Outcomes Of Percutaneous Nephrolithotomy Research Articles

The impact of anterior calyceal stones on the outcomes of percutaneous nephrolithotomy for complex kidney stones: a comparative study

article: The impact of anterior calyceal stones on the outcomes of percutaneous nephrolithotomy for complex kidney stones: a comparative study - Minerva Urologica e Nefrologica 2020 Nov 17 - Minerva Medica - Journals

Investigation of Factors Related to Percutaneous Nephrolithotomy Failure in Horseshoe Kidneys and Comparison of Three Stone Scoring Systems in Prediction of Outcomes

Introduction: We aimed to identify factors affecting percutaneous nephrolithotomy (PNL) outcomes among patients with horseshoe kidney (HSK) and assess the predictive accuracy of the Clinical Research Office of the Endourological Society (CROES), Guy’s Stone Score (GSS), and S.T.O.N.E. scoring systems. Methods: Data from 98 patients with HSK who underwent PNL between November 2010 and January 2020 were evaluated. Patients were divided into the stone-free (SF) and non-SF groups and compared according to demographic data, stone and surgical characteristics, and stone scoring systems. Multivariate logistic regression analysis was performed to identify factors associated with SF status. Results: Among the included patients, 87 were male and 11 were female (mean age: 47.37 ± 14.42 years). The SF rate was 84.7% (83 patients). Group analysis identified GSS (p < 0.001), CROES score (p < 0.001), S.T.O.N.E. score (p = 0.014), stone burden (p = 0.045), and multiplicity (p < 0.001) as factors associated with SF status. Among our cohort, 10 patients developed complications. All scoring systems were significantly correlated with SF status (CROES: r = −0.442, p < 0.001; GSS: r = 0.442, p < 0.001; S.T.O.N.E.: r = 0.250, p = 0.013), while CROES score was identified as an independent factor associated with SF status (95% CI: 0.937–0.987; p = 0.003). Conclusions: PNL is an effective method for treating nephrolithiasis among patients with HSK. Moreover, stone-related factors, such as larger size, multiplicity, and complexity, were associated with procedural failure. Finally, the CROES nomogram was a better predictor of SF status compared with other scoring systems.

Mini Percutaneous Nephrolithotomy Is a Noninferior Modality to Standard Percutaneous Nephrolithotomy for the Management of 20–40 mm Renal Calculi: A Multicenter Randomized Controlled Trial

BackgroundHigh quality of evidence comparing mini percutaneous nephrolithotomy (mPNL) with standard percutaneous nephrolithotomy (sPNL) for the treatment of larger-sized renal stones is lacking. ObjectiveTo compare the efficacy and safety of mPNL and sPNL for the treatment of 20–40mm renal stones. Design, setting, and participantsA parallel, open-label, and noninferior randomized controlled trial was performed at 20 Chinese centers (2016–2019). The inclusion criteria were patients 18–70 yr old, with normal renal function, and 20–40mm renal stones. InterventionPercutaneous nephrolithotomy PNL was performed using either 18 F or 24 F percutaneous nephrostomy tracts. Outcome measurements and statistical analysisThe primary outcome was the one-session stone-free rate (SFR). The secondary outcomes included operating time, visual analog pain scale (VAS) score, blood loss, complications as per the Clavien-Dindo grading system, and length of hospitalization. Results and limitationsThe 1980 intention-to-treat patients were randomized. The mPNL group achieved a noninferior one-session SFR to the sPNL group by the one-side noninferiority test (0.5% [difference], p < 0.001). The transfusion and embolization rates were comparable; however, the sPNL group had a higher hemoglobin drop (5.2 g/l, p < 0.001). The sPNL yielded shorter operating time (–2.2 min, p = 0.008) but a higher VAS score (0.8, p < 0.001). Patients in the sPNL group also had longer hospitalization (0.6 d, p < 0.001). There was no statistically significant difference in fever or urosepsis occurrences. The study’s main limitation was that only 18F or 24F tract sizes were used. ConclusionsMini mPNL achieves noninferior SFR outcomes to sPNL, but with reduced bleeding, less postoperative pain, and shorter hospitalization. Patient summaryWe evaluated the surgical outcomes of percutaneous nephrolithotomy using two different sizes of nephrostomy tracts in a large population. We found that the smaller tract might be a sensible alternative for patients with 20–40mm renal stones.

Outcomes of Percutaneous Nephrolithotomy in Preschool Age Group: A Single-Center Study.

Objective: To determine the factors affecting the outcomes of percutaneous nephrolithotomy (PCNL) in patients in infantile/toddler and preschool age group. Materials and Methods: The data of 186 renal units from 152 patients who underwent PCNL were retrospectively analyzed. Patients under ≤72 months of age were included in the study. The patients were divided into two groups according to their age: infantile/toddler and preschool group. Demographics and stone features were compared between infantile/toddler and preschool age groups. Effects of different factors on complications and stone-free rates were investigated. Comparisons in the study were done using SPSS 24.0 software for Windows. Results: The mean age of the patients was 40.5 ± 16.5 months, and the female/male ratio was 87/99. The median stone burden was 1.92 cm2 (0.12-20). Stone-free rates were 75.3% and 84.4% when cases with Clinically Insignificant Residual Fragments were also included. The numbers of patients with Clavien grade 1, grade 2, and grade 3b complications were 7 (3.8%), 39 (21%), and 9 (4.8%), respectively. There was no difference between infantile/toddler and preschool children in terms of stone-free and complication rates (p = 0.082, p = 0.088, respectively). Mini PCNL and tubeless-totally tubeless- urinary diversion techniques were more frequently performed in the infantile/toddler group compared to the preschool group (p = 0.001, p = 0.028, respectively). Presence of staghorn stone was the only significant factor for complications, while the number of stones was significant for stone-free rates for patients ≤72 months (p = 0.012, p = 0.001, respectively). Stone burden was the only predictive factor for complications in patients aged ≤36 months, while number of stones was predictive for success in patients aged between 37 and 72 months (p = 0.034, p = 0.006, respectively). Conclusion: PCNL is a feasible and effective method in preschool age group with acceptable complications and high success rates. Presence of staghorn stone is predictive for complications, while number of stones is predictive for success in the preschool age group.

Outcomes of Percutaneous Nephrolithotomy in Patients with Previous Ipsilateral Open Renal Stone Surgery.

Nephrolithiais is a recurrent disease. Recent advances have enabled stone surgeries to be performed by minimal invasive techniques; but still a large number of patients present with history of ipsilateral open renal stone surgery. Previous scar to the kidney and overlying muscles are fraught with possibility of increased complications. This study was conducted to evaluate the perioperative results of percutaneous nephrolithotomy in patients with a history of open stone surgery and to compare with those undergoing percutaneous nephrolithotomy for the first time. A retrospective study of all the percutaneous nephrolithotomy performed by standard technique within four years at Bir Hospital was made. Patients were divided into those undergoing percutaneous nephrolithotomy for the first time and those who had undergone open renal stone surgery in the past. Preoperative and intraoperative variables were recorded and postoperative stone free status and complications were evaluated. Six hundred and twenty seven patients; out of 691, who had undergone percutaneous nephrolithotomy were included. Demographic variables and stone characteristics were similar in the two study groups. percutaneous nephrolithotomy was found to be statistically similar in the two groups in terms of the number of tracts made (p= 0.1642) and operative time (0.9197). Exit strategies were similar in both groups. Stone free rate was 83.33% in patients undergoing percutaneous nephrolithotomy for first time and 82.08% in those with history of open surgery. Average hospital stay was 3 days in both groups. Although the group with history of previous surgery had significantly more complications (p= 0.0207), Clavien grading was similar in the two groups. This study shows that the rate of complications is more in patients with history of open surgery, most complications are minor, not requiring intensive management. percutaneous nephrolithotomy is efficient and safe in patients with history of open renal stone surgery.

Impact of Obesity on Outcomes of Supine Percutaneous Nephrolithotomy.

Objectives: To determine whether obesity has an impact on the outcomes of supine percutaneous nephrolithotomy (PCNL). Patients and Methods: We retrospectively evaluated a prospectively created database of patients who underwent PCNL in the supine position from June 2009 to June 2014. The patients were divided into two groups according to their body mass index (BMI): <30 kg/m2 (group 1, nonobese) and ≥30 kg/m2 (group 2, obese). Pre, peri, and postoperative data were analyzed. Stone complexity was classified according to Guy's stone score. The primary endpoint was the absence of stone fragments of ≥4 mm on CT scans at postoperative day 1. Complications were graded according to the modified Clavien classification. Results: Of the 401 patients, 307 (76.6%) were nonobese and 94 (23.4%) were obese. Regarding demographic and stone characteristics, group 2 (BMI ≥30 kg/m2) had a higher percentage of female patients (67.3% vs 50.4%, p = 0.002) and a higher mean BMI (34.8 vs 24.5 kg/m2, p < 0.001) than group 1. Success rates were not statistically different between the groups (group 1 = 61.8%, group 2 = 51%, p = 0.08). There were no differences in the transfusion rate (group 1 = 2.9%, group 2 = 4.2%, p = NS) or total number of complications greater than Clavien grade 1 (group 1 = 13.6%, group 2 = 13.8%, p = NS). Conclusion: In a retrospective study of 400 patients undergoing PCNL, the outcomes were not different between nonobese and obese patients. To our knowledge, this is the first study evaluating these outcomes for PCNL performed in the supine position. Further multicenter and prospective studies are necessary to verify these findings.

Ultrasound or Fluoroscopy for Percutaneous Nephrolithotomy Access, Is There Really a Difference? A Review of Literature

Objective: To compare whether the outcomes of ultrasound-guided access percutaneous nephrolithotomy (USGA-PCNL) are similar to standard fluoroscopy-guided access percutaneous nephrolithotomy (FGA-PCNL). Methods: A review was developed by using the MEDLINE and Scopus databases and following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Studies comparing the USGA-PCNL and the FGA-PCNL were included. Case reports, editorials and letters, unpublished studies, posters, and comments abstracts were excluded. Results: We found 12 published articles that compared USGA-PCNL and FGA-PCNL. These included six randomized controlled trials, three case-control trials, and three meta-analyses. The overall results showed no difference in the success of percutaneous access, bleeding, blood transfusion, operative time, postoperative complications, or hospital stay. Conclusion: The reported data demonstrate that there are no significant differences between the fluoroscopic-guided access PCNL and the ultrasonographic access PCNL. The choice of puncture depends on the surgeon's expertise in a particular technique and the patient and stone characteristics. Both approaches are equally safe and effective in experienced hands. It is important to recall that the use of one technique does not exclude the use of the other, and they can sometimes be complementary to each other.

Comparison of Middle and Lower Calyceal Access for Renal Pelvis Stone in Percutaneous Nephrolithotomy: A Prospective Randomized Study

Objective: The aim of the study was to evaluate the possible effects of calyceal choice for renal puncture under sonographic guidance on the outcomes of percutaneous nephrolithotomy (PNL). Materials and Methods: A total of 70 patients for whom ultrasound-guided PNL was planned for 20–30-mm single renal pelvic stones were prospectively allocated to group 1 (n:35) with middle calyx entry or group 2 (n:35) with lower calyx entry. Procedure-related parameters such as duration of operation, stone-free rates, complication rates, and radiation exposure time were analyzed in detail. Results: The mean age of the patients was 45.67 ± 1.50 years and the mean stone size was 316.4 ± 17.95 mm². There was no significant difference regarding the age, BMI, stone burden, and the grade of hydronephrosis between the groups. Skin to collecting system distance was significantly shorter in the middle calyx entrance (p = 0.021). Total duration of the procedure was again significantly shorter in group 1 cases (74.69 ± 2.94 min) than in group 2 (84.29 ± 4.25 min) (p = 0.003). Regarding the success rates, the postoperative stone-free rate was higher in group 1 (91.4% in group 1, 80.0% in group 2, p = 0.305). Last, there was no statistically significant difference in hemoglobin reduction rates, blood transfusion requirements, and complication rates between the 2 groups. Conclusion: Getting access to the renal pelvis through the middle calyx during ultrasonic guided PNL procedure is more advantageous to lower the calyceal approach by reducing both the duration of the PNL procedure with significantly higher stone-free and comparable complication rates.

PT111 - Does skeletal muscle quality impact the outcomes of percutaneous nephrolithotomy?

PT111 - Does skeletal muscle quality impact the outcomes of percutaneous nephrolithotomy?

668 - Comparing different kidney stone scoring systems for predicting percutaneous nephrolithotomy outcomes: A multicenter study

668 - Comparing different kidney stone scoring systems for predicting percutaneous nephrolithotomy outcomes: A multicenter study

666 - The first prospective assessment of S.T.O.N.E, Guy, CROES, S-ReSC nomograms in the prediction of percutaneous nephrolithotomy outcomes

666 - The first prospective assessment of S.T.O.N.E, Guy, CROES, S-ReSC nomograms in the prediction of percutaneous nephrolithotomy outcomes

Comparison Between Mini PCNL and Standard PCNL in Management of Nephrolithiasis

Introduction: The incidence of small and medium size renal stones is rising. Stone clearance, bleeding, urine leak and infectious complications are major concerns for urologist. Urologist chooses best technique from list of armamentarium available. Minimally invasive approach like Percutaneous Nephrolithotomy (PCNL) has significantly influenced the renal stone management since 1976. Miniaturisation of the instruments allow more effective and safer alternatives for urolithasis management.&#x0D; Methods: This is a retrospective study in which the outcome of mini PCNL (mPCNL) was compared with standard PCNL (sPCNL) in management of nephrolithiasis. &#x0D; Result: There were no significant difference in stone free rate between mPCNL and sPCNL (96.2 ± 3.6% vs 95.3 ± 4.8%). The total operative time was longer in mPCNL (55.2 ± 19.0 minute vs 62 ± 21.0 minute) but the difference was not statistically significant.&#x0D; Conclusions: Mini PCNL is as effective as standard PCNL with fewer bleeding complications in management of medium sized nephrolithiasis.

Percutaneous Nephrolithotomy in Horseshoe Kidneys: Results of a Multicentric Study.

Objective: To report the outcomes of percutaneous nephrolithotomy (PCNL) in horseshoe kidneys (HSK) in 12 institutions worldwide and evaluate the impact of patient position during operation. Methods: We carried out a retrospective analysis of PCNL procedures performed between 2008 and 2018 in patients with HSK. Pre-, peri-, and postoperative data were collected, and a subgroup analysis was performed according to patient position. Success was defined as an absence of >4-mm fragments. Values of p < 0.05 were considered significant. Results: We analyzed 106 procedures. The transfusion, complication, and immediate success rates (ISRs) were 3.8%, 17.5%, and 54.7%, respectively. The final success rate (FSR) increased to 72.4% after a mean of 0.24 secondary procedures. Logistic regression showed that higher body mass index (BMI) and stone size were significantly associated with residual fragments ≥4 mm. Sixty-seven patients (63.2%) were treated in prone and 39 (36.8%) in supine position. The prone group had a significantly higher BMI than the supine group (30.1 vs 27.7, p = 0.024). The transfusion, complication, and ISRs between the prone and supine groups were 4.5% vs 2.6% (p = 0.99), 16.9% vs 18.4% (p = 0.99), and 52.5% vs 69.2% (p = 0.151), respectively. Surgical time was significantly longer in the prone group (126.5 vs 100 minutes, p = 0.04). Upper pole was the preferred access in 80.3% of the prone group and 43.6% of the supine group (p < 0.001). The prone group had significantly more Clavien 2 complications than the supine (p = 0.013). The FSR in the prone and supine groups increased to 66.1% and 82.1% after 0.26 and 0.21 secondary procedures, respectively. No complications higher than Clavien 3 occurred. Conclusion: PCNL in patients with HSK is safe and effective with a low complication rate. Higher BMI and stone size negatively impacted outcomes. Supine PCNL may be an option for treating kidney stones in patients with HSK.

Перкутанная нефролитотрипсия при камнях единственной почки

Percutaneous nephrolithotomy (PCNL) is the method of choice for large and staghorn renal stones, including those in patients with solitary kidney. The aim of the literature review was to analyze the results of PCNL in patients with large stones in the solitary kidney. The literature search was conducted in databases Embase, Medline, Google Scholar, Scopus for the period from 2010 to 2019. A total 94 articles were selected, of which 16 papers were included in the review after analyzing the abstracts. Data was pooled and analyzed using SPSS Statistics 22.0. The primary stone-free rate for PCNL in these patients was 68.3+/-14.2%, and the final stone-free rate increased by 86.5+/-4.9%. The average duration of the operation was 86+/-25 (43.7-138.3) min, the length of stay was 5 (2-6) days. The baseline creatinine level was 137 (110-200) mmol/L, compared to 142 (122-183) mmol/L postoperatively. The mean difference between the baseline and postoperative Hb level was 7.8 (1.3-17.5) g/l. The estimated glomerular filtration rate (GFR) before PCNL was 62.3+/-7.5 ml/min/1.73 m2, and it did not exceed 62.5+/-9.3 ml/min/1.73 m2 postoperatively. The overall complication rate ranged from 10.6 to 68.8%, averaging 29.9%. In most cases, there were grade I and II complications, according to Clavien-Dindo classification, which didnt require additional interventions. PCNL is a highly effective treatment method for patients with large stones in solitary kidney. Complications rate is relatively low, which is achieved by an individual approach, with a consideration of the condition and all risk factors.

The Outcome of supine versus prone percutaneous nephrolithotomy in multiple renal stones Author: - Emad Abdellah. prof Dr Abd Elmoneim Abou zeid. prof Dr Ahmed Hammadi. Assit prof Hazem Elmoghazy

ABSTRACT:- Purpose: To differentiate the outcomes of percutaneous nephrolithotomy (PCNL) discharged in the prone posture versus the supine posture in multiple renal stones.Materials and Methods:-Comparative prospective randomized study of 30 cases divided into two sectors sector A included 15 cases in the supine posture and sector B included 15 cases in the prone posture. The outcomes of a period of exposure to radiation, renal stone-free rate, body mass index (BMI), size of the stone, period of operation, hold up in the hospital, and complications were compared.Results:-There were no differences in age, gender, site of stone, body mass index, size of the stone, and the presence of hydronephrosis between the two sectors. The supine sector had a little mean surgical period (93 minutes vs. 123 minutes, p

MP63-06 PREDICTING THE POSTOPERATIVE OUTCOME OF PERCUTANEOUS NEPHROLITHOTOMY WITH MACHINE LEARNING SYSTEM: SOFTWARE VALIDATION AND COMPARATIVE ANALYSIS WITH GUY’S STONE SCORE AND THE CROES NOMOGRAM

You have accessJournal of UrologyStone Disease: Surgical Therapy VI (MP63)1 Apr 2020MP63-06 PREDICTING THE POSTOPERATIVE OUTCOME OF PERCUTANEOUS NEPHROLITHOTOMY WITH MACHINE LEARNING SYSTEM: SOFTWARE VALIDATION AND COMPARATIVE ANALYSIS WITH GUY’S STONE SCORE AND THE CROES NOMOGRAM Alireza Aminsharifi*, Dariush Irani, Sona Tayebi, Tayebeh Shabanian, and Mehdi Parsaei Alireza Aminsharifi*Alireza Aminsharifi* More articles by this author , Dariush IraniDariush Irani More articles by this author , Sona TayebiSona Tayebi More articles by this author , Tayebeh ShabanianTayebeh Shabanian More articles by this author , and Mehdi ParsaeiMehdi Parsaei More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000938.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To validate the output of a machine learning-based software as an intelligible interface for predicting multiple outcomes after percutaneous nephrolithotomy (PCNL). We compared the performance of this system with Guy’s stone score (GSS) and the Clinical Research Office of Endourological Society (CROES) nomogram. METHODS: Data from 146 adult patients (87 males, 59%) who underwent PCNL at our institute were used, and preoperative variables and postoperative outcomes were recorded. Stone-free status was determined by computed tomography scan postoperatively. Preoperative data were consecutively imported into the software and its output was extracted. To validate the system, accuracy of the software for predicting each postoperative outcome was compared to the actual outcome. Similarly, preoperative data were analyzed with GSS and CROES nomograms to determine stone-free status as predicted by these nomograms, and the predictive performance of these two systems was calculated. A receiver operating characteristic (ROC) curve was generated for each scoring system, and the area under curve (AUC) was calculated and used to assess the predictive performance of the nomograms versus ANN software. RESULTS: Overall stone-free rate (SFR) was 72.6% (106/146). Forty of 146 patients (27.4%) were scheduled for Forty-two ancillary procedures (shock wave lithotripsy (SWL) (n= 31) or repeat PCNL (n=11)) to manage residual renal stones. Overall, the machine learning system predicted the PCNL outcomes with an accuracy ranging between 80% and 95.1%. A higher GSS grade and lower CROES nomogram score were significantly associated with lower SFR (p=0.01 and p= 0.03, respectively). When ROC curves were plotted for each predictive model for stone-free status, the area under the ROC curve for ANN software (0.915) was significantly larger than the AUC for GSS (0.615) or CROES nomograms (0.621) (p<0.001) (Figure 1). CONCLUSIONS: At the internal institutional level, the machine learning-based software was a promising tool for recording, processing and predicting outcomes after PCNL. Validation of this system against an external dataset is highly recommended before its widespread application. Source of Funding: Shiraz University of Medical Sciences. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e956-e956 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alireza Aminsharifi* More articles by this author Dariush Irani More articles by this author Sona Tayebi More articles by this author Tayebeh Shabanian More articles by this author Mehdi Parsaei More articles by this author Expand All Advertisement PDF downloadLoading ...

Percutaneous Nephrolithotomy Outcomes Based on S.T.O.N.E., GUY, CROES, and S-ReSC Scoring Systems: The First Prospective Study.

Objective: To evaluate predictive capability and clinical applicability of the current nephrolithometric scoring systems of S.T.O.N.E. score, Guy's scoring system (GSS), CROES (Clinical Research Office of the Endourological Society) nomogram, and S-ReSC (Seoul National University Renal Stone Complexity) score for percutaneous nephrolithotomy (PCNL) outcomes in the same cohort in a prospective study. Methods: Consecutive patients undergoing PCNL between 2015 and 2018 were included calculating the four scores in the same cohort. Stone-free status (SFS), complications, operative time (OT), estimated blood loss (EBL), fluoroscopy time, and length of hospital stay were investigated. Receiver operator characteristic (ROC) curves for predictive accuracy and regression analysis for predictors of SFS were performed. Results: In all, 162 PCNLs were accomplished and analyzed. Overall, SFS was 75.9% and complication rate was 30.9%. The mean acquisition time of scores was 52.9 ± 0.5 seconds for GSS, 05.1 ± 0.3 seconds for S.T.O.N.E. score, 224 ± 3.1 seconds for CROES, and 102.6 ± 3.5 seconds for S-ReSC score. SFS had the best association with CROES grade. Clavien grade was associated with S.T.O.N.E. score. Moreover, EBL and OT had best association with S-ReSC score. All scores had comparable predictive accuracy on ROC curves regarding SFS. Stone essence and tract length are not different in cases with residual stones. Number of involved calyces, single vs multiple stones and renal pelvic obstruction were significant predictors of SFS in regression analysis. Conclusion: The four scoring systems had comparable predictive accuracy for SFS. However, S.T.O.N.E. and S-ReSC scores were easily applicable and provided better association with EBL and OT compared with the GSS score. Number of involved calyces, stone multiplicity, and renal pelvic obstruction were significant predictors of SFS; hence, further studies are needed to invent a universally agreeable scoring system covering reported shortcomings in the currently used scores.

Impact of Anterior Kidney Calyx Involvement of Complex Stones on Outcomes for Patients Undergoing Percutaneous Nephrolithotomy

Introduction: A number of factors that can impact the outcomes of percutaneous nephrolithotomy (PCNL) procedures have previously been investigated. Complex stones that extend to the anterior calyx could affect the success and complication rates of PCNL. Objective: We analyzed the effect of anterior calyx involvement on the outcomes of patients with complex stones treated with PCNL. Methods: A total of 132 consecutive patients who underwent PCNL due to complex stones (multiple, partial staghorn, or staghorn stones) between 2015 and 2017 were enrolled in this study. They were stratified into two groups based on whether the stone extended to the anterior calyx (group 1, n = 45) or not (group 2, n = 87). The stratification was achieved through contrast-enhanced computerized tomography (CT). Demographics, laboratory tests, and peri- and postoperative findings (operation and fluoroscopy duration, hospital stay, utilization of flexible instruments, access numbers, total blood count change, stone-free rate [SFR], and complications) were compared between the groups. The SFR was evaluated by plain kidney-ureter-bladder radiography or CT. Results: The demographics, operation and fluoroscopy duration, access number, and hospital stay were similar between the groups (p < 0.05). A higher drop in the hemoglobin level in group 1 was identified (group 1 [2.14 ± 1.49 g/dL] vs. group 2 [1.43 ± 1.31 g/dL]) (p = 0.006). The SFR among the patients with extension to the anterior calyx was 60%, compared to 77% among the patients with no extension to the anterior calyx (p = 0.041). Flexible instruments were utilized in 60% of the patients of group 1, which was a higher rate than for group 2 (36%) (p = 0.007). Complication rates were similar in the two groups according to the Clavien-Dindo classification (p > 0.05). Conclusions: Our study demonstrated that complicated stones with extension to the anterior calyx are more challenging than cases without extension to the anterior calyx. This was noted by a lower SFR, a more prominent drop in total blood count, and more frequent utilization of flexible scopes.

Retrograde Intrarenal Surgery (RIRS) vs Percutaneous Nephrolithotomy (PCNL) in Treatment of Lower Pole Renal Stone

Abstract Objective Compare the outcomes of RIRS and PCNL for the treatment of 1 to 2 cm lower calyceal renal calculi regarding the stone free rate, operative time, fluoroscopy time, hospital stay and complication rate. Materials and Methods Patients with a single lower calyceal stone with an evidence of a CT diameter between 1 and 2 cm were enrolled in this randomized study. Patients were randomized into two groups: group 1: underwent RIRS (20pts); group 2: underwent PCNL (20 pts). Patients were evaluated with KUB and CT after one month. Results Mean fluoroscopy times and Hospital stay were significantly greater in the PCNL group than in RIRS group, In the RIRS group, the stone-free rate was 85% (17/20 patients); this rate increased to 95% after a second intervention. After a single PCNL procedure, 19 of 20 (95%) patients were completely stone free and For complications, there were minimal differences in both procedures, except for hemorrhage three patients who were treated with PCNL need blood transfusion Conclusions PCNL and RIRS are safe and effective methods for medium-sized LP calculi. For selected patients, RIRS may represent an alternative therapy to PCNL, with acceptable efficacy and low morbidity., RIRS compared to PCNL offers the best outcome in terms of radiation exposure and hospital stay.

Comparison of Stone Scoring Systems in Predicting Outcomes of Percutaneous Nephrolithotomy in Patients with Solitary Kidney

Comparison of Stone Scoring Systems in Predicting Outcomes of Percutaneous Nephrolithotomy in Patients with Solitary Kidney