Effectiveness and Safety of Percutaneous Nephrolithotomy (PCNL) in Malrotated Kidneys

Background and Aim: The renal stones of any size could be effectively managed through an essential surgical technique known as Percutaneous Nephrolithotomy (PCNL). The large size renal stones with abnormal kidneys imposed additional challenges for PNCL in anomalous kidneys. The present study aimed to evaluate the effectiveness and safety of Percutaneous Nephrolithotomy in malrotated kidneys. Place and Duration: Conducted at Urology department of Mian Gul Abdulhaq Jehanzeb Kidney Hospital Manglawar, Swat for duration of two years (from May 2019 to April 2021). Materials and Methods. This single-centered retrospective study was conducted on 80 patients who underwent percutaneous nephrolithotomy with malrotation kidneys. The individuals with anomalous kidneys and complex calculi were enrolled in this study. These patients had kidneys anomalies such as horseshoe kidneys, crossed fused ectopia, malrotation kidneys, pelvic and complete stone clearance. Posterior or anterior approaches were followed for the procedure after preoperative evaluation in kidney anomalies. Retrograde catheterization was carried out under spinal and general anesthesia with the patients. For all the patients, stone size and clearance were measured. Results: Of the total 80 kidneys anomalies patients, 55 (68.7%) were male and 25 (31.3%) were females. Overall mean age was 35.26 ± 13.51. The stone size varied from 1.3cm to 7 cm. Patients were categorized into two groups based on stone sizes such as group I (1.3-2.5 cm) had 42 (52.5%) and group II (25-7cm) 38 (47.5%) patients. The patients included renal pelvis 19 (23.6%), the pelvic ureteric junction (PUJ) 8 (10%), horseshoe kidneys 2 (2.5%), crossed fused ectopia 9 (11.3%), and malrotation kidneys 3 (3.8%).The stone clearance was completed in 77 (96.3%) patients. The statistically significant factor for complete clearance was the staghorn stone calculus. Conclusion: Percutaneous nephrolithotomy is a safe and effective procedure for large renal stones management in patients of anomalous kidneys. Higher renal stones clearance can be achieved with minimum morbidity by suitable preoperative evaluation and technical experts. Keywords: Malrotated kidney; Nephrostomy, Percutaneous; Nephrolithiasis; Abnormality

Factors associated with urosepsis following percutaneous nephrolithotomy

Objective: To evaluate factors associated with urosepsis after percutaneous nephrolithotomy (PCNL). Materials and Methods: Seventy-six upper tract urinary calculi patients underwent PCNL at Loei Hospital between July 2014 to January 2019, all were enrolled onto the study. The following data were collected: demographics, type and size of stone, intraoperative data, pelvic urine culture and urosepsis complications after the procedure. Association of factors with urosepsis after PNCL were identified using a binary logistic regression model with a bootstrap estimation. Results: Urosepsis complications occurred in 7 patients (9.2%). Mean (SD) of age was 54.4 (10.3) years. Of all patients, 2% with staghorn stone and 22% positive urine culture. Multivariable analysis indicated that staghorn stone (a OR =6.75; 95%CI: 1.59-28.63, p=0.01) and positive pelvic urine culture (a OR =7.51; 95%CI: 1.35-41.77, p=0.02) were associated with urosepsis after PCNL. Conclusion: There was no mortality after PCNL in this study. Staghorn stone and positive pelvic urine culture may be associated with an increased risk of urosepsis complication.

Differences Effectiveness of Percutaneous Nephrolithotomy and Open Surgery in Staghorn Stone Patients: Systematic Review

This study purpose to analyze the differences in the effectiveness of PCNL and open surgery in patients with staghorn stones. We searched the literatures from PubMed and ScienceDirect from year 2005 until 2020. The method used in this study was a systematic review with a quantitative statistical approach (meta-analysis) using primary research data. From 4 studies there were 148 cases of PCNL and 98 cases of open surgery. PCNL had lower postoperative stone-free rate than open surgery (OR 0.168). PCNL had a lower final stone-free rate than open surgery (OR 0.603). The number of patients who had complications with PCNL was lower than open surgery (OR 0.451). The number of patients receiving blood transfusions on PCNL was lower than for open surgery (OR 0.494). Patients who received PCNL procedure required a shorter hospital stay than open surgery (MD -3,234). The number of patients who received additional therapy modalities on PCNL was lower than open surgery (OR 1.917). The conclusions obtained in this study indicate that there are differences in the effectiveness of PCNL and open surgery for patients with staghorn stones. Keywords: percutaneous nephrolithotomy; open surgery; staghorn stone

Gas-Containing Renal Stones: A Case Report and Literature Review

We report the 11th case of gas containing renal stone. A 92-year-old Chinese female presented with fever and lower urinary tract symptoms. Urine culture grew Escherichia coli (E. coli). CT abdomen pelvis showed a large gas containing partial staghorn stone. She was managed conservatively with two weeks of antibiotics. Follow up plain kidney, ureter and bladder (KUB) radiograph at 3 months showed that the stone was stable in size. She remained asymptomatic at follow up.