scholarly journals Percutaneous Nephrolithotomy in Paediatric Population: A Single Center Experience

2020 ◽  
Vol 18 (2) ◽  
pp. 205-209
Author(s):  
Mahesh Bahadur Adhikari ◽  
Sumeet Karna ◽  
Kinju Adhikari ◽  
Jagdish Lal Baidya
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Invasive Procedure ◽  
Paediatric Population ◽  
High Risk Group ◽  
Time Duration ◽  
Stone Size ◽  
Residual Stone ◽  
Complex Anatomy ◽  
Stone Free Rate ◽  
Free Rate

Background: Management of paediatric stone disease is challenging as they are considered high risk group. Percutaneous nephrolithotomy is minimally invasive procedure with definite advantages in terms of higher stone clearance in single session and no long term effect in renal function.Methods: Retrospective study was done including all patients upto the age of 18 years who underwent Percutaneous nephrolithotomy from January 2010 to December 2018 in our center after taking approval from ethical committee. Data was collected regarding gender, operative side, operative time duration, hospital stay, post-operative decrease in hemoglobin, stone size, Guy’s stone score and early post-operative complications with Clavien-Dindo grade.Results: Percutaneous nephrolithotomy was done in 48 renal units in 44 patients. 28 patients were boys and 16 were girls with mean age of 10.91 ± 5.22 years and mean stone size 17.16 ± 6.43 mm. 91.6% of cases had Guy’s stone score of 1 and 2. Standard percutaneous nephrolithotomy was done in 21 renal units, mini percutaneous nephrolithotomy in 24 renal units and supermini percutaneous nephrolithotomy was done in three renal units with total stone free rate of 93.4%. Three patients required extracorporeal shockwave lithotripsy for significant residual stone. Average post-operative hemoglobin drop was 1.2 gm%. Overall complications rate was 18.1% with 4.5% of complications being grade 1 and 2 whereas 13.6% were Grade 3.Conclusions: Percutaneous nephrolithotomy is safe and feasible in paediatric patients with large stone burden, complex anatomy or shock-wave lithotripsy failure with acceptable complication and stone free rate. Keywords: Endourology; paediatric; percutaneous nephrolithotomy; PNL; urolithiasis

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.

scholarly journals Non-Fluoroscopic Uretero-Lithotripsy for Distal and Mid Ureteric Stone: Is it Safe and Feasible? Single Center Experience

2017 ◽  
Vol 16 (1) ◽  
pp. 48-52
Author(s):  
Naser S Hussein ◽  
Hussein A Al Khumasi
Keyword(s):  
Operative Time ◽  
Intraoperative Complications ◽  
Medical Science ◽  
Ureteric Stone ◽  
Stone Size ◽  
Residual Stone ◽  
Single Center Experience ◽  
Stone Free Rate ◽  
Case Basis ◽  
Free Rate

Objective: To assess safety and feasibility of completely non-fluoroscopic ureteroscopy for treatment of mid and distal ureteric stone in term of stone free-rate and complications.Material and Methods: Over study period between January 2014 and January 2015, ninety-one complete fluoroscopy-less semirigid ureteroscopies were performed for treatment of symptomatic ureteric stones. Age, sex, stone size, location, side, operative time, auxiliary procedures, stonefree rate and complications, all were assessed. A Stone-free rate was defined as the lack of radiographic evidence of residual stone at 4 weeks. Postoperative imaging, and complications were grading according to modified Clavien classification system, which used initially to grade complications of general surgery.Results: The average age of our subjects was 32.9, with male and right side predominant, 68 % and 64.8% respectively. The average stone size and operative time were 10.07 and 32.08 respectively. Fifty six semirigid retrograde ureteroscopies were done for distal ureteric and 35 for mid ureteric stones, achieving 91.2% stone –free rate, with overall intraoperative complications of 18.6%. All cases were managed on day case basis, ureters were stenting preoperatively in 37 patients and all cases were stenting with an appropriate size of double J.Conclusion: Zero fluoroscopic semirigid retrograde ureteroscopy is a safe and feasible treatment modality for management of distal and mid ureteric stones.Bangladesh Journal of Medical Science Vol.16(1) 2017 p.48-52

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 Safety and efficacy of mini-percutaneous nephrolithotomy in the treatment of large impacted proximal ureteral stones

2019 ◽  
Vol 6 (2) ◽  
pp. 518
Author(s):  
Bilal Yousuf Mir ◽  
Fayaz Ahmad Najar ◽  
Mohammad Asim Mir
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Ureteral Injury ◽  
Ureteral Stones ◽  
Residual Stone ◽  
Analgesic Requirement ◽  
Female Ratio ◽  
Stone Free Rate ◽  
The Mean ◽  
Free Rate

Background: To evaluate the efficacy and safety of Mini-Percutaneous Nephrolithotomy (PCNL) in the treatment of large (≥15mm) impacted proximal ureteral stones.Methods: This was a prospective observational study and was conducted in the Postgraduate Department of Surgery, Govt. Medical College, Srinagar. A total of 60 patients were included in this study.Results: The mean age (in years) of patients was 38.5±9.31 and range 22-58, the male female ratio was 40:20, the disease laterality (right: left) was 48:12, the mean stone size (in mms) was 17.6±2.11. All the patients were having hydronephrotic kidneys, however, all the renal units were functional. The mean operative time (in minutes) was 62±9.62. The overall success rate was 96.7% after one month of follow-up the stone free rate was 96.7% while as the stone free rate on discharge was 86.7%. The mean hospital stays (in days) was 2.8±1.08. The overall complication rate in this study was 15 patients (25%) which include post-operative fever in 5 patients (8.33%), prolonged hematuria in 4 patients (6.67%), residual stone/disease after 4weeks of follow-up was seen in 2 patients (3.33%) and in 4 patients (6.67%) thoracic complication was seen. However, no ureteral injury, hollow visceral or pelvic perforation was noted. The post-operative analgesic requirement was 100±40.45mgs of Inj. Tramadol. The need of auxiliary procedures was required in 3.3% of patients.Conclusions: Mini-PCNL is both safe as well as an effective therapy for large impacted proximal ureteral stones with a higher success, stone clearance rate and with acceptable complications.

scholarly journals Comparison of the most popular methods for predicting stonefree rate after percutaneous nephrolithotomy

2017 ◽  
Vol 77 (4) ◽  
Author(s):  
Rodrigo Ugalde-Resano ◽  
Christian Isaac Villeda-Sandoval ◽  
Elisa Kobashi-Sandoval ◽  
José Alejandro Rivera-Ramírez ◽  
Manuel Alexis Vargas-Robles ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Scoring System ◽  
Tertiary Care ◽  
Scoring Systems ◽  
Time Frame ◽  
Predictive Capacity ◽  
Residual Stone ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Free Rate

BACKGROUND: The Guy’s stone score, S.T.O.N.E. nephrolithometry, CROES nomogram, and S-ReSC scoring system have recently been externally validated as effective predictors of stone-free rate after percutaneous nephrolithotomy.OBJECTIVE: We describe herein the advantages of identifying the most accurate scale and propose its standardized use.MATERIALS AND METHODS: We analyzed 188 patients that underwent percutaneous nephrolithotomy for kidney stones within the time frame of October 2010 and July 2015 at a tertiary care referral center. Preoperative and postoperative non-contrast computed tomography scans were used in all patients to compare the four scoring systems, using the strict criterion of absolute absence of residual stone as the stone-free rate.RESULTS: The overall stone-free rate was 57.9%. All scoring systems presented a statistically significant stone-free rate (p<0.001). Only the Guy’s stone score had no correlation with postoperative complications. The four scoring systems had similar accuracy, none of them were more predictive for stone-free rate than the other, and there was no significant difference in the areas under the curve between them (p=0.2). In addition, each scale had a correlation with operative time and length of hospital stay.CONCLUSIONS: The four scales analyzed were excellent predictors for stone-free rate. They had similar receiver operating characteristic curves and areas under the curve, with no significant differences between them. However, the Guy’s stone score presented the best predictive capacity and the S-ReSC scoring system was the best method for predicting complications. It is up to the urologic community to decide which evidence-based scale is the most suitable. Meanwhile, the need for a standardized method continues to grow. KEYWORDS: Stone-free rate; Percutaneous nephrolithotomy; CROES; S-ReSC, S.T.O.N.E.; Guy’s stone score

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 Evaluation and comparison of S.T.O.N.E. and Guy’s scoring systems for predicting percutaneous nephrolithotomy outcomes in supine position

2022 ◽  
pp. 039156032110376
Author(s):  
Ahmet Arıman ◽  
Erkan Merder ◽  
Erdem Toprak
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Supine Position ◽  
Scoring Systems ◽  
Renal Stones ◽  
Complication Rates ◽  
Residual Stone ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Operation Duration ◽  
Free Rate

Background: Percutaneous nephrolithotomy (PCNL) was applied in the prone position until recently. But also, in recent years supine positions was applied in patients with kidney stones. Predicting how much renal stones can be cleared after surgery and possibility of complications is an important question for both surgeons and patients. Therefore different scoring systems are used to evaluate outcomes of PCNL before surgery. Patients and methods: Between 2018 and 2020, 80 patients with renal stone who underwent PCNL in the supine position were evaluated preoperatively by S.T.O.N.E. and Guy’s scoring systems (GSS). The predictions of both scoring systems for stone-free and complication rates in patients who underwent PCNL in the supine position were evaluated. Also, these scoring systems were compared among themselves for reliability. Result: In both scoring systems, there was a statistically significant difference between postoperative stone-free (SF) and residual stone (RS) of patients and in predicting the likelihood of complications in patients. No statistically significant difference was found between the two scoring systems in predicting the stone-free rate. Conclusion: Our findings revealed that S.T.O.N.E. nephrolithometry and Guy’s score systems can be used effectively to predict stone-free rate, complications, and operation duration in supine position PCNL for renal stones.

scholarly journals Evaluation and Comparison of S.T.O.N.E. and GUY's Scoring Systems for Predicting Percutaneous Nephrolithotomy Outcomes in Supine Position

2021 ◽  
Author(s):  
Ahmet Arıman ◽  
Erkan Merder ◽  
Erdem Toprak
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Supine Position ◽  
Scoring Systems ◽  
Renal Stones ◽  
Complication Rates ◽  
Residual Stone ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Operation Duration ◽  
Free Rate

Abstract Percutaneous nephrolithotomy (PCNL) was applied in the prone position. But also, in recent years supine positions was applied in patients with kidney stones. Predicting how much renal stones can be cleared after surgery and possibility of complications is an important question for both surgeons and patients. Therefor different scoring systems are used to predict stone-free and complication rates before surgery. Patients and Methods: Between 2018 and 2920, 80 patients with renal stone who underwent PCNL in the supine position were evaluated preoperatively by S.T.O.N.E. and Guy’s scoring systems. The predictions of both scoring systems for stone-free and complication rates in patients who underwent PCNL in the supine position were evaluated. Also, these scoring systems were compared among themselves for reliability. Result: In both scoring systems, there was a statistically significant difference between postoperative stone-free (SF) and residual stone (RS) patients and in predicting the likelihood of complications in patients. No statistically significant difference was found between the two scoring systems in predicting the stone-free rate. Conclusion: Our findings revealed that S.T.O.N.E. nephrolithometri and Guy’s score systems can be used effectively to predict stone-free rate, complications and operation duration in supine position PCNL for renal stones.

scholarly journals BODY MASS INDEX RELATIONS WITH THE DIFFICULTIES AND COMPLICATIONS OF PERCUTANEOUS NEPHROLITHOTOMY

2016 ◽  
Vol 23 (2) ◽  
Author(s):  
Fauriski Febrian Prapiska ◽  
Sunaryo Hardjowijoto ◽  
Doddy M Soebadi ◽  
Tarmono Djojodimedjo
Keyword(s):  
Body Mass ◽  
Percutaneous Nephrolithotomy ◽  
Kidney Stone ◽  
Open Surgery ◽  
Stone Size ◽  
Stone Free Rate ◽  
Patients With Diabetes ◽  
Grade Ii ◽  
The Right ◽  
Free Rate

Objective: To identified outcomes and complications of percutaneous nephrolithotomy (PCNL) in patients of various body mass indices (BMI) to determine the safety of this procedure in patients with elevated BMI.Material & methods: The analytic observational prospective study of patients who underwent PCNL between February to July 2015 in the operating room Soetomo General Hospital Surabaya. Specifically, BMI, stone-free rates, difficulties duringsurgery, complications, and Clavien score were assessed. We evaluate the independent contribution of BMI as a predictor of outcomes. Results: There were 35 selected patients with kidney stone and planned to PCNL, 20 patients were included and 15 patients were excluded from this study. The patients consisted of 10 men (50%) and 10 women (50%). Mean age was 47.55 years (range 33-75). There were 4 patients with diabetes (20%), and 10 patients with hypertension (50%). Mean stone size was 23.30 mm. Stone location was 11 patients (55%) in the right kidney, and 9 patients (45%) in the left. There were 12 patients (60%) with a single stone, and 8 patients (40%) with multiple stones. BMI values were distributed as follows,underweight 1 patient (5%), normoweight 7 patients (35%), overweight 6 patients (30%), obesity 6 patients (30%). Mean skin to stone distance (SSD) was 87.56 mm. Stone free rate was 55%, and difficulties during surgery only seen in 1 patient (5%) bleeding profusely and open surgery was performed. Clavien score in these patients were grade I in 11 patients (55%), grade II in 7 patients (35%), and grade IIIB in 2 patients (10%). The BMI had no significant effect with Intra operative and postoperative difficulties (0.390. p <0.05. CI 95%). However the lower stone free rate had significant effect (0.040. p <0.05. CI 95%).Conclusion: BMI had no significant effect with Intraoperative and postoperative difficulties in PCNL.However, the lower stone-free rate risk associated with elevated BMI was significant.

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