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 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 Factors affecting stone free rate of primary percutaneous nephrolithotomy on staghorn calculi: a single center experience of 15 years

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2106 ◽  
Author(s):  
Widi Atmoko ◽  
Ponco Birowo ◽  
Nur Rasyid
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Univariate Analysis ◽  
Staghorn Calculi ◽  
Stone Burden ◽  
Stone Free Rate ◽  
History Of ◽  
Renal Stone Surgery ◽  
The Mean ◽  
Free Rate

Objectives: Percutaneous nephrolithotomy on staghorn calculi is challenging for urologists because it is difficult to remove all of the stones. The purpose of this study was to evaluate the associated factors of stone-free rate after primary percutaneous nephrolithotomy on staghorn calculi in a large series of patients at a single, tertiary referral, endourologic stone center. Methods: We collected data from medical record between January 2000 and December 2015. A total of 345 primary percutaneous nephrolithotomy procedures were performed for patients with staghorn calculi. This study included both and made no distinction between partial and complete staghorn calculi. Stone-free is defined as the absence of residual stones after undergoing percutaneous nephrolithotomy for the first time. Significant factors from univariate analysis that correlated with stone-free rate after primary percutaneous nephrolithotomy of staghorn stone were further analyzed using multivariate regression analysis. Results: The mean patient age was 52.23±10.38 years. The stone-free rate of percutaneous nephrolithotomy monotherapy was 62.6%. The mean operating time was 79.55±34.46 minutes. The mean length of stay in hospital was 4.29±3.00 days. Using the chi-square test, history of ipsilateral open renal stone surgery (p = 0.01), stone burden (p = < 0.001), and type of anesthesia (p = 0.04) had a significant impact on the stone-free. From multivariate analysis, the history of ipsilateral open renal stone surgery [OR 0.48; 95% CI 0.28-0.81; p 0.01] and the stone burden [OR 0.28; 95% CI 0.18-0.45; p 0.00] were significant independent risk factors for stone-free.

scholarly journals Safety and Efficacy of Percutaneous Nephrolithotomy in Children

2017 ◽  
Vol 15 (2) ◽  
pp. 130-134 ◽  
Author(s):  
Udaya Man Singh Dongol ◽  
Yugal Limbu
Keyword(s):  
Blood Transfusion ◽  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Anatomical Location ◽  
Transfusion Rate ◽  
Safety And Efficacy ◽  
Stone Free Rate ◽  
The Mean ◽  
Tract Infections ◽  
Free Rate

Background: Renal stone disease is a common problem in children in developing countries. Its prevalence in children varies from 5% to 15%. It is suggested that anatomic abnormalities, recurrent urinary tract infections, metabolic disturbances, dietary and environmental factors are the predisposing factors.The aim of this study is to evaluate the safety and efficacy of percutaneous nephrolithotomy in children.Methods: Between May 2012 and Dec 2016, 25 children with renal stone diseases underwent percutaneous nephrolithotomy and were evaluated for stone free rate, complications, blood transfusion rate, sandwich therapy, etc.Results: The mean age of children was 9.3 years (7-15 years) and the mean size of the stone was 20 mm (13-27 mm). The anatomical location of stone was important in terms of stone clearance. Three patients needed blood transfusion. The overall stone free rate was 88% before discharge. Three patients had residual stones and were treated with extracorporeal shockwave lithotripsy. Complications included fever, haematuria, ileus and urine leak. No major complications were noted. There were no significant differences in haemoglobin and creatinine levels before and 12 hours after the surgery.Conclusions: Percutaneous nephrolithotomy (PCNL) can be considered a safe, effective and feasible modality of treatment for children with an average of 2 cm sized renal stones.

scholarly journals TRANSITION FROM PRONE TO SUPINE PERCUTANEOUS NEPHROLITOTOMY: EVALUATING THE LEARNING CURVE FROM THE SINGLE SURGEON EXPERIENCE

2021 ◽  
Vol 28 (2) ◽  
pp. 147-152
Author(s):  
Zulfikar Ali ◽  
Andika Afriansyah
Keyword(s):  
Learning Curve ◽  
Hospital Stay ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Major Complication ◽  
Hemoglobin Level ◽  
Stone Free Rate ◽  
Surgeon Experience ◽  
The Mean ◽  
Free Rate

Objective: This study aims to evaluate the learning curve of the urologist to perform supine PCNL and the perioperative outcome of patients based on a single surgeon’s experience. Material & Methods: 60 consecutive patients who underwent modified supine PCNL for renal stone were analyzed. A single experienced urological surgeon performed the supine PCNL. Mean operative time, drop in hemoglobin level, stone-free rate, complications, and length of hospital stay were analyzed to evaluate the learning curve of the surgeon. All parameters were compared among all six groups obtained from the 60 cases in chronological order. Besides, the outcomes of supine PCNL were also compared to prone PCNL. Results: Mean operative time from 60 cases of supine PCNL was 100 ± 27 minutes. The mean operative time was decreased over time, particularly after 20 cases. Significantly different mean operative times (89 ± 14 minutes vs. 126 ± 21 minutes, p < 0.001) in the groups of cases 21-60 compared to the group of 1–20 cases were observed. The total stone-free rate for supine PCNL from all cases was 68%. There was no difference regarding the reduction of hemoglobin level, stone-free rate, hospital stay, and complication rate. No major complication was found among study subjects. Supine PCNL showed similar outcome parameters compared to prone PCNL. Conclusion: The surgeon acquired the surgical competencies to perform supine PCNL after 20 cases. The supine PCNL could remove the kidney stone as effective and safe as prone PCNL.

scholarly journals Factors affecting stone free rate of primary percutaneous nephrolithotomy on staghorn calculi: a single center experience of 15 years

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2106 ◽  
Author(s):  
Widi Atmoko ◽  
Ponco Birowo ◽  
Nur Rasyid
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Univariate Analysis ◽  
Staghorn Calculi ◽  
Stone Burden ◽  
Stone Free Rate ◽  
History Of ◽  
Renal Stone Surgery ◽  
The Mean ◽  
Free Rate

Objectives: Percutaneous nephrolithotomy on staghorn calculi is challenging for urologists because it is difficult to remove all of the stones. The purpose of this study was to evaluate the associated factors of stone-free rate after primary percutaneous nephrolithotomy on staghorn calculi in a large series of patients at a single, tertiary referral, endourologic stone center. Methods: We collected data from medical record between January 2000 and December 2015. A total of 345 primary percutaneous nephrolithotomy procedures were performed for patients with staghorn calculi. This study included both and made no distinction between partial and complete staghorn calculi. Stone-free is defined as the absence of residual stones after undergoing percutaneous nephrolithotomy for the first time. Significant factors from univariate analysis that correlated with stone-free rate after primary percutaneous nephrolithotomy of staghorn stone were further analyzed using multivariate regression analysis. Results: The mean patient age was 52.23±10.38 years. The stone-free rate of percutaneous nephrolithotomy monotherapy was 62.6%. The mean operating time was 79.55±34.46 minutes. The mean length of stay in hospital was 4.29±3.00 days. Using the chi-square test, history of ipsilateral open renal stone surgery (p = 0.01), stone burden (p = < 0.001), and type of anesthesia (p = 0.04) had a significant impact on the stone-free. From multivariate analysis, the history of ipsilateral open renal stone surgery [OR 0.48; 95% CI 0.28-0.81; p 0.01] and the stone burden [OR 0.28; 95% CI 0.18-0.45; p 0.00] were significant independent risk factors for stone-free.

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 Percutaneous nephrolithotomy-a versatile technique for both simple and complex renal stone

2014 ◽  
Vol 39 (3) ◽  
pp. 99-103
Author(s):  
TMS Hossain ◽  
M Asaduzzaman ◽  
MN Uddin ◽  
MH Rahman ◽  
MU Jahan ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Age Groups ◽  
Renal Calculi ◽  
First Line ◽  
Stone Size ◽  
Stone Free Rate ◽  
Versatile Technique ◽  
Free Rate ◽  
Puncture Technique

Percutaneous Nephrolithotomy is currently the preferred first line treatment for simple & complex renal calculi. The technique also being used increasingly for smaller stones that have failed ESWL. Aim of the study is to share our experience in PCNL in course of time. This study was conducted from January 2009 to December 2012, 131 patient’s with 142 renal units of 5-75 yrs of age, PCNL were performed in NIKDU, BSMMU & JBFH. Stone were classified into simple (isolated renal pelvis or isolated calyceal stones) or complex (partial or complete staghorn stones, renal pelvic stone with accompanying calyceal stones). The stone size was 1.5-5cm approximately. We asses our initial puncture technique, need for multi-tract, supra 12th rib access, stone free rate, operative duration, postoperative complication, number of transfusion and hospital stay. Operative durations were 60 min -180 minutes. Puncture technique improved in course of time. 14 patients need multi-puncture and tract, all are supra 12th access. Out of 142 renal units 120 (83%) were stone free after first procedure, another 22 need and auxiliary procedure, (5 2nd look PCNL, 6 URS, 11 ESWL) to become stone free result in a 95% stone free rate. Complications occurred in 17 procedures which dealt accordingly. This study revealed PCNL is an effective, versatile safe and cosmetically acceptable procedure for all age groups in simple and complex renal stone. DOI: http://dx.doi.org/10.3329/bmrcb.v39i3.20308 Bangladesh Med Res Counc Bull 2013; 39: 99-103

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 Prediction of the stone free rate by using the guy's stone score after percutaneous nephrolithotomy

2019 ◽  
Vol 45 (3) ◽  
pp. 197-200
Author(s):  
Mohammad Shafikul Islam ◽  
Muhammad Hossain ◽  
Md. Saiful Islam ◽  
AKM Khurshidul Alam ◽  
Md. Habibur Rahman Dulal ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Normal Body Mass Index ◽  
Patient Counseling ◽  
Residual Stone ◽  
Female Ratio ◽  
Stone Free Rate ◽  
Grade Ii ◽  
Free Rate ◽  
Grade Iii

Background: Urolithiasis is one of the common diseases of the urinary system, with an incidence of approximately 5-10% among the general population. Among the minimally invasive surgeries, percutaneous nephrolithotomy (PCNL) is the gold standard therapy for large and/or complex renal stones. Objective: The study was carried out to predict the stone-free rate after PCNL by using the Guy's stone score. Methods: This prospective cross-sectional study was conducted in the Department of Urology, Bangabandhu Sheikh Mujib Medical University, (BSMMU), Dhaka from February 2016 to January 2017. The patients with renal stone attending the outpatient department who met the criteria of standard PCNL. Results: Atotal of 52 patients with renal stone were included in this study.  The mean age was to be found 45.3±14.0 with range of 18 to 73 years. Male to female ratio was 3.3:1. Almost three fourth (74.5%) patients had normal body mass index. All patients had normal anatomy. More than half 27 of the (51.9%) patients had found grade I, 10 (19.2%) Grade II, 11(21.2%) Grade III and 4 (7.7%) Grade IV. Nearly two third 34 (65.4%) patients were found total stone cleared and 18(34.6%) had residual stone. Cleared stone was found 23(85.2%) in grade I, 7(70.0%) grade II, 3(27.3%) in grade III and 1(25.0%) in grade IV. Conclusion: Based on the study findings, it may be concluded that higher the GSS less the stone free rate.It will help in better patient counseling preoperatively, and to predict the need for ancillary treatment.

Percutaneous nephrolithotomy of staghorn renal stones in pediatric patients using adult-sized instrument

2019 ◽  
Vol 86 (4) ◽  
pp. 211-215
Author(s):  
Akbar Nouralizadeh ◽  
Hamid Pakmanesh ◽  
Abbas Basiri ◽  
Mohammad Hadi Radfar ◽  
Behzad Narouie ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Pediatric Patients ◽  
Renal Stones ◽  
Adult Size ◽  
Efficacy And Safety ◽  
Double J Stent ◽  
Stone Free Rate ◽  
The Mean ◽  
Free Rate ◽  
Free Status

Introduction: In this study, we aimed to evaluate the safety and efficacy of the percutaneous nephrolithotomy procedure performed with adult-sized instruments in pediatric cases with staghorn kidney stone. Methods: We retrospectively evaluated the efficacy and safety of 94 percutaneous nephrolithotomy procedures performed during 15 years in a single center for 82 pediatric patients with staghorn calculi using adult-sized instruments (24-Fr nephroscope). Stone free status was defined as complete clearance of the stones or the presence of insignificant residual stones of <3 mm in diameter. Results: The mean age was 108 ± 53 months (range, 14–180 months). There were 39 patients (48%) with complete staghorn stones and 43 cases (52%) with partial staghorn. We fulfilled 91.4% of operations through a single access. The stone free rate was 86.6% after one percutaneous nephrolithotomy session. In total, seven patients referred for shock wave lithotripsy and four cases were scheduled for the second percutaneous nephrolithotomy session. Fever occurred in 18 patients (21%) and bleeding requiring transfusion in four children (5%). Prolonged leakage from nephrostomy site requiring anesthesia for double J stent placement occurred in one patient. No grade IV or V Clavien complication occurred. Conclusion: The success rate and complications of percutaneous nephrolithotomy with adult-size instruments in pediatric patients are acceptable.

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