Percutaneous Nephrolithotripsy Research Articles

Bilateral percutaneous mininephrolithotripsy: simultaneous or staged approach?

Introduction. Patients with bilateral nephrolithiasis are a challenge for the treating physician. Therefore, such patients traditionally are subject to phased surgery to reduce the rate of complications. At the same time, the enhancement of endoscopic technologies and anesthesia makes it possible to perform surgical treatment of bilateral nephrolithiasis simultaneously.Objective. To evaluate the effectiveness and safety of performing simultaneous bilateral percutaneous nephrolithotripsy (PCNL).Materials & methods. The main group comprises 19 patients (avg age 45.0 ± 2.25 years) suffering from bilateral nephrolithiasis (13 men and 6 women). The control group include 20 patients (avg age 45.80 ± 2.29 years) suffering from bilateral nephrolithiasis. Main group patients underwent simultaneous bilateral mini-PCNL, control group patients — staged PCNL within two hospitalisations. The visual analogue scale (VAS) was used to assess the pain severity. Patients noted subjective pain sensations on post-op days 1 and 3. QoL indicators were assessed using the SF-36 general questionnaire, as well as the Russian-language validated version of the WISQoL questionnaire.Results. There were no statistically significant differences between the parameters (the difference between the hemoglobin before and after mini-PCNL was 12 g/l; between the serum creatinine was 18 µmol/l). There was a decrease in total surgery time (121.0 ± 6.1 min) for main group patients compared to (147.0 ± 7.3 min) control group patients (total surgery time during the first and second hospitalisations) and a reduction in hospital stay (4.50 ± 0.23 days) for main group patients compared to control group patients (10.0 ± 0.5 days). Complications observed by us in the two groups were comparable. The valuesobtained on the SF, RE and MH scales in main group patients were higher both on post-op day 1 (67.9 ± 3.39; 56.90 ± 2.85 and 63.80 ± 3.19, respectively) and post-op day 3 (86.80 ± 4.34; 83.70 ± 4.19 and 82.50 ± 4.13, respectively) compared to control group patients during the first and second hospitalizations. Statistically significant differences were also recorded according to the grades "Social functioning" and "Emotional influence" in main group patients (80.90 ± 0.26 and 82.6 ± 0.19, respectively).Conclusion. Simultaneous bilateral mini-PCNL is safe and effective in well-selected patients.

COMPARISON OF ANTEGRADE PERCUTANEOUS VERSUS RETROGRADE URETEROSCOPIC LITHOTRIPSY FOR MANAGEMENT OF UPPER URETERIC CALCULUS.

Background: Technical advancements in urology have profoundly changed the management of upper ureteric calculus, however, its optimal management remains controversial. Methods: To compare antegrade percutaneous nephrolithotripsy (PCNL) and retrograde ureteroscopic lithotripsy (URSL) for management of upper ureteric calculus by measuring stone clearance rates, morbidity and complications. A prospective, observational, single centre, study including patients of either sex presenting with upper ureteric stone [size>8 mm and >800 Hounseld Unit (HU)]. Patients underwent either antegrade PCNL or retrograde ureteroscopic lithotripsy with follow up on outpatient (OPD) basis at 1 week, 1 month and 3 months post-surgery with Visual Assessment Score (VAS) and radiological investigations. Results: Stone clearance rate for antegrade PCNL was 89.1 % and 72.7% for retrograde ureteroscopic lithotripsy which is a statistically signicant difference. Incidence of pain in antegrade PCNL at 1st and 4th week follow-up was 10.9 % and 1.8% respectively compared to 5.5% and 0% for retrograde ureteroscopic lithotripsy. Two patients (1.8%) who underwent PCNL developed segmental artery pseudoaneurysm; one was managed conservatively while other required angioembolization. One patient in the antegrade PCNLgroup and two in retrograde ureteroscopic lithotripsy group had post operative urine culture proven urinary tract infection (UTI) and were treated with antibiotics. Conclusion:As compared to retrograde ureteroscopic lithotripsy, PCNLis a safer and more effective procedure with higher stone-free rates and acceptable complication rates to treat patients with large impacted upper ureteral stones.

MP35-20 COMPARING TREATMENT OUTCOMES FOR FLUOROSCOPIC AND ‘FLUOROSCOPY-FREE’ ENDOUROLOGICAL PROCEDURES: A SYSTEMATIC REVIEW ON BEHALF OF THE EAU UROLITHIASIS GUIDELINES PANEL

You have accessJournal of UrologyCME1 Apr 2023MP35-20 COMPARING TREATMENT OUTCOMES FOR FLUOROSCOPIC AND ‘FLUOROSCOPY-FREE’ ENDOUROLOGICAL PROCEDURES: A SYSTEMATIC REVIEW ON BEHALF OF THE EAU UROLITHIASIS GUIDELINES PANEL Niall Davis, Lazaros Tzelves, Robert Geraghty, Riccardo Lombardo, Cathy Yuan, Ales Petrik, Andreas Neisius, Giovanni Gambaro, Helene Jung, Robert Shepherd, Thomas Tailly, Bhaskar Somani, and Andreas Skolarikos Niall DavisNiall Davis More articles by this author , Lazaros TzelvesLazaros Tzelves More articles by this author , Robert GeraghtyRobert Geraghty More articles by this author , Riccardo LombardoRiccardo Lombardo More articles by this author , Cathy YuanCathy Yuan More articles by this author , Ales PetrikAles Petrik More articles by this author , Andreas NeisiusAndreas Neisius More articles by this author , Giovanni GambaroGiovanni Gambaro More articles by this author , Helene JungHelene Jung More articles by this author , Robert ShepherdRobert Shepherd More articles by this author , Thomas TaillyThomas Tailly More articles by this author , Bhaskar SomaniBhaskar Somani More articles by this author , and Andreas SkolarikosAndreas Skolarikos More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003269.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Endourological procedures frequently necessitate fluoroscopic guidance, which results in harmful radiation exposure to patients and staff. Recently, several reports underlined the possibility to bypass the use of fluoroscopy. The aim of this systematic review and meta-analysis is to compare benefits and risks of fluoroscopic vs fluoroscopy-free procedures. METHODS: A systematic review of literature in MEDLINE/Pubmed, Embase and Cochrane controlled trials database and ClinicalTrial.gov was performed between 1970-2022. Primary outcomes assessed were complications and stone-free rate (SFR), while eligible studies reported data on ureteroscopy and percutaneous nephrolithotripsy (PCNL). RESULTS: 24 eligible studies (12 randomized and 12 observational) out of 834 initially screened abstracts were eligible for analysis, accounting for 4882 patients. Pooled analysis of all procedures revealed no significant differences for SFR, operative time, length of stay, minor (Clavien I-II) or major complications (Clavien III-V) between groups. Similar results were noted when subanalyses for ureteroscopy and PCNL were performed. When only randomized studies were analyzed, results were similar except that minor and major complications favored fluoroscopy-free group (RR 0.68 and 0.59 respectively). CONCLUSIONS: Pooled analysis revealed that the SFR and complication rates when fluoroscopy-free procedures are used, are similar with fluoroscopy-guided procedures. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e477 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Niall Davis More articles by this author Lazaros Tzelves More articles by this author Robert Geraghty More articles by this author Riccardo Lombardo More articles by this author Cathy Yuan More articles by this author Ales Petrik More articles by this author Andreas Neisius More articles by this author Giovanni Gambaro More articles by this author Helene Jung More articles by this author Robert Shepherd More articles by this author Thomas Tailly More articles by this author Bhaskar Somani More articles by this author Andreas Skolarikos More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison of post-operative shivering, nausea and vomiting between pre-intubation and pre-extubation intravenous paracetamol in percutaneous nephrolithotripsy under general anaesthesia

Comparison of post-operative shivering, nausea and vomiting between pre-intubation and pre-extubation intravenous paracetamol in percutaneous nephrolithotripsy under general anaesthesia

OUTCOMES AND SAFETY OF RETROGRADE INTRA RENAL SURGERY FOR RENAL STONES

Background: Renal stones are one of the most common urological problems requiring surgical interventions. Retrograde intra-renal surgery is a minimally invasive surgical technique with minimal complications and a good stone-free rate. In the present study we aimed to assess the outcomes and safety of retrograde intrarenal surgery. Methods: A retrospective study was performed at Chitwan Medical College Teaching Hospital in the span of two years from Dec 2019 to Nov 2021. Patient demographics; stone burden, stone density, and location were collected from the medical records and evaluated. The data was collected in a proforma which was then entered into SPSS version 20. The data was presented in form of frequency and percentage. Results: One hundred and seventy patients were subjected to retrograde intrarenal surgery, out of which 32 were converted to mini- percutaneous nephrolithotripsy, 12 were presented and total of 126 were subjected to retrograde intrarenal surgery. The major complications were pyrexia in 21(16.67%) patients followed by hematuria in 4(3.17%) patients, and sepsis in 2(1.58%) patients. The stone-free rate was 94.4%. 2 (1.58%) patients underwent mini- percutaneous nephrolithotripsy and5 (3.96%) of them showed stones of varying size 2-6mm, non-obstructive with none of cases planned for staged retrograde intrarenal surgery. Conclusions: Primary Retrograde intrarenal surgery is the safe and effective treatment for the intrarenal stones.

The influence of climatic factors in the seasonal fluctuation of urolithiasis and the trend of stone disease management in the southern Taiwan

This study aims to analyze the effects of climate parameters on the number of urolithiasis treatments in our hospital and understand the effects of climate parameters on the prevalence of urolithiasis in southern Taiwan. We also look at trends associated with urolithiasis and treatments. Retrospectively reviewed the records of extracorporeal shockwave lithotripsy (ESWL), ureteroscopy (URS), retrograde intrarenal surgery (RIRS), and percutaneous nephrolithotripsy (PCNL) performed in our hospital from January 2012 to December 2018. Climate data for were collected from Central Weather Bureau. The monthly meteorological data included average temperatures, humidity, rainfall, sunshine hours, atmospheric pressure, and wind speed. Monthly numbers of patients undergoing stone management was positively correlated to average temperature (r = 0.657), relative humidity (r = 0.234), monthly rainfall (r = 0.261) and monthly sunshine hours (r = 0.348), while it was negatively correlated to atmospheric pressure (r = -0.522). The multivariate linear regression model demonstrated temperature (ß = 10.682, 95% CI 6.178-14.646, p < 0.001) and Relative humidity (ß = -95% CI -5.233- -1.216, p = 0.002) to be independently related to numbers of stone treatment. The data also revealed a rising prevalence of urolithiasis with an associated increase in the number of interventions, with fewer ESWL (74.0-49.4%). Temperature and relative humidity are associated with monthly numbers of stone treatment. Ambient temperature is the most critical climate factor affecting the prevalence of symptomatic urolithiasis and intention of active stone removal in southern Taiwan.

Clinical Value of Mixed Reality-Assisted Puncture Navigation for Percutaneous Nephrolithotripsy

ObjectiveTo evaluate the clinical value of mixed reality-assisted puncture navigation (MRAPN) in percutaneous nephrolithotripsy (PCNL). MethodsTwo hundred patients undergoing PCN were enrolled, all of whom had kidney stones to be subjected to lithotripsy by PCNL and grouped according to surgical procedure into the MRAPN (n = 100) and non-mixed reality-assisted puncture (non-MRAPN) (n = 100) groups. CT data in DICOM format for all patients in the MRAPN group were imported into 3D reconstruction and mixed reality (MR) post-processing workstations, and holographic 3D visualization modelling. Comparing parameters such as the operative time (OT), puncture time (PT), number of attempts, and estimated blood loss (EBL), a Likert scale was used to assess the clinical value of MRAPN. The Cohen κ coefficient (k) was employed to evaluate consistency among assessors; safety was assessed. ResultsThere were no significant differences in patient demographic indicators or preoperative general information between the MRAPN and non-MRAPN groups (P > .05). The clinical value of MRAPN was higher for subjective scores regarding surgical planning, intraoperative navigation, didactic guidance and physician–patient communication (all P < .001). The PT was significantly shorter in the MRAPN group (P < .001), with a shorter overall OT and lower EBL (P < .001). There were no significant differences in the overall comparison, length of hospital stay, or preoperative or postoperative creatinine (all P > .05). ConclusionMRAPN can safely and effectively improve the success of PCN, reduce complications, and decrease the PT, OT, and EBL.

An Update of In Vivo Application of Artificial Intelligence and Robotics for Percutaneous Nephrolithotripsy: Results from a Systematic Review.

Kidney puncture is a key step in percutaneous nephrolithotomy (PCNL). Ultrasound/fluoroscopic-guided access to the collecting systems is commonly used in PCNL. Performing a puncture is often challenging in kidneys with congenital malformations or complex staghorn stones. We aim to perform a systematic review to examine data on in vivo applications, outcomes, and limitations of using artificial intelligence and robotics for access in PCNL. The literature search was performed on November 2, 2022, using Embase, PubMed, and Google Scholar. Twelve studies were included. 3D in PCNL is useful for image reconstruction but also in 3D printing with definite benefits seen in improving anatomical spatial understanding for preoperative and intraoperative planning. 3D model printing and virtual and mixed reality allow for an enhanced training experience and easier access which seems to translate into a shorter learning curve and better stone-free rate compared to standard puncture. Robotic access improves the accuracy of the puncture for ultrasound- and fluoroscopic-guided access in both supine and prone positions. The potential advantage robotics are using artificial intelligence to do remote access, reduced number of needle punctures, and less radiation exposure during renal access. Artificial intelligence, virtual and mixed reality, and robotics may play a key role in improving PCNL surgery by enhancing all aspects of a successful intervention from entry to exit. There is a gradual adoption of this newer technology into clinical practice but is yet limited to centers with access and the ability to afford this.

The Lifetime History of the First Italian Public Extra-Corporeal Shock Wave Lithotripsy (ESWL) Lithotripter as a Mirror of the Evolution of Endourology over the Last Decade

Extracorporeal shockwave lithotripsy (ESWL) is the only non-invasive treatment for kidney stones. It does not require an operating room, anesthesia, or hospital stay. Its role evolved over the years and nowadays ESWL is slowly disappearing from many stone centers and urologic departments. We present the history and the role of ESWL treatment since its birth in 1959 and its development through the following years. We also present details of its application and impact on the first Italian stone center in 1985. ESWL has had different roles over the centuries: in the early years it was a great alternative to open surgery and percutaneous nephrolithotripsy (PCNL), then it had its decline with the introduction of the miniscopes. Currently, although ESWL is not considered a treatment of excellence, newer models are emerging. With the application of new technologies and artificial intelligence, this technique can become a good option alongside endourologic treatments.

Effectiveness of Extracorporeal Shockwave Lithotripsy and Percutaneous Nephrolithotripsy for the Management of Moderate Size Kidney Stone

Aim: To provide a specific guidance in managing renal stones. Study Design: Place and Duration of Study: Pakistan Atomic Energy Commission, General Hospital Islamabad from 1st 2018 to 30th November 2018. Methodology: Eighty two patients were included and divided into two groups. Patients in group A underwent ESWL, while those in group B underwent PCNL. All of the participants underwent thorough diagnostic and therapeutic procedures. As per inclusion and exclusion criteria, patients with renal stones (10-20 mm), detected by CT scan were selected for either ESWL or PCNL. Results: Thirty four patients in the PCNL group and 21 patients in the ESWL group, had post-operative hematuria at the time of presentation (p=0.072). There is a substantial difference between patients between 18-38 years and those in the 60+ years. According to the stone-free rate, 76 individuals had favourable results whereas only 6 had negative ones (p=0.756 and p=0.050). Conclusion: Extracorporeal shockwave lithotripsy and pecutaneous nepthrolithotripsy are both effective technique options for kidney stones. However, since ESWL is non-invasive and has fewer adverse effects than PCNL treatment option, it is more successful in treating medium-sized kidney stones (20 mm or smaller). Keywords: Extracorporeal shockwave lithotripsy, Percutaneous nephrolithotripsy, Kidney stone

Assessment of single-probe dual-energy lithotripters in percutaneous nephrolithotomy: a systematic review and meta-analysis of preclinical and clinical studies.

To evaluate the safety and efficacy of single-probe dual-energy (SPDE) lithotripters in patients undergoing percutaneous nephrolithotripsy (PCNL) through a systematic review and meta-analysis. We searched PubMed, Cochrane Library, Scopus and Embase databases until July 2022 for any preclinical or clinical studies, exploring the safety and efficacy of different SPDE lithotripters in patients undergoing PCNL. We performed a meta-analysis to compare stone-free rate, bleeding, or other complications and mean operative time between SPDE lithotripters and other lithotripters (PROSPERO: CRD42021285631). We included 16 studies (six preclinical, seven observational and three randomized with 625 participants) in the systematic review and four in the meta-analysis. Preclinical studies suggest that SPDE lithotripters are safe and effective for the management of renal stones. Among clinical studies, four studies assessed Trilogy with no comparative arm, two compared Trilogy or ShockPulse with a dual-probe dual-energy lithotripter, two compared Trilogy with a laser, one compared ShockPulse with a pneumatic lithotripter, and one directly compared Trilogy with ShockPulse. Comparing SPDE lithotripters to other lithotripters, no significant differences were demonstrated in stone free rate (OR 1.13, 95% CI 0.53-2.38, I2 = 0%), postoperative blood transfusion (OR 1.33, 95% CI 0.34-5.19, I2 = 0%), embolization (OR 0.45, 95% CI 0.02-12.06), operative time (WMD: 2.82min, 95% CI -7.31-12.95, I2 = 78%) and postoperative complications based on the Clavien-Dindo classification. SPDE lithotripters represent a promising treatment modality for patients requiring PCNL. Despite the initial encouraging findings of preclinical and isolated clinical studies, it seems that Trilogy or ShockPulse provide similar efficiency compared to older generation devices.

Effect of retrograde intrarenal surgery on the inflammatory reaction, renal function indicators and clinical efficacy in male patients with kidney stones

To investigate the effect of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotripsy on the inflammatory reaction, renal function indicators and clinical efficacy in male patients with kidney stones. 122 male patients with kidney stones were separated into the study group (n = 61) and the control group (n = 61) in terms of distinct clinical treatment regimens. The study group was treated with retrograde intrarenal surgery, while the control group was treated with percutaneous nephrolithotripsy. Inflammatory reaction indicators (Interleukin-6 (IL-6), Interleukin-10 (IL-10), serum tumor necrosis factor-α (TNF-α)), renal function indicators (blood urea nitrogen (BUN), serum creatinine (Scr), blood uric acid (BUA), serum β2 microglobulin (BMG)) and other clinical indicators (operative time, hospital stay, intraoperative blood loss, Visual analogue scale (VAS) pain score, complications) were observed and compared. Upon the treatment, significantly lowered inflammatory factors including IL-6, IL-10, TNF-α and renal function indicators including BUN, Scr, BUA, BMG were shown in study group. Notably shortened operative time and hospital stay were presented in study group with lowered intraoperative blood loss and pain score. The total incidence of complications in study group was 3.28%, significantly lower than 14.75% in control group. Compared with percutaneous nephrolithotripsy, retrograde intrarenal surgery for the treatment of male kidney stones with a diameter of less than 3 cm can improve the inflammatory reaction of male patients, maximize the preservation of renal function indicators, and eminently promote the clinical comprehensive efficacy.

Безопасность и эффективность нового метода доступа к чашечно-лоханочной системе во время перкутанных операций на почке

to study the safety and efficacy of using a new method of performing percutaneous nephrolithotripsy under ultrasound and endovisual control.A comparative analysis of the results of percutaneous nephrolithotripsy performed under ultrasound and endovisual control in 515 (84.1%) patients (main group) and percutaneous nephrolithotripsy performed under fluoroscopic control in 97 (15.8%) patients (control group) was carried out. The groups did not differ in age, gender, body mass index, the number and location of stones, and the duration of the disease. In the main group, there were more patients with large, staghorn and X-ray negative stones, and there were also more patients with kidney block. To analyze and stratify the complications of percutaneous nephrolithotripsy, we used a modified classification of surgical complications according to the Clavien-Dindo system. Statistical analysis of the material was carried out using the licensed package IBM SPSS Statistics Version 14.0.1.The average duration and number of stages of operations in the main and control groups was the same. Almost all operations in groups (93,8% 91,8%) were performed in one step (=0,55). In the main group, in the vast majority of cases95,1%; <0,001), percutaneous nephrolithotripsy was performed through one puncture access, with the degree of complete elimination of stones statistically the same as in the control group (80.6% in the main group and 70.1% in the control group, p=0.158). The degree of decrease in hemoglobin in the postoperative period in the groups did not differ (=0,271). The frequency of postoperative complications in both groups did not differ statistically: in the control - 33.0%; in the main group - 29.3% (p=0.469). The severity of complications according to Clavien-Dindo did not differ in the groups either (p=0.17).Percutaneous nephrolithotripsy under ultrasound and endovisual control is a safe and effective operation. The results of the operation and the frequency of early complications are comparable with the traditional X-ray control technique.

Использование биометрических параметров верхних мочевых путей для планирования оперативных методов лечения нефролитиаза.

Introduction. The prevalence of urolithiasis (ICD) reaches 5-20% with an annual increase. Endoscopic methods play a leading role in the surgical treatment of urolithiasis. The aim of the surgery is the achievement of stone free status without complications. The technological progress has led to the development of computer programs for visualization before the surgery, which have been used to assess the topography, skeletotopy, anatomy of the renal cavity system, structural features and angioarchitectonics. Aim of the study. Improving the effectiveness and safety of percutaneous interventions using the biometric planning method. Materials and methods. We analyzed the treatment results of 120 patients who were underwent percutaneous interventions for nephrolithiasis in the period from 2019 to 2021. The main method of preoperative examination was multispiral computer tomography (MSCT) with 3D reconstruction and biometric assessment of anatomical parameters. Results. Single kidney stones were detected in 45 patients, multiple – in 24, coral-shaped – in 51 patients. The growth of microflora in urine culture was noted in 64 cases. The average time of X-ray screening was 20.5 minutes (7-34 minutes). The average duration of surgery is 110 minutes (65-240 minutes). Complete purification of the calyx-pelvic system from concretions was achieved in 78% of patients. Complications were detected in 21 (17.5%) patients, 52% of them – grade I-II on the Clavien-Dindo scale. The optimal parameters for percutaneous nephrolithotripsy in monotherapy mode were determined: lower polar anatomy – neck length &lt; 2 cm, width &gt; 0,5 cm, lower cervical-pelvic angle &gt; 70°, lower cervical-frontal angle &gt;135°; upper polar anatomy – single calyx, calyx neck length &lt; 2 cm, width calyx necks &gt; 1,0 cm, upper cervical-cervical angle &gt; 135°, upper cervical-frontal angle &gt;135°; anatomy of the central segment – A1. Discussion. The creation of a morphometric model makes it possible to define the stages of surgery, reduce the risks of complications, increase the efficiency and safety of the procedure. Conclusion. Currently the use of biometric parameters before percutaneous and endoscopic intrarenal interventions is the most effective method of virtual planning, which allows to free the urinary tract from the maximum volume of stone and return the patient to a full life in the shortest possible time.

Comparative Evaluation of the Choice of the Method of Percutaneous Nephrolithotripsy in Patients with Nephrolithiasis

The objective: to analyze the effectiveness and safety of mini-percutaneous nephrolithotripsy (mPCNL) compared to standard percutaneous nephrolithotripsy (sPCNL) in the treatment of nephrolithiasis. Materials and methods. The study analyzed the results of treatment of 1021 patients with solitary (10–30 mm), coral-like and multiple kidney stones for the period from 2016 to 2022. Patients were divided into two groups: sPCNL (500 patients) and mPCNL (521 patients). The average age of patients in both groups was 44.5±15 years. The results of treatment in both groups were compared with each other according to the following parameters: stone-free rate (SFR), duration of surgery, presence of complications, and length of postoperative hospital stay. Results. Both methods are highly effective in the surgical treatment of nephrolithiasis. At the same time, the duration of the operation in the mPCNL group was longer than in the sPCNL group (81.0±15.5 min vs. 69.1±13.9 min; p&lt;0.001), mCPNL was more often finished with drainageless methods (41.1% vs. 6.8%; p&lt;0.001). The postoperative SFR after mPCNL was generally higher (96.4% vs. 91.8%; p=0.002) both in the treatment of solitary stones (98.5% vs. 97.4%; p&gt;0.05) and in treatment of coral-like (90.1% vs. 77.3%; p&lt;0.05) and multiple nephrolithiasis (89.5% vs. 70.8%; p=0.03). The postoperative hemoglobin decrease was smaller in the mPCNL group (1.1±0.34 g/dL vs. 2.1±0.26 g/dL; p&lt;0.001). The infectious complications frequency and length of postoperative stay in the hospital were less in the mPCNL group than in the sPCNL group – 7.3% vs. 13.2% (p=0.03) and 1.9±0.6 days vs. 4.3± 2.4 days, respectively (p&lt;0.001). Conclusions. Mini-percutaneous nephrolithotripsy (m-PCNL) has been proven to be a safe and effective method of nephrolithiasis treatment. Compared with standard percutaneous nephrolithotripsy (sPCNL), patients after mPCNL have a higher SFR, a lower frequency of postoperative complications and duration of postoperative stay in the hospital. An increase operation time by mPCNL is associated with a decrease in the diameter of the tube.

The use of endoscopic combined intrarenal surgery in the treatment of nephrolithiasis

Urolithiasis is one of the most common urological conditions (30–45 %), peaking in the 4th–6th decades of life. About 50 % of patients have one recurrent episode of nephrolithiasis during their lifetime, and among the operated patients, more than 10–15 % of individuals report recurrences with the need for repeated surgical treatment. Increasing the incidence of nephrolithiasis in the world requires the development of new and improvement of existing methods of surgical treatment, which would be characterized by a high level of efficiency and low invasiveness with minimal complications and postoperative rehabilitation. The use of a combination of percutaneous nephrolithotripsy and flexible ureteronephrolithotripsy, especially in complex cases of urolithiasis, can increase the safety and improve the treatment of nephrolithiasis by combining the positive qualities of both methods. Aim. To summarize the data of the world scientific literature on the treatment of nephrolithiasis by studying a combination of percutaneous nephrolithotripsy and retrograde or antegrade flexible intrarenal surgery based on the evaluation of their effectiveness and safety. Materials and methods. The literature review was conducted using the databases PubMed, Google Scholar, Web of Science and Scopus for the period 2015–2022. The following keywords were used for the search: surgical treatment of nephrolithiasis, endoscopic combined intrarenal surgery (ECIRS), percutaneous nephrolithotomy, retrograde intrarenal surgery, simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotomy, simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotripsy. Conclusions. The use of ECIRS increases the effectiveness of one-stage treatment of nephrolithiasis with minimal complications and reduces the number of re-operations required. Treatment of complex forms of nephrolithiasis may be a priority for ECIRS. The main disadvantages of ECIRS are the need for simultaneous operation of two operating surgeons and the availability of two sets of endoscopic equipment, which make this procedure expensive.

Possibilities of multislice computed tomography in assessing the structural and compositional features of calcium-containing urinary stones

The aim: to study the X-ray density index (HU) in calcium-containing urinary stones with different structural and compositional features. The structural and compositional features of 118 samples of calcium-containing urinary stones, which were obtained as a result of extracorporeal shock wave lithotripsy, percutaneous nephrolithotripsy and ureteroscopic lithotripsy in patients with kidney and ureteral stones were studied. The structural features of the stones were evaluated by conducting a crystal-optical analysis, during which the linear dimensions, shape, color and degree of transparency of crystalline elements were estimated, and the volume fractions of the amorphous and crystalline phases in the sample structure were calculated. The compositional features of kidney stones were studied on the basis of a qualitative and quantitative assessment of their mineral composition by infrared spectroscopy. X-ray density of calcium-containing kidney stones was assessed based on the data of computed tomography without contrast, which was performed in all patients in the preoperative period. Structural and compositional features of calcium-containing urinary stones are characterized by the presence in their composition of calcium oxalate compounds in the form of vewellite and weddelite, as well as calcium phosphate in the form of apatite, hydroxylapatite, fluorapatite, carbonate apatite, which, depending on the stage of crystallization, can be in amorphous, amorphous-crystalline or crystalline state. The X-ray density of this type of urinary stones, according to multislice computed tomography, corresponds to the range of 1090-1785 HU. There is a direct correlation between the level of X-ray density of the stone and the volume fraction of the crystalline phase in its structure.

Efficacy and safety of percutaneous nephrolithotripsy in elderly patients: a retrospective study

BackgroundPercutaneous nephrolithotripsy (PCNL) is difficult to perform for elderly patients; thus, this study aimed to assess its efficacy and safety in elderly patients aged > 70 years, note any associations between outcomes and patient characteristics, and summarize relevant themes and observations.MethodsData from patients older than 70 years who had undergone PCNL for upper urinary tract calculi between January 2016 and January 2021 was retrospectively analyzed. Risk factors for postoperative complications and residual stones were analyzed using multivariate logistic regression.ResultsA total of 116 elderly patients underwent 122 PCNL operations, of which six underwent secondary PCNL operations, and all of which were successfully completed. The average age was 74.6 ± 4.3 years; the average stone size and operation time were 3.5 ± 1.8 (1.2–11 cm), and 71.8 ± 34.1 min, respectively. Of the participants, 16 or 13.8% had postoperative complications and 29 (25%) had residual stones after operation. The stone free rate was 75%. Multivariate analysis revealed that an American Score of Anesthesiology III was an independent risk factor for postoperative complications (odds ratio [OR] = 4.453, p = 0.031), and staghorn calculi were independent risk factors for postoperative residual calculi (OR = 31.393, p = 0.001).ConclusionPCNL was shown to be safe and effective for elderly patients aged > 70 years. Further, ASA III was an independent risk factor for postoperative complications, and staghorn calculi were independent risk factors for postoperative residual calculi in elderly patients.

Post-operative pain following percutaneous nephrolithotripsy- clinical correlates.

Management of postoperative pain following percutaneous nephrolithotripsy (PCNL) is a significant goal. We sought to identify risk factors and clinical correlates of postoperative pain in order to improve perioperative management and patient satisfaction. A single-center, retrospective analysis, from a prospectively maintained database, of all consecutive patients who underwent PCNL for renal calculi between January 2011 and August 2018. Postoperative pain was assessed using the visual analog scale (VAS) and analgesic use. We considered VAS score above 4 as meaningful. Pain management was standardized according to patirnt reported VAS scores. Multivariable logistic regression was performed to identify risk factors and clinical correlates. A total of 496 patients were analyzed. Younger age was associated with VAS above 4 on the operative day and the first postoperative following PCNL (p = 0.003 and p < 0.001, respectively). Female gender was associated with VAS above 4 in the first 2 days following the operation (p < 0.001). Younger age and female gender would most likely benefit from pre-emptive improved pain management protocols following PCNL.

Comparison of minimally invasive percutaneous nephrolithotomy and ureteroscopy in the management of impacted proximal ureteral stones

Introduction and objective: Management of large impacted proximal ureteral stones is often challenging due to the presence of mucosal edema, inflammation and angulations of the ureter and other factors which impede stone access, visibility and lithotripsy and can lead to different types of complications. The objective of our study is to compare the efficacy and safety of minimally invasive percutaneous nephrolithotripsy (mini-PCNL) and ureteroscopy (URS) in the treatment of impacted proximal ureteral stones. Material and methods: The medical records of 345 patients with impacted proximal ureteral stones 10-20 mm, treated between January 2016 – November 2022 were retrospectively reviewed. 178 patients (51.6%) underwent mini-PCNL, and 167 (48.4%) – URS. Data on patients’ preoperative characteristics, stone-free rates, operating times, intra- and postoperative complications were compared. Results: Patients’ preoperative characteristics were comparable between the two groups, except for mean stone surface and stone size, which were significantly higher in the mini-PCNL group (respectively, 137.87±44.32mm2 vs 80.94±29.66mm2, p=0.000; and 15.03±2.43 vs 12.02±2.22mm, p=0.000). The stone free rate after single procedure was 94.9% for mini-PCNL and 89,3% in the URS group (p=0,116). Four patients (2.3%) in the mini-PCNL group had significant hemorrhage necessitating selective renovasography and angioembolization of AV fistula. 21 (12.5%) patients had stones showing upward migration during the URS procedure and 3 (1.8%) had partial perforation of the ureteral wall. Hemoglobin drop was significantly higher in mini-PNL group (13.58±12.79g/l vs 4.69±5.72g/l, p=0,000). Mean operative time was significantly longer in the URS group, despite the smaller size of the stones (respectively, 41.41±13.62min vs. 30.67±10.34min, p=0,000). There were statistically significant difference of the necessity of auxiliary procedures in the URS group (respectively, 78 patients (46,4%) vs 6 patients (3.6%), p=0.000). Conclusions: For an impacted, proximal ureteral stone mini-PNL had better stone-free rates, shorter operative time and low percentage of auxiliary procedure and hospitalizations. However, URS had the advantages of less invasiveness procedure and shorter postoperative hospital stay.