History Of Open Stone Surgery Research Articles

A prospective comparative study of percutaneous nephrolithotomy in patients with and without a history of open stone surgery

Background & Objectives: Percutaneous nephrolithotomy in individuals with prior open stone operations might be difficult. The purpose of our research was to compare the efficacy and complications of the procedure in individuals who had previous open renal stone surgeries with patients without previous open renal surgeries. Methods: This is a prospective comparative study carried out on 115 patients between May 2020 to April 2021, the patients were classified into two groups. Group 1 (n=50) had previously undergone open renal stone surgery. Group 2 (n=65) had no prior open operations. Both groups' demographic data, stone parameters, operative and fluoroscopy time, stone-free rate, hospital stays, and perioperative and postoperative complications were compared. Results: The demographic data and stone parameters were comparable between the two groups, the total operative time and fluoroscopic time were significantly higher for group 1 versus group 2 (74.18 min vs 62.89 min), (22.12 min vs 11.69 min) respectively. Postoperative hospital stays nephrostomy tube removal time, and mean hemoglobin drops were also similar, 6 patients in group 1 received a blood transfusion in comparison to 2 patients in group 2, but statistically was not significant. There were no statistically significant differences between groups 1 and 2 in terms of perioperative and postoperative complications. Conclusion: Individuals with a history of open renal stone operations who have subsequent percutaneous nephrolithotomy may require more fluoroscopic and operating time, although the success rate and overall morbidities were the same in both groups.

Percutaneous nephrolithotomy in patients with or without previous open nephrolithotomy from the same side

Background Reintervention is typically difficult owing to perinephric anatomical changes in individuals with a history of open stone surgery. Aim The aim of the current study was to see what effect open renal surgery may have on the effectiveness and morbidity of later percutaneous nephrolithotomy (PCNL). Patients and methods PCNL was performed on 100 patients between March 2017 and March 2018. Overall, 20 of these patients were eliminated (tubeless or bilateral simultaneous PCNL). The remaining 80 patients were divided into two groups: 40 primary patients and the rest (history of open nephrolithotomy). Before intervention, a standard preoperative assessment was conducted. Statistical analysis was performed using SPSS v. 20 with the χ2 test and the independent samples t-test. P value <0.05 was considered statistically significant. Results In terms of demographics and stone load, both groups were comparable. Group 1 had fewer attempts to access the pelvicalyceal system than group 2 (1.2 ± 0.5 vs. 2.7 ± 0.9, respectively), which was statistically significant (P=0.001*). Moreover, there was a statistically significant difference in the mean operational time between the two groups (85.24 ± 19.47 vs. 128.39 ± 17.45 min, respectively), with a statistically significant difference (P=0.001*). The rate of blood transfusion was similar in both groups (P=0.396). The remaining problems in both groups were similar. Conclusion Patients with renal stone surgery might require additional attempts to reach the pelvicalyceal system and may have difficulties with tract dilatation owing to retroperitoneal fibrosis. However, the overall morbidity and efficacy are the same in both groups.

Outcomes of Percutaneous Nephrolithotomy in Patients with Previous Ipsilateral Open Renal Stone Surgery.

Nephrolithiais is a recurrent disease. Recent advances have enabled stone surgeries to be performed by minimal invasive techniques; but still a large number of patients present with history of ipsilateral open renal stone surgery. Previous scar to the kidney and overlying muscles are fraught with possibility of increased complications. This study was conducted to evaluate the perioperative results of percutaneous nephrolithotomy in patients with a history of open stone surgery and to compare with those undergoing percutaneous nephrolithotomy for the first time. A retrospective study of all the percutaneous nephrolithotomy performed by standard technique within four years at Bir Hospital was made. Patients were divided into those undergoing percutaneous nephrolithotomy for the first time and those who had undergone open renal stone surgery in the past. Preoperative and intraoperative variables were recorded and postoperative stone free status and complications were evaluated. Six hundred and twenty seven patients; out of 691, who had undergone percutaneous nephrolithotomy were included. Demographic variables and stone characteristics were similar in the two study groups. percutaneous nephrolithotomy was found to be statistically similar in the two groups in terms of the number of tracts made (p= 0.1642) and operative time (0.9197). Exit strategies were similar in both groups. Stone free rate was 83.33% in patients undergoing percutaneous nephrolithotomy for first time and 82.08% in those with history of open surgery. Average hospital stay was 3 days in both groups. Although the group with history of previous surgery had significantly more complications (p= 0.0207), Clavien grading was similar in the two groups. This study shows that the rate of complications is more in patients with history of open surgery, most complications are minor, not requiring intensive management. percutaneous nephrolithotomy is efficient and safe in patients with history of open renal stone surgery.

Tract Dilatation Using Biprong Forceps Under Direct Endoscopic Vision: A Salvage Technique for “Short” Dilatation in Percutaneous Nephrolithotomy

Introduction: In some cases, during obtaining access for percutaneous nephrolithotomy (PCNL), working sheath fails to enter the caliceal system. In this video, we present a salvage technique for “short” dilatation of the tract. Materials and Methods: After obtaining access and dilating the tract, at the beginning of nephroscopy, sometimes it is observed that the working sheath did not enter the calix and is placed in the renal parenchyma or even out of the renal capsule (“short” dilatation). In this situation, we use a biprong forceps to dissect and dilate the tract under direct endoscopic vision using nephroscope as described previously by Lezrek et al.1 When the nephroscope reaches the caliceal system, the working sheath is advanced to the calix by twisting over the nephroscope. Results: As long as the guidewire is properly located in the caliceal system, we are able to enter the collecting system using this technique without significant hemorrhage or other complications. Between May 2016 to December 2016, we had 31 patients (17 men and 14 women) with mean age of 46 ± 15 years on whom we used this salvage technique. Mean body mass index was 25 ± 5 kg/m2, 19 (61%) stones were in right side, there was no hydronephrosis in 48%, and 16% were nonopaque stones. In 16%, there was a single caliceal stone, 16% had multiple calixes stones, 29% had a single pelvic stone, and 38% had staghorn stones. Nineteen percent had history of open stone surgery and 9% had history of PCNL. The lower pole calix was accessed in 21 patients (67%) followed by upper pole calix access in 6 patients (19%). Dilatation lasted 6 ± 6 minutes and nephroscopy time was 44 ± 29 minutes. In all cases, we were able to obtain access using this technique. Complication occurred in 10 (32%) patients. Based on Clavien–Dindo classification, grade I occurred in three patients (10%), grade II in six patients (19%), and grade IIIa in one patient (3%). Mean hemoglobin drop was −1.9 ± 1.4 g/dL. Conclusions: This safe, quick, and effective technique could be used in cases with “short” dilatation as a salvage procedure. For example, in case we fail to get the sheath in the calix in the first try, the contrast material may leak out of the collecting system, causing difficulty in confirming the entrance of the sheath in the collecting system using fluoroscopy, especially when managing nonopaque or pelvic stones. Likewise, in diverticular stones sometimes it is not possible to enter the diverticula but we can use a biprong forceps to dilate the parenchyma overlying the stone and place the sheath on the impacted calculi. Moreover, in case the guidewire becomes kinked during the passage of the Amplatz dilator, this technique is also useful. Furthermore, this method helps reduce radiation exposure and avoids significant complications that may be associated with too far dilatation. This is a salvage technique for cases in which standard techniques fail, and may not become a substitution for the standard principles. Putting forward this technique may trigger debates to determine its merits and demerits. Patient Consent: The author has received and archived patient consent for video recording/publication in advance of video recording of the procedure. No competing financial interests exist. Runtime of video: 5 mins

Complications of Percutaneous Nephrolithotomy and their Management

Introduction: Increasing global prevalence of nephrolithiasis has resulted in the development of new minimally invasive techniques and has also led to the resurgence of established methods such as percutaneous nephrolithotomy (PCNL). This procedure is now recommended as the first option for the treatment of single large or multiple renal stones and those in the inferior calyx. This study was done to assess the complications of PCNL and their management, in our centre.&#x0D; &#x0D; Methods: Medical records of 144 patients who underwent PCNL at Lumbini Medical College Teaching Hospital, during the last one year were reviewed. The demographic data, size, tract number and location of the calculi, and intraoperative and postoperative complications were evaluated. The various parameters of the calculi were evaluated. Descriptive analysis with frequencies was done.&#x0D; &#x0D; Results: Complications occurred in 13 (9.02%) patients. Post operative bleeding occurred in seven (4.8%) patients, out of which one patient developed pseudoaneurysms and the other developed arteriovenous fistula. One patient developed hypovolemic shock immediately after surgery. Frequent blockage of urine, excessive drainage of urine from the drain site, hemothorax and colonic perforation was seen in one patient each. One patient had mortality due to post operative bleeding. Complications increased with the number and size of stones and number and site of the tracts.&#x0D; &#x0D; Conclusion: Percutaneous nephrolithotomy has low complication rate in experienced hands and complications depend upon stone size, history of open stone surgery, tract number, and tract location.

Percutaneous nephrolithotomy with one-shot dilation method: Is it safe in patients who had open surgery before?

This study aimed to evaluate whether one-shot dilatation technique is as safe in patients with a history of open-stone surgery as it is in patients without previous open-stone surgery. Between January 2007 and February 2015, 82 patients who underwent percutaneous nephrolithotomy (PNL) surgery with one-shot dilation technique who previously had open-stone surgery were retrospectively reviewed and evaluated (Group 1). Another 82 patients were selected randomly among patients who had PNL with one-shot dilation technique, but with no history of open renal surgery (Group 2). Age, gender, type of kidney stone, duration of surgery, radiation exposure time, and whether or not there was any bleeding requiring perioperative and postoperative transfusion were noted for each patient. The stone-free rates, operation and fluoroscopy time, and peroperative and postoperative complication rates were similar in both groups (p>0.05). Our experience indicated that PNL with one-shot dilation technique is a reliable method in patients with a history of open-stone surgery.

Predictors of excessive renal displacement during access in percutaneous nephrolithotomy: a randomized clinical trial

To determine the magnitude of renal displacement (a major cause of access failure or loss) during the renal access steps in percutaneous nephrolithotomy (PCNL), investigate predictors of excessive renal displacement, and compare the effect of one-stage versus gradual dilation on renal displacement during access. Sixty-six adult patients undergoing PCNL were randomized into two groups containing 33 patients each: Group 1 underwent gradual tract dilation with Alken metal dilators, and Group 2 received one-stage tract dilation. In each patient, maximum renal displacement was measured in three planes (cephalocaudal, anteroposterior, and mediolateral) during the three access steps (needle puncture, Alken guide insertion, and dilator advancement). The patients' demographic data and intraoperative parameters were compared. In both groups, net renal displacement during the three access steps was in the cephalad, medial, and anterior directions. There were no significant differences in the magnitude of renal displacement in patients with gradual versus one-stage tract dilation. Renal displacement was significantly more pronounced in all planes and in all access steps in female patients and in those with no previous history of open stone surgery on the ipsilateral kidney. High body mass index (BMI) showed a significant negative correlation with cephalad and anterior renal displacement, but not with medial displacement. Three-dimensional movement of the kidney during percutaneous access in PCNL is similar when gradual versus one-stage tract dilation is used. Inherent patient characteristics, such as female sex, BMI, and a previous ipsilateral flank scar are major determinants of the magnitude of renal displacement during the PCNL access steps.

PCNL - a comparative study in nonoperated and in previously operated (open nephrolithotomy/pyelolithotomy) patients - a single-surgeon experience

Re-procedure in patients with history of open stone surgery is usually challenging due to the alteration in the retroperitoneal anatomy. The aim of this study was to determine the possible impact of open renal surgery on the efficacy and morbidity of subsequent percutaneous nephrolithotomy (PCNL). From March 2009 until September 2010, 120 patients underwent PCNL. Of these, 20 patients were excluded (tubeless or bilateral simultaneous PCNL). Of the remaining 100, 55 primary patients were categorized as Group 1 and the remaining (previous open nephrolithotomy) as Group 2. Standard preoperative evaluation was carried out prior to intervention, Statistical analysis was performed using SPSS v. 11 with the chi-square test, independent samples t-test, and Mann-Whitney U test. A p-value < 0.05 was taken as statistically significant. Both groups were similar in demographic profile and stone burden. Attempts to access the PCS was less in Group 1 compared to Group 2 (1.2 + 1 2 vs. 3 + 1.3 respectively) and this was statistically significant (p < 0.04). However, the mean operative time between the two groups was not statistically significant (p = 0.44). Blood transfusion rate was comparable in the two groups (p = 0.24). One patient in Group 2 developed hemothorax following a supra-11th puncture. Remaining complications were comparable in both groups. Patients with past history of renal stone surgery may need more attempts to access the pelvicaliceal system and have difficulty in tract dilation secondary to retroperitoneal scarring. But overall morbidity and efficacy is same in both groups.

E118 Complete supine percutaneous nephrolithotomy in patients with and without a history of open stone surgery: The time for change from prone to supine position has come!

E118 Complete supine percutaneous nephrolithotomy in patients with and without a history of open stone surgery: The time for change from prone to supine position has come!

Comparative Analysis of Percutaneous Nephrolithotomy in Patients with and without a History of Open Stone Surgery: Single Center Experience

To report our experience of percutaneous nephrolithotomy (PCNL) in patients who were treated previously with open stone surgery. Sixty-six patients with a history of open stone surgery (group 1) were compared with 90 patients without previous surgical intervention (group 2). Both groups were almost similar in demographic profile (age, sex, laterality, stone burden and success rate, body mass index, and location of stones. Patients who had tubeless or bilateral PCNL were excluded from the study. Antibiotics were administered prophylactically to all the patients. Patients with positive urine culture were treated with appropriate antibiotics, and sterile urine was ensured before surgery. Normal saline was used as irrigation fluid. Statistical analysis was performed using the chi-square test for qualitative variables and the Student t test for quantitative variables. A P value <0.05 was considered significant. Mean time interval between previous open surgery to PCNL in group 1 was 7.6 (range 1-18) years. Mean operative time was longer in group 1 (88.4 min vs 80.2 min), but it was not statistically significant. Average drop in hemoglobin level was comparable in both groups (2.3 vs 2.1 g/dL). A significant number of patients in group 1 needed a metallic dilator for tract dilation. Hospital stay and postoperative analgesic requirement were similar in both groups. Postoperative and intraoperative complications were also similar in both groups. Previous open stone surgery does not alter the outcome of subsequent PCNL significantly except that these patients more frequently need relook procedures for achieving complete clearance.