scholarly journals The active guidewire technique versus standard technique as different way to approach ureteral endoscopic stone treatment

2021 ◽  
Vol 93 (4) ◽  
pp. 431-435
Author(s):  
Alessandro Calarco ◽  
Marco Frisenda ◽  
Emilio Molinaro ◽  
Niccolò Lenci
Keyword(s):  
High Pressures ◽  
Guide Wire ◽  
Operating Time ◽  
Standard Technique ◽  
Treatment Quality ◽  
Ureteral Catheter ◽  
Stone Free Rate ◽  
Stone Treatment ◽  
The Difference ◽  
Free Rate

Background: One of the greatest challenges in semi-rigid ureteroscopies, for both stones and tumors, is the control of endoscopic vision and the maintenance of low intracavitary liquid pressure. We present a comparison between two operative techniques: in the first method an ordinary guide wire (diameter 0.032'') is used for the procedure; in the second one a 5 Fr ureteral catheter replaces the guidewire (we called it “Active guidewire”) Methods We compared 50 semirigid ureteroscopies (sURS) performed using the active guidewire with another 50 procedures conducted with a classic guidewire. We evaluated the difference in operating times, quality of endoscopic vision, periprocedural infections rate and stone-free rate. Results: The use of active guidewire has considerably reduced the standardized operating times per unit stone-volume by about 39%. Vision quality has improved considerably thanks to the continuous flow in-and-out. Consequently, periprocedural infections decreased (3% vs 30%) and the stone-free rate rose from 86% to 92%. Discussion and conclusions: Employing an “active guidewire” instead of the standard guidewire, the risk of complications related to high pressures and operating time is considerably lower, as well as better treatment quality thanks to the cleaner vision. This technique has proven to be safe as well as easy to apply, and in our belief is to be preferred whenever the ureter accepts without forcing, both the presence of the catheter and the semi-rigid 7 F ureteroscope.

Laparoscopic pyelolithotomy in patients with previous ipsilateral renal stone surgery

2019 ◽  
pp. 039156031989099
Author(s):  
Mohammad Hadi Radfar ◽  
Mehdi Dadpour ◽  
Nasser Simforoosh ◽  
Abbas Basiri ◽  
Akbar Nouralizadeh ◽  
...  
Keyword(s):  
Renal Stone ◽  
Operating Time ◽  
Study Groups ◽  
Transfusion Rate ◽  
Renal Surgery ◽  
Laparoscopic Pyelolithotomy ◽  
Stone Free Rate ◽  
Significant Difference ◽  
History Of ◽  
Free Rate

Objectives: To evaluate the safety and efficacy of transperitoneal laparoscopic pyelolithotomy in renal stone cases with previous renal surgeries. Patients and methods: In this prospective study, 190 consecutive patients with renal stones, who were candidates for transperitoneal laparoscopic pyelolithotomy, were enrolled. The patients were divided into two groups. In group A, 163 patients without a history of renal surgery underwent standard laparoscopic pyelolithotomy, whereas in group B laparoscopic pyelolithotomy was performed in 27 patients with a history of kidney stone surgery including percutaneous nephrolithotomy or open stone surgery. All intraoperative data including the operating time and complications such as bleeding requiring transfusion were recorded. Postoperative data such as length of hospitalization, hemoglobin level alteration, and other complications were also recorded. Results: There was no significant difference in the preoperative data such as stone size, stone site, age, sex, and stone side between the two groups. There was no significant difference in the stone-free rate between the two groups (p = 0.4). There was no significant difference between the two study groups regarding the operating time, hospital stay, stone-free rate, complications, and transfusion rate. Conclusion: Laparoscopic pyelolithotomy can be used as a safe and feasible treatment modality in the setting of previous renal surgery. The complications and stone-free rate of laparoscopic pyelolithotomy in patients with history of renal surgery are acceptable.

Counter-Irrigation as a Novel Technique versus the Standard Technique in Percutaneous Nephrolithotomy: A Prospective Randomized Trial

2021 ◽  
pp. 1-7
Author(s):  
Ahmed El-Sakka ◽  
Abdelnaser Elgamasy ◽  
Karim Sallam ◽  
Mohamed G. Soliman
Keyword(s):  
Blood Transfusion ◽  
Hospital Stay ◽  
Randomized Trial ◽  
Percutaneous Nephrolithotomy ◽  
Standard Technique ◽  
Prospective Randomized Trial ◽  
Stone Free Rate ◽  
Group A ◽  
Group B ◽  
Free Rate

<b><i>Objective:</i></b> This study aimed to evaluate the efficacy of our counter-irrigation technique versus the standard technique in percutaneous nephrolithotomy (PCNL) by assessment of the stone-free rate after the procedures and its safety in terms of comparing the intraoperative time, Hb deficit, blood transfusion, length of hospital stay, auxiliary procedures, and perioperative complications with that of the standard one. <b><i>Methods:</i></b> This prospective randomized trial was conducted on patients with renal stone 2–3 cm in diameter without contraindications to PCNL. The patients were randomized into group A in which the counter-irrigation technique has been performed and group B who were managed by the standard technique. The preoperative characteristics including demographic data and stone parameters were compared between both groups. The primary outcome was the stone-free rate assessed by noncontrast spiral CT after 3 months. The secondary outcome included intraoperative time, Hb deficit, blood transfusion, hospital stay, auxiliary procedure required, and rate of complications. <b><i>Results:</i></b> Forty-eight patients were included in this study. Overall, no significant difference was observed between both groups regarding preoperative characteristics, Hb deficit, and complication rate. Operative time was significantly shorter in group B (<i>p</i> = 0.001). None of our patients required blood transfusion. The stone-free rates at 3 months were significantly better in group A (95% for group A and 70% for group B, <i>p</i> = 0.04). <b><i>Conclusions:</i></b> Our results indicate that our counter-irrigation technique has lower stone migration with subsequent significantly better stone-free rate versus the standard technique. We can recommend this technique as a potentially valid option for cases with large stone burden when the access to the upper calyx is feasible to minimize significant residual fragments.

scholarly journals EFFICACY AND SAFETY OF LUBRICATING JELLY INSTILLATION TO PREVENT RETROPULSION DURING URETEROLITHOTRIPSY FOR URETERAL STONES

2017 ◽  
Vol 24 (2) ◽  
Author(s):  
Rameshdo Yuanda ◽  
Doddy M Soebadi ◽  
Soetojo Soetojo ◽  
Sunaryo Hardjowijoto
Keyword(s):  
Ureteral Stones ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Efficacy And Safety ◽  
Ureteral Catheter ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Enhanced Computed Tomography ◽  
And Control ◽  
Free Rate

Objective: We studied the efficacy and safety of lubricating jelly instillation before ureterolithotripsy for prevention of retropulsion and improvement in stone-free rate. Material & methods: We enrolled 22 subjects with ureteral stone in this prospective, randomized, single-blind and controlled clinical trial. Each subject was randomly assigned to the lubricating jelly instillation group (n=11) and control group (n=11). Ureteroscopy and lithotripsy was performed according the standard protocol, using 9.8 F semirigid ureteroscope and pneumatic lithotripter. A 6 F ureteral catheter was advanced beyond the stone, and lubricating jelly was instilled through the catheter lumen. Retropulsion and the presence of residual fragments were evaluated with plain kidneys, ureters and bladder x-ray and ultrasonography, or Non Contrast-enhanced Computed Tomography. Any complication was reported and graded using the Modified Clavien Classification System.Results: The 2 groups had comparable preoperative characteristics. There were no statistically significant difference between the lubricating jelly instillation group and control group regarding the retropulsion rate (54.5% vs 72.7%, ρ=0.375), the stone-free rate (54.5% vs 36.4%, ρ=0.392), and the complication rate (45.5% vs 54.5%, ρ=0.670). Conclusion: Lubricating jelly instillation during ureterolithotripsy has limited value for prevention of retropulsion and improvement in stone-free rate.

scholarly journals Comparison Between Mini PCNL and Standard PCNL in Management of Nephrolithiasis

2020 ◽  
Vol 19 (2) ◽  
pp. 80-83
Author(s):  
Bharat Bahadur Bhandari ◽  
Bikash Bikram Thapa ◽  
Dhirendra Ayer ◽  
Suresh Thapa ◽  
Sanjeeb Bista
Keyword(s):  
Renal Stones ◽  
Infectious Complications ◽  
Bleeding Complications ◽  
Medium Size ◽  
Invasive Approach ◽  
Urine Leak ◽  
Stone Free Rate ◽  
Significant Difference ◽  
The Difference ◽  
Free Rate

Introduction: The incidence of small and medium size renal stones is rising. Stone clearance, bleeding, urine leak and infectious complications are major concerns for urologist.  Urologist chooses best technique from list of armamentarium available. Minimally invasive approach like Percutaneous Nephrolithotomy (PCNL) has significantly influenced the renal stone management since 1976. Miniaturisation of the instruments allow more effective and safer alternatives for urolithasis management. Methods: This is a retrospective study in which the outcome of mini PCNL (mPCNL) was compared with standard PCNL (sPCNL) in management of nephrolithiasis. Result: There were no significant difference in stone free rate between mPCNL and sPCNL (96.2 ± 3.6% vs 95.3 ± 4.8%). The total operative time was longer in mPCNL (55.2 ± 19.0 minute vs 62 ± 21.0 minute) but the difference was not statistically significant. Conclusions: Mini PCNL is as effective as standard PCNL with fewer bleeding complications in management of medium sized nephrolithiasis.

scholarly journals The stone density does not affect the stone-free rate of kidney pelvic stones (2-3 cm) treated with flexible ureterorenoscopy

2020 ◽  
Author(s):  
Yao Bai ◽  
Sheng Hu ◽  
Yuanqing Dai ◽  
Xiong Chen ◽  
Xiaobo Zhang ◽  
...  
Keyword(s):  
Operating Time ◽  
Renal Calculus ◽  
Flexible Ureterorenoscopy ◽  
Whole Process ◽  
Hospitalization Time ◽  
Stone Free Rate ◽  
Study Parameter ◽  
Contrast Ct ◽  
Stone Density ◽  
Free Rate

Abstract Objectives To compare the efficacy of retrograde flexible ureterorenoscopy (FURS) in the treatment of low-density stone (LDS) and high-density stone (HDS).Patients and Methods From January 2017 to March 2019, 241 patients with 2–3 cm kidney pelvic stones were treated with retrograde flexible ureterorenoscopy. The relevant study parameter for all patients, including patients age, body mass index (BMI), gender, stone density values (Hounsfield units [HU]), stone size, stone location, operative time, hospitalization time, stone free rate (SFR), complications were evaluated. The results were assessed one month after the FURS and the follow-up time is 6 months.Results Effectively, 241 patients finish the whole process and are divided into two groups (LDS and HDS). The postoperative hemoglobin (Hb) was 13.31±1.06 vs. 13.21±1.14 g/dL (p=0.50). The mean total operating time was 83.91±13.7 vs. 130.65±19.8 min (p<0.01), respectively. The hospitalization time was 3.4±1.1 vs 3.2±1.1 days (p=0.33), respectively. The free stone rate was 91.5% vs. 93.5% (p=0.54) and the street stone rate was 12(10%) vs. 3(2.4%) (χ2=6.173 a , p=0.01) in the LDS and HDS groups.Conclusions We concluded that FURS is safe and effective for the treatment of large renal pelvic stones 2-3 cm. There is no difference in the SFR between LDS and HDS group after the FURS operation. Density (as measured by non-contrast CT) of the renal calculus can help predict the treatment outcome before FURS. For appropriate patients, FURS should be chosen as a common approach in the treatment of renal pelvic calculus.

scholarly journals Outcome of Percutaneous Nephrolithotomy in Horseshoe Kidneys

2018 ◽  
Vol 6 (2) ◽  
Author(s):  
Udaya Man Singh Dongol ◽  
Sandeep Bohora
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Stone Formation ◽  
Operating Time ◽  
Horseshoe Kidney ◽  
Fisher Exact Test ◽  
Extracorporeal Shock Wave ◽  
Increased Risk ◽  
Stone Free Rate ◽  
The Mean ◽  
Free Rate

Introduction: The horseshoe kidney is extremely rare, the incidence being one in every 400 - 800 patients. In a recent review of more than 15000 radiographic imaging studies, the incidence was one in every 666 patients. The renal stone formation in horseshoe kidney is around 20-80%. Percutaneous nephrolithotomy is the most accepted modality of treatment . This study was carried out to find the outcome of percutaneous nephrolithotomy in horseshoe kidneys. Methods: Between May 2013 and November 2017, 11 adult patients(12 renal units) with stones in horseshoe kidneys underwent percutaneous nephrolithotomy in the department of urosurgery, Kathmandu Medical College and Teaching Hospital and were evaluated for the operating time, stone free rate , complications and hospital stay. Data analysis was done using Statistical Package for the Social sciences (SPSS) Version 20. Categorical data were analysed by using Fisher exact test. Results: The mean age of the patients was 30.9 years (SD = 10.3) and the mean stone burden was 385.83 mm2 (SD = 331.3). The overall stone free rate was 83.33%. The two patients with residual stones when counselled for Extracorporeal shock wave lithotripsy, refused for it and decided to be on follow up. No auxiliary procedure was done. The complications noted were of Clavien-Dindo grade I and II. No pleural or bowel injury was seen. One patient needed blood transfusion. Conclusions: Percutaneous nephrolithotomy is safe and effective in the management of stones in horseshoe kidneys. It does not carry increased risk than reported in normal kidneys.

Comparison of Ureteroscopic Laser Lithotripsy with Laparoscopic Ureterolithotomy for Large Proximal and Mid-Ureter Stones

2015 ◽  
Vol 94 (2) ◽  
pp. 205-209 ◽  
Author(s):  
Onur Kaygısız ◽  
Burhan Coşkun ◽  
Hakan Kılıçarslan ◽  
Yakup Kordan ◽  
Hakan Vuruşkan ◽  
...  
Keyword(s):  
Invasive Procedure ◽  
Laser Lithotripsy ◽  
Minimal Invasive ◽  
Ureteral Stones ◽  
Ureter Stone ◽  
Stone Free Rate ◽  
Effective Option ◽  
Stone Treatment ◽  
Ureter Stones ◽  
Free Rate

Objectives: To compare the effectiveness and complications of ureteroscopic laser lithotripsy with laparoscopic ureter laparoscopic ureterolithotomy in mid- or proximal portion of large ureteral stones. Material and Methods: We reviewed patients with large (>15 mm) ureteral stone and those who underwent ureteroscopic laser lithotripsy (URS group) or laparoscopic ureterolithotomy (LU group). The first attempt was considered successful in patients who had residual fragments smaller than 2 mm and no conversion of the primary procedure to another. Results: Sixty patients (URS group 29, LU group 31) met inclusion criteria. FURS was used as an adjunctive procedure in one patient for URS group and in two patients for LU group in the same season. LU had a higher success rate and the first-day stone-free rate when compared with URS. Number of procedures was also significantly higher in URS group. There was no difference in stone-free rates at the first and third months, and length of hospitalization and operation were higher in the LU group. Only two patients in the LU group and one patient in the URS group had major complications. Conclusions: Laparoscopy is an effective option of large proximal and mid-ureter stone treatment; however, URS provides similar stone-free rates at three months as a minimal invasive procedure.

scholarly journals COMPARISON OF PERCUTANEOUS NEPHROLITOTOMY (PCNL) IN PRONE AND SUPINE POSITION: A SINGLE CENTRE EXPERIENCE REPORT

2021 ◽  
Vol 28 (1) ◽  
pp. 39-43
Author(s):  
Ferry Safriadi ◽  
Dadan Ramdhan
Keyword(s):  
Hospital Stay ◽  
Prone Position ◽  
Percutaneous Nephrolithotomy ◽  
Supine Position ◽  
Operating Time ◽  
Transfusion Rate ◽  
Major Complications ◽  
Stone Free Rate ◽  
The Mean ◽  
Free Rate

Objective: This study aims to compare outcomes of supine percutaneous nephrolithotomy to prone percutaneous nephrolithotomy as a traditional approach in Hasan Sadikin Hospital Bandung. Material & Methods: Data was taken from urology’s database between 2003-2012, which contain data of prone position (2003-2007), and supine position (2008-2012). Three hundred forty-nine patients were included in this study. We reviewed data on demography, stone burden, operating time, stone-free rate, transfusion rate, hospital stay, and major complications. Results: Of 174 patients underwent prone position, and 175 patients were part of the supine position. Age means of prone position was 51.0 years old, the supine position was 50.5 years old. The number of male patients was 65.5% for prone, and 66.1% for supine. The mean stone's largest diameter of prone was 23.87 mm, supine was 22.36 mm. The operating time of prone was 107 minutes; supine was 90 minutes. The stone-free rate of prone was 94.7%; supine was 91.3%. The mean hospital stays of prone was 14.3 days; supine was 9.6 days. The transfusion rate of prone position was 8.9%, supine was 7.2%. No major complications were recorded. Conclusion: Higher stone-free rates are achieved with patients in the prone position during PCNL. Supine position has shorter operating time, and hospital stay, lower blood transfusion rates. The complication rate is not different between the two positions.   

scholarly journals One Shot Dilatation (OSD) in Percutaneous Nephrolithotomy (PCNL) - A Safe and Feasible Technique

2020 ◽  
Vol 23 (2) ◽  
pp. 114-117
Author(s):  
Abdul Matin Anamur Rashid Choudhury ◽  
Tohid Mohammad Saiful Hossain ◽  
Tasmina Parveen
Keyword(s):  
Radiation Exposure ◽  
Percutaneous Nephrolithotomy ◽  
Operating Time ◽  
Fluoroscopy Time ◽  
Access Time ◽  
Control Group ◽  
Transfusion Rate ◽  
Stone Free Rate ◽  
Tract Dilation ◽  
Free Rate

Objective: To evaluate the feasibility, safety and efficacy of one-shot dilation (OSD) in standard percutaneous nephrolithotomy (PCNL). Methods: This is a prospective, single -center study conducted between January 2017 to June 2019. Patients who underwent PCNL using one shot dilatation (21 – 24 Fr) for access in PCNL were included in the study. Access time, fluoroscopy time, successful dilation time, stone free rate, decrease hemoglobin level and transfusion rate, complication rate, length of post operative hospital stay, cost were recorded. Data was analyzed and reported using summary statistics. Results: A total of 30 patients were enrolled in this survey. 30 patients in one shot dilation (OSD) group.The mean age was 39.5 years. Control group of 30 patients were included in standard PCNL procedure where method of tract dilation was done by regid Amplatz dilators. Access time and fluoroscopy time in OSD group was approximately shorter. Statistically it was significant. Successful dilation and stone free rate were subsequently 98% and was significant. Data collected included patient access time, radiation exposure, total operating time, preoperative and postoperative hemoglobin concentrations, tract dilatation failures, complications and transfusions. Conclusion: The use of one shot and standard prone position under general anaesthesia combines the advantages of these both methods including less radiation exposure and shorter access and operative time. One shot dilation technique is safe, economical and feasible technique with added advantage,lesser radiation exposure and lesser chance of blood transfusion. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.114-117

Sign in / Sign up

Export Citation Format

Share Document