Percutaneous Renal Stone Removal Research Articles

Single Specialty–Operated Renal Stone Removal: Initial Experience from 3 Interventional Radiology Centers

This retrospective analysis of the feasibility and safety of percutaneous renal stone removal using single-use flexible ureteroscopes was conducted at 3 academic centers. Twelve patients (58% men) underwent 14 percutaneous renal stone removal procedures between December 2021 and March 2023. All patients experienced symptom improvement and resolution of obstruction after stone removal. The procedural success rate was 92%. Only 1 patient required an additional stone removal procedure. No major adverse events occurred during or after the procedures. The percutaneous nephrostomy removal rate was 92%, with a median tube removal time of 5 weeks. The median procedural and pulsed fluoroscopy times were 106.5 and 16.3 minutes, respectively. Preliminary findings demonstrated that percutaneous renal stone removal using single-use endoscopes by interventional radiologists is feasible and safe.

Comparison of supine and prone positioning methods on the amount of bleeding in percutaneous renal stone removal with spinal anesthesia

Comparison of supine and prone positioning methods on the amount of bleeding in percutaneous renal stone removal with spinal anesthesia

Planning and Execution of Access for Percutaneous Renal Stone Removal in a Community Hospital Setting.

There have been several reports on the feasibility and safety of the superior pole approach to the kidney for percutaneous renal stone removal. To the author's knowledge, no one has published on the huge advantages this approach affords, owing to the rigid nature of the nephroscope/ultrasonic lithotripter, and due to the usually oblique position of the kidney as it lies upon the psoas. Between July 1986 and June 2014, the author has performed more than 500 percutaneous renal access procedures for stone removal at a single community hospital. Procedural technique is reviewed in detail, including the usual supremacy of the superior pole approach, the value of preprocedural sagittal computed tomographic reconstructions in forming a tentative plan of approach to the kidney, and the value of an intraprocedural partial-air nephrostogram in finalizing the plan. The importance of collaboration with the involved urologist, and knowledge of the tools available to the urologist, is emphasized.

Ultrasound assessment of local complications of percutaneous renal stone removal

Ultrasound evaluation of 20 consecutive patients undergoing percutaneous renal stone removal demonstrated fluid collections around the kidney to be common, occurring in 12 (60%). One was intraperitoneal, 7 were perirenal, and 4 were in the track through the posterior abdominal wall. In only 1 were related clinical complications evident. At long-term follow-up, local capsular thickening related to a surface dimple was seen at the puncture site in 66%, and fine cortical scars were visible in 33%. Apart from one slightly larger local cortical scar related to a segmental infarction, no other change related to the procedure was demonstrated.

Pediatric nephroscope for percutaneous renal stone removal

A new 17-F nephroscope was used for percutaneous renal stone management. It appeared useful in reducing the possible main vascular injuries after percutaneous nephrolithotomy. Personal experience with pediatric as well as selected adult cases is presented.

Impact of percutaneous renal stone removal on renal function: Assessment by urinary lysozyme activity

Lysozyme in the urine in concentrations >3 μg per milligram of creatinine reflects renal tubular disease or dysfunction in patients without bowel disease or leukemia. We therefore used urine lysozyme assays to assess renal response to percutaneous nephrostomy and stone removal in 42 patients. Eight patients had striking increases (4.2 – 21.1 [mean 7.58] μg/mg creatinine) immediately after nephrostomy puncture in urine obtained directly from the punctured kidney. Lysozyme declined sharply thereafter and was within normal limits in all cases by postoperative day 3. This increase appeared to result from bleeding into the urine from the tract. Five other patients had lysozymuria on admission, only I of whom had a sharp increase after nephrostomy puncture. In the remaining patients, the lysozyme levels remained within normal limits throughout the hospital course. These data are further evidence of the absence of significant deleterious effects of nephrostomy puncture on the kidney.

Renal effects of percutaneous stone removal

Preoperative and postoperative renography with 993Technetium-diethylene-triamine pentaacetic acid was performed on 33 patients who were free of renal scarring, infection, and obstruction and who underwent percutaneous renal stone removal. Although there was a transient decrease in renal function postoperatively in some patients, statistically significant reductions in renal function occurred only in 1 patient with an arteriovenous malformation that was embolized and in 1 patient who had a postoperative ureteropelvic junction stricture. The creation of more than one nephrostomy tract did not affect the results. In the absence of serious complications, percutaneous nephrostomy does not have a significant effect on renal function.

Therapy With The Knife: Is It Still Needed for Renal Stones?

Therapy With The Knife: Is It Still Needed for Renal Stones?

Radiation dose to patient and staff during percutaneous nephrostolithotomy.

The radiation dose to the patient and to members of staff was monitored during 18 procedures for the percutaneous removal of renal stones. It was found that the radiation dose to the patient was minimal and was about the same as for an IVU. The overall dose to the staff was acceptably low and within safety limits. It was concluded that PCNL is a safe procedure from the radiation point of view but it may be advisable to take certain precautions if the workload is high.

Surface shield: device to reduce personnel radiation exposure.

A simple device is described that can reduce personnel exposure from scatter radiation by up to 75%. The device consists of an oblong piece of shielding (0.75-mm lead equivalent) that is taped to the side of the patient during percutaneous renal stone removal and other interventional procedures. Contrary to other shields and barriers, this does not interfere with access to the patient. Scatter exposure data from phantom studies are presented and the rationale for surface shielding discussed.

A New Technique for the Transurethral or Percutaneous Removal of Renal Stones

This new technique uses a cystoscopically placed torque guide wire and catheters to deliver a stone basket to the renal calix containing the stone. Under fluoroscopic control the basket, placed through a 9F catheter, is used to dislodge and capture the stone. The stone-containing basket and catheter then are removed transurethrally or percutaneously. This procedure was used to remove small caliceal stones in 3 patients undergoing ureteral stone manipulation, and it facilitated the percutaneous removal of a larger stone in the upper pole infundibulum in 1 patient.

Percutaneous Removal of Caliceal and Other “Inaccessible” Stones: Instruments and Techniques

Percutaneous removal of renal stones is becoming an established procedure, especially for stones lying free in the renal pelvis. However, some renal stones, particularly caliceal stones, are less accessible and require special techniques for removal. We discuss these techniques, which include retrograde pyelography to facilitate a thorough understanding of caliceal anatomy and stone position in 3 dimensions, 2) approaches for accurate placement of a nephrostomy tract for straightline access to the stone(s), 3) judicious use of percutaneous punctures above the 12th rib and secondary percutaneous tracts, and 4) skilled choice and use of a large variety of cutting, extracting and disintegrating instruments with endoscopic and/or fluoroscopic control. The flexible nephroscope is valuable especially to reach inaccessible areas, although its skilled use requires experience. Flexible endoscopy often is aided by pressure irrigation, an assistant and simultaneous fluoroscopic control.

Percutaneous Removal of Caliceal and Other “Inaccessible” Stones: Results

Percutaneous removal of renal stones (percutaneous nephrolithotomy) is becoming an established procedure, especially for stones lying free in the renal pelvis. However, some renal stones, particularly caliceal stones, are less accessible and, therefore, more difficult by the percutaneous route. We removed percutaneously 95 caliceal or otherwise poorly accessible renal stones from 53 patients with a variety of techniques, including percutaneous puncture above the 12th rib, double or Y percutaneous nephrostomy tracts, rigid and flexible endoscopy, and intrarenal cutting with diathermy. Intravenously assisted local anesthesia was used exclusively in 89 per cent of the patients.Status free of stones was achieved in all but 1 patient who retained 2 small fragments. The average number of sessions was 1.89 and the average hospital stay was 7.9 days. Complications were minor except for 1 patient who required tertiary renal artery embolization for bleeding. Illustrative cases are presented. Virtually all renal stones can be removed percutaneously.

Dilatation of Nephrostomy Tracts for Percutaneous Renal Stone Removal

Dilatation of Nephrostomy Tracts for Percutaneous Renal Stone Removal

Percutaneous ultrasonic disintegration and removal of renal calculi

The results of percutaneous renal stone removal in the first 50 patients to undergo this procedure are presented. The procedure was successful in 40 patients; in 16 of these, ultrasonic disintegration was necessary. The technique failed in 10 patients. The difficulties encountered and the resulting modifications of technique are described.