Conventional Percutaneous Nephrolithotomy Research Articles

Comparison of safety and efficacy of tubeless vs. conventional mini percutaneous nephrolithotomy in patients with Escherichia coli bacteriuria.

To evaluate the safety and efficacy of tubeless percutaneous nephrolithotomy (PCNL) in patients with Escherichia coli (E. coli) bacteriuria. We conducted a retrospective review of 84 patients with E. coli bacteriuria who underwent PCNL. Patients were divided into two groups according to whether a nephrostomy tube is placed at the end of the procedure. Preoperative clinical data, surgical outcomes, and postoperative complications were compared. Then, regression analysis of factors predicting success rate of PCNL in patients with E. coli bacteriuria was performed. After PCNL, residual fragments ≤ 4mm were considered as success. At baseline, the two groups were similar with regard to age, gender, BMI, underlying disease, hydronephrosis, stone characteristics, and urinalysis. Postoperative fever occurred in 1 patient (3.8%) in the tubeless PCNL group, and in 5 patients (8.6%) in the conventional PCNL group (p > 0.05). There were no significant differences in terms of successful rate, decrease in hemoglobin, pain scores, blood transfusion, and hospitalization expenses. However, the tubeless PCNL group had significantly shorter operative time (60 vs. 70min, p = 0.033), indwelling time of catheter (2 vs. 4 days, p < 0.001), and hospital stays (3 vs. 5 days, p < 0.001) than the conventional PCNL group. In the analysis of factors predicting success, the stone diameter, stone burden, and operative time were associated with success rate of PCNL. It is safe and effective to perform tubeless PCNL in patients with E. coli bacteriuria. Compared to conventional PCNL, tubeless PCNL accelerates patient recovery and shortens hospital stays.

Supine versus prone percutaneous nephrolithotomy in management of patient with complex renal stone diseases.

Compare the surgical outcomes, safety, stone free rate, hospital stay, and complication of prone and supine PCNL in case of complex renal stone. This is an observational study conducted in our institute, it consist of 120 patients over the period of 2 years from July 2021 to June 2023, all the patients were divided into two groups: 60 patients underwent modified supine percutaneous nephrolithotomy (PCNL) and remaining 60 patients underwent standard prone PCNL. The measured data included operative time, number of punctures, blood loss, stone-free rate, length of hospital stays, and rate of complications. The two groups were comparable in mean age, male to female ratio, number of punctures, number of tract, size of tract, residual calculi in follow up period, blood transfusion, re-do surgery, chest complication, hospital stay, and postoperative fever and pain. The mean operating time was 1.59 h in supine PCNL and 2.49 h in prone PCNL. The p value was significant (p = 0.001). By this study we observed that the supine PCNL is associated with statistically significant reduced operating time as compared to conventional prone PCNL with advantages of not putting the patient in prone position. The postoperative complications such as pain and fever were not significant when compared in both groups. We conclude our study and found that, the supine PCNL is an equally effective in treating complex renal stone as compared to prone PCNL.

A comparative analysis of the efficacy and safety of mini-percutaneous nephrolithotomy performed in the supine and prone positions for the treatment of pediatric kidney stones: a single-center experience.

Mini-percutaneous nephrolithotomy (MPCNL), which has a smaller tract size (14-20 Fr) than conventional percutaneous nephrolithotomy, has been shown to be safe and effective in pediatric patients with large and complex upper urinary tract stones. This study aimed to compare the efficacy and safety of MPCNL between the supine and prone positions in a pediatric population. The data of pediatric patients who underwent MPCNL at our center between January 2010 and March 2023 were retrospectively analyzed. According to the surgical position, the patients were divided into the prone (Group P) and supine (Group S) groups. In both groups, dilatation was performed using 14-18 Fr metallic dilators. The two groups were compared in terms of perioperative data, postoperative stone-free rates (SFRs), and complications. There were 36 (59%) patients in Group P and 25 (41%) patients in Group S. Stones were mostly located in the pelvis (49.2%) and second most frequently in the lower pole (27.9%). Fluoroscopy time was shorter in Group S but did not statistically significantly differ compared to Group P (p = 0.181). However, operation time was statistically significantly shorter in Group S (73.8 ± 35 vs. 99.8 ± 37.4min, p = 0.008). Although there was no significant difference, relatively higher SFR were detected in Group S (88% vs. 83%, p = 0.725). Endoscopic combined intrarenal surgery (ECIRS) was performed on six (24%) patients in Group S, and the SFR was 100% among these patients. There was no significant difference between the two groups in terms of the presence of complications (16.7% vs. 16%, p = 0.945). Both supine and prone MPCNL appear to be safe and effective in the pediatric age group, with similar stone-free and complication rates. In the supine procedure, the operation time is shortened compared to the prone. In addition, simultaneous retrograde access has the potential to increase the overall success rate of surgery.

Comparing Tubeless and Tubed Approaches in Percutaneous Nephrolithotomy for Moderate Renal Calculi: Outcomes on Safety, Efficacy, Pain Management, Recovery Time, and Cost-Effectiveness.

Introduction This study focuses on investigating the effect of routine nephrostomy tube placement in patients with moderate renal calculi of size 2.5 cm or less who undergo uncomplicated percutaneous nephrolithotomy (PCNL) procedures. Previous studies have not specified whether only uncomplicated cases were included in the analysis, which may affect the results. This study aims to provide a clearer understanding of the effect of routine nephrostomy tube placement on blood loss in a more homogeneous patient population. Materials and methods A prospective randomized controlled trial (RCT) was conducted at our department over 18 months, dividing 60 patients with a single renal or upper ureteric calculus of size ≤2.5 cm into two groups: 30 patients in each group (group 1: tubed PCNL, group 2: tubeless PCNL). The primary outcome was the drop in perioperative hemoglobin leveland the number of packed cell transfusions necessary. The secondary outcome included the mean pain score, analgesic requirement, length of hospital stay, time to return to normal activities, and the total cost of the procedure. Results The two groups were comparable in age, gender, comorbidities, and stone size. The postoperative hemoglobin level was significantly lower in the tubeless PCNL group (9.56 ± 2.13 gm/dL) compared to the tube PCNL group (11.32 ± 2.35 gm/dL) (p = 0.0037), and two patients in the tubeless group required blood transfusion. The duration of surgery, pain scores, and analgesic requirement were comparable between the two groups. The total procedure cost was significantly lower in the tubeless group (p = 0.0019), and the duration of hospital stay and time to return to daily activities were significantly shorter in the tubeless group (p < 0.0001). Conclusions Tubeless PCNL is a safe and effective alternative to conventional tube PCNL, with the advantages of shorter hospital stay, faster recovery, and lower procedure costs. Tube PCNL is associated with less blood loss and the need for transfusions. Patient preferences and bleeding risk should be considered when choosing between the two procedures.

Complications Rate of Conventional Percutaneous Nephrolithotomy (PCNL) in a tertiary care center

Aim: To observe the complication rate of conventional percutaneous nephrolithotomy (PCNL) in a tertiary care Hospital. Methods: This Retrospective study conducted from January 2016 to January 2020 in the Department of Urology at Lady Reading Hospital in Peshawar, Pakistan.The research included a total of 449 patients who underwent conventional PCNL.Non-contrast CT KUB was performed on all patients before surgery. After passing 6fr Ureteric catheter through a cystoscope in lithotomy position patient was then shifted into prone position. Under the guidance of fluoroscopy, all procedures were carried out while the patient was lying flat and conventional 30FR amplatz sheath was used as working channel. Results: Complications were reported in 46.9% of cases.The majority of the complications occurred in patients with clavien grades I and II, with 120(27%) and 54(12%) patients, respectively. In Grade I complicationstransient feveroccurred in 67(15%) patients treated with antipyretics while 53(12%) patients had nephrostomy site leakage managed with simple pressure dressing at bed site. In grade II complication 45(10%) patients had bleeding which required transfusion and 9(2%) patients developed sepsis treated with parenteral antibiotics. 10(2%) patients developed grade IIIa complication such as persistent bleeding in 4(0.8%) patients managed with percutaneous angioembolization and 6(1.2%) patients required percutaneous drainage of perinephric collection. 25(5.5%) patients had grade IIIb complications, in 24( 5.3%) patients DJ stenting was done for PCS injury or persistent leakage from nephrostomy site while 1(0.2%) patient needed colostomy for colonic injury. Conclusion: The chance of serious complications during percutaneous nephrolithotomy is very minimal. It is also safe, cost effective and well-tolerated. Transient fever or nephrostomy site leakage are the most frequently occurring minor complications often subside spontaneously. Keywords: Nephrostomy, percutaneous nephrolithotomy

The feasibility of ultrasound-guided mini-percutaneous nephrolithotomy for ESWL-resistant lower calyx renal stones of up to two centimeters: a single center experience.

Lower pole renal stones present a significant challenge in urologic practice due to difficulty in accessing the calyx and eliminating fragments. Management options for these stones include watchful waiting for asymptomatic stones, extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopy (URS), and percutaneous nephrolithotomy (PCNL). Mini-PCNL is a newer modification of conventional PCNL. The study aimed to assess the feasibility of mini-PCNL in treating lower pole renal stones equal to or less than 20mm that were not responsive to ESWL therapy. We included 42 patients (24 male and 18 female) with a mean age of 40±2.3 who underwent mini-PCNL at a single urology center between June 2020 and July 2022 and assessed operative and postoperative outcomes. The mean total operative time was 47±3.11 minutes, ranging from 40 to 60 minutes. The stone-free rate was 90%, and the overall complication rate was 26%, which included minor bleeding (5%), hematuria (7%), pain (12%), and fever (2%). The mean hospital stay was 80±3.34 hours (3-4 days). Our findings suggest that mini-PCNL is an effective treatment option for lower pole renal stones that are not responsive to ESWL therapy. The immediate stone-free rate was high, with minimum non-serious complications.

Comparison of the Conventional PNL with Ecirs in the Treatment of Complete Staghorn Kidney Stones.

To analyse the results of conventional percutaneous nephrolithotomy (PNL) and endoscopic combined intrarenal surgery (ECIRS) in treating complete staghorn kidney calculi. A comparative study. Place and Duration of the Study:Department of Urology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey, between January 2007 and January 2022. Clinical data and surgical outcomes of the adult patients who underwent conventional PNL or ECIRS were retrospectively reviewed. Two patient groups were compared regarding the fluoroscopy time, the number of access, surgical time, duration of hospitalisation, haemoglobin (Hb) reduction, complication, and stone-free rates. Results:There were 132 renal units in the conventional PNL (Group 1) and 45 renal units in the ECIRS group (Group 2). The comparative analysis revealed that fluoroscopy time, surgical time, duration of hospital stay, number of access, and the Hb drop were significantly lower in the ECIRS group compared to the conventional PNL group. Although stone-free rates were 48.5% in Group 1 and 64.4% in Group 2, p=0.064 and p>0.05 respectively). The median value of the complication grade was 1 (1-7) in Group 1 and 1 (1-5) in Group 2, (U=2446.5, p=0.026). Conclusion:The ECIRS is a successful and more secure surgical method for treating complete staghorn stones than PNL. PNL, ECIRS, Staghorn, Kidney, Stone.

Comparison of Contrast-Enhanced Ultrasound vs Conventional Ultrasound-Guided Percutaneous Nephrolithotomy in Nondilated Collecting System: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: It has been demonstrated that ultrasound (US)-guided renal collecting system access during percutaneous nephrolithotomy (PCNL) is efficient and secure. The puncture success rate fell to 82%, and the total complication rate rose to 15% in kidneys with nondilated collecting systems. Contrast-enhanced ultrasonography (CEUS) has been used in PCNL techniques to address this issue. Methods: We did this meta-analysis following the preferred reporting criteria for systematic reviews and meta-analysis to combine the data of published studies to compare the CEUS-guided PCNL and the standard US-guided PCNL (PRISMA). For relevant literature, we searched PubMed, Embase, Web of Science, CKNI, and the Cochrane Library. The final inclusion date for this meta-analysis was May 1, 2022, and three randomized controlled trials (RCTs) were finally included. RevMan V5.4.1 was used in this work. Standard mean difference (SMD) with a 95% confidence interval (CI) was utilized as the major estimate in the synthesis of continuous data, while odds ratio (OR) with a 95% CI was synthesized as the main estimate in the synthesis of discontinuous data. Results: We found that compared with traditional US-guided PCNL, CEUS-guided PCNL could offer more benefits in terms of single-needle success rate (OR: 3.02, 95% CI: 1.62 to 5.61, p = 0.0005), shorter puncture time (SMD: -1.33, 95% CI: -2.06 to -0.60, p = 0.0004), shorter hospital stays (SMD: -0.37, 95% CI: -0.60 to -0.13, p = 0.002), and a better stone clearance rate (OR: 2.32, 95% CI: 1.15 to 4.68. p = 0.02). Although the PCNL complication rate after surgery was not significantly reduced by the CEUS technique (overall complication: OR = 0.70, 95% CI: 0.37 to 1.30, p = 0.25. Grade 1/2 complication: OR = 0.79, 95% CI: 0.41 to 1.53, p = 0.48; Grade 3/4 complication: OR = 0.44, 95% CI: 0.10 to 1.98, p = 0.28), it could reduce hemoglobin dropping compared with conventional US-guided PCNL (SMD: -0.82, 95% CI: -1.06 to -0.58, p < 0.001). Conclusion: The CEUS-guided PCNL technique is superior to the US-guided PCNL, according to almost all synthesized data. Additional randomized studies are still required.

Efficacy and safety of the surgical treatments for lower calyceal stones: A systematic review and network meta-analysis.

Efficacy and safety of 5 common surgical treatments for lower calyceal (LC) stones were assessed for LC stones≤20mm. A systematic literature search was conducted up to June 2020 using PUBMED, EMBASE and Cochrane Library. The study has been registered in PROSPERO, CRD42021228404. Randomized controlled trials evaluating efficacy and safety of 5 common surgical treatments for LC stones were collected, including percutaneous nephrolithotomy (PCNL), MiniPCNL (MPCNL), UltraminiPCNL (UMPCNL), extracorporeal shock wave lithotripsy (SWL) and retrograde intrarenal surgery (RIRS). Heterogeneity among studies was assessed by using the global inconsistency and local inconsistency. Both pooled Odds ratio (OR) along with 95% credible interval (CI) and the surface under the cumulative ranking curve (SUCRA) values, were calculated to assess the outcomes, paired comparisons of efficacy and safety of 5 treatments. 9 peer-reviewed RCTs, comprising 1674 patients, in recent 10 years, were included. Heterogeneity tests showed no statistical significance, and a consistency model was chosen, respectively. The order of SUCRA values for efficacy was as follows: PCNL (79.4), MPCNL (75.2), UMPCNL (66.3), RIRS (29), and SWL (0). For safety: SWL (84.2), UMPCNL (82.2), RIRS (52.9), MPCNL (16.6) and PCNL (14.1). In the current study, all 5 treatments are both effective and safe. Many factors must be considered to choose surgical treatments for LC stones≤20mm; the results that we separate conventional PCNL into PCNL, MPCNL and UMPCNL make the questions even more controversial. However, relative judgements are still needed to be used as reference data in clinical managements. For efficacy, PCNL>MPCNL>UMPCNL>RIRS>SWL, SWL is statistically inferior to other 4 treatments, respectively. RIRS is statistically inferior to PCNL and MPCNL, respectively. For safety, SWL>UMPCNL>RIRS>MPCNL>PCNL, SWL is statistically superior to RIRS, MPCNL and PCNL, respectively. RIRS is statistically superior to PCNL. We cannot reach conclusions which surgical treatment is the best choice for all patients with LC stones≤20mm; Therefore, tailored treatments based on individual patients still demand more attention than ever before for both patients and urologists.

Tubeless versus conventional minimally invasive percutaneous Nephrolithotomy: A comparative study

PCNL (Percutaneous Nephrolithotomy) and MPCNL (Miniaturized Percutaneous Nephrolithotomy) are minimally invasive surgical procedures used to treat kidney stones. Both PCNL and MPCNL are effective treatments for kidney stones, but the choice of procedure depends on the size, location, and number of stones, as well as the patient&#39;s medical history and overall health. The present study was aimed to assess the safety and efficacy of tubeless PCNL compared to conventional PCNL in terms of Postoperative pain, hospital stay, Drop in Haemoglobin levels, Operative time, Stone free rate, Post operative fever. Methodology: A Prospective comparative interventional study has been done in Department of Urology, Mamata Super Specialty Hospital, Khammam with a total of 50 patients who were randomized into two groups of 25 each undergoing tubeless mini PCNL and conventional mPCNL respectively. Results: The mean age was 43.76 years and 41.92 years for mini PCNL and conventional mPCNL groups respectively, the mean calculus size in the tubeless PCNL group was 2.028 cm, while in the conventional PCNL group, it was 2.452 cm. There was significantly lesser operative time taken in conventional PCNL group when compared with Tubeless PCNL group. Stone free clearance rate 97% in tubeless PCNL. The mean hospital stay in tubeless PCNL group was significantly more than that in conventional PCNL. Conclusion: Both tubeless mPCNL and conventional mPCNL had similar surgical outcomes, but tubeless mPCNL had reduced surgery time, stone clearance, and hospital stay, indicating its potential for wider use.

Clearance of Metal Particles After Percutaneous Nephrolithotomy with Trilogy Lithotripter.

Purpose: To evaluate the clearance of metal particles produced and released in the pelvicaliceal system (PCS) during percutaneous nephrolithotomy (PCNL) with the use of the Swiss Lithoclast® Trilogy dual-energy (EMS Urology, Nyon, Switzerland) lithotripter. Methods: An experimental in vivo study and a clinical investigation of case series were conducted. An in vivo porcine model with two pigs for lithotripsy (after inserting artificial stones into the collecting system) and two pigs for submucosal injection of metal particles (provided by the manufacturer of Trilogy) was conducted. Porcine kidney histology analysis for metal leftovers was conducted immediately or 2 weeks after the surgery. A prospective observational study design included 10 consecutive patients treated with conventional 30F PCNL or with 22F mini-PCNL technique. Only the patients with the confirmed metal particles in the PCS during the initial PCNL and the need for additional retrograde intrarenal surgery over a period of 2-4 weeks were selected. The presence of metal particles was evaluated during the second endoscopic surgery. Results: The generated metal particles during PCNL and the submucosally injected particles were not found macroscopically 2 weeks postoperatively in porcine models. No pathologic changes such as foreign body granuloma or inflammation were found. Similarly, no metal particles were observed during the second look endoscopy (n = 10). Conclusion: Metal particles observed endoscopically using the Trilogy lithotripter are cleared with no pathologic evidence of tissue damage from the metal particles 2 weeks after the procedure. Thus, the intraoperative release of any particle by the Trilogy lithotripter should not raise any safety concerns.

The optical puncture combined standard percutaneous nephrolithotomy versus the conventional percutaneous nephrolithotomy for kidney stones without hydronephrosis: a comparative study.

To compare the efficacy and safety of optical puncture combined with standard percutaneous nephrolithotomy (PNL) and conventional PNL for the treatment of patients with complex kidney stones with no or mild hydronephrosis. We retrospectively reviewed the data on patients with complex kidney stones treated by PNL in our hospital between May 2019 and February 2022. The patients were divided into two groups according to the puncture techniques applied. In the optical puncture group, 40 patients underwent optical puncture combined with standard PNL. In the control group, 44 patients underwent conventional standard PNL. The demographics and perioperative parameters were analyzed between the two groups. There mean puncture durations were significantly shorter in the optical puncture group (8.2 ± 2.16min) than in the control group (14.0 ± 6.76min) (P = 0.001). The re-puncture rates were lower in the optical puncture group (5%) compared with the control group (20.5%) (P = 0.036). The access loss rate in the optical puncture group (2.5%) was significantly lower than that in the control group (11.36%) (P = 0.037). The mean hemoglobin drop was significantly lower in the optical puncture group (12.6 ± 5.36g/L) compared with the control group (22.3 ± 11.61g/L) (P = 0.001). The mean hospital stay was significantly shorter in the optical puncture group (3.9 ± 1.65d) compared with the control group (5.1 ± 2.10d) (P = 0.042). The primary stone-free rate in the optical puncture group (87.5%) was similar to the control group (84.1%) (P = 0.656). The overall stone-free rates were 95% in the optical puncture group and 93.2% in the control group (P = 0.725). There were significantly more patients in the control group (18.2%) who suffered collecting system injury than in the optical puncture group (2.5%) (P = 0.020). There were no significant differences between the two groups in terms of blood transfusion (P = 0.292), fever (P = 0.696) and urosepsis (P = 0.946). We demonstrated that optical puncture combined with standard PNL could increase the precision and success rate of puncture, and reduce the access-related complications in patients with complex kidney stones without hydronephrosis.

Percutaneous nephrolithotomy in horseshoe kidney: comparing ultrasound-guided access in flank position with conventional fluoroscopic-guided in prone position.

We conducted this study to compare radiation-free US-guided percutaneous nephrolithotomy (PNL) in the flank position with conventional PNL in the prone position for the treatment of renal stones in patients with horseshoe kidneys. In a retrospective study, 14 HSK patients that were treated with conventional fluoroscopy-guided PNL in the prone position (group A) were compared with twenty-four HSK patients that were treated US-guided PNL in the flank position (group B). Data on baseline characteristics, percentage of successful entries, stone-free rate, duration of admission and complication rate were obtained from data registry. The average duration of the operation was 57.6min in group B, which was statistically less than group A with 65.9min (P = 0.001). Access time varied from 10 to 32.4min (mean = 17.1min) in group A and 5-29.5min (mean = 10.9min) in group B (P < 0.001). Access length had a significant relation to the surgery method so PNL with US-guided had less access length (P = 0.002). There was no significant relationship between the surgery guide and the residual stone rate (P = 0.6). Hemoglobin decrease (P = 0.5), hospitalization duration (P = 0.5) and need for blood transfusion (P value = 0.6) were not statistically different between the two groups. PNL with US guidance in flank position is a safe and effective technique in HSK patients and is associated with fewer complications than the traditional approach as well as reduced operating time, radiation exposure, and its complications.

Initial Experience of Totally Tubeless Ultra-Mini Percutaneous Nephrolithotomy

Objectives : The Objectives of this study is to determine the outcome and effectiveness of Ultra-mini percutaneous nephrolithotomy (PCNL) for treating low-volume renal stone without placement of any stent and nephrostomy tube as a supplement to the conventional PCNL. Material and methods: The Patients who underwent ultra-mini PCNL bwtween July 2018 to December 2018. were studied.This was a prospective study of 14 patients.This study was carried out in urology centre of CMH Dhaka.Before the study ethical clearance was taken from hospital ethical committee. All these patients had their first-line treatment. The patients had calculus limited to either a single calyx or just extending to the pelvis and the stone size was less than 1.5 cm in its maximal dimension. The mean stone size was 10.8+_4.2(5-15mm). An 6 Fr operating nephroscope was used. The patients were placed in prone position. The stones were fragmented using Holmium-YAG laser. Various surgical outcomes including duration of the surgery, stone-free rate and any subsequent complications-if any-were analyzed.The stone free rate was assessed on the 1st day and at three month after surgery by X-ray KUB and ultrasonography. Results: The study includes a series of 14 patients (one patient treated with bilateral renal stone disease). The mean age of the patients was 39.07 years and body mass index was 25.5 kg/m2. Intrarenal stone location was as follows: lower calyx, n=7; middle calyx, n=3, upper calyx, n=1, and pelvis, n=3. Median operative time was 52.66 min (range: 40–65) and the stone-free rate was 93.3% at first day and 97% after three month follow up.. Only one patient had residual fragments and needed subsequent extracorporeal shock wave lithotripsy. Conclusion: Ultra-mini PCNL in prone position with a complete tubeless approach for renal stone disease is a safe method for treating low-volume stone disease. A long term large scale multicentre study may be required to validate this technique. Bangladesh J. Urol. 2021; 24(2): 118-123

Residual stone area greater in obese patients after conventional percutaneous nephrolithotomy

Purpose: To assess the safety and effectiveness of percutaneous nephrolithotomy (PCNL) in patients with obesity.Materials and methods: The records of patients who underwent conventional PCNL were retrospectively evaluated using our database in Department of Urology, Gazi Hospital, Samsun, Turkey, from January 2015 to January 2020. Patients were divided into four groups based on body-mass index (BMI) range &amp;lt;25 (Group 1), 25-29.9 (Group 2), 30-34.9 (Group 3), and ≥35 kg/m2 (Group 4). Baseline characteristics, outcomes, and complications were then compared between the groups. Achieving stone-free status or a residual-stone size of ≤4 mm was regarded as an operational success.Results: A total of 462 patients, 121 (26.2%) in Group 1, 159 (34.4%) in Group 2, 133 (28.8%) in Group 3, and 49 (10.6%) in Group 4, were enrolled in the study. No significant difference was determined in terms of operative time, access number, hemoglobin drop, hospital stay, and success/complication rates. Residual-stone area increased in line with BMI. However, this increase in residual-stone area was only statistically significant in Group 1 and Group 4 (p=0.009). The overall stone clearance rate was 81.8%, and the complication rate requiring invasive procedures was 16.4%.Conclusion: Our study revealed that obesity does not affect the outcomes of PCNL without residual-stone size.

Comparison of Mini Percutaneous Nephrolithotomy and Standard Percutaneous Nephrolithotomy in the Management of Renal Stones of more than 2CM

Objective: In patients with kidney stones larger than 2 cm, it is intended to evaluate the effectiveness and safety of small percutaneous nephrolithotomy (mini-PCNL) with conventional percutaneous nephrolithotomy (standard-PCNL). Study Design: Retrospective study Place and Duration: Institute of Kidney Diseases, Hayat Abad Medical Complex, Peshawar, 1st July 2019 - 30th June 2021. Methods: Therewere 170 patients of both genders were presented. All the presented patients had renal stones &gt;2cm were admitted for surgery. Detailed demographics of enrolled cases included age,sex, BMI and comorbidities were recorded after taking informed written consent.Patients were equally divided in two groups. Group I received mini percutaneous nephrolithotomy (mini-PCNL) among 85 patients had renal stone size 2-3cm and 85 patients of group II had renal stone &gt;3cm received standard percutaneous nephrolithotomy (standard-PCNL). Post-operative outcomes among both groups were assessed in terms of Stone-free rate (SFR). SPSS 23.0 was used to analyze all data. Results:Among 170 included cases, 114 (67.1%) patients were males and 56 (32.9%) cases were females. We found that 45 (26.5%) patients had age 20-30 years, 50 (29.4%) patients had age 31-40 years and 75 (44.1%) patients had age &gt;40years. Majority of the patients 130 (76.5%) had BMI &lt;25kg/m2 and 40 (23.5%) had BMI &gt;25kg/m2. Comorbidities were hypertension and diabetes mellitus. We found that operative time of group II was lower 40.7±10.9 minutesas compared to group I 52.4±8.13 minutes while hospitalization, blood transfusion and hemoglobin drops were lower in group I as compared to group II. We found that SFR was higher in group I among 80 (94.1%) cases as compared to group II 78 (91.8%) but difference was insignificant. Most common complications were fever, hematuria and urosepsis but their frequency was higher in group I. Conclusion: Mini-PCNL was an efficient and trustworthy substitute for standard-PCNL in the treatment of renal stones larger than 2 cm (30F). Although there is less blood loss, a lower transfusion rate, and a shorter hospital stay than with standard-PCNL, it nevertheless achieves a similar SFR. The 24F standard-PCNL clearly outperforms the mini-PCNL, but not by much. This method, however, requires more time to complete.

A Tertiary Care Center's Conventional Percutaneous Nephrolithotomy (PCNL) Complications Rate

A Tertiary Care Center's Conventional Percutaneous Nephrolithotomy (PCNL) Complications Rate

Does nephrolithometry scoring systems predict success and complications in miniPCNL?

Auxiliary nephrolithometric scoring systems (NSSs) have been developed to predict complications and treatment success of conventional percutaneous nephrolithotomy (PCNL). However, to our knowledge, there is no study comparing these NSSs in patients undergoing miniPCNL. This study aimed to compare the NSSs in terms of their ability to predict miniPCNL-related complications and treatment success. The data of patients undergoing PCNL between September 2016 and May 2018 were retrospectively reviewed through the electronic medical record system, and 140 patients were included in our study. Stone-free status was evaluated using non-contrast computed tomography between 1 and 3months after the procedure. PCNL was considered successful if the patient was completely stone free. The postsurgical complications were classified according to the modified Clavien-Dindo classification system. The Clinical Research Office of the Endourological Society (CROES) and STONE NSSs significantly predicted miniPCNL treatment success (p = 0.043, p = 0.018). However, the Guy's NSS did not significantly predict the treatment success (p = 0.415). Guy's, CROES and STONE NSSs were not found to significantly predict postsurgical complications (p = 0.584, p = 0.823, p = 0.189). To the best of our knowledge, our study is the first of its kind to investigate the ability of NSSs to predict treatment success and postsurgical complications in patients undergoing miniPCNL. The study found that STONE and CROES NSSs are independent parameters for predicting stone-free status after miniPCNL. In addition, our study found that none of the NSSs were useful in predicting postsurgical complications in patients undergoing miniPCNL.

Supine versus prone percutaneous nephrolithotomy for renal calculi: Our experience.

Objectives:To compare operative times, safety, and effectiveness of percutaneous nephrolithotomy in the supine versus the prone position.Materials and methods:An observational study of 100 patients was conducted in our institution for 2years from 2018 to 2020 divided into 2 groups: 50 patients underwent modified supine percutaneous nephrolithotomy (PCNL) and 50 patients underwent standard prone PCNL. The inclusion criteria included a renal calculus (calyx or pelvis) of any size for which PCNL was indicated and exclusion criteria were patients having contraindications for PCNL such as bleeding disorders, pregnancy, high risk, and co-morbid conditions. The measured data included operative time, number of punctures, stone-free rate, length of hospital stays, and rate of complications.Results:The 2 groups were comparable in mean age, male to female ratio, calculus size, number of punctures, residual calculi, and postoperative fever and pain. The mean difference of hemoglobin in the supine PCNL group was 0.37 g/dL whereas in the prone PCNL group it was 0.61 g/dL. The p value was significant at 0.043. The mean time to finish from initial postion was 72.24 minutes in supine PCNL and 88.12 minutes in prone PCNL. The p value was significant (p < 0.001). The mean time before puncture was 20.92 minutes in the supine position and 31.84 minutes in the prone position. The p value was significant (p < 0.001). The mean time from puncture to finish was 51.32 minutes in the supine position and 56.28 minutes in the prone position. The p value was significant (p < 0.001).Conclusions:As observed from this study, supine PCNL is associated with a significantly reduced operating time when compared to conventional prone position PCNL procedures. The postoperative complications such as pain and fever were not significantly different. Hence, the supine PCNL is an equally effective modality for treatment of a renal calculus with benefits of simultaneous retrograde access and less operative time compared to the prone PCNL.

Is endoscopic combined intrarenal surgery ready for primetime in endourology? Outcomes from a systematic review and meta-analysis.

IntroductionWe aimed to review the outcomes of endoscopic combined intrarenal surgery (ECIRS) as compared to conventional percutaneous nephrolithotomy (PCNL) for kidney stones.Material and methodsWe performed a systematic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. We included all studies comparing ECIRS and conventional PCNL. Surgical time, hemoglobin drop, and postoperative stay were pooled using the inverse variance of the mean difference (MD) with a random effect, 95% confidence intervals (CI), and p-values. Complications, stone-free rate, and retreatment were assessed using Cochran-Mantel-Haenszel method with random effect model and expressed as odds ratio (OR), 95% CI, and p-values.ResultsA total of 17 studies were included. Surgical time and mean postoperative length did not significantly differ between the groups (MD -8.39 minutes 95%CI -21.30, 4.53, p = 0.20; 5.09 days 95%CI -19.51, 29.69, p = 0.69). Mean hemoglobin drop was significantly lower in the ECIRS group (MD -0.56 g/dl 95%CI -1.08, -0.05, p = 0.03), while blood transfusion rate did not differ between the two groups (OR 0.88 95%CI 0.64, 1.23, p = 0.15). While the incidence of postoperative sepsis did not differ between the two groups (OR 0.52 95% CI 0.17, 1.59, p = 0.25), the incidence of postoperative fever was lower in the ECIRS group but the difference was not significant (OR 0.61 95%CI 0.35, 1.06, p = 0.08). The stone-free rate was significantly higher in the PCNL group (OR 2.52 95%CI 1.64, 3.90, p <0.0001) and the retreatment rate was lower in the ECIRS group (OR 0.34 95%CI 0.14, 0.87, p = 0.002).ConclusionsECIRS showed shorter operative time, lower complication rate, and retreatment compared to PCNL. Conventional PCNL showed a higher stone-free rate.