scholarly journals Retrograde intrarenal surgery in the management of solitary large renal stones, 2-3 cm: a single center experience

2021 ◽  
Vol 8 (3) ◽  
pp. 939
Author(s):  
Ahmed Eissa ◽  
Maged Ragab ◽  
Giampoalo Bianchi ◽  
Ayman Hassan
Keyword(s):  
Operative Time ◽  
Treatment Options ◽  
Renal Stones ◽  
Complication Rates ◽  
Retrograde Intrarenal Surgery ◽  
Stone Size ◽  
Single Center Experience ◽  
Stone Free Rate ◽  
Efficient Alternative ◽  
The Mean

Background: Nephrolithiasis represents a major health burden worldwide. Several treatment options are available for renal stones such as open stone surgery, percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and extracorporeal shockwave lithotripsy. PCNL is considered the gold standard treatment for large renal stones (>2 cm); however, it is associated with higher blood loss, complication rates, and longer hospitalization. In this setting, we aimed to assess the value of RIRS in the management of single large renal stones between 2-3 cm. Methods: The database of our center was reviewed to include all the patients who underwent RIRS for single large renal stone (2-3 cm) between February 2018 and April 2019. All the patients were evaluated by preoperative computed tomography to evaluate the stone size, site, and density. Furthermore, the following variables were also collected; pre- and post-operative hemoglobin and creatinine, the operative time, stone free rate (SFR), and duration of hospital stay. All the statistical analysis was performed using SPSS version 20.Results: Overall, the data of 31 patients were retrieved for the current study. The mean age of the patients was 56.9±12.9 years, and the mean stone size was 22.6±7 mm. The mean operative time was 96.4±37.3 minutes and the SFR was 74.2% after single session of RIRS. No major postoperative complications were reported in the current series.Conclusions: RIRS is a safe and efficient alternative to PCNL in the management of single renal stones between 2-3 cm; however, further prospective studies are required to confirm these findings.

scholarly journals A Retrospective Observational Study for Prediction of Stone-Free Status after Single-session of Retrograde Intrarenal Surgery for Renal Stones

2021 ◽  
Author(s):  
Mayank Jain ◽  
CS Manohar ◽  
KN Rajendra Prasad ◽  
Abhishek Umesh Bhalerao ◽  
R Keshavamurthy
Keyword(s):  
Operative Time ◽  
Statistical Tests ◽  
Renal Stones ◽  
Lower Pole ◽  
Single Session ◽  
Invasive Treatment ◽  
Retrograde Intrarenal Surgery ◽  
Stone Size ◽  
The Mean ◽  
Free Status

Introduction: Retrograde Intrarenal Surgery (RIRS) is a preferred minimal invasive treatment modality for renal stones with advantages of being effective and having lower morbidity rates. Aim: To predict the Stone Free Rate (SFR) after RIRS with lower pole and non-lower pole stones. Materials and Methods: The records of 85 consecutive patients who underwent unilateral RIRS from September 2016 to July 2019 were retrospectively analysed. The studied parameters included patient demographics, stone characteristics (size, volume, and attenuation, Lower Pole Infundibulopelvic Angle (LP IPA) and operative time, presence of preoperative Double-J Stent (DJS) and Stone Free Status (SFS). Standard statistical tests were applied with level of significance as p<0.05. Results: Overall success rate was 83.5% (71 cases) while 14 cases had Residual Stones (RS) at 1 month. The mean age of the patients was 41.07±12.25 years. The mean operative time was 68.85±22.3 minutes. Mean stone size and stone volume were higher in the RS group compared to SF (Stone free) group, 15.07±1.5 mm vs. 12.28±1.6 mm, 1187±145 mm3 vs.680.67±289 mm3 respectively (p<0.001; p<0.001). In RS group, 90% (13) cases had IPA<45°, while 80% cases with IPA>45° were stone free. Patients with non-lower pole stones has SFR 2.8 times compared to LP stones (p<0.001). On multivariate analysis, only LP IPA and LP stone location predicts SFS after RIRS. Conclusion: RIRS is effective procedure for renal stones. Stone size, stone volume, LP stone location and LP IPA effectively predict SFR. However, LP IPA and LP stone location are the most significant predictor of SFS, after single session RIRS for solitary renal stone.

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

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.

scholarly journals Application of Pneumatic Lithotripter and Holmium Laser in the Treatment of Ureteral Stones and Kidney Stones in Children

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Marcin Życzkowski ◽  
Rafał Bogacki ◽  
Krzysztof Nowakowski ◽  
Bartosz Muskała ◽  
Paweł Rajwa ◽  
...  
Keyword(s):  
Operative Time ◽  
Treatment Options ◽  
Population Based ◽  
Holmium Laser ◽  
Ureteral Stones ◽  
Stone Free Rate ◽  
Group A ◽  
The Mean ◽  
Laser Group ◽  
Free Rate

Objective.Treatment options for urolithiasis in children include URSL and RIRS. Various types of energy are used in the disintegration of deposits in these procedures. We decided to evaluate the usefulness of URSL and RIRS techniques and compare the effectiveness of pneumatic lithotripters and holmium lasers in the child population based on our experience.Materials and Methods.One hundred eight (108) children who underwent URSL and RIRS procedures were enrolled in the study and divided into two (2) groups according to the type of energy used: pneumatic lithotripter versus holmium laser. We evaluated the procedures’ duration and effectiveness according to the stone-free rate (SFR) directly after the procedure and after fourteen (14) days and the rate of complications.Results.The mean operative time was shorter in the holmium laser group. A higher SFR was observed in the holmium laser but it was not statistically significant in the URSL and RIRS procedures. The rate of complications was similar in both groups.Conclusions.The URSL and RIRS procedures are highly efficient and safe methods. The use of a holmium laser reduces the duration of the procedure and increases its effectiveness in comparison with the use of a pneumatic lithotripter.

scholarly journals Comparison of Ultrasound-assisted and Pure Fluoroscopy-guided Extracorporeal Shockwave Lithotripsy for Renal Stones

2020 ◽  
Author(s):  
Tsung-Hsin Chang ◽  
Wun-Rong Lin ◽  
Wei-Kung Tsai ◽  
Pai-Kai Chiang ◽  
Marcelo Chen ◽  
...  
Keyword(s):  
Complication Rate ◽  
Renal Stones ◽  
Complication Rates ◽  
Disintegration Rate ◽  
Stone Size ◽  
Stone Free Rate ◽  
The Usa ◽  
Retreatment Rate ◽  
Ultrasound Assisted ◽  
Free Rate

Abstract Background: In this study, we aimed to compare the efficacy and clinical outcomes of shock wave lithotripsy (SWL) for patients with renal stones using pure fluoroscopy (FS) or ultrasound-assisted (USa) localization with two lithotripters.Methods: We retrospectively identified 425 patients with renal calculi who underwent SWL with either a LiteMed LM-9200 ELMA lithotripter (209 cases), which combined ultrasound and fluoroscopic stone targeting or a Medispec EM-1000 lithotripter machine (216 cases), which used fluoroscopy for stone localization and tracking. The patient demographic data, stone-free rates, stone disintegration rates, retreatment rates and complication rates were analyzed.Results: The USa group had a significantly higher overall stone-free rate (43.6 vs. 28.2%, p<0.001) and stone disintegration rate (85.6 vs. 64.3%, p<0.001), as well as a significantly lower retreatment rate (14.8 vs. 35.6%, p<0.001) and complication rate (1.9 vs. 5.5%, p=0.031) compared with the FS group. This superiority remained significant in the stone size <1cm stratified group. In the stone size >1cm group, the stone-free rate (32.4 vs. 17.8%, p=0.028), disintegration rate (89.2 vs. 54.8%, p=0.031) and retreatment rate (21.6 vs. 53.4%, p<0.001) were still significantly better in the USa group, however there was no significant difference in the complication rate. The most common complication was post-SWL-related flank pain.Conclusion: Extracorporeal SWL using ultrasound combined with fluoroscopy for stone localization and real-time tracking, provides higher stone-free rates and stone disintegration rates, as well as lower retreatment rates and fewer complications.

scholarly journals Non-Fluoroscopic Uretero-Lithotripsy for Distal and Mid Ureteric Stone: Is it Safe and Feasible? Single Center Experience

2017 ◽  
Vol 16 (1) ◽  
pp. 48-52
Author(s):  
Naser S Hussein ◽  
Hussein A Al Khumasi
Keyword(s):  
Operative Time ◽  
Intraoperative Complications ◽  
Medical Science ◽  
Ureteric Stone ◽  
Stone Size ◽  
Residual Stone ◽  
Single Center Experience ◽  
Stone Free Rate ◽  
Case Basis ◽  
Free Rate

Objective: To assess safety and feasibility of completely non-fluoroscopic ureteroscopy for treatment of mid and distal ureteric stone in term of stone free-rate and complications.Material and Methods: Over study period between January 2014 and January 2015, ninety-one complete fluoroscopy-less semirigid ureteroscopies were performed for treatment of symptomatic ureteric stones. Age, sex, stone size, location, side, operative time, auxiliary procedures, stonefree rate and complications, all were assessed. A Stone-free rate was defined as the lack of radiographic evidence of residual stone at 4 weeks. Postoperative imaging, and complications were grading according to modified Clavien classification system, which used initially to grade complications of general surgery.Results: The average age of our subjects was 32.9, with male and right side predominant, 68 % and 64.8% respectively. The average stone size and operative time were 10.07 and 32.08 respectively. Fifty six semirigid retrograde ureteroscopies were done for distal ureteric and 35 for mid ureteric stones, achieving 91.2% stone –free rate, with overall intraoperative complications of 18.6%. All cases were managed on day case basis, ureters were stenting preoperatively in 37 patients and all cases were stenting with an appropriate size of double J.Conclusion: Zero fluoroscopic semirigid retrograde ureteroscopy is a safe and feasible treatment modality for management of distal and mid ureteric stones.Bangladesh Journal of Medical Science Vol.16(1) 2017 p.48-52

scholarly journals Transurethral use of nephroscope in the management of bladder stone

2014 ◽  
Vol 9 (1) ◽  
pp. 14-18
Author(s):  
Ghanshyam S Sigdel ◽  
A Agarwal ◽  
N Laminchhane ◽  
WK Belokar
Keyword(s):  
Medical Records ◽  
Operative Time ◽  
Bladder Stone ◽  
Endoscopic Management ◽  
Medical Sciences ◽  
Stone Size ◽  
Bladder Stones ◽  
Stone Free Rate ◽  
The Mean ◽  
Free Rate

Objective: Endoscopic management of bladder stone is a well established procedure. The objective of this study was to evaluate the usefulness of transurethral use of nephroscope in the management of bladder stones. Materials and methods: We retrospectively analyzed the medical records of patients who had undergone treatment of bladder stones through transurethral use of nephroscope in our hospital. Various demographic, stone related, intraoperative and postoperative parameters were studied. Results: The mean stone size was 18.1± 6.8 millimetres. Mean operative time and duration of hospital stay were 42.2 minutes and 2.4 days respectively. Intraoperative and postoperative complications occurred in 8 and 16 percent respectively, which were minor and managed without further interventions. Stone free rate was 100 percent. Conclusion: Bladder stones in adults can be effectively managed with the transurethral use of nephroscope without significant complications. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-1, 14-18 DOI: http://dx.doi.org/10.3126/jcmsn.v9i1.9668

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.  

scholarly journals Intraoperative flexible nephroscopy during percutaneous nephrolithotomy: An 8 years’ experience

2021 ◽  
Vol 37 (3) ◽  
Author(s):  
Yasir Masood ◽  
Nadeem Iqbal ◽  
Raja Mohsin Farooq ◽  
Sajid Iqbal ◽  
Faheemullah Khan
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Hounsfield Unit ◽  
Renal Stones ◽  
Stone Size ◽  
Group I ◽  
Stone Free Rate ◽  
Group Ii ◽  
Free Rate

Objectives: To see the effect of intra operative antegrade flexible nephroscopy during Percutaneous nephrolithotomy on stone free rate. Methods: We retrospectively reviewed electronic medical records of patients who underwent percutaneous nephrolithotomy from 2010 to 2017 for renal stones >2cm. Patients found eligible were divided in, Group-I who did not have intraoperative Flexible nephroscopy and Group-II who had flexible nephroscopy during percutaneous nephrolithotomy. All procedures were done by senior consultants. Variables like Mean age, side, stone size, skin to stone distance and Hounsfield unit were compared. Outcomes like Stone free rate, hospital stay and operative time were compared between the groups. Results: The study included 248 patients, consisting 85 (34.3%) females and 163 (65.7%) males. Mean age ± SD was 45.8±13.8 years. Both group were similar in characteristics like mean age, stone size, skin to stone distance and Hounsfield units. The overall stone free rate was 71%. It was not significantly different between the groups, 76% in Group-II vs. 67% in Group-I. However stone free rate markedly improved with flexible nephroscopy in patients with staghorn calculi. Mean operative time and hospital stay were similar between the groups. Conclusions: Intraoperative flexible nephroscopy during percutaneous nephrolithotomy significantly increases stone free rate in patients with staghorn stones. doi: https://doi.org/10.12669/pjms.37.3.3565 How to cite this:Masood Y, Iqbal N, Farooq RM, Iqbal S, Khan F. Intraoperative flexible nephroscopy during percutaneous nephrolithotomy: An 8 years’ experience. Pak J Med Sci. 2021;37(3):---------. doi: https://doi.org/10.12669/pjms.37.3.3565 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Comparison of Ultrasound-assisted and Pure Fluoroscopy-guided Extracorporeal Shockwave Lithotripsy for Renal Stones

2020 ◽  
Author(s):  
Tsung-Hsin Chang ◽  
Wun-Rong Lin ◽  
Wei-Kung Tsai ◽  
Pai-Kai Chiang ◽  
Marcelo Chen ◽  
...  
Keyword(s):  
Complication Rate ◽  
Renal Stones ◽  
Complication Rates ◽  
Disintegration Rate ◽  
Stone Size ◽  
Stone Free Rate ◽  
The Usa ◽  
Retreatment Rate ◽  
Ultrasound Assisted ◽  
Free Rate

Abstract Background In this study, we aimed to compare the efficacy and clinical outcomes of shock wave lithotripsy (SWL) for patients with renal stones using pure fluoroscopy (FS) or ultrasound-assisted (USa) localization with two lithotripters. Methods We retrospectively identified 425 patients with renal calculi who underwent SWL with either a LiteMed LM-9200 ELMA lithotripter (209 cases), which combined ultrasound and fluoroscopic stone targeting or a Medispec EM-1000 lithotripter machine (216 cases), which used fluoroscopy for stone localization and tracking. The patient demographic data, stone-free rates, stone disintegration rates, retreatment rates and complication rates were analyzed. Results The USa group had a significantly higher overall stone-free rate (43.6 vs. 28.2%, p < 0.001) and stone disintegration rate (85.6 vs. 64.3%, p < 0.001), as well as a significantly lower retreatment rate (14.8 vs. 35.6%, p < 0.001) and complication rate (1.9 vs. 5.5%, p = 0.031) compared with the FS group. This superiority remained significant in the stone size < 1 cm stratified group. In the stone size > 1 cm group, the stone-free rate (32.4 vs. 17.8%, p = 0.028), disintegration rate (89.2 vs. 54.8%, p = 0.031) and retreatment rate (21.6 vs. 53.4%, p < 0.001) were still significantly better in the USa group, however there was no significant difference in the complication rate. The most common complication was post-SWL-related flank pain. Conclusion Extracorporeal SWL using ultrasound combined with fluoroscopy for stone localization and real-time tracking, provides higher stone-free rates and stone disintegration rates, as well as lower retreatment rates and fewer complications.

scholarly journals Association of body mass index with the outcomes of retrograde intrarenal surgery

2021 ◽  
pp. 124-130
Author(s):  
Volkan Selmi ◽  
Sercan Sarı ◽  
Mehmet Çağlar Çakıcı ◽  
Harun Özdemir ◽  
İbrahim Güven Kartal ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Renal Stones ◽  
Overweight And Obesity ◽  
World Health ◽  
Complication Rates ◽  
Obese Patients ◽  
Retrograde Intrarenal Surgery ◽  
Stone Free Rate ◽  
Free Rate

Objective: Overweight and obesity increased worldwide over four decades. In 2016, nearly 11% of men and 15% of women over 18 years old were obese. Obesity is accepted as a risk factor for renal stones. The relationship between obesity and urolithiasis is complicated. Various complications can occur during perioperative or postoperative follow-up in obese patients. Minimal invasive nature and high efficacy of Retrograde Intrarenal Surgery (RIRS) present itself as a safe and less morbid treatment option. In this study, we aimed to compare the efficacy and safety of RIRS in the treatment of kidney stones in different BMI levels. Material and Methods: Files of 552 patients who underwent RIRS for renal stones between January 2012 and December 2017 were reviewed. We classified patients according to the World Health Organisation classification. These three groups were compared for stone-free rate, complication rate, operative and fluoroscopy times and length of hospital stay. Results: The stone-free rate (SFR) of the study population was 80.8%. It was 81% for Group 1, 83.7% for Group 2 and 77.7% for Group 3. There was no statistically significant difference between the three groups among SFR (p=0.346). Clinical insignificant residual fragments (CIRF) status was also similar among the three groups (p=0.254). Complication rates between the three groups were statistically similar (p=0.416). Conclusion: In this study, we have shown that RIRS is a suitable option for all urolithiasis patients, even for obese individuals. Stone-free rates, length of hospital stay, operation time and complication rates in obese patients are similar with non-obese patients. Keywords: urolithiasis; obesity; laser lithotripsy

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