PCNL Group Research Articles

Comparison Between the Efficacy & the Safety of Single Use Flexible Ureteroscopy Lithotripsy and Miniaturized Percutaneous Nephrolithotomy (Mini PCNL) for the Management of Renal and Proximal Ureteral Calculi of ≤ 2CM

Abstract Background Urolithiasis has become a common medical problem with about 2- 3% prevalence rate and still increasing in the general population. Renal calculi represent about 80- 90% of all urinary calculi with high recurrence rate. Single Use Flexible Ureteroscopy Lithotripsy and Percutaneous Nephrolithotomy Lithotripsy are recommended in the 2013 European Association of Urology guidelines as the first line in management of lower pole calculi when renal anatomy is unfavorable for Extracorporeal Shock Wave Lithotripsy. Furthermore, Single Use Flexible Ureteroscopy Lithotripsy is extremely effective for management of calculi of ≤ 2 cm in diameter and complex renal calculi. Aim of the Work The aim of our study is to compare the outcome of using Single Use Flexible URS versus Mini-PCNL with ≤22 Fr tract accessin management of pelvic, lower calyceal and proximal ureteral calculi ≤ 2cm. It was conducted on 40 patients that were randomly divided into 2 groups. Group A were treated with Mini-PCNL (20cases), whereas group B were treated with Single Use Flexible URS (20 cases). Patients and Methods A clinical trial, it was carried out at Ain Shams University, Urology department from October 2020 to October 2021 and done over 40 patients complaining of single pelvic, lower calyceal or upper ureteric stone ≤ 2 cm. The patients underwent either Mini-PCNL or Single Use Flexible URS randomly according to simple randomization using Gpowa computer program with ratio 1:1. Results Our study showed that Single Use Flexible URS achieves a comparable stone free rates to Mini- PCNL as there is no statistically significant difference between group A and group B in the stone free rate.Flexible URS reduces the risks associated with Mini-PCNL.Blood loss is highly significant in Mini-PCNL group more than in Single Use Flexible URS group.The incidence of post-operative fever and infection is non- significant between 2 groups. It is (15%)3 cases from 20 cases in group A although, (5%)1case from 20 cases in group B. There is highly significant difference between group A and group B in both operation time and hospital stay. This means that the patients take more intra operative time in Flexible URS group than in Mini-PCNL group,but more hospitalization in Mini- PCNL group than Single Use Flexible URS group.There is no statistically significant difference between 2 groups in the need for double J stent or auxiliary procedure such as ESWL. Conclusion Single Use Flexible URS is widely used nowadays and the treatment of choice for management of renal calculi due to its high efficacy and low morbidity in management of renal stones up to 20 mm. This study indicated that Single Use Flexible URS is an effective technique for management of renal and proximal ureteric calculi ≤ 2cm. In comparison to Mini-PCNL, it not only has a similar stone free rate, but also is associated with lower complication rates, more favorable recovery time. But it has longer operative time.

Efficacy of Retrograde Intrarenal Surgery Versus Percutaneous Nephrolithotomy In Treating Lower Pole Stones of 1-2 cms

Introduction Urologists are always inclined to find techniques with minimal complication and hospital stays with maximum stone-free rates to mitigate not only health concerns but financial burdens too. PCNL is known as the gold standard for large stones, however, RIRS is known for its less invasive and minor complications. Methodology This is a cross-sectional, prospective study conducted at the public hospital of Jamshoro. Patients with renal stones located at the lower pole, measuring 1-2 cm were included. Patients were evaluated before enrollment and detailed history was taken. Intraoperative and post-operative details were documented. SPSS 21 was used to analyze the data, and to assess significance chi-square test was used, a p-value < 0.05 was considered significant. Results The mean age was 42.7 ± 12.8 and 43.2 ± 13.2 in the RIRS and PCNL groups respectively. The RIRS group showed 07 (17.5%) partial clearance cases while PCNL group showed 02 (5%). Hemoglobin drop was measured as minimal (< 2.5ml) and excessive (>2.5ml) after surgery, and only 01 (2.5%) cases of RIRS had excessive blood loss, PCNL group had higher hemoglobin drop cases with 3 (7.5%) cases. Blood transfusion was required in 1 (2.5%) and 2 (5%) cases in the RIRS and PCNL groups respectively. Conclusion RIRS can be beneficial in small stones while PCNL can be an ideal procedure for lower pole renal stones of 1-2 cm size.

In the Treatment of Lower Pole Kidney Stones Between 1-2 cm in Children, Which is the Best Approach? Retrograde Intrarenal Surgery or Mini Percutaneous Nephrolithotomy.

Kidney stones are treated with many methods, but there is no consensus on which method should be preferred for 1-2 cm lower renal stones. In our study, we aimed to investigate the results of mini (Percutaneous Nephrolithotomy) PCNL and (Retrograde Intrarenal Surgery) RIRS in lower renal pole 1-2 cm stones. Twenty-four mini PCNL and 55 RIRS patients were included in the study. Demographic data of the patients and information about stones on Non-Computed Tomography (NCCT) were recorded. Stone-free status (SFR), need for additional treatment and complications of both methods were compared. Operative time was 55.2±20.8 min in mini PCNL and 70.7±36.5 min in RIRS, which was statistically significantly lower (p=0.002). Length of hospital stay was 2.4±1.5 days in the mini PCNL and 1.3±0.7 days in the RIRS, which was statistically significantly longer (p=0.011). In the postoperative 1st month and 3rd month stone-free rates (SFR) were higher in the mini PCNL group. While the 1st month SFR was 91.6% and 54.5%, the 3rd month stone-free rates were 95.8% vs. 69.1%, respectively (p<0.001). The need for re-treatment was statistically lower in the mini PCNL group (p<0.001). In terms of complications, the incidence of complications was 16.6% (pain in 2 patients, fever in 1 patient, need for blood transfusion in 1 patient) in the mini PCNL group and 21.8% (pain in 2 patients, fever in 8 patients, sepsis in 2 patients) in the RIRS group. There was a significant difference between the two groups (p=0.008). Mini PCNL has a higher SFR, less need for re-treatment and fewer complications.

Comparison of Miniperc and Standard Percutaneous Nephrolithotomy in the Treatment of Renal Stone: An Open Level Parallel Arm Randomized Control Trial

Background: Treatment of renal stone is very crucial for the outcomes of the patients. Objective: The purpose of the present study was to compare the Miniperc and standard percutaneous nephrolithotomy in the Treatment of Renal Stone. Methodology: This randomized control trial was conducted in the Department of Urology at National Institute of Kidney Diseases and Urology, Dhaka and some private hospitals in Dhaka city of Bangladesh from July 2016 to November 2017 for a period of one and half year. Patients from 18 to 65 years of age with renal calculi ( 2cm) were selected on the basis of plain X-ray and ultra-sonogram of KUB region, from Urology outpatient Department (OPD) in National Institute of Kidney Diseases and Urology (NIKDU), Dhaka and some private hospitals in Dhaka city. Patients were selected in every alternate sequence (odd numbers for Miniperc in Intervention group and even numbers for Standard PCNL, control group). All patients underwent PCNL of both the procedures under general anesthesia and received intravenous broad spectrum antibiotics. Results: A total number of 60 patients were selected for study of which 30 patients were underwent miniperc and 30 patients were undergoing standard PCNL. The mean age of miniperc group and PCNL group were 34.43±11.09 and 36.70 ± 12.27 years respectively. An overall stone clearance rates was 93.33 (28) in intervention group and 6.67 % (2) was not cleared. Among the control group an overall stone clearance rates were 96.67% (29) and 3.33% (1) was not cleared. Stone clearance rates were not significant. The mean operative time (min) of intervention group was 97.47±15.03 and the mean operative time (min) of control was 86.37±17.73 Operative time was significant between the groups (p&lt;0.05). Conclusion: In conclusion the rate of clearance of intervention group is not statistically significant. Journal of Current and Advance Medical Research, January 2023;10(1):19-24

Mini-Percutaneous Versus Standard Nephrolithotomy Comparison For Staghorn Stones

Background: The treatment for staghorn stones is known as mini-percutaneous nephrolithotomy (mini-PNL), which is a minimally invasive surgical procedure. Despite its shorter duration, reduced morbidity, and lower blood loss when compared to standard nephrolithotomy, it may offer similar results. This study aims to compare the safety and efficacy of mini-PNL versus conventional nephrolithotomy for the treatment of staghorn stones. Objectives: To evaluate the clinical effectiveness (stone-free rate and complication rate) and safety (time to stone clearance, perioperative and postoperative morbidity, hospital stay, and blood loss) of mini-percutaneous nephrolithotomy (PNL) in comparison to standard nephrolithotomy for the management of staghorn stones. Study design: A randomized controlled trial Duration and place of study: Department of Urology, Sahiwal Teaching Hospital, Sahiwal, from January 2021 to August 2021 Methodology: We performed a randomised controlled experiment from January 2021 to August 2021 at the Department of Urology, Sahiwal Teaching Hospital, Sahiwal, to ascertain the stone-free rate among patients with staghorn stones. Two years were dedicated to the study. A total of seventy-five patients were split into two groups for the regular PCNL and mini-PCNL procedures during the study. In this study, In this study, one of these procedures was randomly assigned to each patient-- half received traditional PCNL and half had mini-PCNL surgery. Data were gathered for hospital stays, complications and pain during filming. 81 patients participated in the research, ranging in age from 20 to 90 years old. Results : The mean age was 53 02 years old. There were 78 men and 13 women among these subjects taken as 'normal' statistics. In the miniperc and normal PCNL groups, the success rates were 91.2% and 96.8%, respectively (p=0.05). The mean operating time and duration of hospital stay in mini-PCNL group were significantly shorter than those in normal group (81.1±3.3 and 03.3 days respectively; t=3.728,5), p=0.001. Compared with regular PCNL, mini-PCNL has a higher rate of mum less thick stone (25% compared to 13%; p = 0.036) Conclusion : the mini-PCNL group experienced far less postoperative discomfort (p-0.001). Therefore, minimally invasive PCNL emerges as a more effective treatment for staghorn stones. It offers a number of benefits compared to standard-PCNL, such as reducing operating room time, shortening hospital stays and lower pain after surgery. As a result of these advantages, it has become increasingly favored in practice for treating staghorn stones Keywords: Staghorn stones, PCNL, stone-free rate, hospital stay, complications, postoperative pain

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.

Comparative Study of Prone Position Variations for Percutaneous Nephrolithotomy.

In this comparative study, we evaluated the results of flat prone and prone hip flexed percutaneous nephrolithotomy in terms of efficacy and safety to contribute to the optimal prone percutaneous nephrolithotomy position. Data of the patients who underwent percutaneous nephrolithotomy operations in a flat-prone or prone hip flexed positions due to renal pelvis and/or ≥2 Calix filling stones between January 2016 and January 2022 were collected retrospectively. Demographic data of the patient groups in different prone positions as well as clinical findings, stone characteristics and operative data were analyzed. The groups were also compared in terms of post-operative findings and complications. The average age and CROES scores of patients included in the study were 47.15±15.6 years and 221.76±62.49, respectively. There was no statistically significant difference between the two groups in terms of patient demographic data, stone-free status and complication rates. Operation Room Time (ORT) (min) in flat prone PCNL group was shorter in average (100.57±32.74 min vs 92.32±28.75 min, p = 0.041) and duration with nephrostomy (days) and hospitalization (days) parameters were statistically significantly shorter in prone hip flexed PCNL (respectively, p < 0.001; p = 0.005). Flat-prone PCNL provides significantly shorter ORT. However, the time with nephrostomy and hospitalization with the prone hip flexed PCNL were shorter than flat-prone position. The findings will guide the optimal prone PCNL position.

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

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

A Newly Developed Hematuria Grading System May Predict the Status of Stone-Free and Acute Pyelonephritis of Minimally Invasive Renal Stone Surgery.

The aim of this study was to evaluate the level of hematuria and the presence of clots during retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mPCNL) to predict surgical outcomes. The data of patients who underwent RIRS and mPCNL were analyzed separately. A hematuria grading (HG) system was classified into five grades based on the presence of blood clots and any visible stones according to the irrigation settings. Inter-observer reliability of the grading system was assessed using intra-class correlation and Spearman's rho. The HG system showed high agreement among examiners, with high intra-class reliability and a strong correlation between RIRS and mPCNL groups. The stone density of the Houns-field unit was the most important factor in determining the hematuria across the development and validation groups of RIRS and mPCNL patients. Multivariate logistic regression analysis showed that the HG system was a significant predictor for remnant stones in the PCNL group and the probability of acute pyelonephritis or sepsis in the RIRS group. The high hematuria group showed lower basketing difficulty with the basket with a blue marker instrument than with others. The new HG system shows excellent inter-observer reliability and a correlation with a gradual increase in stone density and surgical difficulty.

MP23-17 COMPARISON OF INTRA PELVIC PRESSURE DEPENDED ON SUPINE AND PRONE POSITION IN ENDOSCOPIC COMBINED INTRARENAL SURGERY: EX-VIVO STUDY OF PORCINE KIDNEY

You have accessJournal of UrologyCME1 Apr 2023MP23-17 COMPARISON OF INTRA PELVIC PRESSURE DEPENDED ON SUPINE AND PRONE POSITION IN ENDOSCOPIC COMBINED INTRARENAL SURGERY: EX-VIVO STUDY OF PORCINE KIDNEY Takaaki Inoue, Satoshi Imai, Shimpei Yamashita, and Masato Fujisawa Takaaki InoueTakaaki Inoue More articles by this author , Satoshi ImaiSatoshi Imai More articles by this author , Shimpei YamashitaShimpei Yamashita More articles by this author , and Masato FujisawaMasato Fujisawa More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intra pelvic pressure (IPP) over than 30 mmHg during endourological procedures for upper urinary tract stones is regarded as risk factor of postoperative fever and sepsis. Although endoscopic combined intrarenal surgery (ECIRS) has been currently developing, there is no evidence regarding with IPP during ECIRS by supine or prone position. We aimed to measure and compare the dynamic change of IPP in supine and prone position during ECIRS by using porcine kidney. METHODS: We created the porcine kidney in which pressure sensor and 15/16F metal tract sheath were placed through renal capsule to renal collecting system, and the ureteral access sheath (UAS; 11/13F) was indwelled through the ureter. Prone position was defined as the tract was oriented upward at vertical position to the kidney. Supine position was defined as the tract was oriented downward at horizontal position to the kidney. 12F Nephroscope was inserted through metal tract with or without flexible ureteroscope (fURS) through UAS. Irrigation pressure of saline in nephroscope and fURS were controlled with the range of 40-160 mmHg and 80 cm H2O, respectively. On each position, we measured the dynamic change of IPP fifth times for 30 seconds in pure percutaneous nephrolithotomy (PCNL-group) with closed UAS, ECIRS with inserting fURS though UAS (fECIRS group), and ECIRS without fURS (non-fECIRS group) RESULTS: In any of three groups, IPP in supine position was significantly lower than in prone position (p<0.01). IPP in non-fECIRS group was significantly lower than in PCNL and fECIRS group in any position (p<0.01). In addition, irrigation volume excreted from tract sheath and UAS was significantly larger in non-fECIRS group (p<0.01). On the other hand, IPP in PCNL and fECIRS group almost changed equivalently. The threshold of antegrade irrigation pressure of saline which exceeds the 30mmHg IPP in PCNL and fECIRS group was 95mmHg under prone position, and 130mmHg under supine position. However, IPP in non-fECIRS group did not exceed over 30 mmHg IPP in any position (Figure 2). CONCLUSIONS: Supine position was lower IPP than prone position. Surprisingly, change of IPP in PCNL and fECIRS group demonstrated same dynamic state. Irrigation pressure might be required to set appropriately depending on kind of positions and procedures. Source of Funding: No © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e313 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Takaaki Inoue More articles by this author Satoshi Imai More articles by this author Shimpei Yamashita More articles by this author Masato Fujisawa More articles by this author Expand All Advertisement PDF downloadLoading ...

Effectiveness of Extracorporeal Shockwave Lithotripsy and Percutaneous Nephrolithotripsy for the Management of Moderate Size Kidney Stone

Aim: To provide a specific guidance in managing renal stones. Study Design: Place and Duration of Study: Pakistan Atomic Energy Commission, General Hospital Islamabad from 1st 2018 to 30th November 2018. Methodology: Eighty two patients were included and divided into two groups. Patients in group A underwent ESWL, while those in group B underwent PCNL. All of the participants underwent thorough diagnostic and therapeutic procedures. As per inclusion and exclusion criteria, patients with renal stones (10-20 mm), detected by CT scan were selected for either ESWL or PCNL. Results: Thirty four patients in the PCNL group and 21 patients in the ESWL group, had post-operative hematuria at the time of presentation (p=0.072). There is a substantial difference between patients between 18-38 years and those in the 60+ years. According to the stone-free rate, 76 individuals had favourable results whereas only 6 had negative ones (p=0.756 and p=0.050). Conclusion: Extracorporeal shockwave lithotripsy and pecutaneous nepthrolithotripsy are both effective technique options for kidney stones. However, since ESWL is non-invasive and has fewer adverse effects than PCNL treatment option, it is more successful in treating medium-sized kidney stones (20 mm or smaller). Keywords: Extracorporeal shockwave lithotripsy, Percutaneous nephrolithotripsy, Kidney stone

PERCUTANEOUS NEPHROLITHOTOMY AND RETROGRADE INTRARENAL SURGERY FOR TREATMENT OF RENAL STONE SIZE BETWEEN 1.0 CM AND 2.5 CM: A COMPARATIVE STUDY

Objectives: To evaluate the efficacy and safety of RIRS and PCNL in treatment of renal stone size between 1-2.5cm.&#x0D; Methods: This comparative prospective study was conducted in the Department of Urology of a tertiary care teaching hospital of Rajasthan from January 2019 to June 2020. Patients were fully informed about the study protocol and a written informed consent has obtained from patients with renal stone disease without any co-morbid conditions, posted for RIRS and PCNL. Stone free rate, post operative complications, hospital stay, operation time and cost between RIRS and PCNL for treatment of renal stone size between 1-2.5cm were compared.&#x0D; Results: Out of total 313 patients, 212 patients underwent PCNL and 101 patients RIRS. The stone clearance rate was significantly better in PCNL (92.45%) than RIRS (85.15%). The hospital stay was significantly less in RIRS (2.02±1.36 days) when compared to PCNL (3.89±2.18 days). Mean operative time for PCNL was significantly less i.e. 71.81±12.89 minutes as compared to 85.79±13.94 minutes in RIRS. Post-operative complications were more in PCNL group than RIRS.&#x0D; Conclusions: This study concluded that PCNL when compared to RIRS both have advantages and disadvantages according to size and location of stone, post-operative complications, stone free rate and operation cost. Judicious use of PCNL and RIRS should be done according to above mentioned parameters.

Comparison of Efficacy and Outcome of Tubeless with Standard Percutaneous Nephrolithotomy in Patient with Renal Stones

Objective: To compare the outcome and complications of standard PCNL with tubeless PCNL in terms of analgesia requirement, incidence of infection, post-operative perinephric urinary collection and post-operative hospital stay. Study Design: Randomized control trial Place and Duration of Study: Department of Urology, Lahore General Hospital Lahore from 1st March 2018 to 30th April 2019. Methodology: Ninety six patients fulfilling the inclusion criteria were randomly categorized into 2 groups; Group A where patients will undergo standard PCNL and Group B where patients will undergo tubeless PCNL. Post-operatively, patients were assessed for the requirement for analgesia, rate of infection, post-operative urinary leakage and hospital stay. Results: The mean duration of surgery had no significant difference between the two treatment groups; tubeless group was on average 51 minutes while the standard PCNL group was 55 minutes. No significant difference was observed in reduction of hematocrit values between the groups (4.9% vs 4.2%). Transfusions were not required in either group. The average post-operative duration of hospital stay was 2 days in group 1 and group 2 was 3 days with P&lt;0.001. Conclusion: Tubeless PCNL is effective in patients with kidney stones and requires fewer analgesic drugs and shorter hospital stay, post-operative complications are almost the same in both groups with no significant difference. Key words: PCNL, Standard, Tubeless, Complications

Comparison between mini-Percutaneous Nephrolithotomy (PCNL) and standard PCNL in pediatric patients: a systematic review and meta-analysis

Background: We conducted a systematic review and meta-analysis to determine the efficacy and safety of mini-Percutaneous Nephrolithotomy (PCNL) compared to standard PCNL in children with nephrolithiasis. Clinical trials and observational studies comparing standard PCNL and mini-PCNL in pediatric patients were identified from electronic databases in November 2021. Method: Studies were extracted for author, year, location, design, subjects’ age, sample size, objective, primary endpoint, level of evidence, and results (stone-free rates and complications). Results were subjected to qualitative analysis using the synthesis method. Adequate results were extracted and analyzed quantitatively using the fixed-effect model on homogenous data or the random-effect model on heterogeneous data for meta-analysis. Outcome variables are shown as odds ratios (ORs) with 95% confidence intervals (CIs). All statistical analyses were performed with Review Manager version 5.4. Result: We reported that stone-free rate and residual stone vary between two studies with contrary results. However, our quantitative analysis showed an insignificant difference between both groups of stone-free rate (OR 0.75; 95% CI 0.22-2.54) and residual stone (OR 1.27; 95% CI 0.55-2.91). Complications rates were insignificantly different between mini-PCNL group and PCNL group in two studies in Clavien 1 (OR 0.65; 95% CI 0.27-1.54) and Clavien 2 grade (OR 0.48; 95% CI 0.19-1.22). In addition, pooled analysis of both complication grades was also insignificant in the difference between groups (OR 0.56; 95% CI 0.30-1.06). Conclusion: The efficacy and safety of mini PCNL were neither superior nor inferior compared to standard PCNL in managing nephrolithiasis in pediatric patients. Moreover, mini PCNL was considered better regarding post-operative pain and tract infection; thus, mini PCNL could be considered a treatment option for pediatric patients with nephrolithiasis.

Clinical study on the minimally invasive percutaneous nephrolithotomy treatment of upper urinary calculi.

BACKGROUNDUpper urinary tract stones are very common in my country, with an incidence of 1% to 5% in the North and an even higher incidence of 5% to 10% in the south. The incidence rate in the south is higher than that in the north, mainly due to the water quality, climate and eating habits of the region. From the perspective of sex, incidence is more likely in males than females. In the high-incidence population, young adults are most prone to stones. Men in the age range of 25 to 40 years are more likely to have stones.AIMTo observe the therapeutic effect of minimally invasive percutaneous nephrolithotomy (mPCNL) on upper urinary tract stones and its influence on the renal function of patients.METHODSPatients with upper urinary tract stones who were treated in our hospital from February 2017 to March 2018 were selected as research subjects and were divided into the PCNL group and the mPCNL group according to the random number table method. The general conditions of the two groups of patients were observed during the perioperative period, and the differences in stone clearance, pain, renal function indicators and complication rates were compared between the two groups to determine which were statistically significant (P < 0.05).RESULTSThe operation time of the mPCNL group was longer than that of the PCNL group (t = -34.392, P < 0.001), and the intraoperative blood loss of the mPCNL group was more than that of the PCNL group (t = 34.090, P < 0.001). There was no difference in renal function indices between the two groups of patients before treatment, and there was no difference in the levels of serum creatinine, β2 microglobulin or retinol binding protein in the mPCNL group after treatment. The visual analog scale score of patients in the mPCNL group was lower than that of the PCNL group (t = 12.191, P < 0.001), and there was no significant difference in the stone clearance rate between the two groups (χ2 value = 1.013, P = 0.314). There was no significant difference in the incidence of urine extravasation, dyspnea and peripheral organ damage between the two groups (χ2 value = 1.053, P = 0.305). At 1 mo after treatment and 3 mo after treatment, the quality of life of the mPCNL group was lower than that of the PCNL group, and the Qmax level of the mPCNL group was higher than that of the PCNL group.CONCLUSIONmPCNL has a good therapeutic effect on upper urinary tract stones, with a high stone clearance rate without causing kidney damage or increasing the incidence of complications, and thus has good application value.

Percutaneous Nephrolithotomy (PCNL) versus Retrograde Intrarenal Surgery (RIRS) in Medium Sized Renal Pelvic Stones

Abstract Corresponding Background Stone size is a key factor in the determination of the success of author: treatment modalities. Recently, there has been a great advancement in technology for minimally invasive management of urinary stones such as percutaneous nephrolithotomy, ureteroscopy, shockwave lithotripsy, and retrograde internal Surgery Aim of the Work to compare the outcome of PCNL and RIRS in medium sized renal pelvic stoned in adults regarding operative time, fluoroscopic time, intra and postoperative complications, stone free rate, hospital stay and postoperative stenting. Patients and Methods This prospective randomized clinical study was conducted on 30 patients from April 2019 to January 2020, all patients had single renal pelvic stone (10 to 20 mm) and had no contraindication to perform these operations at the Urology department, Ain Shams University Hospitals and National Institute of Urology and Nephrology. The patients were randomized by (1 : 1) manner for either PCNL or RIRS. All preoperative, intraoperative and postoperative parameters, results and complications between both groups were recorded. Results Mean fluoroscopic time and hospital stay were significantly greater in PCNL group than RIRS group. The stone free rate was 86.7% (13/15) in PCNL group and 80% (12/15) in RIRS group and for complications (according to Cliven-Dindo score) there were no statistically significant difference between two groups.Complications occurred in 3(20%) patients in PCNL group and in 2(13.3%) patients in RIRS group. PCNL and RIRS are safe and effective methods for medium sized renal pelvic stones. For selected patients, RIRS may represent an alternative therapy to PCNL, with acceptable efficacy and low morbidity. RIRS compared to PCNL offers the best outcome in terms of radiation exposure and hospital stay. Conclusion RIRS may represent an alternative therapy to PCNL, RIRS compared to PCNL offers the best outcome regarding radiation exposure and hospital stay.

Preparation of Cu–Ni–Pt Nano-Cube and Its Application for the Detection of Nanobacteria on Influences of Flexible Ureteroscopy Lithotomy and Percutaneous Nephrolithotomy on Immune Function of Patients with Renal Calculus

This work aimed to find a surgical method suitable for the clinical treatment of renal calculus, and to find a new type of nanomaterial suitable for the detection of nanobacteria. In this paper, Cu–Ni–Pt nano cube was preparation, then the combination of peptidoglycan and Pt–Ni–Cu–NCs was verified. Through continuous surface treatment and continuous modification, an electrochemical biosensor for detecting the content of nanobacteria in the body of renal calculus patients was successfully constructed. 85 patients with renal calculus were d Randomly divided into two groups, percutaneous nephrolithotomy group (PCNL group, 43 patients) and ureteroscope lithotomy (URL group, 42 patients). The venous blood was collected to test tumor necrosis factorα (TNF-α), C-reactive protein (CRP), interleukin-6 (IL-6), and IL-8 levels. Flow cytometry was employed to detect CD4+ and CD8+ T lymphocyte levels. A biosensor for the detection of nanobacteria was constructed based on peptidoglycan and Cu–Ni–Pt nano cubes (Pt–Ni–Cu–NCs), and applied to the detection of nanobacteria in the blood and urine of patients after surgery. It was found that the detection range of the constructed nanobacteria detection sensor was 1.3×102~1.5×108 CFU/mL, which had a good linear relationship. Moreover, within 30 minutes, the detection of nanobacteria in blood and urine was achieved, and a broad-spectrum detection was achieved. In contrast to PCNL group, CRP, TNF-α, IL-6, IL-8, and CD8+ were significantly lower in the URL group (P &lt; 0.05). The detection rates of nanobacteria in blood and urine in PCNL group were 10% and 11.2%, respectively; those of URL group were 6.8% and 5.9%, respectively. Detected by the biosensor, the nanobacteria content was lower after URL treatment, and the immune function was at a higher level, which was more conducive to postoperative recovery.

Can mini PCNL achieve the same results as RIRS? The initial single center experience

BackgroundUrolithiasis is a prevalent disease worldwide with high recurrence rate, minimally invasive interventions have largely replaced open ones, namely PCNL and RIRS. Miniaturization, optical improvements, and modern laser types made these procedures safe and effective in the management of single renal stones.Aim of the study: Is to compare the effectiveness of mini PCNL with RIRS in the treatment of single renal stone of ≤25 mm. Patients and methodsThis prospective study that included 60 patients with single renal stones of ≤25 mm and were treated by either mini PCNL (group A) or RIRS (group B). The study was performed during the period from October 2020 to April 2021. ResultsThe mean operative time RIRS group was 43.6 ± 10.493, while for miniPCNL it was 36.6 ± 7.035 (P = 0.004). The stone free rate in RIRS and miniPCNL group was 70% and 90% respectively (P = 0.053). The need for JJ stent was higher in RIRS compared to miniPCNL group (70% vs. 40%) respectively (P = 0.02). The duration of hospital stay in miniPCNL was 38.2 h compared to 16.7 h for RIRS group (p = 0.0001). The rate of postoperative hemoglobin drop was higher in MiniPCNL compared to RIRS (P = 0.0001). There was no significant difference regarding complication rates between both groups. ConclusionMini-PCNL FOR the treatment of renal stones sized ≤25 mm has high stone free rate, shorter operative time, less requirement for JJ stent and near similar post-operative pain and complications compared to RIRS.

English

BACKGROUND We wanted to compare the outcomes of retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mini-PCNL) in treating lower pole (LP) renal stones with a diameter of &lt; 2 cm in terms of safety, efficacy, and stonefree rate (SFR). METHODS In a retrospective analysis data of 39 patients who underwent mini-PCNL (N = 19) or RIRS (N = 20) for LP stones with a diameter of &lt; 2 cm were reviewed between November 2018 and November 2020 at the Department of Urology in Veer Surendra Sai Institute of Medical Sciences and Research (VSSIMSAR), Odisha. The mean age, sex, stone size, operating time, complications, hospital stay, and SFR were compared between the groups. The success of the procedure was defined as the absence of residual stones or small residuals of size 3mm or less on computed tomography at 12 weeks postoperatively. RESULTS Significant differences were found in the hospital stay duration in hours (103.3 ± 11.7 vs. 145.2 ± 16.4, P &lt; 0.028) between the RIRS and mini - PCNL groups. The mean operation time (in minutes) was also significantly different between the RIRS group (82.5 ± 3.44) and mini PCNL group (86.21 ± 5.90, P = 0.021). The stonefree rates in the postoperative period at three months (RIRS vs. mini - PCNL: 95 % vs. 94 %, P = 0.47) were not significantly different. CONCLUSIONS RIRS and mini-PCNL are both safe and effective methods for treating LP stones with a diameter of &lt; 2 cm. RIRS can be considered as a less invasive alternative to PCNL for the treatment of LP stones of &lt; 2 cm with reasonable SFR with shorter hospital stay. KEYWORDS Retrograde Intrarenal Surgery, Percutaneous Nephrolithotripsy, Lower Pole Kidney Stones, Miniaturized Percutaneous Nephrolithotomy

Comparative Study of Extracorporeal Shock Wave Lithotripsy Versus Mini Percutaneous Nephrolithotomy for the Treatment of Nonlower Calyceal 10–20 mm Size Kidney Stone

Purpose: Urolithiasis is a common medical condition and the treatment is mainly minimally invasive methods. There exists no specific guidelines for the treatment of radio-opaque solitary non lower calyceal kidney stones of 10–20 mm in literature and no head to head study comparing both the procedures. Hence, this study was performed to have a specific guide for the treatment of such stones. Materials and Methods: This study, included all patients aged &gt;18 years, with solitary radiopaque calculi of 10–20 mm size in upper or middle calyx or pelvis of the kidney. A total of 105 patients were assigned to receive extracorporeal shock wave lithotripsy (ESWL) or mini-percutaneous nephrolithotomy (PCNL) for treatment of stone were enrolled in the study and the results were compared in terms of retreatment, stone-free rate (SFR), and complications. Results: The SFR was statistically higher in the mini PCNL group for all locations. The SFR for the ESWL group was low after 1st session; however, it increased with multiple sessions. We had a total of 9 complications in both groups, which was statistically insignificant. Conclusion: This study showed that the mini PCNL is a viable, safe option for the treatment of 10–20 mm non lower calyceal stones, having superior SFRs compared to ESWL with statistically insignificant complications. It can be offered as first-line option for the management of such stones.