scholarly journals Comparative Study Between Mini PCNL and RIRS in the Treatment of Renal Stones <20mm : Our Experience in CMH Dhaka

2020 ◽  
Vol 23 (2) ◽  
pp. 199-204
Author(s):  
Md Abdur Rakib ◽  
Md Shahidul Islam ◽  
SM Shameem Waheed ◽  
Md Ashif Chwdhury ◽  
Mohammad Shafiul Alam ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Renal Stones ◽  
Renal Calculi ◽  
Hemoglobin Level ◽  
Clearance Rates ◽  
Open Label ◽  
Stone Clearance ◽  
Level Data ◽  
The Mean ◽  
Study Participants

Aim: The aim of this study is to compare the outcomes of miniaturized percutaneous nephrolithotomy (mini-perc) and retrograde intrarenal surgery (RIRS) in management of renal stones with a diameter <15 mm. Materials and Methods: This was an open-label prospective study that included a total of 80 cases underwent mini-perc (n = 40) and RIRS (n = 40) between July 2014 and August 2017. The primary outcome objective was stone-free rate, retreatment rate, complications, hospital stay, operative time, and reduction in hemoglobin level. Data were analyzed using SPSS version 16.0 Software. Results: Overall, 80 patients were enrolled in this study. The mean age was 40.12 and 38.20 years, and the mean stone size was 1.15 and 1.30 cm in mini-perc and RIRS group, respectively. Majority of the study participants were males. Overall, mini-perc and RIRS had stone clearance rates of 100% and 95.4%, respectively. Two patients required retreatment in RIRS group. The duration of hospital stay and the rate of complication was similar in both the groups. Operative duration was more in RIRS group. Decrease in hemoglobin level was more in mini-perc group. Conclusions: Results demonstrated that both modalities were associated with high stone clearance rates with minimal complications. RIRS was associated with less reduction in hemoglobin and could be used as standard treatment modality for small renal calculi. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.199-204

scholarly journals Outcomes of Retrograde Intra-Renal Surgery

2019 ◽  
Vol 2 (2) ◽  
pp. 220-223 ◽  
Author(s):  
Samir Shrestha ◽  
Pukar Maskey
Keyword(s):  
Postoperative Pain ◽  
Hospital Stay ◽  
Renal Stone ◽  
Operative Time ◽  
Renal Calculi ◽  
Renal Surgery ◽  
Surgical Morbidity ◽  
Retrograde Intrarenal Surgery ◽  
Stone Clearance ◽  
The Mean

Introduction: Miniaturization of endoscopic instruments has gained wide popularity in the treatment of renal calculi. Retrograde intra-renal surgery and holmium laser in combination has already proven its superiority when compared to other modalities in the treatment of renal calculi. This study was conducted to assess the outcome of retrograde intra-renal surgery in renal stone disease.Materials and Methods: This retrospective study analyzed the outcome of retrograde intra-renal surgery in renal stone less than 2 cm size in the adults above 18 years of age from September 2018 to August 2019 at Patan Hospital, Nepal. The outcome was assessed descriptively on postoperative pain and fever, stone localization, stone size, stone clearance, urosepsis, operative time, hospital stay, mortality, need of the second procedure.Results: A total of 62 patients underwent retrograde intrarenal surgery, out of which 48 cases were included. The mean age of the study population was 32.4± 14 years (19-68 years). Similarly, the mean operative time was 68± 12 (48-124 minutes) and mean hospital-stay was 3.2± 1.1 days. Postoperative pain and fever were observed in 14 (29.16%) & 4(8.33%) patients respectively. Hematuria occurred in 6(12.50%) and urosepsis in 2(4.16%) of the patients. Complete stone clearance was achieved in 34(70.83%) and residual stones were present in 8(16.66%) and clinically insignificant radiological fragments were present in 6(12.50%) patients.Conclusions: Retrograde intrarenal surgery is a technically safe and effective procedure for the treatment of renal calculi, with minimal post-surgical morbidity.

scholarly journals Safety and efficacy of percutaneous nephrolithotomy for the treatment of paediatric urolithiasis

2012 ◽  
Vol 94 (8) ◽  
pp. 588-592 ◽  
Author(s):  
R Veeratterapillay ◽  
MBK Shaw ◽  
R Williams ◽  
P Haslam ◽  
A Lall ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Calculi ◽  
Clearance Rates ◽  
Stone Clearance ◽  
Extracorporeal Shock Wave ◽  
Stone Free Rate ◽  
Surgeon Experience ◽  
The Mean ◽  
Free Rate

INTRODUCTION Paediatric percutaneous nephrolithotomy (PCNL) has revolutionised the treatment of paediatric nephrolithiasis. Paediatric PCNL has been performed using both adult and paediatric instruments. Stone clearance rates and complications vary according to the technique used and surgeon experience. We present our experience with PCNL using adult instruments and a 28Fr access tract for large renal calculi in children under 18 years. METHODS All patients undergoing PCNL at our institution between 2000 and 2009 were reviewed. Demographics, surgical details and post-operative follow-up information were obtained to identify stone clearance rates and complications. RESULTS PCNL was performed in 32 renal units in 31 patients (mean age: 10.8 years). The mean stone diameter was 19mm (range: 5–40mm). Twenty-six cases required single puncture and six required multiple tracts. Overall, 11 staghorn stones, 10 multiple calyceal stones and 11 single stones were treated. Twenty-seven patients (84%) were completely stone free following initial PCNL. Two cases had extracorporeal shock wave lithotripsy for residual fragments, giving an overall stone free rate of 91% following treatment. There was no significant bleeding or sepsis encountered either during the operation or in the post-operative setting. No patient required or received a blood transfusion. CONCLUSIONS Paediatric PCNL can be performed safely with minimal morbidity using adult instruments for large stone burden, enabling rapid and complete stone clearance.

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 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.

Automated Needle Targeting (ANT) Device-Assisted Renal Access during Percutaneous Nephrolithotripsy (PCNL) Puncture: A Pilot Study to Assess the Safety and Efficacy of a Novel Technique

2020 ◽  
Author(s):  
Chu Ann Chai ◽  
W.S Yeoh ◽  
A.N Fadzli ◽  
T.A Ong ◽  
S Kuppusamy ◽  
...  
Keyword(s):  
Adverse Events ◽  
Radiation Exposure ◽  
Renal Stones ◽  
Open Label ◽  
Primary Endpoints ◽  
Ethical Approval ◽  
The Mean ◽  
Set Up ◽  
Surgical Duration ◽  
Mean Time

Abstract Background: To explore the use of an automated needle targeting (ANT) device as an assistive intraoperative navigation modality during PCNL for the treatment of large renal stones, with the aim of reducing surgical durations and radiation exposure.Methods: This open-label, single-surgeon clinical trial included patients with a diagnosis of renal stones for whom PCNL using the ANT device via the percutaneous access technique was indicated. Ethical approval was obtained from the UMMC ethics review board (Ref. 20118105-6740). The ANT was assembled after an initial motor calibration, and the image calibration was performed using the patient’s fluoroscopic images. Subsequently, the ANT software calculated a bullseye alignment before percutaneous puncture. Accurate renal access was confirmed by the efflux of urine in the Chiba biopsy needle, as well as by imaging with the C-arm intensifier at different angles. The primary endpoints were the time to successful renal access (from ANT set-up to urine efflux) and adverse events.Results: In all cases, successful renal access was achieved with a single attempt. The mean time to renal access was 6 minutes, 8 seconds. The mean fluoroscopy duration was 101 seconds, with a mean radiation dose of 23.46 mGy. No adverse events were documented.Conclusion: The ANT device enabled successful, safe and efficient renal access for PCNL in this study. Further research is needed to justify the effectiveness of this device in terms of enabling accurate renal access while reducing the surgical duration and radiation exposure to both surgeons and patients.

scholarly journals An Early Experience of Retrograde Intrarenal Surgery (RIRS) in National Institute of Kidney Diseases and Urology

2020 ◽  
Vol 23 (1) ◽  
pp. 3-10
Author(s):  
Md Nasir Uddin ◽  
Imtiaz Enayetullah ◽  
Kazi Zikrur Razzaque ◽  
Sharif Md Shahadat Ali Khan ◽  
Kazi Rafiqul Abedin
Keyword(s):  
Statistical Analysis ◽  
Blood Transfusion ◽  
Hospital Stay ◽  
Kidney Diseases ◽  
Operation Time ◽  
Renal Stones ◽  
Retrograde Intrarenal Surgery ◽  
Ureteral Access Sheath ◽  
Access Sheath ◽  
The Mean

Background: Advancements in the endoscopic armamentarium, retrograde intrarenal surgery has become a viable and attractive option for the treatment of renal stones because of its high stone-free rates (SFRs) and low morbidity. Objective: To describe our experience and outcome of RIRS for the treatment of renal stones and to assess its effectiveness and safety. Design, setting, and participants: A retrospective analysis of 60 patients who underwent RIRS for renal stones at our institute between January 2018 to December 2018 was performed. Surgical procedure: Flexible ureteroscopy and laser lithotripsy using a standardized technique with last-generation flexible ureteroscopes (Flex-Xc) using Holmium-YAG laser. Outcome measurements and statistical analysis: Clinical data were collected and intraoperative and postoperative outcomes were assessed (Ureteral access sheath placement, operation time, hospital stay, stone free rate, post-operative blood transfusion & fever, need for second session of RIRS. A descriptive statistical analysis was performed. Results and limitations: The mean overall stone size was 13±3 mm. Pre stenting done in all cases. Ureteral access sheath placement was possible in 54(90%) patients. At 1 month follow-up, the overall primary SFR was 86.67%(52 cases), the secondary SFR was 96.67%(58 cases).The mean operative time was 91.96±18.7 min. Mean hospital stay was 1.86±1.02 days. Complications were reported in 8 (13.33%) patients overall, with fever in 6 patients (10%), steinstrasse in 2(3.33%) patients need for second session RIRS in 6 patients (10%).No patient needed blood transfusion. The main limitation of the study is the retrospective nature. Conclusions: RIRS performed using a flexible ureterorenoscope marked the beginning of a new era in urology. It is safe and effective procedure and an alternative to extracorporeal shock wave lithotripsy (ESWL) and Percutaneous nephrolithotomy (PCNL) in the treatment of selected renal stones. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.3-10

scholarly journals Three Years Experience of Bilateral Simultaneous Percutaneous Nephrolithotomy – A Single Center Study in Pakistan

2020 ◽  
Vol I (2) ◽  
pp. 31-34
Author(s):  
Shakeel Haseeb Uddin Siddique
Keyword(s):  
Hospital Stay ◽  
Operative Time ◽  
Adult Population ◽  
Data Entry ◽  
Retrospective Chart Review ◽  
Renal Calculi ◽  
Normal Activity ◽  
Transfusion Rate ◽  
Early Return ◽  
The Mean

Objective To study the outcomes of simultaneous bilateral PCNLs in adult population and discussing therapeutical benefits and complications. Design A Retrospective Study. Setting The Kidney Centre ( The Post Graduate Training Institute, Karachi). Duration of Study Three years from January 2017 to December 2019. Methodology A retrospective chart review at one of the large urology institute in Karachi was conducted. The aim was to document the demographics, operation dynamics, outcomes and complications of simultaneous bilateral PCNL in adult population. Record of 60 patients who underwent simultaneous bilateral PCNL between January 2017 and December 2019 in our hospital were evaluated. Preoperative, post-operative laboratory values, operative time, stone clearance, complications and hospital stay were recorded. SPSS IBM version 20 was used for data entry and analysis. Results The mean age was 40.0±15.1 years. The mean hospital stay was 3.5 days and mean operative time was 144 minutes. The transfusion rate was observed 16.7% and infracostal approach was most frequently used approach. Conclusion Simultaneous bilateral PCNL is a safe, efficacious, and cost-effective option in cases of bilateral renal calculi and should be considered an acceptable treatment option for patients with bilateral stones due to low morbidity, overall short hospital stays, comparable stone free rates, cost effectiveness and early return-to-normal activity time.

scholarly journals Comparison of standard and tubeless percutaneous nephrolithotomy for renal calculi: a prospective randomized control trial

2019 ◽  
Vol 6 (4) ◽  
pp. 185
Author(s):  
Manu Muraleedharan Kamalakshi ◽  
Vasantharaja Ramasamy ◽  
Darsan Sadasivan ◽  
Sunil Raveendran ◽  
Selvam Paramasivam ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Hospital Stay ◽  
Randomized Control Trial ◽  
Renal Stones ◽  
Renal Calculi ◽  
Analgesic Requirement ◽  
Operative Duration ◽  
Significant Difference ◽  
Randomized Control ◽  
Tubeless Pcnl

<p class="abstract"><strong>Background:</strong> In the current era of minimally invasive interventions, the mainstay of treatment of renal stones larger than 2 cm is Percutaneous nephrolithotomy (PCNL). PCNL underwent various evolutionary changes minimizing morbidity to the patients. We prospectively compared the outcome of tubeless PCNL (without nephrostomy drainage tube) to reduce the pain and discomfort caused by tube with standard PCNL in the treatment of renal stones.</p><p class="abstract"><strong>Methods:</strong> In this Randomized control trial (RCT), we divided patients satisfying the inclusion criteria of consenting for trial, single access puncture, less than 3 stones each less than 3 cm, operative duration of less than 2 hours into two groups, standard PCNL (group 1) and tubeless PCNL (group 2) with 25 patients each. Randomization and group assignment were done after complete clearance of renal stones.</p><p class="abstract"><strong>Results:</strong> Patient’s age, gender, sides of stone and stone size were comparable between two groups (standard versus tubeless PCNL). Postoperative hemoglobin drop, bleeding, pyrexia, urine leak, and blood transfusion requirement did not show a statistically significant difference between the two groups. Analgesic requirement (190 mg versus 80 mg of tramadol), operative duration (49.80 min versus 38.60 min), postoperative pain score (6/10 versus 3.64/10-visual analog scale) and duration of hospital stay (68.48 hours versus 41.12 hours) showed statistically significant difference favoring tubeless PCNL.</p><p class="abstract"><strong>Conclusions: </strong>Tubeless PCNL may be a safe, acceptable and effective modality of treatment for renal calculi in carefully selected patients comparing standard PCNL resulting in less operative duration, lower postoperative pain, reduced analgesic requirement and shorter hospital stay.</p>

scholarly journals Comparative analysis of retrograde intrarenal surgery and modified Ultra-mini percutaneous nephrolithotomy in management of lower pole renal stones (1.5-3.5 cm)

2019 ◽  
Author(s):  
Zhuohang Li ◽  
Cong Lai ◽  
Arvind K. Shah ◽  
Weibin Xie ◽  
Cheng Liu ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Renal Stones ◽  
Postoperative Hospital Stay ◽  
Lithotomy Position ◽  
Base Line ◽  
Retrograde Intrarenal Surgery ◽  
The Mean ◽  
Stone Characteristics ◽  
Illness Condition

Abstract Purpose To compare the safety and efficacy of retrograde intrarenal surgery (RIRS) and modified Ultra-mini percutaneous nephrolithotomy (UMP) in semi-supine combined lithotomy position for the management of 1.5-3.5 cm lower pole renal stones (LPSs). Methods A total of 63 patients with 1.5-3.5 cm LPSs who underwent RIRS (n= 33) or modified UMP (n= 30) in diameter between January 2017 and January 2019 were analyzed retrospectively. Modified UMP was performed in semi-supine combined lithotomy position and a 9.5/11.5 F ureteral access sheath (UAS) was inserted during the procedure in order to maintain low pelvic pressure and to facilitate the removal of stone fragments. Base-line parameters, stone characteristics, illness condition, operation time, postoperative hemoglobin (Hb) drop, postoperative creatinine (Cr) elevation, length of hospital stay, length of postoperative hospital stay, stone-free rate (SFR) and complications were compared between the two groups. Results There were no significant differences between the two groups in base-line parameters, stone characteristics and illness condition. The mean operating time of RIRS group was longer than UMP group (95.61 ± 21.9 vs. 55.0 ± 16.1 min, p< 0.001). The mean postoperative Hb drop was less in RIRS group (7.42 ± 4.7 vs. 15.70 ± 9.8 g/L, p< 0.001). The length of hospital stay and postoperative hospital stay for RIRS were shorter than UMP (4.76 ± 1.1 vs. 5.83 ± 0.8 d, p< 0.001, 2.97 ± 0.9 vs. 4.07 ± 0.9 d, p< 0.001). The Early SFR was higher in UMP group (54.5 vs. 80.0%, p< 0.050) while SFR at 1-month and 3-months postoperatively was similar in both groups (p= 0.504, p= 0.675). There were no significant differences between the two groups in complications (p= 0.228). Conclusion For patients with 1.5-3.5 cm LPSs, both modified UMP and RIRS are safe and viable. The modified UMP technique was used in this study, application semi-supine combined lithotomy position and the retention of UAS can improve the surgical efficiency and maintain low pressure perfusion in the kidney, which resulted in superior treatment efficacy. Therefore, we highly recommend this technique for LPSs with heavy stone burdens.

scholarly journals Considering lactate dehydrogenase (LDH) concentration in nasal-wash (NW) as a marker in evaluating the outcome of patients with bronchiolitis

2017 ◽  
Vol 6 (1) ◽  
pp. 10
Author(s):  
Barak M. ◽  
Mirzarahimi M. ◽  
Amani F. ◽  
Ghaemian Y. ◽  
Adel Ahadi
Keyword(s):  
Hospital Stay ◽  
Oxygen Therapy ◽  
Biochemical Marker ◽  
Clinical Status ◽  
Negative Association ◽  
Nasal Wash ◽  
Standard Methods ◽  
Background Estimation ◽  
Level Data ◽  
The Mean

Background: Estimation of bronchiolitis severity in infants is still an important issue and there are no standard methods to help physicians for better evaluation and management of clinical status of these patients. The aim of this study was to investigate the role LDH concentration in NW as a biomarker in evaluation the outcome of patients suffering bronchiolitis in Bu Ali Hospital, Ardabil.Methods: 100 children with bronchiolitis aged below 2 years entered the study. Nasal wash sample was extracted from all patients using 2 ml of normal saline. Samples were sent to laboratory to measure LDH level. Data were analyzed by statistical methods in SPSS.16.Results: The mean age of patients was 6.9±3.7 months and 57% of them were male. 42% of patients had mild bronchiolitis and 58% of them suffered from severe bronchiolitis. The LDH level of nasal wash fluid was neither related with gender nor with age. But it was significantly lower in patients who required oxygen therapy and had fever compared with those who did not require oxygen therapy and without fever. Moreover, LDH level showed a significant negative association with hospital stay (r= -0.570, p<0.001) and bronchiolitis severity (r= -0.440, p<0.001) in a way that its concentration was significantly lower in patients with hospital stay longer than 24 hours compared with hospital stay shorter than 24 hours, and in patients with severe bronchiolitis compared with mild bronchiolitis.Conclusions: According to results of this study, LDH measurement in nasal wash fluid can be used as a biochemical marker to evaluate clinical outcomes of bronchiolitis in children younger than 24 months.

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