Role of Mini-Percutaneous Nephrolithotomy in the Treatment of Renal Stones

The aim of this paper is to assess the efficiency and safety of the tranexamic acid in reducing blood loss and the need for transfusion in patients diagnosed with staghorn calculi treated by percutaneous nephrolithotomy. Percutaneous nephrolithotomy (PCNL) is a minimally invasive technique used for large kidney stones. Hemorrhagic complications and urinary sepsis are serious complications associated with this type of surgery. Tranexamic acid is an antifibrinolytic drug that has the property of reducing intra or postoperative bleeding. The experience with tranexamic acid in preventing blood loss during percutaneous nephrolithotomy for is limited. The use tranexamic acid in percutaneous nephrolithotomy for staghorn type stones is safe and is associated with reduced blood loss and a lower transfusion rate.

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Effectiveness of percutaneous nephrolithotomy, retrograde intrarenal surgery, and shock wave lithotripsy for treatment of renal stones: A systematic review and metaanalysis

Journal of Universal Surgery ◽

10.21767/2254-6758-c1-003 ◽

2018 ◽

Vol 06 ◽

Author(s):

Lee Seon Heui

Keyword(s):

Systematic Review ◽

Shock Wave ◽

Percutaneous Nephrolithotomy ◽

Shock Wave Lithotripsy ◽

Renal Stones ◽

Retrograde Intrarenal Surgery

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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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Efficacy and safety of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for treatment of large renal stones: a meta-analysis

Journal of International Medical Research ◽

10.1177/0300060520983136 ◽

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.

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Complications and surgical results of stone-directed antegrade pyelography compared to the retrograde pyelographic access method in percutaneous nephrolithotomy using ‘bull’s eye’ technique: A randomized clinical trial

Journal of Clinical Urology ◽

10.1177/2051415821993729 ◽

2021 ◽

pp. 205141582199372

Author(s):

Dariush Irani ◽

Abdolreza Haghpanah ◽

Mohammad Mehdi Hosseini ◽

Leila Malekmakan ◽

Mohammad Ali Ashraf ◽

...

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Percutaneous Nephrolithotomy ◽

Renal Stones ◽

Surgical Results ◽

Retrograde Pyelography ◽

Antegrade Approach ◽

Antegrade Pyelography ◽

Significant Difference ◽

Bull's Eye

Objectives: This study aimed to evaluate the differences in outcomes and complications in stone-directed antegrade pyelography using the ‘bull’s eye’ technique in patients with renal stones versus the conventional method of percutaneous nephrolithotomy (PCNL). Although conventional PCNL access using retrograde pyelography is useful, it is time-consuming and may cause postoperative discomfort. Herein, we report our experience in the application of this new technique. Methods: Between January 2017 and June 2018, 100 patients participated in this randomized clinical trial. Stone-directed antegrade pyelography using the ‘bull’s eye’ technique under fluoroscopic guidance was used for percutaneous access in the intervention group. The second group, consisting of those who had undergone conventional PCNL using retrograde pyelography and ‘bull’s eye’ technique in the same period, were considered as the controls. Pre- and postoperative laboratory examinations, surgical results and complications were recorded and compared between the two groups. Results: A single calyceal puncture in partial staghorn and staghorn stone patients was sufficient in 72.2% of the antegrade group and in 78.9% of the retrograde group ( p=0.69). The double-puncture technique was necessary for 71.9% of renal pelvis stones in the antegrade group and for 9.4% in the retrograde group ( p<0.001). The antegrade approach reduced the mean operative time and analgesic requirement significantly ( p<0.001). No statistically significant difference, however, was found between the two groups regarding stone migration to the ureter, radiation time and postoperative complications. Conclusions: The stone-directed antegrade approach using the ‘bull’s eye’ technique is a safe and accurate method in PCNL access in patients with radiopaque and semi-opaque renal stones.

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Vitamin C—Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination

Nutrients ◽

10.3390/nu13020615 ◽

2021 ◽

Vol 13 (2) ◽

pp. 615

Author(s):

Martin Doseděl ◽

Eduard Jirkovský ◽

Kateřina Macáková ◽

Lenka Krčmová ◽

Lenka Javorská ◽

...

Keyword(s):

Ascorbic Acid ◽

Vitamin C ◽

Iron Absorption ◽

Plasma Concentrations ◽

Physiological Role ◽

Renal Stones ◽

Anti Oxidant ◽

High Doses ◽

Epigenetic Processes

Vitamin C (L-ascorbic acid) has been known as an antioxidant for most people. However, its physiological role is much larger and encompasses very different processes ranging from facilitation of iron absorption through involvement in hormones and carnitine synthesis for important roles in epigenetic processes. Contrarily, high doses act as a pro-oxidant than an anti-oxidant. This may also be the reason why plasma levels are meticulously regulated on the level of absorption and excretion in the kidney. Interestingly, most cells contain vitamin C in millimolar concentrations, which is much higher than its plasma concentrations, and compared to other vitamins. The role of vitamin C is well demonstrated by miscellaneous symptoms of its absence—scurvy. The only clinically well-documented indication for vitamin C is scurvy. The effects of vitamin C administration on cancer, cardiovascular diseases, and infections are rather minor or even debatable in the general population. Vitamin C is relatively safe, but caution should be given to the administration of high doses, which can cause overt side effects in some susceptible patients (e.g., oxalate renal stones). Lastly, analytical methods for its determination with advantages and pitfalls are also discussed in this review.

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