Percutaneous Nephroscopy Research Articles

Impact of Prone Jackknife Position on Intraoperative Hypotension During Percutaneous Nephroscopy: A Retrospective Matched Analysis

Impact of Prone Jackknife Position on Intraoperative Hypotension During Percutaneous Nephroscopy: A Retrospective Matched Analysis

Non-drug comprehensive programs to correct nitrogen metabolism and microelement status in patients with urolithiasis in the early rehabilitation period after percutaneous nephroscopy

The article presents the results of a study of the features of the effect of non-drug comprehensive programs, including intravenous laser blood irradiation (ILBI) in combination with ozone therapy and light therapy, on the state of nitrogen metabolism and microelement status before and after percutaneous nephroscopy. Material and methods: 90 patients with urolithiasis aged 28 to 62 years, mean age 37.6±4.5 years, who were divided into three groups comparable in age, sex, and clinical and functional characteristics: group I included 30 patients who, against the background of standard therapy, received a course of intravenous laser blood irradiation (ILBI) and ozone therapy — 6 procedures of each in the preoperative period, and polarized light and ILBI — 6 procedures of each in the early postoperative period (from the second day after surgery); group II included 30 patients who underwent a course of intravenous laser blood irradiation (ILBI) and ozone therapy from the second day after surgery; group III involved 30 patients who received standard therapy after surgery: antispasmodics, antibacterial therapy, taking into account bacterial urine culture, and non-steroidal anti-inflammatory drugs, which served as a background in groups II and III. Results: It has been proven that the use of a 2‑course rehabilitation program, including intravenous laser blood irradiation (ILBI) and ozone therapy in the preoperative period and polarized light and ILBI in the early postoperative period from day 2 after percutaneous nephroscopy, contributes to the normalization of nitrogen and mineral metabolism in patients with urolithiasis with kidney stones after percutaneous nephroscopy to a greater extent than intravenous laser blood irradiation (ILBI) and ozone therapy used from the second day after surgery.

Risk factors for systemic inflammatory response syndrome after endoscopic lithotripsy for upper urinary calculi

BackgroundTo explore the risk factors for systemic inflammatory response syndrome (SIRS) after endoscopic lithotripsy for upper urinary calculi.MethodsThis retrospective study included patients with upper urinary calculi who underwent endoscopic lithotripsy in the First Affiliated Hospital of Zhejiang University between June 2018 and May 2020.ResultsA total of 724 patients with upper urinary calculi were included. One hundred and fifty-three patients developed SIRS after the operation. The occurrence of SIRS was higher after percutaneous nephrolithotomy (PCNL) compared with ureteroscopy (URS) (24.6% vs. 8.6%, P < 0.001) and after flexible ureteroscopy compared with ureteroscopy (fURS) (17.9% vs. 8.6%, P = 0.042). In the univariable analyses, preoperative infection history (P < 0.001), positive preoperative urine culture (P < 0.001), history of kidney operation on the affected side (P = 0.049), staghorn calculi (P < 0.001), stone long diameter (P = 0.015), stone limited to the kidney (P = 0.006), PCNL (P = 0.001), operative time (P = 0.020), and percutaneous nephroscope channel (P = 0.015) were associated with SIRS. The multivariable analysis showed that positive preoperative urine culture [odds ratio (OR) = 2.23, 95% confidence interval (CI): 1.18–4.24, P = 0.014] and operative methods (PCNL vs. URS, OR = 2.59, 95% CI: 1.15–5.82, P = 0.012) were independently associated with SIRS.ConclusionPositive preoperative urine culture and PCNL are independent risk factors for SIRS after endoscopic lithotripsy for upper urinary calculi.

Surgery and Postoperative Care of Patients Undergoing Percutaneous Nephrolithotomy under the Guidance of B-Ultrasound Based on Smart Internet of Things.

At present, percutaneous nephrolithotomy has become an option for hospitals increasingly to treat calculus. However, due to the certain risk of percutaneous nephrolithotomy, it may lead to postoperative complications. Analyzing the preoperative factors of septic shock after percutaneous nephrolithotomy can provide guidance for reducing the incidence of septic shock after PCNL. This article establishes a logistic regression model based on preoperative factors, uses statistical methods, and uses the professional statistical software SPSS to create a database and analyze the data. The method of classification data analysis was used to determine various influencing factors including patient factors, stone factor, and preoperative factors and combined B-ultrasound guidance and percutaneous nephrolithotomy to reduce the risk of surgery. The experimental results found that the percutaneous nephroscope laser lithotripsy guided by the smart Internet of Things can effectively perform lithotripsy; in this paper, the preoperative data of different complications are obtained, and the risk of surgery is closely related to the operation time. The operation time exceeds 90 minutes and causes the risk of severe bleeding after PCNL. It is twice the operation time of less than 90 minutes and 5 times the operation time of less than 60 minutes.

Percutaneous nephroscopy combined with ultrasound-guided negative-pressure suction for the treatment of perinephric abscess: a case series

BackgroundDrainage is indicated in many patients with a perinephric abscess (PA). Surgical drainage is associated with trauma and slow recovery, while percutaneous drainage can be ineffective in some patients. We report on 11 patients with PA treated by percutaneous nephroscopy combined with ultrasound-guided negative-pressure suction under local anesthesia.MethodsThis case series included 11 PA patients operated on from January 2013 to June 2020. All patients received percutaneous nephroscopy combined with ultrasound-guided negative-pressure suction. Data, including operation time, volume of intraoperative blood loss, volume of intraoperative pus suction, time of postoperative drainage tube indwelling, time to restore normal body temperature, length of postoperative hospital stay, and intraoperative and postoperative complications, were collected.ResultsThe age of the patients was 59 (53–69) years. Eight, six, two, and two patients had hypertension, type 2 diabetes, rheumatoid arthritis, and renal calculi, respectively. The operations were successful forall11 patients. Eight, two, and one patients required one, two, and three channels, respectively, to clear their abscess. The average operation time was 44 (30–65) min, and intraoperative blood loss was 16 (10–20) ml. The volume of intraoperative pus suction was 280 (200–400) ml, time of postoperative drainage tube indwelling was 8.2 (6–12) days, and time to restoring normal body temperature was 0.8 (0.5–2) days. The average postoperative hospital stay was 9.8 (7–14) days. No severe intraoperative or postoperative complications occurred. The postoperative follow-up time was typically 4.8 (3–8) months, and there were no recurrences.ConclusionPercutaneous nephroscopy combined with ultrasound-guided negative-pressure suction might be a feasible method for treating PA.

Application of Comprehensive Nursing in the Operating Room Nursing of Patients with Percutaneous Nephroscopy Holmium Laser Lithotripsy

Application of Comprehensive Nursing in the Operating Room Nursing of Patients with Percutaneous Nephroscopy Holmium Laser Lithotripsy

One-stage efficacy of single tract minimally invasive ECIRS in the improved prone frog split-leg position for staghorn stones

ObjectiveTo explore the feasibility, safety, and effectiveness of single tract minimally invasive endoscopic combined intrarenal surgery (stmECIRS) in the improved prone frog split-leg position for staghorn stones.MethodA total of 83 patients with staghorn stones were retrospectively reviewed between January 2018 and June 2021. According to surgical procedure and position, patients were divided into a group of single tract minimally invasive percutaneous nephroscopy (stmPNL) in the prone position and a group of stmECIRS in the improved prone frog split-leg position (turned to the prone position after preset the flexible ureteroscope sheath in lithotomy position, meanwhile, bend both hips and knees to be frog abduction). Demographic characteristics, laboratory tests, stone characters, surgical information, stone-free rate (SFR), and perioperative complications were observed and analyzed.ResultsThere were no significant differences in demographic characteristics, changes level of Scr and Hb, stone size, radiation density, length of hospital stay, and operation time between the two groups. One-stage SFR in the stmECIRS group was significantly higher than that in the stmPNL group (84.4% vs. 57.9%) (P = 0.007), only 2 patients required blood transfusion after surgery (P = 0.862), and other postoperative complications were not statistically significant (P = 0.345).ConclusionsStmECIRS in improved prone frog split-leg position has a higher one-stage SFR than stmPNL for staghorn renal stones, and without complications increased, which is a safe, efficient and feasible treatment.

Comparison of Ultra Microscopic Percutaneous Nephroscopy and Soft Ureteroscopy in the Treatment of Kidney Stones

Comparison of Ultra Microscopic Percutaneous Nephroscopy and Soft Ureteroscopy in the Treatment of Kidney Stones

339 Single Use Flexible Scopes in Percutaneous Renal Surgery

Abstract Introduction Flexible nephroscopy is performed at the end of percutaneous nephrolithotomy (PCNL) to confirm stone clearance. Flexible cystoscopes are commonly used to perform nephroscopy through the PCNL tract, however reusable scopes can provide limited optics due to procedural factors such as renal bleeding and scope factors such as fibre-optic damage. The Ambu® aScope™ 4 Cysto (AmbuScope) is a single-use disposable, video flexible cystoscope which has been solely used in the outpatient setting for bladder visualisation. We describe the first experience of the single use scope in nephroscopy during PCNL. Method Retrospective data was collected and analysed in a 6-month period from 13 consecutive patients undergoing PCNL using the AmbuScope for flexible nephroscopy. Stone free rates on nephroscopy, post-op complications, surgeons’ useability scores and theatre staff opinions were collated. Results All procedures were completed without complication or scope malfunctions. One patient died 27 days post operatively from urosepsis and osteomyelitis: unrelated to the single use scope. All other cases had an uncomplicated recovery. Surgeon useability scores rated the scope as easy (40%) or very easy (60%) to access, very user friendly (100%) and had good (20%) and very good (80%) image quality. 60% of respondents preferred to use the Ambu® aScope™ over the reusable scope. The single scope was found to be more cost-effective at £135 compared to £166 for reusable scopes. Conclusions This study is the first to show that single use scopes are safe, user friendly and cost effectively used during percutaneous nephroscopy.

Influence of non-drug complex programs on severity of pain syndrome, psychoemotional status and quality of life in patients with urolithiasis before and after percutaneous nephroscopy

To study the effect of non-drug complex programs including intravenous laser blood irradiation (ILBI) combined with ozone therapy and light therapy on severity of pain syndrome, psychoemotional status and quality of life in patients with urolithiasis before and after percutaneous nephroscopy. The study included 90 patients with urolithiasis aged 28-62 years (mean 37.6±4.5 years). Patients were divided into 3 groups comparable in age, sex, clinical and functional characteristics: group 1 (n=30) - standard therapy with a course of ILBI combined with ozone therapy (6 procedures) in preoperative period and polarized light therapy and ILBI (6 procedures) in early postoperative period (the next day after surgery); group 2 (n=30) - ILBI combined with ozone therapy in early postoperative period along standard therapy; group 3 (n=30) - standard postoperative therapy (antispasmodics, antibiotic therapy based on bacterial culture of urine, non-steroidal anti-inflammatory drugs). To assess the effectiveness of treatment, we used 11-point numerical rating scale (NRS), 10-point SAM test (well-being, activity and mood) and short version of the SF-12 health questionnaire. Mean NRS score of pain prior to treatment was 5.9±0.8 points. After the course of rehabilitation in the 1st group, there was a significant decrease in intensity of pain (up to NRS score 1.1±0.1, p<0.001). In the 2nd group, analgesic effect was less significant (2.3±0.2 points; p<0.01). In the 3rd group, this value was 3.6±0.2 (p<0.001). The most significant dynamics of all indicators in SAM test was recorded in the 1st group (the indicators reached the values of healthy individuals). In the 2nd group, all indicators were 12.7-17.9% less than in the 1st group. In the 3rd group, the values were 32.4-39.4% less than in the 1st group ( p<0.05). According to the SF-12 questionnaire, 6.7% of patients reported low quality of life after treatment (compared to 83.3 and 53.3% in the 2nd and 3rd groups, respectively), 23.3% of patients reported high quality of life (10% in the 2nd group, no patients in the 3rd group). Two courses of non-drug rehabilitation including ILBI and ozone therapy in preoperative period and polarized light with ILBI in early postoperative period after percutaneous nephroscopy contribute to analgesic and psychocorrective effects. This significantly improves the quality of life of patients with urolithiasis before and after intervention.

Clinical comparative study of standard channel percutaneous nephroscope combined with flexible ureteroscope and traditional standard channel combined with microchannel percutaneous nephrolithotomy in the treatment of multiple renal calculi without hydronephrosis.

Objectives:To evaluate the clinical efficacy of standard channel percutaneous nephroscope combined with flexible ureteroscope and traditional standard channel combined with microchannel percutaneous nephrolithotomy in the treatment of multiple renal calculi without hydronephrosis.Methods:Eighty patients with multiple renal calculi without hydronephrosis treated in Shijiazhuang People’s Hospital from January 2020 to October 2021 were randomly divided into two groups: the experimental group and the control group, with 40 cases in each group. Patients in the experimental group were treated with standard channel percutaneous nephroscope combined with flexible ureteroscopy lithotripsy, while those in the control group were treated with standard channel combined with microchannel percutaneous nephrolithotomy. The differences in operative time, postoperative hospital stay, intraoperative blood loss, calculus clearance rate, and number of channels between the two groups were compared and analyzed. Moreover, the changes of renal function indexes such as serum creatinine, urea nitrogen, blood β 2-microglobulin and blood uric acid were compared and analyzed between the two groups postoperatively; Renal static imaging technology was utilized to compare and analyze the renal parenchymal injury of the two groups postoperatively. The incidence of surgical complications such as pain, fever, urine leakage at the incision, chest tightness and chest pain within 72h postoperatively was compared and analyzed between the two groups.Results:The operative time, postoperative hospital stay and intraoperative blood loss in the experimental group were significantly lower than those in the control group, with statistically significant differences (P=0.00). The number of percutaneous renal channels established in the experimental group was significantly superior to that of the control group (P=0.00); No statistically significant difference can be seen in the calculus clearance rate between the two groups (P=0.17); Postoperative TNF-a, CRP, IL-6 and other inflammatory factors in the experimental group were significantly lower than those in the control group (TNF-a, CRP, P=0.00; Il-6, P=0.01), and cortisol level in the experimental group was significantly lower than that in the control group, which was statistically significant (P=0.00). Postoperative renal static imaging showed that the degree of renal injury in the experimental group was lower than that in the control group (P=0.00). No statistically significant difference was observed in renal function indexes such as serum creatinine, urea nitrogen, blood β2-microglobulin and blood uric acid between the two groups (P>0.05).Conclusion:Standard channel percutaneous nephroscope combined with flexible ureteroscope is a safe and effective treatment regimen for the treatment of multiple renal calculi without hydronephrosis, boasting of numerous advantages such as reduced number of channels, less bleeding, short operative time, low kidney injury, low impact on internal environmental factors such as inflammation and stress in the patients, short postoperative hospital stay, and low incidence of complications.

Physiotherapy technologies in rehabilitation programs in patients with urolithiasis before and after percutaneous nephroscopy

Urinary stone disease (urolithiasis) is one of the most common urological diseases, the prevalence of which is growing every year, despite the development of new approaches to treatment. In recent decades, various endoscopic methods of treating urolithiasis, in particular, percutaneous nephroscopy, have become the most popular, however, even with such minimally invasive and non-invasive methods, the percentage of complications ranges from 5% to 11%. Despite the fairly widespread use of various physical factors in the urolithiasis treatment, it is still not possible to reduce the incidence rate. All this dictates an urgent need to search for new, more effective and safer, mainly non-drug technologies for the treatment of urolithiasis and prevention of the disease recurrence and postoperative complications. The aim of the study was to assess the effectiveness of the combined use of intravascular laser blood irradiation, ozone therapy, and light therapy (bioptron zepter) in the complex treatment of patients with urolithiasis after percutaneous lithotripsy, according to the data of ultrasound examination of the kidneys. Research materials. The study included 60 patients with urolithiasis who underwent percutaneous nephroscopy in the Urology Department of the PHI Railway Clinical Hospital “RZhD Meditsina”, Rostov-on-Don, in 2019–2020, with subsequent rehabilitation. The patients were divided into three relatively equivalent groups according to age, calculus size (from 7 to 20 mm), and stone composition. In the first (control) group, patients received standard therapy after surgery: antispasmodics, antibiotic therapy taking into account the bacterial culture of urine, non-steroidal anti-inflammatory drugs, which served as a background in the main group and the comparison group. In addition to the standard therapy, the patients in the second group (comparison group) underwent intravenous laser blood irradiation (ILBI) and ozone therapy. The patients of group 3 (main group) received intravenous laser blood irradiation (ILBI) and ozone therapy — 6 procedures each in the preoperative period against the background of standard therapy; polarized light and ILBI — 6 procedures each in the early postoperative period. Results. The article shows a higher efficacy of the combined use of ILBI, ozone therapy and light therapy in the complex treatment of patients with urolithiasis before and after percutaneous nephroscopy. Conclusion. Combined use of a course of intravenous laser blood irradiation (ILBI) and ozone therapy in the preoperative period and a course of polarized light and ILBI in the early postoperative period after percutaneous nephroscopy against the background of standard therapy in patients with urolithiasis contributes to a significant improvement in blood flow in the kidney and a reduction in the recovery period of the renal parenchyma, which made it possible to reduce the patient’s stay in the hospital, due to the prevention of the development of postoperative complications.

Bilateral Mini-Percutaneous Nephrolithotomy in a 7-Month-Old Child with Renal Fungus Balls

Abstract Introduction: Fungus ball (FB) is a rare condition that often requires surgical management.1 Percutaneous nephroscopy is rarely described in children to remove FB.2 We report the case of a...

Инородные тела мочевыводящих путей у детей: мультицентровое исследование

Introduction. Urinary obstructions caused by foreign bodies (FB) represent quite a rare clinical case in practicе of pediatric urologists. However, some recent publications note a tendency towards higher occurrence of FB in urinary tracts in children. Most publications on FB urinary obstructions in children are devoted to the descriptions of individual medical cases. Considering the lack of multicenter research works on the problem, a study based on generalized clinical experience of several hospitals appears relevant. Materials and methods. The study is based on retrospective analysis of treatment results of 44 pediatric cases from 10 clinics of Russia and Belarus during the period from 2000 through 2020. The study population comprised 28 (63.3%) boys and 16 (36.4%) girls. Mean age of the patients was 10.9±3.7 years. The children were subdivided into two groups: group I included 28 (63.3%) cases where FB had been introduced in the urethra or bladder by the child; group II included 16 (36.4%) cases where foreign bodies ended up in urinary tracts as a result of instrumental or surgical procedures. Results. Clinical manifestation of FB was typical among the patients in the group I while in group II the condition more often occurred inapparently. Children often concealed FB introduction in the urinary tracts, and so contacts with a healthcare institution were ordinarily triggered by changes in urine analysis findings. Concealment of FB introduction in the urinary tracts determined help seeking start later than 7 days following the incident in 64.2% cases of group I. More than a half of the FB in children of group I were revealed within the first month after the incident. In group II, FB were revealed accidentally during follow-up examinations in 75% of the children. Transurethral FB extraction succeeded in 50% of the patients in group I. In group II, transurethral FB extraction was performed in 5 (31.3%) children. In 2 cases (12.5%), FB were extracted using flexible ureteroscopy. Percutaneous nephroscopy was used in 2 (12.5%) patients. 5 (31.3%) cases required pyelotomy with laparoscopic access, and in 2 (12.5%) patients a lumbotomy had to be carried out. Discussion. The rarity of FB of the urinary tract in the practice of a pediatric urologist is the reason for the combination ofthe existing experience in providing medical care to children from 11 centers. Delayed demand for medical care was noted if FB were introduced by the child independently. The generalized material shows that in childhood, the same approaches to FB extraction are applicable as in adult patients; endoscopic FB removal is optimal. Conclusions. In most cases of children suffering from foreign bodies in urinary tracts, the FB can be extracted using endoscopy without complications and with favourable outcome.

A retrospective analysis on the effect of single-channel minimally invasive percutaneous nephrolithotomy combined with retrograde flexible ureteroscopy using the completely lateral decubitus and semi-lithotomy positions to treat complex kidney stones.

BackgroundSome types of complex kidney stones cannot be broken down and removed through single-channel percutaneous nephroscope or retrograde flexible ureteroscope. In order to be removed, these types of stones require multiple combined methods to be performed. The aim of this study was to retrospectively evaluate the clinical effect of single-channel minimally invasive percutaneous nephrolithotomy (mPCNL) combined with retrograde flexible ureteroscopy using the completely lateral decubitus and semi-lithotomy positions for treating complex renal calculi.MethodsWe selected 117 patients with complex renal calculi who were admitted to Peking University Shougang Hospital and Weifang People’s Hospital from January 1, 2017, to January 31, 2021. All patients were treated with single-channel mPCNL combined with retrograde flexible ureteroscopy in the completely lateral decubitus and semi-lithotomy positions. During the operation, the patients were placed in a completely lateral decubitus position, or their lower limbs were placed in a semi-lithotomy position for a single attempt only.ResultsAn 18-Fr percutaneous channel was successfully established in all patients. The mean operation time was 112±37 minutes, and the average blood loss was 71±31 mL. A 14-Fr renal fistula was maintained for 7 days, a urethral catheter for 2–3 days, and a ureteral stent tube for 2 weeks after each surgery. According to the results of computed tomography (CT) scans performed 3–5 days after the operation, the total lithotripsy success rate reached 100%, with a first-stage lithotripsy rate of 98.29%. Two patients were found to each have 1 residual stone, with a diameter of 4 mm, left in kidney by CT, which then was to be removed under local anesthesia. The average postoperative hospitalized time was 7±2 days, and no severe complications occurred perioperatively.ConclusionsSingle-channel mPCNL combined with retrograde flexible ureteroscopy in the completely lateral decubitus and semi-lithotomy positions is a safe, feasible, and highly effective method of treating complex renal calculi, which is of benefit to save operation time and facilitate operation process, because patient’s position could not need to be changed repeatedly during the surgery.

Experience in the use of physical factors during the recovery of the renal parenchyma after percutaneous nephroscopy

The article reflects the results of the use of physical factors to restore the renal parenchyma in the early postoperative period after percutaneous nephroscopy in patients with urolithiasis. Material and methods: the study included 80patients with concretions of the renal pelvis after percutaneous nephroscopy (45men and 35women, average age — 46 years), who were divided into 2 comparable groups: groupI (main group) — 40 patients who underwent intravenous laser blood irradiation (ILBI) and ozone therapy — 6 procedures in the preoperative period, and polarized light and ILBI — 6 procedures in the early postoperative period; groupII (control group), which served as a background in the main group, were prescribed non-steroidal anti-inflammatory drugs after the surgery, taking into account bacterial urine culture. Inclusion criteria: patients with urolithiasis aged 28 to 62 years; indications for percutaneous nephroscopy. Exclusion criteria: concomitant diseases; compliance; pregnancy; acute inflammatory kidney diseases; abnormalities of the upper urinary tract. Results: The combined use of ILBI, ozone therapy and polarized light in the pre- and early postoperative period in patients with urolithiasis after percutaneous nephrolithotripsy allowed improving clinical, laboratory, subjective and objective indicators, as well as shortening the recovery period of the renal parenchyma, which was confirmed by the data of ultrasound studies in the dynamics in the form of a significant reduction in the recovery period of the index of renal vessels resistance and reduction of edema of the renal parenchyma. As a result of the application of the developed complex, the total bed-day of patients’ stay in the hospital decreased, and there was a rapid recovery of capacity to work. Conclusion: The developed method of the combined use of ILBI, ozone therapy and polarized light in the pre- and early postoperative period in patients with urolithiasis after percutaneous nephrolithiasis is pathogenetically justified and highly effective, which allows us to recommend it for wide use in urological practice.

A preliminary study on percutaneous transhepatic drainage combined with sequential percutaneous nephroscopy in treatment of refractory liver abscess

Objective To investigate the clinical effect of percutaneous transhepatic drainage combined with sequential percutaneous nephroscopy for necrosectomy and drainage in the treatment of refractory liver abscess after transcatheter arterial embolization (TACE). Methods A retrospective analysis was performed for three patients with refractory liver abscess after TACE in The Affiliated 3201 Hospital of Xi'an Jiaotong University School of Medicine from January 2018 to December 2020, and among the three patients, one had the formation of liver abscess after TACE for hepatic metastases after pancreaticoduodenectomy, one had liver abscess after repeated TACE for massive hepatocellular carcinoma, and one had secondary liver abscess after TACE for traumatic hepatic rupture. All three patients received percutaneous transhepatic drainage and sequential percutaneous nephroscopy for the treatment of refractory liver abscess, and their specific treatment process was summarized. Results All three patients were diagnosed with refractory liver abscess based on CT, routine blood test, procalcitonin, blood culture, and clinical manifestation. Percutaneous transhepatic catheterization under the guidance of conventional ultrasonography or CT and effective antibiotics had an unsatisfactory therapeutic effect, and after sequential percutaneous nephroscopy was performed for necrosectomy and drainage, liver abscess was cured and the patients had good prognosis. Conclusion For refractory liver abscess after TACE, when routine puncture treatment has an unsatisfactory therapeutic effect or a patient cannot tolerate surgical operation, percutaneous transhepatic drainage combined with sequential percutaneous nephroscopy is safe and effective in the treatment of refractory liver abscess.

Superselective Renal Artery Embolization Management of Post-percutaneous Nephrolithotomy Hemorrhage and Its Methods

Objective: The purpose of this study was to evaluate the therapeutic efficacy and safety of superselective renal arterial embolization (SRAE) in the treatment of patients with renal hemorrhage after percutaneous nephroscopy (PCNL). In addition, embolization techniques and embolization materials during operation were also worthy of further discussion.Methods: From February 2015 to December 2019, clinical data of 49 consecutive patients with renal hemorrhage after PCNL were retrospectively analyzed. Demographic and clinical data of patients were recorded, changes in serum creatinine values were analyzed, and the safety and efficacy of TAE were evaluated. Clinical experience was also recorded.Results: A total of 49 patients underwent angiography, of which 46 patients received SRAE due to positive hemorrhagic foci detected by angiography, and the technical success rate of 46 patients was 100%. Among the three patients who did not receive embolization, one patient underwent nephrectomy, and two patients improved with conservative treatment, with a clinical success rate of 98%. There was no statistically significant difference between serum creatinine before PCNL and 7 days after SRAE (101.6 ± 36.5 to 100.5 ± 27.1 μmol/L; P = 0.634), and no significant change was observed in serum creatinine at the last follow-up (99.4 ± 34 μmol/L, P = 0.076). No major complications occurred after embolization.Conclusions: SRAE is safe and effective in patients with renal hemorrhage after PCNL. The experience of interventional therapy and the choice of embolization materials in this study may provide certain benefits for the treatment of patients with renal hemorrhage after PCNL.

Diagnosis and Treatment of Retroperitoneal Infection.

Background: Retroperitoneal infection is a persistent and widespread infectious disease that is difficult to treat. It is usually caused by secondary complications such as inflammation, damage, or perforation of adjacent organs in the retroperitoneal space. Pathogenic bacteria invade the retroperitoneal space through retroperitoneal and interstitial organs, peripheral tissue, and the blood. As a result, infections mostly arise from severe acute pancreatitis, acute colonic diverticulitis, inflammatory bowel disease, kidney abscess, and biliary tract injury. Initially manifested by the presence of lumbago, this disease spreads easily, is persistent, and is often misdiagnosed. Methods: Review and synthesis of pertinent literature and guidelines pertaining to abdominal infection and retroperitoneal infection. Results: Recent data indicate that mortality rates associated with retroperitoneal infection have been increasing annually. Early diagnosis and treatment have been shown to improve the prognosis. In the early stage, infection is insidious and lacks typical symptoms, and is primarily diagnosed with computed tomography (CT). Strategies that control the source of infection, rational use of antibiotic agents, and nutritional interventions are the primary approaches to treat the infections. Emergence of minimally invasive drainage technologies, including the ultrasound/CT-guided puncture and drainage, percutaneous nephroscope puncture and drainage, and drainage using a catheter through an abdominal puncture device (trocar) have shortened the treatment cycle and disease burden. However, current diagnosis and treatment for retroperitoneal infection are not sufficiently effective because some patients do not show typical clinical manifestations. Moreover, sensitivity and specificity of available auxiliary examination methods are not supported by sufficient evidence-based medical research. Additionally, there are no uniform standards on the timing of surgical intervention and treatment options. Therefore, we summarized the progresses on current diagnosis and treatment approaches for retroperitoneal infection.

Endoscopic hybridization in the treatment of complicated upper urinary calculus in children

Complicated upper urinary calculi in children, such as staghorn stones or renal calculi with congenital malformation, are difficult to treat. Laparoscopy, flexible ureteroscopy and percutaneous nephroscopy are not effective enough when they were performed alone. In this research we retrospectively reviewed three kinds of cases which use two endoscopic modalities in the operation. We aimed to study the feasibility and safety of endoscopic hybridization. In one case with distal ureter stenosis complicated with renal calculi, the distal ureter was dissected by laparoscopy, then delivered via the laparoscope trocar. A 9.5/11.5F flexible ureteroscope sheath was inserted into ureter. Renal calculi were removed by flexible ureteroscopy. In one case of staghorn stones complicated with hydronephrosis, the child was placed in the oblique lithotomy position. Flexible ureteroscopy and percutaneous nephroscopy were perform at the same time to remove the calculi. In one case of duplex kidney with hydronephrosis of the lower moiety with calculi, nephropyeloplasty of the lower moiety by laparoscopy was performed initially. And 12/14F flexible ureteroscope sheath was inserted into the collecting system of the lower moiety through the laparoscopic trocar when the renal pelvis was open. Then the flexible ureteroscope was used to remove the calculi. All cases were successfully operated without obvious stone residue and major complications. Endoscopic hybridization can be applied safely in children.