Percutaneous Nephrolithotomy In Patients Research Articles

Experience of tubeless percutaneous nephrolithotomy in patients>65 years old at rural community teaching hospital

Experience of tubeless percutaneous nephrolithotomy in patients>65 years old at rural community teaching hospital

Comparison of safety and efficacy of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in patients with large renal pelvic stones: a meta-analysis

To compare percutaneous nephrolithotomy (PCNL) and laparoscopic pyelolithotomy (LP) for surgical management for large (>2 cm) renal stones. We searched MEDLINE, Cochrane, and EMBASE databases until March 11, 2015, using...

Efficacy and Safety of Percutaneous Nephrolithotomy in Patients Over 70 Years with Kidney Stones

Abstract Introduction and objectives: Percutaneous nephrolithotomy represent the main indication for patients with kidney stones, even in the presence of various comorbidities. In our clinic open surgery for this pathology is less than 0.5% of all procedures for renal stones. The objective of this paper is to assess the safety and efficacy of this procedure in patients over 70 years. Material and methods: A retrospective study was performed for a period of 16 years (1997-2012). A totally of 323 patients entered in this study (162 women, 161 men), aged over 70 and with renal stones They were treated endoscopically by percutaneous nephrolithtomy or anterograde ureteroscopy. 85 patients (26.31%) had comorbidities that were preoperatively diagnosed and treated where necessary. Results: Overall status of “stone free” at the end of surgery was present in 263 patients (81.42%). 60 patients (18.58%) had residual fragments. Residual stones were solved by a new percutaneuos nephrolithtomy session, spontaneous elimination or extracorporeal shock wave lithotripsy. The most common complications were bleeding and infection. We had no deaths. No hemostasis nephrectomy was necessary. Conclusions: Recognized preoperative comorbidities do not represent risk factors in elderly patients, but it requires a rigorous evaluation in the preoperative period. The number, size and complexity of stones directly influences the state “stone free” at the end of surgery.

Impact of previous open renal surgery on the outcomes of subsequent percutaneous nephrolithotomy: a meta-analysis

ObjectiveThe aim of this study was to systematically compare the perioperative outcomes of percutaneous nephrolithotomy in patients with or without previous ipsilateral open renal surgery (POS).DesignSystematic searches of the PubMed,...

PD23-01 THE EFFECT OF CONTINUED ASPIRIN THERAPY IN PATIENTS UNDERGOING PCNL

You have accessJournal of UrologyStone Disease: Surgical Therapy IV1 Apr 2016PD23-01 THE EFFECT OF CONTINUED ASPIRIN THERAPY IN PATIENTS UNDERGOING PCNL Brandon Otto, Forat Lutfi, Russell Terry, Mohit Gupta, and VincentG Bird Brandon OttoBrandon Otto More articles by this author , Forat LutfiForat Lutfi More articles by this author , Russell TerryRussell Terry More articles by this author , Mohit GuptaMohit Gupta More articles by this author , and VincentG BirdVincentG Bird More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1740AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Aspirin (ASA) is usually stopped prior to percutaneous nephrolithotomy (PCNL) over the concern for increased surgical bleeding. There is evidence that discontinuing ASA perioperatively increases thromboembolic events. Since 2012 we have continued ASA in all patients undergoing PCNL. We sought to review our experience to date. METHODS We retrospectively reviewed 285 consecutive PCNLs between 2012-2015 at our institution. We compared outcomes and complications of PCNL in patients continuing ASA to patients not taking ASA. Statistical analysis was performed with students t-test and chi-squared test. RESULTS 77 (27%) patients were maintained on ASA and 208 (73%) were not on ASA. Table 1 summarizes ASA dose and indications. The ASA group was older (66 vs 51 years, p<0.001), had more tobacco users (55.8% vs 31.7%, p<0.001) and a higher American Society of Anesthesiologist score (2.9 vs 2.5, p<0.001). There were no differences in mean stone size or blood loss between the ASA and non-ASA groups (37 vs 40 mm, p=0.127 and 42 vs 54 mL, p=0.05 respectively). There were no differences in residual stone fragment size following PCNL between the ASA and non-ASA groups (0-2 mm: 66.7% vs 61.9%, 3-4 mm: 19% vs 16%, >4 mm: 14.3% vs 22.4%, p=0.265 respectively). Length of stay and change in hemoglobin, hematocrit and creatinine were similar between the groups. (Table 2) There were no differences in the number of readmissions or total complications between the ASA and non-ASA groups (12.4% vs 12.4%, p=0.949, 31.6% vs. 26.7%, p=0.401 respectively). Additionally, there were no differences in the number of major complications, bleeding complications and transfusion rates between the ASA and non-ASA groups (8.9% vs 5.7%, p=0.366; 3.8% vs 3.3%, p=0.853; and 1.3% vs 1%, p=1.00 respectively). CONCLUSIONS PCNL appears both effective and safe in patients continuing ASA perioperatively. Postoperative hemorrhage was uncommon and this concern should not dissuade urologists from offering PCNL with perioperative ASA use to this patient population. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e505-e506 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Brandon Otto More articles by this author Forat Lutfi More articles by this author Russell Terry More articles by this author Mohit Gupta More articles by this author VincentG Bird More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Analysis factors of urosepsis after percutaneous nephrolithotomy

Objectives To investigate the influencing factors of urosepsis after percutaneous nephrolithotomy for patients with urinary calculus. Methods 328 cases of patients with urinary calculus undergoing percutaneous nephrolithotomy in our hospital were divided into urosepsis group and non–urosepsis group. The general clinical data and experiment data were collected and analyzed. Results Single factors analysis showed that there was significant difference between gender, stone number, stone volume, operation duration, renal insufficiency, staghorn renal stone, washing pressure, urinary tract infection and hs–CRP of two groups (P<0.05 or P<0.01). Logistic regression analysis showed that stone number, stone volume, operation duration, renal insufficiency, staghorn renal stone, washing pressure, and urinary tract infection were dependent risk factors of urosepsis for patients with urinary calculus undergoing percutaneous nephrolithotomy (P<0.05 or P<0.01). Conclusions Stone number, stone volume, operation duration, renal insufficiency, staghorn renal stone, washing pressure and urinary tract infection were dependent risk factors of urosepsis for patients with urinary calculus undergoing percutaneous nephrolithotomy. Key words: Urinary Calculi; Nephrostomy, Percutaneous; Lithotripsy; Toxemia

Endoscopic Management of Urolithiasis in the Horseshoe Kidney

To assess the endourologic outcomes of patients diagnosed with a horseshoe kidney (HK) and symptomatic urolithiasis. A retrospective review was performed of patients diagnosed with an HK who underwent endoscopic management from 2002 to present. We identified 45 patients with 64 stone-bearing moieties who underwent 56 procedures, of which 31 (69%) were male. Mean age was 49.4 years (23-78) and mean stone size was 1.6 cm (0.2-5.7). Of the 64 moieties, 37 (58%) underwent percutaneous nephrolithotomy (PCNL), 25 (39%) underwent ureteroscopy (URS), and 2 (3%) underwent extracorporal shockwave lithotripsy (SWL). More than one access was utilized in 2 (5.7%) moieties undergoing PCNL. Additional procedures were required in 10 (28.5%) PCNL patients, of which 7 were URS, 2 were secondary PCNL, and 1 sandwich therapy with SWL and PCNL. Stone-free rate by moiety was 81.1% for PCNL, 84% for URS, and 50% for SWL. Postoperative complications occurred in 3 patients in the PCNL group, including readmission for pain and complicated urinary tract infection. With a mean follow-up of 20.5 months (range 0-118 months), stone recurrence was noted in 7 (16%) patients with a total of 11 events. Calcium oxalate was the most common stone type and 20/24 (83%) of patients with metabolic evaluations were found to have at least one abnormality. After careful consideration of the anatomy, individuals with HK and symptomatic urolithiasis can be managed safely by a variety of endoscopic approaches with excellent outcomes; however, secondary procedures and recurrence are common.

Thoracic Paravertebral Block versus Epidural Anesthesia Combined with Moderate Sedation for Percutaneous Nephrolithotomy

Objective: To investigate the feasibility of thoracic paravertebral block (TPVB) for percutaneous nephrolithotomy (PCNL) in comparison with epidural anesthesia (EA) combined with moderate sedation. Subjects and Methods: One hundred American Society of Anesthesiologists (ASA) I-II adult patients scheduled for first-stage unilateral PCNL were randomly assigned to receive either TPVB or EA. All patients were given standard sedation and analgesia with propofol and sufentanil. Patient characteristics, surgical outcomes, anesthetic outcomes, and time to first use of a patient-controlled intravenous analgesic (PCIA) device and postoperative consumption of sufentanil in the first 24 h were recorded. Intergroup differences of the parameters were analyzed using an independent t test, Mann-Whitney test, and χ² test as appropriate. Results: Patients who received TPVB consumed more propofol during ureteroscopy (56.2 ± 28.4 vs. 42.9 ± 27.5 mg, p < 0.05) and more sufentanil during ureteroscopy (9.7 ± 4.8 vs. 3.9 ± 2.7 μg, p < 0.05) and during PCNL (7.0 ± 4.3 vs. 1.9 ± 1.8 μg, p < 0.05) than those who received EA. The volume fluids infused in patients who received TPVB was less than in those who received EA (854 ± 362 vs. 1,320 ± 468 ml, p < 0.05). Time to first PCIA use, postoperative 24-hour consumption of sufentanil, and other parameters were comparable between groups. Conclusions: In this study, TPVB was as effective and safe as EA in providing intraoperative anesthesia and postoperative analgesia for PCNL, although more sedatives and analgesics were used during PCNL in patients who received TPVB.

Percutaneous Nephrolithotomy in Patients With BMI >50: Single Surgeon Outcomes and Feasibility

To evaluate the use of percutaneous nephrolithotomy (PNL) and technical approach in the super obese population (body mass index [BMI] ≥ 50). We performed a retrospective review of 31 consecutive PNL cases with a BMI > 50 from a single surgeon (SYN) from 1995 to 2013. Procedures were performed in the prone position, and upper pole access was used. Operative time, length of hospital stay, stone burden, complication rates, and stone-free rates were measured. Of the 31 patients who underwent PNL (age 51.2 ± 12; 71% female), the mean BMI was 59.1 ± 6 kg/m(2) (range 50.4-71.7 kg/m(2)). Mean stone burden was 3.8 cm ± 2. The majority of patients (90.3%) had an upper pole puncture site for access with an operative time of 122.1 ± 75 minutes. The technique was similar to non-obese patients; however, there was a need for extra-long instrumentation. The overall stone-free rate was 71%, with utilization of a second-look PNL in 11 cases. The complication rate, Clavien grade 3 or higher, was 9.7% (3 of 31). PNL is technically feasible, safe, and effective in patients with a BMI ≥ 50. The complication rate, length of hospital stay, and stone-free rate with use of second-look PNL in super obese patients are comparable to severely obese patients. Intervention should not be automatically ruled out or delayed based on the patient's BMI alone.

Colon Radiological Delineation Technique Prior to Percutaneous Nephrolithotomy in Patients With Horseshoe Kidney

To develop a technique that helps avoid colonic injury during percutaneous nephrolithotomy (PCNL) in these patients. PCNL was prospectively performed in a cohort of adults with renal stones in a horseshoe kidney (HSK). PCNLs were done using a standardized technique in prone position in all patients. The colon was radiologically delineated by injecting air-through a catheter in the anal canal-to help localize its position in relation to the pelvicalyceal system (PCS). Patients were observed in hospital for 48 hours postoperatively to detect any potential complications related to the PCNL or to the colon insufflation modification. Thirteen adult patients (11 men and 2 women) with renal stones in a HSK were included in the study. The colon was well radiologically delineated with air in all cases. The PCS was successfully accessed, subcostally, with a single access at the upper calyx in 11 cases and multiple accesses in 2 cases. The colon was in the way of the puncture in 2 cases in which we used a more medial access and the colon was successfully avoided. Stones were completely removed during the PCNL in 11 of the 13 cases (84.6%). One case necessitated intraoperative blood transfusion. No other complications were reported by any of the patients who were discharged home after 48 hours. Colonic radiological delineation technique is helpful in accessing the PCS quickly, saving the colon, and causing no discomfort to patients with renal stones in a HSK.

Percutaneous nephrolithotomy in patients with solitary kidney: a critical outcome analysis.

ABSTRACTPurpose:To describe our experience with percutaneous nephrolithotomy (PCNL) in patients with solitary kidneys and analyze factors that can impact on intra-operative bleeding and postoperative complications.Materials and Methods:We reviewed our stone database searching for patients with solitary kidney who underwent PCNL from Jan-05 through Oct-13. Demographic data, stone characteristics, and intra- and postoperative outcomes were recorded. Spearman correlation was performed to assess which variables could impact on bleeding and surgical complications. Linear and logistic regressions were also performed.Results:Twenty-seven patients were enrolled in this study. The mean age and BMI were 45.6 years and 28.8Kg/m2, respectively; 45% of cases were classified as Guys 3 (partial staghorn or multiple stones) or 4 (complete staghorn) – complex cases. Stone-free rate was 67%. Eight (29.6%) patients had postoperative complications (five of them were Clavien 2 and three were Clavien 3). On univariate analysis only number of tracts was associated with increased bleeding (p=0.033) and only operative time was associated with a higher complication rate (p=0.044). Linear regression confirmed number of access tracts as significantly related to bleeding (6.3, 95%CI 2.2-10.4; p=0.005), whereas logistic regression showed no correlation between variables in study and complications.Conclusions:PCNL in solitary kidneys provides a good stone-free rate with a low rate of significant complications. Multiple access tracts are associated with increased bleeding.

Incidence of retrorenal colon during percutaneous nephrolithotomy.

Objective The aim of this study was to investigate retrorenal colon incidence in percutaneous nephrolithotomy (PNL) interventions made in our clinic.Materials and Methods Clinical data of 804 PNL patients, accumulated over a 7 year period (2006-2012), was surveyed. The patient files were reviewed retrospectively, and only those who had abdominal computed tomography (CT) images before PNL intervention were included in the study. In the CT images, the position of both the ascending and descending colon in relation to the right and left kidneys were evaluated.Results According to our hospital reports, 394 patients with CT images were included in the present study 27 patients (6.9%) had retrorenal colon, of which 18 (4.6%) were on the left side, 4 (1.0%) on the right side and 5 (1.3%) had bilateral retrorenal colons. Colonic perforation complication was seen only in two patients and the colonic perforation rate was 0.3%. These two cases had no CT images.Conclusions PNL, in the process of becoming the standard treatment modality, is a safe and reliable technique for renal stone treatment. Colonic injury should be taken into consideration during PNL interventions of the lower pole of the kidney (especially on the left side) due to the location of retrorenal colon.

MP30-03 IS PREOPERATIVE ANTIBIOTIC PROPHYLAXIS FOR HIGH-RISK PATIENTS NECESSARY BEFORE PERCUTANEOUS NEPHROLITHOTOMY? A RETROSPECTIVE REVIEW OF 7 VS 2 VS 0 DAY THERAPY

You have accessJournal of UrologyStone Disease: Surgical Therapy III1 Apr 2015MP30-03 IS PREOPERATIVE ANTIBIOTIC PROPHYLAXIS FOR HIGH-RISK PATIENTS NECESSARY BEFORE PERCUTANEOUS NEPHROLITHOTOMY? A RETROSPECTIVE REVIEW OF 7 VS 2 VS 0 DAY THERAPY Jeffrey Larson, Aaron Potretzke, Alana Desai, and Brian Benway Jeffrey LarsonJeffrey Larson More articles by this author , Aaron PotretzkeAaron Potretzke More articles by this author , Alana DesaiAlana Desai More articles by this author , and Brian BenwayBrian Benway More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.585AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Postoperative infection after percutaneous nephrolithotomy (PCNL) is a serious complication that can occur despite sterile urine. Previous studies have suggested that extended preoperative antibiotic therapy can reduce the risk of systemic inflammatory response syndrome (SIRS) in high-risk patients with sterile urine. The goal of this study is to investigate our expanded series comparing 7 vs 2 vs 0 days preoperative antibiotics in high-risk patients with sterile preoperative urine. METHODS We retrospectively reviewed 292 consecutive PCNLs performed by two surgeons at one institution between 2012 and 2014. Patients with positive preoperative urine cultures were excluded and those with sterile urine were divided into low- (excluded from this study) or high-risk (previous UTI, dilated pelvicaliceal system, or stone ≥20mm) groups. Patients in the high-risk group were treated with either 7, 2 or 0 days preoperative antibiotic prophylaxis prior to PCNL. This cohort was used in univariate and multivariate regression models to predict postoperative fever and SIRS. RESULTS Of the 292 patients, 192 (65.7%) had sterile urine of which 140 (47.9%) met high-risk criteria and were treated with either 7 days (27 pts), 2 days (40 pts) or 0 days (72 pts) prophylactic antibiotics. All three groups were similar in age, gender and duration of surgery. In patients treated with 7, 2 and 0 days preoperative antibiotic prophylaxis, 1 (3.7%), 2 (5%) and 3 (4.2%) patients met SIRS criteria. There was no significant difference between groups (Table 1). CONCLUSIONS Our previous study demonstrated that preoperative antibiotic prophylaxis of 7 vs 2 days was equivalent in preventing SIRS and infectious complications in high risk PCNL patients. The current study did not find a difference in postoperative infection between patients treated with extended prophylactic preoperative antibiotics and those given only perioperative antibiotic therapy on the day of surgery. Our results suggest that routine antibiotic prophylaxis in patients with sterile preoperative urine is not necessary to prevent postoperative infection. Table 1. Baseline characteristics Baseline patient characteristics 7-day 2-day 0-day p-value Number of patients 27 40 72 Mean age, years (SD) 55 (15.9) 57.8 (18.4) 56.5 (13.3) 0.562 Female gender (%) 17 (63) 23 (57.5) 33 (45.8) 0.05 Pelvicalyectasis, No. (%) 9 (33.3) 15 (37.5) 33 (45.8) 0.437 History of UTI, No. (%) 13 (48.1) 17 (42.5) 35 (48.6) 0.398 Stone ≥ 20mm, No. (%) 23 (85.2) 29 (72.5) 51 (70.8) 0.531 Mean stone size, (SD) 22.9 (8.5) 24.2 (12.3) 23.9 (12.1) 0.284 Surgery duration, min (SD) 141(54.9) 149(62.6) 104(38.5) 0.074 Infection Outcomes Postoperative fever, No. (%) 1 (3.7) 0 1 (1.4) 1 Met SIRS criteria, No. (%) 1 (3.7) 2 (5) 3 (4.2) 1 SIRS = Systemic Inflammatory Response Syndrome © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e347-e348 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Larson More articles by this author Aaron Potretzke More articles by this author Alana Desai More articles by this author Brian Benway More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Retrograde Intrarenal Surgery versus Percutaneous Lithotripsy to Treat Renal Stones 2-3 cm in Diameter

Objective. Retrograde intrarenal surgery (RIRS) performed using a flexible ureterorenoscope marked the beginning of a new era in urology. Today, even staghorn stones are successfully treated via RIRS. The recommended treatment for larger stones is percutaneous nephrolithotomy (PNL). However, the question of whether PNL or RIRS should be the first-line treatment option for larger stones remains controversial. In this study, we contribute to the debate by comparing the success and complication rates of PNL and RIRS that were used to treat renal pelvis stones 2-3 cm in diameter. Materials and Methods. The medical records of 154 patients (74 PNL, 80 RIRS) were retrospectively evaluated. PNL patients were placed in Group 1 and RIRS patients in Group 2. Results. The complete stone-free rates were 95.5% in the PNL group and 80.6% in the RIRS group 1 month postoperatively (P = 0.061). The respective complication rates (evaluated using the Clavien system) were 13.5% and 8.8% (P = 0.520). Conclusions. RIRS affords a comparable success rate, causes fewer complications than PNL, and seems to be a promising alternative to PNL when larger stones are to be treated. Prospective randomized controlled trials are needed to confirm these findings.

Percutaneous nephrolithotomy in patients with a solitary kidney.

The results of percutaneous nephrolithotomy applied to 716 patients in our clinic between January 2008 and January 2014 were retrospectively evaluated. Age, gender, urinary calculi size (mm(2)), urinary calculi localization, ESWL history, operation duration (min), fluoroscopy duration (sec), access type, reason of solitary kidney, hemoglobin drawdown (g/dl) and operation success of the patients with a solitary kidney were recorded. The patients having no preoperative and postoperative non contrast abdominal tomography were excluded from the study. Fifteen of nineteen patients (79%) were men and 4 of them (21%) were women. The average age of the patients was 42.52 ± 16.72 (14-72). Ten patients had anatomical solitary kidney and nine patients had physiological solitary kidney. In fact counter kidney was non functional in 9 patients (47%) whereas there was agenesis in 2 (11%) and outcome of nephrectomy in 8 (42%) patients. In our study, presence of residual stone less than 4 mm at 1st month postoperative non contrast abdominal tomography was accepted as a successful result and accordingly our success rate was detected as 84%. Mean urinary calculi size was 405 ± 252.9 mm(2); urinary calculi localization was pelvic, lower pole, upper-middle pole, middle-lower pole and staghorn in 11 (58%), 4 (21%), 1 (5%), 1 (5%) and 1 (5%) patients, respectively; previous ESWL history was 16%; operation duration was 55.47-± 28.1 min and fluoroscopy duration 131.10 ± 87.6 sec; access type was subcostal in 79%, supracostal in 10.5% and multiple in 10.5%; hemoglobin drawdown was 1.75 ± 0.97 mg/dl. PNL can be effectively and safely administered for the treatment of solitary kidney. In the treatment of large urinary calculi in patients with a solitary kidney, PNL has some advantages such as short surgery duration, less complication, acceptable hemoglobin drawdown and high success rates. According to our study, PNL operation in patients with a solitary kidney is a good option for carefully and poisedly selected cases.

Comparison of safety and efficacy of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in patients with renal pelvic stones: a randomized clinical trial.

A randomized clinical trial was designed to compare the efficacy, success rate and surgical complications of percutaneous nephrolithotomy (PCNL) and laparoscopic pyelolithotomy (LP). Sixty patients with renal pelvic stones larger than 2 cm were randomly divided into two groups of LP and PCNL. All patients were followed up to three months after surgery using renal diethylenetriamine&shy;pentaaceticacid (DTPA) scan and determining the glomerular filtration rate (GFR). Mean operation time (149 &plusmn; 31 vs. 107 &plusmn; 26 min) and mean hospital stay (3.4 vs. 2.16 days) were significantly higher in LP, but mean hemoglobin drop (0.85 vs. 1.88 g/dL) and the rate of blood transfusion were significantly lower. Stone free rate was 90% and 86.6% for LP and PCNL, respectively (P =.59), while the changes in GFR were not statistically significant 3 days after surgery between two groups. Those in LP group showed better improvement in GFR at three months postoperatively. Improvement of the affected split kidney function was significantly higher in LP group (P =.04). No major complications were observed in both groups according to Clavien grading system. PCNL remains the gold standard treatment for most large kidney stones, nevertheless, laparoscopic pyelolithotomy can be considered for selected cases especially in whom maximal preservation of renal function is &nbsp;necessary.&nbsp;

Does previous stone treatment in children generate a disadvantage or just the opposite?

In this study we aimed to determine the effects of previous open renal surgery, percutaneous nephrolithotomy and extracorporeal shockwave lithotripsy (ESWL) on the results and complications of subsequent percutaneous nephrolithotomy (PCNL) in pediatric patients. We reviewed the files of all 105 patients with 116 renal units (RU) undergoing PCNL at two main institutions between December 2000 and February 2014. The 116 RUs were divided into four groups: primary PCNL patients with 44 RU (37.9%) were categorized as group 1, 29 RU (25%) with a history of failed ESWL on the same side were categorized as group 2, 23 RU (19.8%) with previous PCNL surgery were categorized as group 3 and 20 RU (17.2%) with open renal surgery were categorized as group 4. Patient characteristics, mean operative time, mean fluoroscopy time, time to access the collecting system, hemoglobin change, number of more than 1 access, stone-free rates, postoperative hospitalization time and complications in four groups were compared. There were no differences between the groups in age, sex, mean stone size and stone laterality. Mean operative time, mean fluoroscopy time, time to access the collecting system, hemoglobin change, complication rates, number of more than one access hospitalization times were similar in the each group (p > 0.05 for each parameter). The stone-free rates after PCNL were 81.8% in group 1, 79.3% in group 2, 78.3% in group 3 and 80 % in group 4 (p = 0.67). Percutaneous nephrolithotomy is effective and safe in children who have previously had open nephrolithotomy, history of ESWL or PCNL without no more complications than are seen with primary PCNL of kidneys and with similar success rate.

S209: Percutaneous nephrolithotomy in patients with renal anomalies

S209: Percutaneous nephrolithotomy in patients with renal anomalies

Percutaneous nephrolithotomy in patients with urinary tract abnormalities.

Patients with urinary tract abnormalities are at an increased risk of stone formation. Percutaneous nephrolithotomy (PCNL) plays an important role in the treatment of this patient population; however, outcomes are less well defined compared with patients with normal urinary tract anatomy. Our objective was to evaluate the influence of urinary tract abnormalities on intraoperative and postoperative outcomes with PCNL. We report on a single-center prospective database of 2284 consecutive PCNLs in 1935 patients from 1990 to 2012. For the purposes of this analysis, patients were categorized by the presence or absence of a urinary tract abnormality. Multivariable analyses were used to identify independent predictors of the length of hospital stay, operative time, complications, and residual stones at discharge and 3 months. A urinary tract abnormality was present in 14.4% (n=330) of the cohort. On univariable analysis, patients with urinary tract abnormalities were more likely to present with urinary tract infection (28% vs 19%, P<0.001) and less likely to present with hematuria (13% vs 19%, P<0.02). On multivariable regression, a urinary tract abnormality was predictive of residual stone at discharge, need for a secondary procedure, but did not increase the risk of residual stone at 3 months or the development of complications. Operative time and hospital stay were only moderately prolonged. Patients with urinary tract abnormalities who undergo PCNL have a higher risk of residual stones at discharge and need for secondary procedures, but comparable complication rates, operative time, and hospital stay.

Percutaneous Nephrolithotomy in Patients with Urinary Tract Abnormalities

Percutaneous Nephrolithotomy in Patients with Urinary Tract Abnormalities