Comparison of Standard Percutaneous Nephrolithotomy with  Mini-Percutaneous Nephrolithotomy for Removal of Renal  Stones in Adults

Renal stones are the third most common problem affecting about 10% of global population. The management of nephrolithiasis has undergone a complete transformation since the 1980s. Percutaneous nephrolithotomy (PCNL) has established itself an effective and safe technique that delivers high stone-free rate as well as overall shorter treatment time. We aim to compare the outcome of mini-PCNL with standard-PCNL in patients presenting with renal stones. In all, 90 patients fulfilled the selection criteria and randomized into two groups. Group A underwent mini-PCNL whereas Group B underwent standard-PCNL. Pre-operative hemoglobin level was recorded. Duration of procedure as well as drop in hemoglobin level was also recorded. A kidney, ureter, and bladder (KUB) X-ray was performed to confirm the presence of of stone and stone-free status. The mean age of patients in mini-PCNL group was 43.11 years and in standard-PCNL group, it was 36.91 years. The mean stone size in patients of mini-PCNL group was 29.53 mm and 31.58 mm in standard-PCNL group. The mean duration of renal stone in mini-PCNL group was 1.91 years and that in standard-PCNL group 1.80 years. The mean operative time in mini-PCNL group was 59.56 min and 61.22 min in standard-PCNL group. The mean fall in hemoglobin in mini-PCNL group was 0.38 g/dL and that in standard-PCNL group 0.51 g/dL. In mini-PCNL group, stone clearance was observed in 42 (93.3%) patients, while in standard-PCNL group, it was observed in 45 (100%) patients. This difference was insignificant (P > 0.05). Mini-PCNL and standard-PCNL have no significant differences in terms of outcome, operative time, and stone clearance, although fall in hemoglobin level was less in mini-PCNL group, which showed less blood loss in this group, thereby making it a more appropriate method for renal stone removal.

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Percutaneous nephrolithotomy with or without nephrostomy tube

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v11i2.35932 ◽

2018 ◽

Vol 11 (2) ◽

pp. 189

Author(s):

Mohammed Aulad Hossain ◽

S. M. Yunus Ali ◽

Mohammad Saiful Islam ◽

Mohammad Jahangir Alam ◽

Mollah Md. Abu Sayed ◽

...

Keyword(s):

Percutaneous Nephrolithotomy ◽

Renal Stone ◽

Renal Stones ◽

Stone Disease ◽

Nephrostomy Tube ◽

Visual Analogue Pain ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B

<p class="Abstract">The study has been designed to compare the outcome of percutaneous nephrolithotomy with (Group A) or without nephrostomy tube (Group B) for the management of renal stone disease. JJ stents were given to all cases of both groups. Comparison of outcome between groups shows that urinary leakage time was significantly longer in Group B than that in Group A (24.0 ± 6.2 vs 7.3 ± 3.9 hours; p<0.001). Visual analogue pain score was also significantly high in Group B than in Group A (4.7 ± 0.8 vs 2.4 ± 0.5; p<0.035). Patients in Group B stayed in hospital on an average 4 days, while the Group A patients stayed in hospital on an average 2.5 days (p<0.029). The mean hemoglobin decrease in 24 hours in Group B and in Group A (0.5 ± 0.4 and 0.5 ± 0.4 respectively) did not show any significant difference (p<0.895). In conclusion, percutaneous nephrolithotomy without nephrostomy tube can be practiced in the management of selective cases of renal stones diseases.</p>

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

QJM ◽

10.1093/qjmed/hcaa070.014 ◽

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.

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Comparative Evaluation of Outcomes After Standard versus “Modified Large PCNL”- Is Larger Better…?

Journal of Endoluminal Endourology ◽

10.22374/jeleu.v4i1.103 ◽

2020 ◽

Vol 4 (1) ◽

pp. e1-e12

Author(s):

Deep Kumar Jain ◽

Padmaraj Hegde ◽

Arun Chawla

Keyword(s):

Randomized Trials ◽

Operative Time ◽

Female Ratio ◽

Stone Clearance ◽

Perceived Benefit ◽

Group A ◽

The Mean ◽

Group B ◽

Stone Characteristics ◽

Male To Female

ObjectivesTo comparatively evaluate the outcomes of standard percutaneous nephrolithotomy (PCNL) versus a 36 Fr PCNL in terms of operative time, complications, hospital stay, and stone free rates. Patients and MethodsThe data of 125 PCNL cases, out of the 168 PCNLs done from January 2014 to December 2015, was retrospectively analyzed within two subsets, namely group-A (standard PCNL with 22-32 Fr Amplatz) and group-B (modified large PCNL with 36 Fr Amplatz). The demographic profile, stone characteristics, operative and laboratory parameters, and stone clearance rate were analyzed to determine the safety and efficacy of the modified large PCNL as against standard PCNL. ResultsGroup-A comprised 88 patients with 100 renal units, while group-B comprised 37 patients with 45 renal units. The mean age of the patients in Group-A was 49.1 + 13.1 years, and in Group-B was 52.4 + 11.4 years (range 25-84 years) with a male to female ratio of 4:1. 54.5% and 75.7% unilaterally intervened, group-A and group-B patients respectively, required < 90 minutes for the procedure. Nine patients (10.2%) each of unilaterally and bilaterally intervened group-A cases had an operative time that exceeded 120 minutes compared to only two (5.4%) bilaterally intervened group-B cases. For patients with stone burden >1000 mm2, there was statistically significant (p = < 0.0001) higher complete stone clearance rates with the 36Fr PCNL compared to standard PCNL. ConclusionOur retrospective analysis revealed that 36 Fr PCNL is safe and efficacious in carefully selected patients with large stone burdens providing the advantage of better stone-free rates, less operative time, lesser need for additional punctures without increasing blood transfusion and complications rates. However, more extensive prospective randomized trials are needed to confirm this perceived benefit.

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Use of Amplatz Sheath in Percutaneous Nephrolithotomy and effect of its various sizes: Randomized Controlled Trial

Pakistan Journal of Medicine and Dentistry ◽

10.36283/pjmd9-3/008 ◽

2020 ◽

Author(s):

Adnan Siddiq

Keyword(s):

Percutaneous Nephrolithotomy ◽

Operative Time ◽

Controlled Trial ◽

Renal Stones ◽

P Value ◽

Common Source ◽

Stone Size ◽

Group A ◽

Group B ◽

Hemoglobin Drop

Background: Nephrostomy tract itself is the most common source of hemorrhage during percutaneous nephrolithotomy, which can be avoided by puncturing through the calyx with minimal angulation between calyceal system and the nephroscope shaft. Smaller the sheath diameter, lesser would be the bleeding. Our objective was to compare mean change in hemoglobin (HB) level in patients undergoing percutaneous nephrolithotomy (PCNL) with 24 versus 30 French Amplatz sheath. Methods: In this study, 142 patients were randomly divided into Group A undergoing procedure with 24 French Amplatz sheath; and Group B with 30 French sheath. At the end of procedure in both groups, nephrostomy tube was kept for 24 hours. On first post-operative day, patients’ HB was checked and compared with pre-operative data, along with blood transfusion rates. SPSS 20 was used for data analysis and p-value < 0.05 was considered significant. Results: Median age and interquartile range of Group-A and Group-B patients was (40; 18) and (41; 21) years respectively. While stone size of Group-A and Group-B patients reported as (2.0; 0.60) and (2.1; 0.70) cm. The operative time and interquartile ratio of Group-A and Group-B patients was (75; 45) and (85; 45) minutes and we found significant change in HB of Group-A (0.90; 0.80) with Group-B patients (1.90; 0.70) gm/dl respectively [p = 0.000]. Conclusion: It was observed that use of 24 French Amplatz sheath lead to less renal hemorrhage and less hemoglobin drop compared to standard 30 French Amplatz sheath. Thus, small size Amplatz sheath in percutaneous nephrolithotomy may be considered effective and safe option for treatment of renal stones.

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

African Journal of Urology ◽

10.1186/s12301-019-0002-5 ◽

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.

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Modified Percutaneous Achilles Tendon Lengthening by Triple Hemisection for Achilles Tendon Contracture

BioMed Research International ◽

10.1155/2019/1491796 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Yangjing Lin ◽

Jin Cao ◽

Changgui Zhang ◽

Liu Yang ◽

Xiaojun Duan

Keyword(s):

Achilles Tendon ◽

Recurrence Rate ◽

Operative Time ◽

Achilles Tendon Rupture ◽

Tendon Lengthening ◽

Group A ◽

Achilles Tendon Lengthening ◽

The Mean ◽

Group B

Background. Both percutaneous Achilles tendon lengthening by triple hemisection and the traditional open Z-lengthening are effective methods for Achilles tendon contracture. This study aims to evaluate the efficacy and safety of this new therapeutic method, which is based on the percutaneous sliding technique with three hemi-cuts in the tendon, as compared with the traditional open Z-lengthening. Methods. Retrospective analysis of the Achilles tendon contracture cases in our hospital between January 2010 and September 2016 was conducted. Twenty-five cases received percutaneous Achilles tendon lengthening (group A), and 30 patients who underwent open Z-lengthening during the same period were in the control group (group B). Operative time and hospital stay were statistically analyzed. Incision complication, equinus recurrence rate and Achilles tendon rupture morbidity were recorded. The function was assessed by American Orthopaedic Foot & Ankle Society (AOFAS) score. All cases in group A received Magnetic Resonance Imaging (MRI) of ankle preoperatively and in the follow-ups. Results. The mean follow-up period was 42.04 months in group A and 61.7 months in group B. The entire operative time and the mean hospitalization days were lower in group A than in group B. No incision and infection complication occurred in group A. The infection rate in group B was 3.3%. Equinus recurrence rate was 4% in group A and the equinus recurrence rate in group B was 21.4%. In group A, the mean AOFAS score increased from 64 ± 10.16 points preoperatively to 96.08 ± 3.17 at final follow-up, while the score in group B increased from 63.48 ± 6.2 points to 85.4 ± 10.3. MRI showed continuity of the Achilles tendon and homogeneous signal in group A. Conclusion. Modified surgery can significantly reduce the risk of Achilles tendon rupture, provide better balance in soft tissue strength between ankle dorsiflexion and ankle plantarflexion, helping to avoid recurrence of the deformity.

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Comparison of harmonic scalpel versus Milligan Morgan technique in haemorrhoidectomy patients

Journal of the Pakistan Medical Association ◽

10.47391/jpma.03-1303 ◽

2021 ◽

Author(s):

Muhammad Ahmad ◽

Syed Tatheer Abbas ◽

Amna Javaid ◽

Naveed Arshad ◽

Falak Shair

Keyword(s):

Wound Healing ◽

Operative Time ◽

Harmonic Scalpel ◽

Controlled Trial ◽

P Value ◽

Randomized Controlled ◽

Group A ◽

The Mean ◽

Complete Wound Healing ◽

Group B

Objectives: To assess the comparison of harmonic scalpel versus Milligan Morgan technique in patients undergoing haemorrhoidectomy. Methodology: This randomized controlled trial study was conducted at General Hospital, Lahore, from March 2019 to September 2019. Informed consent was obtained from eligible 60 patients. Patients were randomly divided into two equal groups. In group-A, haemorrhoidectomy was conducted according to the harmonic scalpel method. In group-B, open haemorrhoidectomy was performed by the Milligan Morgan procedure. Data was assembled through a designed questionnaire and investigated via SPSS version 25. Data were stratified for descriptive statistics, level of haemorrhoids and period of haemorrhoids. Post-stratification, independent sample t-test was used. Results: Mean age of both groups patients were 44.6±7.6 and 43.8±8.2 years, respectively. In group-A, mean operative time was 20.8±2.8 minutes, while 26.5±2.8 minutes in group-B, which was statistically significant with p-value of 0.001. In group-A, mean convalescence period was 9.7±2.9 days, while 13.4±3.7 days in group-B, which was statistically significant with p-value of 0.001. The mean convalescence period with harmonic scalpel method was 7.4 days (range 5–14, SD 3.6) versus 18.6 days (range 7–30, SD 5.4) with Milligan Morgan technique (P?0.001). This research observed that harmonic scalpel method required almost six weeks for complete wound healing, whereas in Milligan Morgan technique, complete wound healing was achieved after three months (P<0.05). Conclusion: Harmonic scalpel haemorrhoidectomy found an advantageous method when assessing the operative time and convalescence period. Hence, Harmonic scalpel haemorrhoidectomy can be adapted as a safe and effective alternative method for treating symptomatic haemorrhoids. Continuous...

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Outcomes of Retrograde Intra-Renal Surgery

Nepalese Medical Journal ◽

10.3126/nmj.v2i2.26478 ◽

2019 ◽

Vol 2 (2) ◽

pp. 220-223 ◽

Cited By ~ 1

Author(s):

Samir Shrestha ◽

Pukar Maskey

Keyword(s):

Postoperative Pain ◽

Hospital Stay ◽

Renal Stone ◽

Operative Time ◽

Renal Calculi ◽

Renal Surgery ◽

Surgical Morbidity ◽

Retrograde Intrarenal Surgery ◽

Stone Clearance ◽

The Mean

Introduction: Miniaturization of endoscopic instruments has gained wide popularity in the treatment of renal calculi. Retrograde intra-renal surgery and holmium laser in combination has already proven its superiority when compared to other modalities in the treatment of renal calculi. This study was conducted to assess the outcome of retrograde intra-renal surgery in renal stone disease.Materials and Methods: This retrospective study analyzed the outcome of retrograde intra-renal surgery in renal stone less than 2 cm size in the adults above 18 years of age from September 2018 to August 2019 at Patan Hospital, Nepal. The outcome was assessed descriptively on postoperative pain and fever, stone localization, stone size, stone clearance, urosepsis, operative time, hospital stay, mortality, need of the second procedure.Results: A total of 62 patients underwent retrograde intrarenal surgery, out of which 48 cases were included. The mean age of the study population was 32.4± 14 years (19-68 years). Similarly, the mean operative time was 68± 12 (48-124 minutes) and mean hospital-stay was 3.2± 1.1 days. Postoperative pain and fever were observed in 14 (29.16%) & 4(8.33%) patients respectively. Hematuria occurred in 6(12.50%) and urosepsis in 2(4.16%) of the patients. Complete stone clearance was achieved in 34(70.83%) and residual stones were present in 8(16.66%) and clinically insignificant radiological fragments were present in 6(12.50%) patients.Conclusions: Retrograde intrarenal surgery is a technically safe and effective procedure for the treatment of renal calculi, with minimal post-surgical morbidity.

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Tamoxifen for treatment of abnormal uterine bleeding in etonorgstrel implant users: a randomized clinical trial

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20194876 ◽

2019 ◽

Vol 8 (11) ◽

pp. 4462

Author(s):

Ahmed N. Fetih ◽

Ahmed M. Abbas ◽

Fatma A. Kamel ◽

Ihab H. El Nashar

Keyword(s):

Oral Contraceptive ◽

Treatment Time ◽

Abnormal Uterine Bleeding ◽

Once Daily ◽

Oral Contraceptive Pills ◽

Contraceptive Pills ◽

Tamoxifen Group ◽

Group A ◽

The Mean ◽

Group B

Background: The current study aims to compare the use of tamoxifen and oral contraceptive pills in women using implanon and complain with irregular uterine bleeding.Methods: Women attended family planning clinic using implanon presented by bleeding were invited to participate in the study. They were randomized into two groups: Group A: 100 women received Tamoxifen 10 mg twice daily for 10 days taken at the onset of an episode of bleeding or spotting episode. Group B: 100 women received Combined oral contraceptive pills (microcept) once daily for 21 days take at the onset of an episode of bleeding or spotting episode.Results: No difference regarding the baseline criteria of both groups. No difference between both groups regarding the duration of irregular bleeding in the implanon users (p=0.090). Additionally, the number of bleeding days and spotting in the last month was similar in both groups (p=0.554). The percentage of women who stopped bleeding during the period of treatment is 84% in the tamoxifen group and 92% in the COCs group, but the COCs needs longer treatment time, where the mean of days required to stop bleeding is 5.03±1.8 days in the tamoxifen group and 6.5±2.5 in the COCs group. Headache and nausea were the most prominent adverse effects found in the COCs group (p=0.000).Conclusions: Oral administration of tamoxifen 10 mg twice daily for 10 days is effective on stopping bleeding attacks in implanon users.

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Introducing in clinical practice a new laser suction handpiece for percutaneous nephrolithotomy

Urologia Journal ◽

10.1177/03915603211031874 ◽

2021 ◽

pp. 039156032110318

Author(s):

Noam Bar-Yaakov ◽

Haim Hertzberg ◽

Ron Marom ◽

Jemal Jikia ◽

Roy Mano ◽

...

Keyword(s):

Operative Time ◽

Statistical Significance ◽

Hounsfield Units ◽

Stone Size ◽

Stone Clearance ◽

Stone Free Rate ◽

Average Operative Time ◽

Group A ◽

Group B ◽

Free Rate

Objective: To assess a novel combined laser suction handpiece (LSH) for performing PCNL in a clinical setting. Methods: The study comprised 40 consecutive PCNLs performed between May 2019 and February 2020. The first 20 procedures (Group A) were performed with conventional ultrasonic or pneumatic devices and the other 20 (Group B) were performed with the use of the new LSH. All patients were treated by tubeless supine PCNL. The groups were compared for demographics, clinical data, operative time, lithotrite effectiveness, stone clearance rate (SCR), and outcome. Results: Groups A and B were similar in age, and in stone size, complexity, and density (Hounsfield units) ( p < 0.05). The average operative time was 99 and 78 min, SCR 143 and 200 mm3/min, hospital stay 1.6 and 1.1 days, and stone-free rate 90% and 95%, respectively. Despite a trend toward better results with the new LSH, none of these comparisons reached statistical significance. Ineffective lithotripsy with the initial device (ultrasonic) requiring conversion to another modality (ballistic) occurred in six (30%) procedures in Group A, while all procedures were effectively accomplished with the LSH in Group B ( p = 0.02). There were two complications in Group A and none in Group B ( p > 0.05). Conclusions: The LSH is as effective and safe as the traditional lithotrites for performing PCNLs. This new tool completes the capabilities of the holmium laser high-power machines, enabling them to serve as the sole platform for all endourological treatments.

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