Multiple Renal Stones Research Articles

One-stage versus staged ureteroscopy and percutaneous nephrolithotomy for simultaneous ureteral and renal stones.

Objectives:This study is aimed to investigate the outcome of one-stage ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) for simultaneous ureteral and renal stones over 10years at a tertiary urology institute.Materials and methods:We retrospectively analyzed the data of patients who were operated on for simultaneous ureteral and renal stones from January 2011 to December 2020. Patients were divided into 2 groups: group A, who underwent one-stage URS and prone PCNL, and group B, who underwent staged procedures. The overall success, complications, operative time, and hospital stays were compared between the 2 groups.Results:Data for 190 patients were reviewed; mean age was 50 ± 13years old, and 146 (77%) were male. The one-stage (A) and staged (B) groups included 102 and 88 patients, respectively. Group A included older patients, with a high The American Society of Anesthesiologists score, while group B included more patients with multiple or staghorn stones. The one-stage group recorded shorter operative time (120 ± 12min vs. 140 ± 16min, p = 0.02) and shorter hospital stays (3days [2-6] vs. 4days [3-9], p = 0.06). Otherwise, both groups had equal outcomes in terms of success rates and complications.Conclusions:PCNL and URS can be performed in one-session for simultaneous ureteral and renal stones, except for multiple renal and staghorn stones. The results are comparable to those of the staged procedure in terms of success rate and complications, with the advantage of a shorter operative time and hospital stay.

Primary squamous cell carcinoma of the kidney parenchyma with ascending colon invasion: A case report and literature review.

IntroductionPrimary squamous cell carcinoma (SCC) of the kidney parenchyma is extremely rare, with only seven cases reported to date. Herein, we present a case of primary with colon invasion.Presentation of caseA 61-year-old man presented right flank pain for 5 months. Computed tomography (CT) showed multiple renal stones and a necrotic mass in the lower pole of the right kidney, which was suspicious for ascending colon invasion. There was no history of radiation or occupational exposure to chemicals. Radical nephrectomy, right hemicolectomy, and lymph node dissection were performed. The kidneys showed a solid mass with multiple renal stones. The tumor comprised nests of atypical squamous cells and keratin pearls; however, the renal pelvis was normal. 18-Fluorodeoxyglucose-positron emission tomography/CT failed to demonstrate other primary site. Therefore, the patient was diagnosed as primary SCC of the kidney. The patient did not receive adjuvant therapy and was alive during follow-up for 6 months after surgery.DiscussionSCC of the urinary tract is considered to be the result of squamous metaplasia of the urothelium, which may potentially progress to SCC. Squamous metaplasia may be caused by chronic irritation. However, the mechanism of SCC remains unclear. Although the prognosis of SCC is similar to that of urothelial carcinoma when compared stage for stage, SCC tends to be diagnosed at a more advanced stage.ConclusionThis is a rare case of kidney SCC with adjacent organ invasion. Additional studies are required to further our understanding of this rare tumor and improve diagnosis and treatment.

Management of complex renal stones by a novel ureterorenoscope with vacuum suctioning system combined with flexible ureteroscope

Objective: To evaluate the feasibility and safety of Sotn ureterorenoscope combined with flexible ureteroscope on managing complex renal stones. Methods: Patients treated with the Sotn ureterorenoscope combined with flexible ureteroscope between January 2010 and December 2019 were employed from the Sun Yat-sen Memorial Hospital of Sun Yat-sen University and Jiangmen Wuyi Traditional Chinese Medicine Hospital. The patients' information of age, gender, comorbidities, stone characteristics (stone size, hounsfield units, stone composition, stone location, etc.), operative time and console time, stone-free rate (SFR), and perioperative complication rate were collected. The primary outcome was defined as primary SFR in 1 month of operation, and the secondary outcome was the perioperative complication rate. The differences in preoperative and postoperative data between patients with different kinds of stones were compared. Results: A total of 347 patients were included in the study, with 220 males and 127 females. The age [M(Q1,Q3)] was 51 (42, 58) years. There were 94 patients suffered from multiple renal stones and 253 patients with staghorn renal stones. The operative time and console time age [M(Q1,Q3)] for all patients were 87 (55, 115) min and 59 (27, 75) min, respectively. The primary SFR was 81.3% [83.8% for multiple renal stones and 74.5% for staghorn renal stones (P=0.048)]. Complications occurred in 80 patients (23.1%), of which 79 cases were classified as Clavien-Dindo grade 1-2, and 1 case (0.3%) was grade 3-4. For patients with multiple renal stone, compared with the residual stone group, the complete stone-free group had smaller stone size [15.5 (12.0, 21.0) vs 22.0 (17.5, 28.1) mm, P<0.001], and lower hounsfield units [920.0 (658.0, 1 172.5) vs 1 125.0 (944.9, 1 247.5), P=0.022]. Patients with complications had longer operative time than those without complications [60.0 (38.5, 90.0) vs 75.0 (51.3, 110.0) min, P=0.022]. The SFR was higher in patients with stones size ≤ 20 mm compared to those with stones size > 20 mm (91.8% vs 67.5%, P<0.001), while the difference in complication rate was not statistically significant (P>0.05). In the staghorn renal stones group, compared with the residual stone group, the complete stone-free group had smaller stone size [35.0 (25.8, 45.3) vs 53.5 (39.3, 67.5) mm, P<0.001]. Patients with complications had larger stone size than those without complications [43.5 (34.8, 56.5) vs 36.0 (27.0, 50.0) mm, P=0.007]. Patients with stone size ≤ 40 mm had higher SFR (87.5% vs 55.3%, P<0.001) and lower complication rate(10.7% vs 31.6%, P=0.012) compared to those with stone size >40 mm. Conclusion: Sotn ureterorenoscope combined with flexible ureteroscope is an effective and safe choice for the treatment of complex renal calculi.

971 A Rare Case of a Reno-colic Fistula Presenting as a Retroperitoneal and Psoas Abscess

Abstract Background Fistulous connections arising between the kidney and colon are rare and develop due to multiple aetiologies. We present a rare case of a reno-colic fistula presenting unusually as a retroperitoneal and psoas abscess managed surgically with a good outcome. Case Report A 49-year-old lady presented with 5-day history of left flank pain and swelling with no significant surgical or medical history. Physical examination revealed a tender left renal angle with raised inflammatory markers (CRP and WCC). Computed tomography (CT) revealed an extensive collection extending from an atrophic left kidney through the retroperitoneum and psoas into the subcutaneous tissues with possible fistulation into the descending colon. This was initially treated with antibiotics and percutaneous drainage of the collection. A reno-colic fistula was confirmed via left retrograde pyelogram. Under the multidisciplinary care of the urology and colorectal general surgical teams she underwent a left nephrectomy, large bowel resection and defunctioning colostomy successfully and was discharged eight days later. Histology later confirmed an extensively scarred atrophic left kidney with multiple renal stones with no preserved glomeruli, focal inflammatory infiltrate and stromal calcification consistent with end stage nephropathy. With the resected 5 cm descending colon showing mucosal and serosal inflammation consistent with site of fistula. Conclusions Reno-colic fistula is rare and presentation with a retroperitoneal and psoas abscess uncommon. We report a rare case of a reno-colic fistula secondary to a chronically infected and obstructed left kidney managed surgically with a good outcome.

Spinal versus general anesthesia during retrograde intra-renal surgery: A propensity score matching analysis.

Background:The indications for retrograde intra-renal surgery (RIRS) have greatly increased, however, there is still no consensus on the use of spinal anesthesia (SA) during this procedure. The aim of this study was to evaluate the comparability of surgical conditions and outcomes with RIRS performed under SA versus general anesthesia (GA) for renal stones.Materials and methods:This was a prospective, observational study in patients scheduled for RIRS in a single teaching hospital in Italy. Inclusion criteria were age >18 years and the presence of single or multiple renal stones. We recorded information concerning the site of lithiasis, the number of calculi, total stone burden, and the presence of concomitant ureteral stones or hydronephrosis. A propensity score-matched analysis was performed to evaluate the results in terms of surgical outcome, intraoperative and postoperative complications, and analgesia demand balanced for confounding factors. Patients were followed-up until day 90 from discharge.Results:We included 120 patients, the propensity score-matched cohort included 40 patients in the SA and 40 in the GA groups. The stone-free rate was 67.5% in the GA group and 70.0% in the SA group (p = 0.81). The use of auxiliary procedures within 90 days did not differ between groups (25.0% vs. 22.5%, p = 0.79). No cases of conversion from SA to GA were recorded. We did not find any differences in intraoperative bleedings, perforations, and abortions. Complication rates were similar in the 2 groups (10.0% in GA vs. 5.0% in SA, p = 0.64).Conclusions:In our cohort, RIRS performed under SA and GA was equivalent in terms of surgical results and complications.

Progressive Bilateral Childhood Urolithiasis of Rare Etiology: Ultrasound Images and Evidence-Based Therapeutic Recommendations.

Background: Multiple, recurrent and bilateral renal stones causing progressive bilateral urolithiasis is rare during childhood and metabolic disorder such as cystinuria and oxalosis are commonly. The aim of this paper is to report the very rare presentation of hypercalciuria and hypercalciuria with progressive bilateral renal stone disease, with stones predominantly composed of ammonium and phosphate suggesting infective etiology. Patients and methods: A boy with progressive bilateral renal stone disease since early infancy and had been treated by several urologist during the previous three years was studied. He was first referred at the age of five years requesting the opinion about the use of medical therapies and therefore an evidence-based recommendation was made. Results: The boy was initially diagnosed as having bilateral urolithiasis at about the age of two years and during the previous three years with three surgical operations and two lithotripsy sessions. Stone were predominantly composed of ammonium (++++) and phosphate (++++), but they also contained calcium (+++) and uric acid (+). There was evidence of urinary infections with Klebsiella and Enterobacter species suggesting an infective etiology of the stone disease. On referral, Sodium nitroprusside test for cystine was negative and paper chromatography for cystine was also negative. 24-hour urine examination (volume 1600 ml): Calcium 264 mg/24 hr (more than 12 mg/kg/24hr) and oxalate 0.17 g/24 hr (Normal: 0.01-0.04 g /24). Conclusion: Urologists should make an early consultation with a pediatrician expert in renal disorders to provide the necessary medical therapies. Bilateral progressive renal stone disease is rarely caused by infective etiologies alone and the presence of recurrent urinary infections should not lead to ignoring the possibility of metabolic abnormalities.

Evaluating outcomes of complete supine percutaneous nephrolithotomy for staghorn vs multiple non-staghorn renal stones: a 10-year study.

To evaluate the outcomes of complete supine percutaneous nephrolithotomy (csPCNL) for staghorn stones and multiple large non-staghorn stones. The records of 886 patients who underwent csPCNL from September 2009 to October 2019 were considered. Out of them, 201 cases met the eligibility criteria and they were divided into three groups: 63 cases of staghorn, 68 cases of multiple medium (20mm < diameter ≤ 30mm) non-staghorn and 70 cases of multiple large non-staghorn (> 30mm) stones. Almost all outcomes and stone-related factors were analyzed. There was not any significant difference regarding age, body mass index, history of urinary tract infection, transfusion rate, complication rate, pre and post-surgery serum creatinine, hemoglobin drop and total hospital stay between the three groups. Stone free rate was 98.5% in multiple medium group, 97.1% in multiple large group and 84.1% in staghorn group (P = 0.001). The operation duration was significantly shorter for the multiple medium group (P < 0.001) but it was not significantly different between the multiple large non-staghorn and staghorn group. The results demonstrated that almost all outcomes were not significantly different between the three groups (especially between staghorn and larger non-staghorn ones). These findings reveal that surgeons could choose csPCNL for treatment of staghorn stones and multiple large non-staghorn stones and consider staghorn stones as challenging as multiple large (especially diameter > 30mm) non-staghorn stones.

Metabolic evaluation of patients with recurrent, multiple or bilateral renal stones in Jaffna

A comprehensive evaluation to identify metabolic abnormalities will help design management strategies for prevention of renal stone recurrences. The objective of this study is to identify the metabolic risk factors in a series of patients with recurrent, multiple or bilateral renal stone disease from the Northern Province, Sri Lanka. This is a hospital based observational study on patients with recurrent, multiple or bilateral renal stones. Metabolic evaluation workout included, fasting non-tourniquet venous blood sample for serum ionized calcium, creatinine, and uric acid, freshly voided early morning urine sample for pH and laboratory urinalysis, and collection of two sets of 24 hour urine samples on two separate days, for phosphorous, creatinine, oxalate, uric acid, magnesium, calcium and citrate. The mean values of each metabolic parameter measured on the two sets of 24 hour urine samples, were found to be within the normal reference range for the entire 30 patient study group taken as whole, although the mean values for 24 hour urine magnesium (79.79±51.36 mg) and urine calcium (125.02±73.32 mg) were found to be towards the lower limit of normal reference range and the 24 hour urine oxalate (0.38±0.22 mmol) was found to be towards the upper limit of normal reference range. However, 80% of patients individually showed abnormal metabolic results either as single derangement (13 patients, 43.3%) or in multiple combinations of derangements (11 patients, 36.7%). Six patients (20%) did not have any metabolic abnormalities. Hyperoxaluria, hyperuricosuria, hypomagnesuria and hypocitraturia were the metabolic abnormalities identified among the study group. A comprehensive metabolic evaluation of each patient with recurrent, multiple or bilateral renal stone disease can help identify metabolic abnormalities, either as a single abnormality or combinations of abnormalities, specific for them. Such patient profiling will help develop bespoke management strategy based on appropriate dietary advice and specific medical treatment towards prevention of further stone formation.

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

Outcomes of Percutaneous Nephrolithotomy Versus Open Stone Surgery for Pateints with Staghorn Calculi Safety and Efficacy

ABSTRACT BACKGROUND: The wide use of minimally invasive techniques in the management of multiple renal stones and staghorn stones has replaced the open technique in last 30 year. But the Open techniques for the management of complex multiple and staghorn renal stones are still a viable option that should be considered in treating patients complex staghorn stones with large burden. In this study, we compare outcomes of Percutaneous Nephrolithotomy (PNL) Versus Open Stone Surgery (OSS) for patients with Staghorn calculi at the urology department Fayoum university hospital, in terms of efficacy, safety, operative procedure, intraoperative and postoperative complications. METHODS: This is a prospective randomized study performed on 50 patients divided into OSS group and PNL group (25 patients for each group) during the period from December 2018 to January 2020. Perioperative assessment and investigations were done. Intraoperative and postoperative morbidity, operative time, hospital stay, and stone clearance at discharge home and follow-up were compared for both techniques. Follow up was completed for all cases with a mean duration 2 months. Results: Stone-clearance was higher in OSS group (92%) versus (84%) in PNL group with no significant difference. Mean operative creatinine rise in OSS group was (0.19 ± 0.1 mg/dl) and in PNL group was (0.14mg/dl ± 0.07 mg/dl).There is statistically significant creatinine rise with p-value Conclusions: PNL is a valuable treatment option for staghorn stones with a stone free rate approaching that of open surgery. Also it has less morbidity, with shorter hospital stay and earlier returns to work.

Treatment of isolated small renal stones leads to resolution of symptoms and should be routinely offered to patients: retrospective outcomes from a university hospital

IntroductionTreatment of smaller renal stones and the symptomatic value it offers to patients is often debated. We wanted to analyse surgical outcomes for treatment of small renal stones and whether treatment resulted in symptom resolution.Materials and methodsAll patients who underwent ureterorenoscopy (URS) for isolated symptomatic small renal stones ≤10 mm over a 7-year period were retrospectively included and subdivided into those with stones of ≤7 mm (Group A) and stones of 8–10 mm (Group B). Patients with multiple renal stones, ureteric stones, or combined renal and ureteric stones were excluded. Based on the symptoms, the patient groups were those with pain, urinary tract infection (UTI) and haematuria. Resolution of symptoms was defined as no symptoms during the follow-up period.ResultsA total of 109 patients with a single small renal stone ≤10 mm underwent URS and stone treatment, with mean age of 50 years and a male:female ratio of 1:1.2. The mean operative time was significantly longer in Group B (55.9 min vs 33.07 min, p = 0.001). In total, 97.2% (n = 70) of patients in Group A and 83.7% (n = 31) of patients in Group B were stone free (p = 0.017). Complete resolution of symptoms was seen in 63 (92.6%), 24 (85.7%) and 13 (100%) patients with pain, UTI and haematuria, respectively. There were no statistically significant differences in symptom resolution between patients with stones ≤7 mm and those with stones 8–10 mm in size.ConclusionUreteroscopic treatment is a feasible option for small symptomatic stones, since it may lead to symptom resolution. Based on our study we would recommend that patients with symptomatic small renal stones are offered endoscopic treatment.

Recurrence of nephrolithiasis: incidence and risk factors in Egyptian patients

Introduction Recurrence of nephrolithiasis is common. The knowledge of its incidence and risk factors is the base for proper prophylaxis and preservation of renal function. Objective The aim was To study the recurrence rate and risk factors of nephrolithiasis in Egyptian patients. Patients and methods Files of 974 patients with nephrolithiasis (634 males and 340 females, aged 7–70 years) were reviewed. They were managed between 2008 and 2009, with a 10-year follow-up period since the first stone episode for recurrence. Stone characteristics (sizes, sites, and multiplicity), treatment type, post-treatment residual stones, family history, BMI, and recurrence rate were included. Results Of the 974 patients, stone recurrence rate was 44.45% within 10 years of follow-up. Recurrence was significantly higher in young age group of less than 20 years, male sex, average BMI, and positive family history (61.14, 52.99, 50.99, and 55.82%, respectively) within 10 years. Recurrence was significantly higher with stone size greater than 2 cm (24.20%) at the second 5-year follow-up. Recurrence was significantly higher with multiple (56.59%), pelvicalyceal (59.83%), and bilateral (66.95%) renal stones within 10 years. It was significantly higher with shock wave lithotripsy (20.89%) within the second 5-year follow-up, and with presence of residual stones (32.66%) within the first 5-year follow-up. Conclusion Stone recurrence rate increases with increase in observation time. Risk factors for recurrence are young age of onset; male sex; normal BMI; positive family history; large size, multiple, bilateral, and pelvicalyceal stone; shock wave lithotripsy treatment; and presence of residual stones.

An alternative and novel usage for ultrasound-guided erector spinae plane block: Extracorporeal shock wave lithotripsy in a paediatric patient.

Sir, Erector spinae plane block is a novel paraspinal interfascial plane block.[1] It has been performed for several indications, and its usage for paediatric patients have been increased recently.[23] It may be used safely especially in paediatric analgesia management instead of central neuroaxial techniques because of its distance to the important anatomical structures.[23] Herein, we would like to share our experience using erector spinae plane block (ESPB) for management of interventional pain during extracorporeal shock wave lithotripsy (ESWL) in a 2-year-old paediatric patient. Written informed consent for the procedure and future publishing were obtained from parents of patient. Two-year-old boy was scheduled to undergo ESWL due to multiple renal stones. The patient was taken to the ESWL unit. Midazolam (0.1 mg·kg−1) and propofol (1 mg·kg−1) was administered IV for sedation. The patient was placed in the right lateral decubitus position. Under aseptic conditions; ultrasound-guided ESPB was performed from the level of the Th10 with a high frequency, sterile sheath covered, 12 MHz linear US probe. Following the visualisation of the erector spinae muscle above the transverse process, 22G, 50 mm block needle was inserted in a cranial-caudal direction using the in-plane technique into the deep fascia. 6 ml of 0.25% bupivacaine was injected into the interfacial area[2] [Figure 1]. ESWL was commenced 10 minutes after the block. There were no changes in arterial pressure, heart rate, respiratory rate, and SpO2 during ESWL. No additional analgesic drug or sedation was performed to the patient during the procedure. The patient was immobile during ESWL. Patient was comfortable at the postoperative period and started to walk 1 hour after the ESWL.Figure 1: (a) Sonographic anatomy of the block (b) Needle direction and spread of local anaesthetic. LA indicates local anaesthetic (c) Patient position and probe localisation during ESPB performingAnaesthesia and analgesia management is a very important issue during ESWL. ESWL is a daycare procedure, patients usually are discharged in the same day. Effective opioid-free techniques may be used for post-procedural pain management.[4] The patient should be immobile during the procedure, and the sedation should be light for protection of the spontaneous respiration. So, regimens such opioid-free anaesthesia may be preferred. QLB block may be performed in paediatric patients for abdominal procedures like ESWL analgesia and provides at Th7-L1 dermatomes.[4] However, there have been some reports of complications related to QLB. QLB is administered in closer proximity to the intra-abdominal solid organs such as liver and kidney. Ahiskalioglu et al. reported the visualisation of hepatomegaly during the QLB block.[5] If this block is performed in less skilled hands, a number of complications such as solid organ injury may occur during block application. ESPB is a novel block defined for use in both acute and chronic pain and sometimes as the main anaesthesia method in both paediatric and adult patients.[123] ESPB is performed distant to solid organs and vascular structures. The transverse process is a natural anatomical barrier in front of the needle and visualisation is simpler under ultrasound guidance, so it may be performed safely.[12] To conclude, ESPB may provide effective interventional analgesia during paediatric ESWL safely for opioid-free analgesia treatment. Declaration of patient consent The authors certify that they have obtained all appropriate parent consent forms. In the form the parent(s) has/have given his/her/their consent for his/her/their child's images and other clinical information to be reported in the journal. The parents understand that the name and initials of their child will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Factors affecting operative time during ureteroscopy and stone treatment and its effect on outcomes: retrospective results over 6.5 years.

Background:We aimed to evaluate operative time with the outcomes of ureteroscopy (URS) and investigate the relationship between these factors, and assess if longer operative times were associated with a higher risk of complications.Methods:We retrospectively audited consecutive cases of URS done between March 2012 and June 2018. Data were collected for operative times, patient demographics, stone parameters, stent insertions, use of ureteric access sheath, length of stay, stone-free rate (SFR) and complications. Statistical analysis was performed using IBM SPSS version 24.Results:Over 6.5 years, 736 patients with a male:female ratio of 1.8:1 and a mean age of 54.7 years (range: 2–91 years), underwent 860 URS and stone treatment procedures. The mean operative time was 43.5 min (range: 8–160 min), with a stone size of 12.3 mm (range: 3–100 mm) and access sheath was used in 35.8%. The initial and final SFR was 86% and 92.5%, respectively, and 85.6% (n = 736) patients were discharged the same day of procedure. Treatment of multiple renal stones, ureteric and renal stones, large stones, use of access sheath and post-operative stent were all associated with longer operative times (p <0.001). Patients who were stone free and those having day-case procedures had shorter operative times (p <0.001). There were 27 (3.2%) Clavien I/II complications and 8 (0.9%) Clavien ⩾III complications. Clavien score ⩾III (p = 0.028) and infectious complications (p <0.001) had significantly longer operative times.Conclusion:Patients with shorter operative times have a higher chance of being discharged home the same day without a post-operative stent. Higher operative times are associated with high-grade, especially infection-related, complications.

P007 - Impact of ureteral access sheath on renal stone treatment: Prospective comparative non-randomised outcomes over a 7-year period

To compare the outcomes (stone free rate and complications) of renal stone treatment with and without the use of ureteral access sheath (UAS). The worldwide use of UAS has risen over the last decade; however, questions still remain on the safety and outcomes with its use. We wanted to look at the role of UAS for treatment of consecutive renal stones over a 7-year period. The outcomes of flexible ureteroscopy and stone treatment (FURS) for renal stones with and without the use of UAS was prospectively compared from March 2012 to July 2018. Patients were divided into two groups: group-1 where UAS was used for stone treatment and group-2 where a UAS was not used. Data were collected prospectively on consecutive patients for demographics, stone size, location and number, pre and post-operative stent usage, operative time duration, stone free rate (SFR), length of stay and complications. During the study period, 338 patients underwent FURS for renal stones, of which a UAS was used for 203 (60%) patients. The mean age of patients was 56 years (range 2–89 years) with a male:female ratio of 204:134. The mean cumulative stone size and the mean number of stones was 16.5 ± 10.8 mm and 11.37 ± 8.08 mm (P < 0.001), and 2.17 ± 1.99 and 1.66 ± 1.50 (P = 0.009) for groups 1 and 2 respectively. The pre and post-operative stent insertion rates were similar in the two groups. The procedural time was longer in group-1 (54.8 ± 25.8 min) compared to group-2 (41.3 ± 22.2 min) (P < 0.001). The SFR for group-1 (88%) was slightly lower than group-2 (94%) although this was not statistically significant (P = 0.07). There were no intra-operative complications in either of the groups. Post-operative complications were seen in eight patients in group-1 (7 Clavien I/II and 1 Clavien IVa) and two patients in group-2 (Clavien I) (P = 0.19). The use of UAS for renal stones is safe with no intra-operative complications noted in our series. Good stone-free rates were obtained for large and multiple renal stones with a small risk of minor complications post-operatively.

Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period

PurposeTo compare the outcomes (stone free rate and complications) of renal stone treatment with and without the use of ureteral access sheath (UAS). The worldwide use of UAS has risen over the last decade; however, questions still remain on the safety and outcomes with its use. We wanted to look at the role of UAS for treatment of consecutive renal stones over a 7-year period.MethodsThe outcomes of flexible ureteroscopy and stone treatment (FURS) for renal stones with and without the use of UAS was prospectively compared from March 2012 to July 2018. Patients were divided into two groups: group-1 where UAS was used for stone treatment and group-2 where a UAS was not used. Data were collected prospectively on consecutive patients for demographics, stone size, location and number, pre and post-operative stent usage, operative time duration, stone free rate (SFR), length of stay and complications.ResultsDuring the study period, 338 patients underwent FURS for renal stones, of which a UAS was used for 203 (60%) patients. The mean age of patients was 56 years (range 2–89 years) with a male:female ratio of 204:134. The mean cumulative stone size and the mean number of stones was 16.5 ± 10.8 mm and 11.37 ± 8.08 mm (P < 0.001), and 2.17 ± 1.99 and 1.66 ± 1.50 (P = 0.009) for groups 1 and 2 respectively. The pre and post-operative stent insertion rates were similar in the two groups. The procedural time was longer in group-1 (54.8 ± 25.8 min) compared to group-2 (41.3 ± 22.2 min) (P < 0.001). The SFR for group-1 (88%) was slightly lower than group-2 (94%) although this was not statistically significant (P = 0.07). There were no intra-operative complications in either of the groups. Post-operative complications were seen in eight patients in group-1 (7 Clavien I/II and 1 Clavien IVa) and two patients in group-2 (Clavien I) (P = 0.19).ConclusionThe use of UAS for renal stones is safe with no intra-operative complications noted in our series. Good stone-free rates were obtained for large and multiple renal stones with a small risk of minor complications post-operatively.

Laparoskopik Pyeloplasti Ve Pyelolitotomi Operasyonlarında Taş Çıkarılmasında Fleksible Sistoskop Kullanımı

Objective: Laparoscopic pyeloplasty and laparoscopic pyelolithotomy are widely used in the treatment of ureteropelvic junction (UPJ) obstructions and renal stones in the urology field. Flexible cystoscopy can be used simultaneously with these methods for removal of calyceal stones in patients with UPJ obstructions. The present study assessed the usefulness of these surgical procedures . Material and Methods: Between February 2016 and October 2017, 7 patients underwent stone removal with a flexible cystoscope during laparoscopic pyelolithotomy and laparoscopic pyeloplasty. The durations of the operations and hospital stays, blood loss, preoperative and post- operative complications, and follow-up times were evaluated. Results: Five of seven patients had renal stones with UPJ obstruction. Two patients had calyceal stones in the lower calyx , in addition to renal pelvic stones. The mean age of the patients was 36.8 (18–73) years. The stone-free rate was 85.7%. The mean duration of the operation was 153.5 (105–230) min, and the duration of the hospital stay was 4.4 (3–7) days. There were no intraoperative or postoperative complications. Conclusion: Laparoscopic pyeloplasty and pyelolithotomy, with simultaneous use of flexible cystoscopy in UPJ obstruction patients with kidney stones and patients with multiple renal stones is a feasible treatment option, with a high success rate.

Factors Affecting the Success Rate of Renal Stone Treatment by Extracorporeal Shock Wave Lithotripsy

ESWL is one of the treatment modalities for kidney stones smaller than 2 cm. However, not all ESWL treatments are successful. The success rate has been reported to be between 50% to 87%, depending on various factors. This study was conducted to evaluate factors affecting the success rate of renal stone treatment by extracorporeal shock wave lithotripsy (ESWL). The study was carried out for a period of one year where total 96 patients with single or multiple radio-opaque renal stones treated with ESWL monotherapy using Stortz Modulith SLX-F2 lithotriptor were included. 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;4mm). The results of treatment were correlated with the patient characteristics (age, sex, body mass index) and stone features (size, site, number and radio density). At 3-months follow-up, the overall success rate was 76%. Among them, repeated ESWL sessions were required in 19 patients (53.9%). Post-ESWL complications were recorded in 8 patients (12.5%). Four factors had statistically 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 (26/26; 100%) and lowest for those located in lower calyx (15/20; 75%) (p=0.019). Stone with a largest diameter of &lt;15mm are associated with a success rate of 93.6% (59/63), compared to 75.82% (25/33) for those with a diameter of &gt;15mm (p=0.01). The success rate is also higher for single stone (76/84; 90.5%) than multiple stones (8/12; 66.7%) (p=0.02). Patients with lower BMI (&lt;24) have a better success than higher BMI (&gt;25) (p=0.001).Other factor including age, sex and stone radio density compared to ipsilateral 12th rib have no significant impact on the success rate. The success rate for ESWL for the treatment of renal stones can be predicted by stone size, location, number, and patient BMI.&#x0D; Bangladesh Med J. 2017 May; 46 (2): 1-6

Supine versus Prone Position Percutaneous Nephrolithotomy

Background: percutaneous nephrolihotomy (PCNL) is the first choice for treatment of single more than 2cm and multiple renal stones. The prone position is the classical position preferred by most surgeons. Then the supine position was developed for percutaneous nephrolithotomy. Objective: to compare between supine and prone PCNL in the management of renal stones regarding number of puncture, stone free rate, operative time, intraoperative and postoperative complications. Patients and Methods: the patients were selected, all having multiple stones, or stone size 2 cm or more. They were 30 patients divided into two groups, group (A) prone 15 patients and group (B) supine 15 patients. The study excluded patients with renal anomalies, uncontrolled coagulopathy, pregnancy, immunosuppression, and ages less than 10 years. Results: the study demonstrated a significant difference only in operation time which was (89.00±30.37) in prone group & (64.67±24.75) in supine group with p-value (0.023) between the prone and supine position, with shorter operation time in the supine than the prone. The study has also demonstrated that there is no statistically significant difference between the two groups as regarding to stone free rates, hospital stay, intraoperative, and postoperative complications. Conclusion: in patients with multiple renal stones, or stone size 2 cm or more, supine PCNL has proved to be superior to prone PCNL as regarding operative time. However, Urologists should be familiar with the differences in the positions and be able to use the method appropriate for each patient.

Supra-costal tubeless percutaneous nephrolithotomy is not associated with increased complication rate: a prospective study of safety and efficacy of supra-costal versus sub-costal access

BackgroundTo assess the morbidities of tubeless percutaneous nephrolithotomy (PCNL) using supra-costal access and re-evaluate traditional concept of increased complications with supra-costal access.MethodsFrom January 2010 to December 2014, a single surgeon performed 118 consecutive one-stage fluoroscopic guided PCNL’s for complex renal and upper ureteral stone. Our definition for complex renal stone is defined as partial or complete staghorn stone, multiple renal stones in more than 2 calyxes, obstructive uretero-pelvic stone > 2 cm, and a renal stone in single functional kidney. Inclusion criteria include: staghorn stones, renal calculi > 2 cm in diameter, upper ureteral stone > 1.5 cm in diameter. Exclusion criteria for tubeless PCNL include: significant bleeding or perforation of the collecting system, large residue stone, multiple PCNL tract and obstructive renal anatomy. Morbidity, operation time, analgesia requirement, length of hospital stay, stone- free rate, were analyzed.ResultsOf the 118 consecutive PCNL, eighty-six patients underwent tubeless PCNL (56 supra-costal and 30 sub-costal) and included in our prospective follow-up period. The mean age, operation side, stone locations were similar. The male to female ratio is higher in supra-costal than sub-costal. Large renal stones and staghorn stones makes up for most patients (supra-costal: 75%, sub-costal: 80%). The stone–free rate of supra-costal group was 59% (33/56) and in sub-costal group was 50% (15/30). The operative times, length of stay, post-op analgesic use, hematocrit change was similar in both groups. The overall complication rate is 6% [supra-costal (1/56), sub-costal (4/30)] with the majority being infectious complications.ConclusionsSupra-costal access above 12th rib during tubeless PCNL is safe and effective procedure and is not associated with higher incidence of post-op complications in experience hands.