Large Staghorn Stones Research Articles

Managing a large staghorn stone in a Doughnut kidney

Doughnut or Pancake kidney is a condition in which both the kidneys fused at the medial borders of each pole to produce a ring-shaped mass. In addition to nonspecific lower abdomen discomfort, pyrexia and haematuria, signs of a urinary tract infection may also be present in an otherwise asymptomatic pancake kidney. Sometimes the diagnosis is coincidental. However different imaging modalities like USG, MDCT, computed tomography (CT) urography, and radio nucleotide scanning are use confirmed the diagnosis. Different surgical options such as open pyelolithotomy, laparoscopic or robot assisted pyelolithotomy can be consumed to treat such patient, however the literature proposes that an open pyelolithotomy is a safer and more rational approach to avoid injury to any aberrant vessels which are more common in such cases. KeyWord: Doughnut Kidney, Renal Stone, Pyelolithotomy

Anatrophic Nehphrolithotomy: Preservation of Renal Function and Stone Clearance Rate

Aim: To assess the outcomes of anatrophic nephrolithotomy in terms of stone clearance and change in renal function. Study design: Observational study Place and duration of study: Department of Urology Sindh Institute of Urology & Transplantation, Karachi from 1st January 2016 to 31st December 2021. Methodology: Fifty patients who underwent anatrophic nephrolithotomy from were enrolled. Outcomes were measured in terms of stone clearance, change in pre and post procedure eGFR, serum creatinine and differential renal function on renal scan (MAG-3 scan). Results: There were 30 (60%) males and 20 (40%) females with mean age was 5.96±13.09 years. Post-operative serum creatinine and eGFR were compared with pre-operative values and no statistically significant difference observed. Comparison of pre-operative and post-operative 99mTc-mercaptoacetyltriglycine (MAG3) scans revealed statistically significant mild loss of renal function with p-value of0.376. Conclusion: Anatrophic nephrolithotomy can be an alternative for multi tract PCNL when there is huge stone burden as it yields excellent stone clearance, and it can be practiced fearlessly for large staghorn stones because they can become the frequent cause of infections and mortality. Although parenchymal damage after anatrophic nephrolithotomy is of concern, renal dysfunction is usually clinically insignificant. Key words: Anatrophic nephrolithotomy, Staghorn stone, Renal calculi

V03-07 INTRACORPOREAL ROBOTIC PYELOLITHOTOMY USING THE BOSTON SCIENTIFIC SWISS LITHOCLASTⓇ TRILOGY LITHOTRIPTER

You have accessJournal of UrologyCME1 May 2022V03-07 INTRACORPOREAL ROBOTIC PYELOLITHOTOMY USING THE BOSTON SCIENTIFIC SWISS LITHOCLASTⓇ TRILOGY LITHOTRIPTER Micah Levy, Chih Peng Chin, Krishna T. Ravivarapu, Osama Al-Alao, and Michael Palese Micah LevyMicah Levy More articles by this author , Chih Peng ChinChih Peng Chin More articles by this author , Krishna T. RavivarapuKrishna T. Ravivarapu More articles by this author , Osama Al-AlaoOsama Al-Alao More articles by this author , and Michael PaleseMichael Palese More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002539.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Boston Scientific Swiss LithoClast© Trilogy Lithotripter was released in 2019, intended for use in percutaneous nephrolithotomy (PCNL). Its use has been shown to improve efficiency for stone fragmentation and removal, however, it has never been used for intracorporeal procedures. Our video depicts the first use of the Trilogy lithotripter in intracorporeal robotic pyelolithotomy and discusses the indications and advantages of this technique. METHODS: The patient was a 65-year-old female with a large left staghorn calculus with hydronephrosis and a left ureteropelvic junction (UPJ) obstruction. The combination of a staghorn stone with a UPJ obstruction indicated the use of robotic pyelolithotomy for stone removal and UPJ reconstruction. Due to the size and location of the stone, it was decided to use the Trilogy lithotripter for more efficient stone removal. The patient was consented to undergo a robotic pyelolithotomy with Trilogy lithotripsy. RESULTS: The patient was positioned in the flank position. The robot was docked, and the abdomen was insufflated. Initial dissection was made, and the colon was mobilized, revealing a hydronephrotic kidney with significant inflammation and a large staghorn stone branching into the upper, middle, and lower pole. The 2.4mm Trilogy probe was passed into the abdomen through the 12mm assistant's port and under direct vision the stone was segmented into several large fragments which were manually removed by the robotic graspers. Renal endoscopy was performed using a disposable LithoVue™ ureteroscope and remnant stones were removed using a stone basket until the kidney and ureter were noted to be stone free. The operation was completed successfully with minimal estimated blood loss and no intraoperative or postoperative complications. The patient returned for a six-week follow-up, and CT scans showed full stone clearance with no signs of hydronephrosis. CONCLUSIONS: This was the first documented use of the Trilogy lithotripter during intracorporeal surgery. The Trilogy’s efficacy in intracorporeal surgery is partially due to its built-in cooling system which allows for use of the Trilogy with reduced need for continuous irrigation which must be limited during robotic pyelolithotomy. Thus, this technique was indicated for complex procedures such as robotic pyelolithotomy for stone removal and concurrent UPJ reconstruction. It proved to be an efficient method for staghorn stone fragmentation and removal without requiring multiple percutaneous incisions or multiple procedures. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e203 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Micah Levy More articles by this author Chih Peng Chin More articles by this author Krishna T. Ravivarapu More articles by this author Osama Al-Alao More articles by this author Michael Palese More articles by this author Expand All Advertisement PDF DownloadLoading ...

V33 - Robot-assisted laparoscopic pyelolithotomy and concomitant partial nephrectomy for large staghorn stone and kidney neoplasm

V33 - Robot-assisted laparoscopic pyelolithotomy and concomitant partial nephrectomy for large staghorn stone and kidney neoplasm

High-Power Holmium Laser Percutaneous Nephrolithotripsy for Large Staghorn Stone

Purpose: To investigate the safety and efficacy of high-power holmium laser (70 W) in percutaneous nephrolithotripsy (PCNL) for large staghorn calculi. Materials and Methods: From December 2004 to March 2008, 438 consecutive patients (456 renal units) with large staghorn stones (diameter ≥4 cm) underwent PCNL with a pulsed holmium:YAG laser using a 1000-μm end-firing optical fiber. For the first 106 patients, a 30 W (3.0 J/pulse and 10 pulse/s) holmium:YAG laser was used for the management of renal stones, whereas for the other 332 patients (Group B), the laser power was set at 3.5 J/pulse with a frequency of 20 pulses/s. For stones in a calyx that were visible with a nephroscope, but unreachable with laser during lithotripsy, the renal mucosa of the calyx was split with 100 W holmium laser to further fragment the stones. Moreover, a porcine mode for the safety of high-power holmium laser was developed. Results: The average stone size was 5.6±0.8 cm in Group A and 5.8±0.8 cm in Group B. All of the patients in both groups had successful PCNLs. The average lithotripsy time in Group B was significantly shorter than that in Group A (44+11.5 minutes vs. 69±14.8 minutes, p>0.05). No patient had a severe complication. In addition, a total of 39 patients underwent calyx splitting, and no hemorrhage happened during and after operation. For patients undergoing 70 W high-power holmium laser, the GFR of operated kidney re-examined 6 months after operation improved greatly after operation than before (45.12 vs. 31.91 mL/min, p>0.05). Pathological evaluation of porcine kidneys exposed to laser firing showed no renal damage of high-power holmium laser. Conclusions: The high-power holmium:YAG laser enhances the lithotripsy efficacy by vaporizing and bursting the renal stone quickly and reduces the lithotripsy time significantly. The high-power holmium:YAG laser percutaneous nephrolithotomy is an effective and safe treatment for patients with large renal stones. No competing financial interests exist. Runtime of video: 3 mins X. Gao, T. Zhou and C. Yang have contributed equally to this work.

Laparoscopic management of a large staghorn stone

Urinary calculi are prevalent and result in significant morbidity,with a marked economic impact. Various therapeutic optionsexist, from medical to surgical management according to stonesize. Laparoscopic pyelolithotomy is a viable option for significantstaghorn renal stones. We report the case of a laparoscopicpyelolithotomy performed on a 48-year-old man with a left recurrent staghorn renal stone secondary to an ureteropelvic junction obstruction following a grade IV renal trauma several years ago.

Three-Dimensional Dual-Energy Computed Tomography for Enhancing Stone/Stent Contrasting and Stone Visualization in Urolithiasis

The use of dual-energy computed tomography (DECT) for evaluating urinary calculi has been appreciated due to the modality's capability of differentiating between uric acid (UA) and non-UA stones, which are color coded based on a postprocessing algorithm. No other imaging modality or laboratory test is able to identify the stone composition without first attaining the stone material. Knowledge of the stone composition is clinically significant since UA calculi may be treated medically whereas non-UA calculi may require surgical removal. Regardless of the stone type, ureteral stents are often placed to prevent or treat obstruction. Recent work has demonstrated that commonly used stents are also colored based on their dual energy characteristics and may thereby either improve or obscure the identification of adjacent calculi. Herein, we report the case of a 65-year-old man who underwent percutaneous nephrolithotomy of a large staghorn stone with subsequent significant residual stone fragments noted on a follow-up scan. By using three-dimensional DECT and taking advantage of color contrasting, the stone composition, burden, shape, and boundary were clearly depicted apart from the adjacent stent, resulting in successful medical treatment and obviating the need for further surgical intervention.

Laparoscopic management of a large staghorn stone

Urinary calculi are prevalent and result in significant morbidity, with a marked economic impact. Various therapeutic options exist, from medical to surgical management according to stone size. Laparoscopic pyelolithotomy is a viable option for significant staghorn renal stones. We report the case of a laparoscopic pyelolithotomy performed on a 48-year-old man with a left recurrent staghorn renal stone secondary to an ureteropelvic junction obstruction following a grade IV renal trauma several years ago.

A case of staghorn stones in a kidney with an ileal ureter treated by percutaneous nephrolithotomy

A 59-year-old man was admitted to hospital for investigation of a 1-year history of intermittent hematuria. He had undergone ileal ureteral replacement for left renal stones 36 years earlier. Renal ultrasonography, physical examination, abdominal plain radiography, intravenous urography, CT urography, measurement of serum levels of creatinine, urea and electrolytes, renal scintigraphy, urinalysis and urine culture. Staghorn calculi in the left kidney, with a high-lying anastomosis between the renal pelvis and the proximal ileal segment. The patient underwent percutaneous nephrolithotomy via a middle-calyx access for the large staghorn stones. After surgery, no residual calculi were found and the patient was discharged with an uneventful postoperative course. At 1 month, renal scintigraphy showed normal bilateral kidney function. The patient received potassium citrate supplementation and was followed up with 6-monthly imaging studies. At the last report, he had been stone-free for 7 months.

One-Year Follow-Up of Unselected Group of Renal Stone Formers Treated with Extracorporeal Shock Wave Lithotripsy

Except in eight patients with very large staghorn stones, extracorporeal shock wave lithotripsy (ESWL) was used as primary treatment of 274 renal units in 250 patients. Because all patients were fr...

Percutaneous nephrostolithotomy: application to staghorn calculi.

Twenty-five renal staghorn stones measuring at least 5 cm in diameter were removed percutaneously from 24 patients. Twelve patients required multiple access tracts for complete stone removal. Estimated blood loss more than 1000 ml occurred in 16 patients and temperature greater than 38.5 degrees C in 19 patients. All stones were successfully removed, with only two patients having definite residual fragments. Percutaneous nephrostolithotomy may be successfully applied to large staghorn stones. The relative roles of percutaneous therapy and extracorporeal lithotripsy remain to be determined.

The Case for a More Aggressive Approach to Staghorn Stones

The threat to the patient and kidney of leaving a large staghorn stone in situ in 60 cases is compared to the risk of operative removal in 125 cases. The over-all mortality rate in patients treated conservatively was 28 per cent, carcinoma developing in 4 cases and a life-threatening pyonephrosis in 16. Of patients treated by removal of the stone the mortality rate was 7.2 per cent (during 10 years of observation) and stones recurred in 21 cases. These studies refute the notion of the silent staghorn calculus and demonstrate that operative removal is safer for the patient and kidney.