Higher Stone-free Rate Research Articles

Effects of minimally Invasive Percutaneous Nephrolithotomy on Health-Related Quality of Life

Objective To evaluate the effects of minimally invasive percutaneous nephrolithotomy(MPCNL)on patients' quality of life (QOL) in the short and long term. Methods We prospectively studied 97 consecutive cases who underwent MPCNL between April 2013 to February 2014. A total of 97 cases were included in this study, of which 53 were males and 44 females.Body mass index was 14.9-28.1 kg/m2 and stone burden was (9.4±2.5) cm2. QOL was measured using the short form-36 (SF-36) questionnaire, 2 weeks before surgery and then in the third postoperative month and a year after. Results MPCNL has rendered 91.8%(89/97) of the cases completely stone free with a 15.5%(15/97) complication rate (14.4% Clavien-Dindo I+ II). Compared with that of preoperation, physical function, role physical, bodily pain were improved significantly after postoperative 3 months(P<0.05). Physical function, role physical, bodily pain, social function, role emotional, mental health, general health and vitality were improved after postoperative 1 year(P<0.05). Conclusions MPCNL not only has the advantage of high stone free rate and low complication rate but improves QOL. The physical aspects of QOL is improved at early gradually improve the mental component of QOL late. Key words: Kidney Calculi; Nephrostomy, Percutaneous; Lithotripsy; Quality of Life

Flexible Ureteroscopy with Laser Lithotripsy versus Extracorporeal Shock Wave Lithotripsy in Management of Ureteric Stones in Pediatric Age Group

Background: pediatric stone disease is one of the most common urological issues in pediatric urology practice. The incidence of urinary stone disease is increasing in children in last decades. Aim of the Work: determination of the efficacy and outcome of flexible ureteroscopy using holmium Yttrium aluminium garne laser lithotripsy and compare its results with that of Extracorporeal shock wave lithotripsy EWSL in management of ureteric stones in pediatric age group. Patients and Methods: this study included 40 patients in pediatric age group. Complaining of upper ureteric stones less than (1cm). Patients underwent either ESWL or Flexible Ureteroscopy randomly according to 1: 1 ratio. The procedures were done at Eldemerdash hospital and National Institute of Urology and Nephrology. The patients were divided into two groups. Group A: Patients undergone extracorporeal shock wave lithotripsy (ESWL). Group B: Patients received flexible ureteroscopy and laser lithotripsy. Results: there was no statistically significant difference found between the two studied groups regarding age, sex, size and BMI, and stone free rate. Also there was highly statistically significant difference as regard hospital stay. The SWL group required a shorter period of hospitalization and there was highly statistically significant difference between the two groups regarding duration of the procedure which is more prolonged in flexible group. Conclusion: flexible URS lithotripsy and laser are considered a safe, highly efficient, minimally invasive, and reproducible surgery technique -with a higher stone free rates and less postoperative complications, after a single procedure, when compared to ESWL- for management of upper ureteric calculi in children after failure of ESWL.

Flexible Ureteroscopy with Laser Lithotripsy versus Extracorporeal Shock Wave Lithotripsy in Management of Ureteric Stones in Pediatric Age Group

Background: pediatric stone disease is one of the most common urological issues in pediatric urology practice. The incidence of urinary stone disease is increasing in children in last decades. Aim of the Work: determination of the efficacy and outcome of flexible ureteroscopy using holmium Yttrium aluminium garne laser lithotripsy and compare its results with that of Extracorporeal shock wave lithotripsy EWSL in management of ureteric stones in pediatric age group. Patients and Methods: this study included 40 patients in pediatric age group. Complaining of upper ureteric stones less than (1cm). Patients underwent either ESWL or Flexible Ureteroscopy randomly according to 1: 1 ratio. The procedures were done at Eldemerdash hospital and National Institute of Urology and Nephrology. The patients were divided into two groups. Group A: Patients undergone extracorporeal shock wave lithotripsy (ESWL). Group B: Patients received flexible ureteroscopy and laser lithotripsy. Results: there was no statistically significant difference found between the two studied groups regarding age, sex, size and BMI, and stone free rate. Also there was highly statistically significant difference as regard hospital stay. The SWL group required a shorter period of hospitalization and there was highly statistically significant difference between the two groups regarding duration of the procedure which is more prolonged in flexible group. Conclusion: flexible URS lithotripsy and laser are considered a safe, highly efficient, minimally invasive, and reproducible surgery technique -with a higher stone free rates and less postoperative complications, after a single procedure, when compared to ESWL- for management of upper ureteric calculi in children after failure of ESWL.

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

Emergency extracorporeal shockwave lithotripsy as opposed to delayed shockwave lithotripsy for the treatment of acute renal colic due to obstructive ureteral stone: a prospective randomized trial.

The aim of this study was to assess the efficacy of emergency extracorporeal shockwave lithotripsy (eSWL) as first-line treatment in patients with acute colic due to obstructive ureteral stone. Seventy-four patients were randomized to emergency SWL within 12 hours (eSWL group) and deferred SWL later than 3 days (dSWL group). Follow-up included ultrasound, KUB (kidney-ureter-bladder) radiography and CT (computed tomography) scan at 24 hours, 7 days, 1 and 3 months from the treatment. When necessary, repeated SWL (re-SWL) or ureteroscopy (auxiliary-URS) was performed. Preoperative and postoperative data were compared and stone free rates (SFR) and efficiency quotients (EQ) were evaluated. Analyses were performed using SAS software. Complete data of 70 patients were collected. 36 underwent eSWL and 34 dSWL. The mean patient age was 48.7. Mean stone size was 9.8 mm (CI 95%: 8.9-10.8). 25 (35.7%) were proximal and 45 (64.3%) distal. Mean SWL energy was 19.2 kV (CI 95%: 18.5-19.9) and mean number of shocks was 2657 (CI 95%: 2513-2802). eSWL patients needs less auxiliary-URS than dSWL patients (13.9% vs. 44.1%, P=0.039) and less re-SWL sessions (8.3% vs. 32.4%, P=0.093). SFR at 24 hours was 52.8% and 11.8% (P<0.001) and the EQ at 3 months was 79.1% and 57.5% in the eSWL and dSWL group respectively. Patients from the dSWL group spent more time in the hospital (2.21 vs. 1.36 days, P=0.046) and complication rates between the two groups were similar. eSWL is a safe procedure and delivers high SFR even within 24 hours especially for <10 mm stones. It is able to reduce the number of auxiliary procedures and hospitalization.

Extracorporeal shock wave lithotripsy versus flexible ureterorenoscopy in the treatment of untreated renal calculi

[This corrects the article DOI: 10.1093/ckj/sfx151.].

MP68-15 THE EVOLUTION OF PERCUTANEOUS NEPHROLITHOTOMY: ANALYSIS OF A SINGLE INSTITUTION EXPERIENCE OVER 25 YEARS

You have accessJournal of UrologyStone Disease: Surgical Therapy IV1 Apr 2018MP68-15 THE EVOLUTION OF PERCUTANEOUS NEPHROLITHOTOMY: ANALYSIS OF A SINGLE INSTITUTION EXPERIENCE OVER 25 YEARS Jennifer Bjazevic, Linda Nott, John Denstedt, and Hassan Razvi Jennifer BjazevicJennifer Bjazevic More articles by this author , Linda NottLinda Nott More articles by this author , John DenstedtJohn Denstedt More articles by this author , and Hassan RazviHassan Razvi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2219AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The incidence of nephrolithiasis and the use of percutaneous nephrolithotomy (PCNL) has risen significantly over the years. PCNL aims to achieve a high stone-free rate with a low risk of complications. The objective of our study was to determine the impact of changes in patient demographics and surgical techniques over a 25-year time period, on PCNL outcomes. METHODS A retrospective analysis on a prospectively maintained database, including 2554 consecutive PCNL treatments in 2486 patients from July 1990 to July 2015 was undertaken. Collected data included patient demographics, comorbidities, stone and procedure characteristics, adverse events, and stone-free status at three-month follow-up. Adverse events were categorized according to the Clavien-Dindo classification. Patients were divided into equal terciles, each representing 852 consecutive procedures, ordered chronologically. Chi squared test was used to evaluate changes in patient characteristics and surgical techniques over time. A multivariate logistic regression was used to identify the effect of time on operative duration, adverse events, stone-free rate and hospital length of stay. RESULTS Our cohort had a mean age of 54 ± 15 years, was 66.6% male, had a mean body mass index (BMI) of 31 ± 8, and a mean stone surface area of 895 ± 602 mm2. Medical comorbidities were present in 46.9% of patients, most commonly hypertension (22%), diabetes (14%), and cardiac disease (13%). Overall complication rate was 15.6%, including a 2.5% rate of major complications (Clavien grade 3-5). Three-month follow-up of 1873 available patients showed residual stones in 13.3%. Over time there was a statistically significant increase in patient age, BMI, comorbidities, and ASA score. Over time, both OR duration (mean Δ 16 mins, p<0.001) and hospital length of stay (mean Δ 3 days, p<0.001) decreased significantly. Intra-operatively, there was an increase in the use of the balloon dilator and ultrasonic lithotripter (p<0.001). Stone-free rate decreased significantly over time (OR 1.09, p<0.001), but was correlated with an increased use of CT scans for follow-up imaging. There was an increased complication rate with time (OR 1.15, p=0.010); however, this was correlated with the increased rate of medical comorbidities. The overall transfusion rate was 1.0% and did not change over time (p=0.131). CONCLUSIONS Despite an increasingly complex patient population, PCNL remains a safe and effective procedure for the management of large and complex urolithiasis; resulting in a high stone-free rate and low risk of complications. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e922 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jennifer Bjazevic More articles by this author Linda Nott More articles by this author John Denstedt More articles by this author Hassan Razvi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The outcome of percutaneous nephrolithotomy on ≥50 mm staghorn and multiple calyceal stones.

To determine the success rate of percutaneous nephrolithotomy (PNL) in kidney stones over 50 milimeters. Twenty-four patients with a renal stone size of >50 mm between January 2007 and December 2016 were enrolled. Stone-free and complication rates were investigated. Twenty-one (87.5%) patients were male and 3 (12.5%) were female. Fifteen (62.5%) stones were located in the right, and 9 (37.5%) in the left kidney. Twenty-one (87.5%) patients were operated using single-access, and three (12.5%) patients were double-access. Thirteen (54%) patients were found to have no stone after operation and 11 (46%) patients had residual stones. Extracorporal shock wave lithotripsy was applied to 5 of 11 patients with residual stones, while flexible ureteroscopy was applied to 6 of them. After additional treatments, 8 (33.5%) patients were observed to be stone free. The stone-free rate was 87.5%. The mean operation time was 135.43 (85-240) minutes. Hemoglobin levels before and after operation were 14.8 (12-16.7) and 12.6 (9.3-15.5), respectively (p=0.001). The hospital stay was 6.04 (4-8) days. Complications were observed in four patients (16.6%). PNL has high stone-free rate on staghorn type large stones compared with multiple calyceal scattered large stones.

Extracorporeal shock wave lithotripsy versus flexible ureterorenoscopy in the treatment of untreated renal calculi.

ABSTRACTBackgroundThe reported success rates for treatments of kidney stones with either extracorporeal shock wave lithotripsy (ESWL) or flexible ureterorenoscopy (URS) are conflicting. We aimed to compare the efficacy and safety of ESWL and URS for previously untreated renal calculi.MethodsAll patients treated with ESWL or URS at our tertiary care centre between 2003 and 2015 were retrospectively identified. Patients with previously untreated kidney stones and a stone diameter of 5–20 mm were included. Stone-free, freedom from reintervention and complication rates were recorded. Independent predictors of stone-free and freedom from reintervention rates were identified by multivariable logistic regression and a propensity score-matched analysis was performed.ResultsA total of 1282 patients met the inclusion criteria, of whom 999 (78%) underwent ESWL and 283 (22%) had URS. During post-operative follow-up, only treatment modality and stone size could independently predict stone-free and freedom from reintervention rates. After propensity score matching, ESWL showed significantly lower stone-free rates [ESWL (71%) versus URS (84%)] and fewer patients with freedom from reintervention [ESWL (55%) versus URS (79%)] than URS. Complications were scarce for both treatments and included Clavien Grade 3a in 0.8% versus 0% and Grade 3b in 0.5% versus 0.4% of ESWL and URS treated patients, respectively.ConclusionsTreatment success was mainly dependent on stone size and treatment modality. URS might be the better treatment option for previously untreated kidney stones 5–20 mm, with similar morbidity but higher stone-free rates and fewer reinterventions than ESWL.

Efficacies of Various Surgical Regimens in the Treatment of Renal Calculi Patients: a Network Meta-Analysis in 25 Enrolled Controlled Clinical Trials

Background/Aims: Renal calculi, or kidney stones, are masses made of crystals that affect people of all geographical, cultural, and racial groups. We conduct this study with the aim of comparing the efficacy of various surgical methods in the treatment of renal calculi. Methods: Controlled clinical trials (CCTs) related to different surgical treatment approaches for renal calculi were included in this study by retrieving them from electronic English databases. The odds ratios (OR), the weighted mean difference (WMD), 95% confidence intervals (95% CI) and surface under the cumulative ranking curves (SUCRA) were evaluated, followed by a cluster analysis. Results: Compared with the extracorporeal shockwave lithotripsy (SWL), minimally invasive percutaneous nephrolithotomy (mini-PCNL), retrograde intrarenal surgery (RIRS), standard percutaneous nephrolithotomy (standard PCNL), ureterorenoscopy (URS) and micro-percutaneous nephrolithotomy (microperc) regimens, the open anatrophic nephrolithotomy (Open AN), URS + RIRS and laparoscopic pyelolithotomy (LP) surgical procedures all presented with a higher stone-free rate in renal calculi. Lower auxiliary procedures were found in the URS + RIRS treatment approach compared with SWL, RIRS, URS and microperc regimens. In addition, the SWL regimen indicated a lower stone-free rate than the mini-PCNL, standard PCNL, Open AN, URS + RIRS and LP regimens. Finally, the RIRS regimen presented with the shortest in-patient stay compared to the mini-PCNL, standard PCNL, Open AN, URS, URS + RIRS and LP regimens. Conclusion: This meta-analysis demonstrated that the URS + RIRS surgical procedure has the best stone-free rate and the lowest number of auxiliary procedures. The RIRS and Microperc both have the shortest hospital stay and operative time.

Minimally invasive percutaneous nephrolithotomy compared with retrograde intrarenal surgery: a meta-analysis

Percutaneous Nephrolithotomy (PCNL) and Retrograde Intrarenal Surgery (RIRS) are widely used in the management of kidney stones. But the safety and efficiency between these two technologies is still a mystery. This meta-analysis was performed to compare the efficacy as well as safety of Minimally Invasive Percutaneous Procedures (MIPPs) including ultra mini-PCNL, mini-PCNL, and micro-PCNL with RIRS. PubMed, Embase and Scopus were searched, and twelve studies included data on 1207 cases (613 for MIPPs and 594 for RIRS) satisfied the inclusion criteria and were included in this research finally. MIPPs were found to be associated with higher stone-free rate but longer hospital stays, and a larger drop in hemoglobin levels. Difference between MIPPs and RIRS in complication rate, operative time, and total cost were not notable. Given no obvious difference in the complication rate and higher efficacy, our findings suggest that mini-PCNL should be recommended over RIRS for stones>2 cm, and that for stones<2 cm any of MIPPs or RIRS are reasonable.

Worldwide Use of Antiretropulsive Techniques: Observations from the Clinical Research Office of the Endourological Society Ureteroscopy Global Study.

Retropulsion, defined as unintended migration of a stone under the influence of the fragmentation device in ureteroscopy (URS) procedures, occurs in 2% to 60% of the cases. Antiretropulsive devices (ARDs) have been studied in experimental and small clinical studies. The current study aims at describing the worldwide usage of ARD and the outcomes related to their usage. The Clinical Research Office of the Endourological Society URS Global Study enrolled 11,885 patients who underwent URS and stone fragmentation for ureteral and/or renal stones. Of the 11,885 treated patients, 9877 were treated for ureteral stones, and data were available on stone migration and ARD use. Of all procedures, 14.5% were performed with the use of an ARD. Less stone migration (-2.0%; p = 0.050), higher stone-free rates (SFRs) (2.8%; p < 0.001), and shorter length of stay (-4.7%; p = 0.001) were observed in the antiretropulsive group. When an ARD is used during URS, less migration, higher SFRs, and shorter length of hospital stay are observed. This effect is independent from baseline differences and corrected for other treatment characteristics.

Miniaturisation of PCNL.

Conventional PCNL leads to a high stone-free rate but is associated with a significant treatment morbidity. To decrease the morbidity of PCNL but to achieve an equal stone-free rate, in 2001 a miniaturised version of a conventional PCNL (Mini-PCNL) was introduced. Meanwhile numerous modifications of the Mini-PCNL were reported. The ongoing experience with the Mini-PCNL technique showed that Mini-PCNL is not only a miniaturisation but also a different method to remove the stones, as the stones come out of the calyceal system only by means of the irrigation flow without any further need of forceps or baskets. Due to a limited number of papers in the literature, the guidelines so far do not distinguish between conventional and Mini-PCNL, although the Mini-PCNL already became a frequent treatment modality in daily routine worldwide. From the current point of view, Mini-PCNL can be recommended to treat all kinds of upper urinary tract stones exceeding a diameter of 10mm. In this context, Mini-PCNL is a treatment alternative to flexible ureterorenoscopy, SWL and conventional PCNL. The available literature shows that the morbidity of Mini-PCNL is less and the stone-free rate is equal to that of conventional PCNL. It seems that there is no limitation to Mini-PCNL in the treatment of upper urinary tract stones. The future will show what kind of further miniaturisation of the Mini-PCNL procedure will be appropriate.

The recommendations of the S2k guideline for the diagnosis, therapy and metaphylaxis of urolithiasis provide a safe course of action for ureterorenoscopic stone treatment - results of the BUSTER study

Given the high incidence, prevalence and rate of recurrence, urolithiasis stone treatment at a high stone-free rate should have a low complication rate. The German S2k guideline (GS2k-GL) for the diagnostic testing, therapy and metaphylaxis of urolithiasis provides recommendations for the first and second choice for stone treatment, depending on stone location and size. Ureterorenoscopy (URS) is the treatment of first choice for most stones. URS is only the second option for renal stones > 20 mm and proximal ureteric stones ≤ 10 mm. The objective was to examine the impact of using URS as the stone treatment of first or second choice on the endpoints stone-free rate and severity of complications. The multicentric prospective observational study "Evaluation of ureteroroscopic stone treatment- results with regard to complications, quality of life and the stone-free rate" (BUSTER) standardised recorded perioperative data from 307 patients who had undergone ureterorenoscopic stone treatment from January to April 2015 at 14 German urological clinics. Treatment decisions were not affected by the study protocol. In the univariate analysis, the stone-free rate for ureteric stones was significantly higher when URS was the treatment of first choice (OR 2.21, 95 % CI 1.11 - 4.40, p = 0.027). After adjustment for age, BMI, ASA score, preoperative ureteral stenting, stone location and size, presence of multiple stones, experience of the surgeon, acute or elective URS and operating time, the application of URS as treatment of first choice had no significant effect on the stone-free rate (OR 2.048, 95 % CI 0.890 - 4.710, p = 0.092). After adjustment for stone location and size as well as ureteral stenting following URS, the application of URS as treatment of first choice had no significant influence on the severity of complications (OR 1.019, 95 % CI 0.347 to 2.993; p = 0.973). On the basis of our data, URS proved to be a safe and effective stone treatment procedure regardless of the degree of guideline conformity. Although the stone-free rate was higher with URS as treatment of first choice, the results of URS as treatment of second choice were not significantly worse. The recommendations of the GS2k-GL offer a safe guide for ureterorenoscopic stone treatment. The tendency for higher stone-free rates in URS as a treatment of first choice should be examined in further studies.

Outcomes of miniaturized percutaneous nephrolitotomy in infants: single centre experience

ABSTRACTObjectives:The present study was aim to evaluate the safety and efficacy of Mini-PNL to treat kidney stones in patients aged <3 years. This is the one of the largest series in the literature in this age group of patients.Material and methods:From May 2012 to April 2016, the medical records of 74 infant patients who underwent mini-PNL for renal stones were reviewed retrospectively. All infants were evaluated with the plain abdominal radiograph, urinary ultrasound, non-contrast computerized tomography and/or intravenous urogram. Pre-operative, intraoperative and post-operative data were analyzed.Results:A total of 74 infant (42 male, 32 female) with a mean age 21.5±8.2 (10-36) months were included in this study. The mean size of the stones was 22.0±5.9 (14-45) mm. A 17 Fr rigid pediatric nephroscope with a pneumatic intracorporeal lithotripsy were used through 20-22 Fr access sheath. The stone-free rate was 84.7% at 1 month after the operation. Mean operative time was 74.0 (40-140) min. Mean fluoroscopy screening time was as 4.3(3.1-8.6) min. Average hospitalization time was 3.8 (2-9) day. Auxiliary procedures were performed to 11(15.3%) patients (7 extracorporeal shock wave lithotripsy, 3 re- percutaneous nephrolitotomy, 1 retrograde intrarenal surgery). No major complication classified as Clavien IV-V observed in study group.Conclusions:Mini-PNL with pneumatic intracorporeal lithotripsy can be performed safely and effectively to manage kidney stones in infants with high stone free rate and low complications.

Effects of modified three-step procedure for anatrophic nephrolithotomy in the treatment of complex staghorn renal calculi

Objective: To investigate the effects of modified three-step procedure for anatrophic nephrolithotomy in the treatment of complex staghorn renal calculi. Methods: A total of 22 patients with complex staghorn renal calculi between June 2013 and June 2016 at Department of Urology in Guangzhou General Hospital of Guangzhou Military Command were retrospective analyzed. There were 13 males and 9 females, ranging from 35 to 62 years old with mean age of 47 years. There were 17 patients with dull pain, and 5 patients who were found through physical examinations. Kidney calculi located in left kidney in 15 patients, right kidney in 7 patients. All patients were treated with modified three-step procedure for anatrophic nephrolithotomy. The operation time, blood loss, time of intraoperative renal ischemia, and postoperative complications were recorded. Serum creatinine (Scr), blood urea nitrogen(BUN), β(2)-microglobulin(β(2)-MG), diseased side glomerular filtration rate(GFR) , and renal cortical thickness of the diseased kidney in preoperative and postoperative were compared. The clinical data were compared by paired sample t test between pre-operation and post-operation. Results: The calculi were completely removed in 22 patients, the mean operation time was 84 minutes (50 to 126 minutes), the mean time of intraoperative renal ischemia was 31 minutes (20 to 56 minutes), the mean blood loss was 246 ml (150 to 360 ml). There were no secondary bleeding or urinary fistula happened, the perinephric drainage tub was removed in 3 to 7 days postoperative, the mean hospitalization time was 7 days.Compared with the preoperative, the Scr ((172.7±21.3)μmol/L vs. (146.4±22.8)μmol/L, t=7.197, P=0.000), BUN ((9.2±1.8)mmol/L vs. (8.0±0.5)mmol/L, t=3.798, P=0.001) and β(2)-MG ((203.0±32.0)μg/L vs. (175.6±23.8)μg/L, t=5.009, P=0.000) in postoperative decreased, the diseased side GFR increased ((28.6±4.0) ml/min(31.8±3.3) ml/min, t=-3.521, P=0.002). There were no significant difference of diseased renal cortical thickness between preoperative and postoperative(t=-1.323, P=0.200). There were 12 patients with postoperative pain, 2 patients with vomiting, 3 patients with fever, and 2 patients with wound infection. The follow-up time was 6 months, no residual stones in 22 patients. Conclusion: The modified three-step procedure for anatrophic nephrolithotomy has high stone free rates with less effects on renal function and fewer complications, the method could be widely applied.

Clinical analysis of percutaneous nephrostomy in the treatment of solitary kidney calculi

Objective To investigate the clinical efficacy of percutaneous nephrolithotomy (PCNL) for renal calculi in solitary kidneys and analyze risk factors of operative complications. Methods The clinical data of 32 patients with renal calculi in solitary kidneys in our hospital were recorded and retrospectively analyzed from November 2009 to January 2016. Logistic regression was used to analyze the risk factors of bleeding and operative complications. Results Thirty-two patients were enrolled in our study, including 9 males and 23 females, the mean age was 47.75(29~67) years old, mean BMI was 23.7(18.2~28.4) kg/m2, one staghorn calculi, 11 multiple stones, mean stone burden was 501.25(300~800) mm2, the Guys score: 11 cases of Guys 1, 9 cases of Guys 2, 11 cases of Guys 3, 1 case of Guys 4. Four patients were established two tracts, the mean operative time was 73.75(40~120) min, the mean blood loss of the operation was 85 (40~300) mL, stone free rate was 81.25%. Three patients had operative complications. There was no significant variation in Hb and SCr before and after operation. Logistic regression confirmed number of access tracts as significantly related to bleeding while operative time related to surgical complications. Conclusions PCNL for renal calculi in solitary kidneys has high stone free rate with a low operative complication rate. Multiple access tracts are associated with increased bleeding. Key words: Kidney Calculi; Nephrostomy, Percutaneous; Lithotripsy

Efficacy and safety on upper ureteric lithotripsy by Shuo Tong ureteroscopy

Objective To investigate the efficacy and safety of Shuo Tong ureteroscopy in the treatment of upper ureteric stones. Methods The data of 832 patients , who underwent Shuo Tong ureteroscopy combined with holmium laser for the treatment of upper ureteric stones were collected between July 2014 and February 2017. The patients accepted general anesthesia under lithotomy position.After dilating the ureter, a ureteral access sheath was inserted along the guide wire. Finally, stones were broken and clean up by Shuo Tong ureteroscope.According to the stone size, 823 patients were divided into ≤2.0 cm group (n=112, 13.6%), 2.1-3.0 cm group (n=395 , 48.0%), 3.1-4.0 cm group (n=257, 31.2%), >4.0 cm group (n=59 , 7.2%)The stone free rate(SFR)and post-operative complications were observed. Results Among 983 operations, 663 cases accepted one-stage operations and 160 cases accepted second stage operations. the operative time and postoperative hospital stay were 23-145 min(mean 74.8±35.3)and 1-5 days(mean 1.9±0.8), respectively. The SFR in the first day and one month after operation was 75.6% and 83.8% , respectively. The stone free rate in each group were 89.3%, 82.5%, 61.1%, 52.5% at first day after operation respectively(P<0.05). While, the SFR after one month were 95.5%, 87.6%, 72.0%, 61.0% in each group, respectively(P<0.05). Fever rate after operation was 11.1%, ureteral injury rate was 1.9%, severe hematuria rate was 0.6%, stone street formation rate was 1.2%, perirenal hematoma rate was 0.4%. All patients were improved after conventional treatment. Conclusion Shuo Tong ureteroscopy is a safe treatment with high stone free rate for upper ureteric stones. Key words: Shuo Tong ureteroscopy; Upper ureteric stones; Stone free rate; Complication

Management of bladder stones: the move towards non-invasive treatment

Background: Bladder stone accounts for 5% of all cases of urolithiasis. Bladder stones management has evolved over the last decades from open bladder surgery (sectio alta) to intracorporeal cystholithotripsy as well as extracorporeal shock wave lithotripsy (ESWL). ESWL presents to be a promising modality in the management of bladder calculi due to its simplicity and well tolerability. This study is thus conducted to present data on the safety and effectiveness of ESWL in the management of bladder stone patients.Methods: This is a retrospective study evaluating the medical records of 92 bladder calculi patients admitted to Cipto Mangunkusumo General Hospital (RSCM) from January 2011 to April 2015. Patient’s age, gender, type of stone and procedure being done, status of stone disintegration, length of hospital stay, and any complications that may occur are noted down and statistically analyzed using SPSS v. 20.Results: Majority of the patients underwent ESWL (49 out of 92, 53.3%). The stone free rates for ESWL, intracorporeal lithotripsy, and sectio alta are 93.9%, 97.0% and 100% respectively. One patient had to repeat ESWL. The ESWL group had the smallest stone size average compared to the intracorporeal lithotripsy and section alta group (2.5 cm±2.0 cm vs 4.8 cm±3.7 cm vs 7.4 cm±5.4 cm respectively). The ESWL sessions were conducted in the outpatient clinic, and thus no hospital stay was required.Conclusion: ESWL can be suggested as an effective non-invasive approach in the disintegration of bladder stone of ≤25 mm with a promisingly high stone-free rate (93.9%) Furthermore, ESWL can be performed on an outpatient basis with minimal complications.

Same-Session Bilateral Ureteroscopy: Safety and Outcomes

To assess the complications and outcomes associated with same-session bilateral ureteroscopy in a tertiary referral center, as same-session bilateral ureteroscopy for stone disease has been critiqued for the theoretical risk of injury to both ureters with subsequent risk to renal function. We retrospectively reviewed all cases of bilateral ureteroscopy performed for urolithiasis by a single surgeon at out institution between 2009 and 2014. These were compared to a prospective unilateral ureteroscopy database. There were 117 same-session bilateral ureteroscopic procedures performed in 113 patients totaling 234 ureteroscopies. A flexible ureteroscope was used in 228 ureters (97.4%), and 6 (2.6%) were semirigid only. Ureteral dilators were required in 8 (6.8%) cases. Pre-stenting was performed in 23 (19.6%) patients. Short-term complications were observed following 19 (16.2%) procedures, including 11 (9.4%) Clavien I, 4 (3.4%) Clavien II, and 4 (3.4%) Clavien III. Of the 84 (71.8%) patients who completed a 6-week follow-up, there were no long-term complications. Stone-free rates were 91.4% for patients imaged with abdominal x-ray and ultrasound, and 84.2% for those imaged with computed tomography scans. Neither complications nor re-admissions were significantly different in the unilateral group. Median length of follow-up for the entire cohort was 2.8 years (range 0-7 years). Bilateral ureteroscopy can be performed safely with short-term complications, consistent with published literature. We found no long-term complications and high stone-free rates. Bilateral ureteroscopy in a single procedure represents a viable standard of care for patients with bilateral stone disease.