Mini-percutaneous Nephrolithotripsy Research Articles

Micropercutaneous nephrolithotripsy in the treatment of patients with nephrolithiasis: medical and organizational aspects

The article is devoted to modern methods of treating nephrolithiasis. A review of the results of studies on the effectiveness and safety of micro- and minipercutaneous nephrolithotripsy and the advantages of different treatment methods is presented. A trend towards miniaturization of surgical methods for the treatment of nephrolithiasis has been shown, accompanied by an improvement in their results and economic feasibility. The issues of organizing surgical treatment of patients with kidney stones are considered.

Risk factors of high fluid absorption in patients treated with mini-PCNL: a single-center prospective study.

The factors influencing fluid absorption in mini-percutaneous nephrolithotripsy (mini-PCNL) are still unknown. We aim to investigate the factors that influence irrigation fluid absorption during mini-PCNL. A total of 94 patients who underwent mini-PCNL were included in this prospective study. The endoscopic surgical monitoring system (ESMS) was used to measure the volume of irrigation fluid absorbed during the procedure. Irrigating time, the total volume of irrigation fluid, stone size, S.T.O.N.E. score, hemoglobin, electrolyte levels, and postoperative complications were recorded. A significant correlation was observed between fluid absorption and the presence of postoperative fever, and based on this phenomenon, patients were divided into low and high fluid absorption groups. The serum creatinine level in the high fluid absorption group was significantly high (7 vs. 16.5, p = 0.02). Significant differences were observed between the low and high fluid absorption groups in terms of mean stone size (21.70 mm vs. 26.78 mm), presence of stone burden ≥ 800 mm2 (4% vs. 23%), S.T.O.N.E. score > 8 (4% vs. 38%), the fluid used > 18,596 ml (19% vs. 78%), irrigation time (55.61 min vs. 91.28 min), and perfusion rate (24% vs. 45%) (all p < 0.05). The rates of postoperative fever and SIRS in the high fluid absorption group were significantly high (p < 0.05). Mean stone size, presence of stone burden ≥ 800 mm2, S.T.O.N.E. score > 8, the fluid used > 18596 mL, irrigation time, and perfusion rate are risk factors of intraoperative fluid absorption in mini-PCNL.

Flexible ureteroscopy with novel flexible ureteral access sheath versus mini-percutaneous nephrolithotomy for treatment of 2-3 cm renal stones.

To assess and compare the effectiveness and safety of flexible ureteroscopy (f-URS) with a novel flexible ureteral access sheath (f-UAS) versus mini-percutaneous nephrolithotripsy (mini-PCNL) in treating 2-3 cm renal stones. Retrospectively analyzed consecutive cases that underwent f-URS with f-UAS (12/14 Fr) from January 29, 2022, to November 30, 2022. Consecutive cases that underwent mini-PCNL (18 Fr) from June 5, 2021, to January 26, 2022, were selected as controls. The f-UAS is a novel device with a 10 cm anterior tip that passively bends along with the f-URS to enter the renal calyx. We analyzed demographic characteristics, stone parameters, operative time, stone-free rates (SFR), hospitalization time, and complication. A total of 96 consecutive cases that underwent f-URS with f-UAS and 96 consecutive cases that underwent mini-PCNL were included in the study. There were no significant differences between the two groups in terms of operative time (p = 0.06), stone volume clearance (p = 0.533) and complete SFR (p = 0.266) on the first postoperative day or residual Stone after 1 month (p = 0.407). We observed a significantly shorter postoperative hospital stay (1.4 days vs. 2.1 days; p < 0.001) and a lower decrease in hemoglobin levels (0.39 g/dL vs. 0.68 g/dL; p < 0.001) in the f-UAS group. The mini-PCNL group had a significantly higher overall complication rate (13.5%) compared with the f-UAS group (5.2%; p = 0.048). In the treatment of 2-3 cm renal stones, f-URS with a novel f-UAS may provide a superior alternative to mini-PCNL, potentially challenging its established status.

The modern view on the surgical treatment of nephrolithiasis

The choice of surgical treatment for nephrolithiasis remains a matter of debate. The article is a literature review dedicated to a comparative analysis of the efficacy and safety of extracorporeal shock-wave lithotripsy (ESWL) and endoscopic methods for the treatment of nephrolithiasis. The literature review was based on the analysis of articles published in the PubMed / MEDLINE, and eLibrary databases. Sixty publications on the topic of the review were analysed. As a result of data analysis, endoscopic therapies have a significant advantage over ESWL with comparable safety. The development and dissemination of less invasive techniques such as mini-percutaneous nephrolithotripsy and ultra-mini-percutaneous nephrolithotripsy in the future may change the approach to the surgical treatment of any form of nephrolithiasis.

Planning the approach in mini percutaneous nephrolithotripsy according to individual kidney anatomy detected by computed tomography

Aim to analyze postoperative complications after mini percutaneous nephrolithotripsy, taking into account an assessment of individual variations of kidney anatomy.&#x0D; Material and methods. Postoperative complications after mini percutaneous nephrolithotripsy were analyzed in 60 patients who underwent preoperative CT urography with intravenous bolus contrast and 3D reconstruction.&#x0D; Results. We found no significant correlation between the number of complications after mini percutaneous nephrolithotripsy and the type of division of the branches of the renal artery of the 2nd order, as well as no dependence of the occurrence of complications on the presence of accessory arteries. A moderate correlation between the number of complications and the number of accesses was noted.&#x0D; Conclusion. In mini percutaneous nephrolithotripsy, the preoperative planning and marking of the access trajectory can significantly reduce the number of postoperative complications.

Enhanced recovery after retrograde intra-renal surgery (RIRS) in comparison with mini-percutaneous nephrolithotomy (Mini-PCNL) for renal stone treatment

The study presents a comparative analysis of the mini-percutaneous nephrolithotripsy (mini-PCNL) and retrograde nephrolithotripsy (RIRS) with a logistic analysis of outcomes and complications. The prospective study included 50 patients diagnosed with urolithiasis from 2018 to 2021 in the urological hospitals in Irkutsk. Patients were divided into two groups: RIRS (group I, n = 23) and Mini-PCNL (group II, n = 27). The comparison groups are statistically homogeneous. Both procedures equally lead to high stone free rates (SFR > 1 mm, 91.3% vs 85.1%; p = 0.867; SFR > 2 mm, 95.6% vs 92.5%; p = 0.936). The intergroup analysis of the total operation time (and lithotripsy) demonstrated similar times (p > 0.05). Postoperative complications of classes II-III (Clavien-Dindo) in the early and late postoperative period developed rarely and were comparable (p > 0.05). Class I complications were predominant in the PCNL group (p = 0.007). Some parameters demonstrated the superiority of RIRS over PCNL: less pronounced pain syndrome (p = 0.002), less drainage time (p < 0.001), no postoperative hematuria (p = 0.002), shorter hospitalization and total treatment period (p < 0.001). The study highlighted the positive effect of the one-day surgery principle on the risk of developing postoperative hematuria, urinary infection, or severe postoperative pain. RIRS and mini-PCNL have similar effectiveness, but RIRS meets the criteria of the enhanced recovery program more than PCNL.

Comparative Evaluation of the Choice of the Method of Percutaneous Nephrolithotripsy in Patients with Nephrolithiasis

The objective: to analyze the effectiveness and safety of mini-percutaneous nephrolithotripsy (mPCNL) compared to standard percutaneous nephrolithotripsy (sPCNL) in the treatment of nephrolithiasis. Materials and methods. The study analyzed the results of treatment of 1021 patients with solitary (10–30 mm), coral-like and multiple kidney stones for the period from 2016 to 2022. Patients were divided into two groups: sPCNL (500 patients) and mPCNL (521 patients). The average age of patients in both groups was 44.5±15 years. The results of treatment in both groups were compared with each other according to the following parameters: stone-free rate (SFR), duration of surgery, presence of complications, and length of postoperative hospital stay. Results. Both methods are highly effective in the surgical treatment of nephrolithiasis. At the same time, the duration of the operation in the mPCNL group was longer than in the sPCNL group (81.0±15.5 min vs. 69.1±13.9 min; p&lt;0.001), mCPNL was more often finished with drainageless methods (41.1% vs. 6.8%; p&lt;0.001). The postoperative SFR after mPCNL was generally higher (96.4% vs. 91.8%; p=0.002) both in the treatment of solitary stones (98.5% vs. 97.4%; p&gt;0.05) and in treatment of coral-like (90.1% vs. 77.3%; p&lt;0.05) and multiple nephrolithiasis (89.5% vs. 70.8%; p=0.03). The postoperative hemoglobin decrease was smaller in the mPCNL group (1.1±0.34 g/dL vs. 2.1±0.26 g/dL; p&lt;0.001). The infectious complications frequency and length of postoperative stay in the hospital were less in the mPCNL group than in the sPCNL group – 7.3% vs. 13.2% (p=0.03) and 1.9±0.6 days vs. 4.3± 2.4 days, respectively (p&lt;0.001). Conclusions. Mini-percutaneous nephrolithotripsy (m-PCNL) has been proven to be a safe and effective method of nephrolithiasis treatment. Compared with standard percutaneous nephrolithotripsy (sPCNL), patients after mPCNL have a higher SFR, a lower frequency of postoperative complications and duration of postoperative stay in the hospital. An increase operation time by mPCNL is associated with a decrease in the diameter of the tube.

Comparative analysis of the results of standard and minipercutaneous nephrolithotripsy for staghorn stones

Introduction. There are conflicting data in the literature on the results of mini-percutaneous nephrolithotripsy (PCNL) in staghorn stones.Objective. To compare the results of standard and mini-PCNL.Materials and methods. The results of PCNL in 90 patients with staghorn stones were analyzed, which were divided into two groups. In the I group, 58 (64.4%) patients underwent standard PNL with a nephroscope 24 Fr, in the II group, 32 (35.6%) patients underwent mini-PCNL with an endoscope 15 Fr. The operative time and the number of postoperative complications were compared. To assess the effectiveness of PCNL, an overview radiography or native computed tomography was performed. The operation was considered successful with residual fragments less than 3 mm.Results. Operative time, number of complications and blood transfusions, the effectiveness of PCNL in groups I and II were 80.0 ± 20.6 and 96.5 ± 25.0 min, 24.1% and 15.6%, 10.3% and 3.1%, 86.2% and 84.4%. Additional interventions were resorted to in 7 (12.1%) patients in I group, and in 4 (12.5%) patients in II group. Complications in I and II groups were observed in 14 (24.1%) and 5 (15.6%) cases. The frequency of blood transfusions was significantly higher after standard PCNL (10.3% / 3.1%, p &lt; 0.05). Complications of grade III with mini-PCNL, replacement of an incorrectly installed stent was included in 2 patients, and with standard PCNL, ureteral stenting with urine leakage through the nephrostomic tract in 2 patients, drainage of the pleural cavity in one case.Conclusion. Standard PCNL is an effective method in staghorn stones, but the number of complications after it remains higher. In selected patients with staghorn stones, the results of mini-PCNL are comparable to those of standard PCNL.

Totally tubeless single access tract mini-percutaneous nephrolithotripsy in treatment of large burden\u2009>\u20092-cm and/or complex renal stones: a case series of 62 patients

BackgroundLimited literature has focused on the use of totally tubeless mini-percutaneous nephrolithotomy (PCNL) for the treatment of large renal stones. We present our findings of treating patients with large and/or complex renal stones using single renal access totally tubeless mini-PCNL.MethodsFrom March 2018 to May 2021, 62 consecutive cases in which single tract totally tubeless mini-PCNL was used to treat complex renal stones were enrolled, all with calculi > 2 cm. All procedure of puncture and dilation were guided by fluoroscope. The complexity of stones was assessed according to the Guy’s Scoring System (GSS). The surgical duration, length of hospital stay, analgesia requirement, stone-free rate, and perioperative morbidity were assessed.ResultsThe mean preoperative stone burden was 36.69 ± 19.76 mm (above 2 cm in all cases), mean surgical duration was 61.93 ± 40.84 min (range 15–180 min), and mean hematocrit reduction was 4.67 ± 2.83%. Postoperative Nalbuphine was used in 6 patients. The mean length of stay was 2.46 ± 1.19 days (range 2–8 days), and the postoperative stone-free rate was 83.9% (52/62), and 87.1% (54/62) after auxiliary ESWL. The overall complication rate was 14.5%, the majority of complications being postoperative transient fever.ConclusionFor the treatment of large bursen > 2 cm and/or complex renal stones, totally tubeless single tract mini-PCNL ensures a feasible SFR, low morbidity and short hospital stay. According to the low complication rate in our study, the totally tubeless manner was not associated with an increased risk of postoperative morbidity, and patients benefited from decreased postoperative analgesics use.

MINIMALLY INVASIVE PERCUTANEOUS NEPHROLITHOTRYPSY IN THE TREATMENT OF PATIENTS WITH KIDNEY STONES.

The aim: To evaluate the outcomes and complications rate of minipercutaneous nephrolithotripsy (MPCNL) for renal stones treatment. Materials and methods: MPCNL was performed to 123 patients with kidney stones from January 2020 till November 2021. All operations were performed under endotracheal inhalation anesthesia. After the ureteral catheter was introduced ultrasound controlled punction of kidney collecting system and work channel dilation were performed. Stones were fragmented by holmium laser. The fragments extracted passively with fluid flow through the outer sheath. Operation ended by introduction of nephrostomy tube 14Ch. Results: In total 135 MPCNLs were performed in 123 patients. The average duration of operations was 55±5,4 minutes and stone size was 1,6±0,2 sm. 12 patients were per¬formed simultaneous MPCNL on both sides. The simultaneous MPCNL duration amounted 105±8,1 min. In 3 (2,2%) cases residual stones were observed. The average hospital stay was 1,31±0,2 days. The renal drainage was removed in 24 ± 3,2 hours after operation. Acute pyelonephritis was presented in 4 (3,3%) and postoperative bleeding in 2 (1,6%) patients, which were stopped by antibacterial and hemostatic drugs with drainage occlusion respectively. Conclusions: To advantages of MPCNL belong short hospital stay, high safety level, insignificant intraoperative and postoperative bleeding, good operation field visualization, opportunity of quick removal of renal drainage, ureteral and urethral catheters. Benefit in patients with severe comorbidities, opportunity of simultaneous bilateral MPCNL and almost complete postoperative pain absence allow to consider MPCNL the operation of choice in kidney stone management.

The best treatment approach for lower calyceal stones ≤20 mm in maximal diameter: mini percutaneous nephrolithotripsy, retrograde intrarenal surgery or shock wave lithotripsy. A systematic review and meta-analysis of the literature conducted by the European Section of Uro-Technology and Young Academic Urologists.

The highest in quality data in the literature which compared mini percutaneous nephrolithotripsy (mPCNL), retrograde intrarenal surgery (RIRS) and shock wave lithotripsy (SWL) for the management of lower pole stone (LPS) with a maximal diameter ≤20 mm were investigated by means of systematic review (SR) and meta-analysis. A SR of the literature was conducted on PubMed, Cochrane, SCOPUS and EMBASE in January 2020. The study complied with the PRISMA statement and recommendations of the EAU Guidelines office. Only randomized controlled trials (RCTs) comparing retrograde intrarenal surgery (RIRS), shock wave lithotripsy (SWL) and mini-percutaneous nephrolithotripsy (mPCNL) were selected for the meta-analysis. The endpoints were the efficacy of each modality, measured by stone-free rate (SFR), operative time and retreatment rate and the safety of each method, based on hospitalization time and complications. Subgroup analyses for stones with a maximal diameter <10 mm and 10-20 mm were performed. Twenty-one RCTs were included in the meta-analysis. mPCNL had the highest SFR and the lowest retreatment rate among the three modalities, while SWL had the lowest SFR and the highest retreatment rate. The operative and hospitalization time were shorter in the case of SWL, whereas they were similar in the case of mPCNL and RIRS. The highest complication rate was observed in mPCNL group, which accounted for 8.3-22.4%, while RIRS and SWL had similar complication rates, which ranged between 1.3-31.4% and 0-48.5%, respectively. Further classification of the complications according to Clavien-Dindo system revealed that SWL had lower grade II complication rates compared to mPCNL and RIRS. Regarding stones <10 mm, SWL and RIRS had similar SFR, complication rate, operation and hospitalization time. SWL had higher retreatment rate. For LPSs ≤20 mm, mPCNL provides the highest SFR and the lowest retreatment rate. This modality has a higher complication rate and longer hospital stay in comparison to the other modalities. SWL provides the lowest SFR with the highest retreatment rate. RIRS has similar complication rate to SWL and could be preferred over SWL. For stones up to 10 mm, SWL may provide a valid alternative. Despite a higher retreatment rate, its SFR is similar to RIRS.

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.

Microperc with Self-Assembled Fr 4.85 Visual Needle and Ureteral Access Sheath

Background Micropercutaneous nephrolithotomy (microperc) is the least invasive among percutaneous nephrolithotripsy (PCNL) procedures. Although microperc has a high stone-free rate and certain advantages over other methods, modifications may be needed to improve the technique. We describe our experience performing microperc using a self-assembled visual needle and ureteral access sheath (UAS). Methods Between June 2016 and April 2019, the data of 30 patients with kidney stones undergoing microperc with our self-assembled 4.8 Fr visual needle combined with a UAS was retrospectively analyzed. Patients were placed in an obilique spine lithotomy position. Results Two cases were excluded: one due to conversion to mini PCNL and the other required flexible ureteroscopy during microperc. The remaining 28 cases included 18 men and 10 women, age 38.4 ± 7.5 years, stone size 1.7 ± 0.4 cm, and stone density on CT 969 ± 233 HU. Operative time was 47 ± 9.9 minutes, visual analogue scale score of tract pain on postoperative day 1 was 2.5 ± 1.0, hemoglobin decrease was 6.4 ± 1.0 g/L, and hospital stay was 3.1 ± 0.8 days. There was 1 case of fever and urinary infection, 2 cases of hematuria, and 1 case of flank pain. All symptoms resolved after conservative or antibiotic treatment. On postoperative day 1, 12 (42.9%) caseswere stone-free. The stone-free rates at postoperative month 1 and 3 were 92.9% (26/28) and 100% (28/28), respectively. Conclusions Our self-assembled visual needle and UAS instrument is effective for microperc. Use of the UAS may improve the operative outcome.

Prone Versus Flank-free Modified Supine position Mini Percutaneous Nephrolithotomy in Pediatric Age Group

Background: Children with nephrolithiasis constitute a high-risk patient population with increased risk for stone recurrence during their life- times, so proper evaluation and management is very important. The present study aimed to compare operative time, complications rate, stone free rate in the prone position versus flank-free modified Supine position (FFMSP) Mini-perc percutaneous nephrolithotripsy (M-PCNL) in pediatric age group. Patients and methods: A prospective randomized comparative study was carried out on 20 patients with renal stones scheduled for PCNL at the Urology Department, Faculty of Medicine, Zagazig University in the period from December 2017 till November 2018, they were randomized in two groups; Group A: for Flank-free Modified Supine position Mini Percutaneous Nephrolithotomy position; Group B: for prone mini percutaneous nephrolithotomy position. Results: the current study showed that there was a statistical significant difference between the studied groups regarding to operative time & position time, it was shorter in FFMS than prone with highly significant difference, also there was no statistical significant difference between the two groups in radiation time, access time and laser time, the needed for auxiliary maneuver as ESWL in both position was 5 cases in both group together, there was no significant difference in studied groups. Conclusion: we conclude that the mini- percutaneous nephrolithotripsy in Flank Free Modified Supine position as treatment of pediatric renal stones is, shorter in operation time, less in complication rate but not significant different and has same efficiency as compared to prone mini-percutaneous nephrolithotripsy.

Supine Mini- Percutaneous Nephrolithotripsy (Mini PCNL) for Renal Stones 0.5 – 2 CM in Pediatric Age Group: New Experience of TBRI

Objective To establish the new experience as well as to evaluate the safety and efficacy of mini percutaneous nephrolithotripsy (mini PCNL) in treatment of kidney stones 0.5-2 cm in pediatric age group. Patients and Methods Between December 2018 and October 2020 seventeen patients admitted to the Urology Department, presented with renal pelvis or calyceal stone (5-20 mm) were enlisted for mini PCNL. Achieving success of the technique is considered when stone free or radiologically insignificant residual fragments &lt;4mm. Results The demographic data in this study is comparable with those in adults age group regarding the stone size with no statistical significance. Meanwhile, the operative time was 59.71 ± 19.44 min , and Fluoroscopy times had mean of 8.11 ± 2.05 min. The stone free rate was 96.2% in mini PCNL, one case of mini PCNL (5.9%) had significant bleeding and needed transfusion. One patient of mini PCNL (5.9%) had perforation in the renal pelvis which was resolved with insertion of Double J stent &amp; nephrostomy. Conclusion Supine mini PCNL can be an effective and alternative option for treatment of renal stones 0.5-2 cm in pediatric age group. Supine mini PCNL has accepted operative and postoperative course. Larger numbers of patients will be more effective to confirm these results. Keywords: Pediatric; Mini percutaneous nephrolithotomy; Stone

Mini- Percutaneous Nephrolithotomy (MPCNL) VS. Flexible Ureterorenoscopy (RIRS) for Renal Stones &gt;2cm

To evaluate the efficacy and safety of mini percutaneous nephro-lithotripsy (mini PCNL) and retrograde intrarenal surgery (RIRS) in treatment of renal stones larger than 20mm in its longest diameter. Patients & Methods: In a prospective randomized study including 40 patients divided into two groups each 20 patient. Gathering An included 12 guys and 8 females with age went from 15 to 62 years had smaller than expected PCNL for renal pelvic and calyceal stones. Gathering B included 8 guys and 12 females with age extended from 18 to 65 years of age had RIRS. Adaptable ureteroscopy was utilized for pelvic and calyceal stones utilizing holmium:YAG laser (tidying approach). In the two gatherings the strategy result regarding Operative time, Blood misfortune, clinic remain, entanglements utilizing changed Clavien reviewing framework , the need of assistant systems , stone free rates following 3 weeks by utilizing CTUT, were assessed measurably. Measurable investigation of the information indicated that there was immaterial contrast between the {mean ± SD} of the BMI in patients of gathering A which was {27.850±3.183} kg/m2; while in patients of gathering B was {29.700±7.927} kg/m2 . With respect to measure, there was immaterial contrast between the {mean ± SD} of gathering A which was 2.57±0.22mm, while in bunch B was 2.6±0.24mm. With respect to usable time the {mean ± SD} of gathering A was 104.43±14.79 minutes which was altogether (P<0.05) higher contrasted with bunch B 59.71±19.44 minutes. As with respect to emergency clinic stay it was unimportantly (P lower 0.05) higher in bunch A 1.41±0.46 days contrasted with bunch B 1.29±0.44 days. Concerning free rate 89 % of patients rewarded with bunch A were without stone (17 out of 20), while in bunch B 83.4% of patients were sans stone (16 out of 20) following 3 weeks by utilizing CTUT imaging. As to utilizing changed Clavien evaluating correlation with our investigation in which Grade 1: 1 in bunch An and 0 in bunch B , grade 2: 1 in bunch An and 0 in bunch B , grade 3A : 1 in bunch An and 0 in bunch B likewise grade 3B : 0 in bunch An and 0 in bunch B additionally 0 in grade 4 and 5 in the two gatherings In patients with renal stones bigger than 20 mm , results indicated that little PNCL has higher stone free rate and longer employable time than RIRS in cost of higher entanglements rate, blood misfortune, and longer medical clinic remain.

Оптимизация параметров суперимпульсного тулиевого волоконного лазера с длиной волны излучения 1,94 мкм при миниперкутанной литотрипсии

At present, minipercutaneous nephrolithotripsy is a highly effective and safe method for fragmentation of stones with sizes up to 3 cm. The use for lithotripsy of a holmium: yttrium aluminum garnet laser with wavelength 2.1 μm (Ho:YAG) is a common practice today. Of late, however, more attention is paid to a new superpulse thulium fiber laser with wavelength 1.94 μm and maximum output power 40 W. The use of a thulium laser with pulse energy 0.025–6 J and a high repetition rate (to 1600 Hz) permits to obtain (compared with a holmium laser) better results of stone dusting. Objective. Selection of the optimal modes of stone fragmentation in minipercutaneous nephrolithotripsy with the use of a superpulse thulium fiber laser with wavelength 1.94 μm and maximum output power 40 W in patients with nephrolithiasis. Patients and methods. The study included patients (n = 171), who underwent minipercutaneous nephrolithotripsy using a superpulse thulium fiber laser during the period from February 2018 to July 2019. The following parameters of laser radiation were used: pulse energy 0.1-6 J, power 6-40 W, pulse rate 30-300 Hz. The impact of modes on endoscopic visualization and retropulsion was assessed intraoperatively. Results. Statistical analysis of the specificities of the most often used modes was conducted: No 1 – «0.15 J, 200 Hz, 30 W», No 2 – «0.5 J, 30 Hz, 15 W», No 3 – «0.8 J, 31.25 Hz, 25 W», No 4 – «0.8 J, 37.5 Hz, 30 W», No 5 – «1.5 J, 15 Hz, 30 W», No 6 – «1.5 J, 26.6 Hz, 40 W», No 7 – «2 J, 15 Hz, 30 W», No 8 – «2 J, 20 Hz, 40 W», No 9 – «4 J, 10 Hz, 40 W»; their effects on retropulsion and on endoscopic visualization were studies. The stone free rate was assessed on the first post-operative day according to the findings of low-dose CT. Conclusion. Study of the modes of thulium fiber lithotripsy, assessment of retropulsion and endoscopic visualization depending on the choice of emitted radiation parameters of a thulium fiber laser make it possible to improve the outcomes of operative treatment in patients with nephrolithiasis. Key words: minipercutaneous, nephrolithotripsy, nephrolithiasis, MPNL, thulium fiber lithotripsy, retropulsion, visibility, superpulse thulium fiber laser, wavelength 1.94 μm, stone free rate

Medical and surgical interventions for the treatment of urinary stones in children.

Medical and surgical interventions for the treatment of urinary stones in children.

Retrograde intrarenal surgery versus mini-percutaneous nephrolithotripsy to treat renal stones 20 mm or larger in diameter using holmium:YAG laser

Objective To evaluate the efficacy and safety of mini-percutaneous nephrolithotripsy (mini-PCNL) and retrograde intrarenal surgery (RIRS) in the treatment of renal stones 20 mm or larger in the longest diameter using holmium:YAG laser. Patients and methods This was a prospective randomized study that included 40 patients who were divided into two groups, with 20 patients each. Group A underwent mini-PCNL using holmium:YAG laser lithotripsy for renal pelvic and calyceal stones. Group B underwent RIRS in which flexible ureteroscopy was used for pelvic and calyceal stones, and semi-rigid ureteroscope was used for only renal pelvic and upper calyceal stones using holmium:YAG laser. In both groups, the procedure outcomes in terms of operative time, blood loss, hospital stay, complications using modified Clavien grading system, the need of auxiliary procedures, and stone-free rates (SFRs) after 3 weeks by using CTUT were evaluated statistically. Results Statistical analysis of the data showed that there was significant difference in the operative time, which was higher in RIRS group compared with mini-PCNL group, whereas the blood loss in terms of mean±SD change in pre-treatment and post-treatment hemoglobin levels and the hospital stay were significantly higher in mini-PCNL group compared with RIRS group. The complications using modified Clavien grading system were higher in mini-PCNL group compared with RIRS group. The SFR was higher in mini-PCNL group. Conclusion In patients with renal stones 20 mm or larger, results showed that mini-PNCL has significantly shorter operative time with higher blood loss and longer hospital stay compared with RIRS. In both groups, the SFR and the need of the auxiliary procedures were comparable.

Оценка эффективности и безопасности мини-перкутанной нефролитотрипсии при коралловидных, крупных и множественных камнях почек

Оценка эффективности и безопасности мини-перкутанной нефролитотрипсии при коралловидных, крупных и множественных камнях почек