scholarly journals Papillary vs non-papillary access during percutaneous nephrolithotomy: Retrospective, match-paired case-control study

2020 ◽  
Vol 92 (1) ◽  
pp. 50-52
Author(s):  
Ahmet Tahra ◽  
Resul Sobay ◽  
Ahmet Bindayi ◽  
Ferhat Yakup Suceken ◽  
Eyup Veli Kucuk
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Residual Stone ◽  
Significant Difference ◽  
Feasible Option ◽  
Stone Material ◽  
The Mean ◽  
Free Status

Objective: The most crucial steps of percutaneous nephrolithotomy (PCNL) are the percutaneous access and dilation of the access route. Recent literature suggests that papillary access to renal calyx is the accepted method. Despite this rule, we do not always make papillary puncture and we puncture wherever we can to achieve stone-free status and reduce unnecessary access. In this study, we present our results with papillary vs non-papillary access in patients with a kidney stone. Material and methods: Two hundred and seven patients with non-papillary access and 69 patients with papillary access who had similar demographics (age, body mass index (BMI), stone size) were selected with pair match analysis (3:1). Preoperative and postoperative data were collected from the patient's chart. Operative time (from starting surgery to nephrostomy tube), drop-in hematocrit level, transfusion rate, duration of hospital stay, perioperative and postoperative complications (Clavien-Dindo Classification) and stone-free status (no or < 3 mm residual stone) were also evaluated in both groups. Results: The mean operative time was similar in between two groups. The mean hematocrit decreases not differ between the two groups (p = 0.56). In papillary group, only 2 patients (3.2%) required transfusion and only one patient (1.4%) in the non-papillary group had a transfusion with no statistically significant difference (p = 0.43). The overall complication rates were 7.1% in the papillary group and 7.2% in the non-papillary group (p = 0.89). Postoperative mean creatinine level was similar between the two groups.  Conclusions: In this study, we found that non-papillary access is a feasible option for PCNL in the terms of stone-free status and complication rates.

scholarly journals Bilateral simultaneous percutaneous nephrolithotomy versus staged approach: a critical analysis of complications and renal function

2020 ◽  
Vol 66 (12) ◽  
pp. 1696-1701
Author(s):  
Fabio C. M. Torricelli ◽  
Regina S. Carvalho ◽  
Giovanni S. Marchini ◽  
Alexandre Danilovic ◽  
Fabio C. Vicentini ◽  
...  
Keyword(s):  
Renal Function ◽  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Safe Procedure ◽  
Stone Free Rate ◽  
Significant Difference ◽  
The Impact ◽  
Free Rate

SUMMARY INTRODUCTION: Patients with bilateral kidney stones and burdened by large stones are challenging cases for endourologists. Simultaneous bilateral percutaneous nephrolithotomy (sbPCNL) is an option; however, it may be accompanied by important morbidity. An alternative is a staged PCNL, operating one side each time. Herein, we compare the impact of sbPCNL and staged PCNL on complication rates and renal function. METHODS: Patients who underwent sbPCNL or staged bilateral PCNL with a frame time of 6 months were searched in our prospectively collected kidney stone database. Groups were compared for age, gender, body mass index (BMI), comorbidities (classification by the American Society of Anesthesiology - ASA), stone size, Guy's score, stone-free status, renal function, blood loss, blood transfusion rate, complication rate, and length of hospital stay. RESULTS: Twenty-six patients and 52 kidney units were enrolled. The mean operative time was 134.7 min. Only 11.3% of cases had complications, all of them minor (Clavien ≤ 2). Overall, the stone-free rate was 61.50%. Comparing the groups, there was a significantly longer operative time in the sbPCNL group (172.5 vs. 126.3 min; p=0.016), as well as a higher transfusion rate (12.5% vs. 5.6%; p=0.036). There was no statistically significant difference in creatinine levels between the groups. Regarding the stone-free rate, there was a significantly higher proportion of patients in the staged PCNL group (64.9% vs. 43.8%; p=0.012). CONCLUSION: sbPCNL is a safe procedure; however, when compared to staged procedures it has a higher transfusion and lower stone-free rate.

scholarly journals Initial Canadian experience with robotic simple prostatectomy: Case series and literature review

2015 ◽  
Vol 9 (9-10) ◽  
pp. 626 ◽  
Author(s):  
Nathan Y. Hoy ◽  
Stephan Van Zyl ◽  
Blair A. St. Martin
Keyword(s):  
Blood Loss ◽  
Operating Time ◽  
Case Series ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Intraoperative Blood Loss ◽  
Transfusion Requirements ◽  
Simple Prostatectomy ◽  
Significant Difference ◽  
The Mean

Introduction: Robotic-assisted simple prostatectomy (RASP) has been touted as an alternative to open simple prostatectomy (OSP) to treat large gland benign prostatic hyperplasia. Our study assesses our institution’s experience with RASP and reviews the literature.Methods: We performed a retrospective chart review from January 2011 to November 2013 of all patients undergoing RASP and OSP. Operative and 90-day outcomes, including operation time, intraoperative blood loss, length of hospital stay (LOS), transfusion requirements, and complication rates, were assessed.Results: Thirty-two patients were identified: 4 undergoing RASP and 28 undergoing OSP. There was no difference in mean age at surgery (69.3 vs. 75.2 years; p = 0.17), mean Charlson Comorbidity Index (2.5 vs. 3.5; p = 0.19), and mean prostate volume on TRUS (239 vs. 180 mL; p = 0.09) in the robotic and open groups, respectively. There was a significant difference in the mean length of operation, with RASP exceeding OSP (161 vs. 79 min; p = 0.008). The mean intraoperative blood loss was significantly higher in the open group (835.7 vs. 218.8 mL; p = 0.0001). Mean LOS was shorter in the RASP group (2.3 vs. 5.5 days; p = 0.0001). No significant differences were noted in the 90-day transfusion rate (p = 0.13), or overall complication rate at 0% with RASP vs. 57.1% with OSP (p = 0.10).Conclusions: Our data suggest RASP has a shorter LOS and lower intraoperative volume of blood loss, with the disadvantage of a longer operating time, compared to OSP. It is a feasible technique and deserves further investigation and consideration at Canadian centres performing robotic prostatectomies.

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 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 The Effects of Previous Renal Stone Surgery on Percutaneous Nephrolithotomy Outcomes

2021 ◽  
Author(s):  
Joshgun Hüseynov ◽  
Nadir Kalfazde ◽  
Ekrem Güner
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Intraoperative Blood Loss ◽  
Significant Difference ◽  
History Of ◽  
Renal Stone Surgery ◽  
The Mean ◽  
Free Status

Objective: We aimed to compare outcomes of percutaneous nephrolithotomy (PNL) surgery in patients who had and had not undergone renal stone surgery before PNL. Material and Methods: We retrospectively analyzed the medical records of all patients who underwent PNL in our department between 2010 and 2019. Examined parameters consisted of patient demographics, medical and surgical history, stone size, stone density, stone site, estimated intraoperative blood loss, duration of operation, hospital stay and stone-free status. Results: A total of 193 patients were included the study. The mean age of the patients was 45±13 years. The mean duration of surgery was 69±11.5 minutes. The mean stone area was 720.2±600.4 mm2 and the mean stone attenuation was 982.8±327.7 HU. The mean postoperative hemoglobin decrease was 1.8±1.3 g/dL. 66 patients had previous stone surgery including open stone surgery, PNL and retrograde intrarenal surgery (RIRS). There was no statistically significant difference between patients who had and had not previousşy undergone renal stone surgery in terms of age, gender, body mass index and stone area. Operative time, estimated intraoperative blood loss, postoperative hemoglobin decreases and hospital stay were comparable between patients who had, and hed not undergone previous renal stone surgery. Stone-free rate was significantly higher in primary PNL patients compared to patients with a history of renal stone surgery (92.1% vs 77.3%, p=0.006). Conclusion: PNL has a similar complication rate in patients with and without previous kidney stone surgery. However, achieving stone-free status may be challenging in patients with a history of ipsilateral renal stone surgery.

scholarly journals Minimal invasive percutaneous nephrolithotomy (Mini-PCNL) in children: Ultrasound versus fluoroscopic guidance

2021 ◽  
Vol 93 (2) ◽  
pp. 173-177
Author(s):  
Ali Eslahi ◽  
Faisal Ahmed ◽  
Mohammad Mehdi Hosseini ◽  
Mohammad Reza Rezaeimehr ◽  
Nazanin Fathi ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Previous History ◽  
Minimal Invasive ◽  
Complication Rates ◽  
Procedural Information ◽  
Hemodynamic State ◽  
History Of ◽  
The Mean ◽  
Retrospective Comparative Study

Background: Miniaturization of endoscopic instruments in percutaneous nephrolithotomy (PCNL) allowed less invasive procedures with low complication rates, especially in children. This study was conducted to evaluate the safety and efficacy of ultrasonography-guided (USG) versus fluoroscopy-guided (FG) mini-PCNL in children.Materials and methods: This is a retrospective comparative study conducted from June 2015 to June 2020. The sample included 70 children (35 pateints underwent USG mini-PCNL and 35 pateints underwent FG mini-PCNL). They were compared mainly by the patients’ demographic characteristics, procedural information, and post-treatment outcomes. In the USG mini-PCNL group, puncturing was performed using a 3.5 MHz US probe, whereas fluoroscopy was utilized in the FG mini- PCNL group. Results: Both groups were comparable in terms of gender, previous history of failed ESWL, and hydronephrosis grade. The mean stone burden was 15.94 ± 3.69 mm and 19.20 ± 7.41 mm in USG and FG groups, respectively (p = 0.024). The stonefree rate (SFR) was 97.1% in the USG group and 94.3% in the FG group, which was not statistically significant (p = 0.16). Mean operative time in the USG group and FG group was 69.00 ± 13.33 minutes and 63.48 ± 16.90 minutes, respectively. Four (11.4%) patients in the FG group required blood transfusions to restore the hemodynamic state (p = 0.039). Fever was detected in 4 (11.4%) patients in the USG group and 15 (31.4%) patients in the FG group (p = 0.041). Conclusions: In children, mini PCNL under USG is safe and as effective as fluoroscopy.

The Percutaneous Surgical Approach for Repairing Acute Achilles Tendon Rupture

2010 ◽  
Vol 100 (4) ◽  
pp. 270-275 ◽  
Author(s):  
Shay Tenenbaum ◽  
Niv Dreiangel ◽  
Ayal Segal ◽  
Amir Herman ◽  
Amnon Israeli ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Demographic Data ◽  
Achilles Tendon Rupture ◽  
Treatment Modalities ◽  
Main Concern ◽  
Complication Rates ◽  
Percutaneous Surgery ◽  
Significant Difference ◽  
The Mean

Background: Treatment modalities for acute Achilles tendon rupture can be divided into operative and nonoperative. The main concern with nonoperative treatment is the high incidence of repeated ruptures; operative treatment is associated with risk of infection, sural nerve injury, and wound-healing sequelae. We assessed our experience with a percutaneous operative approach for treating acute Achilles tendon rupture. Methods: The outcomes of percutaneous surgery in 29 patients (25 men; age range, 24–58 years) who underwent percutaneous surgery for Achilles tendon rupture between 1997 and 2004 were retrospectively evaluated. Their demographic data, subjective and objective evaluation findings, and isokinetic evaluation results were retrieved, and they were assessed with the modified Boyden score and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale. Results: All 29 patients demonstrated good functional outcome, with no- to mild-limitations in recreational activities and high patient satisfaction. Mean follow-up was 31.8 months. Changes in ankle range of motion in the operated leg were minimal. Strength and power testing revealed a significant difference at 90°/sec for plantarflexion power between the injured and healthy legs but no difference at 30° and 240°/sec or in dorsiflexion. The mean modified Boyden score was 74.3, and the mean Ankle-Hindfoot Scale score was 94.5. Conclusions: Percutaneous surgery for Achilles tendon rupture is easily executed and has excellent functional results and low complication rates. It is an appealing alternative to either nonoperative or open surgery treatments. (J Am Podiatr Med Assoc 100(4): 270–275, 2010)

scholarly journals A Novel Technique of Ultra-Mini-Percutaneous Nephrolithotomy: Introduction and an Initial Experience for Treatment of Upper Urinary Calculi Less Than 2 cm

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Janak Desai ◽  
Guohua Zeng ◽  
Zhijian Zhao ◽  
Wen Zhong ◽  
Wenzhong Chen ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Urinary Calculi ◽  
Renal Stones ◽  
Laser Lithotripsy ◽  
Complication Rates ◽  
Modified Technique ◽  
Average Operative Time ◽  
Grade Ii ◽  
The Mean ◽  
Metal Sheath

Objectives. To describe our novel modified technique of ultra-mini-percutaneous nephrolithotomy (UMP) using of a novel 6 Fr mininephroscope through an 11–13 Fr metal sheath to perform holmium: YAG laser lithotripsy.Methods. The medical records of 36 patients with moderate-sized (<20 mm) kidney stones treated with UMP from April to July 2012 were retrospectively reviewed. Patients were assessed at the 1st day and 1st month postoperatively by KUB and US to assess stone-free status.Results. The mean stone size was 14.9 ± 4.1 mm (rang: 6–20). The average operative time was 59.8 ± 15.9 (30–90) min. The stone-free rate at postoperative 1st day and 1st month was 88.9% and 97.2%. The mean hospital stay was 3.0 ± 0.9 (2–5) days. Complications were noted in 6 (16.7%) cases according to the Clavien classification, including sepsis in 2 (5.6%) cases (grade II), urinary extravasations in 1 (2.8%) case (grade IIIa), and fever in 3 (8.3%) cases (grade II). No patients needed blood transfusion.Conclusions. UMP is technically feasible, safe, and efficacious for moderate-sized renal stones with an advantage of high stone-free rates and low complication rates. However, due to the limits of its current unexplored indications, UMP is therefore a supplement to, not a substitute for, the standard mini-PCNL technology.

scholarly journals A comparison of screw versus drill and curettage epiphysiodesis to correct leg-length discrepancy

2018 ◽  
Vol 12 (5) ◽  
pp. 509-514 ◽  
Author(s):  
M. Troy ◽  
B. Shore ◽  
P. Miller ◽  
S. Mahan ◽  
D. Hedequist ◽  
...  
Keyword(s):  
Operative Time ◽  
Surgical Techniques ◽  
Leg Length Discrepancy ◽  
Complication Rates ◽  
Leg Length ◽  
Treatment Groups ◽  
Length Discrepancy ◽  
Baseline Activity ◽  
Significant Difference

Purpose To compare two common surgical techniques of epiphysiodesis: drill/curettage epiphysiodesis (PDED) versus cross screw epiphysiodesis (PETS). The hypothesis is that the two techniques have similar efficacy but demonstrate differences in length of hospital stay (LOS), time to return to activity and complication rates. Methods A retrospective review of growing children and adolescents less than 18 years old who required an epiphysiodesis with leg-length discrepancy (LLD) of 2 cm to 6 cm with minimum two years of follow-up was conducted. Characteristics including age at surgery, gender, epiphysiodesis location, side, operative time, LOS and hardware removal were compared across treatment groups. LLD, expected growth remaining (EGR) and bone age were determined preoperatively and at most-recent visit. The correction ratio (change in EGR) was calculated along with a 95% confidence interval (CI) to assess if correction in leg length was achieved. Results A total of 115 patients underwent epiphysiodesis in the femur (53%), tibia (24%) or a combination (24%). The cohort was 47% male, with a mean age of 12.6 years (7.7 to 17.7) at surgery. Median follow-up was 3.7 years (2.0 to 12.7). In all, 23 patients underwent PETS and 92 patients had PDED. Both treatment groups achieved expected LLD correction. There was no significant difference in median operative time, complication rates or LOS. PETS patients returned to activity at a mean 1.4 months (interquartile range (IQR) 0.7 to 2.1) while PDED patients returned at a mean 2.4 months (IQR 1.7 to 3) (p < 0.001). Conclusion Effectiveness in achieving expected correction, LOS and operative time are similar between screw and drill/curettage epiphysiodesis. Patients undergoing PETS demonstrated a faster return to baseline activity than patients with PDED. Level of Evidence: III

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