scholarly journals Guy’s Stone Score (GSS) Based on Intravenous Pyelogram (IVP) Findings Predicting Upper Pole Access Percutaneous Nephrolithotomy (PCNL) Outcomes

2016 ◽  
Vol 2016 ◽  
pp. 1-6
Author(s):  
Bannakij Lojanapiwat ◽  
Pattara Rod-Ong ◽  
Pruit Kitirattrakarn ◽  
Wilaiwan Chongruksut
Keyword(s):  
Success Rate ◽  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Success Rates ◽  
Intravenous Pyelogram ◽  
Stone Size ◽  
Clavien Classification ◽  
Reliable Tool ◽  
Major Complications ◽  
Tubeless Pcnl

Objective. To predict the success rate and complications following percutaneous nephrolithotomy via the upper pole using the Guy’s Stone Score (GSS) based on the findings of a preoperative intravenous pyelogram (IVP). Patients and Methods. Two hundred and twenty-seven renal operations, which were carried out using PCNL via the upper pole, were classified according to the GSS assigned. Any complications were classified according to the Clavien classification. The success rates and incidence of any complications were compared between each GSS. Results. The immediate success rates were 87.50% of GSS1, 71.43% of GSS2, 53.62% of GSS3, and 38.46% of GSS4, P<0.01. There were statistically significant differences between the groups in stone size, overall immediate success rate, operative time, number of access tracts, and frequency of tubeless PCNL. Major complications (a Clavien score of 3–5) were significantly higher in the cases with a higher GSS. Conclusion. A GSS based on an IVP is a simple and reliable tool in predicting the success rate and possible complications following upper pole access PCNL.

scholarly journals Assessing radiation exposure during endoscopic-guided percutaneous nephrolithotomy

2014 ◽  
Vol 8 (9-10) ◽  
pp. 347 ◽  
Author(s):  
Andrea G Lantz ◽  
Padraic O'Malley ◽  
Michael Ordon ◽  
Jason Y Lee
Keyword(s):  
Radiation Exposure ◽  
Effective Dose ◽  
Percutaneous Nephrolithotomy ◽  
Treatment Success ◽  
Fluoroscopy Time ◽  
Success Rates ◽  
Stone Size ◽  
Lower Treatment ◽  
The Mean ◽  
Stone Characteristics

Introduction: Percutaneous nephrolithotomy (PCNL) may be associated with significant ionizing radiation exposure for patients and operating room staff. Endoscopic-guided PCNL (ePCNL) is a technique that may be associated with less radiation exposure. This study examines ePCNL-related radiation exposure (fluoroscopytime, effective dose) and investigates variables that may predict increased exposure.Methods: A retrospective review of all consecutive ePCNLs performed at our institution, by a single surgeon, was conducted between November 2011 and November 2013. Patient demographics, stone characteristics and perioperative details were recorded, including radiation exposure. Pearson and Spearman correlation were used to assess variables correlated with radiation exposure.Results: In total, 55 ePCNL cases were included in the study. The mean age was 60 ± 15 years, mean body mass index (BMI) 30.0 ± 6.4 kg/m2 and mean stone size 3.2 × 2.1 cm. Seven cases (13%) involved complete staghorn stones, and 69% involved supracostal punctures. The mean fluoroscopy time was 3.4 ± 2.3 minutes, mean ED 2.4 ± 1.9 mSv. The treatment success rate, assessed 1-week postoperatively, was 87.3% and 7.3% of cases required ancillary procedures. The overall complication rate was 29%, but only 3 cases (5.5%) were Clavien ≥3. Longer fluoroscopy time correlated with increased stone size (p < 0.01), longer operative time (p < 0.01) and lower treatment success rates (p < 0.01); higher effective dose correlated with longer fluoroscopy time (p < 0.01) and increased skin-to-stone distance (p < 0.01). BMI did not correlate with fluoroscopy time or effective dose.Conclusions: Outcomes of ePCNL are comparable to traditional PCNL techniques and may be associated with lower radiation exposure, particularly beneficial for patients with higher BMI.

scholarly journals Risk Factors for Postoperative Complications after Percutaneous Nephrolithotomy

2018 ◽  
Vol 16 (1) ◽  
pp. 79-83 ◽  
Author(s):  
Robin Bahadur Basnet ◽  
Anil Shrestha ◽  
Parash Mani Shrestha ◽  
Bishwa Raj Joshi
Keyword(s):  
Postoperative Complications ◽  
Percutaneous Nephrolithotomy ◽  
Scoring System ◽  
Operative Time ◽  
Standard Technique ◽  
Diabetic Patients ◽  
Staghorn Calculi ◽  
Stone Burden ◽  
Major Complications ◽  
A Prospective Study

Background: To identify the perioperative factors associated with complications after percutaneous nephrolithotomy by classification of complications according to the modified Clavien scoring system and evaluation of the minor and major complications related to the procedure.Methods: A prospective study of all the percutaneous nephrolithotomy performed by standard technique within 1.5 years at Bir Hospital was made. Possible demographic, preoperative and intraoperative variables were included in the study and patients were followed up postoperatively for any complications. All complications were classified according to modified Clavien scoring system and analyzed to identify the prognostic variables.Results: Two hundred and forty six percutaneous nephrolithotomy done within the study period were analyzed. Although 41.06 % of the study population developed complications, only 9.35 % had major complications. Age, body mass index, gender, clinical presentation, history of previous surgery and ASA score did not correlate with complications. Diabetes was the only comorbidity associated (p = 0.0482). Preoperatively estimated stone burden (p = 0.0023), number of calyces involved by the stones (p = 0.0002), and presence of staghorn calculi were significantly associated with development of postoperative complications. Multiple tracts were required (p = 0.0151) and operative time was longer (p < 0001) in the patients who developed complications.Conclusions: Percutaneous nephrolithotomy has lesser complications. Diabetic patients are more prone to develop complications. Larger stone burden, involvement of multiple calyces by stones and staghorn calculi are associated with need of multiple tracts and longer operative time, thus predisposing to higher incidence of complications.

scholarly journals Complications and Success Rate of Percutaneous Nephrolithotomy in Renal Stone: A Descriptive Cross-sectional Study

2019 ◽  
Vol 57 (220) ◽  
Author(s):  
Robin Joshi
Keyword(s):  
Success Rate ◽  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Point Estimate ◽  
Care Hospital ◽  
Success Rates ◽  
Sectional Study ◽  
Cross Sectional

Introduction: Renal stone disease has been affecting people for centuries. Percutaneous nephrolithotomy is one of the five interventions offered to a patient with renal stone. With the continuous development of noninvasive or minimally invasive techniques, these surgical procedures have been refined over time. This study was conducted to find the success rate of percutaneous nephrolithotomy in renal stone using Guy’s score and complication by Modified Clavien score. Methods: This descriptive cross-sectional study was done among 114 patients who underwent percutaneous nephrolithotomy in a tertiary care hospital, from September 2016 to December 2018 after receiving ethical approval from the Institutional Review Committee. Convenient sampling was done. All patients were informed about the potential benefits and risks of the percutaneous nephrolithotomy procedure and patients signed an informed written consent form. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion. Statistical analysis was done by using Statistical Package for Social Sciences version 22.2. Results: Forty-six (40.3%) patients had Guy’s stone score I, 43 (37.71%) patients had a score of II, 15 (13.6%) patients had a score of III and 10 (8.77%) patients had a score of IV. The success rates of stone clearance were 97.8 %, 95.3%, 80% and 50% for Guy’s stone score 1, 2, 3 and 4 respectively. A total of 114 patients were enrolled in the study out of which 66 were male and 48 were female. Eighteen patients experienced some form of complications out of which 3 patients needed surgical intervention with Modified Clavien score of III. Conclusions: Using Guy’s scoring system for percutaneous nephrolithotomy we evaluated the success rate. It is reproducible, easy and proves to be a useful tool to counsel patients about stonefree rate and prognosis for the surgical procedure. Modified Clavien score was helpful in evaluating complication rate.

scholarly journals Comparison of efficacy of laser lithotripter with ultrasonic lithotripter in mini percutaneous nephrolithotomy

2016 ◽  
Vol 87 (4) ◽  
pp. 276
Author(s):  
Fatih Akbulut ◽  
Onur Kucuktopcu ◽  
Emre Kandemir ◽  
Erkan Sonmezay ◽  
Abdulmuttalip Simsek ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Success Rate ◽  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Fluoroscopy Time ◽  
Total Operative Time ◽  
Laser Group ◽  
Group 2 ◽  
The Cost ◽  
Group 1

Objective: The aim of the study was to compare the efficacy of the laser lithotripter with the ultrasonic lithotripter in mini percutaneous nephrolithotomy (miniperc). Material and Methods: From June 2013 to January 2014; medical records of 77 consecutive patients who underwent miniperc operation were retrospectively evaluated. Ultrasonic lithotripter was used in 22 patients (Group 1), while laser was used in 55 patients. In the laser group, 22 patients were randomly selected who had same characteristics compared to group 1 (Group 2). Success rate, total operative time, complications according to modified Clavien classification, fluoroscopy time, haemoglobin drop, hospital stays and cost analysis were assessed. Success rates were evaluated on the second postoperative day and after the first month. Results: Total operative time (p = 0.635) and fluoroscopy time (p = 0.248) were not significantly different between the two groups. In the laser group, the success rate (81.8%) was notably more than in the ultrasonic lithotripter group (68.2%) but there was no statistically significance (p = 0.296). Ten reusable ultrasonic probe were used for 22 patients, due to thinness and sensitiveness of the probe. Conversely, one single laser fiber (550 micron) was used for 22 patients. When the cost analysis of lithotripsy was considered, the cost per case was 190 dollar in group 1 and 124 dollar in group 2. (p = 0.154) Complication rate, hospital stay and haemoglobin drop were similar in both groups. Conclusion: Laser lithotripsy seems to be more cost effective than ultrasonic lithotripsy for miniperc but larger number of patients are required to confirm this estimation.

scholarly journals Tubeless Supine Percutaneous Nephrolithotomy in Calyceal Diverticular Stone

2021 ◽  
Author(s):  
Sandeep Gupta ◽  
Ankit Verma ◽  
Dilip Kumar Pal
Keyword(s):  
Prone Position ◽  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Operating Time ◽  
Additional Benefit ◽  
Total Operating Time ◽  
Tubeless Pcnl

Percutaneous Nephrolithotomy (PCNL) has routinely been performed in prone position as a treatment for calyceal diverticular stone. PCNL is performed supine as an alternate modality for calyceal diverticular stones. The objective of the procedure is to reduce operative time and anaesthetic morbidity during supine tubeless PCNL in calyceal diverticular stone. The series is about three patients with calyceal diverticular stones. These patients underwent supine tubeless PCNL in Galdakao modified supine Valdivia position. There was no intraoperative, postoperative or on follow-up complications in any of the the patients. In all the patients stones were cleared completely in single sitting. Supine PCNL in calyceal diverticular stone could be an alternative with similar outcomes to the standard prone PCNL. It provides an additional benefit of performing the procedure in a single position, which is known to reduce total operating time and also reduces anaesthesia complications.

scholarly journals The Safety and Efficacy of Mini Percutaneous Nephrolithotomy During Learning Curve

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.  

Comparison of Ultrasound and Fluoroscopically Guided Percutaneous Transhepatic Biliary Drainage

2018 ◽  
Vol 37 (1) ◽  
pp. 77-86 ◽  
Author(s):  
Simon Nennstiel ◽  
Matthias Treiber ◽  
Alexander Faber ◽  
Bernhard Haller ◽  
Stefan von Delius ◽  
...  
Keyword(s):  
Success Rate ◽  
Biliary Drainage ◽  
Percutaneous Transhepatic Biliary Drainage ◽  
Standard Technique ◽  
Biliary System ◽  
Complication Rates ◽  
Success Rates ◽  
Major Complications ◽  
The Right ◽  
Transhepatic Biliary Drainage

Background: Percutaneous transhepatic biliary drainage (PTBD) plays a significant role especially in the palliation of an endoscopically inaccessible biliary system. Since a standard technique of PTBD is not defined, we compared a fluoroscopically guided technique (F-PTBD) with an ultrasound (US-PTBD) guided approach. Patients and Methods: Procedure characteristics, success-rates and complication-rates of the different PTBD techniques were compared in patients who underwent PTBD between October 1, 2006, and ­December 31, 2014. Results: In 195 patients, 251 PTBDs (207 F-PTBDs, 44 US-PTBDs) were performed. F-PTBDs were mostly inserted from the right and US-PTBDs from the left. Patient age, gender and physical status were comparable in both techniques. There was no difference regarding overall procedure success (90%/86.4%), overall interventional complication rates (10.6%/9.1%), fluoroscopy times, intervention times or sedatives dosages. However, major complications were only encountered in F-PTBDs. There was a higher success rate for F-PTBD vs. US-PTBD from the right side (91.9 vs. 75%; p = 0.033) and a trend towards a higher success rate for US guidance from the left side (82.9 vs. 95.8%; p = 0.223). Conclusions: For drainage of the right biliary system F-PTBD seems superior over the US-PTBD technique used in this study. However, major complications can occur more frequently in F-PTBD.

Hearing results after stapedotomy for otosclerosis: comparison of prosthesis variables

2021 ◽  
Vol 135 (1) ◽  
pp. 28-32
Author(s):  
H Odat ◽  
Y Kanaan ◽  
M Alali ◽  
M Al-Qudah
Keyword(s):  
Success Rate ◽  
Operative Time ◽  
Success Rates ◽  
Hearing Results ◽  
Shaft Diameter ◽  
Style Manual

AbstractObjectiveTo evaluate the influence of different piston variables on hearing following stapedotomy.MethodsData were analysed in groups according to: piston material (titanium vs fluoroplastic), shaft diameter (0.4 mm vs 0.5 mm) and crimping style (manual crimping vs self-crimping). Pre- and post-operative average air–bone gap, air–bone gap difference, success rate and operative time were evaluated.Results and conclusionFifty-one patients (58 ears) were included. A post-operative air–bone gap of 10 dB or lower was achieved in 44 cases, with a success rate of 75.9 per cent; 52 cases (89.7 per cent) had an air–bone gap of 20 dB or lower. The success rate was higher, but not significantly, in fluoroplastic than in titanium pistons (85 per cent vs 70 per cent). Pistons with shaft diameters of 0.5 mm and 0.4 mm had success rates of 79 per cent and 72 per cent, respectively. No significant differences were found for any audiometric parameters. There were no significant differences between manual crimping and self-crimping pistons in terms of audiometric results or success rate.

scholarly journals Percutaneous nephrolithotomy in patients with a solitary kidney

2014 ◽  
Vol 86 (4) ◽  
pp. 253
Author(s):  
Tufan Süelözgen ◽  
Salih Budak ◽  
Orcun Celik ◽  
Okan Yalbuzdag ◽  
Oguz Mertoglu ◽  
...  
Keyword(s):  
Success Rate ◽  
Percutaneous Nephrolithotomy ◽  
Urinary Calculi ◽  
Solitary Kidney ◽  
Lower Pole ◽  
Success Rates ◽  
Successful Result ◽  
Residual Stone ◽  
Study Results ◽  
Operation Duration

Material and method: The results of percutaneous nephrolithotomy applied to 716 patients in our clinic between January 2008 and January 2014 were retrospectively evaluated. Age, gender, urinary calculi size (mm2), urinary calculi localization, ESWL history, operation duration (min), fluoroscopy duration (sec), access type, reason of solitary kidney, hemoglobin drawdown (g/dl) and operation success of the patients with a solitary kidney were recorded. The patients having no preoperative and postoperative non contrast abdominal tomography were excluded from the study. Results: Fifteen of nineteen patients (79%) were men and 4 of them (21%) were women. The average age of the patients was 42.52 ± 16.72 (14-72). Ten patients had anatomical solitary kidney and nine patients had physiological solitary kidney. In fact counter kidney was non functional in 9 patients (47%) whereas there was agenesis in 2 (11%) and outcome of nephrectomy in 8 (42%) patients. In our study, presence of residual stone less than 4 mm at 1st month postoperative non contrast abdominal tomography was accepted as a successful result and accordingly our success rate was detected as 84%. Mean urinary calculi size was 405 ± 252.9 mm2; urinary calculi localization was pelvic, lower pole, upper-middle pole, middle-lower pole and staghorn in 11 (58%), 4 (21%), 1 (5%), 1 (5%) and 1 (5%) patients, respectively; previous ESWL history was 16%; operation duration was 55.47-± 28.1 min and fluoroscopy duration 131.10 ± 87.6 sec; access type was subcostal in 79%, supracostal in 10.5% and multiple in 10.5%; hemoglobin drawdown was 1.75 ± 0.97 mg/dl. Conclusions: PNL can be effectively and safely administered for the treatment of solitary kidney. In the treatment of large urinary calculi in patients with a solitary kidney, PNL has some advantages such as short surgery duration, less complication, acceptable hemoglobin drawdown and high success rates. According to our study, PNL operation in patients with a solitary kidney is a good option for carefully and poisedly selected cases.

Supine tubeless PCNL in horseshoe kidney (a series of cases)

2021 ◽  
pp. 039156032110155
Author(s):  
Sandeep Gupta ◽  
Atar Kasim ◽  
Dilip Kumar Pal
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Supine Position ◽  
Operative Time ◽  
Operating Time ◽  
Case Series ◽  
Horseshoe Kidney ◽  
Renal Calculi ◽  
Additional Benefit ◽  
Tubeless Pcnl

Objective: Objective of this case series is accurate access to the respective calyx with stone in horseshoe kidney while performing percutaneous nephrolithotmy in supine position. Reducing operative time and anaesthetic morbidity while performing percutaneous nephrolithotomy in horseshoe kidney with nephrolithiasis in supine position. Materials and Methods: Four patient with one having bilateral renal calculi with horshoe kidney were selected randomly. There were no preference for age, gender; size, location and laterality of stone or BMI. All the patients fit into the AUA guideline criteria for management by percutaneous nephrolithotomy. Preoperative, perioperative and follow up data were collected. Results: Four patients with one having bilateral renal calculi underwent supine tubeless PCNL in 1 year in GMSV position. There was no intraoperative, post operative or on follow up complications in any patient. In all the patients stones were cleared completely in single setting. Conclusion: Supine percutaneous nephrolithotomy in horseshoe kidney is an alternative to the standard prone percutaneous nephrolithotomy in the horseshoe kidney. It provides an additional benefit of performing the procedure in a single position, which is known to reduce total operating time, less anaesthesia related complications and less neuromusculoskeletal injury.

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