Complications Of Percutaneous Nephrolithotomy Research Articles

Comparison outcomes of percutaneous nephrolithotomy in prone and flank position in obese patients: A randomized clinical trial.

The aim of this study was to compare the complications of percutaneous nephrolithotomy (PCNL) surgery in Flank and Prone positions in patients with a BMI above 30. In this randomized clinical trial patients were randomly assigned to PCNL treatment in one of two groups undergoing PCNL under fluoroscopic guidance in Flank or Prone positions. Patient demographic information, stone number, size and location, stent duration, hospital stay, blood loss, Creatinine, hemoglobin, hematocrit changes, and arterial blood gas changes and acid-base hemostasis were collected. In this study, 60 patients were examined, which were divided into two groups of 29 people, prone and 31 people. Mean stone size was 3.16 ± 0.82 cm. arterial blood gases did not differ significantly between two groups. The SFR (stone free rate) in the prone and flank groups was 91.02% and 86.89%, respectively. However, SFR and Complications in the prone and flank groups were not significantly different (p value of 0.081 and 0.13, respectively). According to the results of this study, PCNL complications and acid-base changes is not significantly different in flank and prone positions in obese patients. However, SFR is slightly lower in flank group. Thus, PCNL in flank position is not superior to prone position in obese Patients. It is recommended to choose each of these surgical methods according to the surgeon's facilities and skills.

Visualization of the renal vein filled with contrast agent may indicate the renal vein injury during percutaneous nephrolithotomy: two case reports

BackgroundIntravenous misplacement of a nephrostomy tube is a rare complication of percutaneous nephrolithotomy (PCNL) or percutaneous nephrostomy. The mechanism of misplacement of a nephrostomy tube into the vascular system is seldom investigated. One type of the possible mechanism is that the puncture needle penetrates a major intrarenal tributary of the renal vein and enters the collecting system. However, the guidewire is located outside the collecting system near the large branches of renal vein or perforates into the renal vein. The dilation is performed and causes a large torn injury. Subsequently, the nephrostomy tube is placed inside the vessel when radiological monitoring is not used. However, there is no imaging evidence and the scene of procedure is not demonstrated. This paper reports two cases of visualization of the renal vein filled with contrast agent during PCNL. The findings may be good evidence to support the step of renal vein injury in patients with intravenous nephrostomy tube misplacement.Case presentationWe presented two cases with visualization of the renal vein filled with contrast agent during PCNL. In the process of injecting the contrast agent through the puncture needle, we could see the renal vein. Moreover, it was identified that the puncture needle tip was not on the optimal position. The position of puncture needle tip lay outside the collecting system, which was close to the calyceal infundibulum and branches of renal vein.ConclusionsVisualization of the renal vein filled with contrast agent may be good evidence to verify the renal vein injury in patients with intravenous nephrostomy tube misplacement during PCNL or percutaneous nephrostomy. The suboptimal location of the puncture needle tip and visualization of the renal vein filled with contrast agent indicate the renal vein injury. One type of mechanism of intravenous nephrostomy tube misplacement is as following. Firstly, the guidewire stays outside the collecting system. Subsequently, dilatation directed by the guidewire results in the injury of the vein. Then, the nephrostomy tube migrates into the venous system due to prompt tube inserting and the direction of the sheath and/or the guidewire to the injured vein.

EVALUATION OF COMPLICATIONS AND SUCCESS RATES OF PCNL,USING MODIFIED CLAVIEN GRADING SYSTEM: A SINGLE-CENTER EXPERIENCE

OBJECTIVE: The purpose of this retrospective study is to document the perioperative complications of percutaneous nephrolithotomy (PCNL) using the modied Clavien grading system at a tertiary care centre. MATERIAL & METHODS: A retrospective study of 133 patients who underwent standard PCNL in the department of Urology and Renal Transplant,during the period January 2019 to March 2020 at Sri Aurobindo Institute of Medical Sciences,Indore, India. A structured questionnaire was used to get relevant information,while peri-operative complications were recorded using the modied Clavien grading system. RESULTS: The mean age of patients was 38.2years,male: female ratio was 1.18:1. Stones were categorized as simple in 48.9% and complex in 51.1%. The lower calyx was the commonest site of stone location (45.5%) and puncture site (76.7%). The mean operative time was about 58 minutes and the mean haemoglobin drop was 1.5g/dl. The blood transfusion rate was 3% and the stone free rate after the procedure was 93.2%. The mean length of hospital stay was 3.4 days. CONCLUSION: PCNL is an effective treatment with good clearance rate and acceptable morbidity in experienced hands.

To Evaluate the Rate of Stone Clearance of Supracostal and Infracostal Approaches and to Identify the Complications of Two Groups

Introduction: Renal stone disease is a challenging problem in urological practice because of large stone burden and high rate of recurrence. The primary goal of surgical stone management is to achieve maximum stone clearance with minimum morbidity to the patients. There are lot of uncertainty with renal stone management, many factors impact on management course, stone up to 10 mm can be pass on their own, roughly, the chance of a stone passing spontaneously is inversely to the size in millimeters. A 1mm stone passes 90% of the time, a 5 mm stone 50% of time, a 9 mm stone 10% of the time and so on. Objectives: The aim of this study was to evaluate the rate of stone clearance of supracostal and infracostal approaches and to identify the complications of two groups. Methods: This Quasi experimental study was carried out in the Department of Urology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh Medical College Hospital, Popular Medical College and Hospital; and Barakah Kidney Hospital & Research Institute, Dhaka, during the period of February 2011 to January 2013, to compare the safety and efficacy between supracostal and infracostal upper pole approaches for PCNL. Results: Stone clearance was 94.29% in group I and 85.7% in group II, which was higher in group I but not statiscally significant (P>0.05). Hundred percent stone clearances were observed in patients who had stone size upto 3 cm in group I and 88.23% in group II. In patients who had stone size >3 cm the stone clearance was 89.4 % in group I and 83.33 % group II. Complications of percutaneous nephrolithotomy were found in 20.0% in group I and 22.9% in group II. Conclusion: In conclusion we can say that supracostal approach in a single session percutaneous nephrolithotomy is not safe and effective then infracostal approach.

Effect of Renal Function on Success and Complications of Percutaneous Nephrolithotomy

Objective: In this study, we aimed to compare the success and complication rates of percutaneous nephrolithotomy (PCNL) according to preoperative glomerular filtration rates (GFR) of patients who underwent PCNLdue to kidney stones. Material and Methods: Between January 2012 and December 2016, 794 patients who underwent PCNL due to kidney Stones were evaluated retrospectively. Preoperative GFR values of patients were calculated according to Cockcroft –Gault formula. The patients with preoperative GFR values>90 ml/min, 60-90 ml/min, 30-60 ml/min were respectively defined as group-1, group-2 and group-3. Preoperative and perioperative values, Stone free rates and complication rates were compared between the groups. Postoperatively , <4 mm residual stone was identified as success. Results: There were 466 patients in Group-1, 259 in Group-2 and 67 patients in Group-3. The mean preoperative GFR values of the patients were 118.53 ml/min, 77.76 ml/min and 48.52 ml/min, respectively in group-1, group-2 and group-3 (p <0.001).The mean age of the patients was 62.8±11.47, 51.86±11.10, and60.31±12.7, respectively, in group-1, group-2 and group-3 (p<0.001).The mean Stone burden of the patients were 497.34±518.60 mm2, 517.6±493.8 mm2and 711.06±679.07 mm2, respectively, in group-1, group-2 and group-3 (p=0.013). The number of patients identified with success after surgery was 355 (86.2%), 195 (76.1%) and 50 (74.6%) in group-1, group-2 and group-3, respectively (p = 0.542). The number of patients who develop complications was 114 (%24.65), 57 (%22) and 11 (%16.4) in group-1, group-2 and group-3, respectively (p=0.310). Conclusion: Preoperative GFR valuesare not lonely sufficient to predict success and complications after PCNL. Keywords: Percutaneous nephrolithotomy, renal function, renal stone, glomerular filtration rates

Post-operative complications in percutaneous nephrolithotomy - A single center experience with emphasis on supracostal approach

Post-operative complications in percutaneous nephrolithotomy - A single center experience with emphasis on supracostal approach

A Comparison of Complications and Success Rates after PCNL in Younger and Elderly Patients

To compare the outcomes of percutaneous nephrolithotomy (PCNL) across younger and elderly, especially PCNL complications in terms of modified Clavian grading system. Cros-sectional comparative study. Department of Urology, Shifa International Hospital, Islamabad, from 2010 till 2018 December at a tertiary care hospital. Patients who underwent unilateral PCNL were reviewed group 1 (younger, age < 60 years) had 594 patients; while group 2 (elderly, age >60 years) had 137 patents. Information regarding complication and success rate were recorded by residents in proforma and then processed for statistical computations. There were total of 731 subjects. The mean age in group 1 was 39.7±11.2 years and that of group B was 65.66±4.55 years. The mean size for calculi in group 1 was 2.83±1.32 cm while in group 2 stone size reached 2.81±1.04 cm. A total of 174 (23.8%) complications and stone free rate of 81.8% (598/731) was recorded in this study. Overall when compared, no notable difference in complications, hospital duration and success rates was observed between the young and elderly age group. Despite old age, the success rates and complications were not remarkably different from that of the younger subjects for prone PCNL. Key Words: Percutaneous nephrolithotomy, Geriatrics, Renal stone, Complications.

Injury to Biliary Tract During Percutaneous Nephrolithotomy: Minimally Invasive Management of a Dreadful Complication

Background: Percutaneous nephrolithotomy (PCNL) is an effective minimally invasive surgical modality for the management of renal calculi. It is generally considered safe with commonly encountered complications being urinary extravasation, fever, and bleeding. Injury to the biliary tract or puncture of the gallbladder is an extremely rare but a grave complication of PCNL. Case Presentation: We present a case of a 70-year-old man who underwent PCNL for an obstructing right renal pelvic calculus. Upon middle caliceal puncture to access the pelvicaliceal system, an unexpected green aspirate suggestive of bile was noted egressing through the puncture needle when stiletto was detached. The needle was swiftly withdrawn and percutaneous renal access was effective on the second puncture to complete the procedure. In the postoperative period, biliary ascites was confirmed on imaging, which was managed in a minimally invasive manner with an ultrasonography-guided abdominal drain insertion. The patient recovered well and was discharged home. Conclusion: Biliary ascites with or without peritonitis is a rare but potentially fatal consequence of biliary tract injury that can occur during PCNL. If there is recognition of biliary aspirate during a percutaneous renal procedure, aggressive management, including diverting the biliary fluid in appropriately selected cases, can obviate the need for emergent open or laparoscopic surgical intervention as highlighted in our case.

Percutaneous nephrolithotomy in previously operated patients: A prospective study

Purpose:To determine the effect of previous renal stone surgery on result and complications of percutaneous nephrolithotomy (PCNL).Materials and Methods:Total 300 patients were enrolled in the study. We enrolled 100 surgery-naive cases (those with no history of any renal surgery) as control and labeled them as Group A. Group B comprised 100 cases who had PCNL in the past. Group C constituted 100 patients who had open renal stone surgery in the past. Stones were classified using Guy's stone score. PCNL was performed by standard technique in prone position and technical features encountered during operation and outcomes were compared between groups. Complications were graded using modified Clavien grading system.Results:There were no differences between the three groups in age, gender, body mass index, stone burden, and stone opacity. Multiple calyceal stones and distorted pelvicalyceal system anatomy were more in Group C, but stone score showed no statistically significant difference from other groups. The mean operative time (68.91 ± 21.27 min) and fluoroscopy time (264.40 ± 74.90 s) were longer in Group C, but there was no statistically significant difference between the groups. Multiple access was significantly more common in Group C compared to the other two groups (P < 0.001). Access location too did not show any statistically significant difference between the groups. Postoperative complications were more in previous stone surgery patients, but did not show statistically significant difference.Conclusion:PCNL is a safe and effective treatment modality for patients with renal stones regardless of history of previous PCNL or open renal surgery.

AN UNCONVENTIONAL CONNECTION: IATROGENIC NEPHROPLEURAL FISTULA AFTER PERCUTANOUS NEPHROLITHOTOMY

SESSION TITLE: Medical Student/Resident Signs and Symptoms of Chest Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: A nephropleural fistula is an abnormal connection between renal parenchyma and pleural lining, it’s a known complication of percutaneous nephrolithotomy (PCNL) which can happen in both immediate and delayed setting (1). We describe a case of 88-year-old female who developed this fistula 2 days after the procedure. CASE PRESENTATION: 87-year-old female with a past medical history of recurrent UTIs and right nephrolithiasis presented with right sided flank pain. CT abdomen pelvis showed 8 mm right ureteral calculus and mild right hydronephrosis. Urine and blood cultures grew E. coli. She was diagnosed with urosepsis and treated with IV ceftriaxone. She required a right ureteric stent and patient was discharged home. A few weeks later, the patient was admitted to the hospital for a cystoscopy and replacement of her right sided JJ stent. She underwent right sided percutaneous nephrolithotomy. On Post-op day 2, the patient started to develop hypoxemia while ambulating, and required 3L nasal canula to maintain oxygen saturation >95%. Chest X ray revealed new bilateral pleural fluid collections. Patients hemoglobin dropped from 11.9 to 6.6. CT scan of the chest showed moderate to large right basilar hemothorax with a communication between right kidney to the right pleural cavity. Thoracic surgery was consulted for evaluation/management of right hemothorax. The patient required a video-assisted thoracoscopic surgery procedure with hemothorax evacuation and intercostal tube placement and drainage. The patient's condition improved, and the chest tube was removed with closure of the nephropleural fistula. Deemed medically fit to be discharged with follow up for the removal of her JJ stent through cystoscopy. DISCUSSION: Iatrogenic nephro-pleural fistula is a very rare but potentially life-threatening complication following PCNL. There are only a handful of case reports in the current literature. Most often occurring in the immediate phase during intraoperative fluoroscopy (1). The direct connection created intra-operatively between the thoracic cavity and renal collecting system allows the build up of fluid and urine into the chest. This can potentially lead to the development of pleural effusions and invariably compromising respiratory function & status. Most fistulas can be managed conservatively with the use of thoracentesis without the need for further surgical intervention. However rarely more aggressive treatment is required including temporary chest tube placement with or without pleurodesis for recurrent/refractory fistulas(2). CONCLUSIONS: This case highlights the importance of a considering a delayed nephropleural fistula following an uneventful PCNL in patients complaining of respiratory symptoms following stent removal. A delayed nephropleural fistula should be considered in any patient that develops shortness of breath, increasing oxygen requirement or evidence of pleural effusions. Reference #1: Kaler, K. S., Cwikla, D., & Clayman, R. V. (2016). Delayed Nephropleural Fistula After Percutaneous Nephrolithotomy. Journal of endourology case reports, 2(1), 99–102. https://doi.org/10.1089/cren.2016.0050 Reference #2: Baugh, A. D., Youssef, E., Hasan, S. S., Siddiqui, N. S., Elsamoloty, H., Shahrour, K., & Javaid, T. (2016). Nephropleural Fistula Effectively Managed with Serial Thoracentesis: A Case Report. Journal of endourology case reports, 2(1), 212–214. https://doi.org/10.1089/cren.2016.0102 DISCLOSURES: No relevant relationships by Sanchit Chawla, source=Web Response No relevant relationships by hussain karimi, source=Web Response

Preoperative risk factors for complications of percutaneous nephrolithotomy.

This study was conducted to evaluate preoperative risk factors for development of complications of percutaneous nephrolithotomy (PCNL). All consecutive patients aged ≥ 16years who underwent PCNL during 2015 were retrospectively reviewed. Non-contrast CT (NCCT) was performed for all patients to evaluate stone complexity. The technique of PCNL was the same for all patients. Intra-operative and postoperative complications were recorded and classified based on modified Clavien system. The differences in preoperative data (patients, renal and stone characteristics including Guy's and STONE scores) between complicated and uncomplicated cases were compared using univariate and multivariate statistical analyses for detection of independent risk factors. The study included 1178 patients (61% were males). Mean age was 50 ± 12years, and mean BMI was 30.7 ± 5.7kg/m2. Complicated group included 166 patients (14.1%). Independent risk factors on multivariate analysis were infected preoperative urine culture (RR: 2.098, P 0.001, 95%CI: 1.380-3.189), largest stones diameter 30mm or more (RR: 2.481, P > 0.001, 95%CI: 1.697-3.627) and number of calyces affected by the stones (RR: 2.431, P 0.002, 95%CI: 1.400-4.222 for affection of two calyces and RR: 2.778, P 0.005, 95%CI: 1.357-5.684 for affection of three calyces). While two scoring systems (Guy's and STONE) were not predictive of complications after PCNL, preoperative risk factors were infected preoperative urine culture, distribution of the stones or stone branches in two or three calyceal groups and stone size 30mm or more.

Embedded upper end of double J stent at the site of renal pelvis injury following percutaneous nephrolithotomy: a rare complication

BackgroundInjury of the renal collecting system is a well-known complication of percutaneous nephrolithotomy (PNL). Large injuries may cause excessive bleeding and fluid extravasation and require adequate drainage using several modalities such placement of JJ stents. Herein, we report on two cases in which the upper coil of the JJ stent got buried in the fibrous tissues which formed due to an injury of the collecting system during PNL.Case presentation40 years old male and 32 years old female underwent standard PNL for partial and total staghorn calculi, respectively. During the procedure in both cases, the renal pelvis was injured. In both cases, JJ stent was used to drain the collecting system. Trial to remove the JJ stent 6 weeks following the procedure failed because the upper coils of the stents were embedded in the fibrous tissues at the perforation site. Laser incision of the fibrous tissues and releasing the upper coil of the stents were performed using percutaneous approach in the first case and flexible ureterorenoscopy (fURS) in the second patient. The procedures were uneventful in both cases.ConclusionThis is the first report of embedded JJ stents which got buried by fibrous tissues at the site of collecting system injury that occurred during PNL. To prevent this complication in such cases, we suggest draining the collecting system using nephrostomy tube instead of JJ stent. Alternatively, the upper coil of the stent should be placed away from the injury site.

Guy’s Stone Score as a Predictor for Stone-Free Rate and Complications in Percutaneous Nephrolithotomy: A Single-Center Report from a Stone Belt Country

Objectives: To evaluate Guy’s Stone Score (GSS) as a grading system for the complexity of renal calculi before percutaneous nephrolithotomy (PCNL) and as a predictor for stone-free rate (SFR) and potential complications in the setting of a developing country with many cases of advanced complex stone disease. Patients and Methods: We performed a prospective study on 115 patients with renal stones who had PCNL between August 2017 and October 2018. Stone complexity was classified according to GSS using preoperative imaging. The rates of perioperative complications were assessed using the Clavien grading system, and the SFR was assessed in the 3rd postoperative week by abdominal X-ray and renal ultrasound. The χ² and one-way ANOVA tests were used for statistical analysis. A p value ≤0.05 was considered significant. Results: The study included 115 patients (77 males) with a mean age of 50.2 (±13.3) years. Cases were classified according to GSS into 4 grades; there were 24 (20.9%) grade I, 48 (41.7%) grade II, 25 (21.7%) grade III, and 18 (15.7%) grade IV cases. There was a significant inverse correlation between GSS grade and SFR (p < 0.001). The rate of complications using the Clavien grading system were significantly higher in GSS grades III and IV (p = 0.002). So were the rates of blood transfusion, the need for >1 access tract, and the duration of hospitalization. Conclusion: GSS is a simple and easily reproducible system to classify the complexity of renal stones. In our setting, it also proved an excellent tool to predict SFR, perioperative complications, and associated ancillary procedures. Ultimately, it can help surgeons and, above all, patients to make a more informed decision about their surgery.

Predictive Factors of Complications of PNL in Solitary Kidney: A Prospective Study.

Objectives: To analyze factors that can impact the intraoperative and postoperative complications and bleeding after percutaneous nephrolithotomy (PNL) in patients with a solitary kidney. Material and Methods: A prospective hospital-based study that was carried out at the Urology Department, Sohag University Hospital from June 2017 to June 2019. All patients with renal calculi in a solitary kidney were recruited and underwent PNL. Results: 150 patients were enrolled in this study. 93 (62%) patients were males while 57 (38%) patients were females. Initial SFR was achieved in 129 (86%) patients while residual fragments were reported in 21 (14%) patients. 39 (26%) patients had postoperative complications. On univariate analysis, the rate of complications was associated with the complexity of the stones, acute dilatation of the tract, and operative time (P-value = 0.048, 0.004 & 0.023 respectively). On the other hand; there was an association between the number of the accessed tracts and the rate of bleeding and blood transfusion (P-value = 0.008).Conclusion: PNL in solitary kidneys is a challenging procedure; however high SFRs can be achieved with a low rate of significant complications. The complexity of the stones, acute dilatation of the tract, and prolonged operative time are associated with more complications. Multiple tracts have a significant effect on intraoperative bleeding. PNL should be considered by urologists as an effective therapeutic choice for patients presenting with large burden stone disease in a solitary kidney.

3:36 PM Abstract No. 112 Hemorrhagic complications of percutaneous nephrolithotomy: factors affecting the complications

To elucidate factors affecting hemorrhagic complications of percutaneous nephrolithotomy (PCNL). Between April 2012 and January 2018, 196 kidneys (right/left: 85/111) in 188 patients (male/female: 83/105, median age: 66) with nephrolithiasis were treated with PCNL. Renal access was obtained mostly through a stone-bearing calyx (79.6%) in the angiography suite prior to PCNL. Medical records and imaging studies were reviewed to record hemorrhagic complications of PCNL, which required abortion of PCNL, blood transfusion, or CT angiography with/without angioembolization. To elucidate the factors affecting the hemorrhagic complications, binary logistic regression analyses were conducted with variables from patients’ demographics (age, sex, body mass index (BMI)), stone characteristics (size, location, CT density, complete or partial staghorn vs. non-staghorn, chemical composition/calcium oxalate-dominance), renal access characteristics (number of calyces punctured, number of renal access for PCNL obtained, accessed calyx (upper, mid, lower), fluoroscopy time/dose) and PCNL characteristics (operator (senior vs. junior), operation time). Of 196 PCNL procedures, 18 (9.2%) were associated with hemorrhagic complications including 5 (2.6%) requiring angioembolization. In univariate analysis, BMI<20 (P = 0.047), complete staghorn (P = 0.047), upper pole stone (P = 0.02), multiple accesses (P <0.01) and renal access fluoroscopy time (P = 0.03) were significant risk factors for hemorrhagic complications of PCNL. Stone composition/calcium oxalate dominance (P = 0.75), PCNL operator (P = 0.15) and operation time (P = 0.25) were not the significant risk factors. In multivariate analysis, BMI<20 (odds ratio (OR) 6.74, confidence interval (CI) 1.50-30.3, P = 0.013), multiple accesses (OR 9.82, CI 2.65-36.4, P = 0.001) and renal access fluoroscopy time (OR 1.04, CI 1.004-1.075, P = 0.028) remained statistically significant. Although hemorrhagic complications of PCNL could be multifactorial, renal access techniques appear to affect the complications. Prolonged manipulation for renal access and PCNL through multiple accesses, especially in patients with BMI<20, may increase the chance of the hemorrhagic complications.

Comparison of Stone-free Rate, Operation Procedure, and Complication Rate According to guy's Stone Score in Supine Percutaneous Nephrolithotomy

Background and Aim: Percutaneous nephrolithotomy (PCNL) was considered a safe and efficient method for removing kidney stones, with a low incidence of complications. This study aims to compare the success rate of PCNL based on guy's stone score (GSS) operating procedure and its complications. Methods: Data were collected from patients with kidney stones who underwent PCNL. A stone-free rate (SFR) was considered if the patient was either had no stone or had any stone that is &lt;4 mm and asymptomatic residual fragment. Complications were assessed using the modified Clavien score, and SFR was assessed by abdominal radiography. Results: A total of 198 patients were included in this study. There was a significant difference in SFR between simple (GSS I and II) and complex stone (GSS III and IV) groups (P = 0.000). The operation procedure was longer in the complex group compared to the simple groups for both total operating time and stone fragmentation time (P = 0.000). X-ray time was not significantly different (P = 0.061). Almost all patients were classified as Clavien I, as there was no significant difference between the two groups for complication (P = 0.277) or blood loss (P = 0.176). Conclusion: The success rate of PCNL based on the GSS at Gunung Jati Regional Hospital is quite good. There was a difference in the SFR between the groups, and the operating procedure time was longer in the complex stone group. There was no difference between the simple stone and complex stone groups in PCNL complications, which indicated a good surgical practice.

Can antibiotic preference affect bleeding in percutaneous nephrolithotomy? Retrospective comparative study of two commonly used antibiotics.

Objective:Bleeding is one of the most common and alarming complication of percutaneous nephrolithotomy (PCNL). In this study, we aimed to compare the effects of ciprofloxacin and cefuroxime on the bleeding in PCNL procedures.Methods:The study was a retrospective analysis of 97 patients who underwent PCNL between February 2011 and June 2017. We just included the patients who had single tract lower pole PCNL for more objective evaluation of bleeding in the study. The patients were divided into two groups as ciprofloxacin group (Group-I, n:40) and cefuroxime group (Group-II, n:56) according to the type of antibiotic used in the operation. Patient age, gender, body mass index, stone size, preoperative INR, preoperative and postoperative platelet counts and difference, operative time, need for blood transfusion, postoperative fever, hospital stay, postoperative hemoglobin and hematocrit drop were analyzed.Results:There was no statistically significant difference in patients’ gender distribution, body mass index, preoperative INR, preoperative and postoperative platelet counts, preoperative and postoperative platelet difference, duration of operation, hospital stay, postoperative fever and need for postoperative blood transfusion between two antibiotic groups (p > 0.05). Mean patient age was 42,75±16,97 in Group-I and 35,54±14,71 in Group-II (p < 0.05). The mean stone size of Group-I and Group-II were 27,23±7,05 mm and 30,59±8,20, respectively (p < 0.05). The mean postoperative hemoglobin and hematocrit drop were significantly higher in Group-I than in Group-II. The mean hemoglobin drop was 1,73±0,95 for Group-I and 1,28±0,67 for Group-II (p < 0.05). The mean hematocrit drop was 5,17±2,76 for Group-I and 3,80±1,99 for Group-II (p < 0.05).Conclusion:On the basis of the results of the initial study, the antibiotic preference in patients undergoing surgery may be one of the bleeding factors during and after PCNL.

Effect of Irrigation Solution Temperature on Complication of Percutaneous Nephrolithotomy: A Randomized Clinical Trial.

Many factors affecthypothermia and shivering during percutaneous nephrolithotomy and in recovery.Hence this study was carried out to determine the effect of irrigation solution temperature on complications ofpercutaneous nephrolithotomy. In this randomized clinical trial, 60 patients undergoing PCNL in Sina University Hospitalwere enrolled. The patients were randomly assigned in three groups according to simple random manner. Thegroups included three groups of room temperature fluid (24 degree), warm solution (37 degree), and cold fluid (20degree) during nephroscopy. Although the initial core temperature was alike across the groups (P > .05); the hypothermia rate occuredin all 20 patients in the cold fluid group (P = .012). There was significant difference between the groups interms of final temperature and alteration amount (P = .001). The mean VAS scores were significantly lower in thewarm fluid group compared with the others groups at recovery, and 8hrs post-operatively (P = .03). Assessmentof shivering rates revealed that 3(15%) patients in warm solution group shivered compared to8 (40%) patients incold fluid group (P = .018). Warm irrigation solution during PCNL results in significantly decreased hypothermia, mean postoperativepain score and shivering. Hence use of warm irrigation fluid for this matter is recommended.

Perkutan Nefrolitotomide Komplikasyonları Öngörebilir Miyiz?

Introduction: Percutaneous nephrolithotomy (PNL) has a high success rate, but on the other hand, serious perioperative and postoperative complications can be seen occasionally. In our study, we intended to identify the factors that might help us to predict the success of PCNL and the complications that may develop. Materials and Methods: PNL operations performed in 481 renal units in our clinic were divided into two groups as the cases with and without complications. Complications such as clinical conditions requiring blood transfusion, fever, ureteral stones, colonic injury, pleural injury and arteriovenous fistulas were compared. Results: Mean age was significantly higher in the group with postoperative complications in comparison to the group without complication. However, the incidence of complications was significantly lower in cases with pelvic stones in comparison to those with calyx and calyx+pelvic stones, while the cases with calyx+pelvic stones had a significantly higher rate of complications with respect to the other groups. Conclusion: It is demonstrated in our study that patient’s age and stone localization can predict complications in PNL. More attention needs to be paid to avoid complications in elderly patients and in complex stones.

Does Body Mass Index Impact the Outcomes of Ultrasound-Guided Percutaneous Nephrolithotomy?

Background and Purpose: To evaluate whether body mass index (BMI) has an impact on the outcomes of ultrasound-guided percutaneous nephrolithotomy (PCNL). Materials and Methods: The data of 359 patients who required PCNL at ShengJing hospital between June 2013 and July 2015 were reviewed, with the patients divided into 4 groups based on different ranges of BMI: <25, 25–29.9, 30–34.9, and ≥35 kg/m². Baseline characteristics and outcomes were compared between the groups. Multivariable logistic regressions were used to evaluate the independent contribution of BMI as a predictor of outcomes. The Modified Clavien classification system was used for reporting complications. Results were compared between the groups using the chi-square and multivariate logistic regression tests. Results: No significant differences were noted in the demographic data between the 4 groups. Ultrasound screening time, total operative time, and hospital stay all increased with increasing BMI. No difference was found in the complication rate, stone free rate, or need for auxiliary procedures. Conclusion: Obesity does not increase the incidence of complications in ultrasound-guided PCNL, and the efficacy of the technique for obese patients is similar to that for normal weight patients. The lateral decubitus position was preferred in patients with higher BMI.