Percutaneous Nephrolithotomy Group Research Articles

Comparison of percutaneous nephrolithotomy and retrograde intrarenal surgery outcomes for kidney stones larger than 2cm from Guy's stone scoring system perspective.

To compare surgical outcomes of percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgeries (RIRS) as a result of kidney stones larger than 2cm, together with Guy's stone scores (GSS). The data of 811 patients with stone sizes 2-6cm were operated using PNL (n=361) and RIRS (n=450) reviewed retrospectively. GSS were graded 1, 2, 3 or 4 according to the computed tomography findings. Stone-free rate (SFR), operation times, length of hospital stay (LOHS) and Clavien complications (CC) were recorded. Although mean operative times were significantly longer in the RIRS group than the PNL group in GSS grades 1, 2 and 3 (P<.001), it was similar between the two groups in GSS grade 4 (P=.186). SFRs in the PNL and RIRS group were 90.3% and 58.4% on post-operative 10th day (P<.001), and it raised up to 95.3% and 81.6% after secondary interventions (P<.001). Significantly higher SFRs observed in the PNL group in GSS grades 1, 2 and 3 categories. On postoperative 10th day, the SFRs were similar in both GSS grade 4 categories (P=.06). LOHS was longer in the PNL group (P<.001). Although LOHS was significantly longer only in GSS grade 3 (P=.043) and GSS grade 4 (P<.001) in the PNL group, it was similar in GSS grade 1 and 2 between groups. Clavien complications increased in line with GSS in the PNL group (P<.001), but the difference did not differ between GSS grade 3 and 4. SF of PNL in a single session and short operation time seems to be significant especially in GSS grades 1, 2 and 3 category stones. Although the number of patients in the GSS 4 group is very small to claim this, RIRS might be considered as an alternative to PNL in a special group of patients such as GSS grade 4 because of its lower complication rates and shorter LOHS.

Comparison of Minimally Invasive Treatment Methods for Urinary Stones: A Retrospective Analysis

Introduction: Nephrolithiasis is one of the health concerns worldwide with the increasing prevalence and recurrence rates and the prevalence is ranging from 7% to 13% in North America, 5-9% in Europe, and 1-5% in Asia. Urinary stones are affecting approximately 12% of the world population of all ages, sex, and race. In this study, we evaluate of efficacy of retrograde intrarenal surgery (RIRS) combined with percutaneous nephrolithotomy (PCNL) in the treatment of kidney stones and compare its results with RIRS and PCNL monotherapy. Methods: We analyzed 144 patients who underwent combined method (12.5%), RIRS (53.4%), and PCNL (36.1%) treatments between 2017 and 2018. The stone-free rates after one session at different treatments were following combined method (94.44%), RIRS (83.78%), and PCNL (78.85%). The mean duration of operation was 58.88±13.12 min in combined method, 55.94±26.50 min in the RIRS, and 67.01±29.39 min in the PCNL group (p<0.0277). Duration of hospitalization, intraoperative blood loss, blood transfusion hematuria and complication in the postoperative period were also evaluated. Results: We found that the combined method had a higher stone-free rate, shorter length of stay. This could partially be explained by the minimal invasiveness, less trauma and high stone-free, which result in the complete evacuation of stones and fast recovery. Notably, most of the large, rigid, and complex stones were treated with the combined method. Although the combined treatment is a safe and effective method, the complication rate was slightly higher.

Comparison between OPEN STONE SURGERY vs PERCUTENOUS NEPHROLITHOTOMY in Management of Renal Stones By Using S.T.O.N.E Nephrolithometry Scoring System

Abstract Background In spite of Percutaneous nephrolithotomy (PCNL) became the first-line treatment option for patients with large and complex renal stones, there still remains a need of using open stone surgery (OSS) for removal of stones as a second or third line of treatment option. To date, 3 scoring systems have been proposed utilizing different metrics including the Guy’s Stone Score, S.T.O.N.E. nephrolithometry and the Clinical Research Office of the Endourological Society (CROES) nomogram, and that used to assess and estimate the treatment success rate. Aim of the Work To evaluate and compare between OSS and PCNL in the management of renal stones by using the S.T.O.N.E. nephrolithometry scoring system to predict and assess the stone free rate and the correlation with peri-operative complications in that two procedures. Patients and Methods A total 100 patients who need surgical intervention for renal stones were treated with OSS (35 pa ents) and PCNL (65 pa ents) from January 2019 ll the end of October 2019, were invited to participate in the present study. This was a multicenter, comparative, prospective cohort controlled study. This study was controlled by the standard results recorded in the previous literatures. Only adult(&amp;gt;18 ys. Old) patients with renal stone size ≥ 20mm were involved in the study. Peri-operative and follow-up data included stone free rate and complications were collected for all patients and were compared between both procedures. S.T.O.N.E nephrolithometry scoring systems was applied to preoperative non-contrast computed tomography(CTUT) for all cases and compared the results of both procedures. Stone-free rate was diagnosed using early postoperative kidney, ureter, bladder X-rays(KUB) and another CTUT on the postoperative day30. Results There was a significant difference between the PCNL group and the OSS group in the primary stone free rate (90% and 97.5% respec vely, p-value=0.021), peri-operative major complications (3% and 14.3% respectively, p-value=0.033), opera ve me (123.46 ± 34.61 and 175.71 ± 55.10 respec vely, p-value=0.000) and postopera ve hospital stay (3.52 ± 0.84 and 5.23 ± 1.00 respec vely, p-value=0.000), while there was no significant difference in the intra-opera ve bleeding requiring blood transfusion (10.8% and 14.3% respec vely, pvalue=0.124). S.T.O.N.E score showed a significant difference between PCNL and OSS groups ( 7 (6-11) and 10 (7-12) respectively, p-value=0.000) and it also had a significant rela on with the outcome SFR (p-value=0.000) a er both PCNL and OSS(r= -0.581 and r= -0.567 respec vely), the higher the score, the lower the SFR and the higher the possibility of OSS choice. While this score had on relation with the peri-operative complications. Conclusion The S.T.O.N.E. nephrolithometry score was predictive of the stone-free status in both surgical procedures (PCNL and OSS) and can be used as an formal guidance for surgical planning and patient counseling. This score would be classified into two categories “low” score range from 5 to 8 recommend PCNL procedure with expec ng SFR of 88% to 97% and “high” score range from 9 to 12 recommend Open Stone Surgery with expec ng SFR of 90% to 96%, to reach the most acceptable results for each procedures to sa sfy the patient and the doctor. The S.T.O.N.E score was not associated with the peri-operative complications in both procedures.

Comparison between different techniques for management of renal stones in horseshoe kidneys

Abstract Objective To report the operative management , intra and post operative complications and subsequent stone-free rates of patients with urolithiasis in a horseshoe kidneys. Materials and Methods We retrospectively reviewed all patients presenting to our centre with a horseshoe kidney and urolithiasis over a 20-year period. The stone burden, surgical management, complications and stone clearance rates were recorded. Results In all, 80 patients with urolithiasis in horseshoe kidney were treated. Percutaneous nephrolithotomy (PCNL) was used in 28 patients. 12 patients had laparoscopic assisted PCNL , 8 had flexible ureteroscopy and 18 had laparoscopic pyelolithotomy . PCNL was used for large stones = (mean digitized surface area= 614.32 mm 2 ) and required one to four stages to achieve an overall stone clearance rate of 88%. Stones were cleared at one sitting in 77% of PCNL procedures. only 33% of patients treated with flexible ureteroscopy was cleared from stones in one session and surprisingly, 89% of patients treated with laparoscopic pyelolithotomy was stone free after one session Complications were minimal, with 15% minor and 3% major complications in the PCNL group only.. Conclusions Appropriate management of urolithiasis within the horseshoe kidney depends not only on stone burden, but also on stone location, calyceal configuration and malrotation. Stones can be cleared successfully in almost all patients providing that all techniques are available to the operating surgeon.

Preparation of Cu–Ni–Pt Nano-Cube and Its Application for the Detection of Nanobacteria on Influences of Flexible Ureteroscopy Lithotomy and Percutaneous Nephrolithotomy on Immune Function of Patients with Renal Calculus

This work aimed to find a surgical method suitable for the clinical treatment of renal calculus, and to find a new type of nanomaterial suitable for the detection of nanobacteria. In this paper, Cu–Ni–Pt nano cube was preparation, then the combination of peptidoglycan and Pt–Ni–Cu–NCs was verified. Through continuous surface treatment and continuous modification, an electrochemical biosensor for detecting the content of nanobacteria in the body of renal calculus patients was successfully constructed. 85 patients with renal calculus were d Randomly divided into two groups, percutaneous nephrolithotomy group (PCNL group, 43 patients) and ureteroscope lithotomy (URL group, 42 patients). The venous blood was collected to test tumor necrosis factorα (TNF-α), C-reactive protein (CRP), interleukin-6 (IL-6), and IL-8 levels. Flow cytometry was employed to detect CD4+ and CD8+ T lymphocyte levels. A biosensor for the detection of nanobacteria was constructed based on peptidoglycan and Cu–Ni–Pt nano cubes (Pt–Ni–Cu–NCs), and applied to the detection of nanobacteria in the blood and urine of patients after surgery. It was found that the detection range of the constructed nanobacteria detection sensor was 1.3×102~1.5×108 CFU/mL, which had a good linear relationship. Moreover, within 30 minutes, the detection of nanobacteria in blood and urine was achieved, and a broad-spectrum detection was achieved. In contrast to PCNL group, CRP, TNF-α, IL-6, IL-8, and CD8+ were significantly lower in the URL group (P &lt; 0.05). The detection rates of nanobacteria in blood and urine in PCNL group were 10% and 11.2%, respectively; those of URL group were 6.8% and 5.9%, respectively. Detected by the biosensor, the nanobacteria content was lower after URL treatment, and the immune function was at a higher level, which was more conducive to postoperative recovery.

Influence of Webinar-Based Learning on Practice of Percutaneous Nephrolithotomy: Outcomes of a Global Survey.

Background: With webinars looking to be the mainstay post-pandemic, it is important to demonstrate whether webinars are, indeed, effective educational tools for professional training and skill acquisition. We aim at demonstrating, via a global survey, the efficacy of webinars on percutaneous nephrolithotomy (PCNL) and how this knowledge transforms clinical practice. Methods: A structured online survey covering the following sections: (1) Demographics, (2) PCNL techniques, and (3) PCNL equipment was circulated. The target study population were practicing urologists and residents. Categorical data were presented with counts and percentages, and they were compared by using Chi-square test. Continuous data were analyzed with non-parametric methods. Respondents were dichotomized according to attendance of webinar type, attendees of dedicated PCNL webinars (Group A), or attendees of endourological webinars that discussed some aspects of PCNL (Group B). Results: A total of 303 respondents from 38 countries participated. Overall, 91.7% (n = 278) were in Group A and 8.3% (n = 25) were in Group B; 77.9% were younger than 50 years, whereas 51.8% had more than 10 years of urology experience. In group A, urologists of all ages, in academic institutions and private practitioners, significantly benefited in gaining knowledge about the merits of newer devices and the role of suction-assisted devices in modern PCNL. The majority of group A also reflected that by attending a dedicated PCNL-based webinar they benefited in learning newer positions for PCNL access, especially supine, and how to effectively use laser as energy devices for lithotripsy. In Group B, the only area of benefit was in lasing techniques and the use of newer lasers such as the thulium fibre laser. Conclusion: Our survey positively validates the two proposed hypothesis, that is, webinars as a medium of education do benefit practicing urologists in knowledge and the clinical practice domains. Age, experience, or place of practice is no barrier to adopting newer mediums of education such as webinars.

MP65-04 RIRS VERSUS PCNL IN LARGER KIDNEY STONES. COULD SUPERPULSED TFL CHANGE THE GAME?

You have accessJournal of UrologyStone Disease: Surgical Therapy V (MP65)1 Sep 2021MP65-04 RIRS VERSUS PCNL IN LARGER KIDNEY STONES. COULD SUPERPULSED TFL CHANGE THE GAME? Mark Taratkin, Camilla Azilgareeva, Denis Chinenov, Stanislav Ali, Dmitry Korolev, Dmitry Tsarichenko, Mariela Corrales, and Dmitry Enikeev Mark TaratkinMark Taratkin More articles by this author , Camilla AzilgareevaCamilla Azilgareeva More articles by this author , Denis ChinenovDenis Chinenov More articles by this author , Stanislav AliStanislav Ali More articles by this author , Dmitry KorolevDmitry Korolev More articles by this author , Dmitry TsarichenkoDmitry Tsarichenko More articles by this author , Mariela CorralesMariela Corrales More articles by this author , and Dmitry EnikeevDmitry Enikeev More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002105.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The novel SuperPulsed Thulium-fiber laser (SP TFL) produces higher stone ablation rates, three to four-times more dust, smaller stone fragments, when compared to Ho:YAG laser. The aim of the study was to compare retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) efficacy and safety with SuperPulsed Thulium-fiber laser (SP TFL) for stones > 20 mm. METHODS: Patients with large kidney stones (>20mm) were recruited to undergo PCNL or RIRS with SP TFL lithotripsy. Both RIRS and PCNL were performed under general anaesthesia with all the patients in the lithotomy position. During the RIRS, the FLEX-X2 (Karl Storz Gmbh Germany) or the LithoVue™ (Boston Scientific, Marlborough, USA) ureteroscopes with a 200 μm laser fiber were used. All PCNL procedures were performed using a 12 Fr nephroscope with MIP set (16.5-17.5 Fr) (Richard Wolf Gmbh, Germany). Lithotripsy was performed with a 400 μm laser fiber using a fragmentation setting only. Both groups were comparable in terms of stone size and density, operation time, laser-on time (LOT), stone-free rate, residual fragments and complication rate. Stone retropulsion and visibility were assessed based on the surgeon's feedback using three-point Likert scales. RESULTS: A total of 14 and 56 patients were included in the RIRS and PCNL groups respectively. The mean stone density was 833.8±298.3 HU in the RIRS group and 882.3±408.5 HU in the PCNL group (p=0.072). The median LOT was 11.7 (10.0-15.5) min for RIRS and 10.0 (6.0-12.1) min for PCNL (p=0.207). The median total energy for stone ablation was 13.8 (11.8-25.0) kJ for RIRS and 12.0 (7.0-20.1) kJ for PCNL (p=0.508). The median ablation speed was 3.9 (3.9-5.7) mm3/sec for RIRS and 5.0 (4.6-11.3) mm3/sec for PCNL (p=0.085). In both groups LOT was positively correlated with total energy (RIRS: r= 0.865 with p<0.001; PCNL: r= 0.834 with p<0.001). We found a significant correlation between retropulsion and the type of surgery performed: with higher retropulsion in the PCNL (r=0.298 with p=0.012). The stone-free rate at 3-months was 85.7 % (12/14 cases) in RIRS and 89.3 % (50/56 cases) in PCNL (p=0.505). The postoperative complication rate was relatively low with only 14.2% (2/14) in RIRS and 14.3% (8/56) in PCNL with only Clavien Grade I-II complications. CONCLUSIONS: TFL is a safe and effective modality for both RIRS and PCNL resulting in minimal retropulsion and good visibility. No discrepancies in procedure duration, complications, or LOT were identified between the different modalities. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1120-e1120 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mark Taratkin More articles by this author Camilla Azilgareeva More articles by this author Denis Chinenov More articles by this author Stanislav Ali More articles by this author Dmitry Korolev More articles by this author Dmitry Tsarichenko More articles by this author Mariela Corrales More articles by this author Dmitry Enikeev More articles by this author Expand All Advertisement Loading ...

MP34-14 PERIOPERATIVE TRENDS AND RISK FACTORS FOR PERSISTENT OPIOID USE AFTER ENDOSCOPIC STONE SURGERY

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety II (MP34)1 Sep 2021MP34-14 PERIOPERATIVE TRENDS AND RISK FACTORS FOR PERSISTENT OPIOID USE AFTER ENDOSCOPIC STONE SURGERY Alex Nourian, Eric Ghiraldi, Sarah Christianson, Jeffy Jacob, Young Son, Jay Simhan, and Justin Friedlander Alex NourianAlex Nourian More articles by this author , Eric GhiraldiEric Ghiraldi More articles by this author , Sarah ChristiansonSarah Christianson More articles by this author , Jeffy JacobJeffy Jacob More articles by this author , Young SonYoung Son More articles by this author , Jay SimhanJay Simhan More articles by this author , and Justin FriedlanderJustin Friedlander More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002043.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We examined opioid prescribing patterns following surgical management of nephrolithiasis. Our goal was to identify the absolute risk and specific risk factors for long-term opioid use after endoscopic stone surgery. METHODS: We performed a single-center retrospective review of patients undergoing ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) from 2014-2019. Perioperative opioid prescribing trends were assessed with the Pennsylvania Prescription Drug Monitoring Program (PA-PDMP). Number of prescriptions, number of tablets and total morphine equivalents (TME) were quantified. Persistent opioid use was defined as ongoing use at 6 months after surgery. RESULTS: PDMP data was available for 273 patients who were opioid naive prior to URS or PCNL. The absolute risk of persistent opioid use was 7.9% (9/113) and 2.5% (4/160) for URS and PCNL groups, respectively. The relative risk for persistent opioid use for URS compared to PCNL was 3.185 (95% CI 1.05-10.9). Sub-analysis was performed on the URS group to identify factors associated with persistent use. TME at discharge (mean 147.44 vs 274.66, p=0.003), at 0-3 months (mean 106.9 vs 341.66, p=0.003), and the number of narcotic prescription refills between 0-3 months (mean 0.53 vs 1.22 p=0.003) were all significant risk factors for persistent opioid use. On multivariate adjusted analysis, TME prescribed at discharge was an independent predictor for persistent opioid use. CONCLUSIONS: Patients undergoing URS had a higher absolute risk of opioid use at 6 months when compared to PCNL. Limiting TME and number of prescriptions between discharge and 3 months after URS can help reduce the risk of ongoing opioid use after ureteroscopy. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e621-e622 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Nourian More articles by this author Eric Ghiraldi More articles by this author Sarah Christianson More articles by this author Jeffy Jacob More articles by this author Young Son More articles by this author Jay Simhan More articles by this author Justin Friedlander More articles by this author Expand All Advertisement Loading ...

Case selection and implementation of tubeless percutaneous nephrolithotomy.

BackgroundThe tubeless percutaneous nephrolithotomy (PCNL) was proposed to eliminate the side effects of the nephrostomy tube in recent years, such as pain, channel infection, postoperative bleeding, and longer hospital stay. But there is neither clinical guidelines nor consensus about tubeless PCNL in clinical practice. The study is aimed to how to implement the tubeless PCNL step by step, including case selection preoperatively, improving the technique of the surgeon, making the correct decisions at the end of the procedure, which had not been previously examined.MethodsFrom January 2017 to March 2018, 364 consecutive patients requiring PCNL were comprehensively analyzed preoperatively and patients were selected for scheduled tubeless PCNL based on four aspects. The selected patients were divided into two groups according to whether the nephrostomy tube was finally placed. The mean operative time, intraoperative blood loss, stone clearance rate, visual pain score, postoperative hospitalization days and perioperative complications were all evaluated.ResultsBased on the preoperative evaluation, 42 patients were selected for tubeless PCNL, among which there were finally 37 cases of completed tubeless PCNL. Compared with patients undergoing conventional PCNL, there were not statistical differences in the mean operative time (P=0.207) or intraoperative blood loss (P=0.450) in the tubeless group. Stone clearance rate was 100% in both groups. The visual pain scores in the tubeless PCNL group were lower on operation day (P=0.029), first postoperative day (P<0.001) and the day of discharge (P=0.025). The postoperative hospitalization for the tubeless PCNL group was shorter than that of the control group (P<0.001). No significant difference in grade 1 complications was seen (P=0.424), and no grade 2 or higher complications were observed in either group.ConclusionsPostoperative pain was significantly relieved and postoperative hospitalization was significantly shortened in the tubeless PCNL group. Tubeless PCNL is safe if patients are carefully selected using four criteria before operation, attention is paid to four key points and five confirmations are made during operation.

Minimal invasive percutaneous nephrolithotomy (Mini-PCNL) in children: Ultrasound versus fluoroscopic guidance

Background: Miniaturization of endoscopic instruments in percutaneous nephrolithotomy (PCNL) allowed less invasive procedures with low complication rates, especially in children. This study was conducted to evaluate the safety and efficacy of ultrasonography-guided (USG) versus fluoroscopy-guided (FG) mini-PCNL in children.Materials and methods: This is a retrospective comparative study conducted from June 2015 to June 2020. The sample included 70 children (35 pateints underwent USG mini-PCNL and 35 pateints underwent FG mini-PCNL). They were compared mainly by the patients’ demographic characteristics, procedural information, and post-treatment outcomes. In the USG mini-PCNL group, puncturing was performed using a 3.5 MHz US probe, whereas fluoroscopy was utilized in the FG mini- PCNL group. Results: Both groups were comparable in terms of gender, previous history of failed ESWL, and hydronephrosis grade. The mean stone burden was 15.94 ± 3.69 mm and 19.20 ± 7.41 mm in USG and FG groups, respectively (p = 0.024). The stonefree rate (SFR) was 97.1% in the USG group and 94.3% in the FG group, which was not statistically significant (p = 0.16). Mean operative time in the USG group and FG group was 69.00 ± 13.33 minutes and 63.48 ± 16.90 minutes, respectively. Four (11.4%) patients in the FG group required blood transfusions to restore the hemodynamic state (p = 0.039). Fever was detected in 4 (11.4%) patients in the USG group and 15 (31.4%) patients in the FG group (p = 0.041). Conclusions: In children, mini PCNL under USG is safe and as effective as fluoroscopy.

Mini versus ultra-mini percutaneous nephrolithotomy in a paediatric population

ObjectiveTo evaluate whether there would be a difference in outcome when the smaller ultra-mini 12 Fr sheath was used instead of the mini 16 Fr sheath for percutaneous nephrolithotomy (PCNL) in paediatric patients for stones less than 25 mm. MethodsThis was a prospective cohort study of patients who underwent PCNL in our hospital in a 2-year period from July 2016 to June 2018 by a single surgeon. PCNL was performed in a prone position and tract was dilated to the respective size using single step dilatation. Laser was used to fragment the stone. Stone-free outcome was defined as absence of stone fragment at 3 months on kidney, ureter, and bladder X-ray. ResultsThere were 40 patients in each group. Mean stone size was comparable between the two groups (14.5 mm vs. 15.0 mm). The procedure was completed faster in the 16 Fr group compared to 12 Fr group (24.5 min vs. 34.6 min). Stone clearance was highly successful in both groups (97.5% vs. 95.0%). There was no difference in complications between the two groups. The decrease in hemoglobin was minimal in both groups (0.2 g/dL vs. 0.3 g/dL). ConclusionWe found that the success rates were similar in both mini PCNL and the smaller ultra-mini PCNL groups. No significant difference in bleeding was noted in our pilot study, however, operative time was longer in the ultra-mini group as compared to the mini sheath group.

The comparison of perioperative outcomes between percutaneous nephrolithotomy and retrograde intrarenal surgery in elderly patients.

In this study, we aimed to compare the outcomes and complication rates of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in elderly patients. Between April 2011 and January 2020, patients who underwent PCNL and RIRS for renal stone in elderly patients were retrospectively evaluated. The two groups' perioperative values, stone-free rates and complication rates were compared. Post-operative complications were noted according to the Clavien scoring system. There were 89 and 72 patients in the PCNL and RIRS group respectively. The median age was 67years in both the groups (P=.192). The stone size were 22.2±3.5mm and 19.9±7.1mm in the PCNL and RIRS group, respectively (P=.082). Stone-free rates were significantly higher in PCNL group (P=.021, P=.034). Also we found that overall complication and major complication rates were significantly higher in PCNL group (P=.016, P=.029). Despite there was higher stone clearance in PCNL, the complication rates were higher compared with RIRS. So RIRS might be a safe alternative treatment method to PCNL in older patients.

The effectiveness of percutaneous nephrolithotomy for the treatment of large impacted upper ureteral stones

Objective: To compare the efficacy of semi-rigid or flexible ureteroscopic surgery and percutaneous nephrolithotomy, which is the standard method for the surgery of ≥2 cm upper ureteral impacted stones .&#x0D; Materials and Methods: The data of 123 patients who underwent stone surgery for ≥2 cm impacted ureteral stones in the upper ureter in our clinic were retrospectively analyzed. The patients were divided into two groups as ureteroscopic surgery group (URS, n = 59) and percutaneous nephrolithotomy group (PNL, n = 64) according to the type of operation. Patients with stones impacted in the ureter at the level between the L4 vertebra and ureteropelvic junction were included in the study. Preoperative demographic data and postoperative results of the patients in two groups were compared.&#x0D; Results: Average operation time was similar in both groups (p = 0.147). Mean hospital stay was significantly higher in the PNL group compared to the URS group (3.28 ± 0.57 days vs 1.11 ± 0.32 days, p = 0.001). Mucosal injury was developed in 10 (16.9%) patients in the URS group during the operation, while it was only 3 (4.7%) in the PNL group (p = 0.027). Postoperative urinary tract infection development was found to be similar in URS and PNL groups (8.5% vs 4.7%, p = 0.479). Postoperative stone-free rate was found to be significantly higher in the PNL group compared to the URS group (95.3% vs 79.7%, p = 0.008).&#x0D; Conclusion: PNL is a very effective and safe procedure in the surgical treatment of stones ≥2 cm in diameter impacted in the upper ureter. The complication rate of PNL is comparable with URS; however, it is seen that the PNL is more advantageous than URS in terms of postoperative total stone-free rate.

Retrograde Intra-Renal Surgery Versus Percutaneous Nephrolithotomy in Management of Renal Stone 10-20 Millimeters, A Comparative Clinical Study

Purpose: comparison the efficacy and safety of percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS) in treatment of renal stones. Patients and Methods: Records of patients who underwentsurgery for renal stone were retrospectively reviewed, for two years from the beginning of 2017 till the endof 2019. Patients who had renal stones between 10 - 20 Millimeter and located in different renal caliceswere included, patients who underwent percutaneous nephron-lithotomy PNL and retrograde intra-renalsurgery RIRS were defined as Group I and Group II, respectively. Patient criteria (age, sex, BMI); the stonecharacteristics; time of procedure, fluoroscopy and hospitalization; stone-free and complications (bleeding,pain, infection, visceral injury, conversion to open surgery, and need for blood transfusion) were evaluatedbetween the treatment groups. Result: There were no significant differences in terms of age, gender, BMI,laterality, number of stones, Hounsfield units and surface area characteristics of the stone between the PNL(n 25) and RIRS (n = 35) groups (P = .558, P = .278, P = .375, P = 0.051, P = .053, P = .064, P = .642, P =.080, respectively). Stone free rate was 59.6% (n=28) in PNL, and 88.6% (n=31) in RIRS (P=.004). 1st or2nd degree complications according to Modified Clavien Classification developed in 10 patients (21.3%) inGroup I and 1 patient (2.9%) in Group II (P = .015). The 3A or 3B complications were similar in groups (P= .077). Time of procedure, fluoroscopy and hospitalization were significantly lower in Group II (P &lt; .001,P &lt; .001 and P &lt; .001, respectively). Conclusion: RIRS is more effective and more reliable procedure thanPNL with higher stone-free and lower complication rates in treatment of single renal stone (10 t0 20 mm).

Comparison of safety and efficacy between single-tract and multiple-tract percutaneous nephrolithotomy treatment of complex renal calculi: a systematic review and meta-analysis.

A systematic review and meta-analysis was conducted to explore the safety and efficacy of single-tract and multiple-tract percutaneous nephrolithotomy (PCNL) in complex renal calculi treatment. PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases (updated November 2020) were searched for studies assessing the effect of different numbers of tracts on cases that underwent PCNL. The search strategy and study selection process were managed according to the PRISMA statement. Five comparative studies were included in the meta-analysis. The multiple-tract PCNL group had a significantly increased total complications rate than the single-tract group (OR=2.35, 95% CI=1.71, 3.25; P<0.00001) with insignificant heterogeneity (I2=0%, P=0.52). Subgroup analysis showed there were different incidence of complications, mainly because the multiple-tract PCNL group was significantly associated with a higher rate of blood transfusion (OR=2.99, 95% CI=1.95, 4.57; P<0.00001) with insignificant heterogeneity (I2=9%, P=0.35). There were no differences in operation time (MD=12.04, 95% CI=6.36, 17.72; P<0.0001) or hospitalization (MD=0.54, 95% CI=0.14, 0.95, P=0.008). However, the single-tract group had a higher stone-free rate (OR=0.37, 95% CI=0.19, 0.74; P=0.005) with heterogeneity (I2=51%, P=0.08), as stones in the single-tract group were smaller than those in the multiple-tract group. The current research did not find that the multiple-tract group had a higher stone-free rate. Additionally, multiple-tract PCNL was associated with a higher incidence of blood transfusion and negative impact on renal function.

Comparison of contrast-enhanced ultrasound versus conventional ultrasound-guided percutaneous nephrolithotomy in patients with nondilated collecting system: a randomized controlled trial.

To compare the safety, effectiveness, and feasibility of contrast-enhanced ultrasound (CEUS) versus conventional ultrasound-guided percutaneous nephrolithotomy (PCNL) in patients with nondilated collecting system. Between July 2018 and July 2020, 160 kidney stone patients with nondilated collecting system planned for PCNL were randomly assigned into two groups, CEUS with retrograde ureteral contrast injection and conventional ultrasound with retrograde ureteral normal saline injection. Patient's demographics, the success rate of puncture, success rate of a single-needle puncture, number of punctures, puncture time, perioperative outcomes, stone-free rate, and incidence of complications were compared. The success rate of a single-needle puncture for CEUS-guided PCNL was higher than that in the conventional ultrasound group (88.5% vs. 73.7%, p = 0.02). Patients performed with CEUS-guided PCNL required less needle passes (p = 0.02), shorter needle puncture time (p = 0.031), and shorter channel establishment time (p = 0.04) than those guided with conventional ultrasound. The postoperative hemoglobin decrease in the CEUS-guided PCNL group was less than that of the control group (p = 0.02). There was no significant difference in operating time, length of hospital stays, kidney function change, and complications between the two groups (p > 0.05). The 1-month stone-free rate was 94.9% in the CEUS group and 90.8% in the control group (p > 0.05). Compared with conventional ultrasound, CEUS-guided PCNL may facilitate ultrasound-guided PCNL for patients without hydronephrosis, and benefited with a higher success rate of a single-needle puncture, less needle passes, shorter puncture time, and lower postoperative Hb drop. Chinese Clinical Trial Registry: ChiCTR1800016981 KEY POINTS: • Compared with conventional ultrasound, CEUS-guided PCNL is a safe and efficacious procedure for kidney stone patients with nondilated collecting system. • Compared with conventional ultrasound, CEUS-guided PCNL benefited with a higher success rate of a single-needle puncture, less needle passes, shorter puncture time, and lower postoperative Hb drop. • CEUS-guided PCNL associated with the more accurate needle puncture and acceptable complications.

A systematic review and meta-analysis of minimally invasive vs. standard percutaneous nephrolithotomy in the surgical management of renal stones.

The present study aimed to assess current evidence on the effectiveness and safety of minimally invasive vs. standard percutaneous nephrolithotomy (PCNL) in the management of renal stones. A systematic search of electronic databases, which included PubMed, EMBASE and the Cochrane Library up to May 2019 was performed. Using Review Manager statistical software (version 5.3), primary outcomes, including stone-free rates (SFRs), were evaluated. Meanwhile, analysis was also performed to compare secondary outcomes, such as peri- and postoperative complications and operative data. Fourteen studies involving 1,611 patients with renal stones were analyzed based on the inclusion criteria. On the basis of the present analysis, mini percutaneous nephrolithotomy (MPCNL) was proven to have non-inferior clinical efficacy with respect to the SFR compared with PCNL [odds ratio (OR)=1.10; 95% confidence interval (CI), 0.84-1.44; P=0.48]. In addition, the meta-analysis showed that MPCNL had a significantly lower hemoglobin decrease [mean difference (MD)=-0.68; 95% CI, -1.05 to -0.31; P=0.0003] and fewer blood transfusions (OR=0.36; 95% CI, 0.18-0.71; P=0.003) compared with PCNL. Moreover, the MPCNL group had a shorter inpatient stay (MD=-0.81; 95% CI, -1.55 to -0.08; P=0.03) compared with the PCNL group. However, the overall evidence was insufficient to suggest a statistically significant difference in the adverse event profile for MPCNL compared with PCNL. The present meta-analysis indicates that MPCNL is an effective method for treating renal stones. Compared with PCNL, MPCNL not only has similarly high SFRs but is also associated with less blood loss, fewer blood transfusions, more favorable recovery time and shorter inpatient stays. However, the findings of the present study should be further confirmed by well-designed prospective randomized controlled trials with a larger patient series.

Retrograde intrarenal surgery versus percutaneous nephrolithotomy in larger kidney stones. Could SuperPulsed Thulium-fiber laser change the game?

IntroductionThe aim of this article was to compare retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) efficacy and safety with SuperPulsed Thulium-fiber laser (SP TFL) for stones 20 mm and larger.Material and methodsPatients with large kidney stones (20 mm and larger) were recruited to undergo PCNL or RIRS with SP TFL lithotripsy. Both groups were comparable in terms of stone size and density, operation time, laser-on time (LOT), stone-free rate, residual fragments and complication rate. Stone retropulsion and visibility were assessed based on the surgeon's feedback using Likert scales.ResultsA total of 14 and 56 patients were included in the RIRS and PCNL groups, respectively. The mean stone density was 833.8 ±298.3 HU in the RIRS group and 882.3 ±408.5 HU in the PCNL group (p = 0.072). The median LOT was 11.7 (10.0–15.5) min for RIRS and 10.0 (6.0–12.1) min for PCNL (p = 0.207). The median total energy for stone ablation was 13.8 (11.8–25.0) kJ for RIRS and 12.0 (7.0–20.1) kJ for PCNL (p = 0.508). The median ablation speed was 3.9 (3.9–5.7) mm3/sec for RIRS and 5.0 (4.6–11.3) mm3/sec for PCNL (p = 0.085). We found a significant correlation between retropulsion and the type of surgery performed: with higher retropulsion in the PCNL (r = 0.298 with p = 0.012). The stone-free rate at 3-months was 85.7% in RIRS and 89.3% in PCNL (p = 0.505).ConclusionsSP TFL is a safe and effective modality for lithotripsy for both, RIRS and PCNL, achieving minimal retropulsion and good visibility. No discrepancies in procedure duration, complications, or LOT were identified between the different modalities.

Supine Versus Prone Percutaneous Nephrolithotomy – A Randomised Comparative Study

Percutaneous Nephrolithotomy (PCNL) is the standard procedure for large renal stones. This study was conducted to compare the conventional Prone position PCNL with the newer concept of Supine PCNL. A prospective, randomised controlled, double blind study was conducted in 100 patients planned for PCNL. They were randomised into 2 groups with 50 patients each and PCNL was performed either in the prone or supine position. The patient groups were compared for the length of hospital stay, duration of surgery, postoperative and intra operative complications, postoperative stone free status, and requirement of adjunctive procedures. Stone free rates were significantly better for the supine PCNL group. Post operative complications such as fever was more for Prone PCNL group. The other parameters that were not statistically significant were mean operating time which was less for the supine group and duration of hospital stay which was less for the supine group. There was no difference in the other complication rates between the two procedures. The requirement of additional procedures for stone clearance were also same between both the groups. To conclude, Our study demonstrates that supine PCNL is a better technique than prone PCNL in terms of stone free rates, post-operative complications such as fever, lesser number of punctures required for stone clearance and more tubeless procedures.

Percutaneous Nephrolithotomy in Supine versus Prone Position in Tertiary Hospital in Mysore: A Prospective Cohort Study

Introduction: Percutaneous Nephrolithotomy (PCNL) is a procedure of choice for large renal calculi. It is a common urological procedure. PCNL can be performed in various positions. Aim: To determine the surgical outcomes in patients undergoing PCNL in supine and prone positions. Materials and Methods: A cohort study was conducted on patients with renal and upper ureteral stones who underwent PCNL in either prone or supine position between August 2019 to August 2020 at Urology Department, JSS Hospital, Mysuru. Supine PCNL was done in the flank Free Oblique Supine Modified Lithotomy (FOSML) position. All the procedures were performed under fluoroscopy guidance. Surgical outcomes including operative time, length of hospital stay, Stone Free Rate (SFR), radiation dose, and postoperative complications were evaluated. The collected data was tabulated and frequency (n) and percentage (%) analysis was performed. The Chi-square test was used to find the level of significance. Results: A total of 70 patients were included in the study and out of which 35 patients were in the supine (46.37±14.73 years, 28 males and 7 females) and 35 patients (47.54±12.45 years, 23 males and 12 females) were in the prone PCNL groups. Statistically significant difference was observed in the mean operating time in the supine and prone PCNL groups (81.43 vs 127.71 minutes; p-value=0.001), with a higher stone-free rate (94.29% vs 91.43%; p-value=0.643) observed in the supine PCNL group. One patient in supine group had postoperative sepsis and one patient in prone group had bleeding requiring transfusion. The Visual Analog Scale (VAS) score in supine PCNL was (5.08±0.32) less than in prone group (8.03±0.40) (p-value &lt;0.001). Conclusion: PCNL in the supine position compared with the prone position demonstrates significantly lower operative time with similar SFR and lower VAS score.