Effect Of Percutaneous Nephrolithotomy Research Articles

Percutaneous nephrolithotomy and laparoscopic surgery efficacy and renal function outcomes for large and complex renal calculi

Abstract Background There is limited published evidence regarding the incidence of intraoperative and postoperative events and the effect of percutaneous nephrolithotomy (PCNL) in supine and prone positions and laparoscopic pyelolithotomy on kidney function in patients with large and complex calculi. Materials and methods We evaluated the surgical outcomes of 97 patients with large and complex kidney stones. The patients were divided into 3 groups: those who underwent PCNL in the prone position, PCNL in the supine position, and pyelolithotomy by laparoscopy and retroperitoneoscopy. General surgical outcomes, size of residual stones, stone-free rate, glomerular filtration rate (GFR), and split GFR obtained from Tc-99m renal dynamic scintigrams were analyzed. Results Percutaneous nephrolithotomy in the prone position was correlated with improved function of the affected kidney. In the supine PCNL group, none of the analyzed indicators demonstrated a significant difference. Dynamic nephroscintigrams revealed negative changes in terms of accumulation and secretion of the affected kidney. A slight decrease in creatinine clearance was noted. However, positive dynamics in split GFR and secretory index were seen in this group. The laparoscopic group showed positive results in all analyzed parameters. However, full assessment of the function of the affected kidney in this group was limited due to restricted use of laparoscopic pyelolithotomy for complex stones. Conclusions Percutaneous nephrolithotomy in the prone position resulted in the most favorable renal functional outcomes for patients with high-grade renal calculi, whereas a laparoscopic approach may be preferred for patients with stones of lower grades. The most significant factors that adversely affected renal function were intraoperative bleeding volume, kidney stone size and density, and body mass index.

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BACKGROUND Post-operative pain and discomfort is a common side effect of percutaneous nephrolithotomy (PCNL) surgery. The study intended to evaluate the efficacy of landmark guided erector spinae plane block (ESPB) in early post-operative pain relief following (PCNL) surgery. METHODS In this randomised prospective, single blind, interventional study, 70 patients aged 20 - 60 years of ASA grade I and II, scheduled for elective percutaneous nephrolithotomy (PCNL) surgery under general anaesthesia were included. Patients were randomly allotted into two groups of 35 each. Group 1 was the control group and received parenteral analgesia according to institutional protocol for postoperative pain relief. Group 2 was the study group and received landmark guided erector spinae plane block (ESPB) with 20 cc of 0.25 % bupivacaine for postoperative pain relief. Post-operatively patients were monitored for pain and Visual Analogue Scale (VAS) score was noted at 2nd, 4th and 6th hr and was maintained below 4 by providing them with additional analgesics if required. Time and doses of analgesics required were recorded. RESULTS All the statistical analysis was done using R-Studio 1.2.5001 software. MannWhitney-U test was used for quantitative variables of pain score. Proportion test was used for qualitative demographic data and for post-operative analgesics requirement. Both the groups were comparable on demographic variables. The average VAS score at 2nd and 4th hr was significantly lower in the study group than in the control group (P < 0.05). The VAS score at 6th hr was comparable in both the groups. The analgesic requirement was significantly lower in study group as compared to the control group. CONCLUSIONS The landmark guided ESPB is an effective and simple method to alleviate immediate postoperative pain in PCNL surgeries under general anaesthesia. KEYWORDS Erector Spinae Plane Block, Percutaneous Nephrolithotomy Surgery, Postoperative Pain

The effect of percutaneous nephrolithotomy in patients with chronic kidney disease in northeast India population

Background: Renal stone disease is a recognized precursor for renal deterioration, if untreated, it can lead to renal failure. With advances in the PCNL, the effect on patients with established renal insufficiency remains under reported. So, we aimed to evaluate the efficacy as well as safety of PCNL in chronic kidney disease patients.Methods: This retrospective cohort study included patients admitted in our hospital from January 2016 to December 2018, which were diagnosed with urolithiasis and chronic kidney disease and treated by PCNL. Patients with GFR <60 ml/min/1.73 m2 in non-obstructed renal stone disease who underwent PCNL were included. We studied the change in renal function, complete stone free rate (SFR) complications stone composition, operative time and hospital stay.Results: The study comprised 50 patients (M/F-32/18) of CKD who underwent PCNL. Mean operative time was 90.50±12.57minutes in group 1 and 98.00±12.35 minutes in group 2. One or more complications were noted in 12 patients (24%) after PCNL. At a mean follow-up of 18 months, renal function stage had improved in 24 patients (48%) and it was maintained in 13 (26%). Worse CKD with an increase in disease stage was noted in 13 patients (26%). Association between hypertension, diabetes and postoperative deterioration in kidney function wasn’t significant statistically (p=0.9). The stone-free rate at postoperative month 3 was 76%.Conclusions: PCNL has a favourable outcome in patients with chronic kidney disease stage III/IV, with a good calculus clearance rate and improved kidney function.

The Effect of Percutaneous Nephrolithotomy on the Estimated Glomerular Filtration Rate in Patients with Chronic Kidney Disease.

Objective: We evaluated the influence of percutaneous nephrolithotomy (PCNL) on the estimated glomerular filtration rate (eGFR) in patients with chronic kidney disease (CKD). Materials and Methods: Between September 2007 and April 2019, 280 patients with a preoperative eGFR level <90 mL/min/1.73 m2 and who underwent PCNL were retrospectively examined. The primary endpoint of this study was the effect of PCNL on eGFR levels in the 1st and 12th month after surgery in patients with CKD according to CKD stages. The secondary endpoint of this study was the identification of potential risk factors for deteriorated eGFRs. Results: The mean eGFR of patients was 48.7 ± 17 mL/min/1.73 m2 in the preoperative period, 54.7 ± 21 mL/min/1.73 m2 in the postoperative 1st month, and 59.1 ± 23.2 mL/min/1.73 m2 in the postoperative 12th month. It was determined that the increases in eGFRs in the postoperative 1st and 12th months were significant in all CKD stages (p < 0.005). Compared with preoperative values, the eGFR value was reduced in 61 (21.8%) patients in the 1st month and 49 (17.5%) patients in the 12th month. When these patients were compared with those in the stable eGFR and recovery group, multiaccess PCNL was an independent risk factor for renal function deterioration at the postoperative 1st and 12th month on multivariate analysis (odds ratios were 6.94 and 9.46, respectively). Conclusion: PCNL was found to have a positive effect on short- and long-term eGFRs in patients with CKD. However, multiaccess PCNL may have adversely affected eGFRs in both the short and long term.

Effect of percutaneous nephrolithotomy on stone removal and complications in patients with renal calculi under low velocity perfusion.

Objective To investigate the effect of percutaneous nephrolithotomy (PCNL) on stone removal and complications in patients with renal calculi under low velocity perfusion. Methods A retrospective analysis was used to select 90 patients with renal calculi in the People′s Hospital of Kaizhou District of chongqing from January 2015 to June 2017. The patients were divided into control group and study group in random double-blind method, with 45 cases in each group. The control group was treated with high speed perfusion of PCNL, and the study group was treated with low speed perfusion of PCNL, and the operating time, blood loss, stone clearance rate, incidence of complications, percentage of neutrophil and shock index were compared with the two groups. Measurement data were expressed by (±s). t test was used to compare with the two groups. Counting data were expressed in percentage (%), and Chi-square test was used to compare wth the two groups. Results There was no significant difference in the treatment effect of the two groups, including operating time, blood loss, stone clearance rate (the P values were 0.392 4, 0.446 1, and 0.693 9, respectively). The incidence of complications in the study group was significantly lower than that in the control group (31.09% vs 53.31%, χ2=5.408 6, P=0.020 0), and the incidence of infectious diseases was much lower than that in the control group(17.78% vs 40.00%). After treatment, the percentage of neutrophil and shock index in the study group was lower than those in the control group. Conclusion Low rate perfusion of PCNL has less negative effect on the effect of stone removal in patients with renal calculi, and it also reduces the incidence of complications and is worth promoting in clinical practice. Key words: Nephrostomy, percutaneous; Kidney calculi; Postoperative complications; Low velocity

Effect of percutaneous nephrolithotomy on renal functions in children: assessment by quantitative SPECT of 99mTc-DMSA uptake by the kidneys

Objective: To determine the impact of percutaneous nephrolithotomy (PNL) on global and regional renal function in children. Methods: In total, 40 children (41 renal units) undergoing PNL were included in this prospective study. All patients were evaluated using quantitative single-photon emission computed tomography (QSPECT) with technetium-99 m-dimercaptosuccinic acid (99mTc-DMSA) examinations before and 3 months after surgery. Results: The mean age was 9.5 years (range, 3–16), and the mean stone size was 3.4 cm (range, 2–6.5). Of the cases, 39 (95%) were managed as being stone-free after a single session of PNL. After additional treatment procedures, 40 (97.5%) of the cases were managed as being stone-free. Of the 41 renal units, new focal cortical defects on 99mTc-DMSA scans were seen in 4 (9.7%) patients. Total relative uptake in the treated kidneys increased from 42.3% to 44.1%. The mean creatinine level before PNL was 1.18 ± 0.45 (0.8–1.6) mg/dL compared with 1.16 (0.7–1.5) mg/dL by the end of the follow-up period (not statistically significantly different, p > 0.05). Conclusions: PNL in children is a safe and feasible method for the maximal clearance of stones. QSPECT of 99mTc-DMSA confirmed that renal function is preserved or even improved after percutaneous stone removal.

Observation of the effect of percutaneous nephrolithotomy with pneumatic and ultrasonic power guided by B-type ultrasound in the treatment of complex renal calculi

Objective To discuss the method and effect of B-type ultrasound guided percutaneous nephrolithotomy(PCNL) in the treatment of complex renal calculi.Methods The clinical data of 98 cases with complex renal calculi who underwent B-type ultrasound guided PCNL were retrospectively reviewed.Results The percutaneous renal access guided by B-type ultrasound was successfully established in all patients,of whom 15 patients were via two tracts,4 patients via three tracts and 10 patients with both sides.The average operation time was 95 minutes.The time of stone cleaning was about 15-150 minutes,average 85 minutes.10 cases needed blood transfusion because of intraoperative and postoperative bleeding,2 cases occured pseudoaneurysm (interventional selective renal artery embolization),2 cases occured hydropneumothorax (through the 11 intercostal approach),and 2 patients had sepsis,there were no abdominal visceral injury and other serious complications.Stones were cleared in 85 cases(86.7％),residual stone fragment was found in 8 cases,who received second PCNL or extracorporal shock wave lithotripsy.Conclusion PCNL with pneumatic and ultrasonic power guided by B-type ultrasound is an effective and safe way to treat complex renal calculi with the features of high stone clearance rate. Key words: Percutaneous nephrolithotomy ; Kidney calculi ; Surgical management; Ultrasonography

The Safety and Efficacy of Percutaneous Nephrolithotomy for Management of Large Renal Stones in Single- Versus Double-Functioning Kidney Patients

To demonstrate the safety and efficacy of percutaneous nephrolithotomy (PCNL) for management of large renal stones between single-functioning kidney and double-kidney patients. Thirty single-functioning kidneys and 30 double-kidney patients with a mean age of 38.5 (±15.6) years in the single group and 42.1 (±14.3) years in the double group (range 11-72 years) underwent PCNL for renal stones larger than 2 cm. The effect of PCNL on global and regional cortical activity was measured using quantitative single-photon emission CT measurement of technetium-99m ((99m)Tc) dimercaptosuccinic acid (DMSA) scan uptake by the kidneys before and 6 months after PCNL. Variables assessed were stone bulk, size, location, the number of punctures, and anatomic factors. Average hemoglobin and serum creatinine changes, mean operative time, transfusion rate, hospital stay, and different complications were also assessed. Mean stone size, mean hospital stay, success rate, and complications were statistically similar in both groups. Mean serum creatinine changes (preoperative and postoperative) were not statistically significant between the two groups (P=0.12). Mean hemoglobin drop (preoperative and postoperative) in both groups was significant, and there was a valuable difference between them (P=0.01). There was a significant difference in the uptake by the treated kidneys before vs after PCNL between both groups statistically (P=0.019), so that the DMSA renal uptake was obviously higher 6 months after PCNL in the double-kidney group compared with its uptake in the single-functioning kidney group. (99m)Tc-DMSA renal scan confirms that renal function was preserved or even often improved after percutaneous stone removal, and the procedure had no detrimental effects on renal function in both groups. There was no statistically significant difference between these groups in terms of morbidity and stone clearance.

Effect of Percutaneous Nephrolithotomy and Tract Dilatation Methods on Renal Function: Assessment by Quantitative Single-Photon Emission Computed Tomography of Technetium-99m–Dimercaptosuccinic Acid Uptake by the Kidneys

The aim of this study was to determine the impact of percutaneous nephrolithotomy (PCNL) and tract dilatation methods on global and regional renal function using quantitative single-photon emission computed tomography (QSPECT) of technetium-99m-dimercaptosuccinic acid ((99m)Tc-DMSA). Seventy-five patients undergoing PCNL between May 2008 and April 2009 were included in this randomized study. Of the 75 patients, 50 were evaluated by QSPECT of (99m)Tc-DMSA examinations before and at 3 to 6 months after surgery. This group of patients were categorized into three groups according to the dilatation technique used: group I (balloon dilator, n = 12 [24%] patients), group II (metal dilator, n = 14 [28%] patients), and group III (Amplatz dilator, n = 24 [48%] patients). Of 50 renal units, new focal cortical defects on (99m)Tc-DMSA scan were seen in nine patients (18%). In six of these kidneys the site of focal defect corresponded to the access site for tract formation during PCNL (two in group II and four in group III). Total relative uptake and total area of treated kidney, for the entire group, increased from 42.2% and 42.3% preoperatively to 44.12% and 43.9% postoperatively. There was no statistically significant differences between the groups for total uptake and area of the treated kidneys before and after the procedure (p > 0.05 for each parameter). QSPECT of (99m)Tc-DMSA confirms that renal function is preserved or often improved after percutaneous stone removal, and nephrostomy tract dilatation methods have similar effects on renal function.

Percutaneous nephrolithotomy in patients with normal versus impaired renal function

This study aimed to compare the results of percutaneous nephrolithotomy (PCNL) in patients with impaired renal function (IRF) and normal renal function (NRF). Records of 300 consecutive patients who underwent PCNL from July 2002 to July 2005 were retrospectively reviewed. Nineteen patients (6.3%) had serum creatinine values higher than 1.5 mg/dl before surgery (IRF Group). Nineteen gender and age matched patients with normal renal function were chosen as controls (NRF Group). The surgical parameters, outcome, and complication rates were compared. The effect of PCNL on the renal function was assessed in patients with IRF. There were 13 male and 6 female patients in both groups. In the IRF group, seven patients had a solitary kidney and three had bilateral stones. Thus, PCNL was performed on 22 kidneys. No patients in the NRF Group had solitary kidney or bilateral stones and PCNL was performed on 19 kidneys. There were no statistically significant differences between the two groups for success and complication rates (P = 0.376 and P = 0.184, respectively). In a mean follow-up of 15.6 months, mean serum creatinine decreased from 2.8 to 2.6 mg/dl (P = 0.273) in patients of the IRF group. Similar stone clearance and complication rates were obtained with PCNL in patients with impaired and normal renal function. Surgery does not cause biochemical deterioration in patients with compromised renal function before treatment.

Effect of percutaneous nephrolithotomy on differential renal function as measured by mercaptoacetyl triglycine nuclear renography

Objectives. To determine the impact on differential renal function of percutaneous nephrolithotomy for complex renal calculi. Methods. From July 1999 to December 2000, 45 patients underwent percutaneous nephrolithotomy. Of these, 19 agreed to participate in the study. All patients completed a quantitative assessment of differential renal function preoperatively and postoperatively with technetium 99m mercaptoacetyl triglycine nuclear renography and serum creatinine measurements. Results. The mean patient age was 49 years (range 11 to 75) for the 13 female and 6 male patients. The mean stone burden was 1432 mm 2 (range 156 to 5220). The mean surgical time was 2.57 hours (range 1.17 to 5.08). The median hospital stay was 2.0 days (range 1 to 19). Of the 19 patients, 13 (68%) were stone free after one procedure. Four patients underwent ureteroscopy with stone extraction for residual fragments. One patient underwent secondary extracorporeal shock wave lithotripsy. One patient underwent nephrectomy for poor renal function. Renal function, for the entire group, increased from 36.8% preoperatively to 38.5% postoperatively. Renal function was preserved in 16 (84%) of 19 patients, including improvement of function in 7 (37%) of 19 patients. Serum creatinine was unchanged in the two groups. Conclusions. Percutaneous nephrolithotomy does not result in loss of renal function when treating complex renal calculi as measured by nuclear scintigraphy. Operative and hospitalization times were decreased compared with historical open nephrolithotomy and stone clearance was similar.

Effect of percutaneous nephrolithotomy on differential renal function as measured by mercaptoacetyl triglycine nuclear renography: Reply by the authors

Effect of percutaneous nephrolithotomy on differential renal function as measured by mercaptoacetyl triglycine nuclear renography: Reply by the authors