Postoperative Residual Stones Research Articles

Efficacy and cost-effectiveness analysis of flexible ureteroscopic lithotripsy with TFDS in the treatment of urolithiasis.

At present, there is no effective drug to remove residual stones. Total flavonoids of desmodium styracifolium (TFDS) is an innovative traditional Chinese medicine listed in 2022, which can be used to treat ureteral calculi. This study was to explore the effectiveness and economic value of TFDS in the treatment of residual stones after flexible ureteroscopic lithotripsy (FURL). A total of 161 patients who underwent unilateral ureteroscopic lithotripsy for urinary calculi by the same surgeon in our center from May 2022 to February 2024 were retrospectively included. According to the use of stone-removal drugs after operation, patients were divided into TFDS group and Control group. The residual stones showed by x-ray plain film when the double J tube was removed were compared between the two groups, and the economic benefits of TFDS were analyzed by cost-benefit analysis. The data of 161 patients were collected, including 80 cases in TFDS group and 81 cases in Control group. The SFR rates at the endpoint of follow-up in TFDS group and Control group were 98.75% and 88.88%, respectively. In the subgroup analysis of post-operative residual stones, the stone clearance rate of TFDS was higher (47.62% vs. 18.18%). No obvious adverse events were reported in two groups. The cost/benefit ratio of TFDS was lower (20.43 vs. 32.57). Cost of TFDS was increased by ¥12.97 for each additional unit of total effective rate. The combination of dusting FURL and TFDS can effectively remove the urolithiasis when compared to only FURL, which showed highly economic benefits.

Association of health-related quality of life with urinary tract infection among kidney stone formers

Kidney stones and infections significantly affect patients’ health-related quality of life (HRQOL); however, the relationship between urinary tract infections (UTIs) and HRQOL in patients with kidney stones remains unclear. This study aimed to investigate the relationship using the validated Chinese version of the Wisconsin Stone Quality of Life questionnaire (C-WISQOL). We prospectively recruited 307 patients with kidney stones to complete the C-WISQOL before and after stone removal. The participants were diagnosed with UTI based on the presence of pyuria or bacteriuria with or without clinical symptoms. The psychometric properties of the C-WISQOL were statistically analyzed. Multivariate linear regression was used to predict the risk factors for impaired HRQOL in patients with stones and UTIs. The questionnaire is a reliable and robust tool for evaluating HRQOL in Chinese-speaking patients with urolithiasis. The UTI and kidney stone co-occurrence was significantly associated with female sex, diabetes mellitus, more previous stone events, higher antibiotic usage, positive stone- or UTI-related symptoms, and postoperative residual stones. The preoperative C-WISQOL scores and improvement in the HRQOL after stone removal in patients clinically diagnosed with UTI were significantly inferior to those in patients without UTI. The regression analyses showed that worse HRQOL was predicted by more previous stone events and positive stone- or UTI-related symptoms. In contrast, the presence of diabetes mellitus and postoperative residual stone fragments predicted a lower improvement in the HRQOL. These findings underscore UTI’s harmful impact on perioperative HRQOL in patients with kidney stones and could help strategies benefit those patients.

Factors effecting the success of retrograde intrarenal surgery in pediatric patients with renal stones: The experience of two tertiary centres with 368 renal units

Currently, in the field of pediatric urology, the primary aim of surgical approaches for the treatment of renal stone disease is to provide a stoneless state through minimally invasive methods, and to prevent the damage that such stones may cause in the urinary system and stone recurrence. The aim of this study was to evaluate the efficacy and safety of RIRS and the factors affecting its success in the surgical treatment of renal stones in pediatric patients. Data from 357 pediatric and 368 renal units were collected retrospectively. The recorded parameters were age, gender, location and burden of the stone, and presence of postoperative residual stones. The stone location was the upper pole in 28 (7.6%) patients, the middle pole in 44 (12%), the pelvis in 98 (26.6%), the lower pole in 139 (37.8%), and multiple locations in 59 (16%) patients. A stoneless state was achieved in 277 (75.3%) units, while 91 units (24.7%) had residual stones at the end of the first month. In the multivariate analysis, the development of residual stones was found to be significantly associated with age (odds ratio [OR], 1.123; p=0.012) and stone location (OR, 3.142; p=0.018). RIRS is an endourological procedure with a high success rate in the achievement of a stoneless state in both pediatric and adult age groups, with an 82-100% success rate reported in various studies. A full stoneless state was achieved in 277 (75.3%) units after the initial RIRS in the present study, and full stone clearance was achieved in 304 units after the second RIRS session, with a success rate of 82.6%. A limitation of our study is that it was not performed by a single surgeon, and stone samples could not be taken from all patients for stone analysis. RIRS has also been associated with a high success rate in the endoscopic treatment of renal stones and is an efficient and safe method with a minimal rate of complications, especially in the pediatric age group.

Flexible ureteroscopy with novel flexible ureteral access sheath versus mini-percutaneous nephrolithotomy for treatment of 2-3 cm renal stones.

To assess and compare the effectiveness and safety of flexible ureteroscopy (f-URS) with a novel flexible ureteral access sheath (f-UAS) versus mini-percutaneous nephrolithotripsy (mini-PCNL) in treating 2-3 cm renal stones. Retrospectively analyzed consecutive cases that underwent f-URS with f-UAS (12/14 Fr) from January 29, 2022, to November 30, 2022. Consecutive cases that underwent mini-PCNL (18 Fr) from June 5, 2021, to January 26, 2022, were selected as controls. The f-UAS is a novel device with a 10 cm anterior tip that passively bends along with the f-URS to enter the renal calyx. We analyzed demographic characteristics, stone parameters, operative time, stone-free rates (SFR), hospitalization time, and complication. A total of 96 consecutive cases that underwent f-URS with f-UAS and 96 consecutive cases that underwent mini-PCNL were included in the study. There were no significant differences between the two groups in terms of operative time (p = 0.06), stone volume clearance (p = 0.533) and complete SFR (p = 0.266) on the first postoperative day or residual Stone after 1 month (p = 0.407). We observed a significantly shorter postoperative hospital stay (1.4 days vs. 2.1 days; p < 0.001) and a lower decrease in hemoglobin levels (0.39 g/dL vs. 0.68 g/dL; p < 0.001) in the f-UAS group. The mini-PCNL group had a significantly higher overall complication rate (13.5%) compared with the f-UAS group (5.2%; p = 0.048). In the treatment of 2-3 cm renal stones, f-URS with a novel f-UAS may provide a superior alternative to mini-PCNL, potentially challenging its established status.

Impact of ureteric access sheath use during flexible ureteroscopy: A comparative study on efficacy and safety

ObjectivesThis study evaluates the impact of using an access sheath (AS) during flexible ureteroscopy (fURS) for urolithiasis treatment, focusing on outcomes such as stone-free rate, operation time, and complications. MethodsThis prospective, randomized study was carried out at Badr Hospital, Helwan University, and Ain Shams University hospitals from August 2021 to August 2022. Patients were systematically randomized into two groups (fURS with AS: 33 patients and without AS: 31 patients) and underwent preoperative and postoperative assessments, including lab tests and imaging. Possible procedure-associated risks, such as failed stone access, pain, bleeding, and sepsis, were monitored. ResultsThe two groups were found to be comparable in terms of demographic characteristics or preoperative stone findings (p > 0.05 for all). However, operation duration was shorter in the No Sheath group (79.4 ± 15.3 min vs. 90.4 ± 16.7 min in the Sheath group, p = 0.008). Intraoperative complication rates, including failed access, operation termination, ureteric injury, and bleeding, were comparable in both groups (p > 0.05). Postoperative stone-free rates (78.8% vs. 71.0%, p = 0.305) and mean residual stone size (2.7 ± 3.5 mm vs. 3.1 ± 3.1 mm, p = 0.687) showed no significant differences. ConclusionsThe present study suggests that fURS without an access sheath may offer an efficient and equally effective option for managing upper ureteric and renal stones. However, more studies with larger sample sizes and longer follow-up periods are required to validate these findings and to establish more precise indications for this approach.

Laparoscopic anatomical left hemihepatectomy guided by middle hepatic vein in the treatment of left hepatolithiasis with a history of upper abdominal surgery.

This study aimed to investigate the safety and efficacy of laparoscopic anatomical left hemihepatectomy guided by the middle hepatic vein (MHV) for the treatment of patients with hepatolithiasis who had a history of upper abdominal surgery. Retrospective data analysis was performed on patients who underwent laparoscopic left hepatectomy for hepatolithiasis and with previous upper abdominal surgery at the Second Affiliated Hospital of Nanchang University from January 2018 to April 2022. According to the different surgical approaches, patients were divided into laparoscopic anatomical left hepatectomy guided by the MHV group (MHV-AH group) and laparoscopic traditional anatomical left hepatectomy not guided by the MHV group (non-MHV-AH group). This study included 81 patients, with 37 and 44 patients in the MHV-AH and non-MHV-AH groups, respectively. There was no significant difference in the basic information between the two groups. Five cases were converted to laparotomy, and the remaining were successfully completed under laparoscopy. Compared to the non-MHV-AH group, the MHV-AH group had a slightly longer operation time (319.30min vs 273.93min, P = 0.032), lower bile leakage rate (5.4% vs 20.5%, P = 0.047), stone residual rate (2.7% vs 20.5%, P = 0.015), stone recurrence rate (5.4% vs 22.7%, P = 0.028), and cholangitis recurrence rate (2.7% vs 22.7%, P = 0.008).There were no significant differences in the results of other observation indices between the groups. Laparoscopic anatomical left hepatectomy guided by the MHV is safe and effective in the treatment of left hepatolithiasis with a history of upper abdominal surgery. It does not increase intraoperative bleeding and reduces the risk of postoperative bile leakage, residual stones, stone recurrence, and cholangitis recurrence.

Nomogram to predict the risk of adverse outcomes in patients with residual stones following percutaneous nephrolithotomy.

To investigate the risk factors associated with adverse outcomes in patients with residual stones after percutaneous nephrolithotomy (PCNL) and to establish a nomogram to predict the probability of adverse outcomes based on these risk factors. We conducted a retrospective review of 233 patients who underwent PCNL for upper urinary tract calculi and had postoperative residual stones. The patients were divided into two groups according to whether adverse outcomes occurred, and the risk factors for adverse outcomes were explored by univariate and multivariate analyses. Finally, we created a nomogram for predicting the risk of adverse outcomes in patients with residual stones after PCNL. In this study, adverse outcomes occurred in 125 (53.6%) patients. Multivariate logistic regression analysis indicated that the independent risk factors for adverse outcomes were the diameter of the postoperative residual stones (P < 0.001), a positive urine culture (P = 0.022), and previous stone surgery (P = 0.004). The above independent risk factors were used as variables to construct the nomogram. The nomogram model was internally validated. The calculated concordance index was 0.772. The Hosmer-Lemeshow goodness-of-fit test was performed (P > 0.05). The area under the ROC curve of this model was 0.772. Larger diameter of residual stones, positive urine culture, and previous stone surgery were significant predictors associated with adverse outcomes in patients with residual stones after PCNL. Our nomogram could help to assess the risk of adverse outcomes quickly and effectively in patients with residual stones after PCNL.

Impacto del uso de la vaina de acceso ureteral durante la ureteroscopia flexible: estudio comparativo de eficacia y seguridad

ObjectivesThis study evaluates the impact of using an access sheath (AS) during flexible ureteroscopy (fURS) for urolithiasis treatment, focusing on outcomes such as stone-free rate, operation time, and complications. MethodsThis prospective, randomized study was carried out at Badr Hospital, Helwan University, and Ain Shams University hospitals from August 2021 to August 2022. Patients were systematically randomized into two groups (fURS with AS: 33 patients and without AS: 31 patients) and underwent preoperative and postoperative assessments, including lab tests and imaging. Possible procedure-associated risks, such as failed stone access, pain, bleeding, and sepsis, were monitored. ResultsThe two groups were found to be comparable in terms of demographic characteristics or preoperative stone findings (P>.05 for all). However, operation duration was shorter in the No Sheath group (79.4±15.3minutes vs. 90.4±16.7minutes in the Sheath group, P=.008). Intraoperative complication rates, including failed access, operation termination, ureteric injury, and bleeding, were comparable in both groups (P>.05). Postoperative stone-free rates (78.8% vs. 71.0%, P=.305) and mean residual stone size (2.7±3.5mm vs. 3.1±3.1mm, P=.687) showed no significant differences. ConclusionsThe present study suggests that fURS without an access sheath may offer an efficient and equally effective option for managing upper ureteric and renal stones. However, more studies with larger sample sizes and longer follow-up periods are required to validate these findings and to establish more precise indications for this approach.

Outcomes of (chinese) mini-percutaneous nephrolithotomy for renal stones: a prospective trial

Objective: Mini-percutaneous nephrolithotomy (mini-PCNL) has been recently advocated as a minimally invasive procedure for the management of renal stone. In this trial, we assessed the postoperative outcomes of chinese mini-PCNL (MPCNL) in adult patients with renal calculi less than 3 cm in diameter. Material and methods: We performed a single-arm prospective trial that recruited adult patients with unilateral single kidney stones less than 3 cm. Patients were followed up for the assessment of postoperative complications and stone-free status. Results: Sixty patients were included in the present study, with a mean age of 36.9 ±8.5 years and slightly male predominance (56.7%). The mean operative time was 133.7 ±29.2 minutes. None of the patients needed a nephrostomy tube or DJ tube stent. The mean hospital stay was 1.4±0.62 days. Eight patients (13.3%) showed mild perinepheric collection on the postoperative US. All patients had mild postoperative pain, with no incidence of post-operative bleeding, residual stone, sepsis, or pelvi-calyceal injury. A total of four patients (6.7%) had a postoperative fever. The incidence of postoperative urine was 13.3%. Conclusion: Chinese Mini-PCNL is an effective minimally invasive modality for the management of renal calculi less than 3 cm, with a low rate of postoperative complications and excellent stone-free status. Mini-PCNL can be used in well-resourced centres to reduce postoperative complications and hospital stay among patients with renal calculi.

MODIFICATION OF GUY’S SCORING SYSTEM FOR POST PCNL PREDICTION OF STONE FREE RATE AND COMPLICATION RATE

Background Due to the wide variation in methods used by urologists to assess clinical and academic outcomes of PCNL, the SFR (Stone Free Rate) and complications can differ. Therefore, it is crucial to examine preoperative factors that influence these outcomes. To improve guidance for patients considering PCNL, nephrolithotomy scoring systems have been developed based on preoperative indicators, as inconsistent reporting of PCNL outcomes across different centres has been observed.&#x0D; Objectives To demonstrate the efficacy of integrating further possible patient and stone factors in this nephrolithmetry system provided, keeping the predictive value of this system as simple and reproducible as possible.&#x0D; Patients and MethodsData from one hundred consecutive cases of prone PCNL were collected after obtaining ethical approval. All cases were operated in Al-Sulaymaniyah Surgical Teaching Hospital and Shar Teaching Hospital between August 2021 and July 2022. Preoperative Guy’s scoring was applied by two endo-urologist to categorize all patients into four grades. The data included patients’ sociodemographic characteristics and stone parameters measured on preoperative non-contrast Computed tomography.&#x0D; ResultsThe mean age of patients was 44.85 years. The distribution of Guy’s stone score was as follows: G1=35 patients, G2=40 patients, G3=15 patients, and G4=10 patients. Tract length was &lt;100mm in 51 cases and &gt;100mm in 49 cases. Stone density was &lt;1000 in 34 patients and &gt;1000 in 66 patients. Postoperative residual stones were seen in 12 patients, and significant complications and blood transfusion were seen in 8 patients; all were more frequent with higher Guy’s scores. We found a statistically significant correlation between more than 100mm tract length and high postoperative residual stone by Chi-square test P-value 0.01. In addition, we observed strong relation between tract length and postoperative complication rates, though statistically insignificant.&#x0D; ConclusionWe suggest modifying Guy’s stone score by adding an expected tract length of more than 100mm to predict a higher residual stone rate and complication rate. Tract length can be added to Guy’s stone score and used as an upgrading factor by one grade whenever preoperative CT shows a tract length of more than 100mm.

Laparoscopic common bile duct exploration with primary closure is preferred for selected elderly individuals with choledocholithiasis.

Laparoscopic common bile duct exploration with primary closure (LCBDE-PC) exhibits more benefits than other surgeries for patients with choledocholithiasis. It remains unclear whether it is feasible for and beneficial to elderly individuals. This study aimed to clarify and stratify elderly patients who would benefit from LCBDE-PC. A retrospective study of 1240 patients with choledocholithiasis who underwent laparoscopic procedures between 2011 and 2019 was conducted. Patients were divided into the young group (<65 years old, n=708) and the elderly group (≥65 years old, n=532). Perioperative outcomes were compared between the two groups. Laparoscopic common bile duct exploration with primary closure was successfully performed in 90.20% of the elderly and 94.20% of the young. No significant differences were observed between the two groups regarding reoperation, postoperative bile leakage, residual stones, drainage removal, and postoperative mortality. Compared with the young, the elderly had longer postoperative hospital stay (p=0.035) and delayed postoperative eating time (p=0.036) in the matched cohort. Independent risk factors for failed LCBDE-PC were preoperative pancreatitis (p=0.018), year of the surgeon's experience (p=0.008), preoperative C-reactive protein level (p=0.034), preoperative total bilirubin (p=0.021), impacted common bile duct (CBD) stones (p=0.006), blood loss (p=0.001), and edema of the CBD (p=0.001). A novel nomogram for predicting failed LCBDE-PC in elderly individuals exhibited a sufficient discriminative ability according to the estimated area under the curve (AUC) of 0.869 (95% CI: 0.817-0.921, p < 0.01). Laparoscopic common bile duct exploration with primary closure is safe, feasible, and effective for elderly individuals with choledocholithiasis. Elderly patients with a high risk of failed LCBDE-PC should be cautious of undergoing LCBDE-PC.

A nomogram for predicting the risk of residual stone fragments after ureteroscopy.

The residual stone fragment is a tremendous issue after ureteroscopic lithotripsy and requires urologists to evaluate the condition of patients comprehensively. Our study aimed to construct a nomogram to make a personalized prediction of postoperative residual stone rate (RSR). We implemented a retrospective cohort study in the Department of Urology, Shanghai General Hospital. A total of 277 patients undergoing ureteroscopy (URS) were enrolled in our study. Among them, 186 patients were included in the training group and the remaining 91 patients comprised the testing group. We utilized stepwise forward algorithm and logistic regression analysis to build predictive models and selected the best model based on Akaike's information criterion (AIC). The model was assessed by receiver operating characteristic (ROC) curves and the Hosmer-Lemeshow (HL) test. We also conducted decision curve analysis (DCA) to demonstrate the net benefit of the model. The independent testing group was used to validate the practicability of the nomogram. The severity of hydronephrosis, stone location, the transverse diameter of stone, hypertension, and white blood cell (WBC) were found to be significant predictive variables for RSR after URS. The area under the curve (AUC) of the training group was 0.7203 and that of the testing group was 0.7280. Besides, the nomogram also presented great calibration and accepted net benefit in a wide range of probabilities. Our study achieved a predictive nomogram with excellent application value for urologists to assess RSR and make personalized treatment decisions.

Post-ERCP Complication Analysis of an Experienced Center.

Post-ERCP pancreatitis (PEP), post-sphincterotomy bleeding (PSB), and Post-ERCP perforation are the most common complications of endoscopic retrograde cholangiopancreatography (ERCP). Identification of risk factors for post-ERCP complications is critical for postoperative follow-up. This study aimed to evaluate the most common post-ERCP complication risk factors in an experienced center. The sample consisted of 1288 patients with naive papillae. Demographic characteristics, patient-related risk factors, procedure-related risk factors and postoperative complications were recorded. Patients had a mean age of 61.5±18.4 years. The prevalence of PEP, PSB, and post-ERCP perforation was 7.9%, 11.9%, and 0.5%, respectively. Among patient-related factors, female sex (OR 1.672 95% Cl 1.046 to 2.672) and narrowing of the choledochal diameter (OR 2.910 95% Cl 1.830 to 4.626) were associated with PEP. From procedure-related factors; precut sphincterotomy (OR 2.172 95% Cl 1.182 to 3.994), difficult cannulation (OR 5.110 95% Cl 2.731 to 9.560), pancreatic cannulation (OR 5.692 95% Cl 0.994 to 32.602) and postprocedure residual stone (OR 2.252 95% Cl 1.403 to 3.614) were found to be associated with PEP. The successful procedure (OR 0.378 95% Cl 0.204 to 0.699) had a protective effect on PEP. Choledocholithiasis indication (OR 3.594 95% Cl 1.444 to 8.942) and small papilla (OR 2.042 95% Cl 1.170 to 3.562) were associated with the development of PSB. Choledochal stenosis, periampullary-diverticulum, oral anticoagulant, and oral antiaggregant use were not associated with the development of PSB. Of the patients with post-ERCP perforation, 85.7% had difficult cannulation, 57.1% had precut sphincterotomy, and 28.6% had periampullary-diverticulum. Female sex, biliary stricture, precut sphincterotomy, difficult cannulation, pancreatic cannulation, and postoperative residual stone were associated with PEP. Choledocholithiasis indication and the presence of small papilla were associated with PSB.

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.

Preliminary Exploration on the Efficacy of Augmented Reality-Guided Hepatectomy for Hepatolithiasis

The augmented reality-assisted navigation system (AR-ANS) has been initially applied to the management of hepatolithiasis. The current study examines the safety and efficacy of the AR-ANS for hepatectomy in the treatment of hepatolithiasis. It is the first study to assess the preoperative and long-term outcomes of hepatectomy guided by the AR-ANS for hepatolithiasis. From January 2018 to December 2021, 77 patients with hepatolithiasis who underwent hepatectomy at Zhujiang Hospital of Southern Medical University were included. The subjects were divided into the AR group (n = 31) and the non-AR group (n = 46) according to whether the surgery was guided by the AR-ANS. Clinical baseline features, operation time, intraoperative blood loss, immediate postoperative residual stone rate, postoperative stone recurrence rate at 6 months, and postoperative complications were analyzed. There was no significant difference between preoperative baseline data from the 2 groups (p > 0.05). The AR group had a longer surgical time than the non-AR group (p < 0.001). The intraoperative blood loss in the AR group was lower than in the non-AR group (p < 0.001). Alanine transaminase, aminotransferase, immediate residual stone rate, and stone recurrence rate in the AR group were lower than in the non-AR group (p < 0.05). There was no significant difference in postoperative complications between the 2 groups. The application of the AR-ANS in hepatectomy for hepatolithiasis has not only achieved satisfactory therapeutic efficacy, but has also shown significant advantages in reducing intraoperative blood loss, immediate stone residual rate, and stone recurrence rate, which has clinical promotion value.

Guy’s stone Scoring in Predicting Post operative Residual Stones

Objective: To determine the frequency of postoperative residual stone based on preprocedural Guy’s scoring system.Methodology: This cross-sectional descriptive study was conducted from1st June 2018 to 30th November 2019 at University Medical College Faisalabad. All patients with stones in the kidney undergoing PCNL, 20 to 60 years of age of both genders were included. Patients with secondary stones due to pelviureteric junction obstruction, CRF and recurrent stones were excluded. In all patients Guy’s scoring was measured. Then all patients underwent PCNL. After 24 hours of operation, CT scan was done in each patient and residual stone (present/absent) was noted.Results: This study was comprised of 91 patients of age ranged from 20- 60 years. Fifty-three patients (58.24%) were males and 38 (41.76%) females. Seven (7.69%) were of Guy’s grade I, 48(52.75%) grade II, 21(23.08%) grade III and 15 of grade IV. Number of patients with residual stone was 09 (9.89%), 0.0% of GS 1, 12.5% of GS 2, 4.76% of GS 3 and 13.33% of GS 4 patients had residual stone.Conclusion: Pre-PCNL Guy’s scoring is easy, rapid and useful for predicting the residual stone after percutaneous nephrolithotomy. Keywords: Percutaneous nephrolithotomy, Guy’s scoring system, residual stone.

Evaluation and comparison of S.T.O.N.E. and Guy's scoring systems for predicting percutaneous nephrolithotomy outcomes in supine position.

Percutaneous nephrolithotomy (PCNL) was applied in the prone position until recently. But also, in recent years supine positions was applied in patients with kidney stones. Predicting how much renal stones can be cleared after surgery and possibility of complications is an important question for both surgeons and patients. Therefore different scoring systems are used to evaluate outcomes of PCNL before surgery. Between 2018 and 2020, 80 patients with renal stone who underwent PCNL in the supine position were evaluated preoperatively by S.T.O.N.E. and Guy's scoring systems (GSS). The predictions of both scoring systems for stone-free and complication rates in patients who underwent PCNL in the supine position were evaluated. Also, these scoring systems were compared among themselves for reliability. In both scoring systems, there was a statistically significant difference between postoperative stone-free (SF) and residual stone (RS) of patients and in predicting the likelihood of complications in patients. No statistically significant difference was found between the two scoring systems in predicting the stone-free rate. Our findings revealed that S.T.O.N.E. nephrolithometry and Guy's score systems can be used effectively to predict stone-free rate, complications, and operation duration in supine position PCNL for renal stones.

Surgical outcome of Mirizzi syndrome: Value of endoscopic retrograde cholangiopancreatography and laparoscopic procedures.

Laparoscopic cholecystectomy (LC) with associated procedures and endoscopic retrograde cholangiopancreatography (ERCP) have been the standard treatments for both common and rare biliary diseases. Mirizzi syndrome (MS) is a rare and complex biliary condition. We report our experience with MS treatment and investigate the value of laparoscopic procedures and ERCP in patient management. From 2004 to 2017, 100 consecutive patients with MS were diagnosed by ERCP and underwent surgery in a referral center. Sixty patients were treated with intended LC, and 40 patients were treated with open cholecystectomy (OC). The clinical manifestations, ERCP and associated procedures, surgical procedures, and postoperative outcomes were investigated. The surgical mortality rate was 1%, while the surgical morbidity rate was 15%. The patients treated with intended LC suffered from less morbidity (5%). The percentage of postoperative residual biliary stones was 32% (n=32), and only three patients underwent re-operation (laparotomy) for stone removal. The laparotomy conversion rate in the intended LC group was 16.7% (10/60). The length of hospitalization for the patients with successful LC was significantly shorter than that for the patients with conversion and intended OC. Csendes classification was a risk factor for conversion from LC to OC (type I vs types II to V, P<.0001). A combination of a laparoscopic procedure and ERCP may provide therapeutic benefits for patients with MS.

Value of multidisciplinary team (MDT) in minimally invasive treatment of complex intrahepatic bile duct stones.

This study aimed to investigate the value of multidisciplinary team (MDT) management in minimally invasive treatment of complex intrahepatic bile duct stones (IHDs) by laparoscopy, choledochoscopy and percutaneous choledochoscopy. The characteristics, perioperative index, complication rate and minimally invasive rate of patients in MDT group (n = 75) and non-MDT group (n = 70) were compared. The members of MDT include doctors in ultrasound, imaging, hepatobiliary and pancreatic surgery, anaesthesia and intensive care medicine. The results showed that minimally invasive surgery reduced the incidence of postoperative residual stones, OR (95% CI) = 0.365 (0.141-0.940) (p = 0.037). MDT reduced the operation time, OR (95% CI) = 0.406 (0.207-0.796) (p = 0.009). Minimally invasive surgery significantly reduced intraoperative bleeding, OR (95% CI) = 0.267 (0.133-0.534) (p < 0.001). Minimally invasive surgery also reduced hospitalization time, OR (95% CI) = 0.295 (0.142-0.611) (p = 0.001). The stone clearance rates of MDT group and non-MDT group were 81.33% and 81.43% respectively. In the MDT group, the operative time was less than that in the non-MDT group (p = 0.010); the intraoperative bleeding volume was significantly less than that in the non-MDT group (p < 0.001); the hospitalization time was less than that in the non-MDT group (p = 0.001). Minimally invasive operation rate:48 cases (64.00%) in MDT group were significantly higher than 17 cases (24.29%) in non-MDT group (p < 0.001). In conclusion, minimally invasive procedures can be selected more through MDT. MDT can shorten the operation time, and minimally invasive surgery can reduce the incidence of residual stones, reduce intraoperative bleeding, and may shorten hospital stay. Therefore, MDT management model can provide personalized and minimally invasive surgical protocol for patients with complex IHD, which has high application value.

Ultrasonographic percutaneous nephrolithotomy, with or without ureteral catheter

Introduction: Access by ultrasonography rather than fluoroscopy in addition to reducing radiation exposure to the patient and staff, is safe and effective. Access by ultrasonography is bi-planar and real-time compared to fluoroscopy, because it provides fewer side effects and more stone free rate. Objectives: To study the complications and outcome of PCNL (percutaneous nephrolithotomy) with or without using ureteral catheter. Patients and Methods: We studied 59 patients with at least 2 cm diameter of renal stone from January to December of 2018. After general anesthesia, 35 patients in the ureteral stent group were prepared in bladder lithotomy position. Then 5-French (Fr) ureteral catheters were introduced endoscopically in stone affected side and fixed to 16 Fr urethral Foley catheters in the patients. Other 24 patients in the non-stent group following anesthesia were directed to prone position instantly. In all of the patients, ultrasonography was performed in posterior auxiliary line below the ribs in prone position. Retrograde instillation of normal saline was performed through ureteral catheter in stent-group. Then we inserted 18G Chiba needle to desired calyx without needle holder guidance in all patients. Our approach according to probe was transverse. Results: Our patients comprised of 24 men and 35 women aged 24 to 66 years. Thirteen of them had no hydronephrosis and their stone sizes ranged from 21 mm to 65 mm. Patients in the ureteral stent group were more obese compared to the non-stent group (P=0.02) in addition to significantly more operation time (P=0.03). However hydronephrosis was not significantly different between groups (P=0.3). Postoperative residual stone rate, hospital stay days and complications (Fever, blood transfusion) were the same between both groups. Only urinary leak was more common in the non-stent group (P=0.04) Conclusion: Ultra-sonographic-PCNL without inserting ureteral catheter before surgery is conceivable especially in patients with lower body mass index (BMI). Advantages and complications are same in ureteral stent and non-stent patients except urinary leak that is more common in non-stent patients.