scholarly journals Outcome of mini percutaneous nephrolithotomy ‘miniPCNL’ in children

2018 ◽  
Vol 5 (2) ◽  
pp. 12-17
Author(s):  
Samir Shrestha ◽  
Pukar Maskey ◽  
Jay N Shah
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Pediatric Population ◽  
Renal Stones ◽  
Safe Procedure ◽  
Gross Hematuria ◽  
Residual Stone ◽  
Stone Clearance ◽  
Conversion To Open Surgery

Introductions: Renal stone disease is one of the common urological disorders with prevalence approximately 2-3% in the general population and the incidence in children is increasing at a rate of 4% per year. Miniaturization of endoscopic instruments, minimally invasive endoscopic procedures of mini percutaneous nephrolithotomy (miniPCNL) in children is increasingly used. This study was conducted to assess the outcome of miniPCNL in pediatric population. Methods: This retrospective study analyzed the outcome of miniPCNL in children below 18 years of age from August 2015 to July 2018 at Patan Hospital, Nepal. Ethical approval was obtained. Outcome was assessed descriptively on stone localization, puncture success, stone clearance, bleeding requiring transfusion, gross hematuria, urosepsis, operative time, hospital stay, mortality and need of second procedures. Results: A total of 26 patients underwent miniPCNL, mean age 10.8±5.45 years (1-18 years), mean operative time was 122±26.03 minutes and mean hospital stay was 3.2±1.12 days.  Postoperative transfusion was required in 1 (2.6%), gross hematuria occurred in 1 (2.6%), no urosepsis, no conversion to open surgery. Complete stone clearance was achieved in 22 (84.61%) patients.  Mortality was nil. Second procedure was required in 4 (15.38%) to achieve residual stone clearance. Conclusions: Our study shows miniPCNL is an effective and safe procedure with minimal morbidity for the treatment of pediatric renal stones.

scholarly journals Retrograde Intrarenal surgery- Our experience

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.

scholarly journals Safety and Viability of Totally Tubeless Ambulatory Percutaneous Nephrolithotomy (APCNL) in the Fast Paced World

2018 ◽  
Vol 11 (1) ◽  
pp. 14-21
Author(s):  
BM Zeeshan Hameed ◽  
Arun Chawla ◽  
Padmaraj Hegde ◽  
Avinash Odugoudar ◽  
Tirth Vasa
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Renal Stones ◽  
Endoscopic Management ◽  
Safe Procedure ◽  
Early Recovery ◽  
Early Return ◽  
Skin Infiltration ◽  
Retrograde Pyelogram ◽  
Dj Stent

Background: Percutaneous Nephrolithotomy (PCNL) is the gold standard for endoscopic management of large renal stones. Various modifications have been done to bring down the morbidity of this procedure. Ambulatory PCNL (APCNL) defines PCNL as day-care procedure, avoiding overnight hospital stay which is less than 24 hours. Totally tubeless makes faster recovery without the need for double J stent or nephrostomy tubes. This study aimed at exploring the feasibility and safety of APCNL in selective patients. It also aimed at improvising the procedure to facilitate early recovery and discharge of patients within 24 hrs. Materials ands Methods: In this study, 12 patients underwent APCNL under general anaesthesia with endotracheal intubation from April 2016 to March 2017. All the procedures were done by a single surgeon. The inclusion criteria were stone size of less than 2cm, without any co-morbidities, Computed Tomography (CT)/Retrograde Pyelogram(RGP) evidence of normal pyelocalyceal anatomy, patient staying within the radius of 15km, well informed patient. All patients underwent totally tubeless PCNL i.e. without nephrostomy, DJ stent and catheter. Skin infiltration was given with 0.25% Bupivacaine. Post operatively analgesia was given on demand (intramuscular Aceclofenac / oral Acetaminophen plus Tramadol). All patients were followed up after 2 weeks. Results: Twelve patients underwent prone PCNL. All patients had single puncture (10 lower calyx, 2 middle calyx), Amplatz size was less than 30F, size of the stone (1.3cm to 2cm) with a mean size- 1.7cm, saline used around 300ml. But, two patients were discharged after 36hrs and 48hrs due to pain. None of them returned to hospital with haematuria, pain or urinary tract infection. Conclusion: APCNL is a safe procedure in well informed selective patients. These are the patients with small burden of stone and staying close to the hospital. APCNL reduces the hospital stay, expenses and results in early return to work.

scholarly journals Comparative Study Between Percutaneous Nephrolithotomy and Extra Corporeal Shock Wave Lithotripsy in Managing Renal Stones

2014 ◽  
Vol 41 (3) ◽  
pp. 23-27
Author(s):  
MS Islam ◽  
NP Biswas ◽  
MZ Hossan ◽  
I Rahman ◽  
AKM K Alam ◽  
...  
Keyword(s):  
Shock Wave ◽  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Shock Wave Lithotripsy ◽  
Renal Stone ◽  
Renal Stones ◽  
Cutaneous Fistula ◽  
Stone Clearance ◽  
Post Procedure ◽  
Significant Difference

To find out better treatment option in treating renal stone safely, expeditiously. A total of 90 patient were prospectively randomized for Percutaneous Nephrolithotomy (PCNL) (40) and Extra Corporeal Shock Wave Lithotripsy (ESWL) (50). Stone clearance, adjuvant procedures, hospital stay, post procedure morbidity, were compared for both methods. Stone clearance in PCNL and ESWL group was 87.50 and 66 percent respectively with a significant difference of clearance (P<0.05). Considering the stone size, in smaller stones, clearance was 87.50% and 72 50% among PCNL and ESWL group respectively without any significant difference (P>0.05). But in larger stones, stone clearance was 87.50% and 60.72% among PCNL and ESWL group respectively with significant difference in clearance between the groups (P<0.05). The rate of adjuvant procedures in PCNL and ESWL group was 12.50%, and 34% respectively. Requirement of adjuvant procedures were significantly higher in ESWL group (P<0.051 Post procedure hospital stay was significantly shorter in ESWL group than PCNL group (1.32 0.47 vs 4.52 1.99) with P yalue <0 05. Steinstrasse and Haematuria were significantly higher in ESWL group than PCNL group. Bleeding requiring transfusion, urinary cutaneous fistula and .fever were significantly higher in PCNL group than ESWL group. PCNL is more effective than ESWL in clearing larger renal stones. DOI: http://dx.doi.org/10.3329/bmj.v41i3.18954 Bangladesh Medical Journal 2012 Vol.41(3): 23-27

scholarly journals Tract Size in Percutaneous Nephrolithotomy (PCNL) : Does It Really Matter?

2020 ◽  
Vol 18 (2) ◽  
pp. 18-22
Author(s):  
Mofizur Rahman ◽  
Mohammed Monowar Ul Hoque ◽  
Kazi Md Monwarul Karim ◽  
AKM Akramul Bari ◽  
Tanvir Rahman ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Statistical Difference ◽  
Pain Perception ◽  
Operative Time ◽  
Previous History ◽  
Postoperative Fever ◽  
Stone Clearance ◽  
Significant Difference

Background : Percutaneous Nephrolithotomy (PCNL) is the treatment of choice in removal of renal and proximal ureteral calculi. The primary goal of PCNL is to achieve stone free status while minimizing morbidity and complications. In recent years, the instruments used have been miniaturized in an effort to decrease morbidity associated with standard PCNL as well as increase the efficacy of stone removal. The aim of this study is to compare the safety and efficacy of PCNL using different tract size. Materials and methods: This hospital based prospective interventional study was conducted on patients with 1 to 4 cm renal stones who underwent PCNL either by Minior Standard PCNL technique in Chattogram Medical College Hospital and different private hospitals in Chittagong from July 2016 to June 2018. Patients aged above 12 years of age, irrespective of gender with normal renal function were evaluated to compare stone clearance, total operative time, need for blood transfusion, postoperative pain and other complications. Those who had previous history of open renal surgery, active urinary tract infection, renal malformation, uncorrected coagulopathy and morbid obesity were excluded. Results: A total of 64 patients were enrolled consecutively for PCNL who were divided equally into two groups randomly for minimally invasive PCNL (Mini- PCNL) and Standard PCNL. The average stone size in mini-PCNL group was 2.64 ± 0.94 cm and 2.776 ± 0.97 cm in standard-PCNL group. Mean tract size was 18.44 ± 1.32 F (16-20) and 26.7 ± 5 F (24-30) respectively. In mini-PCNL operative time was significantly longer than that of standard PCNL with 110.31 ± 21.77 vs 95.94 ± 19.82 min respectively. Conversely, there was an advantage of mini-PCNL over the standard one in terms of a significantly reduced hemoglobin drop (0.5 ± 0.25 vs. 0.8 ± 0.34) gram and hospital stay (2.13 ± 0.79 vs.3.38 ± 1.13 days) respectively though there was no statistical difference in terms of stone clearance rates between two groups (86.7% vs. 93.33%). There was no statistical difference in terms of Visual Analogue Scale (VAS) score (5.44 ± 1.5 vs.6.19 ± 1.65) for pain perception. The complication rate of mini-PCNL had no significant difference with that of standard PCNL (10% vs 13.6%). No statistical difference was recorded in terms of postoperative fever (³38oC) between two groups (2 in each group, 6.67%, p=1). Blood transfusion requirement was much less in mini PCNL group (10% vs. 33.33%). Conclusion: In addition to minimal bleeding and excellent stone clearance, mini- PCNL has several features for which it should be considered as an alternative or adjunct to standard PCNL, URS and ESWL. These include safe supra-costal puncture, excellent access to nearly all calyces and upper ureter, less hospital stay and suitable for large stones also. Future studies should continue to refine methods to assess complexity and safety and to determine consensus on the use of mini- PCNL. Chatt Maa Shi Hosp Med Coll J; Vol.18 (2); July 2019; Page 18-22

scholarly journals Impact of Miniaturization on Early Outcome of Percutaneous Nephrolithotomy

2019 ◽  
Vol 17 (3) ◽  
pp. 320-324
Author(s):  
Mahesh Bahadur Adhikari ◽  
Sumeet Karna ◽  
Kinju Adhikari ◽  
Atul Kasaju ◽  
Jagdish Lal Baidya
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Standard Procedure ◽  
Renal Stones ◽  
P Value ◽  
Complication Rates ◽  
Significant Difference ◽  
Size Standard ◽  
Hemoglobin Drop

Background: Percutaneous nephrolithotomy has become the standard procedure for large renal stones but still remains highly challenging due to complications such as bleeding and sepsis, even though it has high stone free rate (SFR). We report the early outcomes of more than 1000 percutaneous nephrolithotomys done in our center.Methods: A retrospective study of all patients undergoing percutaneous nephrolithotomy from January 2010 to December 2017 in single institution was conducted. All cases were stratified into three groups based on tract size; standard percutaneous nephrolithotomy with tract size ? 22 F, mini percutaneous nephrolithotomy with tract size 15 – 20 F and ultramini percutaneous nephrolithotomy with tract size ? 14 F. Age, gender, stone complexity using Guy’s stone score, stone size, operative time, hemoglobin drop, hospital stay, early major and minor complications were reviewed.Results: A total of 1074 patients had undergone percutaneous nephrolithotomy among which, 578 patients were standard percutaneous nephrolithotomy, 433 mini percutaneous nephrolithotomy and 63 had undergone ultramini percutaneous nephrolithotomy. There was even distribution of patients with Guy’s stone score 1 and 2 in all three groups. However, majority of patients with Guy’s stone score 3 underwent standard percutaneous nephrolithotomy or mini percutaneous nephrolithotomy and no patients with Guy’s stone score 4 underwent ultramini percutaneous nephrolithotomy. Age group, gender and operative time were comparable between the groups; however, significant difference was noted in terms of less hemoglobin drop and shorter hospital stay (p-value < 0.05) in the miniaturized percutaneous nephrolithotomy group. Complications were found to be fewer in mini percutaneous nephrolithotomy and ultramini percutaneous nephrolithotomy group in comparison to standard percutaneous nephrolithotomy.Conclusions: Miniaturization of tract size significantly decreases post-operative complication rates, blood loss and hospital stay while maintaining high stone free rates in well selected patients undergoing Percutaneous nephrolithotomy.Keywords: Endourology; percutaneous nephrolithotomy; PNL; urolithiasis.

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 Standard Percutaneous Nephrolithotomy with Mini-Percutaneous Nephrolithotomy for Removal of Renal Stones in Adults

2021 ◽  
Vol 5 (2) ◽  
pp. 20-25
Author(s):  
Asif Alam Khan ◽  
Inam Malkani ◽  
Junaid Jameel Khattak ◽  
Hassan Mumtaz ◽  
Mubashir Mazhar ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Operative Time ◽  
Treatment Time ◽  
Renal Stones ◽  
Hemoglobin Level ◽  
Stone Clearance ◽  
Group A ◽  
The Mean ◽  
Group B

Renal stones are the third most common problem affecting about 10% of global population. The management of nephrolithiasis has undergone a complete transformation since the 1980s. Percutaneous nephrolithotomy (PCNL) has established itself an effective and safe technique that delivers high stone-free rate as well as overall shorter treatment time. We aim to compare the outcome of mini-PCNL with standard-PCNL in patients presenting with renal stones. In all, 90 patients fulfilled the selection criteria and randomized into two groups. Group A underwent mini-PCNL whereas Group B underwent standard-PCNL. Pre-operative hemoglobin level was recorded. Duration of procedure as well as drop in hemoglobin level was also recorded. A kidney, ureter, and bladder (KUB) X-ray was performed to confirm the presence of of stone and stone-free status. The mean age of patients in mini-PCNL group was 43.11 years and in standard-PCNL group, it was 36.91 years. The mean stone size in patients of mini-PCNL group was 29.53 mm and 31.58 mm in standard-PCNL group. The mean duration of renal stone in mini-PCNL group was 1.91 years and that in standard-PCNL group 1.80 years. The mean operative time in mini-PCNL group was 59.56 min and 61.22 min in standard-PCNL group. The mean fall in hemoglobin in mini-PCNL group was 0.38 g/dL and that in standard-PCNL group 0.51 g/dL. In mini-PCNL group, stone clearance was observed in 42 (93.3%) patients, while in standard-PCNL group, it was observed in 45 (100%) patients. This difference was insignificant (P > 0.05). Mini-PCNL and standard-PCNL have no significant differences in terms of outcome, operative time, and stone clearance, although fall in hemoglobin level was less in mini-PCNL group, which showed less blood loss in this group, thereby making it a more appropriate method for renal stone removal.  

scholarly journals Initial Experience of Percutaneous Nephrolithotomy at Lumbini Medical College

2013 ◽  
Vol 1 (1) ◽  
pp. 35
Author(s):  
Prakash Sapkota ◽  
Y B Tambey ◽  
Sunil Thapa ◽  
Rajan Shakya
Keyword(s):  
Prospective Study ◽  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Renal Stones ◽  
Invasive Approach ◽  
Medical College ◽  
Stone Burden ◽  
Estimated Blood Loss ◽  
The Mean

  Introduction: Renal stone disease is a challenging problem in urologic practice especially in our locality because of large stone burden and recurrence. Since ,the early 1980s when percutaneous nephrolithotomy (PCNL) was established for management of renal stones, open surgical procedures have virtually been replaced. PCNL is a safe, effective and minimally invasive approach compared to open surgery for patients with large single, multiple or staghorn stones. The aim of this prospective study was to evaluate and to review our experience with PCNL in management of renal and upper ureteric stones.   Methods: Prospective study carried out at Lumbini Medical College and Teaching Hospital during 1stJanuary 2011 to 31st October 2011. Sixty patients were evaluated and subjected to PCNL. After clinical investigations like ultrasonography (USG) and intravenous urography (IVU), once patients were found to have renal or upper ureteric stones they were informed and explained about PCNL, its likely complications, probable hospital stay, the cost of treatment and data were recorded along with the operative time, estimated blood loss, stone burden, stone-free rate, length of hospitalization and complications .Patients were followed up after three months to rule out recurrence of stones by plain abdominal x-ray of kidney, ureter and bladder and USG.   Results: Out of 60 patients 35 were male and 25 were female (M: F=1.4:1) with mean age of 37 years and were subjected to PCNL monotherapy. With the average stone size of 3.26cm, the mean operative time was 78 minutes. Complete stone removal achieved by PCNL alone in 60 cases, with insignificant residual small stones we achieved 97% stone clearance rate. The mean hospital stay was 3.7 days. No Serious complications were encountered, 9 (15%) patients required blood transfusion and 3 (5%) patients developed transient post-operative pyrexia.   Conclusion: PCNL is the first line treatment option for management of large renal stones which as monotherapy has advantages in removal of renal and upper ureteric stones and achieving excellent results with minimal morbidity.

scholarly journals Percutaneous nephrolithotomy tract dilatation techniques comparison (Balloon vs. Amplatz): Our Experience in Middle East.

2020 ◽  
Author(s):  
Adnan A. Abu-Qamar ◽  
Mohanad M. Al-Naser ◽  
Ashraf S. Al-Majali ◽  
Mohammad A. Al-serhan ◽  
Firas A. Al-Hammouri ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Statistical Evaluation ◽  
Renal Stones ◽  
Invasive Technique ◽  
Transfusion Rate ◽  
Stone Clearance ◽  
Achievement Rate ◽  
Spss Software

Abstract Background: percutaneous nephrolithotomy (PCNL) is a gold widespread minimally invasive technique for the remedy of huge renal stones > 2 cm. Our intention is to review the versions among the Balloon and Amplatz dilatation of percutaneous nephrolithotomy (PCNL) tract exploitation peri- and postoperative variables and make clear which technique is efficient.Methods: 600 sufferers who underwent PCNLs among (1-April 2012 and 20-September 2018) in our Urology Center had been listed all through this retrospective look at, and divided into 2 groups: (group1) balloon tract dilatation (300 sufferers) and (group2) Amplatz serial fascial (ASF) dilatation (300 sufferers). Therefore, the demographic and categorical statistics were compared between each team.Statistical evaluation used: SPSS software version twenty-four, T-test.Results: operative time (balloon vs. Amplatz group: (85 ± 32 vs. 86.5 ± 31) mins; P= zero.073), preoperative Hematocrit value (41.5 ± 8.2 vs. 40.three ± 9.4; P= 0.088), postoperative Hematocrit cost (36.1 ± 2.2 vs. 34.6 ± three.4; P= 0.023), blood transfusion levels (10.6% vs. 12.1%; P= 0.002), tract dilatation trials (20.4% vs. 22.6%; P= 0.051), stone clearance price (78.three% vs. 77.8%; P= 0.083), and therefore, the versions regarding the price have been higher slightly in balloon cluster while within the opportunity variables had been statistically insignificant besides blood transfusion rate and postoperative hospital live.Conclusion: The balloon dilatation is price effective than amplatz method in manner of postoperative hospital live length and blood transfusion, whereas most of the other diverse factors like safety, operative period, achievement rate, and stone clearance price; they gave comparable consequences.

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