Lower Pole Of Kidney Research Articles

PD26-06 IS LESS MORE WHEN USING THE NOVEL THULIUM LASER: WHAT FIBER SIZE AND LASER SETTINGS RESULT IN THE MOST EFFICIENT IN SITU LOWER POLE LITHOTRIPSY?

You have accessJournal of UrologyStone Disease: Surgical Therapy III (PD26)1 Sep 2021PD26-06 IS LESS MORE WHEN USING THE NOVEL THULIUM LASER: WHAT FIBER SIZE AND LASER SETTINGS RESULT IN THE MOST EFFICIENT IN SITU LOWER POLE LITHOTRIPSY? Akin S. Amasyali, Joshua D. Belle, Natalie Chen, Mohammed Keheila, Jenna Lee, Nathaniel Srikureja, Elizabeth Baldwin, and D. Duane Baldwin Akin S. AmasyaliAkin S. Amasyali More articles by this author , Joshua D. BelleJoshua D. Belle More articles by this author , Natalie ChenNatalie Chen More articles by this author , Mohammed KeheilaMohammed Keheila More articles by this author , Jenna LeeJenna Lee More articles by this author , Nathaniel SrikurejaNathaniel Srikureja More articles by this author , Elizabeth BaldwinElizabeth Baldwin More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002019.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The novel thulium fiber laser (TFL) has advantages compared to the Holmium laser (HL) including smaller fiber size (150 μm) and higher frequency settings (up to 2000 Hz). These characteristics may be of particular benefit when performing in situ treatment of calcium oxalate monohydrate (COM) lower pole kidney stones. The purpose of this study was to determine the optimal fiber size and laser settings for in situ treatment of COM lower pole stones. METHODS: In a benchtop model, a 3D printed kidney and ureter were attached to a 2x2 mm metal mesh and submerged in a saline bath. Forty 1cm BegoStones (COM consistency) were placed in the lower pole and fragmented in situ by the same surgeon using a flexible ureteroscope. The stone was considered fully treated when residual fragments were small enough to fit through the 2mm mesh grid. Laser settings used were: 1Jx20Hz (20W), 0.4Jx50 Hz (20W), 0.2Jx100Hz (20W), and 0.1Jx200Hz (20W) for both the 150 and 200μm fiber sizes. Data collected included lasing time, procedure time, total pulse energy, and fiber stripping. ANOVA and independent T-tests were used to compare outcomes between treatment arms with p<0.05 considered significant. RESULTS: Pre-procedure stone weights were similar between trials (0.99 gm, p=0.944). Lasing time, overall procedure time, and total pulse energy were significantly different across all 8 trials (p<0.05 for all; Fig 1). Overall, use of the 150μm fiber resulted in less total lasing time, procedure time, and pulse energy compared to the 200μm fiber (p<0.05 for all). Lasing with 0.2J and 100Hz and the 150μm fiber had the shortest procedure time (18.5 min) compared to all other laser setting and fiber combinations (p<0.05). There was no difference in the number of fiber strippings between groups (p>0.05). CONCLUSIONS: In this benchtop lower pole model of in situ treatment of COM stones, the 150μm laser fiber resulted in shorter lasing time, procedure time, and lower total pulse energy compared to the 200μm fiber overall. When comparing different laser energies and frequencies, the fastest procedure time was seen when using 100Hz and 0.2J. Understanding these data can help improve efficiency of treatment for dense lower pole COM stones in situ. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e439-e439 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akin S. Amasyali More articles by this author Joshua D. Belle More articles by this author Natalie Chen More articles by this author Mohammed Keheila More articles by this author Jenna Lee More articles by this author Nathaniel Srikureja More articles by this author Elizabeth Baldwin More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement Loading ...

A Comparative Study of Percutaneous Nephrolithotripsy and Extracoeporeal Shockwave Lithotripsy For The Treatment of Lower Pole Kidney Stone of Size 10-20 mm

Introduction: A renal stone is commonly found at the Lower-pole of the kidney. Studies have reported various opinions about efficacy and safety of Percutaneous Nephrolithotripsy and Extracoeporeal Shockwave Lithotripsy for the treatment of lower pole stone of size 10-20 mm. &#x0D; Aims: The present study aimed to compare between Percutaneous Nephrolithotripsy and Extracoeporeal Shockwave Lithotripsy for safe and effective treatment of lower pole stone of size 10-20 mm.&#x0D; Methods: It is a prospective study conducted from December 2019 to November 2020 in the Urology Department of Nepalgunj Medical College. Total 66 patients under inclusion criteria were divided into two groups. Group I (32 patients) was allocated for patients who were treated under Percutaneous Nephrolithotripsy while Group II (34 patients) was allocated for patients who were treated with Extracoeporeal Shockwave Lithotripsy. Two groups were compared for stone free rate, retreatment rate, auxiliary treatment (%), operation time, hospital stay, haematuria, blood transfusion, obstruction and fever.&#x0D; Results: The stone free rate was significantly higher in Group I when compared to Group II. While the rate of retreatment and auxiliary treatment were significantly lower in Group I than Group II. However, mean hospital stay, mean operation time and the rate of haematuria was significantly higher in Group I when compared to group II. There were no statistically significant differences between Group I and Group II for post-operative complications such as, blood transfusion, obstruction and fever.&#x0D; Conclusion: Stone free rate was significantly higher in Group I while retreatment rate and auxiliary treatment rate were significantly higher in Group II. Therefore, Percutaneous Nephrolithotripsy is more effective for the treatment of the lower pole stone of size 10-20mm when compared to Extracoeporeal Shockwave Lithotripsy. However, duration of hospital stay and operation time were longer and incidence of haematuria was higher in Percutaneous Nephrolithotripsy than Extracoeporeal Shockwave Lithotripsy.

Evaluation of the anatomical factors affecting the success of retrograde intrarenal surgery for isolated lower pole kidney stones.

Studies which examine the factors affecting success rate in kidney stones located in the lower pole as well as the effects of infundibulopelvic angle (IPA) and infundibular length (IL) have been conducted with a small number of patients. We aimed to evaluate the cut-off points of IPA and IL parameters that effect the success of retrograde intrarenal surgery (RIRS) for isolated lower pole kidney stones. This retrospective study includes 168 patients who underwent primary RIRS due to isolated lower pole kidney stones in our clinic between January 2013 and May 2020. Pre-operative demographic data, medical history, physical examination, surgery duration as well as the post-operative hospitalization time of patients specifics were obtained. According to pre-operative computed tomography (CT), stone size, stone burden, stone density, number of stones (single and multiple), stone laterality, congenital kidney abnormality, the presence of solitary kidney, parameters of IPA and IL were measured and both included in the study. All patients were divided into two groups as the successful group and the unsuccessful group according to their post-operative success. These two groups were compared in terms of pre and post-operative data. Stone burden, IPA < 42.65°, and IL > 27.5mm were specified as the independent risk factors for success of RIRS procedure. The patients for whom RIRS procedure is planned for lower pole kidney stones, stone burden, IPA, and IL should be taken into consideration to be able to predict success and it should be kept in mind that additional treatment may be required.

Aggressive uncommon pediatric renal tumor: Rhabdoid tumor of kidney

Rhabdoid tumor of kidney is one of the uncommon pediatric renal neoplasms with highly aggressive clinical course. We are presenting a case of 1 year child with abdominal distension and hematuria. On Contrast enhanced computed tomography (CECT) a heterogenous mass in lower pole of kidney was detected. Histopathological and immunohistochemical study after radical nephrectomy revealed Malignant rhabdoid tumor of kidney. It has a tendency to metastasize early and it is associated with synchronous presence of other malignancies. No definite effective treatment for this tumor is available till now. This further necessitates the early diagnosis and prompt management which can be life saving for the patient. We are presenting this case to emphasize on its rarity and aggressive clinical behaviour. Keywords: Rhabdoid tumor, Kidney neoplasm.

English

BACKGROUND We wanted to compare the outcomes of retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mini-PCNL) in treating lower pole (LP) renal stones with a diameter of &lt; 2 cm in terms of safety, efficacy, and stonefree rate (SFR). METHODS In a retrospective analysis data of 39 patients who underwent mini-PCNL (N = 19) or RIRS (N = 20) for LP stones with a diameter of &lt; 2 cm were reviewed between November 2018 and November 2020 at the Department of Urology in Veer Surendra Sai Institute of Medical Sciences and Research (VSSIMSAR), Odisha. The mean age, sex, stone size, operating time, complications, hospital stay, and SFR were compared between the groups. The success of the procedure was defined as the absence of residual stones or small residuals of size 3mm or less on computed tomography at 12 weeks postoperatively. RESULTS Significant differences were found in the hospital stay duration in hours (103.3 ± 11.7 vs. 145.2 ± 16.4, P &lt; 0.028) between the RIRS and mini - PCNL groups. The mean operation time (in minutes) was also significantly different between the RIRS group (82.5 ± 3.44) and mini PCNL group (86.21 ± 5.90, P = 0.021). The stonefree rates in the postoperative period at three months (RIRS vs. mini - PCNL: 95 % vs. 94 %, P = 0.47) were not significantly different. CONCLUSIONS RIRS and mini-PCNL are both safe and effective methods for treating LP stones with a diameter of &lt; 2 cm. RIRS can be considered as a less invasive alternative to PCNL for the treatment of LP stones of &lt; 2 cm with reasonable SFR with shorter hospital stay. KEYWORDS Retrograde Intrarenal Surgery, Percutaneous Nephrolithotripsy, Lower Pole Kidney Stones, Miniaturized Percutaneous Nephrolithotomy

Reply letter to Reply letter to: Retrograde Intrarenal Surgery vs. Percutaneous Nephrolithotomy vs. Extracorporeal Shock Wave Lithotripsy for Lower Pole Renal Stones 10-20 mm : A Meta-analysis and Systematic Review.

We read the article entitled ''Retrograde Intrarenal Surgery vs. Percutaneous Nephrolithotomy vs. Extracorporeal Shock Wave Lithotripsy for Lower Pole Renal Stones 10-20 mm: A Meta-analysis and Systematic Review'' published in Urology Journal (1). The topic is still hot in urology regarding lower pole kidney stones in 10-20 mm diameters. Although extracorporeal shock wave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are the available options for the patients with lower pole renal stones 10-20 mm diameter, the decision making among the methods is still controversy. This manuscript is valuable in this regard. At the present manuscript, the authors prepared a very comprehensive meta-analysis of existing evidence to quantify and compare the safety and efficacy of PCNL, RIRS and ESWL for lower pole renal stones 10-20mm. They emphasized the longer operative time of PCNL and RIRS compared to ESWL. They also reported a higher stone-free rate, the lower retreatment rate and auxiliary procedure following PCNL with the longest hospital stay for PCNL. When it comes to ESWL, the lowest SFR, the higher retreatment rate and auxiliary procedure rate, but a shorter operative time and the shortest hospital stay was reported. The authors indicated stone to skin distance (SSD) as an unfavourable factor for ESWL. This issue is also reported in current literature. SSD was calculated by measuring the distance from the stone to the skin in three angles (0°, 45° and 90°) and the cut-off value for SWL failure was reported in a wide-scale from 100 mm to 119 mm(2,3). At the present study, the authors presented 10 mm as a predictive value for the criteria of SWL failure. This statement seems to be not correct totally also 10 mm is an impossible value for SSD. In our opinion, it was caused by a misspelling, and a correction may be informative for the readers.

Evidence and clinical trials in Endourology: where are we going.

There is an ongoing explosion in the amount and quality, of research in the field of Endourology. From a solid basis of systematic reviews and small, single centre trials it has been possible to design large randomised controlled trials in the UK and in the USA. This review will describe some of the more recent trials (small and large) that are helping to provide a solid evidence base for our practice in Endourology. Randomised controlled trial (RCTs) include: The Therapeutic Interventions for Stones in the Ureter (TISU), the Percutaneous nephrolithotomy, flexible Ureterorenoscopy and extracorporeal Shockwave lithotripsy for lower pole kidney stones (PURE RCTs) and the Prevention of Urinary Stones with Hydration (PUSH). Quality of life (QoL) measures and studies include: the Wisconsin Stone QoL Questionnaire, the Cambridge Renal Stone PROM, the Cambridge Ureteral Stone PROM, the Urinary stone and Intervention QoL questionnaire and the Study to Enhance Understanding of sTent-associated Symptoms (STENTS). The Core Outcome Set in Trials on treatments for Renal and UreteriC sTones (COSTRUCT) study aims to define a core outcome set to be used in future trials. On-going studies will provide higher quality evidence on the treatment of ureteric and renal stones to inform treatment decision making and guideline recommendations. They will also guide decisions relating to prevention and recurrence and give insight into the true impact of urinary stones and endourological interventions on patients' quality of life. Future studies will incorporate big data and artificial intelligence.

InsKid-a new mobile application (app) that measures the infundibulopelvic angle before retrograde intrarenal surgery more reliably than does other approaches: pilot study.

This study compared our program's ("InsKid") capability for measuring the infundibulopelvic angle (IPA) with existing ones. Prospectively, data from 50 patients with lower pole kidney stones with indications for retrograde intrarenal surgery (RIRS) were collected. All patients underwent computed tomography (CT)-urography. The IPA of each pelvicalyceal (PCS) unit was measured with the Elbahnasy's, Sampaio's, and "InsKid" methods. Results were compared. Finally, we compared the area under the receiver operating characteristic (ROC) curve (AUC) for predicting stone-free status after RIRS. We defined success as stone fragments ≤ 2mm on the CT scan on the first postoperative day (POD1). The stone-free rate refers to no identifiable stone fragments on the POD1 CT. Test-retest reliability and face validity were defined to estimate psychometric properties of InsKid. The success rate after first procedure was 87.5%. The average value of IPA using the Elbahnasy and Sampaio methods and our program were 85.2° ± 11.9°, 95.1° ± 10.1°, and 79.9° ± 13.0, respectively. There was a significant difference among the InsKid, Elbahnasy, and Sampaio (AUC = 0.762, 0.601, and 0.629, respectively) approaches with respect to the capability of predicting the immediate success of RIRS. Repeated measurement did not affect values of IPA (1.3° ± 0.7, p = 0.67). All specialist appreciated proposed software as highly useful (5/5). This new application reproduces the intraoperative aspects of the PCS more clearly than the other methods and also provides an easy solution for clearly defining the IPA without relying on the central axes.

A Cheap Kidney Phantom for Kidney Biopsy

Percutaneous renal biopsy is the most common method for obtaining renal tissue. In this article, the authors first explained how to make a cheap model of phantom easily by sheep’s kidney in a bowl filled with jelly. Then in the attached video, they showed how to find the ideal site (lower pole of kidney) and in real time, traced biopsy needle from jelly surface to kidney concomitant with ultrasound screen.

The clinical and cost effectiveness of surgical interventions for stones in the lower pole of the kidney: the percutaneous nephrolithotomy, flexible ureterorenoscopy and extracorporeal shockwave lithotripsy for lower pole kidney stones randomised controlled trial (PUrE RCT) protocol

IntroductionRenal stones are common, with a lifetime prevalence of 10% in adults. Global incidence is increasing due to increases in obesity and diabetes, with these patient populations being more likely to suffer renal stone disease. Flank pain from stones (renal colic) is the most common cause of emergency admission to UK urology departments. Stones most commonly develop in the lower pole of the kidney (in ~35% of cases) and here are least likely to pass without intervention. Currently there are three technologies available within the UK National Health Service to remove lower pole kidney stones: extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and flexible ureterorenoscopy (FURS) with laser lithotripsy. Current evidence indicates there is uncertainty regarding the management of lower pole stones, and each treatment has advantages and disadvantages. The aim of this trial is to determine the clinical and cost effectiveness of FURS compared with ESWL or PCNL in the treatment of lower pole kidney stones.MethodsThe PUrE (PCNL, FURS and ESWL for lower pole kidney stones) trial is a multi-centre, randomised controlled trial (RCT) evaluating FURS versus ESWL or PCNL for lower pole kidney stones. Patients aged ≥16 years with a stone(s) in the lower pole of either kidney confirmed by non-contrast computed tomography of the kidney, ureter and bladder (CTKUB) and requiring treatment for a stone ≤10 mm will be randomised to receive FURS or ESWL (RCT1), and those requiring treatment for a stone >10 mm to ≤25 mm will be randomised to receive FURS or PCNL (RCT2). Participants will undergo follow-up by questionnaires every week up to 12 weeks post-intervention and at 12 months post-randomisation. The primary clinical outcome is health status measured by the area under the curve calculated from multiple measurements of the EuroQol five dimensions five-level version (EQ-5D-5L) questionnaire up to 12 weeks post-intervention. The primary economic outcome is the incremental cost per quality-adjusted life year gained at 12 months post-randomisation.DiscussionThe PUrE trial aims to provide robust evidence on health status, quality of life, clinical outcomes and resource use to directly inform choice and National Health Service provision of the three treatment options.Trial registrationISRCTN: ISRCTN98970319. Registered on 11 November 2015.

Evaluation of the Management of Urolithiasis with Clinical Study

Background: Urolithiasis encompasses both renal and ureteric stones. It is estimated that up to 5% of the world population is affected by this disease and the lifetime risk of getting urinary stone is 8-15%. The aim of this study is to look for epidemiological patterns in the disease distribution, understand the causative factors of the disease and assess the existing surgical modalities of treatment of this disease. Subjects and Methods: In the present study 68 cases of Urolithiasis fulfilling the study parameters were admitted and subsequently operated in Medical College and Research Hospital. Results: 65% of the patients were between age group 18-40. The most common site of urinary calculus was lower 1/3ureter followed by lower pole kidney. Diet, fluid intake, diabetes and obesity were significant predisposing factors for urolithiasis. PCNL was the treatment of choice for renal calculus while ECSWL was treatment of choice in upper ureteric calculi and ureteroscopy for lower ureteric calculi. Conclusion: For renal calculi, PCNL is the best treatment modality as of now, but it is associated with greater post-operative morbidity. For stone less than 1cm size, ECSWL is a good alternative to PCNL, but has poor clearance rate and thus greater need for auxiliary procedure. For ureteric calculi, both ECSWL and ureteroscopy have given good results but ECSWL is better tolerated by the patients.

PD15-08 RENAL STONE FEATURES ARE MORE IMPORTANT THAN RENAL ANATOMY TO PREDICT SHOCK WAVE LITHOTRIPSY OUTCOMES

INTRODUCTION AND OBJECTIVE:Lower pole kidney stones have been associated with poor shock wave lithotripsy (SWL) outcomes due to its location. However, the real impact of collecting system anatomy o...

Percutaneous Nephrolithotomy via a Middle Calyx Access Is Effective in the Treatment of Lower Pole Kidney Stones: A Single-Center Study

Purpose: To compare the efficacy of the middle calyx access (MCA) and lower calyx access (LCA) in the treatment of lower pole kidney stones. Materials and Methods: The data of patients with isolated lower pole kidney stones who underwent percutaneous nephrolithotomy via MCA or LCA between 2009 and 2019 were evaluated retrospectively. Pre-, peri-, and postoperative parameters of the groups (LCA group and MCA group) were compared. A value of p < 0.05 was considered significant. Results: A total of 601 patients with lower pole kidney stones were included in the study. LCA was performed for the initial tract in 400 patients, and MCA was performed in 201 patients. There were no significant differences in terms of age, gender, laterality, body mass index, previous operation history, stone burden, duration of fluoroscopy, and stone-free rate between the groups. Operation time was significantly longer in the LCA group (p = 0.041). In the LCA group, additional access was required in 50 cases, which was significantly higher than in the MCA group (p = 0.013). Clinically insignificant residual fragments (CIRF) were present in 28 patients (7%) in the first group (significantly higher vs. MCA: p = 0.044). There were no statistically significant differences in terms of overall complication and transfusion rates. Conclusions: MCA had superior outcomes in terms of operation time, CIRF rate, hemoglobin drop, and requirement of an additional tract compared to LCA. Further studies evaluating the efficacy of MCA in lower pole kidney stones should be performed to verify our results.

Renal Stone Features Are More Important Than Renal Anatomy to Predict Shock Wave Lithotripsy Outcomes: Results from a Prospective Study with CT Follow-Up.

Introduction: Lower pole kidney stones have been associated with poor shock wave lithotripsy (SWL) outcomes because of its location. However, the real impact of collecting system anatomy on stone clearance after SWL is uncertain. There is a lack of prospective well-controlled studies to determine whether lower pole kidney stones have inferior outcomes than nonlower pole kidney stones when treated with SWL. Methods: We prospectively evaluated patients with a single kidney stone of 5-15 mm undergoing SWL from June 12 through January 19. All patients were subjected to computed tomography before and 3 months after the procedure. Demographic data (age, gender, and body mass index), stone features (stone size, stone area, stone density, and stone-skin distance-SSD), and collecting system anatomy (infundibular length and width, and infundibulopelvic angle) were recorded. Outcomes (fragmentation and stone clearance rates) were compared between lower pole and nonlower pole cases. Then, a multivariate analysis including all variables was performed to determinate which parameters significantly impact on SWL outcomes. Results: One hundred and twenty patients were included in the study. Mean stone size was 8.3 mm and mean stone density was 805 Hounsfield units. Overall stone fragmentation, success, and stone-free rates were 84.1%, 64.1%, and 34.1%, respectively. There were no significant differences in stone fragmentation (76.0% vs 71.4%; p = 0.624), success rate (57.6% vs 53.3%; p = 0.435), and stone-free rate (40.2% vs 35.7%; p = 0.422) in the lower vs nonlower pole groups, respectively. On multivariate analysis, only stone density (p < 0.001) and SSD (p = 0.006) significantly influenced fragmentation. Stone size (p = 0.029), stone density (p = 0.002), and SSD (p = 0.049) significantly influenced kidney stone clearance. Conclusions: Stone size, stone density, and SSD impact on SWL outcomes. Lower pole kidney stones have similar fragmentation and stone clearance compared with nonlower pole kidney stones.

ESWL EFFECTIVENESS FOR LOWER POLE KIDNEY STONES

Objective: To describe the profile of lower pole kidney stone patients who underwent Extracorporeal Shock Wave Lithotripsy (ESWL) and the clearance rate of ESWL for lower pole kidney stones at Soetomo General Hospital from 2012 to 2016. Material &amp; Methods: This research design was analytical retrospective, lower pole kidney stone patients who underwent ESWL in Soetomo General Hospital from 2012 to 2016 who fulfill inclusion criteria become samples in this research. Samples were divided into two group, stone size &lt;15 mm and 15-20 mm. Results: Total samples in this study were 128, consist of 81 males and 47 females. The age average was 48 ± 11.124. The stone size average was 9.5 ± 4.5 mm consisted of 109 patients with stone size &lt;15 mm and 19 patients with stone size 15-20 mm. There were 119 single lower pole kidney stones and 9 multiple ones. From all patients, 77 patients (60.2%) were stones free and the rest (39.8%) were not. Stone free rate for lower pole kidney stones was higher in stone size &lt;15 mm compared with 15-20 mm, 65.2% and 31.5% respectively. Statistical analysis with Chi-square showed significant ESWL clearance rate difference between lower pole kidney stone size &lt;15mm group and 15-20 mm (p&lt;0.05). Conclusion: ESWL was a safe option for lower pole kidney stones with high success rate. There was significant relationship between stone size and stone clearance rate. ESWL was effective for lower pole kidney stones size &lt;15 mm.

Comparison of success rate and complications of mini PCNL with ESWL in treatment of &lt;2cm lower pole kidney stones

Comparison of success rate and complications of mini PCNL with ESWL in treatment of &lt;2cm lower pole kidney stones

Comparison of the Efficacy of Ultra-Mini PCNL, Flexible Ureteroscopy, and Shock Wave Lithotripsy on the Treatment of 1–2 cm Lower Pole Renal Calculi

Objective: To compare the efficacy of new percutaneous technique (“ultra-mini PCNL”, UMP), shock wave lithotripsy (SWL) and flexible ureteroscopy (FURS) on the treatment of 1–2 cm lower pole kidney stones, and to determine the advantages and disadvantages of each method. Materials and Methods: This prospective study was based on data collected from the files of patients between March 2015 and March 2017. This study recruited a total of 180 patients with single radio-opaque lower caliceal calculi of 1–2 cm. All patients were randomly divided into 3 groups: group A was treated with UMP, group B was treated with FURS by using holmium laser and group C was treated with SWL by using the electromagnetic lithotripter. The average age, sex, size of the stone, the time of operation, the rate of no stone, the time of hospitalization, the rate of retreatment, the cost and the complications of the 3 groups were compared. The success of the operation was defined as no residual stone or < 0.3 cm on computed tomography at 3 months postoperatively. Results: The stone burdens of the groups were equivalent. The re-treatment rate in group C was significantly higher than that in group A and B (30 vs. 1.6%, 5%). The average operating time in group B (93.35 ± 21.64 min) was statistically significantly longer than that in group A and C (68.58 ± 15.82 min, 46.33 ± 5.81 min). Although the time of hospitalization of group A (5.32 ± 1.20 day) was longer than that of group B (3.22 ± 0.52 day) and C (1.08 ± 0.28 day; p < 0.05). The stone-free rate (SFR) in UMP, FURS, SWL were 98, 92, and 73% respectively; the highest SFR was in the UMP group (p < 0.05). The complication rates were evaluated by using the Clavien grading system, which were determined to be 16.67% in UMP, 6.67% in SWL and 8.33% in FURS. In particular, the complications of GI and GII were more common in group A (p < 0.05). Conclusions: UMP, FURS, and SWL are all safe and effective in the treatment of 1–2 cm lower pole kidney stones. UMP and FURS had a better SFR than SWL, but the time of hospitalization in UMP group was longer and there were more complications in the UMP group. In addition, the operation time of FURS is longer as compared to UMP and SWL, and there is a higher rate of postoperative fever. The invasiveness and cost of SWL were lower than that of UMP and FURS, but the re-treatment rate was higher.

The impact of pelvicalyceal anatomy on the stone formation in patients with lower pole renal stones.

The aim of our study was to determine whether various anatomic factors constitute a predisposition to a lower pole renal stones. We analysed the computed tomography (CT) urography of 75 patients with a single lower pole stone. Measurements were taken of the infundibulopelvic angle (IPA), infundibular width (IW), infundibular length (IL) and calyceopelvic height (CPH). The mean patient age was 50 years (range 17-79 years). The mean stone size was 11.9 mm. The mean IPA using Sampaio method in affected kidney was 113.4 ± 15.3o (range 80-139o), 59.5 ± 17.3o using Elbahnasy method. The values of IPA on the contralateral kidney were 119.86 ± 15.37o (range 79-141o; p = = 0.001) using Sampaio method of measurement and 59.78 ± 12o (range 34-90 o; p = 0.465) using the method described by Elbahnasy. We reported statistically significant differences between stone-bearing kidney and contralateral kidney in measurement IPA using only Sampaio method. The mean infundibular width was 4.22 ± 1.81 mm on the affected kidney and 3.72 ± 2.5 mm on the contralateral side (p = 0.164). The mean infundibular length was 15.37 ± 4.57 mm on the affected kidney and 14.66 ± 4.35 mm on the unaffected side (p = 0.329). The CPH was 10.19 ± 4.05 mm on the affected kidney and 10.44 ± 3.83 mm on the normal side (p = 0.688). Pelvicalyceal morphology of the kidney is one of the factors that determine the risk of developing kidney stones. Out of the analysed morphological parameters of kidney IPA is a statistically significant risk factor to form lower pole kidney stones. Other anatomic parameters did not seem to have a significant role in predisposing to form lower pole kidney stone. (Folia Morphol 2018; 77, 1: 16-21).

Possibilities of retrograde intrarenal surgery in the treatment of renal lower pole stones in children

Background/Aim. Renal stones located in the lower pole of kidney represent a serious challenge for surgical treatment in children. The options are: open surgery, extracorporeal shock-wave lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery. Reports about the endoscopic treatment in children are limited. The aim of the study was to evaluate the effectiveness of retrograde intrarenal surgery in pediatric patients with renal stones in lower pole of the kidney. Methods. We retrospectively analyzed the results of the retrograde intrarenal surgery in 24 patients with renal stones in lower pole, between April 2012 and April 2016. Flexible ureterorenoscopy in combination with holmium laser lithotripsy were performed. We considered stone fragment size 3 mm or less as a measure of sufficient fragmentation of the stone. Results. Mean duration of general anesthesia was 68 (range, 40?90) minutes. Duration of hospitalization was 1?3 (mean, 1.6) days. Complications were found after two (8.4%) surgical procedures: perirenal haematoma in one (4.2%) and urinoma in one (4.2%) patient. The stone was completely fragmented in 18 (75%) patients. In 3 (12.5%) patients the stone was incompletely fragmented and in 3 (12.5%) patients the stone was not fragmented. Double J stent was placed in 5 (21%) patients. Mean follow-up was 9 (range, 6?18) months. Conclusion. Retrograde intrarenal surgery in children is the least invasive, effective and safe surgical procedure for stones in lower pole of the kidney, with minimal complication rate. Unsuccessful treatment in some patients was due to loss of ureterorenoscope deflection with laser probe in working channel.

The treatment of renal lower pole calculi with flexible ureteroscope and percutaneous nephrolithotomy in obese patients

Objective To evaluate the efficacy and safety of flexible ureteroscopy (FURS) for the treatment of renal lower pole calculi in obese patients. Methods From October 2012 to May 2017, a total number of 184 obese patients(body mass index, BMI≥30) with lower pole kidney stones were randomly divided into two groups, FURS group(n=65) and percutaneous nephrolithotomy(PNL) group (n=119). The mean stone size was (15.8±5.7)mm in FURS group and (18.6±4.9)mm in PNL group. Results All of the D-J stents were removed 4 weeks after operation in both groups, and ultrasonic or X-Ray 87.69% vs. 89.92% (P>0.05). Residual stones were found in 8 vs. 12 patients in each group, and all disappeared after active lithagogue treatment with external physical vibration lithecbole (EPVL). Complications in FURS group were lower than PNL group , including fever(1 vs. 2), pain(8 vs. 23), perirenal hematoma(none vs. 1) , the visual analogue scale/score(3.3±1.1) vs.(5.6±0.9) and hospital stay(3.7±0.6) d vs. (5.4±0.8 ) d was also lower(P<0.05). Conclusions FURS is a safe and efficient option for renal lower pole calculi in obese patients. Key words: Kidney Calculi; Nephrostomy, Percutaneous; Ureteroscopes; Obesity