Percutaneous Nephrolithotomy Group Research Articles

Comparison of two percutaneous nephrolithotomy methods for the treatment of pediatric kidney stones: Mini-PCNL and standard PCNL.

In this study, the aim was to compare the results of mini and standard percutaneous nephrolithotomy (PCNL) for the treatment of pediatric kidney stones. Data for 128 patients < 18 years of age who underwent mini and standard PCNL due to pediatric kidney stones were retrospectively examined. Patients were divided into two groups: mini-PCNL (16-20 Fr) and standard PCNL (26 Fr). Surgery time, number of punctures to the pelvicalyceal system, hospital stay, postoperative hemoglobin drop, complications and stone-free status (SFR) were compared between the groups. Additional surgical intervention (double-J stent, ureterorenoscopy, secondary PCNL) performed after the surgery was recorded. The absence of residual stones or < 3 mm residual stones on kidney, ureter and bladder radiography (KUB) and ultrasonography (USG) performed in the third postoperative month were accepted as success criteria. There were 32 (43.8%) patients in the mini-PCNL group and 41 (56.2%) patients in the standard PCNL group. The mean age was 9.3 ± 4.1 years in the mini-PCNL group and 10.1 ± 5.4 years in the standard PCNL group. Mean stone size in the mini-PCNL group was 2.1 ± 1.2; while for standard PCNL it was 2.3 ± 1.4. The mean surgery time was statistically significantly higher in the mini-PCNL group (p = 0.005). There was no difference between the groups in terms of intraoperative double J stent use, postoperative complications and SFR. A double J stent was inserted in two patients in the mini-PCNL group and in one patient in the standard PCNL group due to urine leakage from the nephrostomy tract in the postoperative period. Although the postoperative hemoglobin drop was found to be significantly higher in standard PCNL (p = 0.001), hematuria and blood transfusion rates were low in both groups. Mean hospital stay was shorter in the mini-PCNL group compared to standard PCNL (3.6 ± 1.2 days vs. 2.5 ± 1.1; p = 0.018). Although mini-PCNL has longer surgery time compared to standard PCNL, it should be preferred for the treatment of pediatric kidney stones due to advantages such as similar success and complication rates to standard PCNL, short hospital stay and less postoperative hemoglobin drop.

Percutaneous nephrolithotomy or flexible ureteral lithotripsy, which one is better for patients with upper ureteral calculi of 1.5–2.0 cm in diameter

PurposeFirst research to evaluate the clinical efficacy and safety of flexible ureteral lithotripsy (FURSL) and percutaneous nephrolithotomy (PCNL) in the treatment of the upper ureteral stone is between 1.5 cm and 2.0 cm in diameter since there is no consensus with such ureteral stone yet.MethodsFrom December 2018 to October 2022, 104 patients with calculi in the upper ureter received percutaneous nephrolithotomy (PCNL)or flexible ureteroscopic lithotripsy (FURSL) in our institution. The clinical data of the patients in the two groups were retrospectively searched. Stone removal rate, operation time, blood loss, postoperative pain score, postoperative inflammatory factor, postoperative complication rates and ureteral obstruction three months after the operation were compared between the two groups.ResultsA total of 104 patients were included in the study. The stone clearance rate and the secondary surgery rate were 88.89% and 7.41% in the FURSL group, the figures were 97.96% and 2.0% in the PCNL group (p = 0.067, 0.497). Regarding ureteral obstruction three months after the operation, there were 2 patients in FURSL group and 0 patients in PCNL group(p = 0.497).Compared to patients in FURSL group, patients in the PCNL group had shorter operation time(PCNL 71.81 ± 18.94 min vs. FURSL 86.80 ± 22.49 min, p = 0.0004), fewer complications(PCNL 20.37% vs. FURSL 6.12%), and lower postoperative inflammatory factor(p = 0.0004), yet they got more hemoglobin drop (PCNL 13.14 ± 9.81 g/L vs. FURSL 4.77 ± 3.55 g/L, p < 0.0001), higher postoperative pain scores(p = 0.0017) in the first three postoperative days and longer hospital stay (PCNL 4.96 ± 1.21 days vs. FURSL 3.60 ± 0.83 days).ConclusionBoth FURSL and PCNL were effective methods for treating upper ureteral stones of 1.5–2.0 cm in diameter given the extremely high stone clearance rate and a very low secondary surgery rate, as long as rare ureteral obstruction in medium-long term observation. Additionally, FURSL can effectively reduce surgical bleeding, postoperative pain, and hospital stay, while PCNL can decrease operation time, the risk of infection, and complications. Therefore, doctors could select suitable surgical treatment for those patients depending on their different clinical situations based on these findings.

Efficacy of Flexible Ureteroscopy Lithotripsy and Percutaneous Nephrolithotomy in the Treatment of Patients with Kidney Stones and Their Impact on Inflammatory Response and Renal Function.

Kidney stones are one of the most common benign diseases in urology. As technology updates and iterates, more minimally invasive and laparoscopic surgeries with higher safety performance appear. This paper explores the effectiveness of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) in treating kidney stones, focusing on their effects on inflammatory responses and renal function. We conducted a retrospective analysis of 200 patients with kidney stones treated in our hospital between June 2019 and June 2023. 100 patients who underwent RIRS were included in the RIRS group. Another 100 patients who underwent PCNL treatment were included in the PCNL group. The intraoperative blood loss, operation duration, and hospitalization time of the two groups of patients were recorded and compared. The enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of inflammatory factors in the serum of the two groups of patients: [serum amyloid A (SAA), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (CRP)] and renal function index [blood urea nitrogen (BUN), creatinine (Scr) and serum cystatin (Cys-c)]. The two groups of patients were recorded separately: Postoperative complications and stone-free rate. Operation duration was longer for the RIRS group than the PCNL group, which exhibited significantly less intraoperative blood loss and shorter hospital stays (p < 0.05). Before surgery, there was no statistically significant difference in the serum levels of SAA, IL-6, and CRP between the two groups of patients (p > 0.05). On the first day after surgery, the serum SAA levels in both groups were lower than before surgery, IL-6 and CRP levels were higher than before surgery, and the serum levels of SAA, IL-6, and CRP in the RIRS group were significantly lower than those in the PCNL group. The difference was statistically significant (p < 0.05). Before surgery, there was no statistically significant difference in the serum BUN, Scr, and Cys-c levels between the two groups of patients (p > 0.05). On the first day after surgery, the serum BUN, Scr, and Cys-c levels of the two groups of patients were significantly higher than those before surgery. The serum BUN, Scr, and Cys-c levels of the RIRS group were significantly lower than those of the PCNL group, and the difference was statistically significant (p < 0.05). Both surgical methods have sound stone-clearing effects regarding long-term stone clearance rates 1 month and 3 months after surgery (p > 0.05). PCNL had a better stone clearance rate on the 2nd postoperative day (p < 0.05). The incidence of postoperative complications in the RIRS group was significantly lower than that in the PCNL group, and the difference was statistically significant (p < 0.05). For kidney stones ≤2 cm, PCNL showed higher stone clearance rates on the second postoperative day. However, RIRS and PCNL demonstrated adequate long-term stone clearance at 1 and 3 months post-surgery. Both surgical methods are safe and effective, and RIRS is safer than PCNL. Compared with PCNL, RIRS is a new method of kidney stone operation, which has less trauma to the patient's body and fewer complications after the operation, speeding up the recovery process of the patient.

Comparison of safety and efficacy of tubeless vs. conventional mini percutaneous nephrolithotomy in patients with Escherichia coli bacteriuria.

To evaluate the safety and efficacy of tubeless percutaneous nephrolithotomy (PCNL) in patients with Escherichia coli (E. coli) bacteriuria. We conducted a retrospective review of 84 patients with E. coli bacteriuria who underwent PCNL. Patients were divided into two groups according to whether a nephrostomy tube is placed at the end of the procedure. Preoperative clinical data, surgical outcomes, and postoperative complications were compared. Then, regression analysis of factors predicting success rate of PCNL in patients with E. coli bacteriuria was performed. After PCNL, residual fragments ≤ 4mm were considered as success. At baseline, the two groups were similar with regard to age, gender, BMI, underlying disease, hydronephrosis, stone characteristics, and urinalysis. Postoperative fever occurred in 1 patient (3.8%) in the tubeless PCNL group, and in 5 patients (8.6%) in the conventional PCNL group (p > 0.05). There were no significant differences in terms of successful rate, decrease in hemoglobin, pain scores, blood transfusion, and hospitalization expenses. However, the tubeless PCNL group had significantly shorter operative time (60 vs. 70min, p = 0.033), indwelling time of catheter (2 vs. 4 days, p < 0.001), and hospital stays (3 vs. 5 days, p < 0.001) than the conventional PCNL group. In the analysis of factors predicting success, the stone diameter, stone burden, and operative time were associated with success rate of PCNL. It is safe and effective to perform tubeless PCNL in patients with E. coli bacteriuria. Compared to conventional PCNL, tubeless PCNL accelerates patient recovery and shortens hospital stays.

Assessing the Efficacy of Mini-PCNL Versus Standard PCNL for Management of Staghorn Calculi &gt;2cm: A Prospective Study in Peshawar

Background: Staghorn stones pose a significant challenge in urology, given their complex nature and potential for causing substantial renal damage. Traditional management has often involved standard percutaneous nephrolithotomy (PCNL), known for its efficacy in stone clearance but also associated with considerable complication rates. Recent advancements have led to the development of mini-PCNL, aiming to reduce these complications while maintaining high stone clearance rates. Objective: This study aims to compare the efficacy, safety, and outcomes of standard and mini-PCNL in the management of staghorn stones, with a focus on complication rates, stone clearance, and hospital stay durations. Methods: A prospective study was conducted at the Institute of Kidney Diseases, Hayatabad, Peshawar, involving 162 patients undergoing PCNL for staghorn stones from January 2020 to December 2023. Patients were categorized into standard PCNL (n=69) and mini-PCNL (n=93) groups based on the procedural approach. Pre-operative, intra-operative, and post-operative data were collected, including patient demographics, stone size and density, operative findings, post-operative complications, and stone clearance rates. Statistical analysis was performed using SPSS version 25. Results: The mini-PCNL group demonstrated a significantly smaller average stone size (26.8 ± 5.8 mm) compared to the standard PCNL group (32.3 ± 10.3 mm, p=0.037). Single tract use was more prevalent in mini-PCNL (87.1%) than in standard PCNL (71.0%, p=0.016). Stone clearance rates were higher in the mini-PCNL group (87.1%) versus the standard group (73.9%, p=0.041). The average hospital stay was shorter for mini-PCNL patients (2.4 ± 1.0 days) compared to those undergoing standard PCNL (3.0 ± 1.1 days, p=0.030). Complications, including post-operative hematuria requiring transfusion, were more common in the standard PCNL group. Conclusion: Mini-PCNL offers a safer and more effective alternative to standard PCNL in the management of staghorn stones, with lower complication rates, higher stone clearance rates, and shorter hospital stays. These findings support the adoption of mini-PCNL as a preferred approach for managing complex renal calculi.

Medium-Term Stone Recurrence after zero-fragment transperitoneal Laparoscopic Pyelolithotomy Compared with Percutaneous Nephrolithotomy for Large Single Renal Pelvis Stones.

To compare medium-term stone recurrence between laparoscopic pyelolithotomy (LP) and percutaneous nephrolithotomy (PCNL). 98 patients who underwent PCNL or LP (2015-2019) for large single renal pelvis or staghorn stones (≥ 2 cm) were selected. The stone-free rate was evaluated using a computed tomography scan at one month and then, ultrasonography at six months intervals during the first year and annually thereafter for up to three years. Time-to-stone recurrence was compared using the Kaplan-Meier estimate. Hazard ratio was estimated by Cox regression. The one month stone-free rate was 93.88% in the LP group vs. 79% in the PCNL group (P = .03). The mean overall time-to-stone recurrence was 31 (CI:24-34) months in the LP vs. 28 (CI: 23-32) in the PCNL groups (P = .02). Cox regression analysis showed that PCNL increased the risk of stone recurrence with a hazard ratio of 2.3 (CI: 1.1 - 5.3) compared to the laparoscopy. (p = .03) In subgroup analysis, time-to-stone recurrence in those without previous history of intervention was estimated at 31 (CI: 27 to 35) months in the LP vs. 25 (CI:16 to 34) in PCNL groups (= 0.04). Subanalysis with a BMI cutoff of 25 kg/m2 showed an overall time-to-stone recurrence of 34 (CI:30 to 37) months in the LP group and 28 (CI:22 to 33) months in the PCNL group (= 0.04) in those with BMI higher than 25 kg/m2. Medium-term time to stone recurrence was in favor of LP compared with PCNL for large single renal pelvis or staghorn stones.

A Cross-Sectional Study Comparing Tubed PCNL And Tubeless PCNL: An Experience at the Institute of Kidney Diseases (IKD), Peshawar

Background: Percutaneous Nephrolithotomy (PCNL) has revolutionized the treatment of large renal and proximal ureteric stones, offering a minimally invasive alternative to open surgery. The introduction of tubeless PCNL, which omits the placement of a nephrostomy drainage tube, has generated discussion regarding its efficacy and safety compared to the traditional tubed PCNL. Objective: This study aims to compare the outcomes of tubed versus tubeless PCNL in terms of post-operative complications, recovery time, and efficacy in stone removal. Methods: A retrospective cross-sectional analysis was conducted on 110 patients who underwent PCNL at the Institute of Kidney Disease, Peshawar, from January 2017 to December 2020. Patients were allocated into two groups, tubed PCNL (n=50) and tubeless PCNL (n=50), based on 1:1 sequential randomization. The inclusion criteria were ASA I and ASA II classification, age between 5 to 70 years, and single tract procedure with complete clearance without the need for a second look nephrostomy. Exclusion criteria included patients with a solitary kidney, active urinary tract infections, and congenital malformations. Data on age, gender, co-morbidities, history of ESWL, stone size, location, quantity, and post-operative outcomes were collected and analyzed using SPSS version 25. Results: No significant differences were found in patient demographics or stone characteristics between the two groups. The tubeless PCNL group demonstrated a significantly lower rate of post-operative ESWL sessions (4% vs. 22%, p=0.02) and a trend towards shorter hospital stays, although not statistically significant. The drop in hemoglobin levels post-operation was less in the tubeless group (0.84 ± 1.87 mg/dl) compared to the tubed group (1.56 ± 0.91 mg/dl), but this was not statistically significant (p=0.17). Conclusion: Tubeless PCNL offers a viable alternative to traditional tubed PCNL, particularly for patients with smaller renal stones. It is associated with a lower need for post-operative ESWL sessions and potentially shorter hospital stays, suggesting an advantage in terms of recovery and post-operative comfort. Further prospective studies are warranted to confirm these findings and explore the long-term outcomes of the tubeless technique.

Comparative study between radiation exposure in common urological procedures

BackgroundFluoroscopy has become essential to urological surgery since advancement of endourology. Fluoroscopy use has increased, placing urologists as well as staff members at risk for occupational radiation exposure and related dangers. This study compared radiation exposure for staff personnel in percutaneous nephrolithotomy (PCNL), ureteroscopy (URS) and extracorporeal shock wave lithotripsy (ESWL). Then, study determined the maximum number of PCNL, URS and ESWL cases that staff members can handle safely each year.ResultsRadiation exposure in PCNL group was higher than URS and ESWL especially for surgeon. Dose of radiation exposure in ESWL for surgeon, assistant and nurse was 2.4 microsievert (μSv), 0.9 μSv and 0.8 μSv, respectively. Dose of radiation exposure in URS for surgeon, assistant and nurse was 18.5 μSv, 14.3 μSv and 13.1 μSv, respectively. Dose of radiation exposure in PCNL for surgeon, assistant and nurse was 73 μSv, 51.3 μSv and 47.6 μSv, respectively.ConclusionIncreased stone size and increased fluoroscopy time were associated with high radiation exposure. PCNL procedure was 8.8 times more likely to exhibit high-dose exposure than other procedures. Urologists can perform: 274 PCNL case, 1081 URS case and 8333 ESWL case per year within safe radiation exposure limits advised by International Commission on Radiation Protection (ICRP).

Comparison of RLP and PCNL for large pelvis calculi with CKD

Objectives To compare the effect and safety of retroperitoneal laparoscopic pyelolithotomy (RLP) and percutaneous nephrolithotomy (PCNL) for large pelvis calculi with chronic kidney disease (CKD). Material and methods Between June 2017 and July 2021, 62 patients with CKD and large renal pelvis calculi (>4 cm2) were treated with RLP. Another 62 patients receiving PCNL served as controls. The perioperative parameters were compared. All patients were followed up for at least 6 months with the stone-free rate and the recovery of renal function evaluated. Results Significantly longer operation time (101.47 ± 9.25 vs 62.55 ± 7.54 min), less drop in hemoglobin level (0.90 ± 0.38 vs 2.13 ± 0.80 g/dl), staged operations (0% vs 12.9%), postoperative fever (3.23% vs 16.13%) and delayed bowel movement (3.23% vs 14.52), and shorter hospitalization time (3.90 ± 1.66 vs 4.72 ± 1.80 days) were observed in the RLP group (p < 0.05). The stone-free rates were 100% in the RLP group and 88.7% in the PCNL group at the 3-months follow-up (p < 0.05). The serum creatinine level was significantly lower in the RLP group at 24 h (2.81 ± 1.18 vs 3.00 ± 1.15 mg/dl) and 1 week (2.08 ± 1.13 vs 2.34 ± 1.01 mg/dl) postoperatively (p < 0.05). Conclusions Although associated with a longer operation time, RLP is a safer and more efficient surgical option for CKD patients with large pelvic stones than PCNL.

Stone clearance rate in patients treated with open surgery versus percutaneous nephrolithotomy for the management of staghorn renal calculi.

Background: Urinary calculi, particularly staghorn renal calculi, pose a significant health challenge. Percutaneous nephrolithotomy (PCNL) and open surgery are two distinct surgical interventions employed for treating staghorn renal calculi. This study aimed to compare the stone clearance rates of patients undergoing open surgery versus percutaneous nephrolithotomy at the Department of Urology, Sindh Institute of Urology and Transplantation (SIUT) in Karachi, Pakistan. Methodology: A prospective cohort study was conducted from February 8th to August 7th, 2019. Patients aged 18 to 60 years, diagnosed with staghorn renal calculi, were included. Patients with other renal stones and untreated urinary tract infections were excluded. The study enrolled 230 patients, divided into two groups: Group I underwent percutaneous nephrolithotomies, and Group II underwent open surgery. Stone clearance was assessed through post-surgery X-ray KUB. Results: The mean age of participants was 44.99 years, with a balanced gender distribution. Both PCNL and open surgery achieved stone clearance rates of 68.7%, with significantly higher rates observed in the PCNL group (74.8% vs. 62.6%, p = 0.04). Stratification by age, gender, illness duration, and stone location did not yield substantial variations in stone clearance rates. Conclusion: PCNL demonstrated a superior stone clearance rate compared to open surgery in the treatment of staghorn renal calculi. This finding highlights the potential of PCNL as a more effective intervention for addressing this challenging urological condition.

Tubeless PCNL versus standard PCNL for the treatment of upper urinary tract stones: a propensity score matching analysis

PurposeIn this study, the feasibility of tubeless percutaneous nephrolithotomy (PCNL) for the treatment of upper urinary tract stones was investigated.MethodsFrom January 2021 to December 2022, the clinical data of 273 patients who received tubeless PCNL (Group A) were studied. The control group includes clinical data from 302 patients (from January 2019 to October 2022) who received standard PCNL (Group B). The baseline characteristics were consistent between the two groups after using the propensity score matching (PSM) method. Compare the preoperative clinical characteristics, postoperative complications, residual stones, catheterization time, and hospital stay between the two groups.Results146 pairs of patients were successfully paired through PSM. There was no statistically significant difference in operative time, blood leukocyte counts, haemoglobin decrease, fever, urinary extravasation, sepsis, bleeding, blood transfusion rates, embolism, and residual stones after surgery between the two groups; Postoperative day 1 and discharge day, the VAS pain score in Group A was significantly lower than that in Group B. The catheterization time and hospitalization time of patients in Group A were significantly lower than those in Group B.ConclusionAccording to the inclusion and exclusion criteria, selecting suitable patients for tubeless PCNL is safe and effective, while significantly alleviating pain and reducing catheterization time and hospital stay.

Comparison of Two Centers' Experience in Pediatric Supine and Prone Miniaturized Percutaneous Nephrolithotomy with Propensity Match Analysis.

Introduction: Percutaneous nephrolithotomy (PNL) is the treatment of choice in children with complex and large stones. With the experience gained from adult practice, supine PNL is increasingly performed in children as well. We aimed to evaluate the comparative results of prone and supine mini-PNL (m-PNL) performed for large/complex stones in children. Patients and Methods: The study included children who underwent supine and prone m-PNL at two centers between September 2019 and 2022. Patients were divided into two groups with a 1:1 ratio to index supine m-PNL and prone m-PNL cases for the size, number, location of the stones, degree of hydronephrosis, and age. Operative related parameters, success, and complication rates are being discussed on a procedure-based manner. Results: Forty-two patients (21 supine and 21 prone) were included. The mean age was 9.6 ± 4 years and mean stone size was 28.8 ± 13.6 mm. Regarding the operative data, the mean duration of procedure time was 65.7 ± 17.8 minutes in supine group, whereas 86.9 ± 19.0 minutes in prone group (p = 0.001). Fluoroscopy time was shorter in supine group (p = 0.027). Tubeless PNL was performed in 11 cases of prone group (52%), whereas this number was 18 (86.7%) in supine group (p = 0.019). Stone-free rates were similar in both groups (supine m-PNL: 90.5%, prone m-PNL: 85.7%, p = 0.634). Complications were minor in nature in most of the cases of both groups, which resolved with supportive measures in a short period of time. However, there was a statistically significant difference regarding the location and number accesses between two groups (p = 0.008). Simultaneous flexible ureterorenoscopy was performed in eight patients in the supine PNL group (<0.001). Conclusions: Our current findings and the highly limited data reported in the literature indicate that as an established minimal invasive treatment alternative m-PNL procedure in supine position can also be performed with similar success and complication rates in pediatric population.

Evaluation of the safety and efficiency of color Doppler ultrasound-guided percutaneous nephrolithotomy in clinical practice: results from a retrospective study

This study evaluated the clinical value of color Doppler ultrasound-guided percutaneous nephrolithotomy (PCNL) in avoiding bleeding caused by punctured blood vessels. Herein, we retrospectively included patients who underwent color Doppler ultrasound-guided PCNL or PCNL using the conventional channel technique from August 2018 to August 2022. The clinical characteristics of patients during surgery, complications, and hospital stay were recorded and compared. Overall, 228 patients were enrolled, with 126 patients (age, 47.6 ± 13.2 years; men: 57.14%) in the color Doppler ultrasound-guided PCNL group and 102 patients (age, 46.6 ± 12.3 years) in the B-mode ultrasound-guided puncture group. The total operation time (63.5 ± 15.5 vs. 61.3 ± 16.3 min, p = .5236) and stone clearance rate (86.50% vs. 83.33%, p = .7139) were similar between the two groups. However, the puncture time for the color Doppler ultrasound-guided PCNL group was longer than that for the B-mode ultrasound-guided puncture group (5.1 ± 2.3 vs. 2.6 ± 1.6 min, p = .0019). Moreover, the length of postoperative hospital stay in the color Doppler ultrasound-guided PCNL group reduced significantly by ∼1 day compared with that in the B-mode ultrasound-guided puncture group (4.5 ± 1.6 vs. 5.6 ± 2.1 days, p = .0087). The blood transfusion rate (1.58% vs. 4.9%, p = .0399), sedation-related adverse event rate (0.79% vs. 2.9%, p = .0332), perineal hematoma incidence (0% vs. 2.94%, p < .0001), and serum decreased hemoglobin levels (12.2 ± 9.7 vs. 23.5 ± 10.1 g/L, p < .001) after color Doppler ultrasound-guided PCNL were significantly lower than those after B-mode ultrasound-guided puncture. The stone clearance rate was similar between the two groups, with a similar operation time. Moreover, color Doppler ultrasound-guided PCNL shortened the postoperative hospital stay and decreased Hb levels, blood transfusion rate, and perineal hematoma incidence.

Efficacy and Safety of Treatment Options for Large Upper Ureteral Stone

Background: There are three minimally invasive methods for the treatment of large (&gt;1 cm) upper ureteral stones: ureteroscopic lithotripsy (URSL), percutaneous nephrolithotomy (PCNL) and laparoscopic ureterolithotomy (LUL). With multiple surgical options, the controversy of choosing the best option for a given patient lies. Objective: To compare efficacy and safety between URSL, PCNL and LUL to determine the best choice. Methodology: This study was conducted from March 2020 to February 2022 with 120 patients who had upper ureteral stones admitted at NIKDU. They were randomized into 3 equal URSL, PCNL &amp; LUL groups, 40 patients in each group. The primary outcome was a stone-free rate after 1 month of surgery, and the secondary outcomes were the duration of surgery, length of hospital stay, and complication rate postoperatively. Result: Eight patients needed auxiliary PCNL after URSL and 1 patient after LUL, but none after PCNL. The stone-free rate was 78.1% (25/32) in the URSL group, 95% (38/ 40) in the PCNL group and 100% (39/39) in the LUL group. Operation time was the shortest with URSL and the longest with LUL (all p &lt;0.05). Hospital stay was shorter in the URSL group compared with PCNL &amp; LUL group (p=0.0001). Operation-related complications were almost similar among the three groups. Conclusion: Laparoscopic ureterolithotomy followed by PCNL is the most efficacious modality for treating large upper ureteral stones with a superior stone-free rate and lesser need for auxiliary treatments compared to URSL. Bangladesh J. Urol. 2022; 25(2): 93-97

Comparative analysis of standard, tubeless and total tubeless percutaneous nephrolithotomy: A prospective study.

This study was done to review and compare safety, effectiveness and advantages of total tubeless percutaneous nephrolithotomy (PCNL), tubeless PCNL with standard PCNL. This prospective comparative study involving 30 patients in each total tubeless PCNL, tubeless PCNL and standard PCNL group from Feb 2021 to June 2022. Significant difference was found in mean duration of surgery (p < 0.01), mean hospital stay (p < 0.01), mean VAS post op score (p < 0.01), mean time to return to normal activity (p < 0.01) in total and tubeless PCNL group as compared with standard PCNL. While no significant difference found in mean haemoglobin drop (p = 0.1417), blood transfusion (p = 3721), incidence of urine leak (p = 0.13), need of accessory secondary procedure (p = 0.1322) and associated complications (p = 0.5939) among three groups. Study observed that total tubeless, tubeless PCNL is a safe and efficient technique. It is significantly associated with the advantages of shorter hospital stay, shorter time to return to normal activity, lower postoperative pain scores. Total tubeless PCNL obviates need of second procedure of removing DJ stent. Standard, tubeless and total tubeless PCNL have similar post op complication rate. Study thus concludes that total tubeless, tubeless PCNL can be used as a substitute for traditional standard PCNL.

Comparing Tubeless and Tubed Approaches in Percutaneous Nephrolithotomy for Moderate Renal Calculi: Outcomes on Safety, Efficacy, Pain Management, Recovery Time, and Cost-Effectiveness.

Introduction This study focuses on investigating the effect of routine nephrostomy tube placement in patients with moderate renal calculi of size 2.5 cm or less who undergo uncomplicated percutaneous nephrolithotomy (PCNL) procedures. Previous studies have not specified whether only uncomplicated cases were included in the analysis, which may affect the results. This study aims to provide a clearer understanding of the effect of routine nephrostomy tube placement on blood loss in a more homogeneous patient population. Materials and methods A prospective randomized controlled trial (RCT) was conducted at our department over 18 months, dividing 60 patients with a single renal or upper ureteric calculus of size ≤2.5 cm into two groups: 30 patients in each group (group 1: tubed PCNL, group 2: tubeless PCNL). The primary outcome was the drop in perioperative hemoglobin leveland the number of packed cell transfusions necessary. The secondary outcome included the mean pain score, analgesic requirement, length of hospital stay, time to return to normal activities, and the total cost of the procedure. Results The two groups were comparable in age, gender, comorbidities, and stone size. The postoperative hemoglobin level was significantly lower in the tubeless PCNL group (9.56 ± 2.13 gm/dL) compared to the tube PCNL group (11.32 ± 2.35 gm/dL) (p = 0.0037), and two patients in the tubeless group required blood transfusion. The duration of surgery, pain scores, and analgesic requirement were comparable between the two groups. The total procedure cost was significantly lower in the tubeless group (p = 0.0019), and the duration of hospital stay and time to return to daily activities were significantly shorter in the tubeless group (p < 0.0001). Conclusions Tubeless PCNL is a safe and effective alternative to conventional tube PCNL, with the advantages of shorter hospital stay, faster recovery, and lower procedure costs. Tube PCNL is associated with less blood loss and the need for transfusions. Patient preferences and bleeding risk should be considered when choosing between the two procedures.

A Comparative Study on Outcomes of Retrograde Intrarenal Surgery (RIRS), Mini Percutaneous Nephrolithotomy (PCNL), and Extracorporeal Shock Wave Lithotripsy (ESWL) for Lower Pole Renal Calculi of &lt; 1.5 cm

Background: Percutaneous nephrolithotomy (PCNL), established in the 1970s, has replaced open surgery for large stones. Extracorporeal shock wave lithotripsy (ESWL), once the preferred first-line treatment for small-to-medium-sized renal stones, has a questionable charm owing to patient reluctance for repeated treatments and hospitalizations since ESWL has a reduced stone-free rate (SFR). Flexible ureterorenoscopy, also referred to as RIRS, originally applied in the management of lower pole stones resistant to ESWL, is increasingly being used as a primary modality to manage lower pole stones, and it may potentially achieve higher SFR than ESWL and lower morbidity than PCNL for patients with low-volume stone diseases. Objectives: Observations were made to compare ESWL, mini PCNL, and RIRS in managing lower pole renal calculi of &lt; 1.5 cm. Methods: This observational study encompassed all patients with lower pole renal stones with &lt; 1.5 cm diameter and &lt; 1000 HU density who underwent mini PCNL, RIRS, or ESWL from January 2020 to July 2021. There were 40, 60, and 60 patients in the RIRS, mini PCNL, and ESWL groups, respectively, for all of whom preoperative CT urogram was performed. The patients were informed of the procedures, and their informed consent was obtained. The stone-free rates of the three modalities were compared, and the outcomes were statistically analyzed. Results: The mean stone sizes in the present study were 12.99 × 3.56 mm in mini PCNL, 10.62 × 2.51 mm in RIRS, and 10.93 × 3.13 mm in ESWL. The mini PCNL group's SFR was significantly higher than those of other groups: 59 (98.3%) in mini PCNL, 34 (85%) in RIRS, and 46 (76.7%) in ESWL (P = 0.002). Out of the 60 patients in the mini PCNL group, only one (1.7%) required an ancillary procedure, while only six (10%) out of 40 patients in the RIRS group and 11 (18.33%) out of 60 patients in the ESWL group required the ancillary procedure (P = 0.031). Conclusions: For lower pole renal calculi &lt; 1.5 cm, mini PCNL has the highest SFR, followed by RIRS and ESWL, in sequence. The ancillary procedure rate was 18.33% in the ESWL group, which was higher than those of mini PCNL (1.7%) and RIRS (10%).

Comparison between Standard Percutaneous Nephrolithotomy versus Tubeless Percutaneous Nephrolithotomy

Background: Percutaneous nephrolithotomy (PCNL) technique has become a routine treatment for upper urinary calculi. Objectives: To describe the socio-demographic characteristics of the patients and to compare the outcome of operated patients. Materials And Methods: This was a retrospective study, of patients underwent PCNL in our Urology Center, between January 2020 and December 2022. Data of age, side, location of stone, size of stone, operating time, hospital stay, post operation pain, residual stones, fever, fistula, blood transfusion, and postoperative infection were recorded and compared between the two groups. Data were analyzed by using the SPSS version 22. Independent t-tests were used to analyze continuous variables, while for categorical variables chi-square test was used to compare two groups and a p value of less than 0.05 was determined as statistically significant. Results: 51.1% of the patients were females and 48.9% were males, (P = 0.000). The mean age was 38.1 ± 11.1 years. The highest number of patients were in the age group 30 – 39 years (40.0%), (P = 0.000). The location of stones was in pelvic (48.9%), lower calyces (30.0%) and pelvic + lower calyces (21.1%), (P = 0.000). Pain was more common as moderate in both groups PCNL (42.2%). Residual stones were (23.4%) only in standard PCNL group, (P = 0.000). Fever was in (7.8%) standard PCNL and in tubeless PCNL was in (2.2%), (p = 0.045). Blood transfusion was provided to (5%) for the standard PCNL patients and (3.3%) for tubeless PCNL patients. Patients who had standard PCNL had postoperative infectious (2.2%) was found in standard PCNL patients. Mean operation-time and mean hospital stay of standard PCNL was predominant. Conclusion: Tubeless PCNL proved to be the safest and most effective. Keywords: Comparison, standard, tubeless percutaneous, nephrolithotomy.

COMPARATIVE STUDY OF PERCUTANEOUS NEPHROLITHOTOMY IN SUPINE VERSUS PRONE POSITION

Prone positioning in percutaneous nephrolithotomy is more and more being replaced by supine positioning now a days for its various benefits. This is a prospective study which does Comparative study on percutaneous nephrolithotomy in supine versus prone position and their various outcomes were analysed. There were totally 100 patients included in the study with 50 patients each group (supine versus prone). 57 were male and 43 female patients. Age ranging from 18 to 70 years. Right side stones were 58 and left side was 42. Age, gender and side of stones were similar between two groups. Stone burden were 2.6cm and 2.9cm for supine and prone group respectively. But average operating time were 63.5 minutes ( 35 to 120 minutes) for supine group versus 80 minutes ( 45 to 160 minutes) for prone group. fluoroscopy time was 18.9 minutes for supine group versus 29.4 minutes for prone group. Clearance rate in our study were pretty good in both groups around 90% in both groups (90% vs 88%). five had complications in form of sepsis and bleeding requiring blood transfusion in both groups. Five in supine group and six in prone group required second procedures. Thus Supine percutaneous nephrolithotomy group had significant advantage in terms of less operative duration and less fluoroscopy time than prone percutaneous nephrolithotomy . The stone clearance and complication rates were similar in both the groups

Comparison of stone-free rate between percutaneous nephrolithotomy and retrograde intrarenal surgery.

The management of urolithiasis in the kidney has been drastically changed in the era of endourology, mainly consisting of three surgical procedures: extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS). Since ESWL is usually less invasive via ambulatory clinic routes, this study aimed to examine the stone-free rate (SFR) between PCNL and RIRS. We retrospectively reviewed patients who had renal stones and were treated with either PCNL or RIRS from June 2016 to June 2018. Staghorn stones, stones with diameters <1 cm, and stones with diameters >2 cm were excluded. Patients who underwent multiple surgeries for bilateral renal stones and those with graft kidney stones were excluded from the study. X-ray, sonography, and/or computed tomography (CT) were used to calculate the size of the stones. Follow-up was evaluated by the same image examination within three months after surgery. Stone-free was defined as no residual stone or the presence of asymptomatic calculi <4 mm. The operation time was defined as a skin-to-skin interval. Following exclusion criteria, there were 39 patients in each arm, with no difference in age, sex, or any other demographic data. The average stone size in the PCNL and RIRS groups was 16.3 and 14.0 mm, respectively ( p = 0.009). There was no significant difference in SFR (71.8% vs 61.5%, p = 0.337); the operation time was significant longer ( p < 0.001), and the hospital stay was significantly shorter ( p < 0.001) in the RIRS group. PCNL and RIRS are both feasible options for managing kidney stones. However, the initial stone size might affect the selection of operation. The SFR in the PCNL group was numerically but not statistically higher. The RIRS group, on the other hand, had a longer operation time but a shorter hospital stays.