Robot-assisted partial nephrectomy and nephrolithotomy for multiple lower pole calculi in an atrophic kidney

Open renal stone surgery has been largely replaced by retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (ESWL). However, when these methods fail to remove a stone or there are certain contraindications, such as pregnancy and obesity, laparoscopic, robotic or open surgery may still be indicated. In fact, robotic surgery has been increasingly used by urologists for different benign indications including chronic pyelonephritis, neglected ureteropelvic junction obstruction and renal tuberculosis. This article describes a case of robotic-assisted partial nephrectomy and nephrolithotomy for a large amount of small lithiasis in a non-functioning lower pole after failed stone clearance with a single use Boston ureteroscope owing to non-accessibility.

The Effects of Previous Renal Stone Surgery on Percutaneous Nephrolithotomy Outcomes

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.

Outcomes of Percutaneous Nephrolithotomy in Patients with Previous Ipsilateral Open Renal Stone Surgery

Background: Nephrolithiais is a recurrent disease. Recent advances have enabled stone surgeries to be performed by minimal invasive techniques; but still a large number of patients present with history of ipsilateral open renal stone surgery. Previous scar to the kidney and overlying muscles are fraught with possibility of increased complications. This study was conducted to evaluate the perioperative results of percutaneous nephrolithotomy in patients with a history of open stone surgery and to compare with those undergoing percutaneous nephrolithotomy for the first time.Methods: A retrospective study of all the percutaneous nephrolithotomy performed by standard technique within four years at Bir Hospital was made. Patients were divided into those undergoing percutaneous nephrolithotomy for the first time and those who had undergone open renal stone surgery in the past. Preoperative and intraoperative variables were recorded and postoperative stone free status and complications were evaluated. Results: Six hundred and twenty seven patients; out of 691, who had undergone percutaneous nephrolithotomy were included. Demographic variables and stone characteristics were similar in the two study groups. percutaneous nephrolithotomy was found to be statistically similar in the two groups in terms of the number of tracts made (p= 0.1642) and operative time (0.9197). Exit strategies were similar in both groups. Stone free rate was 83.33% in patients undergoing percutaneous nephrolithotomy for first time and 82.08% in those with history of open surgery. Average hospital stay was 3 days in both groups. Although the group with history of previous surgery had significantly more complications (p= 0.0207), Clavien grading was similar in the two groups.Conclusions: This study shows that the rate of complications is more in patients with history of open surgery, most complications are minor, not requiring intensive management. percutaneous nephrolithotomy is efficient and safe in patients with history of open renal stone surgery. Keywords: Complications; open renal stone surgery; percutaneous nephrolithotomy

The risk factors associated with colonic injury during percutaneous renal stone surgery – a literature review

Objective: A focused literature review was conducted of colonic injuries occurring during percutaneous nephrolithotomy (PCNL) procedures to determine the importance of patient position, identifiable risk factors and methods to avoid colonic injury. Method: A MEDLINE literature search was performed from PubMed and Scopus databases to retrieve all articles relating to colonic injuries occurring during PCNL. Incidence of colonic injury, patient management, position, side of stone and recognised risk factors were compiled for analysis. Results: Of the 35,054 PCNLs carried out, 87 colonic perforations were identified, which results in a 0.25% chance of perforation. A total of 65.5% (57/87) of colonic perforations occurred during left-hand punctures, and 54.0% (47/87) occurred in the prone position. Retrorenal colon, posterior colon, previous renal tract surgery, horseshoe kidney and mobile kidneys were the most common risk factors identified. Discussion: The risk of colonic perforation during PCNL was 0.25% across these studies. It more commonly occurred in the prone position and on the left-hand side. Only four perforations were noted to be in the supine position. A retrorenal colon is implicated as the most common identifiable risk factor. Careful preoperative work-up, planning and intraoperative use of ultrasound combined with fluoroscopy is the best method of preventing a colonic injury. Level of evidence: Not applicable for this multicentre audit.