Outcomes Of Percutaneous Nephrolithotomy Research Articles

Propensity Score-Matched Analysis of Perioperative Outcomes of Supine versus Prone Percutaneous Nephrolithotomy.

Objective: To compare the perioperative outcomes of supine and prone percutaneous nephrolithotomy (PCNL). Methods: A retrospective search of a tertiary medical center database yielded 517 patients who underwent supine (n = 91) or prone (n = 426) PCNL between September 2015 and July 2020. Data on demographics, baseline clinical parameters, and stone burden were included as predictors in a logistic regression model, generating a set of propensity scores. Seventy patients after supine PCNL were propensity score-matched 1:1 with patients after prone PCNL and compared for operative time, perioperative complications, system complexity, and stone-free rate. Results: We found that the operative time was significantly shorter in the supine PCNL group than in the prone PCNL group (85.5 ± 25.2 min vs. 96.4 ± 25.8 min, respectively; p = 0.012). The majority of both groups had low-grade (I-II) complexity systems (85.6% and 88.6%, respectively), with no significant difference among all grade groups (p = 0.749). There were no significant differences between the supine and prone PCNL groups in terms of the overall perioperative complication rate (8.6% vs. 4.3%, respectively; p = 0.301) or stone-free rate (74.3 vs. 65.7%, respectively; p = 0.356), while the rate of blood transfusion was significantly higher in the supine group (p = 0.023). Conclusions: In our study, we used propensity score matching to compare patients who underwent PCNL in the supine or prone position, adjusting for selection bias. Supine PCNL was associated with a shorter operative time but a higher blood transfusion rate, with no differences in the overall complication and stone-free rates.

Bilateral Single-session PCNL with Minimally Invasive Technique in Pediatric Nephrolithiasis.

To assess outcomes of bilateral single-session percutaneous nephrolithotomy (PCNL) with minimally invasive techniques in pediatric population. From August 2015 to July 2021, 45 children (including 12 infants) were treated with bilateral single-session PCNL, which included miniPCNL (12-16-Fr) and Microperc (4.8-Fr). Patient, stone and operation-related characteristics, stone-free rate (SFR) and complication rate (CR) were compared using ANOVA. Independent predictors were determined using multivariate linear regression. The mean stone burden was 3.2 cm in sum diameter for both kidneys. For bilateral kidneys, the mean operative time was 61.6min and SFR was 93.3%; CR was 53.3%, of which complications of Clavien grade 1 and 2 accounted for 46.7%. Bilateral Microperc, bilateral miniPCNL and Microperc plus miniPCNL was performed in 19, 14 and 12 children respectively. Both irrigation volume and postoperative stay were less in groups with Microperc. Both SFRs and CRs were satisfactory for the three groups. Self-limiting hematuria represented the most common complication of all cases (33.3%), especially in groups with miniPCNL. The stone burden was the only independent predictor for operative time (P < .001) and the postoperative complication (P = .008). Children with older age (P = .009), higher body mass index (P = .016) or a higher stone burden (P < .001) received larger irrigated fluid volume. Microperc was associated with less irrigated fluid volume (P = .001). Children with Clavien grade 3 complications (P = .004) spent prolonged postoperative hospital stay. With favourable SFR and acceptable CR, bilateral single-session PCNL with minimally invasive techniques might be an effective and safe procedure for pediatric nephrolithiasis.

Is the Mayo Adhesive Probability Score Predictive in Patients Undergoing Percutaneous Nephrolithotomy?

Introduction: Mayo Adhesive Probability (MAP) score was developed as a means to predict the presence of adherent perinephric fat. Our aim was to determine the predictive value of the MAP score on surgical outcomes in patients undergoing standard adult percutaneous nephrolithotomy (PCNL). Materials and Methods: We retrospectively analyzed the data from 130 renal units that underwent PCNL between January 2022 and 2023. MAP scores 0-2 were classified as low, whereas MAP scores 3-5 were classified as high. The impact of the MAP score on perioperative and postoperative outcomes was studied. All statistical analyses were performed using SPSS 24.0 for Windows. Results: The median age of the patients at the time of surgery was 48 (21) years, with a female-to-male ratio of 1:1.82. The median MAP score was 2 (2), with 43.8% of patients falling into the high MAP score group. Advanced age, hypertension history, low estimated glomerular filtration rate (eGFR) levels, and low renal parenchymal thickness were significantly higher in the high MAP score group (P = .010, P = .004, P = .001, and P = .005, respectively). Female patients had a significantly higher MAP score of 0 (P = .021). Operation time, postoperative hematocrit decrease, blood transfusion rate, postoperative fever rate, hospitalization, and stone-free rates were comparable between the low and high MAP score groups (P = .535, P = .209, P = .313, P = .289, P = .281, and P = .264, respectively). Gender and eGFR levels were shown to be significant predictors of a MAP ≥3 (P = .004 and P = .003, respectively). Conclusion: The present study showed that the MAP score groups had similar perioperative and postoperative results. Low eGFR levels and the male gender were associated with MAP score ≥3. To determine the predictive MAP score value for PCNL outcomes, more prospective studies are needed.

Stone Free Success Rate by Using Modified Guy’s Scoring System in Patients Undergoing Percutaneous Nephrolithotomy

Background: Renal stone disease (RSD) is a prevalent condition globally, with significant impacts on patient health and healthcare systems. The complexity of RSD management, particularly in achieving high stone-free rates (SFR) with minimal complications, necessitates ongoing research into effective treatment modalities. Percutaneous nephrolithotomy (PCNL) has emerged as a standard treatment, but predicting its success pre-operatively remains a challenge. Objective: The study aimed to evaluate the efficacy of the Modified Guy’s Stone Score (M-GSS) in predicting the SFR in patients undergoing PCNL, and to analyze the relationship between various patient and stone characteristics and the success of the procedure. Methods: This descriptive case series study involved 161 patients undergoing PCNL at a tertiary care center. Data on patient demographics, stone characteristics, and operative details were collected. Stones were classified using the M-GSS, and PCNL outcomes were assessed in terms of SFR. Statistical analysis was performed using SPSS 23.0, with a focus on the correlation between M-GSS grades and SFR. Results: The overall SFR was 59.6%. The majority of patients (38.5%) were classified as M-GSS grade 1. The mean stone size was 2.74 ± 1.6 cm, and the mean operative time was 73.4 ± 14.6 minutes. There was no significant difference in SFR across different M-GSS grades (p=0.236). Stone size was the only factor significantly affecting the SFR (p=0.0001). Conclusion: The study indicates that while M-GSS is a useful tool for preoperative assessment in PCNL, stone size remains a crucial determinant of SFR. The findings suggest the need for further research, particularly larger, multi-center randomized studies, to validate these results and refine preoperative patient counseling and outcome prediction strategies in PCNL.

Clinical Utility of S.T.O.N.E, Guy's Scoring System, and Renal Stone Complexity Scoring in Predicting Outcome of Single-Tract Percutaneous Nephrolithotomy.

Several imaging-basedscores have been developed to predict postoperative stone-free state (SFS) and complications. This study aimed to assess the accuracyof the S.T.O.N.E., Guy Scoring System (GSS), and Seoul National University Renal Stone Complexity (S-ReSCS) scores inpredicting theoutcomes of single-tract percutaneous nephrolithotomy (ST-PCNL). This scoring system holds paramount importance for low-incomeand low-middle-income countries (LMICs), as it is inexpensive and cost-effective for the healthcare system. This retrospective study was carried out with 147 participants. Based on the preoperative computerized tomographic (CT) scan, each patient's S.T.O.N.E. score, GSS, and S-ReSCS were recorded. The modified Clavien grading system was used to document intra- and postoperative complications. The mean age of the sample population was 45 years. SFS was achieved in 110 (74.8%) patients. The number of calyces involved (p = 0.008), S.T.O.N.E. scoring (p = 0.001), GSS (p = 0.008), and S-ReSCS (0.001) correlated well with the SFS. Forty-nine (33.33%) patients developed complications. The most common complications fell within Clavien grade II. No statistical significance was noted between the S.T.O.N.E. score, GSS, and S-ReSCS with the modified Clavien grading system. The S.T.O.N.E. scoring, GSS, and S-ReSCS have a high predictive value for achieving SFS in ST-PCNL. In addition, findings from LMICs are comparable with those from the rest of the world.

Outcomes and Complications of Percutaneous Nephrolithotomy (PCNL) at Al-Ribat Urology Center (Omer Sawi Hospital)

BACKGROUND: Percutaneous nephrolithotomy generally is safe, effective, and associated with a few but specific complications. However, the definition of complications of PCNL and their management still lacks consensus. PCNL is the first-line approach for large, multiple, and inferior calyx renal stones according to the European Association of Urology (EAU) guidelines. We aimed to evaluate the Technique, Outcome, and Complication of percutaneous Nephrolithotomy at Al-ribat Urology Center (Omer Sawi Hospital). METHODS: A prospective, institutional-based cross-sectional study was used to investigated all patients presented to the study area with renal stones during the period from November 2019 to January 2020 in Al-Rebat Hospital. . A total of 28 patients were enrolled using multi-stage sampling. The researcher completed a validated questionnaire consisting of several sections to assess outcomes and complications of percutaneous nephrolithotomy. RESULTS: the study assessed the outcome of PCNL among 28 patients. The study found that the mean size of stones recorded was 1.25 cm, and the stones were on the left and right kidneys in 53.6%, and 46.4% respectively. Stones present by a percentage of 10.7%,28.6%, and 53.6% in the upper and lower calyx and pelvis respectively. The stones were rounded in 78.6% and staghorn in 21.4%. the stone was single in 53.6% and multiple in 46.4%. all operations were done under fluoroscopy guidance. Patients were supine in 25% and prone in 75% of the operations. The mean operative time was 27.9 minutes calculated from puncture time does not include retrograde and positioning. In addition to that 57.1% of the patients had nephrostomy tubes and double J. 92.9% of the patients were stones-free at the end of the operation. Injury to the surrounding organs did not occur. Mild bleeding occurs in 10.7% of the patients, in which blood transfusion was necessary. Extravasation of fluid occurs in 10.7%. Fever occurs in 42.9%. Most of the patients stay for 1 day postoperatively 57.1%. CONCLUSION: This study demonstrated that PCNL is a safe elective, minimally invasive surgical modality with good outcomes and lower incidences of major complications.

Prediction of percutaneous nephrolithotomy outcomes and flexible ureteroscopy outcomes using nephrolithometry scoring systems.

Kidney stones account for a high proportion of urological emergencies. The main objective of this paper is to evaluate the predictive ability of five scoring systems for overall stone-free status and postoperative complications after percutaneous nephrolithotomy and retrograde ureteroscopy. This study retrospectively analysed 312 cases of kidney stone patients between January 2021 and May 2022 at our centre. Multivariate logistic regression as well as ROC curves were applied to determine the ability to evaluate each scale to predict stone-free rates and postoperative complications. 179 patients have undergone PCNL. After multivariate logistic regression, the S.T.O.N.E score and history of ipsilateral renal surgery were predictive of stone-free status, and the predictive power of the S.T.O.N.E score was higher than that of history of ipsilateral renal surgery. Grade 1 complications were considered to be related to Guy's score and grade 2 complications were considered to be related to history of diabetes mellitus. 133 patients have undergone f-URS. After multivariate logistic regression analysis, the modified S-ReSC score, RUSS score, and R.I.R.S score were predictive of stone-free status, with the R.I.R.S score being the strongest predictor. Evidence of grade 2 complications was considered to be related to abnormal renal function. For PCNL, the S.T.O.N.E score had the best efficacy in predicting stone-free status, and the Guy's score had the best efficacy in predicting postoperative complications; for f-URS, the R.I.R.S score had the best efficacy in predicting stone-free status, and no scoring system predicted postoperative complications.

Outcomes and Complications of Percutaneous Nephrolithotomy (PCNL) at Al-ribat Urology Center (Omer Sawi Hospital)

Objective: Percutaneous nephrolithotomy generally is safe, effective, and associated with a few but specific complications. However, the definition of complications of PCNL and their management still lacks consensus. We aimed to evaluate the Technique, Outcome, and Complication of percutaneous Nephrolithotomy at Al-ribat Urology Center (Omer Sawi Hospital). Methods : A prospective, institutional-based cross-sectional study, the study investigated all patients presented to the study area with renal stones The data was collected by a pre-designed questionnaire filled out inside the theater during the surgery and 1-month follow-up by phone calls. Result: The study assessed the outcome of PCNL among 28 patients. The study found that the mean size of stones recorded was 1.25 cm, and the stones were on the left and right kidneys in 53.6%, and 46.4% respectively. Stones present by a percentage of 10.7%,28.6%, and 53.6% in the upper and lower calyx and pelvis respectively. The stones were rounded in 78.6% and staghorn in 21.4%. the stone was single in 53.6% and multiple in 46.4%. all operations were done under fluoroscopy guidance. Patients were supine in 25% and prone in 75% of the operations. Injury to the surrounding organs did not occur. Mild bleeding occurs in 10.7% of the patients, in which blood transfusion was necessary. Extravasation of fluid occurs in 10.7%. Fever occurs in 42.9%. Most of the patients stay for 1 day postoperatively 57.1%. Conclusion: This study demonstrated that PCNL is a safe elective, minimally invasive surgical modality with good outcomes and lower incidences of major complications.

COMPARISON OF RETROGRADE INTRARENAL SURGERY OUTCOME VERSUS PERCUTANEOUS NEPHROLITHOTOMY IN RENAL STONES &gt;2 CM IN DIAMETER IN LOWER CALYCES AT A TERTIARY CARE HOSPITAL

This study aimed to compare the outcome of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy in treating renal stones larger than 2 cm in diameter in lower calyces at a tertiary care hospital. A randomized control trial was conducted at the Department of Urology, Bahawal Victoria Hospital, Bahawalpur, for 8 months from 01-06-2021 to 01-02-2022 using a non-probability purposive sampling technique. Seventy patients met the inclusion and exclusion criteria and were enrolled in the study. The patients were randomly divided into two groups using a lottery method. Group A underwent PCNL, while Group B underwent RIRS. During the procedure, the operative time was noted from the time of intubation to the time of extubation. After the procedure, the duration of hospital stay was noted, and the patients were followed up in the OPD for 12 weeks. After 12 weeks, an abdominal ultrasound was conducted to evaluate if there were any residual stones. If there were no residual stones, the patients were labeled stone-free. Seventy patients participated in the study, with a mean age of 45.51±13.68 years, ranging from 20 to 69 years. The mean age of patients in the RIRS group was 47.63 ± 13.51 years, while in the PCNL group, it was 43.40 ± 13.71 years, with a non-significant p-value of 0.198. The gender distribution among the patients revealed that 30 (42.86%) were male and 40 (57.14%) were female, with an equal distribution of males (15, 42.9%) in both the RIRS and PCNL groups. However, there were substantial differences in the duration of surgery, with the RIRS group having a mean operative time of 107.57 ± 6.99 minutes and the PCNL group having a significantly shorter mean operative time of 75.86 ± 7.19 minutes (p-value &lt; 0.001). Moreover, the RIRS group had a shorter mean hospital stay, with 4.77 ± 1.03 days compared to 5.46 ± 1.09 days in the PCNL group (p-value = 0.009). Post-procedure, 63 (90%) patients achieved stone-free status, with 29 (82.9%) patients in the RIRS group and 34 (97.1%) in the PCNL group, with a non-significant p-value of 0.106. This study concluded that RIRS is a safe procedure and a good alternative to PCNL in treating renal stones larger than 2 cm in diameter in lower calyces to achieve stone-free status and length of hospital stay.

Complications of tubeless versus standard percutaneous nephrolithotomy.

The necessity of nephrostomy tube after percutaneous nephrolithotomy (PCNL) has been called into question in modern series. We sought to examine differences in postoperative complications and outcomes of tubeless PCNL versus standard PCNL at our institution. A retrospective review of our institutional stone database was conducted from January 2016 to December 2021 for patients who had undergone either tubeless PCNL, defined by placement of only an internal ureteral stent, or standard PCNL, which involved placement of an externalized nephrostomy tube. Patients were excluded if they underwent totally tubeless PCNL. A total of 438 patients were included for analysis: 329 patients underwent tubeless PCNL and 109 patients underwent standard PCNL. Between tubeless and standard groups, there was no difference in readmission rates 6.1% vs. 9.2% (p = 0.268), Clavien 2 or > complications 18.5% vs. 19.3% (p = 0.923), and Clavien 3 or > complications 4.0% vs. 7.3% (p = 0.151). The tubeless group experienced shorter operative duration 121.5 vs. 144.8 min (p = 0.012), shorter length of stay 2.5 vs. 3.8 days (p = 0.002), and higher stone-free rates 72.3% vs. 60.2% (p = 0.014), but also increased blood transfusion rates 6.4% vs. 0.9% (p = 0.022). In comparing tubeless with standard PCNL, there was no difference in readmission rates, or significant Clavien complication rates. Patients undergoing tubeless PCNL experienced higher stone-free rates, but more number of patients required postoperative blood transfusion. The decision to leave a nephrostomy tube after PCNL appears unlikely to impact overall complication rates and can be left to surgeon experience and case-based discretion.

Outcomes of Percutaneous Nephrolithotomy in an Experienced Center: 1000 Cases Experience

Outcomes of Percutaneous Nephrolithotomy in an Experienced Center: 1000 Cases Experience

Outcome of Tubeless Percutaneous Nephrolithotomy in Patients with Single Kidney; A Cross-Sectional Study

Background: While tubeless Percutaneous Nephrolithotomy (PCNL) is becoming more popular, there might still be doubt in performing it on single kidney patients. This study is performed to assess outcomes and complications of tubeless PCNL in patients with single kidney.&#x0D; Methods: In this cross-sectional study, 134 single kidney patients who underwent tubeless PCNL for renal stones, were assessed for outcomes including stone-free rate, duration of operation, length of hospital stay, changes in serum creatinine and hemoglobin levels, bleeding, infectious complications, damage to adjacent organs, and mortality. These outcomes were compared based on age, sex, history of comorbidities, history of interventions for kidney stones and the number of accesses during the operation.&#x0D; Results: Mean duration of operation was 139.14 minutes. Mean length of hospital stay was 2.59 days. In total, 11.9% of patients required intraoperative blood transfusion and 3.7% required ICU admission due to complications. The most common postoperative complications included fever, hematuria and UTI. Initial stone-free rate after surgery was 67.2% and two weeks later 76.9%. No mortality was reported. Postoperative serum creatinine levels increased slightly in short term, however, improved significantly in long-term. Comorbidities such as diabetes mellitus, hypertension, ischemic heart disease, and chronic kidney disease were associated with a higher incidence of minor and major complications of tubeless PCNL and a lower rate of stone-free rate.&#x0D; Conclusion: Tubeless PCNL is a relatively safe, feasible and efficient method with acceptable complications in single kidney patients.

A systematic review of postoperative outcomes of kidney stone surgery and meta-analysis of outcomes of percutaneous nephrolithotomy in individuals with spinal cord injury.

Systematic review and meta-analysis. To evaluate outcomes of surgical treatment for nephrolithiasis in individuals with spinal cord injury (SCI). We systematically reviewed the Ovid MEDLINE, Embase, CENTRAL, and Web of Science databases for studies examining outcomes of kidney stone procedures in individuals with SCI. Our primary outcomes were stone-free rate (SFR) and complications as categorized by Clavien-Dindo classification. A meta-analysis of comparative studies was performed to assess differences in SFR and complication rate between individuals with and without SCI following PCNL. A total of 27 retrospective and observational articles were included. Interventions for kidney stones included PCNL, shockwave lithotripsy (SWL), and ureteroscopy. Pooled SFR in individuals with SCI was 54%, for SWL, 74% for PCNL, and 36% for ureteroscopy. Meta-analyses found that there was higher rate of grades I (OR 9.54; 95% CI, 3.06 to 29.79), II (OR 3.38; 95% CI, 1.85 to 6.18), and III-V (OR 2.38; 95% CI, 1.35 to 4.19) complications in individuals with SCI compared to non-SCI individuals following PCNL. The rate of infectious complications was also higher in individuals with SCI (OR 6.15; 95% CI, 1.86 to 20.39). However, there was no difference in SFR (OR 0.64; 95% CI, 0.15 to 2.64) between groups. Individuals with SCI are at higher risk of minor, major, and infectious complications following PCNL compared to non-SCI individuals. There was no significant difference between groups in SFR following PCNL, suggesting that PCNL is an effective surgery for kidney stones in individuals with SCI.

Evaluation of the STONE nephrolithometry score in predicting surgical outcomes of percutaneous nephrolithotomy: results of a prospective study at a university hospital

Objective: One of the popular advances in percutaneous nephrolithotomy (PCNL) includes nephrolithometry classification systems. It enables better patient counseling, surgery planning, outcome evaluation, and uniform academic reporting. The STONE nephrolithometry is a validated quantitative scoring system that is undervalued in clinical settings, and this study evaluates the scoring system's ability to predict the outcome of PCNL surgery. Methodology: From January 2017 to June 2018, a total of 102 PCNL patients were studied prospectively. The STONE score was derived from a preoperative non-contrast computed tomography (NCCT) scan which was used to evaluate stone-free status at 4 weeks followup. Results: The STONE nephrolithometry scoring system predicted stone-free rate (SFR) following PCNL surgery with an accuracy of 88%. The statistical cut off level of the STONE score of 8 was superior for predicting SFR. Individual variables such as stone size, degree of pelvicalyceal obstruction, number of calyceal involvement, and stone density were found to have a significant correlation with STONE score, although there was no statistically significant correlation between SFR and tract length (p=0.81). The score was divided into three categories: low complexity score 5-6 (SFR-58.7%), moderate complexity score 7-8 (SFR-40%), and high complexity score 9-13 (SFR- 1.2%). The STONE score had excellent inter-observer reliability and reproducibility (p=&lt;0.001). Conclusions: The STONE score was a simple and easy to apply tool for predicting the stone complexity and stone clearance after PCNL. The STONE score had no statistically significant correlation with postoperative complications. Furthermore, it demonstrated high inter-observer reliability and reproducibility.

The effect of anesthesia type on the outcomes of percutaneous nephrolithotomy in elderly males

Objective: To compare the anaesthesia methods in percutaneous nephrolithotomy in terms of safety and effectiveness in elderly men. Methods: Elderly male patients who had undergone percutaneous nephrolithotomy were screened retrospectively and divided into 2 groups: percutaneous nephrolithotomy under combined spino-epidural anaesthesia (Group CSEA, n = 70) and percutaneous nephrolithotomy under general anaesthesia (Group GA, n = 114). Preoperative, perioperative and postoperative outcome measures were examined. Results: Between the two groups, there was no statistically significant difference in terms of stone burden, stone location, presence of the previous operation in the same kidney, presence of staghorn stones, mean American Society of Anesthesiologists scores and presence of abnormal kidney (p > 0.05). The mean duration time in the operation room and post-anaesthesia care unit (PACU) was statistically shorter in the Group CSEA (p < 0.01). There was no significant difference between the two groups in terms of Clavien Grade 1 and above complications (p > 0.05). Stone-free rates and success rates were similar in both groups (p = 0.133 and p = 0.273, respectively). Conclusion: The type of anaesthesia does not affect the success rate and complication rate of percutaneous nephrolithotomy in elderly male patients. Patients who underwent percutaneous nephrolithotomy under CSEA needed less analgesic injection during the postoperative period. CSEA can shorten the time a patient spends in the operating room and PACU, which provides more effective use of operation room working hours.

Outcomes of Percutaneous Nephrolithotomy Under Local Anesthesia: Outcomes of a Systematic Review of Literature.

Background: Several studies have reported on the safety and feasibility of percutaneous nephrolithotomy (PCNL) under local anesthesia (LA). The aim of this systematic review is to assess the perioperative outcomes of PCNL under LA. Methods: Three electronic databases, including MEDLINE, EMBASE, and Web of Science, were searched for relevant English-language studies published from January 1980 to March 2023. The systematic review has been performed according to the Cochrane style and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. The primary outcomes include stone-free rate (SFR) and conversion to general anesthesia (GA). Secondary outcomes include postoperative complications. Results: Of 301 articles that were extracted, 42 full-text articles were selected, of which 36 were excluded, yielding a total of 6 articles in our results. A total of 3646 patients were included in this review. The SFR of PCNL under LA ranged between 69.9% and 93.3%. PCNL under LA was not tolerated by 19 (0.5%) patients: 6 patients had conversion to general anesthesia, 2 had conversion to epidural anesthesia, and 11 had their procedure terminated. The overall complication rates varied from 4.8% to 21% across studies. Grade I-II complications were reported in 2.4%-16.7% of cases, while grade III-IV complications were encountered in 0.5%-5% of patients. Conclusions: In this review, we found a few studies that examined the outcomes of PCNL under LA, which highlight the feasibility and safety of PCNL under LA and the low conversion rate to GA.

Correlation of the S.T.O.N.E. Score with surgical outcomes of Percutaneous Nephrolithotomy in an academic hospital

Introduction: Percutaneous nephrolithotomy (PCNL) is the best option for the treatment of patients with large kidney stones. The S.T.O.N.E score system takes measurements of objective parameters from preoperative tomography into account, and aims to provide the surgical team with a preliminary assessment of the complexity of each case, allowing the surgeon to more accurately predict the final results of PCNL. However, adequate studies that confirm its results and effectiveness are so far lacking. Hence, our objective was to correlate the S.T.O.N.E. nephrolithometry scoring system to the actual surgical outcomes achieved in a cohort of patients undergoing PCNL, in an academic hospital.Patients e Methods: We retrospectively reviewed the charts of 277 consecutive patients who underwent percutaneous nephrolithotomy from 2014 to 2019 in our academic hospital. Only those patients with all radiological images available for review were included in this cohort. The S.T.O.N.E nephrolithotomy score was calculated based on the preoperative computed tomography (CT) scans and then correlated with stone-free rate (SFR), postoperative complications (PC) in accordance with the Clavien-Dindo system, length of hospital stay (LHS) and operative time (OT). Results: A total of 193 PCNLs were included. Mean age was 50.7 years (25-82); 56% of patients were female, and the right side was slightly more affected (51.8%). The mean S.T.O.N.E. score for the entire cohort was 8.45, but for patients with residual stone after PCNL, this figure was actually higher, at 9.4 (p &lt;0.01). The overall SFR after an initial procedure was 51.8%, with logistic regression analysis showing that the number of involved calyces and stone size were significantly correlated with stone-free status (p&lt;0.001). Mean LHS (3.47 days) and OT (117.9 mins) also significantly correlated with S.T.O.N.E. score (p&lt;0.001). The overall complication rate after the primary procedure was 16.6% (of which 68.8% were grade I or II), and there were no complications Grades IVb or V. There was no significant correlation between complications and the S.T.O.N.E. score (p=0.37). Conclusion: The S.T.O.N.E nephrolithometry score was significantly associated with stone free status, operative time and length of hospital stay, although not with occurrence of complications.

Comparison between the Outcomes of Standard Percutaneous Nephrolithotomy (S-PCNL) and Mini-Percutaneous Nephrolithotomy (M-PCNL) while Treating Renal Calculi

Background: In urology, the most common disorder is represented as renal stones. Renal stones have 10% of humans reporting complaints. Their recurrence rate is very high, exhibiting approximately 70 percent recurrence rate. There have been significant advancements made in the treatment of renal stones. PCNL can be used in situations where renal stones are between 10-20 millimeters in the lower pole of a kidney and larger than 20 millimeters. Objective: This study was performed to compare the outcomes of S-PCNL and M-PCNL while treating renal calculi. Study design: A randomized control trial Place and Duration This study was conducted in Karachi Institute of Kidney Diseases Karachi from February 2022 to February 2023 Methodology: There were a total of 50 people included in this research who were equally divided into 2 groups. All of the participants were having a single unilateral renal stone which was &lt;3cm in size. All of the included people were aged 18 years or older. Each patient underwent a physical examination as well as laboratory investigations which included urine culture, CBC, liver function, urinalysis, coagulation profile, and kidney function. There were certain imaging studies that included pelvic and abdominal ultrasonography, kidney–urinary bladder X-ray (KUB), and either intravenous pyelography (IVP) or computed tomography urinary tract (CTUT).

Is Percutaneous Nephrolithotomy (PCNL) as Safe and Effective in Children as Adults?

Background: Percutaneous Nephrolithotomy (PCNL) is an endoscopic procedure of choice for the larger renal stones in both adult and children. Adequate literature is present regarding the efficacy of PCNL in clearing the adult kidney stones but limited data in our part of world is available to show noticeable renal stone clearance after PCNL with minimal complications in pediatric group. We set out to compare the outcomes of PCNL in both groups so we can recommend its efficacy and safety in pediatric group. Methods: The prospective cross-sectional comparative study conducted in 86 patients who underwent PCNL for Renal Calculi. Patients were divided into two groups. Thirty patients were in the pediatric group and 56 patients in the adult group. Both groups were compared for the safety and efficacy of PCNL. Safety will be assessed through post-operative complications and graded according to Modified Clavien grading system. Efficacy was assessed through stone clearance. The aim of study is to determine the safety and efficacy of percutaneous nephrolithotomy in children so it can be done frequently and confidently without fear of complications and incomplete clearance of stones. Results: When we compare children with adults for safety and efficacy of PCNL, no statistical significance was observed in both groups in terms of stone clearance and postoperative complications. Conclusion: Percutaneous nephrolithotomy is as safe and effective in pediatric age as adult age. Keywords: Percutaneous Nephrolithotomy, Renal Stones, modified Clavien grading system.

Ultrasound-Only Percutaneous Nephrolithotomy Is Safe and Effective Compared to Fluoroscopy-Directed Percutaneous Nephrolithotomy.

Introduction: Outcomes after ultrasound-only percutaneous nephrolithotomy (PCNL), in which no fluoroscopy is used, are not well known. The goal of this study was to compare outcomes of ultrasound-only and fluoroscopy-directed PCNL. Materials and Methods: Prospectively collected data from the Registry for Stones of the Kidney and Ureter database were reviewed for all patients who underwent PCNL at one academic center from 2015 to 2021. Primary outcomes were complications and stone-free rates (no residual fragments ≥3 mm). Results: Of the 141 patients who underwent ultrasound-only PCNL and 147 who underwent fluoroscopy-directed PCNL, there was no difference in complication rates (15% vs 16%, p = 0.87) or stone-free status (71% vs 65%, p = 0.72), respectively. After adjusting for body mass index, American Society of Anesthesiologists (ASA), stone size, and stone complexity by Guy score, ultrasound-only PCNL was not associated with any increased odds of complications (odds ratio [OR] 0.7, 95% confidence interval [CI] 0.3-1.6, p = 0.41) or residual stone fragments ≥3 mm (OR 1.0, 95% CI 0.5-1.9, p = 0.972) compared with fluoroscopy-directed PCNL. Ultrasound-only PCNL was associated with shorter operative time (median 99.5 vs 126 minutes, p < 0.001), and the use of ultrasound remained a significant predictor of short operative time (<100 minutes) after controlling for supine positioning, stone size, and stone complexity by Guy score (OR 2.31, 95% CI 1.01-5.29, p = 0.048). Patients in the ultrasound-only group were spared a mean radiation exposure dose of 10 mGy per procedure. Conclusions: Ultrasound-only PCNL is safe and achieves similar stone-free rates compared with fluoroscopy-directed PCNL with the added benefit of avoidance of radiation.