Percutaneous Nephrolithotomy For Staghorn Stones Research Articles

Evaluating outcomes of patient-centered enhanced recovery after surgery (ERAS) in percutaneous nephrolithotomy for staghorn stones: An initial experience.

To evaluate the outcomes of patient-centered enhanced recovery after surgery (ERAS) in -percutaneous nephrolithotomy (PCNL) for staghorn stones. A retrospective analysis of 106 patients with staghorn calculi who underwent PCNL treatment at the Third Xiangya Hospital from October 01, 2018 to September 30, 2021 was performed. The patients were divided into the ERAS group (n = 56) and traditional group (n = 50). The ERAS program focused on a patient-centered concept, with elaboration on aspects, such as patient education, nutritional support, analgesia, body warming, early mobilization, nephrostomy tube removal, and strict follow-up. The total stone free rate and total complication rate were similar in both groups. The visual analogue scale (VAS) 6 h after surgery, ambulation off bed time, indwelling fistula time, indwelling catheter time, and postoperative hospital stays were lower in the ERAS group than in the traditional group (P < 0.05). The multiple session rate in the ERAS group (19, 28.57%) was lower than that in the traditional group (30, 60%) (P = 0.007). The 1-year stone recurrence rate in the ERAS group (7, 17.5%) was lower than that in the traditional group (14, 38.9%) (P = 0.037). The patient-centered ERAS in PCNL for staghorn stones accelerated rehabilitation by relieving postoperative pain, shortening hospitalization time, accelerating early ambulation, and reducing multiple session rate and 1-year stone recurrence rate, which have socioeconomic benefits.

Evaluation of nephrolithometric scoring systems to predict outcomes and complications of percutaneous nephrolithotomy for staghorn stone

Background/Aim: Urinary system stone disease develops with a frequency of 1-20 % in the general population. There are various surgical methods and percutaneous nephrolithotomy (PCNL) is a commonly used treatment method, especially in large, staghorn kidney stones. Aim of this study was compare stone nomograms in forecasting operative and complicating parameters subsequent to PCNL in staghorn stones. Methods: The study analysed 66 patients with staghorn stones who underwent PCNL between 2017 and 2022, retrospectively. The researcher evaluated the Guy, S.T.O.N.E. and CROSS nephrolithotomy scores in patients using non-contrast computed tomography. The Clavien Dindo Classification was used to evaluate the surgical complication. Results: The mean stone burden, GUY, S.T.O.N.E. and CROES scores were 1114.9 ± 520.18 mm²; 3.64 ± 0.48; 10.11 ± 1.2 and 142.9 ± 31.99, respectively. Total stone-free status (SFS) was achieved in 37.9 % of the patients, while the median stone clearance rate was 93.74 (50-100). While no statistical significance was observed between GUY score and SFS, it was observed in S.T.O.N.E. and CROES scores (p = 0.020 and 0.004, respectively). ROC analysis showed that CROES and S.T.O.N.E. scoring systems and the stone burden parameter showed similar accuracy in the estimation of SFS. The results showed that only the S.T.O.N.E. score showed a significant relationship with the presence of complications (p = 0.034). Conclusion: If the percutaneous nephrolithotomy for staghorn stones in question is, current scoring systems alone couldn't be predictive for postoperative outcomes and degree of complications. Further large scale multicentre prospective studies are needful.

Preliminary Outcome Comparison of Flexible Uretero-Renoscopic Lasertripsy Versus PCNL in the Treatment of Staghorn Calculi

Percutaneous nephrolithotomy (PCNL) is a well-established treatment for staghorn stones. Given the im-provement in technology and techniques of flexible ureterorenoscopic lasertripsy (FURS), we retrospectively compared its treatment outcome against PCNL for staghorn stones at our institution. Materials and Methods All patients with partial and complete staghorn stones treated by FURS or PCNL between December 2014 and December 2017 were included. Outcome measures included the duration of the procedure, length of stay, retreatment rate, auxiliary rate, complications, and clinical success rates (stone or dust-free status). Results Out of 22 staghorns, 10 (1 complete, 9 partial) had FURS and 12 (2 complete and 10 partial) had PCNL. Comparatively, the FURS group were older (mean 70.1 vs. 57.1 years, U-test p&lt;0.001) with higher mean ASA scores (mean 2.3 vs. 1.5, U-test, p=0.04), with a similar body-mass index (mean 29.1 vs. 27.3), maximum stone size (29.7 vs. 34.6mm) and Hounsfield unit (836 vs. 891HU). FURS was quicker to clinical success (102.4min vs. 159.5min, U-test p&lt;0.001) and had shorter hospital stay (1.1d vs. 3.5d, U-test p&lt;0.001). Higher primary procedure success [80% vs. 36%, 95% CI = (-3.0%, 74.5%)], higher overall success [90% vs. 73%, 95% CI = (-22%, 51%)], similar retreatment rate (10%), and higher auxiliary treatment rate (100% vs. 18%) were observed. 1 patient from FURS had a small intrapa-renchymal aspect of staghorn inaccessible to a laser. There were no complications in the FURS group. In the PCNL group, one developed a pseudoaneurysm requiring embolization, and 1 had failed PCNL access (excluded from the statistical calculation). Conclusion Our preliminary data suggest that FURS is efficacious and safe for staghorn stones treatment, and comparable to PCNL. In this context, we highlight FURS potential role as first-line management of staghorn stones.

Assessment of lower calyceal single-access percutaneous nephrolithotomy for staghorn stones: A single-surgeon and a single-center experience at KAMC, Riyadh.

Introduction:Percutaneous nephrolithotomy (PCNL) is still the mainstay and the treatment of choice for most complex renal stones. The success of PCNL is defined by achieving a stone-free rate (SFR). Lower calyceal access PCNL is established to be the safest percutaneous access to the renal system, but controversy is present when it comes to SFR in comparison to upper calyceal and middle calyceal accesses.Aim:We aim to prove that lower calyceal access PCNL is the safest PCNL access and has the same efficacy as upper calyceal access PCNL for staghorn stones.Methodology:All lower calyceal access PCNLs done from May 2012 to August 2017 were included in the study. Postoperative complications were reported using the modified Clavien Grading System.Results:Sixty-seven patients were included in the study. The mean age was found to be 49.39 years; most (36 [53.73%]) patients were male. The prevalence of diabetes, hypertension, dyslipidemia, and chronic kidney disease was 40.91%, 47.76%, 37.31%, and 20.00%, respectively. The mean hospital stay was 7.9 days; mean operative time was 138.52 min. The mean staghorn stone burden was 476.34 mm2. About 80.59% (n = 54) of patients had complete stone resolution after the first session. Only 3 (4.47%) patients had complications and classified as Grade 2 on the modified Clavien Grading System and the remainder were classified as Grade 1, two patients needed postoperative blood transfusion, and one had a renal pelvis perforation.Conclusion:When it comes to safety and efficacy, the use of lower calyceal single-access PCNL has a very low complication rate compared to upper calyceal access PCNL, especially pneumothorax and bleeding.

Percutaneous nephrolithotomy for staghorn stones: Which nomogram can better predict postoperative outcomes?

To identify independent predictors for postoperative stone-free status after percutaneous nephrolithotomy (PCNL) for staghorn stones and to compare Guy's, CROES and STONE nomograms regarding their predictive ability and accuracy specifically for staghorn stones. Data of 286 patients who underwent PCNL in our department were collected and analyzed. Several parameters, including the three nomograms, were analyzed to reveal independent predictors for postoperative stone-free status. The area under the curve was used to assess the predictive ability of the independent predictors. A total of 73 staghorn calculi were identified with mean stone burden of 1253.5mm(2). Mean Guy's, CROES and STONE score was 3.34, 125.8 and 9.95, respectively. Postoperative stone-free rate was 65.8%. In univariate analysis, all three nomograms were significantly associated with stone-free status. However, STONE was the only significant independent predictor in multivariate analysis. STONE also revealed the highest predictive accuracy compared to Guy's and CROES nomogram. STONE nephrolithometry was found to be the only predictor for stone-free rate after PCNL for staghorn stones compared to Guy's and CROES nomograms.

Balloon dilator versus telescopic metal dilators for tract dilatation during percutaneous nephrolithotomy for staghorn stones and calyceal stones

ObjectiveTo compare the results of balloon dilatation (BD) vs. telescopic metal dilators (TMDs) in establishing the tract for percutaneous nephrolithotomy (PCNL) in patients with calyceal stones or staghorn stones, but with no hydronephrosis. Patients and methodsData from selected patients over 4years were recorded retrospectively. Patients with complex staghorn stones, an undilated targeted calyx, or the stone filling the targeted calyx, were included in the study. In all, 97 patients were included, of 235 undergoing PCNL between March 2010 and March 2014, and were divided into two groups according to the technique of primary tract dilatation. Group A included patients who had BD and group B those treated using TMDs. ResultsIn group A (BD, 55 patients) dilatation was successful in 34 (62%). The dilatation failed or there was a need for re-dilatation using TMD in 21 patients (38%). In one of these 21 patients the dilatation failed due to extravasation. In group B (TMD, 42 patients) dilatation was successful in 38 (90%) patients, with incomplete dilatation and a need for re-dilatation in four (10%) patients, and no failed procedures. Group A had a significantly higher failure rate than group B (P<0.001). Differences in operative duration, blood loss, stone-removal success rate and complication rate were statistically insignificant. ConclusionBD has a higher failure rate than TMD when establishing access for calyceal stones or staghorn stones that have little space around them.

Clinical study of balloon dilation in percutaneous nephrolithotomy for staghorn stones

Objective To access the safety and efficacy of balloon dilation in percutaneous nephrolithotomy for staghorn stones.Methods Clinical data of 64 patients with staghorn stone according to the inclusion criteria in our institution from April 2013 to April 2014 were collected and analyzed retrospectively.According to the dilation methods,the patients were divided into balloon dilation group (dilated to 24 F by balloon dilator,31 cases) and fascial dilation group (dilated to 16 F by Amplatz fascial dilator,33 cases).There was no significant difference in sex,age,body mass index between the 2 groups.The data of duration of percutaneous access,one-attempt success rate of dilation,puncture complications (kidney calices fracture,perinephric fluid collection and postoperative delayed hemorrhage etc.),removing stones time,stone free rate,hemoglobin drop after surgery and number of patients who experienced postoperative fever ＞37.5 ℃ were recorded.Results Compare to fascial dilation group,balloon dilatation group had significant differences in terms of duration of percutaneous access [(5.6± 2.1) min versus (9.4± 1.7) min],oneattempt success rate of dilation[100％ (31/31) versus 88％ (29/33)],removing stone time[(32.4±3.4) min versus (49.5±3.7) min],stone free rate [84％ (26/31) versus 61％ (20/33)],hemoglobin drop after surgery [(16.7±3.3) g/L versus (28.4±2.6) g/L],renal intrapelvic pressure[(19±3) mmHg versus (25±6) mmHg] and rate of patients who experienced postoperative fever ＞37.5 ℃ [16％ (5/31) versus 39％(13/33)] (P＜0.05).No injury of adjacent organs,including pleura,liver,spleen,or bowel was noted in all patients.Conclusions Balloon dilation is quick and safe with less hemorrhage when building percutaneous renal channel.And it has higher stone free rate and less complication rate in percutaneous nephrolithotomy with staghorn stones. Key words: Balloon dilation; Nephrostomy, percutaneous; Kidney calculi; Staghorn stones

Balloon dilation versus Amplatz dilation during ultrasound-guided percutaneous nephrolithotomy for staghorn stones

Background Amplatz dilation and balloon dilation are different methods in creating the accesses during percutaneous nephrolithotomy (PCNL). The aim of this study was to review the surgical experiences of managing staghorn calculi by Amplatz dilation and balloon dilation for 3 years. Methods We retrospectively analyzed clinical data from 125 patients (129 kidneys) with staghorn kidney stones who underwent PCNL from January 2010 to December 2012, of whom 60 patients underwent Amplatz dilation (AD group) and 65 underwent balloon dilation (BD group) during PCNL. Results The AD and BD groups were similar in age, male-female ratio, stone burden, stone type, hydronephrosis, and proportion of patients who had undergone extracorporeal lithotripsy. However, these two groups showed significant differences in terms of duration of percutaneous access (15.1±3.6) minutes vs. (10.0±3.3) minutes, one-attempt success rate of dilation via a single access 88.9% (72/81) vs. 97.8% (91/93), hemoglobin drop after surgery (3.5±0.9) g/dl vs. (1.7±0.9) g/dl, number of cases requiring intraoperative and postoperative blood transfusion 27.9% (n=17) vs. 13.2% (n=9), changes of central venous pressure before and after surgery (2.3±1.2) cmH2O vs. (1.2±0.7) cmH2O, number of patients who experienced postoperative fever &gt;37.5°C 21 (34.4%) vs. 13 (19.1%) (all P &lt;0.05). No injury of adjacent organs, including pleura, liver, spleen, or bowel, was noted in patients. Conclusions During ultrasound-guided PCNL for staghorn stones, balloon dilation and Amplatz dilation are all effective and safe. Compared with Amplatz dilation, balloon dilation is a better choice, as it has a higher access creation success rate, shorter access creation time less blood loss, and lower proportions of circulatory overload and postoperative fever.

Percutaneous Nephrolithotomy for Staghorn Stones in Patients with Solitary Kidney in Prone Position or in completely Supine Position: a Single-center Experience

To evaluate the effectivity and safety of percutaneous nephrolithotomy (PCNL) in the treatment of solitary kidney with staghorn stones in prone position or in completely supine position. We retrospectively reviewed the records of 18 patients with staghorn stones in a solitary kidney treated with PCNL. 12 patients underwent PCNL in prone position (group A). 6 patients underwent PCNL in completely supine position (group B). Demographic data, number of accesses, operating time, stone free rate, hemoglobin values, hospital stay and complications were studied. Serum creatinine, systolic and diastolic blood pressure, and new onset hypertension were determined preoperatively and postoperatively at 3 months. No blood transfusions were required and no abdominal or thoracic organ injuries were reported in both groups. The mean operative time was 104 minutes (range: 72-145 minutes) and 128 minutes (range: 80-170 minutes), respectively. The I stage stone free rate was 91.7 % and 83.3 %, respectively. There was no new onset hypertension by the end of follow-up in both groups. Both groups showed a similar fall in serum creatinine at 3 month follow-up period (p = 0.004 and 0.029, respectively). Systolic blood pressure showed a statistically significant improvement in group B (p = 0.034). PCNL is safe and has an acceptably high stone free rate in patients with solitary kidneys in both prone and completely supine position. At short-term follow-up, systolic blood pressure had improved in PCNL in supine position.