Lower Calyx Research Articles

A single center study that evaluates the preclinical use of a newly developed software and moving bed system to facilitate the spontaneous excretion of residual fragments after primary stone treatment (RIRS or PCNL)

PurposeWe developed a Postural Drainage Lithotripsy System (PDLS) that uses the patient's computed tomography urography (CTU) data to reconstruct the three-dimensional figure of the renal pelvis, provides an individualized inversion and overturning angle and uses gravity to remove residual fragments (RFs). The purpose of this study was to investigate PDLS in the treatment of renal RFs.MethodsA stone with a diameter of 4.0 mm was placed in the upper, middle, and lower calyx of the renal model. A total of 60 trials were applied to 20 renal models. The movement trajectory, passage rate, and postural drainage angle of calculi during the treatment of PDLS were observed.ResultsAll of the stones in 60 trials were observed to move during treatment, and 53/60 (88%) were relocated successfully to the renal pelvis. The passage rate of the upper calyx was 14/20 (70%), that of the middle calyx was 20/20 (100%), and that of the lower calyx was 19/20 (95%).ConclusionsPDLS can provide individualized inversion and reversal angles and remove stones from the renal model. More clinical trials are needed to verify the above view and evaluate its efficacy.

Медико-экономическое обоснование применения микроперкутанной нефролитотрипсии в клинической практике

Introduction. Percutaneous nephrolithotripsy (PNL) is traditionally used in the surgical treatment of patients with kidney stones. The use of retrograde intrarenal surgery using a flexible endoscope (RIRS) and micropercutaneous nephrolithotripsy (micro PNL) in the treatment of kidney stones with a diameter of 10-15 mm allows minimizin renal bleeding and reducing the period of hospitalization of the patient. Despite the development of urolithiasis treatment methods, the results of a comparative study of the medical and economic aspects of various surgical options for kidney stones treatment were not described. Materials and methods. We carried out a retrospective analysis of 654 cases of PNL and RIRS for the period of 2015-2019. We analyzed the results of surgical and medical material costs in 15 patients whom micro PNL was done according to the standard protocol. All patients underwent an assessment of the blood hemoglobin level and the frequency of complications according to Clavien-Dindo classification, as well as a control examination to exclude residual stones was done. Results. According to the data of the planning and economic service of healthcare institutions, the costs under the mandatory medical insurance tariff for RIRS and PNL amounted to 47,743.10 rubles and 71,300.00 rubles, respectively, without differences in hardware. The cost of endoscopes used for RIRS and PNL differed significantly (1,045,185. 00 rubles and 886,203. 00 rubles, respectively). Taking into account labor costs and general anesthesia, the cost of surgical treatment of kidney stone in PNL increased by 7,429. 78 rubles (74.9%). For fragmentation of the stone with micro PNL, a thulium or YAG laser was used, without nephrostomic drainage. The duration of the PNL was longer-on average 113 minutes (62-186 minutes), than with micro PNL – on average 83 minutes (42-122 minutes,). After micro PNL, there was a slight decrease in the level of hemoglobin and a minimal degree of complications (I-II Grade Clavien-Dindo), compared with PNL. The transition to the RIRS was required in three cases: during the mobilization of the migration of the stone into the middle calyx and during the removal of residual fragments of the upper and lower calyx. The duration of hospitalization of patients decreased after micro PNL to 2 days. Conclusions. Micro PNL for small (up to 2 cm) kidney stones treatment is more advantageous compared to traditional PNL in a number of positions: less the duration of the operation, reduced blood loss, lack of drainage, reduced costs for hospital observation of the patient. From a medical and economic point of view, the RIRS is the most preferable, but it requires initially large costs for the purchase of flexible endoscopes with a small working resource and a relatively high cost. The development of surgical equipment and production capacities, as well as the accumulation of clinical experience of micro PNL will allow us fairly assess the feasibility of this technique with a personalized approach.

MP65-12 EFFECTS OF BOLSTER ALIGNMENT ON ANATOMICAL ORIENTATION OF KIDNEY IN REFERENCE TO PRONE PERCUTANEOUS NEPHROLITHOTOMY

You have accessJournal of UrologyStone Disease: Surgical Therapy V (MP65)1 Sep 2021MP65-12 EFFECTS OF BOLSTER ALIGNMENT ON ANATOMICAL ORIENTATION OF KIDNEY IN REFERENCE TO PRONE PERCUTANEOUS NEPHROLITHOTOMY Rishi Nayyar, Prashant Singh, Barun Bagga, Sanjay Sharma, Amlesh Seth, Prabhjot Singh, and Brusabhanu Nayak Rishi Nayyar Rishi Nayyar More articles by this author , Prashant SinghPrashant Singh More articles by this author , Barun BaggaBarun Bagga More articles by this author , Sanjay SharmaSanjay Sharma More articles by this author , Amlesh SethAmlesh Seth More articles by this author , Prabhjot SinghPrabhjot Singh More articles by this author , and Brusabhanu NayakBrusabhanu Nayak More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002105.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: During prone percutaneous nephrolithotomy (PCNL) rolled blankets or foam or gel bolsters are often placed underneath the patient to allow for chest and abdominal wall expansion. This study aimed to evaluate the anatomical changes in kidney orientation in prone position with the use of horizontal and vertical bolster alignment. METHODS: Patients who had renal stone disease underwent computed tomography scan in prone position. Measurements were made to quantify the cranio-caudal, antero-posterior, side to side and rotational movements of kidneys. RESULTS: The kidneys move caudally with both bolster positions. Horizontal bolsters provide more caudal displacement than vertical bolsters (p<0.01), more so on right side. There was a mean 2.14 and 2.03 cms increase in right upper calyceal-diaphragm and lower calyceal-diaphragm distance, respectively with the use of horizontal bolsters as compared to vertical bolsters (p<0.01) (Figure 1). Similarly, the mean increase on the left side was 1.50 and 1.41 cms, respectively (p<0.01). Horizontal bolsters also result in more (0.4-0.85 cm) calyx-skin distance (p<0.01), being more pronounced at lower calyx. Also, there was significant increase in the erector spinae-mid posterior calyceal-colon angle with the horizontal bolsters as compared to the vertical bolsters (124.89 v/s 110.05; p<0.01 for the right and 96.25 v/s 85.73; p<0.01 for the left kidney). There was insignificant medial rotation (kidney angle 15.17 v/s 22.06; p=0.58 for the right kidney and 31.26 v/s 39.58; p=0.475 for the left kidney) and insignificant decrease in the posterior abdominal wall space available for puncture (rib iliac blade distance 8.59 v/s 9.11 cms; p=0.93 for the right kidney and 8.61 v/s 9.04; p=0.99 for the left kidney) with the horizontal bolsters. CONCLUSIONS: Horizontal bolster position provides significantly more caudal displacement of both the kidneys; the right kidney being displaced more as compared to the left. However, there is also increase in skin-calyceal distance with horizontal as compared to the vertical bolsters. These assessments may help the surgeons decide optimal bolster position individualized to the patient. Source of Funding: None. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1124-e1124 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rishi Nayyar More articles by this author Prashant Singh More articles by this author Barun Bagga More articles by this author Sanjay Sharma More articles by this author Amlesh Seth More articles by this author Prabhjot Singh More articles by this author Brusabhanu Nayak More articles by this author Expand All Advertisement Loading ...

Comparison of the safety and efficacy between the prone split-leg and Galdakao-modified supine Valdivia positions during endoscopic combined intrarenal surgery: A multi-institutional analysis.

To evaluate the safety and efficacy of the prone split-leg and the Galdakao-modified supine Valdivia positions during endoscopic combined intrarenal surgery. A multi-institutional, retrospective cohort study was conducted between January 2014 and December 2018.The stone-free and complication rates were compared between the prone split-leg and the Galdakao-modified supine Valdivia positions. Anatomical variations were evaluated using contrast-enhanced computed tomography imaging. In total, 118 and 100 patients underwent endoscopic combined intrarenal surgery in the prone split-leg and Galdakao-modified supine Valdivia positions, respectively. Renal punctures in the prone split-leg position were predominantly executed through the lower calyces (78.0%), whereas those in the Galdakao-modified supine Valdivia position were primarily performed through the middle calyces (64.0%; P<0.001). Surgical duration in the prone split-leg position was significantly shorter than that in the Galdakao-modified supine Valdivia position (106.5 vs 126.0min; P=0.0459). There were no significant differences in the stone-free rate between the two positions (78.8% vs 76.0%; P=0.629). Incidences of urinary tract injury (P=0.033) and febrile urinary tract infection (23.7% vs 10.0%; P=0.011) in the prone split-leg position were significantly higher than that in the Galdakao-modified supine Valdivia position. The tilt of the major renal axis was significantly greater in the prone position than the corresponding values in the oblique position (19.4° vs 8.5°; P=0.019). Anatomical variation might result in the differences of renal puncture calyx. Endoscopic combined intrarenal surgery in the Galdakao-modified supine Valdivia position may bring equal stone-free status, with a longer surgical time but fewer complications including febrile urinary tract infection and urinary tract injury than the prone split-leg position.

A single centre experience of percutaneous nephrolithotomy in infants and its long-term outcomes

Renal stones in infants requiring Percutaneous nephrolithotomy (PCNL) is rare. There is insufficient literature on the long-term implications of PCNL in growing kidneys of these children. To review our experience of PCNL amongst infants i.e., < 1year of age and to analyse the safety and efficacy of this procedure and assess its long-term renal outcomes. This was a retrospective analysis of a prospectively maintained data base between 2005 and 2020. All infants with unilateral renal stones >12mm underwent PCNL. Changes in the serum creatinine, estimated glomerular filtration rate and renal size prior to the PCNL and at the last follow up were monitored. The demographics, clinical profile, operative details, post-operative complications and follow up data were collated and analyzed. 86 children were diagnosed with renal stones of whom, 24 infants met our inclusion criteria and were included in the review. The average age was 9.75 months with fever being the commonest presenting symptom. Five infants were diagnosed with metabolic abnormalities, hypercalciuria being the commonest. Majority of the infants (22) had single stones and the lower calyx was the commonest site (50%). The mean stone burden was 19.5mm. The stone free rate was 91% during the primary PCNL, which increased to 100% after re-do PCNL. The overall complication rate was 16% which was graded by the modified Clavien Dindo scale for surgical complications. The median follow up period was 144 months and average age at the last follow up was 10.5 years. At the last follow up, a mean serum creatinine of 0.4mg/dl, mean estimated glomerular filtration rate of 98ml/min/1.72m2 and a mean renal size of 8.3cm was recorded, which was comparable to that of a normal child, thus signifying no deterioration of renal functions and renal growth. Three children showed the presence of cortical scars on an isotope scan at follow up. However, all the 24 operated renal units demonstrated preserved renal functions. PCNL performed during infancy does not hinder the growth potential of the kidney. Each of the 24 children achieved the target renal size and estimated glomerular filtration rate corresponding to the duration and body size at the end of the follow-up. Thus, PCNL in infants <1 year of age is safe and effective with no adverse effects at long term follow-up.

EVALUATION OF COMPLICATIONS AND SUCCESS RATES OF PCNL,USING MODIFIED CLAVIEN GRADING SYSTEM: A SINGLE-CENTER EXPERIENCE

OBJECTIVE: The purpose of this retrospective study is to document the perioperative complications of percutaneous nephrolithotomy (PCNL) using the modied Clavien grading system at a tertiary care centre. MATERIAL &amp; METHODS: A retrospective study of 133 patients who underwent standard PCNL in the department of Urology and Renal Transplant,during the period January 2019 to March 2020 at Sri Aurobindo Institute of Medical Sciences,Indore, India. A structured questionnaire was used to get relevant information,while peri-operative complications were recorded using the modied Clavien grading system. RESULTS: The mean age of patients was 38.2years,male: female ratio was 1.18:1. Stones were categorized as simple in 48.9% and complex in 51.1%. The lower calyx was the commonest site of stone location (45.5%) and puncture site (76.7%). The mean operative time was about 58 minutes and the mean haemoglobin drop was 1.5g/dl. The blood transfusion rate was 3% and the stone free rate after the procedure was 93.2%. The mean length of hospital stay was 3.4 days. CONCLUSION: PCNL is an effective treatment with good clearance rate and acceptable morbidity in experienced hands.

Comparison of reusable and single-use ureteroscopes for the treatment of medium-sized stones in the lower calyx: A prospective randomized study

Comparison of reusable and single-use ureteroscopes for the treatment of medium-sized stones in the lower calyx: A prospective randomized study

Micro-Ureteroscopy as a Treatment of Renal Pelvis Lithiasis in Young Children.

Aim: Miniaturization of endoscopic instruments has allowed to improve the efficacy of kidney stone treatment in young children. Aim of the study is to evaluate the usefulness of microureteroscopy with 4.85F sheath in the treatment of renal stones in children.M&M: We present 4 cases of microureteroscopy in 3 younger than 3 years patients with renal pelvic stones. Lithiasis was unilateral in 2 female patients and bilateral in 1 male patient. Microureteroscopy was performed using a MicroPerc set 4.85F sheath, without placing a safety guide or dilating the meatus in 3 procedures. The lithotripter system used was Ho:YAG Laser with 200-μm fiber in all cases.Results: Mean operating time was 100 ± 16 min. There were no intraoperative complications. In all procedures, complete pulverization of the lithiasis was achieved, except in the coraliform lithiasis in which 5 mm residual lithiasis remained in the lower calyx. All patients were discharged 24 h after the intervention.Conclusion: Microureteroscopy can be considered a new alternative for treatment of selected cases of renal pelvic stones in infants and children.

Перкутанная нефролитотрипсия у детей младшей возрастной группы

Introduction. Urolithiasis remains one of the most common diseases in the pediatric urology practice. A special category is made up of children weighing up to 15 kg with large and coral-like kidney stones, which require a smaller instrument to remove. Aim. The aim of the study was to evaluate the effectiveness of percutaneous nephrolithotripsy, used for urolithiasis treatment in children aged 1 to 3 years. Materials and methods. Between 2008 and 2019 in the pediatric uroandrology department of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation 93 children aged 1 to 3 years (69 (74.2%) boys and 24 (25.8%) girls) had nephrolithotripsy. The average patients age was 1 year and 9 months. Fifty-one (54.8%) patients had coral-like kidney stones, while the remaining 42 (45.2%) had kidney pelvic stones. The average stone size was 25.8mm. (15 – 56 mm). Nephrolithotripsy was performed according to the standard technique, all patients underwent cystoscopy and ureteral catheterization. In the prone position, under ultrasound and X-ray guidance, a puncture of the renal collecting system was performed. In 59 cases (63.5.1%) the puncture was performed through the lower calyx, in 31 cases (33.3%) – through the middle one, and in nine children two approaches were performed. In 93 children the intervention was performed using a mini-nephroscope with tubes of 12, 15 and 16.5 Ch. To disintegrate the stone, a pneumatic lithotripter and a holmium laser "Auriga" with a fiber of 365 and 600 μm in diameter were used. Only in 31 cases, when the kidney size allowed, a standard 24 Ch nephroscope and combined lithotripsy (ultrasound and pneumatic) were used. The duration of the procedure varied from 32 to 145 minutes, with an average of 43.5 minutes. In the postoperative period, all patients underwent infusion and antibiotic therapy based on the results of urine bacteriological examination. After the patients’ activation on days 1 – 3, a survey urography and antegrade pyeloureterography were performed. In the absence of residual stones and urinary passage disorders, nephrostomy drainage was removed. Results. The effectiveness of nephrolithotripsy in our cohort of patients was 87.1% (81 patients). Four children (4.3%) required second percutaneous intervention. The remaining 8 (8.6%) patients with residual stones underwent distance lithotripsy in the short postoperative period. Significant bleeding occurred in 2 patients who then required transfusion of blood products. Fever was noted in 5 (5.4%) patients. We have not observed a single case of septic and bacteriotoxic shock. Discussion. As a first-line surgical treatment in pediatric practice, it is recommended to use extracorporeal shock wave lithotripsy (ESWL). This treatment is ideal for stones ≤ 15 mm in size, with SFR of 68-95%. However, the need for repeated ESWL sessions occurs in 14-54% cases. Complications rate, frequency of retreatment, as well as a decrease in SFR, increase when a stone size is greater than 1.5 cm. Since all types of surgical treatment in children require anesthesia, and the treatment approach may not provide a complete problem solution, it is preferable to choose a procedure with the greatest possible success in one session. Primary SFR was significantly lower in children with stones ≥ 30 mm in size and multiple kidney stones. Mini– percutaneous nephrolithotripsy is an effective (87.1%) method for nephrolithiasis treatment in children aged 1 to 3 years. Conclusion. Mini-percutaneous nephrolithotripsy in children aged 1 to 3 years is an effective treatment for nephrolithiasis. However, in a small percentage of cases, it becomes necessary to combine the procedure with extracorporeal lithotripsy. Paying attention to the small size of the organ, to reduce the number of hemorrhagic complications, it is preferable to perform this intervention with one approach. The occurrence of even a small amount of bleeding during the operation is a formidable complication, given the small volume of circulating blood in children.

Novel Use of a Modified Triangular Prismatic Double-J Stent for 2- to 3-cm Renal Stones after One-Stage Retrograde Intrarenal Surgery

Objectives: To initially evaluate the outcomes of the modified triangular prismatic double-J (DJ) stent in the management of 2- to 3-cm renal stones after one-stage retrograde intrarenal surgery (RIRS). Methods: Patients with 2- to 3-cm renal stones who underwent one-stage RIRS with indwelling DJ stents were retrospectively evaluated. Eighty-eight patients who were placed the triangular prismatic DJ stents and 64 patients who received standard DJ stents were randomly included. The clinical characteristics and intraoperative and postoperative outcomes of the 2 groups were compared and analyzed. Results: The 2 groups had similar baseline characteristics. The urinary symptom score and pain score did not differ between groups (p > 0.05). The residual fragments of the 2 groups were similar 1 day after operation (p = 0.134). There was no significant difference in residual fragments in the lower calyx between groups at the time of stent removal (p = 0.834). The patients in the modified group had better spontaneous passage of residual fragments in the nonlower calyx than those in the standard group during the 2 weeks with the stents (p = 0.005). Fewer patients in the modified group had residual fragments (>4 mm) in the nonlower calyx (p = 0.026) and ureter (p = 0.010) than the patients with standard stents at the time of stent removal. Conclusion: The indwelling triangular prismatic DJ stent is a safe and efficient treatment method. Patients with these stents had better spontaneous residual fragment passage than those with the standard DJ stents.

Effect of the External Physical Vibration Lithecbole on the Discharge of Upper Urinary Stones: A Systematic Review and Meta-analysis.

The external physical vibration lithecbole (EPVL) is a new device that accelerates the discharge of urinary stones by changing the patient's body position and providing multi-directional simple harmonic waves. It is clinically employed to improve the stone-free rate (SFR). However, it is not widely accepted in clinical practice due to the lack of high-level evidentiary support and a standard protocol. The present meta-analysis aims at the evaluation of the efficacy and safety of EPVL treatment in improving the SFR. This study was a systematic review and meta-analysis. A systematic literature review was conducted using PubMed, Scopus, Embase, Medline, the Web of Science, and the Cochrane Library to find randomized controlled trials (RCTs) as recent as April 2020 that evaluated the efficacy and safety of EPVL treatment for patients with stones/residual stones in the upper urinary tract. In total, 7 prospective studies with 1414 patients were included. Compared with patients in the control group, patients treated with an EPVL (the intervention group) had higher SFRs (95% CI: 0.59-0.86, RR = 0.71, P = .0004) and lower complication rates (95% CI: 1.37-3.12, RR = 2.07, P = .0006). In a subgroup analysis based on previous surgery (ESWL, RIRS), the intervention group had an improved SFR as compared to the control group (95% CI: 0.59-0.95, RR = 0.75, P = .02; 95% CI: 0.56-0.73, RR = 0.64, P < .00001, respectively). In a subgroup analysis based on stone location, the SFRs for stones in the upper/middle/lower calyx and renal pelvis were significantly higher in the intervention group than in the control group: for residual stones in the upper and middle calyx, 95% CI: 0.63-0.98, RR = 0.79, and P = .03; for residual stones in the lower calyx, 95% CI: 0.54-0.75, RR = 0.64, and P < .00001; for residual stones in the renal pelvis, 95% CI: 0.47-0.79, RR = 0.61, and P = .0002. However, the SFRs for ureter stones were not significantly different between groups (95% CI: 0.82 -1.05, RR = 0.93, P = .23). The external physical vibration lithecbole can effectively improve the SFR after ESWL and RIRS without significant side effects, especially for residual stones in the upper/middle/lower calyx and renal pelvis.

Interior definition of the calyceal orientation suitable for percutaneous nephrolithotripsy via mobile software.

To date, there is no paper on defining the puncture of a kidney from the interior view of the pelvicalyceal system (PCS) to alleviate its performance. The objective of this study isto define the usefulness of the Rubik's Cube method determining calyceal orientation from inside via mobile software for the percutaneous nephrolithotripsy (PCNL). Over September 2019-September 2020, 25 patients with indications for PCNL were enrolled in this single-arm study. All patients underwent computed tomography (CT)-urography. Primary endpoints were the duration of renal cavity puncture, number of attempts and success rate. Complication rate ordered according to Clavien-Dindo classification was analyzed as a secondary endpoint.The stone-free rate was 91%. The same experienced urologist performed all procedures through the single-access PCNL without puncture site reposition. The puncture was made through the upper, middle, and lower calyx in 9, 12 and 4 cases, respectively. The mean duration of cavity puncture was 2.8 ± 1.1min. The mean number of attempts to reach desirable calyx was 1.4 ± 0.6. It should be noted that there were no cases with three and more punctures. The overall complication rate was 28% (7/25) when only one patient experienced ≥ 3 Grade. The proposed Rubik's Cube method facilitates preoperative planning of PCNL and makes that procedure easier for specialists and safer for the patients.

Une grande distance entre le domicile et l’hôpital ne contre-indique pas l’ambulatoire pour urétéroscopie en Guyane française

French Guyana is 83,500 km2 wide (equivalent to 1/6 of France). Communes are distant. Public urology is set in Kourou only. These particularities led to develop ambulatory urological surgery including for patients living far away from the reference centre. We report our experience with patient ureteroscopy (URS). The study is retrospective (2018-2019), and includes 125 patients. Among these patients, 19.2% live in Kourou, 71.1% live 40 to 100km from the hospital and 9.7% beyond 100km. Every patient had an outpatient procedure for rigid and/or flexible URS to treat stone disease, including in lower calyx [LC] (38.4%). Ambulatory surgery was also proposed to the patients living away with the usual restrictions. Complications, results and switch to conventional hospitalisation (CH) were studied. Mean stone size was 10,5mm (4-30), stone density was 1030 UH (470-1700). The postoperative complication rate was 4%. There were 90.4% 'stone free' patients (85.4% for LC). One patient was rehospitalised within 48hours for acute flank pain and 9 patients had a switch of ambulatory to CH: 6 for discharge too late and 3 for complication (fever and/or pain). Distance between home and hospital was linked neither to complication rate, nor to switch to CH. Ambulatory URS is possible without further complications in selected patients living beyond 100km from the hospital, because of a specific organisation and an appropriate training of the caregivers involved in postoperative patient care. 3.

A Prospective Longitudinal Study onthe Predictability of Quadruple-D Score in the Success Rate of Extracorporeal Shock Wave Lithotripsy for Renal Stones 1-2cm in Diameter

Introduction: Quadruple-D, based on Computed Tomography (CT) derived metrics, is a scoring system that helps urologists to predict the Stone Free Rate (SFR) following Extracorporeal Shock Wave Lithotripsy (ESWL) in renal stones. Aim: To evaluate the efficacy of Quadruple-D scoring system to assess the SFR in individuals with renal stones measuring 1-2 cm in diameter after giving ESWL. Materials and Methods: The study was conducted on 120 patients. Systemic random sampling technique was applied with a sampling interval of two. Quadruple-D scoring, comprising of four Computed Tomography (CT) based metrics that is stonedimension, stone density, Hounsfield units (HU), Skin-to-Stone Distance (SSD) and stone location, was done prior to ESWL. The scores ranged from zero (worst) to four (best) points. Plain abdominal radiography was done three weeks after ESWL to assess SFR. Complete clearance was considered the stone free status. Patients were divided into group A with complete stone clearance and group B with residual stone. All the statistical analysis was done using IBM SPSS 26.0. Student’s t-test or Mann-Whitney U-test was used to compare continuous variables. Fisher’s-exact test and Chi-square test were used to analyse the cross charts between two categories. Results:The mean ellipsoid Stone Volume (SV) was 396.44±163.23 mm3 and 395.81±227.52 mm3 in group A and B, respectively. The stone density was 724.28±210.90 in group A and 814.56±190.63 in group B. In group A, 9.20% and in group B, 34.09% of the patients had stones in lower calyx. The difference between the groups based on the above parameters were statistically significant. The Quadruple-D score was 2.09±0.65 and 1.54±0.79 in group A and B, respectively. The Area Under the Curve (AUC) of Quadruple-D scoring system was 0.674. The age, sex, BMI, laterality of the stone and SSD did not predict stone-free status in this study. Conclusion: Quadruple-D scoring system has been successfully validated as the SFR showed a parallel increase with every positive component. Quadruple-D is an easy to use clinical tool to predict the success rate of ESWL.

Лапароскопическая заместительная кишечная пластика мочеточника: илеокаликостомия в комбинации с PSOAS HITCH

A 50-year-old female presented to our department of urology with nephrostomy drain in the right kidney been placed because of an acute obstructive pyelonephritis. Nephrostogram revealed an intra-renal pelvis with no passage of contrast into the ureter. Retrograde pyelography identified the extended ureteric stricture and need for a substitution. Laparoscopic ileocalicostomy was performed to achieve a communication between the lower calyx and bladder. Video describing surgical technique is available on https://youtu.be/bIW_m3lwXWY. Due to thick and full-blooded renal parenchyma, a partial nephrectomy of the lower pole had to perform to get an access to the renal calyx. It took 25 min of warm ischemia. At that, sutures of renorrhaphy should have provided reliable hemostasis on the one hand, and free outflow of urine via an isolated calyx on the other. To reduce the length of ileoureter a bladder psoas hitch maneuver was used. A 25-cm-long segment of ileum was isolated and rotated in isoperistaltic manner. Double J stent was held through it. Ileocalicostomy by interrupted and ileovesicostomy by continuous sutures were performed one after another. There were no intraop complications. OR time - 300min. EBL - 200ml. Postoperative course was uneventful. Ten days after surgery, nephrostogram and cystography confirmed the patency of the neoureter and the tightness of both anastomoses. Nephrostomy drain was removed first, ureteral - one day after. JJ stood for 3 weeks. The patient is doing well at more than 12 months of follow-up with a stable renal and ileoureteral function. In comparison with open procedure our surgery is significantly less invasive, per contra robotic - not so expensive. As far as we known, this is the first case report of conventional laparoscopic intracorporeal ileocalicostomy with long-term good functional results demonstration.

Evaluation of Factors Influencing Outcome of Extracorporeal Shock Wave Lithotripsy (Eswl) for Renal Stone in Adult

Background: Renal stone disease is a common disorder with a prevalence ranging from 4-15% in different parts of the world. Modalities of kidney stone management includes drug therapy, extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), Retrograde intrarenal surgery ureteroscopy (RIRS) and open surgery. ESWL is an acceptable technique and widely used because it is a non-invasive treatment and does not require anesthesia and usually done on an outpatient basis. Generally, ESWL is the treatment of choice for kidney stones &lt;1 cm. However, not all ESWL treatments are successful. The success rate has been reported to be between 50%-87%, depending on various factors. This study was conducted in order to evaluate thefactors affecting renal stones treatment by extracorporeal shock wave lithotripsy (ESWL).On the basis of different variables andfactors affecting the renal stones treatment by ESWL was evaluated. Objectives: To evaluate the factors affecting the outcome of Extracorporeal Shock Wave Lithotripsy (ESWL) in the treatment of renal stone in adults.To assess the success and failure rate by using ESWL for treatment of renal stone, to determine the effects of stone related factors to correlate the success rate with characteristics of the patients condition of the urinary tract and stone features; to observe the patient groups most likely to benefit from or fail an initial intervention with ESWL and to evaluate the post ESWL complications. Materials and methods: This is a prospective observational and analytical, hospital based study. Total 500 patients with single or multiple radio-opaque renal stones were treated with ESWL monotherapy using Siemens MODULARIS Variostarlithotriptor. This study was carried out inthe Department of Urology, Combined Military Hospital, Dhaka for a period of two years between 01 July 2015 to 31 July 2017. The results of treatment were evaluated after 3 months of follow-up. Treatment success was defined as complete clearance of the stones or presence of clinically insignificant residual fragments (&lt;3mm). The results of treatment were correlated with the patient characteristics (age, sex, body mass index) and stone features (size, site, number &amp; radio density). Results: At 3-months follow-up, the overall success rate is 87.6%. Among them, repeated ESWL sessions were required in 266 patients (53.2%). Post-ESWL complications were recorded in 62 patients (12.4%). Using the chi-square test, only four factors have a significant impact on the success rate, namely stone site, size (the largest diameter of the stone), stone number, BMI (body mass index) of the patient. The success rate is highest for stones located in the upper calyx (136/136; 100%) and lowest for those located in lower calyx 104/78; 75%) (p=0.001). Stone with a largest diameter of &lt;10mm are associated with a success rate of 93.6% (307/328), compared to 76.2% (131/172) for those with a diameter of &gt;10mm (p=0.001). The success rate was also higher for single stone (396/437; 90.6%) than multiple stones (42/63; 66.7%) (p=.001). Patients with lower BMI (&lt;24) have a better success than higher BMI (&gt;25) (p=.001). Other factors including age, sex and stone radio density compared to ipsilateral 12th rib have no significant impact on the success rate. Conclusion: The success rate of ESWL for the treatment of renal stones can be predicted by stone size, location, number, and patients BMI. Bangladesh Journal of Urology, Vol. 22, No. 2, July 2019 p.141-150

Efficacy of Percutaneous Nephrolithotomy in the Treatment of Renal Calculi of 10 to 20 MM Size: A Comparison With Extracorporeal Shock Wave Lithotripsy

Background: Stones in the urinary tract is a common medical problem in the general population. At present, the great expansion in minimally invasive techniques has led to the decrease in open surgery. Extracorporeal shock wave lithotripsy (ESWL) has been introduced as an alternative approach which disintegrates stones in the kidney and upper urinary tract through the use of shock waves. Nevertheless, as there are limitations with the success rate in ESWL, other minimally invasive modalities for kidney stones such as percutaneous nephrolithotomy (PCNL) is also widely applied. There is a trend of using ESWL for treatment of renal stones smaller than 1 cm and PCNL in those with stones greater than 2 cm. Nevertheless, no consensus regarding treatment of renal stones between 1 to 2 cm stones. The objective of this prospective study was to compare the results of ESWL and PCNL for treatment of 1 to 2 cm renal stones. Method : This is a quasi experimental study. This study was conducted to compare the efficacy and safety of percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL) in treating 10 to 20 mm sized renal stone among the Bangladeshi population. This prospective study conducted between the periods of September, 2011 to August, 2012 in the department of urology, Bangabandhu Sheikh Mujib medical university (BSMMU) Hospital. All the patients attending the urology outpatient clinic with 10 to 20mm renal calculi were the study population. A total of 70 subjects were enrolled for this study and they were equally divided into two groups so that each group had 35 subjects. The one group received PCNL whereas the other group received ESWL. Statistical analyses of the results were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-15). Results: There is no statistically significant difference in regarding age, sex, stone side(lt. or rt.), the distribution of stone (upper, middle and lower calyx) and size between the groups (p&gt;0.05). At 3 month follow up among the patients in ESWL group stone cleared and not cleared were 25(71.4%) and 10(28.6%) respectively and at 3 month follow up among the patients in PCNL group stone cleared and not cleared were 33(94.3%) and 2(5.7%)respectively. There is statistically significant difference in stone clearance rate at 3 month follow up between the groups (p&lt;0.05). All patients in ESWL group developed post procedure haematuria 35(100.0%). Other post procedure complications among the ESWL group pain, fever and steinstrasse were 12(34.3%), 07(20.0%) and 03(08.6%) respectively. Common post procedure complications among the patients of PCNL group pain, haematuria and fever were 11(31.4%), 33(94.3%) and 13(37.1%) respectively. Other post procedure complications in PCNL group were vomiting (8.6%), urinary leakage (5.7%), wound infection (11.4%) and urinary cutaneous fistula (5.7%). There was no statistically significant difference post procedure pain, haematuria and fever between the groups (p&gt;0.05), but statistically significant difference observed in steinstrasse and wound infection between the groups (p&lt;0.05). Mean±SD of hospital stay among the patients of ESWL group and PCNL group was 1.37±0.65 and 4.34±1.43 days respectively. There is statistically significant difference in hospital stay between the groups (p&lt;0.05). Conclusion: Though some specific complications which can be treated conservatively are more in PCNL group it may be concluded that the treatment with PCNL is better option than ESWL among the patients having renal calculi 10 to 20 mm. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.98-104

In-vitro and in-vivo new evidence for Flexor® Vue™ deflecting endoscopic system use: optimization of the stone free rate (SFR) after flexible ureteroscopy and Ho:YAG laser lithotripsy.

To test in-vitro and in-vivo the Flexor® Vue™ deflecting endoscopic system (FVDES) as a new technology able to improve the removal of residual intrarenal fragments.This is an observational prospective "proof of concept" study performed in patients with renal calculi treated with flexible ureteroscopy and Ho:YAG laser lithotripsy (f-URS) in Humanitas Research Hospital (Rozzano, Italy). We assessed feasibility, efficacy and safety of FVDES as an in-vivo tool for removing residual fragments after f-URS. The stone-free rate (SFR) at 30days post-operatively was evaluated using CT. An in-vitro model was developed to evaluate the FVDES when used for this purpose.Eleven patients (M/F ratio: 7/4, mean age 63.5 ± 8.3) were treated. The stones were located in the lower calyces and the renal pelvis in 3 and 8 patients, respectively. Mean stone size was 18 ± 3.2mm. The procedure with FVDES was feasible and effective in all the patients. Mean operative time was 82 ± 13.7min and median hospitalization was of 1.5days. The SFR after 90days was 81% (9/11). We reported no relevant complications (Clavien-Dindo > 2); one patient had fever and was treated with antibiotics. The experimental in-vitro model demonstrated the efficacy of FVDES, allowing the removal of about 90% of fragments.Our study showed that FVDES is effective when used as a tool for retrieval of residual fragments at the end of f-URS. This technology could ensure a complete cleaning of the intrarenal collecting system and represent a safe alternative to basketing.

Efficacy and Safety of Percutaneous Nephrolithotomy: A Single-center Initial Experience

BACKGROUND: In the age of modern medicine, thanks to the development of small-caliber nephroscope as well as various types of intracorporeal lithotripters, treatment options for renal stones have changed dramatically, and the area of percutaneous nephrolithotomy (PCNL) has expanded. Nowadays, PCNL is not only the first choice in the treatment of stones &gt;2 cm, as well as complicated renal stones (staghorn stones, multiple stones, and stones associated with abnormal renal anatomy), but is also the method of optimal treatment for medium-sized stones not treated with other less invasive methods.&#x0D; AIM: The purpose of this study is to assess the efficacy and safety of PCNL as monotherapy in the treatment of renal stones larger than 15 mm.&#x0D; MATERIALS AND METHODS: This study presents a retrospectively prospective study of 14 (4 retrospective and 10 prospective) consecutive patients with renal stones larger than 15 mm treated with PCNL in the period from January 2020 to March 2020 at the GH “8 September” – Skopje. Pre-operative preparation of patients included: A history along with physical examination, a complete blood count and radiological examinations to assess the size of the stones, the anatomical features of the kidney and its function, and to accurately plan the operative approach. PCNL was performed in the prone-position; lithotripsy was performed with a double, pneumatic and ultrasonic intracorporeal lithotripter Swiss LithoClast Master with the use of the Karl Storz 24–26 fr nephroscope. Postoperatively, patients were monitored on the 1st, 7th, and 30th post-operative day, determining the demographic and clinical characteristics, the efficacy of PCNL, perioperative blood loss, the duration of the operative procedure, the duration of hospital stay, and the resulting intraoperative and post-operative complications.&#x0D; RESULTS: The study included eight men (57.1%) and six women (42.8%). The mean age of the patients was 52.35 ± 11.00. In 5 (35.71%) patients, the stones were localized in the left kidney, and in 9 (64.28%) patients in the right kidney. The average body mass index was 25.11 ± 3.92 kg/m². The average area of the stones was 371.24 ± 131.86 mm². Eleven (78.57%) patients had simplex stones, while 3 (21.42%) had complex stones (staghorn stones and multiple stones). The stones were localized in the renal pelvis, upper, middle, and lower calyx at 5 (35.71%), 2 (14.28%), 4 (28.57%), and 3 (21.42%) patients, respectively. The mean value of pre- and post-operative serum hemoglobin was 13.94 ± 1.00 g/dl and 11.77 ± 1.51 g/dl, respectively. The effectiveness of the procedure on the 1st post-operative day assessed by ultrasound diagnostics and kidney-ureter-bladder X-ray was 78.57%. The success rate on the 30th post-operative day after additional procedures was 92.85%. The average operating time in the entire series was 119.28 ± 9.42 min. The average hospital stay was 5.57 ± 1.11 days. The average operative blood loss was 2.19 ± 0.88 g/dl.&#x0D; CONCLUSION: The results of this retrospectively prospective study confirm that PCNL is a minimally invasive, safe, and effective method for removing renal stones. This method, with the development of new technologies, has an increasingly important role in the modern surgical treatment of nephrolithiasis. PCNL can also be performed in the early stages of the learning curve without compromising patient safety and treatment benefits. The procedure is safe and effective, performed even by less experienced urologists if the protocols established for this procedure are followed. This can achieve a rate of success comparable to most established standards without causing major complications.

Treatment of Moderate-sized Kidney Stone with Third-generation Electromagnetic Shock Wave Lithotripter

BACKGROUND: The extracorporeal shock wave lithotripsy (ESWL) is a non-invasive method in the treatment of urinary tract stones and its discovery has led to a complete change in the therapeutic strategy for urolithiasis. Due to the low morbidity and excellent fragmentation of the stones, ESWL has proven to be an effective and non-invasive method in the treatment of renal stones.&#x0D; AIM: The aim of this retrospective study is to evaluate the efficacy and safety of the ESWL as a monotherapy in the treatment of moderate size kidney stones with stone area (SA) of 100–300 mm².&#x0D; MATERIALS AND METHODS: We made a retrospective study of 98 patients with moderate size kidney stones with SA of 100–300 mm², divided into two subgroups, into a group with a SA of 100–200 mm² and with 200–300 mm², treated with ESWL in the period of November 2018–December 2019. The patients were treated with a third-generation electromagnetic lithotripter (Lithoskop®, Siemens Medical Systems, Erlangen, Germany), with a source of electromagnetic shocks (Pulso™) and dual ultrasonographic/fluoroscopic system for detection of the stones. The stone location, size, maximum energy used, localization technique, number of shock waves, sessions, re-treatment rate, and additional procedures were reviewed. All the patients before the intervention had a complete laboratory and radiological examinations. Postoperatively, patients were monitored on the 1st, 30th, and 90th post-operative days.&#x0D; RESULTS: Ninety-eight patients with solitary kidney stone with a SA of 100–300 mm² were treated with ESWL. The study included 58 men (59.18%) and 44 women (40.81%). The average length and width of the stone were 15.47 ± 2.68 mm and 12.99 ± 2.83 mm, respectively. The average surface area of the stones in our series was 203.78 ± 72.85 mm². The mean number of treatments for the entire series of patients was 1.82 ± 0.91. The mean number of shock waves for the total series of patients was 3899.11 ± 40. The mean energy used for the overall patient series was 110106.17 ± 21489.61 mJ. The total re-treatment rate was 47.95%. The entire rate of additional procedures was 19.38%. The overall success rate (SR) in our study was 77.55%. The efficiency quotient for the upper-middle and lower calyx was 55.57, 57.15, and 30.81, respectively.&#x0D; CONCLUSION: ESWL is a safe and effective method in the treatment of renal stones, and we recommend as the first method in the treatment of moderate size kidney stone with a surface area of 100–300 mm². The treatment of each patient should be individualized and take into account all favored and non-favored factors that influence the decision to choose extracorporeal lithotripsy as a method of treatment of medium-sized stones.