PCNL Procedure Research Articles

Investigation of urinary neutrophil gelatinase associated lipocalin (NGAL) for early diagnosis of acute kidney injury after percutaneous nephrolithotomy

IntroductionPercutaneous nephrolithotomy (PCNL) could be mentioned as the most important treatment of choice for kidney staghorn stones. Previous publications reported that the novel biomarker urinary neutrophil gelatinase-associated lipocalin (NGAL) activity significantly increases in acute kidney injury (AKI) but there is not many published articles related to increase of NGAL after PCNL procedure. ObjectiveThis study aimed to investigate AKI by urinary measurement of NGAL after PCNL procedure. Subjects and methodsBased on a cross-sectional design, 41 patients with staghorn renal stones were nominated. All patients have been informed and signed the consent form. NGAL levels were measured by urinary sampling at 2h before and 12h after the procedure. Serum creatinines (Cr) were measured 12h before and 48h after the surgery. Demographic and clinical data including surgical procedure were recorded in Excel and analyzed by SPSS (SPSS Inc., Chicago, IL) for windows. ResultsWith a minimum of 20 and a maximum of 70, the mean age of patients was 47 years old. 71% of patients studied were males. There was a significant change in mean serum Cr (1.06 versus 1.12mg/dL; p<0.01) before and after the procedure respectively. Glomerular filtration rate (GFR) with a mean of 81.93umol/L before the procedure was decreased (p<0.02) to 77.46umol/L after the procedure. The changes in urine level of NGAL were significant (p<0.02), associated to an increase in mean value of 20.63ng/mL (two hours before) versus 56.28ng/mL (twelve hours after)the PCNL procedure. ConclusionsWithin different extents after PCNL procedure there was a significant increase in the biomarker of NGAL levels.In order to reduce AKI and other post-operative complications, further studies in a large population of patients seem to be advantageous.

Intraoperative and postoperative feasibility and safety of total tubeless, tubeless, small-bore tube, and standard percutaneous nephrolithotomy: a systematic review and network meta-analysis of 16 randomized controlled trials

BackgroundPercutaneous nephrolithotomy (PCNL) is performed to treat relatively large renal stones. Recent publications indicate that tubeless and total tubeless (stentless) PCNL is safe in selected patients. We performed a systematic review and network meta-analysis to evaluate the feasibility and safety of different PCNL procedures, including total tubeless, tubeless with stent, small-bore tube, and large-bore tube PCNLs.MethodsPubMed, Cochrane Central Register of Controlled Trials, and EMBASE™ databases were searched to identify randomized controlled trials published before December 30, 2013. One researcher examined all titles and abstracts found by the searches. Two investigators independently evaluated the full-text articles to determine whether those met the inclusion criteria. Qualities of included studies were rated with Cochrane’s risk-of-bias assessment tool.ResultsSixteen studies were included in the final syntheses including pairwise and network meta-analyses. Operation time, pain scores, and transfusion rates were not significantly different between PCNL procedures. Network meta-analyses demonstrated that for hemoglobin changes, total tubeless PCNL may be superior to standard PCNL (mean difference [MD] 0.65, 95% CI 0.14–1.13) and tubeless PCNLs with stent (MD -1.14, 95% CI -1.65–-0.62), and small-bore PCNL may be superior to tubeless PCNL with stent (MD 1.30, 95% CI 0.27–2.26). Network meta-analyses also showed that for length of hospital stay, total tubeless (MD 1.33, 95% CI 0.23–2.43) and tubeless PCNLs with stent (MD 0.99, 95% CI 0.19–1.79) may be superior to standard PCNL. In rank probability tests, small-bore tube and total tubeless PCNLs were superior for operation time, pain scores, and hemoglobin changes.ConclusionsFor hemoglobin changes, total tubeless and small-bore PCNLs may be superior to other methods. For hospital stay, total tubeless and tubeless PCNLs with stent may be superior to other procedures.

A very atypical case report of urothelium encasing a double- J ureteral stent in a post-operative case of percutaneous nephrolithotripsy

Double- J stent or ureteral stent is a commonly used prosthesis in post-operative cases of various urologic surgeries for adequate drainage of urine and also helps in passage of small and residual stones. This is a case report of a 32 year old female who came for follow-up for DJ stent removal after a successful and uneventful PCNL procedure. On cystoscopic examination the ureteral stent was found completely coated with urothelium. The urothelium was incised and ureteral stent removed.

MP41-07 TRENDS IN UROLOGICAL INTERVENTION FOR RENAL STONE DISEASE IN ENGLAND: EVIDENCE FROM HOSPITAL EPISODES STATISTICS (HES) DATABASE

You have accessJournal of UrologyStone Disease: Medical Therapy1 Apr 2015MP41-07 TRENDS IN UROLOGICAL INTERVENTION FOR RENAL STONE DISEASE IN ENGLAND: EVIDENCE FROM HOSPITAL EPISODES STATISTICS (HES) DATABASE Bhaskar Kumar Somani, Ed Chegdy, and Ghulam Nabi Bhaskar Kumar SomaniBhaskar Kumar Somani More articles by this author , Ed ChegdyEd Chegdy More articles by this author , and Ghulam NabiGhulam Nabi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1635AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Treatment of urological stone disease has evolved in the last decade with the advent and popularity of minimally invasive percutaneous and endoscopic techniques and miniaturization of scopes. With an increase in the incidence of stone disease and cost associated with it, knowing the trends in urological stone disease and its intervention will help us plan our services, train juniors and in ongoing and new research. METHODS The hospital episodes statistics (HES) database was devised in 1987 and contains all NHS activity (diagnosis and intervention) in England whereby data is collected and coded for all patients via the local hospital information systems and the number of episodes are recorded as finished consultant episodes (FCE). To capture the trends in the incidence of urolithiasis and its intervention by shock wave lithotripsy (SWL), ureteroscopy (URS), percutaneous stone surgery (PCNL) and open surgery we analyzed data for the last 6 years from 2007-2013. While we looked at the overall trend, we compared annual data from 2007-2008 (period-1) to 2012-2013 (period-2). RESULTS Total number of FCE for ‘Urolithiasis' increased by 12.5% from 79,199 (period-1) to 89,035 (period-2). A total of 224,454 renal/ureteric stone related procedures were done in NHS England during this 6-year period and included 376 (0.16%) open stone procedures, 9,625 (4%) PCNL procedures, 76,110 (33%) URS and 132,085 (59%) SWL procedures. During this 6-year period the total number of SWL procedures increased by 15%(from 19,386 in period-1 to 22,477 in period-2) but this rise was mainly due to a 20% rise in the reporting of renal SWL with a 6% fall in ureteric SWL. There was a 64% rise (from 9,551 in period-1 to 15,667 in period-2) in the total number of URS procedures during the two periods, with a 96% rise in kidney URS and a 51% rise in the ureteric URS procedure. Although the overall proportion of emergency ureteroscopy procedure was similar in the 2 time periods (12-13%), there was a 64% rise in the total numbers of elective URS procedures in period-2. While there was a 39% fall in the reporting of open stone surgery, there was a 43% rise in the number of PCNL type procedures. CONCLUSIONS There is a consistent trend for greater intervention for renal stone disease for all minimally invasive stone treatments, especially for ureteroscopy. Although it does reflect an increase in prevalence of stone disease, the real reason for this might reflect a better training, equipment availability and surgical expertise in modern day minimally invasive techniques. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e502 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bhaskar Kumar Somani More articles by this author Ed Chegdy More articles by this author Ghulam Nabi More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Complication and safety of ultrasound guided percutaneous nephrolithotomy in 8 025 cases in China

BackgroundPercutaneous nephrolithotomy (PCNL) was mostly performed with fluoroscopy and/or ultrasonography. The safety and feasibility of PCNL performed totally under ultrasound are not clearly defined. Therefore, we introduce the 9-year experience of 8 025 ultrasound guided PCNL procedures from multiple centers in China performed by the same surgeon, to evaluate the feasibility and security of this technique.MethodsFrom September 2004 to August 2013, 8 025 cases, 4 398 males (54.8%) and 3 627 females (45.2%), whose age ranged from 6 months to 85 years old, with upper urinary tract stones, underwent PCNL in our center and the supported hospitals. Puncture site selection and channel dilation were all guided using only Doppler ultrasound. Single stones were treated in 1 356 cases, there were 2 817 cases of multi stones, and 3 852 cases of staghorn calculi. The pre- and post-operative imaging data, the intraoperative findings, operation time, perioperative complications, and related parameters were recorded.ResultsAll procedures were successful. No patients died during the operation. Average operation time was 42 minutes (range 10 to 168 minutes), 4 cases converted to open surgery, and 2 patients lost the diseased kidney due to refractory bleeding in the early stage of the PCNL. Ninety-four (1.2%) patients received blood transfusions and 20 (0.25%) patients needed highly selective renal artery embolization. Fifteen (0.19%) patients had a pleural injury. 5 457 (68%) cases were completed by a single tract and 2 568 (32%) cases added more tracts. The mean stone size (longest diameter) was 2.8 cm (range 1.2 to 26.5 cm). The final stone-free rate was 85.5%. Residual stones occurred mainly in patients with renal dysfunction, medullary sponge kidney, and complete staghorn calculi with a slim calyceal neck.ConclusionsX-ray free Doppler ultrasound guided percutaneous nephrolithotomy is feasible and safe in a variety of cases of renal and/or upper ureteral stones. The probability of radiation hazard and adjacent organ injury is low. The morbidity from major complications was reduced remarkably after special training. It is worthy of wider use compared with fluoroscopy in patients with special kidneys (e.g. solitary kidney, spinal deformity, ectopic kidney) and in infants.

Analysis of the factors affecting blood loss in percutaneous nephrolithotomy: A registry of the Spanish Association of Urology in the supine position

ObjectivePercutaneous nephrolithotomy (PCNL) is the minimally invasive procedure of choice for removing renal stones larger than 2cm. This study has aimed to identify the different variables that might influence decrease of hemoglobin during the surgery performed in supine position. Materials and methodsA prospective, multicenter, observational study of supine PCNL, based on the Spanish Association of Urology database, was analyzed. The different preoperative and postoperative factors that might affect the decrease of hemoglobin were assessed: demographics and anthropometric data, comorbidities, size and location of the stones, anatomical variants and technical aspects of the procedure. ResultsFrom September 2008 to December 2012, 397 supine PCNL procedures performed in 15 Spanish centers were registered. Mean hemoglobin decrease was 2.3±1.5g/dl and overall blood transfusion rate was 5.5%. No statistically significant differences were found between genders, body mass index (BMI) and age in terms of blood loss. There were also no differences between patients with cardiovascular, hypertensive, diabetic and anticoagulant treatment background. Blood loss was not significantly influenced by stone size and location. Technical aspects of the procedure as operative time (>120min ≤), access to the pelvi-caliceal system (ultrasound, fluoroscopy), percutaneous tract dilation technique (Alken, balloon or Amplatz) or placement of nephrostomy (tube versus tubeless) were not associated with differences in pre-op/post-op hemoglobin. Only multiple percutaneous tracts (≥2) and middle calix access were statistically significantly (P=.03 and P=.01) related with less blood loss. ConclusionsPCNL in supine position is a minimally invasive procedure for removal of large (≥2cm) and multiple renal stones, with a low incidence of blood loss and minimal transfusion rate. Multiple percutaneous tracts and middle calix puncture were the only statistically significant variables associated with decrease in hemoglobin levels.

Análisis de los factores que influyen en la pérdida hemática en la nefrolitotomía percutánea: registro de la Asociación Española de Urología sobre la posición supina

ObjectivePercutaneous nephrolithotomy (PCNL) is the minimally invasive procedure of choice for removing renal stones larger than 2cm. This study has aimed to identify the different variables that might influence decrease of hemoglobin during the surgery performed in supine position. Material and methodsA prospective, multicenter, observational study of supine PCNL, based on the Spanish Association of Urology database, was analyzed. The different preoperative and postoperative factors that might affect the decrease of hemoglobin were assessed: demographics and anthropometric data, comorbidities, size and location of the stones, anatomical variants and technical aspects of the procedure. ResultsFrom September 2008 to December 2012, 397 supine PCNL procedures performed in 15 Spanish centers were registered. Mean hemoglobin decrease was 2.3±1.5g/dl and overall blood transfusion rate was 5.5%. No statistically significant differences were found between genders, body mass index (BMI) and age in terms of blood loss. There were also no differences between patients with cardiovascular, hypertensive, diabetic and anticoagulant treatment background. Blood loss was not significantly influenced by stone size and location. Technical aspects of the procedure as operative time (> 120min ≤), access to the pelvi-caliceal system (ultrasound, fluoroscopy), percutaneous tract dilation technique (Alken, balloon or Amplatz) or placement of nephrostomy (tube versus tubeless) were not associated with differences in pre-op/post-op hemoglobin. Only multiple percutaneous tracts (≥2) and middle calix access were statistically significantly (P=.03 and P=.01) related with less blood loss. ConclusionsPCNL in supine position is a minimally invasive procedure for removal of large (≥2cm) and multiple renal stones, with a low incidence of blood loss and minimal transfusion rate. Multiple percutaneous tracts and middle calix puncture were the only statistically significant variables associated with decrease in hemoglobin levels.

V1720 SIMPLIFIED METHOD OF PERCUTANEOUS NEPHROLITHOTOMY IN THE SIMPLE MALROTATION: TECHNICAL ASPECTS

You have accessJournal of UrologyTransplantation and Urolithiasis1 Apr 2013V1720 SIMPLIFIED METHOD OF PERCUTANEOUS NEPHROLITHOTOMY IN THE SIMPLE MALROTATION: TECHNICAL ASPECTS Jose Agudelo, Euro Arias, Nasser Ktech, Luis Sanchez, Eduardo Peña, Ricardo Montiel, and Manuel Riveros Jose AgudeloJose Agudelo Maracaibo, Venezuela More articles by this author , Euro AriasEuro Arias Maracaibo, Venezuela More articles by this author , Nasser KtechNasser Ktech Maracaibo, Venezuela More articles by this author , Luis SanchezLuis Sanchez Maracaibo, Venezuela More articles by this author , Eduardo PeñaEduardo Peña Maracaibo, Venezuela More articles by this author , Ricardo MontielRicardo Montiel Maracaibo, Venezuela More articles by this author , and Manuel RiverosManuel Riveros Maracaibo, Venezuela More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2921AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal malrotation is a malformation that is generally combined with other kidney anomalies. The isolated entity known as simple malrotation is rarely seen in a PCNL procedure. Simplified technique is a method described as a renal percutaneous approach that creates a plane of coincidence between the C arm beam axis and the needle axis. We are going to show the feasibility of this technique in the simple malrotation. METHODS We present a video, with a female patient with a 1.4 cm stone, with 1116 Hounsfield units in a malrotated kidney. A percutaneous approach was planned with the patient in prone position. The inferior calyx was selected in this case, and it was marked with the C arm angulated as usual for this technique and the entrance point was selected. A more vertical puncture, parallel to the intervertebral muscle, was done with success. Dilation as well as stone management was accomplished, keeping the vertical orientation at all time. A stone free status was reached for this patient. RESULTS The technique shown in the video was applied to 6 consecutive patients with this infrequent malformation. The mean stone size was 2.1 cm, 4 of them were located in the renal pelvis, a mean operative time of 52 minutes was recorded, a hemoglobin decrease of o.6 g/dl, mean hospital stay of 1.3 days, and the stone free status was reached in all patients. CONCLUSIONS The simplified percutaneous nephrolithotomy tecnique is a rapid, safe, and effective method for renal access in the simple malrotation. We consider that it can also be applied to other renal anomalies with posterior facing calyces. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e707-e708 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jose Agudelo Maracaibo, Venezuela More articles by this author Euro Arias Maracaibo, Venezuela More articles by this author Nasser Ktech Maracaibo, Venezuela More articles by this author Luis Sanchez Maracaibo, Venezuela More articles by this author Eduardo Peña Maracaibo, Venezuela More articles by this author Ricardo Montiel Maracaibo, Venezuela More articles by this author Manuel Riveros Maracaibo, Venezuela More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Paediatric percutaneous nephrolithotomy: Single-centre 10-year experience

IntroductionPercutaneous nephrolithotomy (PCNL) is a standard management option for complex and large renal calculi. In children, there is some concern over potential perioperative complications. We reviewed our 10 years of experience of PCNL in children and present our data. Material and methodsData for paediatric patients who underwent PCNL at our centre in the last decade were retrieved. PCNL was performed in standard prone position under fluoroscopic guidance. Patient characteristics, outcomes and complications were reviewed. Complications were graded according to the modified Clavien system. A comparison was also made between supracostal and infracostal accesses. Results95 children underwent PCNL in our institute in the last decade. 7 patients had bilateral PCNL. The most common presentation was flank pain (85%). 83% patients were stone-free after first PCNL and overall 94% were stone free after second-look PCNL and auxillary procedures. 6 cases had clinically insignificant residual fragments. Supracostal puncture was performed in 32 cases. Complications were higher in the supracostal puncture group (16 (50%)) and included fever in 11, sepsis in 2 and hydrothorax in 3 patients. There were 7 (10%) complications in the infracostal group: fever in 5 and perinephric collection in 2 patients. 16 patients had grade 1, 9 had grade 2 and another 2 cases developed grade 3 complications. ConclusionPCNL is a safe and effective procedure in children. It enables excellent stone clearance with minimal number of interventions.

Percutaneous nephrolithotomy in patients with scoliosis: our institutional experience

It is challenging to treat renal stones in patients with scoliosis. The present study was designed to study the safety and efficacy of minimally invasive percutaneous nephrolithotomy (mPCNL, 18 Fr) and standard tract PCNL (24 Fr) in patients with scoliosis. Twenty cases treated with mPCNL and 18 cases with standard tract PCNL were included in the present study. Laboratory data included preoperative routine complete blood count, serum creatinine, urine bacterial culture, etc. KUB, intravenous urography or CT scanning was done. Fifteen had lumbar and 23 had thoracolumbar scoliosis. Pulmonary function test was performed in all cases. Demographic and clinical details, operative characteristics and complications were studied and compared between two groups retrospectively. The stone burdens of two groups were averagely 754.4 and 816.2mm(2), respectively (P=0.194). Pulmonary function test indicated that 18 (47%) out of 38 patients had decreased function for surgery and anesthesia. The stone clearance rates were 55 and 67%, respectively, after the first session (P=0.522). The requirements of auxiliary treatments including second-look PCNL procedure or SWL (shock wave lithotripsy) were not significantly different for both groups. All patients from both groups achieved final stone clearance after auxiliary treatments. Complications of urinary collecting system injury or fever were observed in one and two cases in each group, respectively, (P=0.548). There were no injuries to neighboring organs or pneumothorax. The requirement of blood transfusion for four cases in mPCNL group and three cases in the standard tract PCNL group, respectively, indicated no significant difference between two groups (P=0.999). We are able to successfully and safely perform both mPCNL and standard tract PCNL in patients with scoliosis in our hospital. Compared with mPCNL, standard tract PCNL is even more efficient due to its shorter operative time.

Supine percutaneous nephrolithotomy with endoscopic combined intrarenal surgery — results of the first one hundred patients from a single UK centre

Objective To review our experience using combined supine PCNL and simultaneous ureterorenoscopy (ECIRS: endoscopic combined intrarenal surgery) to treat renal calculi. Patients and methods Retrospective analysis of operative times, anaesthetic and surgical complications, and stone-free rates in patients who underwent PCNL and ECIRS in the Galdakao Modified Supine Valdivia position at a single centre between September 2007 and November 2011 was undertaken. Outcomes for those patients with BMI &gt; 30 and those with high ASA grade were compared to the remaining patient group. Results One hundred patients underwent 103 PCNL procedures. Thirty-one (31%) patients had BMI &gt; 30 while 48 (48%) had ASA grade III or IV. Mean ± S.D. operative time and hospital stay was 111.34 ± 36.92 min and 49.5 ± 18.6 h respectively with no demonstrable increase in either parameter for patients with high ASA grade or BMI. The overall PCNL stone-free rate was 87% with 13 needing a secondary procedure. Six patients had postoperative complications (three transfusions, two post-operative fever and one ITU admission for sepsis). Conclusions Supine PCNL incurs minimal anaesthetic morbidity. The GMSV position enables PCNL to be performed in the obese safely with high stone-clearance rates when combined with ECIRS thus decreasing the need for ancillary procedures such as ESWL.

Percutaneous Nephrolithotomy in the United Kingdom: Results of a Prospective Data Registry

BackgroundPercutaneous nephrolithotomy (PCNL) is commonly used in the management of large upper renal tract stones. It is highly effective but carries a greater risk of significant morbidity than less invasive treatment options such as ureteroscopy or extracorporeal shock wave lithotripsy. ObjectiveEvaluate the current practice and outcomes of PCNL using a national prospective data registry. Design, setting, and participantsAll surgeons undertaking PCNL in the United Kingdom were invited to submit data to an online registry. MeasurementsEffectiveness was assessed by stone-free rates and safety according to complications including blood transfusion, fever, and sepsis rates. Results and limitationsSince January 2010, data on 987 patients who had 1028 PCNL procedures were collected. A total of 299 of 1012 procedures (30%) were for staghorn calculi, 299 (30%) for stones >2cm, 329 (33%) for stones 1–2cm, and 89 (9%) for stones <1cm. There were no significant differences in rates of failed access or complications according to whether a urologist or radiologist obtained renal access. There was a nonsignificant trend to a higher transfusion rate with balloon dilatation (7 of 222 [3.2%]) compared with serial dilatation (2 of 245 [0.8%]) of the renal tract (p=0.093). Totally tubeless procedures were not associated with higher complication rates but did lead to a significant reduction in median length of stay (3 d vs 1.5 d; p<0.0001). Intraoperatively, 78% of patients were believed to be stone free, which was confirmed in 68% with postoperative imaging. Blood transfusion was required in 24 of 968 patients (2.5%). The incidence of postoperative fever was 16% and of sepsis was 2.4%. ConclusionsThe PCNL data registry is a unique resource providing vital information on current practice and critical outcome data. Using the registry, endourologists can audit their practice against national outcome data for this benchmark procedure. It will help surgeons counsel patients during consent for this complex endourologic procedure about the possible outcome in their hands.

Alkaline citrate reduces stone recurrence and regrowth after shockwave lithotripsy and percutaneous nephrolithotomy

To evaluate the preventive effects of alkaline citrate on stone recurrence as well as stone growth post-ESWL or PCNL in patients with calcium-containing stones. A total of 76 patients with calcium calculi who were stone-free or had residual stones less than 4 mm following ESWL and PCNL were enrolled. All patients were independently randomized into two groups. The treated group (N = 39) was given 81 mEq per day of oral potassium-sodium citrate (27 mEq three times a day), and the untreated group (N = 37) serving as controls. Blood, twenty-four hour urine analysis, and plain KUB were measured and compared at the baseline and after 12 months. At baseline, hypocitraturia was found in 20 of 39 patients (46.05%) of Group I and 15 of 37 patients (40.5%) of Group II. At 12 months, hypocitraturia was found in 3 of 39 (7.69%) and 14 of 37 (37.83%) of Group I and Group II, respectively (p = 0.007). At the 12 month follow-up, of the stone-free group, 92.3% of the treated group and 57.7% of the control group were still stone free. Of the residual stone group, 30.8% and 9.1% of treated and control group were stone-free, respectively. The increased stone size found in 7.7%) and 54.5%) of treated and control groups, respectively. Sodium-potassium citrate provides positive effects on stone-forming activities in calcium stone patients suffering from urolithiasis following treatment with ESWL and PCNL procedures at the 12-month follow-up.

373 MODIFIED CLAVIEN CLASSIFICATION FOR COMPLICATIONS OF PERCUTANEOUS NEPHROLITHOTOMY (PCNL) IN PEDIATRIC PATIENTS: A COMPARATIVE STUDY

INTRODUCTION AND OBJECTIVES: To assess the morbidity and outcome of PCNL in pediatric patients using modified Clavien scale. METHODS: We retrospectively reviewed the computerized records of pediatric patients (ageiU 14 years) who underwent PCNL for treatment of renal stones between 1994 and 2010. All cases were performed by experienced endourologist. The patients were divided into two groups, group I; Simple stones (isolated renal pelvis or isolated calyceal stone) and group II; Complex stones (partial or complete staghorn stones, renal pelvis stones accompanied by calyceal stone). Modified Clavien complication scale was used to grade and compare the perioperative complications between both groups. Success rate of PCNL monotherapy and the need of secondary procedures were compared. RESULTS: During the study period, 122 PCNL procedures were performed for 97 children (61 males, 36 females) with mean age 7.1 (0.5–14) years. Group I included 57 procedures while group II included 65 procedures. There were no statistically significant differences between both groups with regard to age, gender, BMI, indications of the procedure, renal characteristics. Also, a comparable data were found for operative details such as number of PCNL sessions and mini-Perc procedures. However, multiple puncture tracts were created in 4 (7%) procedures in group I and in 21 (32%) procedures in group II (P-value 0.001). Perioperative complications were 35 (28.7%) in 122 procedures. Low grade complications (G1–G3a) were 33 (27%) and high grade complications (G3b-G5) were 2 (1.6%). Table 1 shows the sort and distribution of complications. 2nd session PCNL was needed in 6 and 13 procedures in group I &II respectively (P-value 0.21). Stone free rate for PCNL monotherapy was 94.7% and 72.3% in group I &II respectively (Pvalue 0.013). Secondary procedures were needed once (1.7%) in group I and in 10 procedures (15.3%) in group II (P-value 0.017). CONCLUSIONS: High grade complications during PCNL in pediatric patients were seldom occurring. Complexity of the stone is not a risk of complications as long as the procedure is done by experienced surgeon Table 1. Perioperative complications according to modified Clavien scale. Grades Types of complications Group 1 Group 2 Grade 1 fever for antipyretics 5 2 haematuria 2 3 Grade 2 bleeding or haematuria requiring blood transfusion 2 1

1890 THE “ALL-SEEING NEEDLE“ – AN OPTICAL PUNCTURE SYSTEM CONFIRMING PERCUTANEOUS ACCESS IN PCNL

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopic or Percutaneous Stone Removal IV1 Apr 20101890 THE “ALL-SEEING NEEDLE“ – AN OPTICAL PUNCTURE SYSTEM CONFIRMING PERCUTANEOUS ACCESS IN PCNL Markus Bader, Christian Gratzke, Boris Schlenker, Derya Tilki, Oliver Reich, Christian Gozzi, Rudolf Pfab, and Christian Stief Markus BaderMarkus Bader München, Germany More articles by this author , Christian GratzkeChristian Gratzke Munich, Germany More articles by this author , Boris SchlenkerBoris Schlenker Munich, Germany More articles by this author , Derya TilkiDerya Tilki München, Germany More articles by this author , Oliver ReichOliver Reich Munich, Germany More articles by this author , Christian GozziChristian Gozzi Munich, Germany More articles by this author , Rudolf PfabRudolf Pfab Fürstenfeldbruck, Germany More articles by this author , and Christian StiefChristian Stief Munich, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1844AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In PCNL, real time fluoroscopy and ultrasound have made the percutaneous access substantially safer and have reduced access related complications. However, there is no final confirmation of the quality of the access until the tract has been dilated and the nephroscope has been inserted. After the full size access has been established, there is hardly a way to correct a suboptimal or wrong access. METHODS We describe our initial experience of using a micro-optical system through a particular puncture needle in order to confirm the quality of the chosen access prior to dilating the operating tract to standard nephroscope sizes of 24-28F. We used micro-optics of 0.9mm (angle of view: 120°) and 0.6 mm (angle of view: 70°) diameter, with resolutions of up to 10k Pixels suitable for exploration of renal calyces and pelvis. The micro-optics with integrated light lead are inserted in the working sheath of the puncture needle. The special needle has an outer diameter of 1.6mm (4.85F), slightly larger than the diameter of a standard needle of 1.3mm. The needle comprises a Y-piece for connection of irrigation. The optics are length adjusted so that the distal end is flush with the tip of the needle. The optics are connected via a zoom ocular and light adapters to standard endoscopic camera systems and to Xenon light sources of at least 100W power. RESULTS The optical puncture needle was used in 15 patients during PCNL procedures. In all cases, we were able to visualize the punctured kidney calyces and to confirm presence of calculi prior to dilating up the tract for insertion of the operating nephroscope. The 0.9mm optic was found to be superior in terms of field of view, brightness and sharpness. Sufficient irrigation was confirmed for both optical systems. The puncture with the 1.6mm needle was smooth and no differences compared to standard 1.3mm needles were perceived. CONCLUSIONS The optical puncture needle for PCNL appears to be extremely helpful for confirming the percutaneous access to the kidney prior to dilation of the operating tract, thus making PCNL, a surgery where access is the key, inherently safer. In our opinion, this system can substantially assist the learning curve for puncturing of the kidney. The space inside the working sheath of the needle is even sufficient to introduce a laser fiber (365 micrometer with the 0.9mm optics, up to 600 micrometer with the 0.6mm optics) for lithotripsy of small fragments into spontaneously passable fragments. This therapeutic extension will be investigated in future treatment series. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byDesai M, Sharma R, Mishra S, Sabnis R, Stief C and Bader M (2018) Single-Step Percutaneous Nephrolithotomy (Microperc): The Initial Clinical ReportJournal of Urology, VOL. 186, NO. 1, (140-145), Online publication date: 1-Jul-2011. Volume 183Issue 4SApril 2010Page: e734-e735 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Markus Bader München, Germany More articles by this author Christian Gratzke Munich, Germany More articles by this author Boris Schlenker Munich, Germany More articles by this author Derya Tilki München, Germany More articles by this author Oliver Reich Munich, Germany More articles by this author Christian Gozzi Munich, Germany More articles by this author Rudolf Pfab Fürstenfeldbruck, Germany More articles by this author Christian Stief Munich, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Renal functional effects of simultaneous bilateral single‐tract percutaneous access in pigs

To present our findings of simultaneous bilateral percutaneous nephrolithotomy (sbPCNL) on bilateral renal haemodynamic and excretory function in an in vivo pig model, as despite sbPCNL being a treatment strategy for patients with bilateral renal stones, the functional response of both kidneys to such a procedure is unknown. Nine anaesthetized female pigs ( approximately 70 kg) had a single-tract PCNL procedure in the left kidney and then the right kidney in one session (sbPCNL). Percutaneous access was achieved by a 30 F balloon dilator system. Bilateral renal function was measured before, 1.5 and 4.5 h after sbPCNL and included glomerular filtration rate (GFR), effective renal plasma flow (RPF), renal extraction of para-aminohippurate (EPAH, a measure of the efficiency of tubular organic anion transport), urine flow (UV), absolute sodium excretion (UNaV) and fractional sodium excretion (FENa). Both kidneys had similar baseline haemodynamic and excretory function, and showed comparable changes after sbPCNL. Bilateral GFR and RPF decreased by approximately 35% at 1.5 and 4.5 h after sbPCNL; EPAH was reduced to a similar degree in both kidneys at 1.5 h after sbPCNL and remained depressed throughout the observation period; bilateral UV and UNaV progressively decreased by approximately 30% and approximately 60% at 1.5 and 4.5 h after sbPCNL, respectively; bilateral FENa did not significantly change at 1.5 h after sbPCNL but decreased significantly by approximately 50% at 4.5 h. Both kidneys responded in a similar fashion after sbPCNL, with declines in haemodynamic and excretory function. These bilateral functional responses were comparable to those previously reported after unilateral PCNL, and help to reduce concerns that PCNL of both kidneys in one session could lead to greater functional complications, at least acutely.