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.

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 Outcome of mini percutaneous nephrolithotomy ‘miniPCNL’ in children

2018 ◽  
Vol 5 (2) ◽  
pp. 12-17
Author(s):  
Samir Shrestha ◽  
Pukar Maskey ◽  
Jay N Shah
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Pediatric Population ◽  
Renal Stones ◽  
Safe Procedure ◽  
Gross Hematuria ◽  
Residual Stone ◽  
Stone Clearance ◽  
Conversion To Open Surgery

Introductions: Renal stone disease is one of the common urological disorders with prevalence approximately 2-3% in the general population and the incidence in children is increasing at a rate of 4% per year. Miniaturization of endoscopic instruments, minimally invasive endoscopic procedures of mini percutaneous nephrolithotomy (miniPCNL) in children is increasingly used. This study was conducted to assess the outcome of miniPCNL in pediatric population. Methods: This retrospective study analyzed the outcome of miniPCNL in children below 18 years of age from August 2015 to July 2018 at Patan Hospital, Nepal. Ethical approval was obtained. Outcome was assessed descriptively on stone localization, puncture success, stone clearance, bleeding requiring transfusion, gross hematuria, urosepsis, operative time, hospital stay, mortality and need of second procedures. Results: A total of 26 patients underwent miniPCNL, mean age 10.8±5.45 years (1-18 years), mean operative time was 122±26.03 minutes and mean hospital stay was 3.2±1.12 days.  Postoperative transfusion was required in 1 (2.6%), gross hematuria occurred in 1 (2.6%), no urosepsis, no conversion to open surgery. Complete stone clearance was achieved in 22 (84.61%) patients.  Mortality was nil. Second procedure was required in 4 (15.38%) to achieve residual stone clearance. Conclusions: Our study shows miniPCNL is an effective and safe procedure with minimal morbidity for the treatment of pediatric renal stones.

scholarly journals Mini percutaneous nephrolithotomy: its role in the management of renal stone and our tertiary care centre experience

2020 ◽  
Vol 8 (2) ◽  
pp. 624
Author(s):  
Avinash Pratap Singh Thakur ◽  
Darsan S.
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Operative Time ◽  
Tertiary Care ◽  
Renal Calculi ◽  
Medium Size ◽  
Tertiary Care Centre ◽  
Excellent Outcome ◽  
Stone Fragmentation

Background: Miniaturized percutaneous nephrolithotomy (PCNL) procedures for urolithiasis have gained increased popularity in recent years. To decrease the complications of conventional PCNL by  reduced tract size led to the development of Mini PCNL, which makes the use of 15-18F sheaths in place of 24-30F of conventional PCNL. It has developed rapidly and become a popular technique of renal stone management with reduced morbidity and excellent outcome. Authors report our experience with Mini PCNL for the treatment of renal stone.Methods: In between his August 2015 and January 2018, sixty patients with the diagnosis of unilateral single medium size (8-20mm) renal stone were identified. Patient’s demographical, clinical, diagnostic and procedural data were recorded.  All patients were evaluated by history taking, physical examination and laboratory investigations. Radiological evaluation was done with X ray kidney, ureter and bladder region (KUB) and also with renal ultrasonography followed by computed tomography (CT). All patients underwent Mini PCNL using 12F nephroscope and 16.5/17.5F sheath. Holmium: YAG laser was used for stone fragmentation. No nephrostomy tube was used routinely. Treatment outcome was assessed in terms of operative time, haemoglobin drop, hospital stay and stone free rate.Results: Complete stone fragmentation was achieved in 41 out of 60 patients using Mini PCNL, so initial stone free rate was 68.3%. After 4 weeks of surgery total 53 patients were stone free (88.3%), 5 patients required some auxiliary procedure for complete clearance of stone and other 2 were managed conservatively. The mean operative time was 48.28 min, mean haemoglobin drop was 0.74gm/l and mean postoperative hospital stay was 54.22 hours. After 12 weeks postoperatively all patients were stone free. There were no significant postoperative complications, and all had good quality of life.Conclusion: Mini PCNL technique appears to be safe and effective alternative to conventional PCNL for moderate size renal calculi. It is usually related to less blood loss and shorter hospital stay than the standard method. It can achieve good stone-free rates with minimal complications and low morbidity. Mini PCNL can also be considered as a good alternative to retrograde intrarenal surgery and shockwave lithotripsy in selected cases. However, further high quality studies with larger sample size are required in future.

scholarly journals Retroperitoneal laparoscopic adrenalectomy: its role in the management of adrenal tumour and tertiary care centre experience

2020 ◽  
Vol 8 (3) ◽  
pp. 993
Author(s):  
Avinash Pratap Singh Thakur ◽  
G. Venugopal ◽  
Darsan S.
Keyword(s):  
Hospital Stay ◽  
Laparoscopic Adrenalectomy ◽  
Conversion Rate ◽  
Operative Time ◽  
Tertiary Care ◽  
Adrenal Tumour ◽  
Transperitoneal Approach ◽  
Tertiary Care Centre ◽  
Early Recovery ◽  
Excellent Outcome

Background: Laparoscopic adrenalectomy for adrenal tumour has gained increased popularity worldwide. To decrease the complications of commonly used transperitoneal approach, by not entering into peritoneal cavity the retroperitoneal laparoscopic adrenalectomy (RLA) has developed. It has several advantages over the transperitoneal approach and associated with reduced morbidity and excellent outcome. The objective of this study was to report our experience with RLA for treatment of adrenal tumour.Methods: The study was done from August 2014 and December 2017, data of 44 patients who underwent RLA for adrenal tumour in the institute were retrospectively reviewed. Patient’s demographical, clinical, diagnostic and procedural data were recorded. All patients were assessed by history, physical examinations, laboratory values with biochemical marker test and imaging by computed tomography/magnetic resonance imaging. Treatment outcome was assessed in terms of operative time, haemoglobin drop, conversion rate, hospital stay and complications.Results: In 44 adrenalectomy, 24 men and 20 women, with a mean age of 47.0±8.9 years were enrolled. Mean body mass index was 23.5±2.2 kg/m2. Right adrenal tumour was seen in 26 cases and left in 18 cases. Mean adrenal mass size was 2.6±0.85 cm. Mean operative time was 109.1±21.16 minutes, mean haemoglobin drop was 0.47±0.26 gram/L. Conversion to open surgery was necessary in 2 patients. Mean postoperative hospital stay was 4.0±0.91 days. Recovery time mean value was 12.18±1.7 days postoperatively. In final histopathology result adenoma was most prevalent (25 cases) and myelolipoma was least (1 case).  Conclusions: RLA appears to be safe and effective alternative to transperitoneal adrenalectomy for moderate size adrenal tumour in particular less than 6 cm. It is associated with less blood loss, shorter hospitalization, low conversion rate, fewer complications and early recovery. RLA offers an alternative method for treating adrenal tumour with improved surgical outcomes.

scholarly journals A comparative study of functional outcome between posterior lumbar fusion and posterior lumbar interbody fusion in spondylolisthesis

2021 ◽  
Vol 7 (3) ◽  
pp. 544
Author(s):  
Harpreet Singh ◽  
Dhruv Patel ◽  
Sangam Tyagi ◽  
Krushna Saoji ◽  
Tilak Patel ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Interbody Fusion ◽  
Operative Time ◽  
Lumbar Fusion ◽  
Tertiary Care ◽  
Posterior Lumbar Interbody Fusion ◽  
Invasive Technique ◽  
Lumbar Interbody Fusion ◽  
Tertiary Care Centre ◽  
Posterior Lumbar Fusion

<p class="abstract"><strong>Background:</strong> Spondylolisthesis is condition in which one vertebra slips over other vertebra. This study has been done to compare the functional outcome and complications of two techniques: posterior lumbar fusion (intertransverse fusion) and posterior lumbar interbody fusion.</p><p class="abstract"><strong>Methods:</strong> Total 20 patients with spondylolisthesis admitted in a tertiary care centre in Rajasthan were allotted alternatively in posterior lumbar fusion (PLF) group and posterior lumbar interbody fusion (PLIF) group. In PLF, fusion was done by placing bone graft between transverse processes and around facets. In PLIF, fusion was bone by placing cage in between vertebral bodies.</p><p class="abstract"><strong>Results:</strong> 20 patients were included in our study with female predominance (65%). Mean age was 54.2 years (PLF=58.4 and PLIF=50.2). 70% patients have L4-L5 level spondylolisthesis. Average operative time was less in PLF group, which is statistically significant. Functional outcome was measured by using visual analogue scale (VAS) score and Japanese orthopedics association score (JOAS) at 3 weeks, 3 months and 6 months. There is a significant decrease between preoperative VAS and at 6 months, in both PLF and PLIF group. JOAS was significantly increased at 6 months in both PLF and PLIF group as compared to preoperative score. But difference in JOAS at 6 months is not significant between PLF and PLIF.</p><p class="abstract"><strong>Conclusions:</strong> Both PLF and PLIF are equally effective for spondylolisthesis. Both techniques have same satisfactory results. As PLIF is more invasive technique, more operative time and more complications are seen.</p>

Comparison of Retrograde Intrarenal Surgery and Micro-Percutaneous Nephrolithotomy for Kidney Stones: A Meta-Analysis

2020 ◽  
pp. 1-7
Author(s):  
Zhenhua Gu ◽  
Yucheng Yang ◽  
Rui Ding ◽  
Meili Wang ◽  
Jianming Pu ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Kidney Stones ◽  
Operative Time ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Clinical Results ◽  
Retrograde Intrarenal Surgery ◽  
Alternative Approach ◽  
Significant Difference

<b><i>Background:</i></b> Advances in micro-percutaneous nephrolithotomy (PCNL) for kidney stones have made it an alternative approach to the retrograde intrarenal surgery (RIRS) approach. Nevertheless, the superiority of micro-PCNL over RIRS is still under debate. The results are controversial. <b><i>Objectives:</i></b> The purpose of this study was to systematically evaluate the clinical results in patients presenting with kidney stones treated with micro-PCNL or RIRS. <b><i>Methods:</i></b> A literature search was done for electronic databases to identify researches that compared micro-PCNL and RIRS till December 2019. The clinical outcome included complications, stone-free rates (SFRs), hemoglobin reduction, length of hospital stay, and operative time. <b><i>Results:</i></b> Five articles were included in our study. The pooled results revealed no statistical difference in the rate of complications (OR = 0.99, 95% CI = 0.57–1.74, <i>p</i> = 0.99), length of hospital stay (MD = −0.29, 95% CI = −0.82 to 0.24, <i>p</i> = 0.28), and operative time (MD = −6.63, 95% CI = −27.34 to 14.08, <i>p</i> = 0.53) between the 2 groups. However, significant difference was present in hemoglobin reduction (MD = −0.43, 95% CI = −0.55 to 0.30, <i>p</i> &#x3c; 0.001) and the SFRs (OR = 0.59, 95% CI = 0.36–0.98, <i>p</i> = 0.04) when comparing RIRS with micro-PCNL. <b><i>Conclusions:</i></b> Compared with micro-PCNL to treat kidney stones, RIRS is associated with better stone clearance and bearing higher hemoglobin loss. As the advantages of both technologies have been shown in some fields, the continuation of well-designed clinical trials may be necessary.

scholarly journals Accidental Hijab Pin Ingestion: 10 Years Experience from a Tertiary Care Centre

2018 ◽  
Vol 1 (1) ◽  
pp. 54-59
Author(s):  
Naim Abu Freha ◽  
Muhammad Abu Tailakh ◽  
Doron Schwartz ◽  
Ohad Etzion ◽  
Alex Rosenthal ◽  
...  
Keyword(s):  
Emergency Room ◽  
Hospital Stay ◽  
Clinical Observation ◽  
Tertiary Care ◽  
Muslim Women ◽  
Tertiary Hospital ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Duration Of Hospitalization ◽  
Time Of Admission

Background and Aim: Hijab pins ingestion is increasing. Some women hold the pin between their teeth while arranging the Hijab and the inadvertent ingestion of the pin can be the result of any careless movements. The aims of our study were to investigate the clinical outcomes of patients who underwent endoscopic pin removal via gastroscopy as opposed to patients who were treated conservatively with clinical observation, and to compare clinical and endoscopic data pertaining to patients who underwent early versus late gastroscopy.Methods: Muslim women hospitalized in a tertiary hospital from 2005-2015 due to ingestion of Hijab pin ingestion were included. Patients who underwent gastroscopy during 12 hours from the time of admission to Emergency Room (ER) were included in the “early” gastroscopy group, while endoscopy performed at a later time defined the “late” gastroscopy group.Results: During the study period 37 women were included. Twenty four patients (65%, mean age 20 ± 8.9) underwent gastroscopy; and thirteen (35%, mean age 19.9 ± 1.6) were hospitalized for observation. Six patients (25%) had normal gastroscopy; by 8 patients (33%) the pin was located in the antrum, 6 (25%) body, 2 (8.3%) and 1 (4.1%) in the duodenum. Fifteen patients underwent early gastroscopy and nine underwent late gastroscopy. The Duration of hospitalization was significantly shorter among patients who underwent early gastroscopy 1-day (1, 1) median, (IQR) compared with 2 days (1, 3) p < 0.02. Severe complications were found in one patient (2.7%) with stomach perforation which required surgery.Conclusion: Most pins will pass spontaneously, however severe complication may arise inadvertent Hijab pin ingestion. Early gastroscopy shortens the hospital stay.

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 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

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