Nephrolithotomy In Management Research Articles

Supine versus prone percutaneous nephrolithotomy in management of patient with complex renal stone diseases.

Compare the surgical outcomes, safety, stone free rate, hospital stay, and complication of prone and supine PCNL in case of complex renal stone. This is an observational study conducted in our institute, it consist of 120 patients over the period of 2 years from July 2021 to June 2023, all the patients were divided into two groups: 60 patients underwent modified supine percutaneous nephrolithotomy (PCNL) and remaining 60 patients underwent standard prone PCNL. The measured data included operative time, number of punctures, blood loss, stone-free rate, length of hospital stays, and rate of complications. The two groups were comparable in mean age, male to female ratio, number of punctures, number of tract, size of tract, residual calculi in follow up period, blood transfusion, re-do surgery, chest complication, hospital stay, and postoperative fever and pain. The mean operating time was 1.59 h in supine PCNL and 2.49 h in prone PCNL. The p value was significant (p = 0.001). By this study we observed that the supine PCNL is associated with statistically significant reduced operating time as compared to conventional prone PCNL with advantages of not putting the patient in prone position. The postoperative complications such as pain and fever were not significant when compared in both groups. We conclude our study and found that, the supine PCNL is an equally effective in treating complex renal stone as compared to prone PCNL.

Possible Role of Percutaneous Nephrolithotomy in Management of Pediatric Renal Stones

Possible Role of Percutaneous Nephrolithotomy in Management of Pediatric Renal Stones

Comparison between OPEN STONE SURGERY vs PERCUTENOUS NEPHROLITHOTOMY in Management of Renal Stones By Using S.T.O.N.E Nephrolithometry Scoring System

Abstract Background In spite of Percutaneous nephrolithotomy (PCNL) became the first-line treatment option for patients with large and complex renal stones, there still remains a need of using open stone surgery (OSS) for removal of stones as a second or third line of treatment option. To date, 3 scoring systems have been proposed utilizing different metrics including the Guy’s Stone Score, S.T.O.N.E. nephrolithometry and the Clinical Research Office of the Endourological Society (CROES) nomogram, and that used to assess and estimate the treatment success rate. Aim of the Work To evaluate and compare between OSS and PCNL in the management of renal stones by using the S.T.O.N.E. nephrolithometry scoring system to predict and assess the stone free rate and the correlation with peri-operative complications in that two procedures. Patients and Methods A total 100 patients who need surgical intervention for renal stones were treated with OSS (35 pa ents) and PCNL (65 pa ents) from January 2019 ll the end of October 2019, were invited to participate in the present study. This was a multicenter, comparative, prospective cohort controlled study. This study was controlled by the standard results recorded in the previous literatures. Only adult(>18 ys. Old) patients with renal stone size ≥ 20mm were involved in the study. Peri-operative and follow-up data included stone free rate and complications were collected for all patients and were compared between both procedures. S.T.O.N.E nephrolithometry scoring systems was applied to preoperative non-contrast computed tomography(CTUT) for all cases and compared the results of both procedures. Stone-free rate was diagnosed using early postoperative kidney, ureter, bladder X-rays(KUB) and another CTUT on the postoperative day30. Results There was a significant difference between the PCNL group and the OSS group in the primary stone free rate (90% and 97.5% respec vely, p-value=0.021), peri-operative major complications (3% and 14.3% respectively, p-value=0.033), opera ve me (123.46 ± 34.61 and 175.71 ± 55.10 respec vely, p-value=0.000) and postopera ve hospital stay (3.52 ± 0.84 and 5.23 ± 1.00 respec vely, p-value=0.000), while there was no significant difference in the intra-opera ve bleeding requiring blood transfusion (10.8% and 14.3% respec vely, pvalue=0.124). S.T.O.N.E score showed a significant difference between PCNL and OSS groups ( 7 (6-11) and 10 (7-12) respectively, p-value=0.000) and it also had a significant rela on with the outcome SFR (p-value=0.000) a er both PCNL and OSS(r= -0.581 and r= -0.567 respec vely), the higher the score, the lower the SFR and the higher the possibility of OSS choice. While this score had on relation with the peri-operative complications. Conclusion The S.T.O.N.E. nephrolithometry score was predictive of the stone-free status in both surgical procedures (PCNL and OSS) and can be used as an formal guidance for surgical planning and patient counseling. This score would be classified into two categories “low” score range from 5 to 8 recommend PCNL procedure with expec ng SFR of 88% to 97% and “high” score range from 9 to 12 recommend Open Stone Surgery with expec ng SFR of 90% to 96%, to reach the most acceptable results for each procedures to sa sfy the patient and the doctor. The S.T.O.N.E score was not associated with the peri-operative complications in both procedures.

Comparison of retrograde intrarenal surgery and standard percutaneous nephrolithotomy for management of stones at ureteropelvic junction with high-grade hydronephrosis

Percutaneous nephrostomy (PCNL) and retrograde intrarenal surgery (RIRS) are the two main treatments for upper urinary tract stones. The aim of our study was to compare the effectiveness and safety of standard PCNL (S-PCNL) and RIRS for the treatment of stones at ureteropelvic junction with high-grade hydronephrosis. The study included 118 patients who underwent surgery for stones at ureteropelvic junction. S-PCNL and RIRS were performed on 66 and 52 patients, respectively. Patient age, sex, body mass index (BMI), stone side, history of urinary tract infection (UTI), history of diabetes, history of ESWL, stone size, Hounsfield unit (HU) values of stones, grade of hydronephrosis, operating time, postoperative hemoglobin loss, narcotic analgesic use, postoperative transfusion rates, stone-free rates (SFRs), length of hospital stay, complication rates and number of secondary interventions were recorded. The comparison of the operative data between the two groups revealed no statistically significant differences in the operative time, SFRs, narcotic analgesic use, postoperative transfusion rate or other postoperative complications defined according to the Clavien system (P > 0.05). The postoperative urinary sepsis rate in the RIRS group was as high as 15.4%, which was much higher than the 1.5% rate observed in the S-PCNL group, and the difference was statistically significant (P < 0.05). A total of 13.5% of the patients in the RIRS group required a second operation due to failure of the placement of the ureteral access sheath. Additionally, S-PCNL had an advantage in operation time, while RIRS in duration of hospital stay and postoperative hemoglobin loss. RIRS and S-PCNL were safe and effective methods for the treatment of stones at ureteropelvic junction with high-grade hydronephrosis. Importantly, S-PCNL had more advantages in terms of the postoperative urinary sepsis rate and secondary surgery rate.

Renal function evaluation after percutaneous nephrolithotomy in patients with solitary kidney

Objective: To evaluate renal function change after percutaneous nephrolithotomy in patients with solitary kidney. Methods: A prospective study conducted in the urology department at Rizgary Teaching Hospital for a period of 15 months from first of June 2018 until the end of August 2019. It included nine adult patients, all of them with solitary kidney and undergone percutaneous nephrolithotomy for management of renal calculi. Patients were considered to have a solitary kidney in case of congenital abnormality, contralateral nephrectomy, or solitary functioning kidney with contralateral atrophy (relative function &lt; 10%). All patients were received prophylactic antibiotics (Ceftriaxone) at induction of anesthesia. All percutaneous nephrolithotomy procedures performed under general anesthesia in the prone position. Serum creatinine and creatinine clearance before the operation, at day one and day 21 postoperatively, operation time, duration of hospitalization, and postoperative complications recorded. Results: In this study, Means of serum creatinine at 1 day and 21 days postoperatively were significantly decreased compared to preoperative s. creatinine level Mean of creatinine clearance significantly increased after 21 days postoperatively compared to preoperative test, while no significant change in creatinine clearance after one day postoperatively. Conclusion: Generally, percutaneous nephrolithotomy considered as a safe and effective option for treatment of renal stones in solitary kidney patients considering the overall rate of complications and minimal morbidity. Moreover, significant renal function improvement anticipated in the early postoperative period.

Comparative analysis of retrograde intrarenal surgery and modified ultra-mini percutaneous nephrolithotomy in management of lower pole renal stones (1.5\u20133.5\u2009cm)

BackgroundTo compare the safety and efficacy of retrograde intrarenal surgery (RIRS) and modified Ultra-mini percutaneous nephrolithotomy (UMP) in semi-supine combined lithotomy position for the management of 1.5–3.5 cm lower pole renal stones (LPSs).MethodsA total of 63 patients with 1.5–3.5 cm LPSs who underwent RIRS (n = 33) or modified UMP (n = 30) in diameter between January 2017 and January 2019 were analyzed retrospectively. Modified UMP was performed in semi-supine combined lithotomy position and a 9.5/11.5 F ureteral access sheath (UAS) was inserted during the procedure in order to maintain low pelvic pressure and to facilitate the removal of stone fragments. Base-line parameters, stone characteristics, illness condition, operation time, postoperative hemoglobin (Hb) drop, postoperative creatinine (Cr) elevation, length of hospital stay, length of postoperative hospital stay, stone-free rate (SFR) and complications were compared between the two groups.ResultsThere were no significant differences between the two groups in base-line parameters, stone characteristics and illness condition. The mean operating time of RIRS group was longer than UMP group (95.61 ± 21.9 vs. 55.0 ± 16.1 min, p < 0.001). The mean postoperative Hb drop was less in RIRS group (7.42 ± 4.7 vs. 15.70 ± 9.8 g/L, p < 0.001). The length of hospital stay and postoperative hospital stay for RIRS were shorter than UMP (4.76 ± 1.1 vs. 5.83 ± 0.8 d, p < 0.001, 2.97 ± 0.9 vs. 4.07 ± 0.9 d, p < 0.001). The Early SFR was higher in UMP group (54.5 vs. 80.0%, p < 0.050) while SFR at 1-month and 3-months postoperatively was similar in both groups (p = 0.504, p = 0.675). There were no significant differences between the two groups in complications (p = 0.228).ConclusionFor patients with 1.5–3.5 cm LPSs, both modified UMP and RIRS are safe and viable. The modified UMP technique was used in this study, application semi-supine combined lithotomy position and the retention of UAS can improve the surgical efficiency and maintain low pressure perfusion in the kidney, which resulted in superior treatment efficacy. Therefore, we highly recommend this technique for LPSs with heavy stone burdens.

Modified tubeless minimally invasive percutaneous nephrolithotomy for management of renal stones in children: A single-centre experience

ABSTRACTObjectives: To evaluate the safety, effectiveness and morbidity, as well as the usefulness of a modified supine mini-percutaneous nephrolithotomy (PCNL) for managing renal stones in children.Patients and methods: We studied 50 children, from September 2017 to September 2018, who were aged 4–16 years with a single renal pelvic or calyceal stone of <2 cm. We used a 9-F short ureteroscope through a 16-F metal access sheath with an alternative approach that allows a second percutaneous procedure using the same tract. If a residual stone was present, we recovered the track back through the exteriorised ureteric catheter at the flank.Results: Of all 50 patients, 48 (96%) underwent the modified supine mini-PCNL technique, which produced a primary stone-free rate of 80% that increased to 100% after treating the residual stones by a second look. The mean operative and fluoroscopic times were 89.10 and 7.68 min, respectively. One case (2%) had significant bleeding and one case (2%) had pelvic perforation; and a nephrostomy tube was inserted in both cases. The mean haemoglobin drop was 0.91 g/dL (P < 0.001). The mean hospital stay was 1.42 days and the mean pain score was 2.08, the pain score was 5 in the two cases in which a nephrostomy tube was inserted.Conclusion: The modified supine mini-PCNL is a safe and effective method for managing renal stones in children, with less postoperative pain and discomfort, less analgesic requirement, and provides access back for a second look.Abbreviations: ESWL: extracorporeal shockwave lithotripsy; Hb: haemoglobin: PCNL: percutaneous nephrolithotomy; SFR: stone-free rate

Effectiveness and Safety of Tubeless Minimally Invasive Percutaneous Nephrolithotomy in Management of Lower Pole Renal Stones

Effectiveness and Safety of Tubeless Minimally Invasive Percutaneous Nephrolithotomy in Management of Lower Pole Renal Stones

Minimally Invasive Percutaneous Nephrolithotomy in Management of Lower Pole Renal Stones 2cm or Less

AbstractBackground: The best management of lower calyceal stones remains debatable. Small lower calyceal stones are usually managed with SWL, RIRS or PNL.Aim of Study: This study aims to assess the safety, efficacy and complications of minimally invasive percutaneous neph-rolithotomy (mini PNL) in lower calyceal stones.Patients and Methods: Patients with lower calyceal radio-opaque unilateral stones £2cm were enrolled and underwent mini PNL between February 2014 and January 2016 using a semi rigid ureteroscope through a 16Fr sheath and holmium laser lithotripsy. Patients were considered stone free when no stones or residuals <3mm were found on plain X-ray UT or non contrast CT.Result: Thirty patients with mean age of 40±9.2 years underwent mini PNL for lower calyceal stones ranging in size from 10-20mm (16.1±1.8). A single tract was used (16Fr). Six patients (20%) had a nephrostomy tube (12F) at the end of the procedure. Mean hospital stay was 2±0.15 days. Twenty-five (83.3%) of our patients had no or mild post-operative pain that required no analgesia. Minor complications occurred in 4 patients (13.3%) in the form of post-operative fever and was treated conservatively.Conclusion: Mini PNL is a safe and effective treatment option for lower calyceal stones 2cm or less. Mini PNL is limited by longer operative time than standard PNL. It has similar safety profile as of standard PNL with the advantage of causing significantly less pain and shorter hospital stay. Stone Free Rate (SFR) is comparable to PNL and is signifi-cantly better than SWL and possibly RIRS.

Percutaneous Nephrolithotomy under Ultrasound Guidance in Patients with Renal Calculi and Autosomal Dominant Polycystic Kidney Disease: A Report of 11 Cases.

Nephrolithiasis accelerates the renal failure in the patients with ADPKD. In order to evaluate the role of percutaneous nephrolithotomy in management of calculus in these patients, 11 patients with autosomal dominant polycystic kidney disease and renal stones were included in the study. Two patients had bilateral renal stones. All patients were treated by percutaneous nephrolithotomy under ultrasound guidance. 13 percutaneous nephrolithotomy procedures were performed in 1 stage by the urology team under ultrasound guidance. 5 people received second operation with flexible nephroscopy in lateral position. The success rate and morbidity and mortality of the technique and hospital stay were recorded. Results. The puncture procedure was fully successful in all cases. The renal function improved in these patients. 5 patients had moderate fever after the surgery. 5 patients received flexible nephroscopy to take out the residual calculi. 2 persons had ESWL therapy after the surgery. Conclusion. PCNL is an ideal, safe, and effective method to remove the stones from those patients with no definite increase in the risk of complication. The outcome and stone-free rate are satisfactory comparable to the PCNL in the patients without ADPKD.

Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy in management of lower-pole renal stones with a diameter of smaller than 15 mm

The aim of this study was to compare the outcomes of retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mini-PNL) in management of lower-pole renal stones with a diameter smaller than 15mm. Between December 2009 and July 2012, the patients with the diagnosis of lower-pole stones were evaluated by ultrasonography, intravenous pyelography and computed tomography. The records of 73 evaluable patients who underwent mini-PNL (n=37) or RIRS (n=36) for lower-pole (LP) stones with diameter smaller than 15mm were reviewed retrospectively. Of the 73 patients, 37 underwent mini-PNL and 36 underwent RIRS. The stone-free rates were 89.1 and 88.8% for mini-PNL and RIRS groups, respectively. The mean operation time was 53.7±14.5 in the mini-PNL group but 66.4±15.8 in the RIRS group (P=0.01). The mean fluoroscopy times and hospitalization times were significantly higher in the mini-PNL group. There was no major complication in any patient. RIRS and mini-PNL are safe and effective methods for treatment of LP calculi with a diameter smaller than 15mm. RIRS is a non-invasive and feasible treatment option, and has also short hospitalization time, low morbidity and complication rate. It may be an alternative of mini-PNL in the treatment LP calculi with smaller than 15mm.

Re: Laparoscopic Anatrophic Nephrolithotomy for Management of Complete Staghorn Renal Stone: Clinical Efficacy and Intermediate-Term Functional Outcome(From: Alireza Aminsharifi, Patris Hadian, and Kamran Bovei J Endourol 2013;27:000–000)

Re: Laparoscopic Anatrophic Nephrolithotomy for Management of Complete Staghorn Renal Stone: Clinical Efficacy and Intermediate-Term Functional Outcome(From: Alireza Aminsharifi, Patris Hadian, and Kamran Bovei J Endourol 2013;27:000–000)

Percutaneous Nephrolithotomy for Management of Upper Urinary Tract Calculi in Patients With Autosomal Dominant Polycystic Kidney Disease

To evaluate the role of percutaneous nephrolithotomy in management of the patients with autosomal dominant polycystic kidney disease and associated nephrolithiasis. A total of 19 patients with autosomal dominant polycystic kidney disease and upper urinary tract stones were included in the study. One patient had bilateral renal stones. Most of the stones were located in the renal pelvis and/or calices with a stone size >2 cm in the largest diameter. All patients were treated by percutaneous nephrolithotomy at 2 centers. Therefore, 20 percutaneous nephrolithotomy procedures were performed. Most of the procedures were performed in 1 stage by the urology team under fluoroscopic guidance; 6 cases were done in 2 stages. The success rate and morbidity and mortality of the technique and hospital stay were recorded. The pelvicaliceal system was successfully approached in all cases but 1. The overall stone-free rate was 89.4%. Renal function improved in the patients who presented with azotemia and was stable in the others. No patient died. Complications occurred in 3 procedures and consisted of mild postoperative hematuria in 1, bleeding through the nephrostomy tube in 1, and low-grade fever in 1. The mean hospital stay was 3 days. Percutaneous nephrolithotomy is a safe and effective method for the treatment of patients with autosomal dominant polycystic kidney disease and associated upper urinary tract stones.

Anatrophic Nephrotomy and Plastic Calyrhaphy

SummaryA technique of nephrotomy is described in which the kidney is not bivalved, rather the nephrotomy incision is placed between the junction of the anterior and posterior arterial segments. A new method utilizing vertical mattress sutures and water-tight closure is discussed. Correction of calyceal stenosis is achieved by calycoplasty. The results of this procedure in 138 patients as it has evolved in the last 12 years are reviewed.