scholarly journals Evolution of Percutaneous Renal Access

2021 ◽  
Vol 4 (2) ◽  
pp. e29-e35
Author(s):  
Ananda Kumar Dhanasekaran ◽  
Mussammet Ahmed
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Treatment Modality ◽  
Open Surgery ◽  
Literature Search ◽  
Percutaneous Nephrostomy ◽  
Stent Insertion ◽  
Vital Part ◽  
Stone Treatment ◽  
History Of ◽  
Percutaneous Renal Access

Introduction: Nephrostomy insertion is a vital part of modern-day urology used to manage obstructedrenal tract or gain percutaneous renal access.Method: We carried out a PubMed literature search on the history of the development of nephrostomies. Results: The first percutaneous nephrostomy was performed in 1864 on a child who died in 5 years. Nephroscopy was then described and performed in 1941 during an open surgery with subsequent advancement to percutaneous nephrolithotomy in 1976 and antegrade stent insertion in 1978.Conclusion: Clinical need and innovation have led to percutaneous renal access and subsequent stone treatment modality.

scholarly journals Outcomes of Percutaneous Nephrolithotomy in Patients with Previous Ipsilateral Open Renal Stone Surgery

2020 ◽  
Vol 18 (2) ◽  
pp. 277-281
Author(s):  
Robin Bahadur Basnet ◽  
Anil Shrestha ◽  
Parash Mani Shrestha ◽  
Biswa Raj Joshi
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Open Surgery ◽  
Renal Stone ◽  
Standard Technique ◽  
Study Groups ◽  
Average Hospital ◽  
Number Of Patients ◽  
History Of ◽  
Renal Stone Surgery ◽  
First Time

Background: Nephrolithiais is a recurrent disease. Recent advances have enabled stone surgeries to be performed by minimal invasive techniques; but still a large number of patients present with history of ipsilateral open renal stone surgery. Previous scar to the kidney and overlying muscles are fraught with possibility of increased complications. This study was conducted to evaluate the perioperative results of percutaneous nephrolithotomy in patients with a history of open stone surgery and to compare with those undergoing percutaneous nephrolithotomy for the first time.Methods: A retrospective study of all the percutaneous nephrolithotomy performed by standard technique within four years at Bir Hospital was made. Patients were divided into those undergoing percutaneous nephrolithotomy for the first time and those who had undergone open renal stone surgery in the past. Preoperative and intraoperative variables were recorded and postoperative stone free status and complications were evaluated. Results: Six hundred and twenty seven patients; out of 691, who had undergone percutaneous nephrolithotomy were included. Demographic variables and stone characteristics were similar in the two study groups. percutaneous nephrolithotomy was found to be statistically similar in the two groups in terms of the number of tracts made (p= 0.1642) and operative time (0.9197). Exit strategies were similar in both groups. Stone free rate was 83.33% in patients undergoing percutaneous nephrolithotomy for first time and 82.08% in those with history of open surgery. Average hospital stay was 3 days in both groups. Although the group with history of previous surgery had significantly more complications (p= 0.0207), Clavien grading was similar in the two groups.Conclusions: This study shows that the rate of complications is more in patients with history of open surgery, most complications are minor, not requiring intensive management. percutaneous nephrolithotomy is efficient and safe in patients with history of open renal stone surgery. Keywords: Complications; open renal stone surgery; percutaneous nephrolithotomy

scholarly journals Factors Affecting Transfusion During Percutaneous Nephrolithotomy: A Retrospective Study of 665 Cases

2021 ◽  
Author(s):  
Hong Zhao ◽  
Jun-Sheng Li ◽  
Li Li ◽  
Hang Wang ◽  
Yi Miao ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Percutaneous Nephrolithotomy ◽  
Open Surgery ◽  
Transfusion Rate ◽  
Preoperative Hemoglobin ◽  
Stone Burden ◽  
Stone Free Rate ◽  
History Of ◽  
Stone Type ◽  
Free Rate

Abstract Purpose: To evaluate the aspects affecting transfusion following percutaneous nephrolithotomy (PCNL).Background: From 2016 to 2019, 665 patients underwent PCNL for removal of renal calculi in our center. Complications, including hemorrhages, have been reported. Twenty-three patients (3.5%) have received a blood transfusion and twelve (1.9%) were treated by hyper-selective embolization. We focus on the influencing factors related to postoperative blood transfusion. The factors analyzed were (age, sex, hypertension, diabetes, serum creatinine level, preoperative hemoglobin, and use of anticoagulants or antiplatelet medications); renal and stone factors (previous surgery, abnormal anatomy, stone side, stone burden, stone type); and surgical features: (access number, the calyx of puncture and stone-free rate). These data were analyzed for the presence of bleeding.Results: Among individual factors, preoperative hemoglobin level (P<0.001), and urinary infection (P<0.001) were significantly correlated with blood transfusion. Among renal and stone factors, only previous history of open surgery was significantly correlated with blood transfusion (P<0.05). Stone type or stone burden does not correlate with transfusion. There was also no statistically significant correlation between surgical features and bleeding, and a lower stone-free rate reported for transfusion group.Conclusion: The obtained results demonstrated that PCNL is a safer surgery in a high volume center, but anemic conditions, infections and history of open surgery will significantly increase transfusion rate following PCNL.

scholarly journals Uretrorenoscopy laser lithotripsy treatment of stones impacted in the left ureter 10 years after right kidney autotransplantation

2014 ◽  
Vol 71 (10) ◽  
pp. 972-974
Author(s):  
Novak Milovic ◽  
Vladimir Bancevic ◽  
Goran Teodorovic
Keyword(s):  
Percutaneous Nephrostomy ◽  
Laser Lithotripsy ◽  
Stent Insertion ◽  
Large Defect ◽  
Left Ureter ◽  
Stone Treatment ◽  
The Right ◽  
Graft Interposition ◽  
Jj Stent ◽  
Kidney Autotransplantation

Introduction. Urinary tract calculosis is a very common condition in general population. It appears in 5-10% of population, and can be managed conservatively or by minimally invasive, endoscopic and surgical procedures or extracorporeal shock way lithotripsy. Lesions of the ureter can be resolved by JJ stent insertion, end-to-end anastomosis, ureterocystoneostomy, percutaneous nephrostomy, nephrectomy, intestinal graft interposition or kidney autotransplantation. Case report. We presented surgical treatment and outcome in a female patient, with a large defect of the right ureter due to impacted stone treatment, following a successful autotransplantation of the right kidney. Ten years later a stone impacted in the left ureter was successfully treated by ureterorenoscopy and laser lithotripsy. Asynchronously combined kidney aoutotransplantation and ureterorenoscopic lithotripsy preserved kidney function. Conclusion. Bilateral organs preservation should be considered even in the absence of malignancy, especially in younger population.

Systematic Review Comparing Open versus Endoscopic Surgery in Clival Chordomas and a 10-Year Single-Center Experience

2021 ◽  
Author(s):  
Ravindran Visagan ◽  
Asfand Baig Mirza ◽  
Mohamed Okasha ◽  
Timothy Martyn Boardman ◽  
Eleni Maratos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Management ◽  
Open Surgery ◽  
Literature Search ◽  
Optimal Management ◽  
Total Resection ◽  
Single Center Experience ◽  
Institutional Experience ◽  
Open Versus ◽  
Slow Growing

Abstract Objectives Chordomas are rare, slow-growing, and osteo-destructive tumors of the primitive notochord. There is still contention in the literature as to the optimal management of chordoma. We conducted a systematic review of the surgical management of chordoma along with our 10-year institutional experience. Design A systematic search of the literature was performed in October 2020 by using MEDLINE and EMBASE for articles relating to the surgical management of clival chordomas. We also searched for all adult patients surgically treated for primary clival chordomas at our institute between 2009 and 2019. Participants Only articles describing chordomas arising from the clivus were included in the analysis. For our institution experience, only adult primary clival chordoma cases were included. Main Outcome Measures Patients were divided into endoscopic or open surgery. Rate of gross total resection (GTR), recurrence, and complications were measured. Results Our literature search yielded 24 articles to include in the study. Mean GTR rate among endoscopic cases was 51.9% versus 41.7% for open surgery. Among the eight cases in our institutional experience, we found similar GTR rates between endoscopic and open surgery. Conclusion Although there is clear evidence in the literature that endoscopic approaches provide better rates of GTR with fewer overall complications compared to open surgery. However, there are still situations where endoscopy is not viable, and thus, open surgery should still be considered if required.

Uretero-Iliac artery fistula: a rare cause of haematuria

2020 ◽  
Vol 13 (9) ◽  
pp. e232189
Author(s):  
Natalia Hernandez ◽  
Bethany Desroches ◽  
Eric Peden ◽  
Raj Satkunasivam
Keyword(s):  
Iliac Artery ◽  
Percutaneous Nephrostomy ◽  
Arterial System ◽  
Endoscopic Evaluation ◽  
Stent Removal ◽  
Retrograde Pyelogram ◽  
History Of ◽  
Gross Haematuria ◽  
Multiple Episodes

A woman in her mid-forties with a history of cervical cancer requiring chemoradiation presented with bilateral ureteral strictures secondary to radiation therapy. The ureteral obstruction was initially relieved with bilateral percutaneous nephrostomy tubes, and subsequently, bilateral ureteral stents. Over the course of 8 months, she presented with multiple episodes of severe gross haematuria. This persisted even after stent removal and conversion back to percutaneous nephrostomy tubes. The initial evaluation, done with concern for an uretero-iliac artery fistula, which included bilateral retrograde pyelograms and CT angiography was non-diagnostic. Given continued haematuria, repeat endoscopic evaluation was undertaken; on retrograde pyelogram, brisk contrast was seen to pass into the arterial system, consistent with a left ureteroarterial fistula. The patient underwent endovascular iliac artery stent placement. Subsequently, the patient underwent resection of the iliac artery with endovascular graft in situ, left distal ureterectomy with proximal ureteral ligation following femoral-to-femoral bypass. This allowed for complete resolution of the patient’s gross haematuria episodes.

scholarly journals Percutaneous Nephrostomy Tube-related Infections

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S349-S349 ◽  
Author(s):  
Hanine El Haddad ◽  
George Viola ◽  
Ying Jiang ◽  
Issam Raad ◽  
Kenneth V Rolston ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Median Time ◽  
Antimicrobial Therapy ◽  
Urinary Tract Obstruction ◽  
Recurrent Infection ◽  
Percutaneous Nephrostomy ◽  
Infectious Complications ◽  
High Rate ◽  
History Of

Abstract Background Percutaneous nephrostomy tubes (PCN) are indicated for relief of urinary tract obstruction. These devices are prone to mechanical and infectious complications. The infection rate at 90 days is ±20%. Our objective was to determine whether discordant antimicrobial coverage provided prior to PCN exchange was associated with a higher rate of recurrent infection compared with those who received concordant therapy. Methods We retrospectively reviewed 780 patients that had undergone initial PCN placement at our institution between July 2014 and February 2017. We only included patients that had developed a definite PCN infection, subsequent PCN exchange, with a minimum 30 day post-PCN exchange follow up. We defined PCN infection as the presence of a positive urine culture (≥104 cfu/mL) plus symptoms consistent with a urinary tract infection. Recurrence was defined as a new PCN infection with the isolation of the same organism to the initial episode. Antibiotics were defined as concordant if they had activity against all organisms’ isolated based on antimicrobial susceptibilities. Results A total of 47 patients met our inclusion criteria. The median age of patients was 59, with 49% being male. The most common underlying tumors were urothelial (45%), cervical (17%) and prostate cancer (15%). Clinical characteristics included ureteral stents (17%), diabetes (19%), history of GU surgery (38%), and active chemotherapy at the time of PCN insertion (70%). The median time to onset of infection was 42 days. Infections were polymicrobial in 50% of the cases. The most common organisms encountered were Pseudomonas spp. (36%), Enterococcus spp. (23%) and Escherichia coli (18%). The median length of follow up of PCN tubes after exchange was 55 days. There were 12 (26%) recurrences occurring at a median time of 27 days. The provision of discordant antibiotics preceding PCN exchange was significantly associated with recurrence of infection (66.7% vs. 12.8%; P &lt; 0.002). Conclusion Discordant antimicrobial therapy provided during PCN exchange, in the setting of a PCN infection is associated with a higher rate of relapse. Therefore, to decrease the high rate for PCN reinfection, we propose that prior to PCN exchange secondary to infection, patients should be receiving concordant antimicrobial therapy. Disclosures All authors: No reported disclosures.

Transient ureteric obstruction following pelvic floor reconstruction

2021 ◽  
Vol 14 (5) ◽  
pp. e238669
Author(s):  
Liam Joseph Beamer ◽  
Sarah Neary ◽  
Thomas McCormack ◽  
David Ankers
Keyword(s):  
Pelvic Floor ◽  
Kidney Injury ◽  
Solitary Kidney ◽  
Percutaneous Nephrostomy ◽  
Pelvic Organ ◽  
Ureteric Obstruction ◽  
Pelvic Floor Reconstruction ◽  
Transient Nature ◽  
Recurrent Pelvic Organ Prolapse ◽  
History Of

We describe the first reported case of transient distal ureteric obstruction attributed to post-surgical oedema in a patient with a solitary kidney. This occurred following combined pelvic floor repair and sacrospinous fixation for recurrent pelvic organ prolapse and manifested clinically as anuria, radiological hydroureter and acute kidney injury in the postoperative period. The transient nature of this obstruction, which was managed by a temporary percutaneous nephrostomy, indicates that it was caused by ureteric compression secondary to soft tissue oedema following surgery. We highlight the importance of this potential complication in females with a history of nephrectomy, unilateral renal tract anomalies or severely diminished renal reserve.

scholarly journals Study of variations in the pelvicalyceal system of kidney and its clinical importance

2013 ◽  
Vol 8 (3) ◽  
pp. 17-21 ◽  
Author(s):  
PR Wadekar ◽  
SD Gangane
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Clinical Importance ◽  
Percutaneous Nephrostomy ◽  
Clinical Implications ◽  
Clear Understanding ◽  
Medical Sciences ◽  
Pelvicalyceal System ◽  
Collecting System

Objective The present study has been undertaken to study the variations in renal pelvicalyceal system, to compare them with previous studies and to find their clinical implications. Materials and Methods A total of 100 kidneys (from 50 cadavers) were included in this study. The following parameters were measured 1)Lower Infundibular length, 2)Infundibular Width – Lower Infundibular Width (LIW), Middle Infundibular Width (MIW), Upper Infundibular Width (UIW), 3)Number of minor calyces and 4)Number of major calyces. Results The obtained data showed that there were numerous variations not only in the numbers of calyces of kidneys but also in the infundibular length and width. Conclusion Developments in endourology, percutaneous nephrolithotomy and techniques for retrograde percutaneous nephrostomy have rekindled interest in the anatomy of the renal collecting system. To perform these procedures safely and efficiently it is essential to have a clear understanding of pelvicalyceal anatomy and its variations. Thus the in-depth knowledge of pelvicalyceal anatomy will be of immense value to the clinicians of related specialties. Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-3, 17-21 DOI: http://dx.doi.org/10.3126/jcmsn.v8i3.8681

scholarly journals Contemporary Practice of Percutaneous Nephrolithotomy: Review of Practice in a Single Region of the UK

2008 ◽  
Vol 90 (1) ◽  
pp. 40-44 ◽  
Author(s):  
Shalom J Srirangam ◽  
Richard Darling ◽  
Maureen Stopford ◽  
Donald Neilson
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Medical Records ◽  
White Blood Cells ◽  
Urinary Stone ◽  
Stent Insertion ◽  
Intensive Care Admission ◽  
Single Region ◽  
The Uk ◽  
Almost All ◽  
Contemporary Practice

INTRODUCTION Most series of percutaneous nephrolithotomy (PCNL) from single specialised centres represent optimum results achievable and may not reflect outcomes of everyday practice. We analysed the practice in our region. PATIENTS AND METHODS Medical records of 178 patients undergoing PCNL in 2002 in 12 participating hospital trusts were retrospectively analysed. RESULTS Even outside the tertiary referral centres, there was a 6-fold difference between trusts in the frequency of PCNL. In 28% of cases, another stone-removing modality had been tried first. Failed renal puncture was a major cause of abandoning surgery (9%). An indication of the difficulty in obtaining complete stone clearance is that only 107 (60%) operation notes recorded complete clearance, while 75 (42%) patients required a subsequent procedure (13% a secondary PCNL). Use of supra 12th rib punctures was small (6%) as was the rate of ‘tube-less’ PCNL (4%). Some 22% had simultaneous ureteric stent insertion. Approximately 8% of cases required a blood transfusion. Thirty-eight patients (23%) had a proven infection (UTI) pre-operatively (> 104 organisms; > 10 white blood cells) with almost all patients receiving antibiotics at anaesthesia induction. Postoperative sepsis rates (temperature > 38.5°C) were similar in those with and without a pre-operative UTI (18.4% versus 14.3%) and pre-operative antibiotics appeared to have little extra protective effect. Severe sepsis was rare with no patient requiring intensive care admission for this reason. Median length of stay postoperatively was 5 days. CONCLUSIONS These results present important figures to quote when counselling patients pre-operatively, albeit that the degree of difficulty (and hence the likelihood of problems) is identifiable from stone and anatomical configurations. In addition, the present data are a more accurate reflection of urinary stone surgery in non-tertiary, general urological practice.

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