Nephrostomy-free percutaneous nephrolithotripsy: intraoperative hemostasis methods of the percutaneous tract

Review based on the analysis of more than 40 scientific papers published in the Pubmed and Medline databases from 1984 to 2019, dedicated to intraoperative hemostasis of the percutaneous tract and its tightness during nephrostomyfree percutaneous nephrolithotomy (PCNL). The article aimed to summarize scientific data on this issue. We presented information about the history and development of percutaneous surgery in the treatment of urolithiasis. In our review, we have been demonstrated various methods of surgical and intraoperative hemostasis during nephrostomy-free PCNL.

3D printing in urology as a trend in personalized medicine

Introduction. 3D printing technology is being actively introduced into the urological practice. Apart from improving of patients counselling, this technology allows for improved planning end performance of surgery. Aim of study. To determine the current state of three-dimensional printing in the urological practice. Materials and methods. Embase, Medline, Google Scholar, Scopus databases were searched to find related publications until September 2020. Inclusion criteria were: the availability of the full article, the use of 3D models for teaching patients or residents, and their use in planning and performing surgery on patients over 18 years of age. Results. One hundred and ninety seven publications were included, of which 40 were selected for a further analysis. 11 articles were related to the study of the usefulness of printed models in counseling patients with urolithiasis, planning and training of retrograde lithotripsy and percutaneous nephrolithotripsy. In 20 articles, the printed model was used to counsel patients with renal neoplasms, planning and intraoperative navigation. In 9 papers, the results of the use of printed models in communication with patients with prostate tumor, in improving the determination of its localization and planning of the upcoming surgery were published. Conclusion. The creation of three-dimensional printed models is promising in urology. Despite the current limitations this field is becoming more accessible for both patients and doctors.

A Comparative Study of Percutaneous Nephrolithotripsy and Extracoeporeal Shockwave Lithotripsy For The Treatment of Lower Pole Kidney Stone of Size 10-20 mm

Introduction: A renal stone is commonly found at the Lower-pole of the kidney. Studies have reported various opinions about efficacy and safety of Percutaneous Nephrolithotripsy and Extracoeporeal Shockwave Lithotripsy for the treatment of lower pole stone of size 10-20 mm. Aims: The present study aimed to compare between Percutaneous Nephrolithotripsy and Extracoeporeal Shockwave Lithotripsy for safe and effective treatment of lower pole stone of size 10-20 mm. Methods: It is a prospective study conducted from December 2019 to November 2020 in the Urology Department of Nepalgunj Medical College. Total 66 patients under inclusion criteria were divided into two groups. Group I (32 patients) was allocated for patients who were treated under Percutaneous Nephrolithotripsy while Group II (34 patients) was allocated for patients who were treated with Extracoeporeal Shockwave Lithotripsy. Two groups were compared for stone free rate, retreatment rate, auxiliary treatment (%), operation time, hospital stay, haematuria, blood transfusion, obstruction and fever. Results: The stone free rate was significantly higher in Group I when compared to Group II. While the rate of retreatment and auxiliary treatment were significantly lower in Group I than Group II. However, mean hospital stay, mean operation time and the rate of haematuria was significantly higher in Group I when compared to group II. There were no statistically significant differences between Group I and Group II for post-operative complications such as, blood transfusion, obstruction and fever. Conclusion: Stone free rate was significantly higher in Group I while retreatment rate and auxiliary treatment rate were significantly higher in Group II. Therefore, Percutaneous Nephrolithotripsy is more effective for the treatment of the lower pole stone of size 10-20mm when compared to Extracoeporeal Shockwave Lithotripsy. However, duration of hospital stay and operation time were longer and incidence of haematuria was higher in Percutaneous Nephrolithotripsy than Extracoeporeal Shockwave Lithotripsy.

Percutaneous Nephrolithotripsy in the Position of the Patient Lying on His Back

The objective: evaluation of the effectiveness and safety of percutaneous nephrolithotripsy in patients in the supine position. Materials and methods. For the period 2017–2021, 521 mini-PNL were performed according to the standard technique, where in 458 (87,9%) cases the operation was performed in the patient’s prone position, and in 63 (12,1%) cases on the supine position (group 1). The control group (2 group) consisted of 70 patients, sporadically selected among 458 patients to whom PML performed in a standard prone position. Mini-PNL was performed under combined regional (spinal-epidural) anesthesia in 98,7% (514) cases, in 1,3% (7) under endotrachial anesthesia. Results. The average time of surgery was 41,1±11,4 minutes in the 1st group and 57,4±10,3 minutes in the 2nd group (р<0,05), due to the lack of need to revolutionize the patient on the abdomen. Statistically greater (p<0,05) of the ability to perform/ additional percutaneous access in patients in the supaine position. Infectious complications (9,5 vs. 7,1%; p>0,05), stone-free conditions (96,4 vs. 98,2%; p>0,05) and average hospital stays (2,3 vs. 2,2 days; p>0,05). None of the patients in both groups had complications higher than Clavien IIIa. When performing PNL in the supine position, in contrast to performing PNL on the prone position, there is always the possibility of using combined endoscopic methods. Where 3 (4,8%) patients underwent combined retro- and antegrade approaches for combination of nephrolithiasis with «wedged» calculi of the pyelourethral segment and in distal ureter, and retrograde laser endoureterotomy was performed in one (1,6%) patient. The limitation of our study includes a small sample size and a lack of group randomization. Conclusions. The patient’s position on the supine position, during the implementation of PNL, is a safe technique and can be a particularly attractive option for the category of patients with high anesthesiological risk; in the case of planned simultane (transurethral and percutaneous) interventions on the UMP; in patients who are obese or with severe deformityof the spine.

10 years of micropercutaneus nephrolithotripsy: evolution of method

Introduction. This review describes experience of using micropercutaneous nephrolithotripsy by various authors, history of the development this technology, modern indications, steps of the operation and its modifications, outcomes and comparison with other techniques. Materials and methods. We analyzed the original articles on the following databases: Pubmed, Scopus, Medline in the period from 2011 to 2020, dedicated to microcutaneous nephrolithotripsy. Results. Microperc is the preferred method for kidney stones up to 1.5 cm in size because it is associated with less blood loss, shorter fluoroscopy and hospitalization times, and with a higher rate of nephrostomy-free management. Conclusion. Over the 10 years since the introduction of the practice, micro-percutaneous nephrolithotripsy has been able to evolve from a situational, auxiliary method for the treatment of small stones and / or difficult localization, into the potentially most promising method for removing medium and large sizes stones while minimizing operational risks. However, required further modernization and improvement of the technique to using it into routine practice for the treatment of stones more than 1.5 cm.

The use of tranexamic acid for the prevention of hemorrhagic complications in percutaneous nephrolithotripsy

Introduction. The problem of urolithiasis remains relevant throughout the world. The widespread prevalence of the disease is the reason for the search for new and effective methods of dealing with various complications of surgical treatment in order to improve the efficiency of patient treatment. Materials and methods. The material was searched in the following databases: PubMed, Google Scholar, Scopus by keywords such as Tranexamic acid and percutaneous nephrolithotripsy . When searching in the above databases, 18 articles were found and analyzed. The results of preoperative, intra – and postoperative use of tranexamic acid (TA) in various dosages, and the frequency of the drug use, including the addition of TA to the irrigation fluid, are described. Indicators such as the average level of hemoglobin, the time of surgery, the need for blood transfusion, and the volume of irrigation fluid were evaluated. In all these cases, the control group consisted of patients for whom TA was not used either before the operation or in the postoperative period. Results. The article presents an analysis of the literature data on the correction of hemorrhagic complications by the use of TА. The data on intra- and postoperative hemorrhagic complications of percutaneous nephrolithotripsy (PNLT) and the effect of TА on them are presented. The results of preoperative, intra- and postoperative use of TА in various dosages, and the frequency of use of the drug, including the addition of TА to the irrigation fluid, are described. Indicators such as the average hemoglobin level, operation time, the need for blood transfusion, and the volume of irrigation fluid were assessed. In all the above cases, the control group consisted of patients in whom TА was not used either before the operation or in the postoperative period. Conclusions. The results obtained make it possible to judge the safety and appropriateness of the use of TА in order to reduce the degree of hemorrhagic complications both during the operation and in the postoperative period. Assessment of the hemostatic system and the effect of hemostatic drugs during the surgical treatment of urolithiasis on the upper urinary tract, in our opinion, is a key moment in improving the effectiveness of patient treatment.