Complete Staghorn Calculi Research Articles

STUDY OF PERCUTANEOUS NEPHROLITHOTOMY (PCNL) FOR TREATING STAGHORN STONES, ITS OUTCOME, STONE CLEARANCE, INTRA-OPERATIVE, POST-OPERATIVE COMPLICATIONS

Background: In the last two decades the treatment of staghorn stones has changed from traditional open surgery to minimally invasive methods such as percutaneous nephrolithotomy (PCNL) monotherapy and combination of PCNL and ESWL. Present study was aimed to assess the results of percutaneous nephrolithotomy (PCNL) for treating staghorn stones at a tertiary-care center. Material and Methods: Present study was singlecenter, prospective, observational study, conducted in patients > 18 yrs, either gender, cases of partial/ complete staghorn calculus in pelvic calycal system, underwent PCNL. Results: Out of 140 patients, majority were female patients (66%). Common symptoms noted in present study were burning micturition (72.1 %), hematuria (5.7 %), nocturia (5 %), increased frequency (3.6 %), weak stream (2.9 %), straining (2.1 %), incomplete emptying (2.1 %) & urgency (0.7 %). 54.28% patients had urine analysis positive for suggestive of pus cells. 44.1% had urine culture suggestive of growth. 93.6%, 5% and 1.4% patients required 1,2 and 3 are the total numbers of assess site respectively. Intra operatively, 1,2 & 3 calyces punctured in 82.1%, 15.7% and 2.1% patients respectively. 97.9% (137 out of 140) and 2.1% (3 out of 140) had been operated in rst and second stages respectively. In 98.6% patients no complication was reported. 1 patient required blood transfusion and one patient had pleural effusion 12.1% needed secondary look PCNL. 19.3% patients had post-operative fever. 89.3% patients had x-ray suggestive of stone free status and 10.7% had x ray suggestive of residual stones. Conclusion: PCNL is a safe and effective procedure for the management of staghorn renal stones, with outcomes similar to those reported for percutaneous management of smaller volume non-staghorn stones.

Safety and efficacy of prone percutaneous nephrolithotomy (PCNL) in morbidly obese patients.

Objective: To present our experience regarding the safety and efficacy of prone PCNL in morbidly obese patients. Study Design: Observational study. Setting: Armed Forces Institute of Urology, Rawalpindi. Period: February 2018 to February 2020. Material & Methods: After applying inclusion and exclusion criteria, a total of 47 morbidly obese patients undergoing PCNL in prone position were observed prospectively. The demographic data, intraoperative and postoperative outcomes were evaluated. The data were analyzed by SPSS ver. 24. Results: Average age was (46.43±10.41) years with (70.2%) males and (29.8%) females. The mean basal metabolic index (BMI) is (40.47±3.37) kg/m2 and mean stone size was (2.93±0.49 mm). A single stone is seen in twelve patients (25.5%), multiple in sixteen (34.0 %), partial staghorn in nine (19.1 %) and complete staghorn calculus in ten (21.3%) patients. The mean operative time was (83.38±13.20 min), duration of hospital stay (55.94±16.52 hours), stone-free rate (72.3%) and only (27.7%) patients had re-intervention. Calcium oxalate is the most common stone encountered followed by calcium phosphate and uric acid. Intraoperatively, transfusion secondary to bleeding and postoperatively grade 3 clavien-dindo classification is most commonly seen. Conclusion: Prone PCNL is an effective and safe procedure for morbidly obese patients.

Ambulatory percutaneous nephrolithotomy is safe and effective in patients with extended selection criteria.

Ambulatory percutaneous nephrolithotomy (PCNL) has been limited to highly selected patients. The objective of our study was to compare complication and stone-free rates after ambulatory PCNL in standard selection criteria vs. extended criteria patients. We conducted a retrospective review of prospective data on all patients who underwent ambulatory PCNL at one academic center from 2007-2018. Extended criteria patients were defined as one or more of: age >75 years, body mass index (BMI) >30 kg/m2, American Society of Anesthesiologists (ASA) score >2, bilateral stones, solitary kidney, transplant kidney, complete staghorn calculi, stone burden >40 mm, multiple tracts, or prior nephrostomy tubes/stents. Primary outcomes were complication rates (Clavien-Dindo classification) and stone-free rates. We identified 118 patients, of which 92 (78%) met extended criteria. Mean BMI was 31 kg/m2 and 45% were ASA 3 or higher. Mean sum maximum stone diameter was 24 mm. Multiple stones were present in 25%, bilateral stones in 7%, and complete staghorn stones in 4% of patients. There was no difference in complication (12% vs. 18%, p=0.56), emergency department visit (12% vs. 18%, p=0.56), or re-admission (4% vs. 5%, p=1) rates between standard and extended criteria patients, respectively. Of the complications, 85% were Clavien-Dindo grade 1. Stone-free rates were not different between standard (84%) and extended (83%) criteria patients (p=1). No extended criteria variables were associated with complications in multivariable analysis. Complication and stone-free rates were not different between standard and extended selection criteria patients undergoing ambulatory PCNL. This data indicates that many of the preoperative patient and stone factors that have previously been used as exclusion criteria for ambulatory PCNL are not strictly necessary.

Percutaneous nephrolithotomy in patients with spinal cord injury: should all these patients be automatically assigned a Guy's stone score of 4?

To assess the complication and stone-free rates of PCNL in patients with spinal cord injury (SCI) and to evaluate whether this population should be assigned a Guy's stone score (GSS) of 4. A case-control study was conducted, and electronic charts were reviewed to search for patients with SCI, bladder dysfunction, and kidney stones who had undergone PCNL. Control cases were randomly selected from among patients with complete staghorn calculus (GSS = 4). One hundred and seventeen patients were included. Patients with SCI had a significant shorter operative time (119 vs. 141min; p = 0.018). There were no significant differences between the groups in terms of the patients' position, number of renal tracts, bleeding or transfusion rate; however, there was a significantly higher complication rate (23.1% vs. 7.8%; p = 0.009) and a longer hospital stay (5.8 vs. 3.1days; p = 0.002) among patients with SCI. With regards to the stone-free rate in patients with different grades of GSS patients with SCI who had a GSS of 1 had a stone-free rate of 85.7%, while those with a GSS of 2, 3, or 4 had 50%, 50%, and 31.5%, respectively (p = 0.024). Only patients with a GSS of 4 in the SCI group had outcomes that were similar to those of control patients (31.5% vs. 31.6%). Patients with SCI should not be automatically assigned GSS 4. Stone-free rate is related to stone burden in these patients, although they do show a higher complication rate and a longer hospital stay than non-neurological patients.

Anatrophic Nephrolithotomy for The Management of Large Complete Staghorn Calculi

Background: Complete staghorn calculus is a challenging issue in urological practice. Anatrophic nephrolithotomy is a major surgery frequently performed for a large complete staghorn calculus. Current endourological procedures like percutaneous nephrolithotomy or extracorporeal lithotripsy or retrograde intra renal surgery are less effective in the management of complete large staghorn calculi.Objectives: The objective of this study is to assess the safety and effi cacy of anatrophic nephrolithotomy in the management of complete large staghorn calculus diseases.Methodology: Total 25 adult patients with complete staghorn calculi from March 2012 to the fi rst week of Sept 2017 were included in the study and were evaluated for patient demography, operating time, blood transfusion rate, cold ischemia time, hospitalization duration, stone clearance rate and the complications.Results: Twenty five adult patients with the mean age of 36 years (26-73years) and the mean stone size of 50 mm (40- 65mm) underwent anatrophic nephrolithotomy. Fifteen were male patients and 10 female patients. The mean operating time was 156 minutes (130—210 minutes) and the cold ischemia time was 41 minutes (33-54 minutes). Six patients (24%) needed blood transfusion. The duration of hospital stay was 7.2 days (6–11 days). The stone clearance rate was 88 % at the time of discharge and 96 % at three month follow up.Conclusion: Anatrophic nephrolithotomy is a valid and useful approach and is a reasonable alternative in selected patients with complete large staghorn calculi. It can achieve high stone free rate with very low morbidity and low cost. Journal of Kathmandu Medical College,Vol. 6, No. 4, Issue 22, Oct.-Dec., 2017, Page: 140-144

Conservative Management of Staghorn Calculi: When Is It Safe?

To describe the clinical characteristics, infectious and kidney function patterns, and overall outcomes in a cohort of patients with staghorn calculi treated conservatively. Staghorn calculi treated nonoperatively between January 2009 and January 2017 were identified. A retrospective analysis was completed. Twenty-nine patients were identified with a median age of 74 years (interquartile range [IQR] 61-81). Mean follow-up was 24 months. Fifty-nine percent (17/29) had complete staghorn calculi with 6/29 (21%) bilateral. Mean body mass index was 29.4 (IQR 24.8-31.7). Of the 29 patients, 14 were treated conservatively due to comorbidities, 12 refused treatments, and 3 were due to aberrant anatomy. The age-adjusted Charlson Comorbidity Index (CCI) score demonstrated 8 patients in our cohort with a CCI of <3, 11 patients with a CCI of 4 or 5, 7 patients with a CCI of 6 or 7, and 3 patients with a CCI of >8. Overall, kidney function remained stable for 19/29 patients (66%) and the glomerular filtration rate decreased by <10% for 4/29 (14%), by 10%-29% for 2/29 (7%), and >30% for 4/29 patients (14%) over the study period. None of the study patients required hemodialysis. No patients in the cohort developed an abscess, nor were any patients on daily prophylactic antibiotics. There was only one related admission for a complication during the study; this was for pyelonephritis. There were two deaths during the study period. One death was an unrelated cardiac death and the other was from urosepsis; this patient had been noncompliant with follow-up. Outcomes for patients treated conservatively were reasonable in this select group. There is a need for future prospective studies to show whether conservative treatment of these patients is safe.

A contemporary lower pole approach for complete staghorn calculi: outcomes and efficacy.

Percutaneous nephrolithotomy (PCNL) is the preferred surgical treatment for staghorn stones. Two approaches are commonly employed to gain access into the collecting system which consists of either an upper pole (UP) approach or lower pole (LP) approach. However, opinions vary on which approach offers the best access and outcome. In this study, we aim to challenge the traditional paradigm that staghorn stones are most effectively treated through a prone UP approach. We herein report our institutional experience using a prone LP access in PCNL for patients with complete staghorn stones. Data were prospectively collected over 3years on 473 PCNL procedures, of which 76 patients had complete staghorn calculi (five or more calyces). Operative and peri-operative outcomes were analyzed to compare a modified LP approach with the more widely accepted UP approach. A total of 59/76 (77.6%) patients had LP access. There was no difference in the ability of completing the surgery utilizing a single tract as opposed to multiple tracts (74.6% of LP patients vs. 76.5% of UP patients). Stone-free rates for LP and UP access were similar (74.5 versus 70.5%, respectively; p = 0.760. Complication rates were lower for LP access vs. UP access (3.4 vs. 23.5%, p = 0.02) with two pulmonary complications in the UP group. Overall median operative time was not significantlydifferent between LP and UP access (112.0 vs. 126.0min, p = 0.486). Prone LP access demonstrated similar efficacy with decreased morbidity in patients with complete staghorn calculi compared to prone UP access.

Factors affecting stone free rate of primary percutaneous nephrolithotomy on staghorn calculi: a single center experience of 15 years

Objectives: Percutaneous nephrolithotomy on staghorn calculi is challenging for urologists because it is difficult to remove all of the stones. The purpose of this study was to evaluate the associated factors of stone-free rate after primary percutaneous nephrolithotomy on staghorn calculi in a large series of patients at a single, tertiary referral, endourologic stone center. Methods: We collected data from medical record between January 2000 and December 2015. A total of 345 primary percutaneous nephrolithotomy procedures were performed for patients with staghorn calculi. This study included both and made no distinction between partial and complete staghorn calculi. Stone-free is defined as the absence of residual stones after undergoing percutaneous nephrolithotomy for the first time. Significant factors from univariate analysis that correlated with stone-free rate after primary percutaneous nephrolithotomy of staghorn stone were further analyzed using multivariate regression analysis. Results: The mean patient age was 52.23±10.38 years. The stone-free rate of percutaneous nephrolithotomy monotherapy was 62.6%. The mean operating time was 79.55±34.46 minutes. The mean length of stay in hospital was 4.29±3.00 days. Using the chi-square test, history of ipsilateral open renal stone surgery (p = 0.01), stone burden (p = &lt; 0.001), and type of anesthesia (p = 0.04) had a significant impact on the stone-free. From multivariate analysis, the history of ipsilateral open renal stone surgery [OR 0.48; 95% CI 0.28-0.81; p 0.01] and the stone burden [OR 0.28; 95% CI 0.18-0.45; p 0.00] were significant independent risk factors for stone-free.

Factors affecting stone free rate of primary percutaneous nephrolithotomy on staghorn calculi: a single center experience of 15 years

Objectives: Percutaneous nephrolithotomy on staghorn calculi is challenging for urologists because it is difficult to remove all of the stones. The purpose of this study was to evaluate the associated factors of stone-free rate after primary percutaneous nephrolithotomy on staghorn calculi in a large series of patients at a single, tertiary referral, endourologic stone center. Methods: We collected data from medical record between January 2000 and December 2015. A total of 345 primary percutaneous nephrolithotomy procedures were performed for patients with staghorn calculi. This study included both and made no distinction between partial and complete staghorn calculi. Stone-free is defined as the absence of residual stones after undergoing percutaneous nephrolithotomy for the first time. Significant factors from univariate analysis that correlated with stone-free rate after primary percutaneous nephrolithotomy of staghorn stone were further analyzed using multivariate regression analysis. Results: The mean patient age was 52.23±10.38 years. The stone-free rate of percutaneous nephrolithotomy monotherapy was 62.6%. The mean operating time was 79.55±34.46 minutes. The mean length of stay in hospital was 4.29±3.00 days. Using the chi-square test, history of ipsilateral open renal stone surgery ( p = 0.01), stone burden ( p = < 0.001), and type of anesthesia ( p = 0.04) had a significant impact on the stone-free. From multivariate analysis, the history of ipsilateral open renal stone surgery [OR 0.48; 95% CI 0.28-0.81; p 0.01] and the stone burden [OR 0.28; 95% CI 0.18-0.45; p 0.00] were significant independent risk factors for stone-free.

Factors affecting stone free rate of primary percutaneous nephrolithotomy on staghorn calculi: a single center experience of 15 years.

Objectives: Percutaneous nephrolithotomy on staghorn calculi is challenging for urologists because it is difficult to remove all of the stones. The purpose of this study was to evaluate the associated factors of stone-free rate after primary percutaneous nephrolithotomy on staghorn calculi in a large series of patients at a single, tertiary referral, endourologic stone center. Methods: We collected data from medical record between January 2000 and December 2015. A total of 345 primary percutaneous nephrolithotomy procedures were performed for patients with staghorn calculi. This study included both and made no distinction between partial and complete staghorn calculi. Stone-free is defined as the absence of residual stones after undergoing percutaneous nephrolithotomy for the first time. Significant factors from univariate analysis that correlated with stone-free rate after primary percutaneous nephrolithotomy of staghorn stone were further analyzed using multivariate regression analysis. Results: The mean patient age was 52.23±10.38 years. The stone-free rate of percutaneous nephrolithotomy monotherapy was 62.6%. The mean operating time was 79.55±34.46 minutes. The mean length of stay in hospital was 4.29±3.00 days. Using the chi-square test, history of ipsilateral open renal stone surgery ( p = 0.01), stone burden ( p = < 0.001), and type of anesthesia ( p = 0.04) had a significant impact on the stone-free. From multivariate analysis, the history of ipsilateral open renal stone surgery [OR 0.48; 95% CI 0.28-0.81; p 0.01] and the stone burden [OR 0.28; 95% CI 0.18-0.45; p 0.00] were significant independent risk factors for stone-free.

044 - Upper-pole access for PCNL in partial or complete staghorn calculi: Evaluation of effectiveness and safety in a contemporary series

044 - Upper-pole access for PCNL in partial or complete staghorn calculi: Evaluation of effectiveness and safety in a contemporary series

Comparative study of percutaneous nephrolithotomy versus open stone surgery for management of patients with large staghorn calculi

s / Urological Science 26 (2015) S50eS81 S75 success rate. In the multivariate logistic regression of the renal stone group, stone width is the independent factor which affects the success rate. In univariate analysis of the ureteral stone group, only the stone size showed statistically significant. In the multivariate logistic regression of the stone length and stone width of the ureteral stone, only stone length is the independent factor. Conclusion: Stone size is the most important factors influencing the outcome of ESWL both in renal stone and ureteral stone. In renal stone group, the stone width is the major character to affect post-ESWL stone free rate and in the ureteral stone group, the stone length is the major character. NDP096: COMPARATIVE STUDY OF PERCUTANEOUS NEPHROLITHOTOMY VERSUS OPEN STONE SURGERY FOR MANAGEMENT OF PATIENTS WITH LARGE STAGHORN CALCULI Friedrich Bo-Yuan Zhang, Wun-Rong Lin, Jong-Ming Hsu, Huang-Kuang Chang, Wen-Chou Lin, Marcelo Chen. Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan Purpose: Advances in shock wave lithotripsy and endourological procedures have further limited the need for open surgery in the treatment of renal stones. We reviewed our experience of percutaneous nephrolithotomy (PNL)-based therapy with open stone surgery (OSS) to determine the clinical outcomes of these therapeutic modalities. Materials and methods: This retrospective study was conducted at Mackay Memorial Hospitals (Taipei and Tamsui), Taiwan. Hospital and office charts, operative records, and pertinent radiographic studies of all patients undergoing OSS (11 patients) and PNL (61 patients) for the treatment of large staghorn calculi from December 2007 through June 2013 were reviewed. Only patients with stones 10 cm2 or greater were included. Patient characteristics, stone burden, indications, surgical outcomes, and differences between the two procedures were compared and analyzed. Stone-clearance status was confirmed with postoperative kidney, ureter, bladder X-rays. Results: There were no differences between the two groups in patient demographics, stone size, estimated blood loss and mean renal function level change. However, there were statistically significant differences between the groups in mean operative time (282.1± 54.5 [range: 187-340] vs. 156.6± 41.2 [range: 85-285] minutes), mean hospital stay (10.27± 1.79 [range: 8-14] vs. 6.18± 2.71 [range: 2-17] days), postoperative stoneclearance rate (97.5 vs. 76.1%) and number of procedures per patient (1.55 vs. 2.77). Conclusion: In our experience, OSS should still be considered a valid and efficient treatment option for patients with complete staghorn calculi, although PNL is the standard treatment for most cases of renal stones. NDP097: THE USE AND THE PRESCRIPTION PATTERN OF TRADITIONAL CHINESE MEDICINE AMONG UROLITHIASIS PATIENTS IN TAIWAN: A POPULATION-BASED STUDY Jui-Ming Liu , Po-Hung Lin , Shun-Ku Lin . Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan; Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; 3 Institute of Traditional Medicine, School of Medicine, National Yang-Ming University,

Efficacy of endoscopic combined intrarenal surgery in the prone split-leg position for staghorn calculi.

Abstract Purpose: To evaluate the efficacy of endoscopic combined intrarenal surgery (ECIRS) using retrograde flexible ureteroscopy and miniature percutaneous nephrolithotomy (PNL) for the treatment of patients with staghorn calculi in the prone split-leg position. We retrospectively reviewed the records of 42 patients with staghorn calculi (45.8±3.2 mm) who underwent ECIRS using retrograde flexible ureteroscopy and miniature PNL in the prone split-leg position for the treatment of staghorn calculi in our center between December 2010 and August 2013. A flexible ureteroscope with a laser fiber was inserted through a ureteral access sheath, and lithoclast lithotripsy was performed through a mini-percutaneous tract. Both procedures were performed simultaneously by two urologists. Surgical parameters, including surgical time, stone-free (SF) rates, modified Clavien complication grades, and risk factors for residual stones, were analyzed. Fifteen patients (35.7%) had complete staghorn calculi. Among the 42 staghorn calculi treated, 23 had 0 to 5 stone branches, 14 had 6 to 10 stone branches, and 5 had ≥11 stone branches. All procedures were performed successfully using a single lithotripsy tract with the patient in the prone split-leg position. The mean surgical time was 143.2±9.2 minutes. The initial SF rate was 71.4%, and the final SF rate was 83.3% after further treatment. One patient required a blood transfusion (2.4%), but no patient experienced a ≥3 Clavien grade complication. Risk factors for residual stones were stone size, stone surface area, complete staghorn calculi, and the number of stone branches. ECIRS for staghorn calculi in the prone split-leg position is a safe, efficient, and versatile method for the effective management of staghorn calculi without the creation of multiple percutaneous tracts.

Complication and safety of ultrasound guided percutaneous nephrolithotomy in 8 025 cases in China

BackgroundPercutaneous nephrolithotomy (PCNL) was mostly performed with fluoroscopy and/or ultrasonography. The safety and feasibility of PCNL performed totally under ultrasound are not clearly defined. Therefore, we introduce the 9-year experience of 8 025 ultrasound guided PCNL procedures from multiple centers in China performed by the same surgeon, to evaluate the feasibility and security of this technique.MethodsFrom September 2004 to August 2013, 8 025 cases, 4 398 males (54.8%) and 3 627 females (45.2%), whose age ranged from 6 months to 85 years old, with upper urinary tract stones, underwent PCNL in our center and the supported hospitals. Puncture site selection and channel dilation were all guided using only Doppler ultrasound. Single stones were treated in 1 356 cases, there were 2 817 cases of multi stones, and 3 852 cases of staghorn calculi. The pre- and post-operative imaging data, the intraoperative findings, operation time, perioperative complications, and related parameters were recorded.ResultsAll procedures were successful. No patients died during the operation. Average operation time was 42 minutes (range 10 to 168 minutes), 4 cases converted to open surgery, and 2 patients lost the diseased kidney due to refractory bleeding in the early stage of the PCNL. Ninety-four (1.2%) patients received blood transfusions and 20 (0.25%) patients needed highly selective renal artery embolization. Fifteen (0.19%) patients had a pleural injury. 5 457 (68%) cases were completed by a single tract and 2 568 (32%) cases added more tracts. The mean stone size (longest diameter) was 2.8 cm (range 1.2 to 26.5 cm). The final stone-free rate was 85.5%. Residual stones occurred mainly in patients with renal dysfunction, medullary sponge kidney, and complete staghorn calculi with a slim calyceal neck.ConclusionsX-ray free Doppler ultrasound guided percutaneous nephrolithotomy is feasible and safe in a variety of cases of renal and/or upper ureteral stones. The probability of radiation hazard and adjacent organ injury is low. The morbidity from major complications was reduced remarkably after special training. It is worthy of wider use compared with fluoroscopy in patients with special kidneys (e.g. solitary kidney, spinal deformity, ectopic kidney) and in infants.

Traitement en un temps de la lithiase rénale complexe : à propos d’une série moderne de néphrotomies bivalves

Advances in endourology have significantly reduced indications of open surgery in the treatment of staghorn calculi. However, in our experience, open surgery is still the treatment of choice in some cases. This study presents the results of a series of selected patients and discusses the results in terms of efficacy and morbidity. A cohort of 26patients underwent anatrophic nephrolithotomy by lombotomy to treat a complex staghorn calculus. The mean stone size was 68,5mm, 70% were complete staghorn calculi. The operative time was 100minutes. Blood loss was 225mL, with a postoperative transfusion rate of 15.4%. The hospital stay was 8.4days. The stone free rate following the procedure was 92%. The creatinine clearance (MDRD) at 3months was improved from 5.9mL/min/m(2) on average over the entire series. There are clearly still indications for open surgery in staghorn stones management, with good results in this contemporary series on both stone removal and nephronic preservation. Yet, it appears that this technique is no longer taught. 5.

Does the nephrostomy tract length impact the outcomes of percutaneous nephrolithotomy (PNL)?

Different factors can determine the outcomes of percutaneous nephrolithotomy (PNL). We analyzed the effect of tract length (TL) on outcomes after PNL. We performed a retrospective review of patients undergoing PNL between 2006 and 2011. Patients with preoperative computed tomography (CT), one percutaneous access tract and follow-up imaging within 3 months were included. TL was defined as distance between the skin to the calyx of puncture as measured on preoperative CT. Measurements were independently performed by two urologists and the average was used for analysis. Stone-free rate (SFR) was defined as zero fragments on follow-up imaging. Factors independently associated with the likelihood of being stone-free after PNL were determined using multivariable analysis adjusted for TL, location of access, the presence of incomplete or complete staghorn calculi and type of follow-up imaging. Complications (Clavien score) were independently assessed. A total of 222 patients were included. Median stone burden and body mass index (BMI) was 239.4 mm(2) and 30.5 [interquartile range (IQR): 25.7-36.2]. The median TL was 85.0 mm (IQR: 70.3-100.0) and highly correlated with BMI (ρ = 0.66, p < 0.001). A total of 101 patients (45.5 %) were stone-free. TL was not associated with SFR (p = 0.53). Clavien 1 and 2 complications occurred in 38 (17 %) while Clavien 3 and 4 complications occurred in 17 (8 %) patients. Multivariable analysis revealed no association between complications and TL even when adjusted for gender. Percutaneous TL is not associated with outcomes of PNL. PNL is a safe and effective treatment for stones in patients with differing body habitus.

PD36-07 URETEROSCOPY-ASSISTED RETROGRADE NEPHROSTOMY; A 150 CASE EXPERIENCE

You have accessJournal of UrologyStone Disease: New Technology I1 Apr 2014PD36-07 URETEROSCOPY-ASSISTED RETROGRADE NEPHROSTOMY; A 150 CASE EXPERIENCE Takashi Kawahara, Hiroki Ito, Hiroshi Miyamoto, Hiroji Uemura, Yoshinobu Kubota, and Junichi Matsuzaki Takashi KawaharaTakashi Kawahara More articles by this author , Hiroki ItoHiroki Ito More articles by this author , Hiroshi MiyamotoHiroshi Miyamoto More articles by this author , Hiroji UemuraHiroji Uemura More articles by this author , Yoshinobu KubotaYoshinobu Kubota More articles by this author , and Junichi MatsuzakiJunichi Matsuzaki More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2444AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previously introduced a new procedure of ureteroscopy-assisted retrograde nephrostomy (UARN). Since 2011 we have applied this procedure to 150 cases. In this study, we show outcomes of UARN. METHODS Under general anesthesia with epidural anesthesia, patients were placed in a Galdakao-modified Valdivia position. A flexible ureteroscopy (URS) with an inserted ureteral access sheath was inserted into the ureter, while ensuring that the rigid URS does not encounter either ureteral stenosis or ureteral stones. We carefully observed the target calculi and defined the appropriate renal calyx to puncture. Thereafter, a Lawson retrograde nephrostomy puncture wire was set into the flexible URS which approached the desired renal calyx. The route from the renal calyx to the exit skin was confirmed under fluoroscopy. To avoid injuries to the spleen, liver, intestines, and pleural cavity, the puncture was performed after performing ultrasonography. The puncture wire was able to pass through the muscle easily and "tented" the skin at the posterior axially line. The skin was incised, and the needle was then delivered. Next, the dilator was placed by the puncture wire, which was advanced through the skin, subcutaneous fat, abdominal wall musculatue, and perinephic fat until it reached the renal parenchyma. A percutaneous nephron access sheath was passed over the balloon dilator into the calyx under ureteroscopic guidance, and the balloon was removed. RESULTS From April 2009 to August 2013, a total of 150 patients underwent UARN of these, UARN was successfully performed in 116 cases (77.3%). No major or minor complications were observed. This study includes the following complicated cases: complete staghorn calculus (n=8), horseshoe kidney (n=4), incomplete double ureter (n=2), huge obese patients (n=3); patients who underwent urinary diversion (n=1), and patients who underwent anatrophic nehphrolithotomy (n=1). CONCLUSIONS Our results suggest that UARN is a safe and effective procedure. More importantly, UARN can be also easily performed in complicated cases. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e903-e904 Peer Review Report Advertisement Copyright & Permissions© 2014MetricsAuthor Information Takashi Kawahara More articles by this author Hiroki Ito More articles by this author Hiroshi Miyamoto More articles by this author Hiroji Uemura More articles by this author Yoshinobu Kubota More articles by this author Junichi Matsuzaki More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD36-04 RENAL PERCUTANEOUS ACCESS WITH THE URO DYNA-CT

You have accessJournal of UrologyStone Disease: New Technology I1 Apr 2014PD36-04 RENAL PERCUTANEOUS ACCESS WITH THE URO DYNA-CT Fabio Torricelli, Khaled Fareed, Gordon McLennan, Shubha De, and Manoj Monga Fabio TorricelliFabio Torricelli More articles by this author , Khaled FareedKhaled Fareed More articles by this author , Gordon McLennanGordon McLennan More articles by this author , Shubha DeShubha De More articles by this author , and Manoj MongaManoj Monga More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2441AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous nephrolitothomy (PCNL) is the gold standard for surgical management of renal stones >2cm. Renal access may be challenging in cases of complex renal anatomy or large stone burden (i.e. complete staghorn calculi). Herein, we present percutaneous renal access using an Uro Dyna-CT (Siemens Healthcare Solutions, Germany), for high-quality 3-dimensional real-time imaging. METHODS Review of an index patient: 50y/o male presenting with a right partial staghorn and proximal ureteric stone. RESULTS Electing to undergo PCNL, he was referred to radiology for pre-op percutaneous renal access. Two attempts for upper/middle pole NT placement were made (to simultaneously treat lower pole and ureteric stones), however due to the plural reflection and overlying liver a safe puncture tract could not be established. A Uro Dyna-CT was performed by correlating real time fluoroscopic imaging to a simultaneous on-table axial CT scan (Figures 2-3). Delineating a safe window, right middle pole access allowed subsequent PCNL to be performed successfully. CONCLUSIONS In select patients, the Uro Dyna-CT adds simultaneous detailed anatomic imaging to fluoroscopic renal access to improve successful puncture, and reduce potential morbidities. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e902 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Fabio Torricelli More articles by this author Khaled Fareed More articles by this author Gordon McLennan More articles by this author Shubha De More articles by this author Manoj Monga More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Modified Anatrophic Nephrolithotomy "A Salalah Experience"

Anatrophic Nephrolithotomy is a major open Transrenal surgery of the Kidney to extract a Complete Staghorn Calculus of the Kidney in selected situations. The original procedure described by Boyce involved complex dissection of the renal vasculature with selective cannulation and perfusion of the posterior segmental artery with methylene blue. We are presenting our experience of a modified approach of the same procedure, thereby reducing the ischemic time and the morbidity of the original procedure. These modifications have been described in literature and we are presenting our experience of the same with comparable results. It is a highly skilled procedure and a proper case selection, knowledge of the Renal vascular anatomy, adequate surface cooling, is absolutely essential to have a successful outcome devoid of major immediate complications like gross bleeding and hematuria, and delayed complications like Ischemic necrosis with fistula formation and renal Ischemic atrophy. Our complications were easily manageable adopting conservative methods.

Multiple tracts percutaneous nephrolithotomy assisted by LithoClast master in one session for staghorn calculi: report of 117 cases

The objective of the study is to evaluate the safety, efficacy and outcome of multiple tracts percutaneous nephrolithotomy (PCNL) assisted by LithoClast master (the third-generation Electro Medical System) in one session for the treatment of staghorn calculi. From October 2011 to March 2013, 117 patients with staghorn calculi underwent multiple tracts PCNL in our hospital. The combined pneumatic and ultrasonic powered lithotripter (EMS LithoClast master) was used to fragment and remove the calculi. The data were retrospectively analyzed with regard to stone burden, number of tracts, operation time, total operative blood loss, postoperative hospital stay, complications rate, and stone clearance rate. A total of 142 renal units in 117 patients (63 men and 54 women) were treated. Of the 142 renal units, 77 (54.2 %) had complete staghorn calculi, and 65 (45.8 %) had partial staghorn calculi. A total of 416 tracts were established in the 142 renal units. The mean number of tracts used in a single renal unit was 2.8 (range 2-4), most required three tracts. The mean (range) operating time is 72 (55-130) min. The mean (range) duration of postoperative hospital stay is 5.5 (3-9) days. Mean estimated operative blood loss is 150 (60-350) mL. The complications included blood transfusion in 9 (7.7 %) patients, high fever in 12 (10.3 %), sepsis in 5 (4.3 %), hydrothorax in 4 (3.4 %), and pseudoaneurysm in 3 (2.6 %). A complete stone clearance rate of 87.2 % (102/117) was achieved after one session of PCNL. This rate increased to 94.0 % after a secondlook procedure. In conclusion, multiple tracts PCNL assisted by EMS LithoClast master in one session is safe and effective in achieving a great stone clearance rate with acceptable morbidity for the treatment of staghorn calculi.