Mini percutaneous nephrolithotomy: its role in the management of renal stone and our tertiary care centre experience

Background: Miniaturized percutaneous nephrolithotomy (PCNL) procedures for urolithiasis have gained increased popularity in recent years. To decrease the complications of conventional PCNL by reduced tract size led to the development of Mini PCNL, which makes the use of 15-18F sheaths in place of 24-30F of conventional PCNL. It has developed rapidly and become a popular technique of renal stone management with reduced morbidity and excellent outcome. Authors report our experience with Mini PCNL for the treatment of renal stone.Methods: In between his August 2015 and January 2018, sixty patients with the diagnosis of unilateral single medium size (8-20mm) renal stone were identified. Patient’s demographical, clinical, diagnostic and procedural data were recorded. All patients were evaluated by history taking, physical examination and laboratory investigations. Radiological evaluation was done with X ray kidney, ureter and bladder region (KUB) and also with renal ultrasonography followed by computed tomography (CT). All patients underwent Mini PCNL using 12F nephroscope and 16.5/17.5F sheath. Holmium: YAG laser was used for stone fragmentation. No nephrostomy tube was used routinely. Treatment outcome was assessed in terms of operative time, haemoglobin drop, hospital stay and stone free rate.Results: Complete stone fragmentation was achieved in 41 out of 60 patients using Mini PCNL, so initial stone free rate was 68.3%. After 4 weeks of surgery total 53 patients were stone free (88.3%), 5 patients required some auxiliary procedure for complete clearance of stone and other 2 were managed conservatively. The mean operative time was 48.28 min, mean haemoglobin drop was 0.74gm/l and mean postoperative hospital stay was 54.22 hours. After 12 weeks postoperatively all patients were stone free. There were no significant postoperative complications, and all had good quality of life.Conclusion: Mini PCNL technique appears to be safe and effective alternative to conventional PCNL for moderate size renal calculi. It is usually related to less blood loss and shorter hospital stay than the standard method. It can achieve good stone-free rates with minimal complications and low morbidity. Mini PCNL can also be considered as a good alternative to retrograde intrarenal surgery and shockwave lithotripsy in selected cases. However, further high quality studies with larger sample size are required in future.

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Retroperitoneal laparoscopic adrenalectomy: its role in the management of adrenal tumour and tertiary care centre experience

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20200769 ◽

2020 ◽

Vol 8 (3) ◽

pp. 993

Author(s):

Avinash Pratap Singh Thakur ◽

G. Venugopal ◽

Darsan S.

Keyword(s):

Hospital Stay ◽

Laparoscopic Adrenalectomy ◽

Conversion Rate ◽

Operative Time ◽

Tertiary Care ◽

Adrenal Tumour ◽

Transperitoneal Approach ◽

Tertiary Care Centre ◽

Early Recovery ◽

Excellent Outcome

Background: Laparoscopic adrenalectomy for adrenal tumour has gained increased popularity worldwide. To decrease the complications of commonly used transperitoneal approach, by not entering into peritoneal cavity the retroperitoneal laparoscopic adrenalectomy (RLA) has developed. It has several advantages over the transperitoneal approach and associated with reduced morbidity and excellent outcome. The objective of this study was to report our experience with RLA for treatment of adrenal tumour.Methods: The study was done from August 2014 and December 2017, data of 44 patients who underwent RLA for adrenal tumour in the institute were retrospectively reviewed. Patient’s demographical, clinical, diagnostic and procedural data were recorded. All patients were assessed by history, physical examinations, laboratory values with biochemical marker test and imaging by computed tomography/magnetic resonance imaging. Treatment outcome was assessed in terms of operative time, haemoglobin drop, conversion rate, hospital stay and complications.Results: In 44 adrenalectomy, 24 men and 20 women, with a mean age of 47.0±8.9 years were enrolled. Mean body mass index was 23.5±2.2 kg/m2. Right adrenal tumour was seen in 26 cases and left in 18 cases. Mean adrenal mass size was 2.6±0.85 cm. Mean operative time was 109.1±21.16 minutes, mean haemoglobin drop was 0.47±0.26 gram/L. Conversion to open surgery was necessary in 2 patients. Mean postoperative hospital stay was 4.0±0.91 days. Recovery time mean value was 12.18±1.7 days postoperatively. In final histopathology result adenoma was most prevalent (25 cases) and myelolipoma was least (1 case). Conclusions: RLA appears to be safe and effective alternative to transperitoneal adrenalectomy for moderate size adrenal tumour in particular less than 6 cm. It is associated with less blood loss, shorter hospitalization, low conversion rate, fewer complications and early recovery. RLA offers an alternative method for treating adrenal tumour with improved surgical outcomes.

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Retrograde Intrarenal surgery- Our experience

Academia Journal of Surgery ◽

10.47008/ajs/2020.3.1.19 ◽

2020 ◽

Vol 3 (1) ◽

pp. 88-92

Author(s):

Nand Kumar B. Madhekar ◽

A. Nischal Prasad

Keyword(s):

Hospital Stay ◽

Operative Time ◽

Tertiary Care ◽

Renal Stones ◽

Tertiary Care Centre ◽

Renal Surgery ◽

Retrograde Intrarenal Surgery ◽

Residual Stone ◽

Stone Clearance ◽

Residual Stones

Background: RIRS has become an important treatment option for kidney stones in pediatric patients with the development of new-generation ureteroscopy and holmium laser. The present study was conducted to assess cases of retrograde intrarenal surgery. Subjects and Methods: The present study was conducted in a tertiary care centre over a period of one year on 120 cases of retrograde intra renal surgery (RIRS) performed in both genders. Renal stone location and stone clearance, laterality, stone size, operative time, hematuria, postoperative pain & fever, urosepsis, hospital stay, residual stones and need of an adjunctive procedure to achieve residual stone clearance. Results: Out of 120 patients, males were 70 and females were 50. Stones were detected in upper calyx in 50 cases, middle calyx in 40, lower calyx in 20 and pelvis in 10 cases. The mean size of stones was 8.1 mm, operative time was 62.1 minutes, hospital stay was 3.6 days, clinically insignificant radiological fragments were seen in 35 cases and residual stones were seen in 20 cases. Maximum cases of CIRF were seen in middle calyx (15) and residual stones were seen in lower calyx (7). The difference was significant (P< 0.05). Common complications were fever in 7, hematuria in 3, flank pain in 4 and urosepsis in 2 cases. Conclusion: Authors found that retrograde intrarenal surgery is a technically safe and effective procedure for the treatment of renal stones.

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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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Retrograde Intrarenal Surgery (RIRS) vs Percutaneous Nephrolithotomy (PCNL) in Treatment of Lower Pole Renal Stone

QJM ◽

10.1093/qjmed/hcaa070.006 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

S I Ragy ◽

A A Elshorbagy ◽

M A Alzqzouq

Keyword(s):

Hospital Stay ◽

Renal Stone ◽

Operative Time ◽

Randomized Study ◽

Alternative Therapy ◽

Renal Calculi ◽

Stone Free Rate ◽

Group 2 ◽

Free Rate ◽

Group 1

Abstract Objective Compare the outcomes of RIRS and PCNL for the treatment of 1 to 2 cm lower calyceal renal calculi regarding the stone free rate, operative time, fluoroscopy time, hospital stay and complication rate. Materials and Methods Patients with a single lower calyceal stone with an evidence of a CT diameter between 1 and 2 cm were enrolled in this randomized study. Patients were randomized into two groups: group 1: underwent RIRS (20pts); group 2: underwent PCNL (20 pts). Patients were evaluated with KUB and CT after one month. Results Mean fluoroscopy times and Hospital stay were significantly greater in the PCNL group than in RIRS group, In the RIRS group, the stone-free rate was 85% (17/20 patients); this rate increased to 95% after a second intervention. After a single PCNL procedure, 19 of 20 (95%) patients were completely stone free and For complications, there were minimal differences in both procedures, except for hemorrhage three patients who were treated with PCNL need blood transfusion Conclusions PCNL and RIRS are safe and effective methods for medium-sized LP calculi. For selected patients, RIRS may represent an alternative therapy to PCNL, with acceptable efficacy and low morbidity., RIRS compared to PCNL offers the best outcome in terms of radiation exposure and hospital stay.

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The Safety and Efficacy of Mini Percutaneous Nephrolithotomy During Learning Curve

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v18i2.21355 ◽

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.

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Percutaneous nephrolithotomy of bilateral staghorn renal calculi in pediatric patients: 12 years experience in a tertiary care centre

Urolithiasis ◽

10.1007/s00240-016-0920-7 ◽

2016 ◽

Vol 45 (4) ◽

pp. 393-399 ◽

Cited By ~ 5

Author(s):

Bimalesh Purkait ◽

Manoj Kumar ◽

Ashok Kumar Sokhal ◽

Ankur Bansal ◽

Satya Narayan Sankhwar ◽

...

Keyword(s):

Percutaneous Nephrolithotomy ◽

Pediatric Patients ◽

Tertiary Care ◽

Renal Calculi ◽

Care Centre ◽

Tertiary Care Centre ◽

Staghorn Renal Calculi

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A comparative study of functional outcome between posterior lumbar fusion and posterior lumbar interbody fusion in spondylolisthesis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211608 ◽

2021 ◽

Vol 7 (3) ◽

pp. 544

Author(s):

Harpreet Singh ◽

Dhruv Patel ◽

Sangam Tyagi ◽

Krushna Saoji ◽

Tilak Patel ◽

...

Keyword(s):

Functional Outcome ◽

Interbody Fusion ◽

Operative Time ◽

Lumbar Fusion ◽

Tertiary Care ◽

Posterior Lumbar Interbody Fusion ◽

Invasive Technique ◽

Lumbar Interbody Fusion ◽

Tertiary Care Centre ◽

Posterior Lumbar Fusion

Background: Spondylolisthesis is condition in which one vertebra slips over other vertebra. This study has been done to compare the functional outcome and complications of two techniques: posterior lumbar fusion (intertransverse fusion) and posterior lumbar interbody fusion.Methods: Total 20 patients with spondylolisthesis admitted in a tertiary care centre in Rajasthan were allotted alternatively in posterior lumbar fusion (PLF) group and posterior lumbar interbody fusion (PLIF) group. In PLF, fusion was done by placing bone graft between transverse processes and around facets. In PLIF, fusion was bone by placing cage in between vertebral bodies.Results: 20 patients were included in our study with female predominance (65%). Mean age was 54.2 years (PLF=58.4 and PLIF=50.2). 70% patients have L4-L5 level spondylolisthesis. Average operative time was less in PLF group, which is statistically significant. Functional outcome was measured by using visual analogue scale (VAS) score and Japanese orthopedics association score (JOAS) at 3 weeks, 3 months and 6 months. There is a significant decrease between preoperative VAS and at 6 months, in both PLF and PLIF group. JOAS was significantly increased at 6 months in both PLF and PLIF group as compared to preoperative score. But difference in JOAS at 6 months is not significant between PLF and PLIF.Conclusions: Both PLF and PLIF are equally effective for spondylolisthesis. Both techniques have same satisfactory results. As PLIF is more invasive technique, more operative time and more complications are seen.

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Comparison of Retrograde Intrarenal Surgery and Micro-Percutaneous Nephrolithotomy for Kidney Stones: A Meta-Analysis

Urologia Internationalis ◽

10.1159/000506716 ◽

2020 ◽

pp. 1-7

Author(s):

Zhenhua Gu ◽

Yucheng Yang ◽

Rui Ding ◽

Meili Wang ◽

Jianming Pu ◽

...

Keyword(s):

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Kidney Stones ◽

Operative Time ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Clinical Results ◽

Retrograde Intrarenal Surgery ◽

Alternative Approach ◽

Significant Difference

Background: Advances in micro-percutaneous nephrolithotomy (PCNL) for kidney stones have made it an alternative approach to the retrograde intrarenal surgery (RIRS) approach. Nevertheless, the superiority of micro-PCNL over RIRS is still under debate. The results are controversial. Objectives: The purpose of this study was to systematically evaluate the clinical results in patients presenting with kidney stones treated with micro-PCNL or RIRS. Methods: A literature search was done for electronic databases to identify researches that compared micro-PCNL and RIRS till December 2019. The clinical outcome included complications, stone-free rates (SFRs), hemoglobin reduction, length of hospital stay, and operative time. Results: Five articles were included in our study. The pooled results revealed no statistical difference in the rate of complications (OR = 0.99, 95% CI = 0.57–1.74, p = 0.99), length of hospital stay (MD = −0.29, 95% CI = −0.82 to 0.24, p = 0.28), and operative time (MD = −6.63, 95% CI = −27.34 to 14.08, p = 0.53) between the 2 groups. However, significant difference was present in hemoglobin reduction (MD = −0.43, 95% CI = −0.55 to 0.30, p < 0.001) and the SFRs (OR = 0.59, 95% CI = 0.36–0.98, p = 0.04) when comparing RIRS with micro-PCNL. Conclusions: Compared with micro-PCNL to treat kidney stones, RIRS is associated with better stone clearance and bearing higher hemoglobin loss. As the advantages of both technologies have been shown in some fields, the continuation of well-designed clinical trials may be necessary.

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Simultaneous bilateral tubeless percutaneous nephrolithotomy:

Canadian Urological Association Journal ◽

10.5489/cuaj.310 ◽

2013 ◽

Vol 6 (4) ◽

pp. 162 ◽

Cited By ~ 2

Author(s):

Alice Yu ◽

Walid Shahrour ◽

Sero Andonian

Keyword(s):

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Lower Cost ◽

Renal Calculi ◽

Remote Areas ◽

Tubeless Pcnl ◽

Tubeless Percutaneous Nephrolithotomy ◽

Postoperative Discomfort

Percutaneous nephrolithotomy (PCNL) is currently the standardof care to remove large renal calculi. Traditionally, a large-borenephrostomy tube is placed postoperatively. However, the necessityof this practice has been recently challenged. Theoretically, bilateral tubeless PCNL offers advantages of lower postoperative discomfort, shorter hospital stay and thus lower cost. We review the literature and present two cases of simultaneous bilateral tubeless PCNL from two patients who were referred to a tertiary stone centre from remote areas.

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

Journal of Nepal Medical Association ◽

10.31729/jnma.4723 ◽

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.

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