Clearance ◽  
Predicting Factors

CROSS‐PUMPED Cr3+−Nd3+:YAG LASER SYSTEM

1964 ◽  
Vol 5 (10) ◽  
pp. 200-202 ◽  
Author(s):  
Z. J. Kiss ◽  
R. C. Duncan
Keyword(s):  
Laser System ◽  
Yag Laser

scholarly journals Stone clearance times with mini-percutaneous nephrolithotomy: Comparison of a 1.5 mm ballistic/ultrasonic mini-probe vs. laser

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Brennan Timm ◽  
Matthew Farag ◽  
Niall F. Davis ◽  
David Webb ◽  
David Angus ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Alternative Energy ◽  
Final Analysis ◽  
Time Interval ◽  
Clearance Time ◽  
Ho:Yag Laser ◽  
Stone Clearance ◽  
Alternative Energy Sources ◽  
The Mean ◽  
Better Than

Introduction: A limitation of mini-percutaneous nephrolithotomy (mPCNL) is the narrow working channel of mini-nephroscopes, typically restricting instrumentation to 5 F or smaller. We evaluated the efficacy of the 1.5 mm Swiss Lithoclast® Trilogy (Trilogy) rigid probe and compared the results to consecutive cases performed with a 30 W Holmium:YAG (Ho:YAG) laser. Methods: A retrospective review of 30 consecutive mPCNL cases using the Trilogy and 30 W Holmium laser was performed. A 12-French (F) MIPS nephroscope with a 16.5 F access sheath and 6.7 F working channel was used for all mPCNL cases. The Trilogy was used with a disposable 1.5 mm x 440 mm probe with dual ultrasonic and ballistic energy. The Ho:YAG laser was used with a 550 micron fibre and a maximum of 30 W. Stone clearance time (SCT) was defined by the total time interval between activation of the lithotripter until insertion of the nephrostomy tube and measured in mm2/minutes. SCT included time for fragment retrieval, equipment adjustments, and rigid and flexible nephroscopy during and after lithotripsy. Results: Eleven cases using a 1.5 mm Trilogy probe and 16 cases using a Ho:YAG laser met final inclusion criteria. Three cases using the Trilogy were excluded from final analysis due to conversion to alternative energy sources — two of those were upsized to standard PCNL and one was converted to laser. Mean stone diameter and density in the final Trilogy cohort was 26.7 mm and 1193 Hounsfield units (HU). Mean diameter and density in the laser cohort was 25.2 mm and 1049 HU. The mean stone area clearance time for Trilogy was 4.7±1.8 mm2/minute vs. 3.4±0.7 mm2/minute with Ho:YAG laser (p=0.21). For hard stones, defined as density >1000 HU, the Trilogy averaged 3.7±1.6 mm2/minutes, while the laser averaged 3.1±1.3 mm2/minutes (p=0.786). For soft stones, defined as <1000 HU, the Trilogy averaged 8.9±1.0 mm2/minutes compared to the Ho:YAG, which averaged 3.6±1.8mm2/minutes (p=0.019). No device0related complications occurred in either cohort. Conclusions: The 1.5 mm mPCNL Trilogy probe was comparable to 30 W Ho:YAG laser for clearing hard stones. The Trilogy performed better than laser on soft stones with a HU density <1000 HU.

scholarly journals Safety and efficacy of the supracostal access for percutaneous nephrolithotomy: Our initial experience

1970 ◽  
Vol 37 (1) ◽  
pp. 34-38 ◽  
Author(s):  
M Hossain ◽  
ATMA Ullah ◽  
S Regmi ◽  
H Rahman ◽  
SAMG Kibria
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Complication Rate ◽  
Postoperative Hospital Stay ◽  
Initial Experience ◽  
Safety And Efficacy ◽  
Stone Clearance ◽  
Secondary Procedures ◽  
Residual Stones ◽  
Staghorn Stones ◽  
Made In

The aim of this study was to evaluate the safety and efficacy of the supracostal access for percutaneous nephrolithotomy (PCNL). Between July 2007 and June 2010, 122 patients underwent PCNL, of whom 28 (23%) had supracostal access. All procedures were performed in a single sitting under general anesthesia. The data were analysed for indications, stone clearance rates and the complications associated with supracostal puncture. The indications for a supracostal access were staghorn stones (50%), pelvis stones (28.5%), calyceal stones in high-lying kidney (18%) and upper ureter/ureteric stones (3.5%). All tracts were made in the 11th intercostal space. Single tract access was used in 22 cases (78%), but 6 (22%) required a second tract. Additional punctures were required mainly for staghorn stones (4 out of 14). Overall, 82% of the patients were rendered stone free or had clinically insignificant residual stones with PCNL monotherapy, and this increased to 96% with secondary procedures. In patients with staghorn stones, they were completely cleared in 78%. Overall complication rate was 28% and included hydrothorax in 3 (10%) patients, which required insertion of a chest tube. One (3.5%) patient developed haemothorax secondary to injury of the intercostal artery, pelvic perforation in 1 (3.5%), perinephric collection in 1 (3.5%), infection/sepsis in 2 (7%). Except those patients who had complication, all other patient recovered uneventfully. Postoperative hospital stay ranged from 2 to 9 days. In conclusion, supracostal access gives high clearance rate with acceptable complications and should not be avoided for fear of chest complications. DOI:  http://dx.doi.org/10.3329/bmrcb.v37i1.7797 Bangladesh Med Res Counc Bull 2011; 37: 34 - 38  

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