Percutaneous Nephrolithotomy For Stones Research Articles

Randomized Controlled Trial Comparing Three Different Modalities of Lithotrites for Intracorporeal Lithotripsy in Percutaneous Nephrolithotomy.

To compare the efficiency (stone fragmentation and removal time) and complications of three models of intracorporeal lithotripters in percutaneous nephrolithotomy (PCNL). Prospective, randomized controlled trial at nine centers in North America from 2009 to 2016. Patients were randomized to one of three lithotripter devices: the Cyberwand, a dual-probe ultrasonic device; the Swiss Lithoclast Select, a combination pneumatic and ultrasonic device; and the StoneBreaker, a portable pneumatic device powered by CO2 cartridges. Since the StoneBreaker lacks an ultrasonic component, it was used with the LUS-II ultrasonic lithotripter to allow fair comparison with combination devices. Two hundred seventy patients were enrolled, 69 were excluded after randomization. Two hundred one patients completed the study: 71 in the Cyberwand group, 66 in the Lithoclast Select group, and 64 in the StoneBreaker group. The baseline patient characteristics of the three groups were similar. Mean stone surface area was smaller in the StoneBreaker group at 407.8 mm2 vs 577.5 mm2 (Lithoclast Select) and 627.9 mm2 (Cyberwand). The stone clearance rate was slowest in the StoneBreaker group at 24.0 mm2/min vs 28.9 mm2/min and 32.3 mm2/min in the Lithoclast Select and Cyberwand groups, respectively. After statistically adjusting for the smaller mean stone in the StoneBreaker group, there was no difference in the stone clearance rate among the three groups (p = 0.249). Secondary outcomes, including complications and stone-free rates, were similar between the groups. The Cyberwand, Lithoclast Select, and the StoneBreaker lithotripters have similar adjusted stone clearance rates in PCNL for stones >2 cm. The safety and efficacy of these devices are comparable.

Okul Çağı Öncesi Çocuklarda Perkütan Nefrolitotomi Sonuçları: Tek Merkez Deneyimi

Objective: Kidney stones are an important urological problem in both adults and children. They may be accompanied by metabolic disorders and genetic diseases and children make up approximately 20% of stone patients in our country. In our clinic, we evaluated the results from pre-school children 6 years of age and younger who underwent percutaneous nephrolithotomy (PNL) surgery. Material and Methods: Between March 2012 and June 2016, 54 pediatric patients aged 0-6 years were treated with PNL for stones that were larger than 2 cm or ESWL-resistant, after undergoing the appropriate tests at the Urology Department of the Harran University Faculty of Medicine. PNL operations were performed under general anesthesia. After cystoscopy in the supine position, a ureteral catheter was inserted, accompanied by C-arm fluoroscopy. Afterwards, the patients were placed in the prone position before the kidney was entered using a metal needle with a fluoroscopy attachment. We dilated the entrance with amplatzer renal dilators and entered with a 17 fr nephroscope. After the procedure, the nephrostomy catheter was placed in the renal sheath. 4 mm residual fragments remaining after the operation were accepted as clinically insignificant stone residues. Results: A total of 54 patients underwent PNL operations; 23 females and 31 males. The mean age was 3.16± 0.8. 25 left-sided and 29 right-sided procedures were used. Three patients had bilateral kidney stones; co-administration was not staged. Mean stone size was 370±45 mm2, while the mean operation time was 55 ± 21 minutes. 45 (83.3%) of the patients were stone-free after the operation. Postop, 2 (3.7%) had free fluid and ileus and 6 (11.1%) required additional blood products. They were stabilized with additional JJ stents. After a nephrostomy drain, 4 (7.4%) patients had a JJ stent inserted. Average duration of the nephrostomy was 3.1 ± 0.9 days. Conclusion: As with every age group, PNL was effective in treating stones larger than 2 cm as well as smaller ESWL-resistant specimens. Success in preschool children is practically guaranteed, with a minimally invasive surgical procedure.

Acute kidney injury after percutaneous nephrolithotomy for stones in solitary kidneys

Objectives: The aim of this study was to report the incidence, severity, outcome and risk factors of acute kidney injury (AKI) following percutaneous nephrolithotomy (PNL) in solitary kidneys.Methods: The study included consecutive adult patients who underwent PNL for treatment of calculi in a solitary kidney between May 2012 and July 2015. Patients with congenital renal anomalies or with stages 4 and 5 chronic kidney disease (CKD) were excluded. Serum creatinine levels were measured the day before PNL, daily after PNL for 2–5 days and after 3 months. AKI was depicted according to changes in early postoperative serum creatinine levels and its severity was determined based on the Acute Kidney Injury Network (AKIN) classification. The outcome of AKI was evaluated after 3 months by changes in the stage of CKD. Univariate and multivariate statistical analyses were conducted to determine risk factors for developing AKI.Results: The study included 100 patients (62 males) with a mean ± SD age of 50 ± 11.7 years. Complications were reported for 27 patients. AKI developed in 25 patients; at the 3 month follow-up, 23 of them (92%) had completely recovered from AKI and two (8%) had developed stage 4 CKD. Independent risk factors for developing AKI were multiple PNL tracts and postoperative ureteric obstruction (relative risks were 14 and 22, respectively).Conclusions: The incidence of AKI was 25% after PNL for a solitary kidney. The likelihood of renal function recovery was 92%. Multiple PNL tracts and postoperative ureteric obstruction were risk factors for developing AKI.

An anesthetic management of negative pressure pulmonary edema

Negative pressure pulmonary edema (NPPE) is one of the common complications of upper airway obstruction seen by anesthesiologist during either in induction or emergence sometimes both. Patients who have experienced NPPE are generally healthy without comorbidities. NPPE is a result of marked decrease in intrathoracic pressure caused by ventilator efforts against a closed glottis resulting in disruption of normal intravascular Starling mechanism, leading to transudation of intravascular protein, and fluids into the pulmonary interstitium. The onset of NPPE is usually rapid and without prompt recognition and intervention, the outcome can be fatal. This case report is of a 40-year-old female adult, who underwent right-sided percutaneous nephrolithotomy for stone in the right kidney otherwise uncomplicated surgical procedure.

695 Acute kidney injury after percutaneous nephrolithotomy for stones in a solitary kidney

695 Acute kidney injury after percutaneous nephrolithotomy for stones in a solitary kidney

Laparoscopic transperitoneal pyelolithotomy as an alternative to percutaneous nephrolithotomy for stones in anomalous kidneys: a preliminary report

Objective: We report our experience with laparoscopic transperitoneal pyelolithotomy (LTPL) and percutaneous nephrolithotomy (PCNL) in the management of patients with calculi in anomalous kidneys. Materials and methods: Data from 11 patients who underwent LTPL and 13 patients who underwent PCNL for kidney stones between May 2006 and August 2010 were retrospectively analyzed. A flexible nephroscope and holmium:YAG laser lithotripsy were used for stone clearance in 2 patients in LTPL group and 3 patients in PCNL group. Results: The two groups were similar in age, body mass index, and sex; however, mean stone size was slightly greater in the PCNL group, although this difference was statistically insignificant. Mean operative time and hospitalization time were significantly higher in the LTPL group whereas estimated blood loss and mean postoperative analgesic requirement were significantly reduced in the LTPL group. There were no statistically significant differences in terms of stone size, complication rates, blood transfusion rates or stone-free status. There were no residual fragments in either group, and complete clearance was achieved in all the cases. Conclusion: With an experienced surgical team, most cases of stone disease in congenitally abnormal kidneys can be treated laparoscopically with low postoperative morbidity and complication rates, a short convalescence time, and good functional results.

777The safety of the lower pole stone percutaneous nephrolithotomy procedure (PCNL) in comparision to PCNL of other stone locations

777The safety of the lower pole stone percutaneous nephrolithotomy procedure (PCNL) in comparision to PCNL of other stone locations

PERCUTANEOUS STONE REMOVAL IN HORSESHOE KIDNEYS

Purpose We review our experience with percutaneous nephrolithotomy for stones in horseshoe kidneys when extracorporeal shock wave lithotripsy was unsuccessful or inappropriate because of stone burden. Materials and Methods Stone burden, nephrostomy and percutaneous surgical techniques, and clinical outcome of 12 consecutive patients undergoing percutaneous nephrolithotomy for calculi in horseshoe kidneys between 1988 and 1997 were reviewed. Results Complete stone removal was achieved by percutaneous methods alone in 9 patients (75%). More than 1 nephrostomy tract was required in 5 patients and additional intraoperative nephrostomies were necessary in 4. Flexible nephroscopy was essential in achieving complete stone removal in 9 of 11 patients (82%). Second look procedures for stone removal were required in 3 patients. No sepsis occurred and no transfusions were needed. Conclusions Percutaneous nephrolithotomy is a safe and effective method of stone removal in patients with calculi in horseshoe kidneys. Multiple nephrostomy tracts, the use of flexible nephroscopy and second look procedures may be necessary to achieve optimum stone removal.