TO EVALUATE EFFICACY OF LAPAROSCOPIC TRANSPERITONEAL PYELOLITHOTOMY FOR MANAGEMENT OF RENAL PELVIC STONES IN TERM OF BLOOD LOSS

Background: To evaluate efficacy of laparoscopic transperitoneal pyelolithotomy for management of renal pelvic stones in term of blood loss Methods: This study has been conducted in the Department of General surgery, Indira Gandhi Medical College, Shimla on selected patients of Renal pelvis stones admitted in institution Results: Mean blood loss in successful laparoscopic surgery was 58.33 ml and in lap converted to open was 200 ml. Conclusion: Laparoscopic pyelolithotomy is a feasible and safe operation for patients with renal stones in centers with adequate experience in laparoscopy and well trained surgeons. It is found to be safe, effective and efficient with proper patient selection and adherence to standard laparoscopic surgical principles. Keywords: Laparoscopic Transperitoneal Pyelolithotomy, Pelvic stone, Blood loss

USAGE OF SUPPORTING PAD FOR SUPINE PCNL: A SINGLE CENTER EXPERIENCE

Objective: This study aims to compare the safety, efficacy, and other surgical outcomes of supine PCNLs performed with and without the use of supporting pad. Material & Methods: We enrolled 27 patients who undergone PCNL procedure with supine position for renal stones with all sizes between January - December 2019. Divided into two groups, operated with and without supporting pad, with 13 and 14 patients respectively. Inclusion criteria are patients with renal stones, including staghorn, multiple calyx, and proximal ureteral stones. Meanwhile, pediatric patients under 12 years old, uncorrectable bleeding disorders, active urinary infection, and pregnancy are excluded. Results: Our observation showed no statistically significant difference between the two groups, although blood loss and length of stay in supporting pad showed better results. A statistically significant difference was found in stone-free-rate (P = 0.006) favoring in supine PCNL with supporting pad. Conclusion: Supine PCNL with support padding may be a safe and more effective choice to treat renal stones. Nevertheless, the patient’s anatomic variations may influence this. Thus, a prospective study with a larger population is needed to verify our outcomes.

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

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.

Hydroperitoneum: A complication of mini PCNL in pediatric age group? -A case report

Renal stones constitute 40% of renal disorders in Pakistan with silent stones constituting up to 3%. Nephrolithotomy and Pyelolithotomy were the only surgical options available for the treatment of large renal stones, with high rate of complications. Percutaneous nephrolithotomy (PCNL) has now become the mainstay of treatment for large renal stones over the past 30 years. Recent advances in equipment and technology has made PCNL the gold standard for this disease, resulting in removal of stones with shorter recovery time and decreased morbidity and mortality, and with few complications Case Discussion A boy aged 13 years, underwent mini PCNL for treatment of left side renal stone causing hydronephrosis, previously evaluated by KUB X-Rray and non contrast CT scan. His retrograde-percutanous access to the collecting system was done under fluoroscopic guidance. At the end of procedure, patient revealed taut and distended abdomen. Aspiration revealed presence of intraperitoneal fluid. Patient was effectively treated with immediate placement of abdominal drain with improvement of clinical presentation Conclusion Hydroperitoneum is a rare complication of conventional PCNL. Based on our experience and review of published literature, our case of hydroperitoneum after mini PCNL, is the first of its kind. A high degree of sensitivity and knowledge of this complication during PCNL in children would help identify and manage this complication in future. We recommend examination of abdomen post-PCNL in every child before he/she is brought out of anesthesia.

Role of Dietary Supplements in Prevention of Renal Stones: An Update

Kidney stone disease is an oldest known and widespread medical condition characterised by its high prevalence in all over the world. Literature suggests that around 9–12% of population in industrialised countries have kidney stone disease in their lives with the 30–50% of reoccurrence rate. Because of high prevalence, recurrent and unpredictable nature of stone formation and its predominance mainly in adults contributes to the substantial impact on society, individual and health care system. In light of these trends, it’s imperative to use optimum preventive strategies to reduce the burden of kidney stone disease on individual and society. The aetiology of kidney stone disease is a multifactorial and it’s related to diet, environmental factors, genetics, metabolic syndromes and various life style factors. Its noteworthy that dietary and life style modification are the major contributors in the prevention of kidney stone reoccurrence. Dietary interventions aim to reduce the urinary abnormalities known to promote lithogenesis. Therefore, modification in the dietary factors is appealing way to patients and physicians in the treatment and prevention of stone recurrence as it is relatively inexpensive and safe. So, the present chapter is focusing on the role of dietary supplements in prevention of renal stones.