Amplatz Sheath Research Articles

A new percutaneous nephrolithotomy position in horseshoe kidney: 45 degrees sided prone.

IntroductionIn this study we aimed to determine the effects of the 45 degrees sided prone position to the surgeon’s comfort, operation time, fluoroscopy time and complications at the operation of percutaneous nephrolithotomy (PCNL) for the treatment of kidney stone of horseshoe kidney (HK) or rotation anomaly kidney.Material and methodsThirty eight patients (25 male, 13 female) with renal calculi and HK, underwent PCNL. After the amplatz sheath was inserted into the collecting system, the patients in group 1 (n:20) were taken to the 45 degrees side position to the side of the operation and patients in group 2 (n:18) were operated in classical prone position. Operative data of two groups were compared statistically.ResultsMean stone size of group 1 was 557.8 ±244.8 mm3 (188–1175) and group 2 was 590.7 ±172.8 mm3 (423–909) (p = 0.639). In group 1 mean operation time was 78.6 ±21.8 (45–120) minutes and in group 2 was 95.05 ±11.5 (69–120) minutes. The difference for operation time was statistically significant and shorter in the sided group (p = 0.02).ConclusionsThe working position of rigid nephroscope is 90 degrees to the body after the dorsomedial or dorsolateral access. In our study the position of patient is laterally sided 45 degree and the flexion on the surgeon’s shoulder was minimised. This new position described for PCNL in HK allows comfortable working position for surgeon after upper pole posterior calyces access.

Long-term follow-up and outcomes of percutaneous nephron-sparing surgery for upper tract urothelial carcinoma.

Introduction:Upper tract urothelial carcinoma (UTUC) is uncommon, accounting for 5%–10% of all urothelial carcinomas. Current standard of care for localized disease consists of radical nephroureterectomy (RNU) which leads to loss of half the patient's functioning nephrons. Percutaneous nephron-sparing surgery (PCNSS) is an alternative minimally-invasive approach in selected cases where nephron preservation is desired. The long-term outcomes of this procedure at a single center are described.Methods:All patients undergoing PCNSS, with the operation carried out by a single surgeon, were included. Equipment used was a standard 26Ch resectoscope through a 30Ch Amplatz sheath, with all patients receiving postoperative intrapelvic Mitomycin. Data for each patient were collected on patient age; tumor size at diagnosis; grade; stage; oncological recurrence; requirement for subsequent RNU; and overall survival. Primary outcomes were disease recurrence and overall mortality, and secondary outcome was rate of subsequent RNU.Results:Fifteen patients in total underwent PCNSS, 14 were diagnosed with UTUC; benign leiomyoma was proven in one patient and excluded from final analysis. Overall survival at 5 and 10 years was 92.9% and 78.6%, respectively, with disease-specific mortality at 10 years of 7.1% (one patient who developed metastatic carcinoma); 21.4% of patients had recurrent ipsilateral UTUC and all required subsequent RNU for this indication. No patients had seeding of the percutaneous tract.Conclusion:PCNSS for UTUC is a feasible approach to consider in carefully selected patients who agree to intensive follow-up, even for higher grade tumors. Where recurrent UTUC occurs, further management options still exist for disease treatment.

Safety and efficacy of supracostal superior calyceal approach for percutaneous renal surgery.

Supracostal access is avoided for fear of potential intrathoracic complications and subcostal approach is favored as it carries minimal or no risk of intrathoracic complication. The aim of this study was to evaluate safety and efficacy of supracostal approach for percutaneous renal surgery. A total of 60 cases were enrolled and studied prospectively in this study. The patients had upper (n=10), and lower (n=12) calyceal, pelvic (n=12), proximal ureteral (n=14) stones, and pelviureteric junction obstruction (n=12). All the punctures were made by urologist under fluoroscopy. All the punctures were made between 11th and 12th ribs (supra-12th); none of the punctures was made above 11th rib. The overall complication rate in our study was 26.7%. Four patients (6.7%) had pleural rupture and all the four presented with hydrothorax. The other complications included intraoperative hemorrhage in 1 (1.7%), and pelvic perforation in 1 patient (1.7%), Amplatz sheath migration/loss of tract was detected in 1 (1.7%), postoperative fever in 2 (3.3%), prolonged hematuria in 3 (5%) and residual disease in 4 (6.7%) patients CONCLUSION: Supracostal approach should be used whenever indicated which was found to be both effective and safe as far as intrathoracic and other complications are concerned.

Retrograde-Assisted Percutaneous Cystolitholapaxy Versus Transurethral Cystolithotripsy With Holmium-YAG Laser: A Retrospective Study.

Introduction: The retrograde approach is a modification that makes the percutaneous cystolitholapaxy (PCCL) a more trendy method, especially in operating rooms with limited facilities. The transurethral approach for bladder calculi lithotripsy by a laser has become popular among urologists. In this study, we investigate the feasibility and safety of retrograde assisted access for PCCL in comparison with transurethral cystolithotripsy by the holmium-YAG laser (Ho: YAG). Methods: According to the type of intervention, the patients were stratified to two matched groups. In the retrograde-assisted percutaneous cystolitholapaxy (RPCCL) group, a Benique was conducted through the urethra into the bladder; palpating the suprapubic region, an about 1.5 cm incision was done over the tip, then an Amplatz sheath was placed over it, treading into the bladder; further cystolitholapaxy was done by a routine order. In transurethral Ho: YAG laser lithotripsy (TULL) via 200 µm fiber vaporize the stone. Results: A total of 124 male patients with the mean age of 50.33±9.64 years and the average stone burden of 3.35±1.07 cm were included in the study. The most common cause of vesical calculi was spinal cord injury. Statistically significant differences were found in terms of the mean operation time in favor of the RPCCL group (P≤0.05) and the mean hospital stay in favor of the TULL group (P≤0.05). The stone-free rate (SFR) was 100% in both methods after a onemonth follow-up. None of the interventions changed to open surgery. There were not any major complications in both methods. Conclusion: RPCCL is a safe and effective method in bladder stone treatment and is applicable in medical centres without Ho: YAG equipment.

Predictive Factors for Post-Operative Bleeding in Percutaneous Nephrolithotomy.

Introduction: Post-operative bleeding is a serious complication necessitating prompt attention inPercutaneous Nephrolithotomy (PCNL). A number of factors dictate the severity of post-PCNL bleeding.Identification of these risk factors helps prevent bleeding complications. Methods: In this observationalcross-sectional study, a total of 126 patients with renal stones >10mm or stag-horn stones underwent PCNL.All the relevant pre- and intra-operative factors were noted and analyzed. Hemoglobin differences betweenpre- and post-operative levels were considered for the evaluation of blood loss. Univariate and multivariablelogistic regression analysis was done. The strength of association was examined using Odds Ratio and95% confidence intervals derived from the logistic regression. A p value <0.05 was considered statisticallysignificant. Results: The mean age of the patients was 31.9 ±4.47 years. The mean drop in hemoglobinwas 1.83 ±0.98 gm/dl. Age, stone size, number of tracts, size of Amplatz sheath and number of stonessignificantly affected the blood loss in univariate analysis. Among the variables mentioned above only, thenumber of stones could maintain the significance in multivariable analysis (p<0.05). The number of stonesincrease the risk of bleeding post PCNL by 4.4 times. Conclusion: Stone size, number of tracts, size ofAmplatz sheath and the number of stones significantly affect the blood loss post PCNL. Identification ofthese risk factors should be considered for minimizing bleeding in PCNL.

Management of Large Proximal Ureteral Calculi: A Three-year Multicenter Experience of Simultaneous Supine Percutaneous Nephrolithotomy and Retrograde Ureterolithotripsy.

To share our multicenter experience using a safe and effective method for treating large proximal ure-teral calculus by simultaneous supine percutaneous nephrolithotomy (sPCNL) and retrograde ureterolithotripsy (URSL) in the Galdakao-modified supine Valdivia position. Between December 2014 and August 2017, all patients with large proximal ureteral stones (> 15 mm) who underwent simultaneous sPCNL and retrograde URSL at three medical centers were retro-spectively reported. The ureter stone was pushed back (retrograde) with the ureteroscope and was retrieved using forceps with a nephroscope through an Amplatz sheath. Surgical methods and outcomes were described to improve our experience and management of large proximal ureteral calculi. A total of 31 patients underwent simultaneous sPCNL and retrograde URSL. The mean patient age, stone size, operating time, and postoperative hospital stay were 57 years (range, 32-74 years), 20.1 mm (range, 15.0-37.9 mm), 81 minutes (range, 30-150), and 3.2 days (range, 2-7 days), respectively. There were 10 modified Clavien grade I and five grade II complications. No blood transfusions were necessary in this series. All patients were treated with double-J stents without a nephrostomy tube. Only one patient did not achieve stone-free status because of the strict stone impaction into the ureteral wall. This patient received auxiliary URSL after two months. Thereafter, the overall stone-clearance rate at three months was 100%. Our preliminary data showed that this modified method is safe and effective for treating large prox-imal ureteral stones.

P082 - Efficacy and safety of different amplatz sheath sizes used in pediatric PCNL: A single center experience

P082 - Efficacy and safety of different amplatz sheath sizes used in pediatric PCNL: A single center experience

Percutaneous cystolithotripsy in children and its outcome: A single center experience

Background: Pediatric bladder stone disease is very common in certain regions of India. Traditionally, pediatric surgeons have been managing this by open surgeries. Aim: The aim of the study was to manage vesical calculus in children by percutaneous cystolithotripsy (PCCL). Materials and Methods: All the children up to 18 years of age suffering from vesical calculus were operated by PCCL. Cystoscopy performed first to assess the stone burden. 18 Fr angiocath needle was used to puncture the bladder under vision and 0.035 guide wire was passed. Tract was dilated using single-step screw dilator; a 20 French Amplatz sheath was passed over the screw dilator and nephroscope was introduced. Lithotripsy was done using pneumatic lithotripter. Per urethral Foley catheter was placed and suprapubic puncture site was suture closed. Results: A total of 74 patients were operated in the past 3 years with an age range was 1–18 years with female preponderance. Complete clearance was achieved in all patients while the average duration of surgery was 30 min with range of 15–50 min. All the patients were operated under regional anesthesia and were discharged the next day. Among the study population, three patients had superficial wound infections at the puncture site which was managed conservatively. Conclusion: PCCL is a good option for managing vesical calculus in children. It has minimal morbidity and very small scar as compared to open cystolithotomy. Even in recurrent stones, it can be effectively performed, and in fact, it is easy to learn and reproducible.

COMPARATIVE STUDY OF LITHOTRIPSY AND MINIPERC IN 11 TO 18 MM IMPACTED PUJ CALCULI

Background: Impacted PUJ calculi are well known entity. Nephrolithiasis is a common disorder that accounts for significant cost, morbidity, and loss of work. Over last 3 decades considerable advances have been made in the management of kidney stone disease, still there is no single universally accepted and uniformly effective modality of treatment in medium size of impacted PUJ calculi. Aim: To study the efficacy of lithotripsy and MINIPERC in 11mm to 18mm impacted PUJ calculi. Methodology: The patients with impacted PUJ calculi of size 11 to 18mm of both sexes of all age group varying form 18-60 years, on consecutive sampling method total 84 patients were included. All patients underwent basic lab investigations, USG, IVU and investigations for fitness purpose. Group 1: All procedures were tubeless. We used 15 Fr Richard Wolf nephroscope for the procedure. 16 to 20 Fr Amplatz sheath was used depending upon situation. Fragmentation was performed using pneumatic lithoclast or holmium Laser depending upon stone size and characteristics. Group 2: Underwent DJ stenting under subarachnoid block or short GA depending upon situation. On the next day they were subjected for lithotripsy on Dorniel alpha machine under USG guidance, 3000 shocks were given in each sitting. One to three such sittings were given. Post operatively ultrasonography and X-ray KUB was done in all the patients and stents were removed after assuring complete clearance. Patients with absence of stone or presence of stone less than 4 mm on USG or x-ray KUB were declared as completely cleared. Results: Average hospital stay was 48 hours in miniperc group and it was 30 hours in DJ with ESWL group. Clearance rate was 100 % in Miniperc group and it was 85.71 % in DJ with ESWL group. Five patients (11.9%) in DJ lithotripsy group required another procedure. (Two needed miniperc and three needed URS). Two(4.76 %) patients in miniperc group had fever in post op period but nobody suffered major sepsis. Conclusion: Miniperc fulfils many criteria if we see results and complications. Although bigger sized multicentric study and long term follow up is needed.

Predicting surgical outcome of pediatric percutaneous nephrolithotomy

Purpose: The aim was to evaluate the outcome of pediatric percutaneous nephrolithotomy (PCNL) guided by Guy’s stone score grading system. Patients and methods: This was a prospective study of children with renal calculi more than 2 cm. They were younger than 18 years and were a candidate for PCNL at our University Hospitals from January 2013 until July 2016. All of them had a low-dose noncontrast enhanced computed tomography. The procedure was performed under general anesthesia with the patients in the prone position guided by fluoroscopy. The stone-free rate and the presence and type of complications were estimated. The demographic and clinical data, stone characteristics, radiologic anatomy as well the PCNL approach and methods of lithotripsy used were evaluated. Comparison was performed through using univariate and multivariate analyses, and factors predicting the PCNL outcome were determined. Results: A total of 110 children with kidney stones were accepted for PCNL. Overall, 95 (86.3%) of 110 children were stone free after one-stage PCNL. Grade 1 Guy’s stone score was 97.5% (40/41) ( P <0.05). Mean hospital stay was 4.01 ± 2.0 days. Operative complications include bleeding in 12 (10.9%), extravasation in seven (6.4%), injury to the colon in one (0.9%), and renal pelvis perforation three (2.7%). In our study, larger Amplatz sheath, stone burden, and longer operative time are related to complications. Conclusion: Guy’s stone score correlated with both success and complications and can be used for decision making preoperatively in pediatric PCNL. Keywords: Guy’s stone score, minimally invasive, percutaneous nephrolithotomy, pediatric, urolithiasis

Simultaneous antegrade and retrograde endoscopic surgery for benign prostatic hyperplasia with vesical calculi – A single-centre experience

ObjectiveTo describe the effectiveness and safety of our novel technique of simultaneous percutaneous cystolithotripsy with transurethral resection of prostate (TURP) for patients with benign prostatic hyperplasia (BPH) complicated with large vesical calculi. Patients and methodsThis was a retrospective analysis of 25 patients who underwent simultaneous percutaneous cystolithotripsy with TURP between January 2012 and January 2016. Technique: A 28-F Amplatz sheath was inserted percutaneously into the bladder after sequential dilatation under cystoscopic guidance. Percutaneous cystolithotripsy using a nephroscope and pneumatic lithoclast was then performed simultaneously along with monopolar TURP. Preoperative parameters reviewed included: patient’s symptoms, International Prostate Symptom Score, uroflowmetry pattern, prostate volume, and stone burden on ultrasonography of the abdomen and pelvis. Postoperative parameters analysed included: duration of irrigation, time until catheter removal, length of hospital stay, and complications. ResultsThe mean age of the patients was 67.8 years. The mean prostate size was 62.28 mL and the mean stone burden was 3.18 cm. The mean operating time was 54.2 min. The mean time until catheter removal was 3.2 days. ConclusionSimultaneous percutaneous cystolithotripsy with TURP in patients with BPH with large bladder calculi is safe and feasible.

Paediatric cystolitholapaxy through the Mitrofanoff/Monti channel

Bladder calculi are a known complication of bladder augmentation. Open cystolithotomy remains the preferred option for treating large or multiple stones. Increasingly, however, minimal access techniques have been used. Reports of Mitrofanoff cystolitholapaxy are rare and have been limited to adults. This study presented a two centre series of children treated by cystolitholapaxy via the Mitrofanoff/Monti channel. With institutional approval the current study retrospectively reviewed and identified 14 patients, on a prospective database, who underwent Mitrofanoff cystolitholapaxy to treat bladder calculi at two independent institutions in the UK and Chile between 2004 and 2016. It looked at patient demographics, surgical technique, stone clearance and recurrence, as well as leak or catheterisation difficulties of the Mitrofanoff/Monti channel post-procedure. Fourteen patients underwent Mitrofanoff cystolitholapaxy during the period 2004-2016. One patient was excluded due to lack of follow-up. The remaining 13 patients were aged 5-22 (median 14) years at the time of the procedure. Their underlying diagnoses were four neuropathic bladders, four bladder exstrophy, four cloacal exstrophy and one posterior urethral valve. Patients underwent augmentation cystoplasty at a median age of 5 (range 1-15) years, using ileum in 10 and sigmoid colon in three. The channel for clean intermittent catheterisation was an appendix Mitrofanoff in nine and a Monti channel in four. An Amplatz sheath was placed through the Mitrofanoff to allow safe access to the bladder for treating the stones (see Summary Table). Recurrent stones were treated using the same technique. Stone and channel outcomes were analysed for each procedure. There were 22 procedures in 13 patients; five (38%) patients had recurrent stones. Median time to recurrence was 6 months. There were no immediate complications. Stone clearance was confirmed by ultrasound and abdominal x-ray at 3-6 months after the procedure. Median follow-up was 15 (range 3-53) months. There were no leaks or difficulties catheterising the channel on follow-up. This was the first series of Mitrofanoff/Monti cystolitholapaxy for the treatment of calculi in augmented bladders of paediatric patients. Previous concerns about damaging the continence mechanism of the conduit appeared to be unwarranted. The use of an Amplatz sheath protected the continence system from repeated instrumentation, and permitted free backflow of irrigation and rapid clearance of stone fragments. Recurrence of stones occurred in 38%, which was in keeping with rates reported in the wider literature. Mitrofanoff cystolitholapaxy was safe, and with appropriate care did not result in leakage or difficulty catheterising.

Choosing the appropriate size of Amplatz sheath during percutaneous nephrolithotomy-a novel method

To choose appropriate size Amplatz sheath during percutaneous nephrolithotomy (PCNL) based on retrograde pyelogram. We performed standard PCNL in prone position in 20 patients. All these patients had placement of appropriate size of Amplatz sheath based on retrograde pyelogram images. All patients had nephrostomy tubes postoperatively. The preoperative and postoperative renal parameters, hemoglobin, mean operating time and mean hospitalisation stay were measured. There was no significant difference between the pre-operative and postoperative hemoglobin and creatinine levels. Median operating time was 60.5 mins (45 to 98 mins). The median hospitalisation stay was 4.6 days (3 to 7 days). There was no intraoperative pelvic wall or infundibular injury. Choosing correct size of Amplatz sheath lowers the incidence of kidney hemorrhage and renal function impairment.

Laparoscopic-Assisted Percutaneous Nephrolithotomy for Large Stone in the Pelvic Kidney

Introduction and Objectives: The pelvic kidney is the most common form of renal ectopia. An anomalous blood supply and a tortuous ureter with high insertion can lead to poor drainage of urine and formation of calculi. The management of stone disease in ectopic kidneys is very challenging. We report our technique of laparoscopic-assisted percutaneous nephrolithotomy (PCNL) in a 37-year old male patient, who was referred to our department with an ectopic malrotated right kidney containing a 17 × 15 mm sized calculus in the renal pelvis. The patient had previously undergone a flexible ureterorenoscopy during which the stone could not be reached due to difficult angulation. Methods: A computed tomography (CT) with three-dimensional (3D) reconstruction was performed preoperatively to identify the location of the stone and delineate the anatomy of the surrounding structures, including the blood vessels. Under general anesthesia, cystoscopy and pyelography were performed and a retrograde ureteric occlusion balloon was placed. The patient was then placed in the left lateral position and laparoscopy was performed. After mobilization of the large bowel, the kidney was identified and further exposed. The safe area in the lower pole was selected to puncture, taking into consideration the anatomy of renal vasculature. Contrast was used to opacify the renal system, and using fluoroscopy, a puncture needle was introduced to puncture the lower calix. A hydrophilic guide wire was initially inserted, and this was changed to an extra stiff guide wire over an access catheter. The guide wire was coiled in the upper calix. It was not possible to bring the wire into the ureter and bladder due to difficult anatomy. The tract was then dilated with the help of a balloon dilator and a 30F Amplatz sheath was placed. Once the guide wire was in place, we partially deflated the pneumoperitoneum and this helped us to use a normal-sized sheath and instruments for working. All the above steps were performed using fluoroscopic guidance under direct vision by laparoscopy. A nephroscope was used through the sheath. The stone was identified and fragmented using a handheld pneumatic lithotripter. All the fragments were removed using a tipless basket. At the end of the procedure, a Malecot nephrostomy tube was inserted through the tract over a guide wire. The ureteric balloon catheter was then removed with subsequent placement of a urethral catheter. After this, we again looked at the kidney for any bleeding and Surgicel® Fibrillar™ (Ethicon U.S., LLC, Somerville, NJ) was placed as a haemostatic agent. A percutaneous intraperitoneal drain was placed in the perinephric area and we did not try to retroperitonealize the kidney. The total operation time was 170 minutes. The blood loss was not significant. Results: The surgery was uneventful without any immediate perioperative complications. The urethral catheter was removed on the first postoperative day. A check plain X-ray of the abdomen (KUB) showed complete stone clearance. No nephrostogram was performed, and the nephrostomy tube was removed on the second day. The intraperitoneal drain was removed on the third day, and the patient was discharged from hospital on the fourth day. Conclusion: In our experience, laparoscopic-assisted PCNL is a safe and technically feasible procedure for the treatment of stone disease in ectopic kidneys. It is an attractive minimally invasive alternative to open pyelolithotomy. In experienced hands, it can achieve good stone clearance without any complications, especially in patients with a large stone burden or failed retrograde intrarenal surgery. However, the procedure should not be taken lightly due to the frequently associated anomalous anatomy and blood vessels. CT angiogram and 3D reconstruction is essential. Access and control of the renal vessels in the laparoscopic phase of the procedure is the key to effective and safe outcome. No competing financial interests exist. Runtime of video: 7 mins 38 secs

V11-04 DUSTING UTILIZING SUCTION TECHNIQUE (DUST) FOR PERCUTANEOUS NEPHROLITHOTOMY: DEDICATED LASER HANDPIECE TO TREAT A STAGHORN STONE

You have accessJournal of UrologyUrolithiasis1 Apr 2017V11-04 DUSTING UTILIZING SUCTION TECHNIQUE (DUST) FOR PERCUTANEOUS NEPHROLITHOTOMY: DEDICATED LASER HANDPIECE TO TREAT A STAGHORN STONE Khurshid Ghani and William Roberts Khurshid GhaniKhurshid Ghani More articles by this author and William RobertsWilliam Roberts More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2993AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Dusting, use of high frequency and low pulse energy holmium laser settings, is performed during ureteroscopy but reports on this method to treat complex renal calculi via percutaneous nephrolithotomy (PCNL) are limited. We report the first clinical feasibility of a dusting technique during PCNL with the assistance of a specially designed laser suction handpiece (LSHP). METHODS We performed PCNL on a patient with spinal cord injury, urinary tract infection and a computed tomography scan demonstrating a left complete staghorn stone (5x3.5x2.5 cm; 1000 Hounsfield units). Prone PCNL was performed via a 30 Fr Amplatz sheath with access in the lower pole. A 120-Watt holmium laser (P120H, Lumenis) was used as the lithotripsy source to perform Dusting Utilizing a Suction Technique (DUST) for PCNL. A 550um laser fiber was inserted into the LSHP (Lumenis, Israel) which was connected to a suction pump in the P120H. The LSHP weighs 135 grams, and has a stainless steel cannula with an inner lumen diameter of 3.25 mm. Laser fiber length is controlled via a manipulation wheel, with the fiber positioned in a working channel on top of the cannula. Suction is activated on the LSHP, and fragments are sucked into a collection container. We used ″automatic″ mode where suction occurred only during laser activation. RESULTS We successfully performed DUST-PCNL using settings of 0.6 J x 70 Hz, and 1.0 J x 60 Hz, both on long pulse mode. PCNL took 110 minutes to complete; total lasing time was 21.29 mins, and laser energy usage was 47.68 kJ. The fiber tip was easily visible at the tip of the LSHP, with no failure of the device. We did not encounter any difficulty with fragment aspiration or clogging of the steel cannula or suction tubing. Ancillary devices included a basket to retrieve large fragments, and flexible nephroscopy was performed to dust an upper pole branch of the staghorn. At the end, a 22F Malecot re-entry tube was placed. A nephrostogram on post-operative day (POD) 1 demonstrated a 4 mm residual fragment. Patient was discharged on POD 2. There were no complications; stone analysis demonstrated a struvite stone. CONCLUSIONS Utilizing a 120-Watt holmium system, we confirmed initial clinical feasibility and safety of DUST-PCNL to perform simultaneous lithotripsy and aspiration for effective stone clearance. An advantage of this method is versatility in treating a stone with both rigid and flexible endoscopy using a lightweight energy source. Further clinical evaluation is needed to understand the efficacy of this technique in comparison to alternate lithotripsy sources. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1283 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Khurshid Ghani More articles by this author William Roberts More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Percutaneous nephrolithotomy; alarming variables for postoperative bleeding

ObjectivesTo evaluate factors contributing to bleeding after percutaneous nephrolithotomy (PCNL) and ways of managing this complication, as bleeding is a serious sequela that requires prompt management. Patients and methodsThe demographic and procedural data of 200 patients, who underwent unilateral PCNL during a 20-month period, were prospectively collected. Preoperative, operative, and postoperative details were recorded. The preoperative variables analysed included: age, sex, body mass index (BMI), the presence of hypertension, diabetes mellitus, serum creatinine, degree of hydronephrosis, previous ipsilateral open renal surgery, stone size and complexity. The operative variables analysed included: number of tracts, operative time, size of Amplatz sheath, type of anaesthesia, and complications such as calyceal and pelvic perforation. ResultsThe variables of age, sex, BMI, diabetes, hypertension, and a preoperative creatinine level of >1.4mg/dL had no significant effect on blood loss (all P>0.05). However, the rate of bleeding was significantly higher (P⩽0.05) in patients who had a history of previous open renal surgery, intraoperative pelvicalyceal perforations, and Guy’s Stone Score (GSS) grade 3 and 4 complex stones; however, absence of hydronephrosis, larger stone size, operative time (>83min), more than one puncture, and size of the Amplatz sheath (26–30 F) did not maintain their significance in multivariate analysis. ConclusionAccording to our present results stone complexity (GSS grade 3 and 4), history of ipsilateral renal stone surgery, and occurrence of intraoperative pelvicalyceal perforation are alarming variables for post-PCNL bleeding.

Percutaneous Nephrolithotomy Using Split Amplatz Sheath: A Randomized Clinical Trial.

To compare the outcome of percutaneous nephrolithotomy (PCNL) using split or intact Amplatz sheath. Seventy two patients who underwent PCNL were randomly divided into two groups; PCNL using intact (group 1) and split (group 2) Amplatz sheath. Preoperative data, operative time, largest extracted stone size, fluoroscopy and lithotripsy time, and serum biochemistry tests before and after PCNL were evaluated. Preoperative features and stone size were not significantly different between the groups. There were no significant differences in complications and postoperative changes in hemoglobin and serum electrolytes. Stone free rate in group 2 (88.1%) was insignificantly higher than group 1 (83.3%) (p = .05), but in staghorn stones and stones larger than 1000 mm2, stone free rate in group 2 was significantly higher than group 1 (82% vs. 72%). The mean extracted stone size in group 2 (150 &plusmn; 49) was significantly larger than group 1 (40 &plusmn; 16 mm2) (p &lt; .005). The mean operative, lithotripsy and fluoroscopy times were significantly longer in group 1. Using split Amplatz sheath in PCNL facilitates extraction of larger stone fragments which could contribute to shorter fluoroscopy, lithotripsy and operative times.&nbsp.

V6-04 FULL IMMERSION SIMULATED PERCUTANEOUS NEPHROLITHOTOMY USING 3D PRINTING TECHNOLOGY

flexible nephroscope. The technique requires pressure irrigation to 300mmHg and an Amplatz sheath to allow free egress of the fragments. J-wire is particularly useful for calyces that are difficult to reach with the rigid nephroscope and allows for quick and atraumatic removal of small fragments. J-wire also allows relocation of stone fragments to a position that can be easily reached with a rigid nephroscope and lithotriptor. CONCLUSIONS: Techniques demonstrated in this video can aid in improving PCNL stone clearance.

A novel drainage technique during micropercutaneous nephrolithotomy in pediatric patients: double angiocath

Micropercutaneous nephrolithotomy (microperc) is a recently introduced percutaneous nephrolithotomy (PNL) technique that has the smallest tract size. The absence of an amplatz sheath during the microperc technique is a fundamental difference that distinguishes it from all other types of PNL (standard, mini, ultramini). Increasing of the intrarenal pelvic pressure (IPP) was demonstrated by the authors in adult patients but this problem may be even more serious in pediatric patients. Previously, the authors defined the use of a 14 gauge angiocath needle and sheath (microsheath) during microperc surgery for pediatric patient to reduce the IPP. In this novel technique, a second angiocath is used to access the renal collecting system to drain fluid during surgery. This technique is more effective in reducing IPP during microperc, especially in pediatric patients.

Ultra-mini-percutaneous nephrolithotomy: A minimally-invasive option for percutaneous stone removal.

Introduction:Percutaneous nephrolithotomy (PCNL) has witnessed rapid advancements, the latest being ultra-mini-percutaneous nephrolithotomy (UMP), which makes the use of 11–13F sheaths as compared to 24–30F sizes used in conventional PCNL. This miniaturization aims to reduce morbidity and improve patient outcomes. We evaluated the safety and efficacy of UMP and report our ourtcomes.Patients and Methods:A total of 120 patients underwent UMP from July 2012 to March 2014. These patients had a single unilateral renal stone measuring between 8 and 20 mm. All patients underwent UMP using a 3F nephroscope, 7.5F inner sheath, and 11F or 13F outer metallic cannula, which served as the Amplatz sheath. Stone fragmentation and clearance were achieved with holmium laser. No nephrostomy or stent was used routinely.Results:Complete stone fragmentation was achieved in 114 out of 120 patients (95%) using UMP; whereas the remaining 6 were converted into mini-PCNL using a 12.5F nephroscope and 15F Amplatz sheath. The mean operative time was 39.7 ± 15.4 min, and the mean postoperative hospital stay was 22.3 ± 2.2 h. Postoperatively, 6 (5%) patients had residual fragments measuring ≤4 mm. At the 2 weeks follow-up, the stone-free status was >99% (119/120). There were no significant postoperative complications.Conclusion:This study shows UMP to be an effective and safe procedure for managing stones up to 20 mm. This procedure offers an attractive alternative to shock wave lithotripsy and retrograde intrarenal surgery for managing small stones.