scholarly journals A Safe and Effective Two-Step Tract Dilation Technique in Totally Ultrasound-Guided Percutaneous Nephrolithotomy

2021 ◽  
Author(s):  
Shao-Wei Dong ◽  
Chia-Chang Wu ◽  
Chu-Tung Lin ◽  
Kuan-Chou Chen ◽  
Chen-Hsun Ho
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Operation Time ◽  
Ultrasound Guided ◽  
Stone Size ◽  
Second Stage ◽  
Tract Dilation ◽  
Median Operation Time ◽  
Hemoglobin Drop ◽  
Pleural Injury ◽  
Free Status

Abstract Background To evaluate the safety and the efficacy of a radiation-free 2-step tract dilation technique in totally ultrasound-guided percutaneous nephrolithotomy (PCNL). Methods From Oct 2018 to Mar 2020, we prospectively and consecutively enrolled 18 patients with 19 kidney units with urolithiasis. The nephrostomy tract was established by the following four steps: 1) ultrasound-guided renal puncture, 2) first-stage serial dilation to 16 Fr with Amplatz dilators, 3) check and adjustment of the partially dilated tract with a ureteroscope, 4) second-stage dilation with a 24-Fr balloon dilator. Results The median age was 62.0 [IQR 11.0] years, and 11 (61.1%) were male. The median stone size was 3.3 [3.6] cm2, and stone laterality was almost equal over both sides. Successful tract establishment on the first attempt without fluoroscopy was achieved in 18 (94.7%) operations. The median tract establishment time was 10.4 [4.9] mins, and the median operation time was 67.0 [52.2] mins. The median hemoglobin drop was 1.0 [1.1] g/dL, and none required blood transfusion. Three (15.8%) developed fever. Pleural injury occurred in two (10.5%) operations (both had supracostal puncture), and one required drainage with pigtail. Stone-free status was achieved in 15 (77.8%) operations at 3 months postoperatively. Conclusions Herein we present a radiation-free 2-step tract dilation technique, which is characterized by ureteroscopic check of the partially dilated tract in between the first dilation with serial fascial dilators and the second dilation with balloon. Our data suggest that it is a safe and effective method.

Doppler Ultrasound-guided Percutaneous Nephrolithotomy With Two-step Tract Dilation for Management of Complex Renal Stones

Urology ◽  
2012 ◽  
Vol 79 (6) ◽  
pp. 1247-1251 ◽  
Author(s):  
Youming Xu ◽  
Zhonghua Wu ◽  
Jianhua Yu ◽  
Shulong Wang ◽  
Fang Li ◽  
...  
Keyword(s):  
Doppler Ultrasound ◽  
Percutaneous Nephrolithotomy ◽  
Renal Stones ◽  
Ultrasound Guided ◽  
Tract Dilation

RA02.07: A TWO-STAGE OPERATION USING A FREE JEJUNAL FLAP FOR GASTRECTOMIZED ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 21-22
Author(s):  
Koichi Yagi ◽  
Masato Nishida ◽  
Kotaro Sugawara ◽  
Yasuyuki Seto
Keyword(s):  
Esophageal Cancer ◽  
Conflicts Of Interest ◽  
Operation Time ◽  
Tube Placement ◽  
Cervical Esophageal Cancer ◽  
Two Stage ◽  
Subtotal Esophagectomy ◽  
Second Stage ◽  
Free Jejunal Flap ◽  
Median Operation Time

Abstract Background The stomach is not available as a reconstruction organ in previously and synchronously gastrectomized esophageal cancer patients. In these patients, a pedicled jejunum or colon is mainly used for the reconstruction organ instead of the stomach, however, its reconstruction procedure is different among the institutes. In our department, a two-stage operation using a free jejunal flap (FJF) is performed when the stomach is unavailable. Methods A two-stage operation using a FJF for gastrcectomized esophageal cancer performed between 2010 and 2016 were retrospectively analyzed to evaluate a safety and feasibility of our operation. Results A two-stage operation using a FJF was performed for 30 cases, 19 for previously gastrectomized cases, and 11 for synchronous cases, respectively. Among 30 cases, thoracic and cervical esophageal cancer cases were 25 and 5, respectively. For 25 cases of the thoracic esophageal cancer, a subtotal esophagectomy, making a cervical esophagostomy and a jejunal tube placement was performed at the first stage, a reconstruction through the subcutaneous route using a FJF with vascular anastomoses by plastic surgeons was performed at the second stage. Median operation time of first and 2nd stage was 334 and 503 minutes, respectively. An internal thoracic artery was used for a recipient artery in all cases. In 4 of 5 cases of cervical esophageal cancer, a subtotal esophagectomy, esophago-jejuno anastomosis, making a jejunostoma using a FJF was performed at the first stage, the reconstruction of the anal side of a jejunostoma was performed by using a pedicled intestine at the second stage. Median operation time of first and second stage was 640 and 260 minutes, respectively. Clavien-Dindo grade IIIb or IV postoperative complication was seen in 3 cases (10%) after the first stage, 3 cases (10%) after the second stage. Necrosis of a FJF and anastomotic leakage was seen in 0 (0%) and 5 cases (17%), respectively. Conclusion A two-stage operation using a FJF needs plastic surgeon's cooperation, but is considered to be safe and feasible operation when a stomach is not available. Disclosure All authors have declared no conflicts of interest.

scholarly journals The Analysis of Risk Factors for Hemorrhage Associated with Minimally Invasive Percutaneous Nephrolithotomy

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Xiangjun Meng ◽  
Juan Bao ◽  
Qiwu Mi ◽  
Shaowei Fang
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Minimally Invasive ◽  
Logistic Regression Analysis ◽  
Percutaneous Nephrolithotomy ◽  
Operation Time ◽  
Stone Size ◽  
Minimally Invasive Percutaneous Nephrolithotomy ◽  
Staghorn Stone

Objective. This study investigated the risk factors for bleeding during minimally invasive percutaneous nephrolithotomy, so as to prevent the occurrence of bleeding and improve the surgical effect. Patients and Methods. The data of 396 patients who underwent percutaneous nephrolithotomy by an experienced surgeon between May 2014 and December 2017 were retrospectively analyzed. To identify the risk factors for bleeding during percutaneous nephrolithotomy, each group was stratified according to the decrease in median hemoglobin. Age, gender, body mass index, stone size, operation time, stone type, degree of hydronephrosis, number of accesses, puncture guidance, underlying disease (diabetes; hypertension), and previous surgical history were evaluated. Univariate analysis was performed to calculate the potential factors. In order to determine the independence of each factor, we finally selected stone size, staghorn stone, degree of hydronephrosis, and operation time. Multivariate logistic regression analysis was used to identify the risk factors for bleeding during minimally invasive percutaneous nephrolithotomy. Results. A total of 396 patients were successfully treated with percutaneous nephrolithotomy. The univariate analysis demonstrated that the potential risk factors for bleeding during percutaneous nephrolithotomy included stone size, type of stone, operative time, and degree of hydronephrosis. According to the previous studies, stone size, staghorn stone, degree of hydronephrosis, and operation time were ultimately selected. Multivariate logistic regression analysis was used to identify the risk factors for bleeding during percutaneous nephrolithotomy. According to the outcome of logistic regression analysis, stone size, staghorn stone, operation time, and degree of hydronephrosis were the risk factors for bleeding during minimally invasive percutaneous nephrolithotomy. Conclusions. Percutaneous nephrolithotomy is an effective method for the treatment of upper urinary calculi with few complications. According to the results achieved by an experienced surgeon, the size of stone, staghorn stone, operation time, and degree of hydronephrosis were associated with the bleeding during minimally invasive percutaneous nephrolithotomy.

scholarly journals Evaluation and Comparison of Predictive Efficiency of S.T.O.N.E. and CROES Nephrolithometry Scoring Systems in Percutaneous Nephrolithotomy

2020 ◽  
Author(s):  
Erhan Ateş
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Scoring System ◽  
Operation Time ◽  
Hounsfield Unit ◽  
Scoring Systems ◽  
Renal Stones ◽  
Stone Burden ◽  
Preoperative Ct ◽  
The Mean ◽  
Free Status

INTRODUCTION: Currently, there is no consensus on an ideal predictive model that characterizes the complexity of renal stones and predicts surgical results after percutaneous nephrolithotomy (PCNL). The aim of this study is to compare the accuracy of the S.T.O.N.E.nefrolithometry scoring system and CROES nephrolithometric nomogram in predicting stone-free rate and complications of PCNL results. METHODS: Data from 50 renal units (45 patients) who underwent PCNL operation by the same surgeon between March 2016 and January 2019 for > 2 cm kidney stones were retrospectively analyzed. Preoperative clinical and radiological data and postoperative features of the patients were recorded. Postoperative complications were classified according to the modified Clavien scoring system. S.TO.N.E. and CROES nephrolithometry scores were calculated on preoperative CT images for each patient, and their relationship with stone-free status and complications was evaluated by logistic regression analysis. RESULTS: The mean stone burden was 778.6 ± 665.4 mm2, the mean Hounsfield Unit was 990.6 ± 335.1 HU, the mean operation time was 125 ± 34 minutes, the mean hospitalization time was 4.7 ± 2.71 days. The mean S.T.O.N.E score was 8.76 ± 2.03, and the mean CROES score was 134.26 ± 67.36. Complete stone-free was achieved in 21 (42%) of the cases. In cases with residual stones, the stone burden was statistically significantly higher compared to cases without stone-free (p = 0,000). There is a positive correlation between the S.T.O.N.E. score and the operation time (r = 0.487, p = 0.000). But, there was a negative correlation between the operation time with the CROES score (r = -0.514, p = 0.000) and the nephrostomy time (r = -0.29, p = 0.04). The relationship between both scoring systems and stone-free rates were statistically significant (p = 0,000). There was a statistically significant relationship between the presence of complications and only the CROES scoring system (p = 0.032). DISCUSSION AND CONCLUSION: S.T.O.N.E. and CROES scoring systems have predictive value for stone-free status after PCNL. The CROES nephrolithometry nomogram is more effective in predicting complications after PCNL.

scholarly journals Costovertebral angle as a novel tool for predicting the thoracic complication risk following percutaneous nephrolithotomy requiring supracostal access

2021 ◽  
Vol 15 (11) ◽  
Author(s):  
Ahmet Guzel ◽  
Taylan Oksay ◽  
Sefa Alperen Ozturk ◽  
Arap Sedat Soyupek ◽  
Alper Ozorak ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Information Age ◽  
University Hospital ◽  
Access Site ◽  
Stone Size ◽  
Complication Risk ◽  
Significant Difference ◽  
Chest X Ray ◽  
The Mean ◽  
Pleural Injury

Introduction: The objective of this study was to determine whether the costovertebral angle (CVA) and other factors can predict the risk of thoracic complications following percutaneous nephrolithotomy (PCNL). Methods: The data of patients who underwent prone PCNL with supracostal access at Suleyman Demirel University Hospital between January 2015 and December 2019 were retrospectively reviewed. Patients’ demographics information (age, sex, body mass index [BMI], stone size, and stone location), operative data (supracostal access site, renal puncture site, and laterality), and postoperative thoracic complications (pleural injury) were evaluated. The CVA was measured on preoperative posteroanterior chest X-ray images. The mean CVA of patients with and without thoracic complications was evaluated. Results: A total of 89 patients (mean age 46.12±15.66 years; 59 men and 30 women) with supracostal access were included in the study. Thoracic complications occurred in 17 (19.1%) patients. Nine (52.9%) hemothorax cases, five (29.4%) pneumothorax cases, and three (17.7%) urinothorax cases were detected. There was a statistically significant difference in the complication rate compared to the percutaneous access site (10th–11th supracostal vs. 11th–12th supracostal) (p=0.004). The mean CVA was significantly lower in patients with complications (45.47±3.59) than in those without complications (53.26±5.98) (p=0.000). No association was found (p>0.05) with age, sex, BMI, laterality, stone surface area, and access site among patients with and without thoracic complications. Conclusions: Preoperative CVA can be an effective tool in predicting the risk of postoperative thoracic complications.

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

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.

scholarly journals Comparison of Micro-Percutaneous and Mini-Percutaneous Nephrolithotomy in the Treatment of Renal Stones: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiaoshuai Gao ◽  
Wei Wang ◽  
Liao Peng ◽  
Xingpeng Di ◽  
Kaiwen Xiao ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Renal Colic ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Operation Time ◽  
Renal Stones ◽  
Stent Insertion ◽  
Stay Time ◽  
Hemoglobin Drop

Background: To assess the efficacy and safety of micro-percutaneous nephrolithotomy (Microperc) and mini-percutaneous nephrolithotomy (Miniperc) in the treatment of moderately sized renal stones.Methods: Literature search of PubMed, Web of Science, and Embase was performed prior to January 2021. We used odds ratios (OR) and weighted mean difference (WMD) for dichotomous variables and continuous variables, respectively. Results were pooled using Review Manager version 5.3 software.Results: A total of six studies involving 291 Microperc and 328 Miniperc cases was included. The overall stone-free rate (SFR) of Microperc was 87.29% (254/291), while the SFR of Miniperc was 86.59% (284/328). Microperc was associated with lower hemoglobin drop (WMD: −0.98; P = 0.03) and higher renal colic requiring D-J stent insertion (OR: 3.49; P = 0.01). No significant differences existed between Microperc and Miniperc with respect to SFR (OR: 1.10; P = 0.69), urinary tract infection (OR: 0.38; P = 0.18), operative time (WMD: −5.76; P = 0.62), and hospital stay time (WMD: −1.04; P = 0.07).Conclusions: Our meta-analysis demonstrated that Microperc could produce an SFR that was comparable with that of Miniperc. Microperc was associated with lower hemoglobin drop, while Miniperc was associated with lower renal colic rates. In addition, the operation time and hospital stay time for both these procedures were similar.

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