Percutaneous Nephrolithotomy Surgery Research Articles

Comparison of Combined Guidance of Fluoroscopy and Ultrasonography in Total Tubeless Percutaneous Nephrolithotomy with the Standard Method: A Randomized Clinical Trial.

Utilizing the combination of fluoroscopy and ultrasonography during Percutaneous Nephrolithotomy (PCNL) to minimize radiation exposure. In this randomized clinical trial, 118 patients with urinary stones who were candidates for PCNL surgery in the prone position were selected and divided into two groups (with an allocation ratio of 1:1). Cases were grouped according to whether ultrasonography was used for renal tract dilation and Amplatz sheath placement. The number of attempts to establish proper renal access, the time interval between access to the targeted calyx and nephroscope entrance, and the Clavien-Dindo score were collected. The mean age of all patients was 46.12 ± 11.28 (45.6 ± 11.2 in the total fluoroscopy group and 46.5 ± 11.4 in the combined group) years (20-66). The intergroup differences in the baseline features were not significant. The mean duration of fluoroscopy time was significantly reduced in the combined guidance group (36.22 ± 10.73 vs. 23.05±8.94 seconds, (P-value = 0.001). Moreover, the difference in the distribution of Amplatz location on the nephroscopy time was meaningful (P-value = 0.016). However, intergroup differences in the number of attempts to successful puncture, length of hospitalization, recovery time, and postoperative complications, including gross hematuria duration, blood loss volume, pack cells requirement, pain score immediately and 6 hours after the surgery, and Clavien-Dindo score were not meaningful. It can be concluded that the use of ultrasound with X-ray in prone PCNL compared to the use of X-rays alone can significantly reduce the duration of radiation without increasing the risk of intra-operative and postoperative detrimental events.

Diagnostic performance of machine learning in systemic infection following percutaneous nephrolithotomy and identification of associated risk factors

ObjectiveThis study aims to investigate the predictive performance of machine learning in predicting the occurrence of systemic inflammatory response syndrome (SIRS) and urosepsis after percutaneous nephrolithotomy (PCNL). MethodsA retrospective analysis was conducted on patients who underwent PCNL treatment between January 2016 and July 2022. Machine learning techniques were employed to establish and select the best predictive model for postoperative systemic infection. The feasibility of using relevant risk factors as predictive markers was explored through interpretability with Machine Learning. ResultsA total of 1067 PCNL patients were included in this study, with 111 (10.4 %) patients developing SIRS and 49 (4.5 %) patients developing urosepsis. In the validation set, the risk model based on the GBM protocol demonstrated a predictive power of 0.871 for SIRS and 0.854 for urosepsis. Preoperative and postoperative platelet changes were identified as the most significant predictors. Both thrombocytopenia and thrombocytosis were found to be risk factors for SIRS or urosepsis after PCNL. Furthermore, it was observed that when the change in platelet count before and after PCNL surgery exceeded 30*109/L (whether an increase or decrease), the risk of developing SIRS or urosepsis significantly increased. ConclusionMachine learning can be effectively utilized for predicting the occurrence of SIRS or urosepsis after PCNL. The changes in platelet count before and after PCNL surgery serve as important predictors.

Develop a radiomics-based machine learning model to predict the stone-free rate post-percutaneous nephrolithotomy.

Radiomics and machine learning have been extensively utilized in the realm of urinary stones, particularly in forecasting stone treatment outcomes. The objective of this study was to integrate clinical variables and radiomic features to develop a machine learning model for predicting the stone-free rate (SFR) following percutaneous nephrolithotomy (PCNL).A total of 212 eligible patients who underwent PCNL surgery at the Second Affiliated Hospital of Nanchang University were included in a retrospective analysis. Preoperative clinical variables and non-contrast-enhanced CT images of all patients were collected, and radiomic features were extracted after delineating the stone ROI. Univariate analysis was conducted to identify clinical variables strongly correlated with the stone-free rate after PCNL, and the least absolute shrinkage and selection operator algorithm (lasso regression) was utilized to screen radiomic features. Four supervised machine learning algorithms, including Logistic Regression, Random Forest (RF), Extreme Gradient Boosting (XGBoost), and Gradient Boosting Decision Tree (GBDT), were employed. The clinical variables with strong correlation and screened radiomic features were integrated into the four machine learning algorithms to construct a prediction model, and the receiver operating curve was plotted. The area under the receiver operating curve (AUC), the accuracy rate, the specificity, etc., were used to evaluate the predictive performance of the four models.After analyzing postoperative statistics, the stone-free rate following the procedure was found to be 70.3% (n = 149). Among the various clinical variables examined, factors, such as stone number, stone diameter, stone CT value, stone location, and history of stone surgery, were identified as statistically significant in relation to the stone-free rate after PCNL. A total of 121 radiomic features were extracted, and through lasso regression, 7 features most closely associated with the stone-free rate post-PCNL were identified. The predictive accuracy of different models (Logistic Regression, RF, XGBoost, and GBDT) for determining the stone-free rate after PCNL was evaluated, yielding accuracies of 78.1%, 76.6%, 75.0%, and 73.4%, respectively. The corresponding area under the curve AUC (95%CI) were 0.85 (0.83-0.89), 0.81 (0.76-0.85), 0.82 (0.78-0.85), and 0.77 (0.73-0.81), positioning these models among the top performers in logistic regression prediction. In terms of predictive importance scores, the key factors identified by the logistic regression model were number of stone, zone percentage, stone diameter, and surface area. Similarly, the RF model highlighted number of stone, stone CT value, stone diameter, and surface area as the top predictors.Among the four machine learning models, the logistic regression model demonstrated the highest accuracy and discrimination ability in predicting the stone-free rate following PCNL. In comparison to XGBoost and GBDT, RF also exhibited superior accuracy and a certain level of discrimination ability. However, based on the performance of all four models, logistic regression is more likely to aid in clinical decision-making by assisting clinicians in diagnosing PCNL in patients. This enables us to effectively predict the presence of residual stones post-surgery and ultimately select patients who are suitable candidates for PCNL.

Perkütan nefrolitotomi esnasinda sol renal vene kalkül migrasyonu: nadir bir komplikasyon ve literatür taraması

Percutaneous nephrolithotomy (PCNL) has long been the standard treatment of choice for the management of large and complex renal calculi. PCNL is a safe and well-tolerated surgical procedure when performed systematically and correctly; however, as with any surgical intervention, although mild complications may occur in this surgery, serious complications may also occur. In this article, we report a rare case of migration of residual calculi into the renal vein during PCNL surgery and aim to present its presentation, treatment and management in a tertiary care center.

Emergency Placed Percutaneous Nephrostomy Catheter Provides Safe and Effective Access for Future Percutaneous Nephrolithotomy Operation

Objective: It was aimed to investigate the feasibility of the percutaneous nephrostomy (PCN) catheter placed in an emergency in the future percutaneous nephrolithotomy (PNL) operation. Material and Methods: Patients who underwent PCN catheter insertion by an interventional radiologist under emergency situations prior to PNL surgery between January 2013 and December 2018 were included in the study. Demographic characteristics, indication for PCN insertion, stone characteristics, pre- and post-operative laboratory values, intra-operative data, usability/non-usability of PCN catheter for renal access, post-operative data and complications were recorded. Results: A total of 32 patients were included in the study. (PCN usable: 21, unusable: 11). Indications for catheter insertion were obstruction in 26 (81.25%) patients and urinary tract infection in 6 (18.75%) patients. Renal access was achieved in 21 (65.62%) patients by using the PCN catheter tract during PNL. The most common PCN access was used in the inferior pole. In 11 (34.37 %) patients, the PCN tract was not usable for access. In patients in whom PCN was unusable due to an unsuitable calyx for access, the most common new access site was the inferior calyx in 6 patients, the superior calyx in 3 patients and the middle calyx in 2 patients. There was no statistically significant difference between the two groups in which the PCN catheter was usable and unusable for PNL access (p>0.05), except for the mean length of hospital stay (p=0.039). Conclusions: PCN catheters inserted prior to PNL surgery can be used effectively and safely for renal access during surgery. However, in emergency cases, it is important that the PCN catheter is inserted through the appropriate calyx in patients undergoing future surgery.

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

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

Comparison of nephrostomy and double‐J stent in the management of percutaneous nephrolithotomy–induced renal pelvis trauma: A prospective randomized controlled trial

AbstractObjectiveThis study aimed to compare the efficacy of nephrostomy versus double‐J (DJ) ureteral stent in managing kidney pelvis trauma during percutaneous nephrolithotomy (PCNL) procedures.MethodologyThis prospective parallel‐group clinical trial involved 60 PCNL patients diagnosed with kidney pelvis perforation during PCNL through nephroscopy (inclusion criteria). Exclusion criteria comprised a history of previous renal surgery or prior PCNL. Eligible patients were alternately assigned to either the insertion of a nephrostomy or a ureteral DJ stent.ResultsA total of 31 patients were included in the nephrostomy group, and 29 were in the DJ group. The mean ± SD of operation duration in nephrostomy and DJ groups were 50.8 ± 23.7 and 45.7 ± 19.3 min, respectively (P = .17). Two‐access PCNLs were performed in 13% and 18% of PCNL operations in the nephrostomy and DJ groups, respectively (P = .72). In the nephrostomy group, 5 patients (17%) had urinoma collection around the kidney, compared with 11 (39%) in the DJ group, showing a statistically significant difference between the two groups (P = .036). Post‐operative fever and urinary leakage were observed in 48% and 32% of patients in nephrostomy group versus 44% and 22% of patients in group DJ (P = .76 and P = .39).ConclusionThe findings of this study indicate a higher percentage of urinoma detected one week after the insertion of a ureteral DJ compared with nephrostomy in PCNL patients who experienced renal pelvis injury during the operation.

Comparison of ultrasound-guided paravertebral block versus erector spinae plane block for postoperative analgesia after percutaneous nephrolithotomy - A randomised, double-blind, controlled study.

Paravertebral block (PVB) is the regional anaesthesia of choice for percutaneous nephrolithotomy (PCNL). Erector spinae plane block (ESPB) is also effective for the same. This study aims to compare the analgesic efficacy and ease of performing PVB or ESPB for PCNL surgery. This study was conducted in 60 patients undergoing PCNL, who were randomised to Group P (n = 30; received ultrasound-guided [USG] PVB) and Group E (n = 30; received USG ESPB) after general anaesthesia. Blocks were administered at T10 level on the side of the surgery using 20 ml of 0.25% bupivacaine. The trachea was extubated at the end of surgery. The primary outcome was analgesia duration, and secondary outcomes were postoperative pain scores, analgesic consumption, ease of block performance, time taken to perform the block and complications between the two groups. Continuous variables were compared using an independent sample t-test, and categorical variables were analysed using Pearson's Chi-square test. Demographic variables were comparable in both groups. The mean (standard deviation [SD]) time of first rescue analgesia in Group P and Group E were 16.6 (20.4)(95% confidence interval [CI]: 9.02-20.32) h and 16.3 (21.8) (95% CI: 8.17-24.51) h, respectively (P = 0.95). The postoperative pain scores and number of doses of analgesics used were comparable between the groups (P > 0.05). The time taken to perform PVB was much longer compared to the time taken to perform ESPB (P = 0.01). USG PVB and ESPB were equally effective for postoperative analgesia for PCNL surgery.

Mini Percutaneous Nephrolithotomy vs Standard Percutaneous Nephrolithotomy: A Perioperative Decision Support System for Surgical Success Comparison.

This study aimed to rank the features that are important in terms of safety and effectiveness in choosing the surgical method and providing appropriate care to the patient by using the variables examined before and after the surgery to evaluate the success of mini percutaneous nephrolithotomy and standard percutaneous nephrolithotomy surgeries. The features evaluated before and after surgery were ranked according to their importance in the features considered, using Multivariate Adaptive Regression Splines (MARS), LASSO, Ridge, Elastic_net, and Random Forest algorithms as variable selection techniques. There are 278 samples in the relevant data set. Type of surgery (100%), intercostal access (97.75%), kidney opening procedure (94.25%), postoperative creatinine (59.22%), hydronephrosis (52.23%), the number of entries (41.61%), and pre- and post-operative hemoglobin difference (45.13%) were determined as the most critical variables. The MARS algorithm showed the most successful performance, with the lowest mean absolute error (MAE) value of 0.3622, the lowest root mean square error (RMSE) value of 0.3960, and the highest R2 value of 0.3405. Clinical decision support systems can be helpful in eliminating errors and reducing costs. It can also improve the quality of healthcare and aid in the early diagnosis of diseases. Computer-aided decision-making systems can be developed using the results of such products. These systems can provide doctors with better information about their patient's treatment options and improve decision-making. It can contribute to patients being better informed about the surgery results and taking an active role. In conclusion, this study provides essential information that should be included in the surgical decision-making process for patients using medications and with a history of percutaneous nephrolithotomy.

Could pain change position choice? Comparison of pain level, analgesic requirement and hospitalization time in supine and prone percutaneous nephrolithotomy.

Investigation of how position affects postoperative pain levels and hospitalization in patients undergoing percutaneous nephrolithotomy (PNL) surgery. Between August 2019 and December 2022, a total of 156 patients who underwent prone (pPNL) and supine percutaneous nephrolithotomy (sPNL) due to kidney stones were included in the study. Demographic data, preoperative CT scans, laboratory results, transfusion rates, operation durations, complication rates, stone-free rates, analgesic use, nephrostomy removal time, hospitalization duration, fluoroscopy time, hemoglobin decrease and postoperative Visual Analog Scale (VAS) scores were evaluated for all patients. By comparing these data between the sPNL and pPNL groups, the effect of position selection in PNL on pain control, analgesic requirement, and hospitalization duration was examined. In the comparison of the pPNL and sPNL groups, there was a significant difference between the two groups in body mass index, hounsfield unit, complication rate, analgesic rate, nephrostomy remove time, hospitalization time, operation time, fluoroscopy time and VAS score (p = 0.025, p < 0.001, p = 0.012, p = 0.012, p < 0.001, p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). The shorter operation and hospitalization time in the sPNL group could be attributed to performing surgeries in a physiological position. Additionally, sPNL seems advantageous in terms of patients' pain levels, hospitalization time and VAS scores. One reason for this could be the different areas of access in sPNL and pPNL, which may correspond to different dermatome regions. Considering the low level of pain and reduced analgesic usage, sPNL appears to be advantageous.

Comparative analysis of re-entry malecot and nelaton catheters after standard percutaneous nephrolithotomy in adult patients: a cross-sectional study.

Drainage catheters are used almost routinely to provide urinary drainage, prevent extravasation of urine, and create tamponade against bleeding after percutaneous nephrolithotomy (PNL). In the literature, there is no standardized approach to determining which type of catheter is superior. In this context, we aimed to comparatively analyze two different types of catheters (re-entry malecot catheter and nelaton catheter) in terms of success and complications, which we use for drainage after a PNL operation and which have very different costs. Patients who underwent PNL for kidney stones between January 2018 and October 2022 were included in the study. The data of a total of 148 patients who had a 16-F reentry malecot nephrostomy catheter or a 16-F nelaton catheter were analyzed. In addition to the demographic characteristics of the patients, stone characteristics, operative data, hospitalization time, analgesia requirement, hemoglobin exchange, amount of blood transfusion, and postoperative data (success and complications) were comparatively evaluated. The current unit price for a reentry malecot and a nelaton catheter is 4.7 United States dollars (USD) and 0.11 USD, respectively. There were a total of 148 patients in the study, 63 of whom were nelaton catheters and 85 were reentry malecots, and the mean age was 39.95 ± 13.28years. There was no statistically significant difference between preoperative stone sizes and residual stone rates according to the groups. In addition, there was no statistically significant difference between the groups in terms of access site and stone localization. There was no significant difference between the groups in terms of complication rates according to the Clavien-Dindo classification, Hb levels, blood transfusion rates, operation times, or hospitalization times. In conclusion, if a second procedure is planned, a reentry malecot catheter may be preferred. Apart from this situation, nelaton catheters should be preferred because they are similar to reentry catheters in terms of effectiveness, and side effects and are more economical than reentry catheters in terms of cost.

Postoperative Analgesic Efficiency of Quadratus Lumborum Block III versus Peritubal Local Infiltration in Patients Undergoing Percutaneous Nephrolithotomy Operation: A Randomized Controlled Trial

Abstract Background The postoperative pain after percutaneous nephrolithotomy (PCNL) can be managed by many peripheral blocks techniques (e.g., paravertebral and quadrates lumborum block), and local anesthesia infiltration. Therefore, this prospective study was conducted to evaluate the effect of quadratus lumborum type III versus peritubal local infiltrating on postoperative analgesia for patients undergoing PCNL under general anesthesia. Methods Eligible subjects after exclusion of COVID-19 patients, with renal stones less than 2 cm undergoing PCNL surgery under general anesthesia. Exclusion criteria were: 21&amp;lt;years of age or &amp;gt; 60 years of age; bleeding disorders; allergies to local anesthetics; psychiatric patients; and American Society of Anesthesia (ASA) physical status III and IV. Eighty patients were randomly allocated to 2 equal groups. In the Quadratus group, participant received 20 mL of bupivacaine 0.25% in the fascial plane between the quadratus lumborum and Psoas muscle; and in the peritubal group, patients received 10 mL of bupivacaine 0.25% around the nephrostomy tube at 6 and 12 o’clock positions (total 20 mL). The quadratus lumborum block and peritubal infiltration were performed by the primary investigator and the urologist, respectively. All patients received standard postoperative analgesia (paracetamol, ketorolac, and morphine via patient-controlled analgesia. Both patients and Data collecting staff were blinded to study group. Primary outcome was the visual analogue score at rest and on coughing or movement at 2, 4, 6, 12, and 24 hours. Secondary outcomes were 24 hours total morphine consumption, 1st use of morphine pump, incidence of side effects (pruritis and nausea and vomiting) and patient satisfaction. Results Data were analyzed from 78 patients (39 patients in each group). The mean resting VAS score in quadratus group at 6 and 12 hours was (3), while the mean VAS in peritubal group was (5) and (6) at 6 and 12 hours, respectively. Dynamic VAS score in peritubal group at 6 hours was (mean 6) with p&amp;lt;0.0001 when compared to resting value. The 24 hours’ morphine consumption was 8.5-11 mg and 1619 mg, in quadratus and peritubal group, respectively (the difference in mean of 9 at the 95% confidence interval; p&amp;lt;0.0001). patients start to use morphine pump after 121.4 min and 180.2 min in group peritubal and quadratus, respectively. Patients in group quadratus were statistically more satisfied, in both groups incidence of complication was low. Conclusion Quadratus Lumborum block was more effective than Peritubal LA infiltration regarding postoperative VAS score both at rest and during movement with lower postoperative morphine consumption and more satisfaction in patients undergoing PCNL surgery. Trial registration This prospective randomized trial was registered at Clinical Trials.gov in December, 2019. https://clinicaltrials.gov/ct2/show/NCT04215705.

Evaluation of the STONE nephrolithometry score in predicting surgical outcomes of percutaneous nephrolithotomy: results of a prospective study at a university hospital

Objective: One of the popular advances in percutaneous nephrolithotomy (PCNL) includes nephrolithometry classification systems. It enables better patient counseling, surgery planning, outcome evaluation, and uniform academic reporting. The STONE nephrolithometry is a validated quantitative scoring system that is undervalued in clinical settings, and this study evaluates the scoring system's ability to predict the outcome of PCNL surgery. Methodology: From January 2017 to June 2018, a total of 102 PCNL patients were studied prospectively. The STONE score was derived from a preoperative non-contrast computed tomography (NCCT) scan which was used to evaluate stone-free status at 4 weeks followup. Results: The STONE nephrolithometry scoring system predicted stone-free rate (SFR) following PCNL surgery with an accuracy of 88%. The statistical cut off level of the STONE score of 8 was superior for predicting SFR. Individual variables such as stone size, degree of pelvicalyceal obstruction, number of calyceal involvement, and stone density were found to have a significant correlation with STONE score, although there was no statistically significant correlation between SFR and tract length (p=0.81). The score was divided into three categories: low complexity score 5-6 (SFR-58.7%), moderate complexity score 7-8 (SFR-40%), and high complexity score 9-13 (SFR- 1.2%). The STONE score had excellent inter-observer reliability and reproducibility (p=&lt;0.001). Conclusions: The STONE score was a simple and easy to apply tool for predicting the stone complexity and stone clearance after PCNL. The STONE score had no statistically significant correlation with postoperative complications. Furthermore, it demonstrated high inter-observer reliability and reproducibility.

Investigation of Factors Associated with Excessive Bleeding in Patients Undergoing Percutaneous Nephrolithotomy Surgery at Imam Khomeini Hospital in Urmia City during the period from October 2019 to October 2020

Introduction Bleeding during percutaneous nephrolithotomy (PCNL) surgery is a significant concern and a common surgical complication. This study aimed to identify factors associated with excessive bleeding in patients during or after PCNL surgery. Methods In this retrospective study, a total of 357 patients who underwent PCNL surgery were evaluated within the period from October 2019 to October 2020. Patient-related factors, kidney stones, and surgical details were recorded. The median drop in hemoglobin after PCNL was 5.1, and values exceeding this were considered as excessive bleeding. Results In this study, only 51.2% of patients experienced decreased hemoglobin levels. The average stone size in patients with and without reduced hemoglobin levels was 2.48 cm and 2.41 cm, respectively. The mean duration of surgery in patients with and without a decrease in hemoglobin levels was 58.69 minutes and 55.30 minutes, respectively. The mean access time for patients with and without reduced hemoglobin levels was 68.62 seconds and 65.71 seconds, respectively. The mean exposure time to radiation for patients with and without a decrease in hemoglobin levels was 74.11 seconds and 68.80 seconds, respectively. In this study, no significant relationship was found between patient gender, stone size, duration of surgery, access time, previous surgical history, and a decrease in hemoglobin levels. However, a significant association was observed between the access site and decreased hemoglobin levels. Conclusion Despite concerns regarding intraoperative complications, PCNL is an effective and safe treatment modality for patients with kidney stones, irrespective of their clinical treatment history. Furthermore, the advantages of this minimally invasive approach can be applied to all patients.

Quick Sequential Organ Failure Assessment Score Is a Better Predictor of Septic Shock After Percutaneous Nephrolithotomy: A Secondary Analysis of Two Multicenter Prospective Trials.

Introduction: Recent retrospective literature suggests that the quick sequential organ failure assessment (qSOFA) scoring tool is a potentially superior tool over use of the systemic inflammatory response syndrome (SIRS) criteria to predict septic shock after percutaneous nephrolithotomy (PCNL) surgery. Here we examine use of qSOFA and SIRS to predict septic shock within data series collected prospectively on PCNL patients as part of a greater study of infectious complications. Materials and Methods: We performed a secondary analysis of two prospective multicenter studies including PCNL patients across nine institutions. Clinical signs informing SIRS and qSOFA scores were collected no later than postoperative day 1. The primary outcome was sensitivity and specificity of SIRS and qSOFA (high-risk score of greater-or-equal to two points) in predicting admission to the intensive care unit (ICU) for vasopressor support. Results: A total of 218 cases at 9 institutions were analyzed. One patient required vasopressor support in the ICU. The sensitivity/specificity was 100%/72.4% (McNemar's test p < 0.001) for SIRS and was 100%/90.8% (McNemar's test p < 0.001) for qSOFA. Conclusion: Although positive predictive value for both qSOFA and SIRS in prediction of post-PCNL septic shock is low, prospectively collected data demonstrate use of qSOFA may offer greater specificity than SIRS criteria when predicting post-PCNL septic shock.

Efficacy of Ultrasound-Guided Erector Spinae Plane Block in Percutaneous Nephrolithotomy.

Background Percutaneous nephrolithotomy (PCNL) is presently the preferred method for managing renal calculi. Visceral pain from the kidney and ureter and somatic pain from the incision site are the primary causes of immediate postoperative pain following PCNL. Poor pain control is associated with unwanted consequences such as patient discomfort, delayed recovery, and prolonged hospital stay.Recently, the erector spinae plane (ESP) block has been used in many thoracic and abdominal surgeries for the control of postoperative pain. In this study, we aimed to assess the effectiveness of the ultrasound-guided ESPblock following PCNL. Methodology This was a prospective, double-blind, randomized controlled study including 60 patients who were scheduled for elective PCNLunder general anesthesia. Patients were randomly divided into two groups. Group E underwent an ultrasound-guided ESP block with 20 mL of the local anesthetic mixture at the T-9 level unilaterally on the side of surgery, and group C was a sham group in which20 mL of normal saline was injected on the side of surgery. Changes in postoperative pain score were the primary outcome, and the duration of analgesia, the total analgesic requirement in 24 hours, and patient satisfaction were the secondary outcomes. Results The demographic data of both groups were comparable. The Visual Analog Scale score was considerably lower in group E than in group C at two, four, six, and eight hours postoperatively. In group E, the mean analgesic duration was substantially longer than that in group C (8.87 ± 2.45 hours vs. 5.67 ± 1.58 hours, respectively). The tramadol requirement was higher in group C (286.67 ± 62.88 mg) than in group E (133.33 ± 47.95 mg) during the 24-hour postoperative period. At 12hours, patient satisfaction was considerably higher in group E than in group C (6.73 ± 0.45 vs. 5.87 ± 0.35, respectively). Conclusions Theultrasound-guided ESP block provided efficient postoperative pain relief, prolonged duration of analgesia, and reduced tramadol intake after PCNL surgery.

The Efficacy of Erector Spinae Plane Block for Patients Undergoing Percutaneous Nephrolithotomy.

Percutaneous nephrolithotomy (PCNL) is accompanied by somatic and visceral pain intraoperatively and postoperatively. However, pain management strategies lack a decisive consensus. Erector spinae plane block (ESPB) is a novel paraspinal fascial block that can be used in PCNL patients, and we aimed to investigate whether ESPB will reduce intraoperative and postoperative opioid consumption and postoperative pain scores in PCNL patients. The study was randomized, controlled, and open-label. Two groups were formed as the control group (GCont) and block group (Gblock), and patients received total intravenous anaesthesia. GBlock received an ESPB catheter in addition in the prone position. Intraoperative parameters and infusion doses, postoperative rescue analgesic doses, and pain scores were recorded. The primary endpoint was intraoperative analgesic consumption, and the secondary endpoints were postoperative pain scores and analgesic consumption. Sixty-four patients were analyzed. Remifentanil consumption of GCont was found to be significantly higher (GBlock: 0.0865 ± 0.030 vs GCont: 0.1398 ± 0.034, μg kg-1 min-1, P < 0.001). The control group reported higher pain scores between the 30th min and 24th hours and needed more analgesics between the 1st and 6th hours postoperatively. GBlock received local anaesthetics via ESPB catheter before nephrostomy tube removal and fewer patients needed analgesics [5 patients (15.6%) vs. 28 patients (87.5%), P < 0.001]. GCont consumed more tramadol postoperatively (262.5 mg vs. 75 mg, P < 0.001). We found that ESPB reduced intraoperative opioid consumption. It also reduced the need for rescue analgesia and postoperative pain scores during nephrostomy tube removal. We concluded that the ESPB catheter may effectively be used in analgesia management during and after PCNL operations.

Comparative Study of Prone Position Variations for Percutaneous Nephrolithotomy.

In this comparative study, we evaluated the results of flat prone and prone hip flexed percutaneous nephrolithotomy in terms of efficacy and safety to contribute to the optimal prone percutaneous nephrolithotomy position. Data of the patients who underwent percutaneous nephrolithotomy operations in a flat-prone or prone hip flexed positions due to renal pelvis and/or ≥2 Calix filling stones between January 2016 and January 2022 were collected retrospectively. Demographic data of the patient groups in different prone positions as well as clinical findings, stone characteristics and operative data were analyzed. The groups were also compared in terms of post-operative findings and complications. The average age and CROES scores of patients included in the study were 47.15±15.6 years and 221.76±62.49, respectively. There was no statistically significant difference between the two groups in terms of patient demographic data, stone-free status and complication rates. Operation Room Time (ORT) (min) in flat prone PCNL group was shorter in average (100.57±32.74 min vs 92.32±28.75 min, p = 0.041) and duration with nephrostomy (days) and hospitalization (days) parameters were statistically significantly shorter in prone hip flexed PCNL (respectively, p < 0.001; p = 0.005). Flat-prone PCNL provides significantly shorter ORT. However, the time with nephrostomy and hospitalization with the prone hip flexed PCNL were shorter than flat-prone position. The findings will guide the optimal prone PCNL position.

The efficacy of Erector Spinae Plane Block (ESPB) applied under ultrasonography guidance in percutaneous nephrolithotomy operations

Aims: This study aimed to evaluate the effect of erector spinae block (ESPB) applied preoperatively under ultrasonography guidance in percutaneous nephrolithotomy (PNL) operations in terms of the intraoperative need for opioids, postoperative analgesia, and patient satisfaction. Methods: Of 60 patients who were 18 to 65-year-old and evaluated as American Society of Anesthesiologists (ASA) risk I-II-III were planned to undergo elective PNL. The patients were randomly separated into two groups as the Block group-administered ESPB under sedation in the preoperative period and the Control group-administered no ESPB. All the operations were performed under general anesthesia. The study data were analyzed using Mann-Whitney U-test and the Independent Samples t-test. Results: Demographic data of the patients were not different between the groups (p&gt;0.05). Neither intraoperative opioids nor analgesics were required for any of the patients in the ESPB group whereas intraoperative opioids and analgesic drugs had to be administered to all of the patients in the control group (p&lt;0.001). The postoperative patient satisfaction scores in the ESPB group were found statistically higher than that of the control group (p&lt;0.001). Conclusion: The results demonstrated that ESPB applied preoperatively under USG guidance reduced the need for intraoperative opioids and postoperative analgesia in PNL operations. This, in turn, increased patient satisfaction by maintaining patient comfort after surgery.

Intraoperative Assessment of Stone Free Status for Percutaneous Nephrolithotomy Surgery: Surgeon’s Eye

Objective: In patients who underwent percutaneous nephrolithotomy(PNL),it was aimed to determine the accuracy of the surgeon's intraoperative stone-free status(SFS) prediction,the factors affecting it,the predictors that caused the wrong estimation, and finally to evaluate the reliability of the "surgeon's eye".&#x0D; &#x0D; Material and Methods: The data of 1025 patients who underwent PNL and met the inclusion criteria were evaluated retrospectively.Since the basis of our study was based on the evaluation of the surgeon's stone-free prediction,patients identified as "absence of residual stone fragment(RF)" by the surgeon were grouped and compared with postoperative computed tomography imaging according to the presence of RF.&#x0D; &#x0D; Results: Sensitivity, specificity, positive predictive value and negative predictive value were calculated as 67.87%, 96.23%, 91.67% and 83.04%, respectively.In our study, it was found that the "surgeon's eye" predicted SFS incorrectly at a rate of 16.9%.There was no statistically significant correlation between gender,stone side,stone density and hemoglobin decrease between the two groups.Stone size,operation time,fluoroscopy time,location of the stone,number of stones in the calyces and GUY's stone score(GSS) were statistically significantly associated with "surgeon's eye".As a result of multivariate logistic regression analysis of the parameters that were found to have a statistically significant relationship with the surgeon's eye,stone size,the number of stones in the calyces and GSS were significant predictors.&#x0D; &#x0D; Conclusion: The most important predictors of "surgeon's eye" in PNL were stone size,number of stones in the calyces and GSS. These predictors can be used as an effective criterion in the use of methods to reduce radiation exposure in postoperative imaging of patients who are predicted to be stone-free.