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

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.

Mini percutaneous nephrolithotripsy with ultrasound-guided approach in the lateral decubitus position under spinal anesthesia at Viet Duc University Hospital

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Huy Hoàng Nguyễn ◽  
Trường Thành Đỗ ◽  
Ngọc Sơn Đỗ
Keyword(s):  
Minimally Invasive ◽  
Spinal Anesthesia ◽  
Kidney Stones ◽  
Ultrasound Guidance ◽  
Lateral Decubitus Position ◽  
Ultrasound Guided ◽  
Stone Free Rate ◽  
Lateral Decubitus ◽  
Percutaneous Nephrolithotripsy ◽  
Free Rate

Tóm tắt Đặt vấn đề: Can thiệp xâm lấn tối thiểu hiện nay đã thay thế phần lớn phẫu thuật mở trong điều trị bệnh sỏi thận. Nghiên cứu nhằm đánh giá hiệu quả của | phẫu thuật tán sỏi thận qua da đường hầm nhỏ dưới hướng dẫn của siêu âm với người bệnh (NB) ở tư thế nằm nghiêng và gây tê tuỷ sống tại khoa Tiết niệu bệnh viện Việt Đức. Phương pháp nghiên cứu: Mô tả tiến cứu 250 trường hợp sỏi thận được tán sỏi qua da đường hầm nhỏ tại khoa Tiết niệu bệnh viện Việt Đức từ tháng 3/2017 | đến tháng 8/2017. NB được gây tê tuỷ sống, đặt tư thế nằm nghiêng. Chọc dò, tạo đường hầm qua da dưới hướng dẫn siêu âm với nong Amplatz 18 Fr. Sử dụng ống soi niệu quản bán cứng tán sỏi thận bằng Holmium laser 80W. Đánh giá tỷ lệ sạch sỏi và biến chứng sau mổ. Kết quả: 250 NB gồm 176 nam (70,4%) và 74 nữ (29,6%). Tuổi trung bình là 47,13 + 24,31 tuổi (22 - 85). Sỏi bể thận chiếm 34,4%, sỏi đài thận dưới gặp 7,6%, sỏi bể thận và 1 đài 35,6%, sỏi san hô chiếm 22,4%. Sỏi bên phải 38,8% và sỏi bên trái 61,2%, 69 NB (27,6%) có sỏi thận bên đối diện. Phát hiện ứ nước thận trên chụp cắt lớp vi tính (MSCT) trước mổ: 37 đài bể thận bình thường (14,8%); độ 1 gặp 120 (48%), độ 2 gặp 58 (23,2%), độ 3 gặp 35 (14%). Kích thước sỏi: Chiều dài trung bình (TB): 2,41 + 0,86cm (1 - 4,8cm), chiều rộng TB: 1,62 + 0,56cm (1 - 3,2cm). Vị trí đường hầm vào đài giữa 82,4%, đài dưới 16,8%, đài trên 0,8%. Thời gian mổ trung bình: 69,53 + 27,18 phút (35 - 120). Tất cả sỏi thận đều được tán qua da thành công. Biến chứng trong mổ gặp | 9 NB chảy máu (3,6%) không cần truyền máu. Biến chứng sau mổ gặp 5,2% gồm: 1 chảy máu sau mổ được nút mạch chọn lọc, 8 NB sốt sau mổ, 3 NB sốc nhiễm trùng được điều trị tích cực ổn định, 1 NB tử vong do sốc nhiễm trùng và chảy máu. Thời gian nằm viện TB: 4,57 + 2,64 ngày (2 - 8). Dẫn lưu thận | rút sau 2 - 5 ngày (TB: 2,87 + 1,43 ngày). Tỷ lệ sạch sỏi sớm sau mổ: 80,7%. Theo dõi sau mổ: 249 NB khám lại sau 1 tháng và rút ống thông JJ với tỷ lệ sạch sỏi đạt 97,2%. Kết luận: Tán sỏi thận qua da đường hầm nhỏ dưới hướng dẫn siêu âm NB ở tư thế nằm nghiêng và gây tê tuỷ sống mang lại nhiều lợi ích, nên là phương pháp được chọn lựa để điều trị bệnh lý sỏi thận. Abstract Introduction: Minimally invasive treatments have almost completely replaced open surgery in the management of the kidney stone disease. Our study aimed to evaluated the effectiveness of mini percutaneous nephrolithotripsy (mini-PCNL) with ultrasound-guided access in the lateral decubitus position under spinal anesthesia. Material and Methods: Prospective study of 250 kidney stones cases treated by mini-PCNL management at Urology Department of Viet Duc hospital from March 2017 to August 2017. Patients underwent & lyed spinal anesthesia, lying on the side. Small percutaneous renal access tract was performed under the ultrasound guidance with Amplatz dilation sheath 18Fr. Holmium laser nephrolithotripsy was used with semi-rigidureteroscope. Objective: Evaluate the postoperative stone free rate and complication rate. Results: 176 males (70,4%) and 74 females (29,6%) with the average age of 47,13 + 24,31 (range from 22 to 85 years old). Stone site: Renal pelvis: 34,4%; lower calyx 7,6%; pelvis and 1 calyx: 35,6% and staghorn calculi: 22,4%. Right kidney stones:38,8%; Left kidney stones: 61,2% and associate opposite kidney stones: 69 (27,6%). The finding of Hydronephrosis on preoperative MSCT includes: normal: 37 cases (14,8%); grade 1: 120cases (48%); grade 2: 58 (23,2%) and grade 3: 35 (14%). Stone size: mean length: 2,41 +0,86cm (1 - 4,8); mean width: 1,62 = 0,56cm (1 - 3,2). Renal access tract:middle calyx 82,4%; lower calyx 16,8%; upper calyx 0,8%. Average operative time: 69,53 + 27,18 minutes (35 - 120). Laser lithotripsy and stone removal are successful in 100% cases. Peroperative complications: 9 cases of haemorrhage (3,6%) with out blood transfusion requirement. The rate of postoperative early complication was 5,2%: 1 case of haemorrhage requiring embolization, 8 cases have fever. 3 patients with septicemia shock was medically treated and stabilized. 1 patient died from infection and bleeding. The mean of hospital stay: 4,57 = 2,64 day (2 -8). Nephrostomy tube removal after: 2,87 = 1,43 days (2 - 5). Stone free rate: 80,7%. At the postoperative follow-up 1 months, renal function is recovered well and JJ is removed. Stone free rate after 1 month: 97,2%. Conclusion: Mini-PCNL using ultrasound guidance in the lateral decubitus position under spinal anesthesia offers many advantages and should be the chosen method in the treatment of kidney stones. Keyword: Kidney stones, Mini-PCNL, Minimally invasive treatment, spinal anesthesia.

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 Ultrasound for kidney access in percutaneous nephrolithotomy: a contemporary review

2018 ◽  
Vol 20 (4) ◽  
pp. 508
Author(s):  
Alexandru Iordache ◽  
Catalin Baston ◽  
Guler-Margaritis Silviu-Stelian ◽  
Emil Angelescu ◽  
Vasile Cerempei ◽  
...  
Keyword(s):  
Learning Curve ◽  
Percutaneous Nephrolithotomy ◽  
Treatment Options ◽  
Standard Of Care ◽  
Ultrasound Guided ◽  
Stone Free Rate ◽  
Staghorn Calculus ◽  
Comparable Method ◽  
Free Rate ◽  
Kidney Access

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. 

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.

scholarly journals Impact of weight on stone-free rate during percutaneous nephrolithotomy

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.

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

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

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

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.

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.

Guy’s Stone Score as a Predictor for Stone-Free Rate and Complications in Percutaneous Nephrolithotomy: A Single-Center Report from a Stone Belt Country

2020 ◽  
Vol 104 (9-10) ◽  
pp. 746-751
Author(s):  
Aso Omer Rashid ◽  
Huthiem Khalid ◽  
Goran Friad ◽  
Reebeen Yosif Hamed ◽  
Noor Buchholz
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Single Center ◽  
Center Report ◽  
Stone Free Rate ◽  
Free Rate
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