Presence Of Staghorn Calculus Research Articles

Prognostic Factors for Residual Lithiasis in Patients With Staghorn Calculi Undergoing Percutaneous Nephrolithotomy in the Maya Region of Yucatan, Mexico: A Case-Control Study.

Yucatan stands out as the state with the highest prevalence of urolithiasis in Mexico,placing significant demands on healthcare services, such as consultation and surgical intervention. Staghorn calculi are related to recurrent urinary tract infections, and their management is always surgical. The stone-free rate is a parameter used to measure the success of surgery, with residual stones considered those persisting four weeks after surgical management. There are understudied prognostic factors that can predict the success of achieving stone-free status, taking into account the number of stones, their location, and the anatomical variations of the patient's collecting system. The study aims to determine the prognostic factors for residual lithiasis in patients with staghorn calculi treated with percutaneous nephrolithotomy at the High Specialty Regional Hospital of the Yucatan Peninsula. A case-control study was performed including 188 patients, aged 18 years or older, and diagnosed with staghorn calculus from January 2022 to June 2023, grouping the patients according to their stone-free rate evidence on postoperative computed tomography. Data were collected from the records of the Urology Department at a high-specialty hospital in Yucatan. The groups were analyzed, aiming to establish an association between preoperative factors and postoperative outcomes measured in terms of stone-free rate. A total of 188 patients with staghorn calculi were included, with a predominance in females (58.5%) and a mean age of 45.4 ± 11.9 years. The most common comorbidity was hypertension (29.8%), and 27.7% had a history of recurrent urinary tract infections. Regarding the Sampaio classification, B1 was the most prevalent in our population with 66 cases (35.1%), while Type A2 was the least common (13.8%). According to what was obtained through the multivariate logistic regression model, the calyceal anatomy Type A1 and A2 were associated with residual lithiasis (p= 0.016 OR: 2.994 CI: 1.223-7.331), and Grade IV was associated with a higher rate of residual lithiasis (p=0.005 CI: 1.586-13.100).A statistically significant association was found between stone burden and the presence of residual lithiasis (p=< 0.001). Guy's Score Grade IV showed a higher incidence of residual lithiasis,seemingly associated with stone burden, leading to the conclusion that both factors were categorized as predictors for the development of post-surgical residual lithiasis. Regarding anatomical variations according to Sampaio, it was observed that types A1 and A2 showed a lower rate of stone-free status. Therefore, we also consider them as variables that may influence the achievement of success in endourological management. Personalized patient assessment allows for more accurate prognostic factors, enabling a more comprehensive surgical planning in the presence of staghorn calculi.

Blood Loss and Need for Transfusion in Percutaneous Nephrolithotomy

Objective: To determine the amount of blood loss and need for blood transfusion in patients undergoing percutaneous nephrolithotomy (PCNL). Study Design: Observational study. Place and Duration of Study: National Institute of Kidney Diseases and Urology (NIKDU) and Popular Medical College Hospital, Dhaka from 2015 to 2019. Methodology: The percutaneous Nephrolithotomy data were retrospectively reviewed to identify patients with postoperative blood loss and need for blood transfusion. The amount of blood loss was estimated by the postoperative drop in hemoglobin factored by the quantity of blood transfusion. Various patients and procedure-related factors were assessed for association with total blood loss or blood transfusion requirement using stepwise univariate, forward multivariate regression analysis. Results: A total of 232 procedures were performed on 216 patients. Two hundred and thirty-two procedures were included in the study. There were 167 males and 65 females. The mean age was 41±14 years. The mean hemoglobin drop was 1.68 ± 1.3 gm/dL. The overall blood transfusion rate was 13.2%. Stepwise multivariate regression analysis showed that female gender (p = 0.003), stag-horn stone (p = 0.023), stone fragmentation with ultrasound (p = 0.054) and chronic renal failure (p = 0.001) were significantly predictive of the need for blood transfusion. Conclusion: Chronic renal failure, female gender, presence of staghorn calculi, and stone fragmentation using the ultrasonic device were predictive of blood transfusion in this cohort of patients. Bangladesh J. Urol. 2021; 24(2): 124-128

A Rare Case of Renal Squamous Cell Carcinoma with Underlying Staghorn Calculus as Confounding Factor

Renal cell carcinoma is one of the most common kidney pathologies in adults, responsible for approximately 90-95% of cases. The most common variant is clear cell accounting for 60-70% of cases, while papillary accounts for 10-15% of the cases.&#x0D; Diagnosis of carcinoma in the presence of staghorn calculus is seen in less than 1% of patients in recorded data. However, squamous cell carcinoma of the kidney is a rare condition usually associated with chronic irritation by a foreign body, most likely due to staghorn calculus. Here we present a case report of a 65 year old male who came with complaint of pain in the abdomen since two months associated with malaise, weight loss and fever.&#x0D; CT KUB was suggestive of a non-excreting enlarged left kidney with multiple calculi with abnormal cortical and periureteric lesions with encasement of adjacent vessels. Histopathological report revealed a rare case of primary squamous cell carcinoma, most probably originating from the pelvis and secondarily infiltrating the renal parenchyma and associated with nephrolithiasis and hydronephrosis. Initially the patient was managed conservatively. Later the patient underwent nephrectomy.

Predictors of post-percutaneous nephrolithotomy sepsis: The Northern Malaysian experience.

Objectives:Percutaneous nephrolithotomy (PCNL) carries a small risk of postoperative sepsis due to the liberation of bacteria into the patients’ bloodstream during stone fragmentation. The study aims to identify the incidence of post-PCNL sepsis in our center, as well as to delineate perioperative characteristics associated with increased rates of sepsis.Materials and Methods:We performed a retrospective review on all PCNLs performed in our center between July 2012 and June 2017, with emphasis on preoperative urine results, intra-operative findings, and postoperative septic complications.Results:Among 425 cases of PCNL performed, 16 (3.76%) developed sepsis postoperatively. Patients with positive preoperative urine cultures were almost four times as likely to develop post-PCNL sepsis compared to those with negative cultures (8.41% vs. 2.2%, P = 0.004). Among patients with positive urine leukocytes and positive urine cultures, the presence of Staghorn calculi and multiple PCNL punctures both predicted significantly higher risks of postoperative sepsis. In contrast, diabetes mellitus and preoperative stenting were not found to be associated with a greater risk of post-PCNL sepsis.Conclusions:Patients who had positive preoperative urine leukocytes and/or cultures, and either harbor Staghorn calculi or are deemed to require more than one puncture on PCNL, were at an increased risk of developing post-PCNL sepsis. Such at-risk patients should be identified preoperatively, given aggressive perioperative antibiotic treatment, and monitored closely for septic complications during the convalescence period.

Percutaneous nephrolithotomy for large renal stones in anomalous kidneys

Background: Percutaneous nephrolithotomy (PCNL) is an important surgical method for managing renal stones of any size. Anomalous kidneys pose additional technical challenge to the operating surgeon to perform PCNL in these anatomically abnormal kidneys especially if the stone load is large. The aim of this study is to present the efficacy and limitations of PCNL in managing stones &gt;2 cm in size in anomalous kidneys.Methods: This was a retrospective single centre study of PCNL in anomalous kidneys with stones &gt;2 cm in size.Results: 30 patients of kidney stones &gt;2 cm underwent PCNL. Our series of patients included 19 (63.32%) cases of horseshoe kidneys, 9 (30%) malrotated kidneys, 1 (3.34%) pelvic and 1 (3.34%) crossed fused ectopia. We achieved complete stone clearance in 26 (86.67%) patients. Presence of staghorn calculus was the most important statistically significant factor limiting complete clearance.Conclusion: PCNL is an effective procedure for management of patients with large stones in anomalous kidneys. Appropriate preoperative evaluation especially imaging, appropriate selection of cases and most importantly excellent technical expertise is needed to achieve high stone clearance rates with minimal morbidity.

Peri-Operative Factors Affecting Blood Transfusion Requirements During PCNL: A Retrospective Non-Randomized Study.

BackgroundPercutaneous nephrolithotomy (PCNL) is accepted as the gold standard of care for the treatment of large renal calculi. Kidney hemorrhage, which requires blood transfusion, is one of the most common complications after percutaneous kidney stone surgery.ObjectiveTo evaluate perioperative factors associated with transfusion requirements during PCNL.Materials and MethodsA total of 226 patients with kidney calculi undergoing PCNL between January 2011 and December 2019 were reviewed retrospectively. We analyzed the impact of perioperative clinical factors on the necessity of blood transfusion during PCNL.ResultsThe overall blood transfusion rate was 9.29%. Multiple perioperative determinants were significantly correlated with the application of packed red blood cells (PRCs), including larger stone size (p = 0.006), multiple tract punctures (p = 0.029), presence of staghorn calculi (p = 0.026), and long operative time (OT; p = 0.017). Multivariate analysis demonstrated that only multiple tract punctures independently affected blood transfusion requirements during PCNL (p = 0.038).ConclusionIn accordance with the present study, only the multiple tract punctures were associated with blood transfusion requirements in PCNL.

Risk Factors for Postoperative Complications after Percutaneous Nephrolithotomy

To identify the perioperative factors associated with complications after percutaneous nephrolithotomy by classification of complications according to the modified Clavien scoring system and evaluation of the minor and major complications related to the procedure. A prospective study of all the percutaneous nephrolithotomy performed by standard technique within 1.5 years at Bir Hospital was made. Possible demographic, preoperative and intraoperative variables were included in the study and patients were followed up postoperatively for any complications. All complications were classified according to modified Clavien scoring system and analyzed to identify the prognostic variables. Two hundred and forty six percutaneous nephrolithotomy done within the study period were analyzed. Although 41.06 % of the study population developed complications, only 9.35 % had major complications. Age, body mass index, gender, clinical presentation, history of previous surgery and ASA score did not correlate with complications. Diabetes was the only comorbidity associated (p = 0.0482). Preoperatively estimated stone burden (p = 0.0023), number of calyces involved by the stones (p = 0.0002), and presence of staghorn calculi were significantly associated with development of postoperative complications. Multiple tracts were required (p = 0.0151) and operative time was longer (p < 0001) in the patients who developed complications. Percutaneous nephrolithotomy has lesser complications. Diabetic patients are more prone to develop complications. Larger stone burden, involvement of multiple calyces by stones and staghorn calculi are associated with need of multiple tracts and longer operative time, thus predisposing to higher incidence of complications.

Nephrectomy for infected stag horn calculus confounded by the presence of squamous cell carcinoma

Squamous cell carcinoma of kidney is a rare tumour of the many tumours seen in the kidney. It is usually associated with chronic irritation by a foreign body, which is...

Predictive factors for fever and sepsis following percutaneous nephrolithotomy: A review of 580 patients.

Aims:There has been much speculation and discussion about the infective complications of percutaneous nephrolithotomy (PCNL). While fever is common after PCNL, the incidence of it progressing to urosepsis is fortunately less. Which patient undergoing PCNL is at risk of developing urosepsis and in whom aggressive treatment of fever postoperatively may prevent the progression to severe sepsis becomes a very important question. This study aims to answer these vital questions.Settings and Design:This is a single institutional, retrospective study over a period of 3 years.Materials and Methods:Retrospective analysis of medical records of the patients undergoing PCNL from August 2012 to July 2015 was done. A total of 580 patients were included in the study, and the study variables recorded were analyzed statistically.Statistical Analysis Used:Statistical analysis was performed by Chi-square test.Results:Three factors significantly correlated with postoperative severe sepsis, namely, stone size >25 mm, prolonged operative time >120 min, and significant bleeding requiring transfusion. Factors associated with fever after PCNL which did not progress to sepsis were the presence of staghorn calculi and multiple access tracts in addition to the factors listed above for sepsis.Conclusions:Fever after PCNL is not uncommon but it has a low incidence of progressing to life-threatening severe sepsis and multiorgan dysfunction syndrome. Special precautions and monitoring should be taken in patients with bigger stone (>25 mm) and patients with severe intraoperative hemorrhage requiring blood transfusion. It is better to stage the procedure rather than prolong the operative time (120 min). Identifying these factors and minimizing them may decrease the incidence of this life-threatening complication.

Are there any predictors of pyonephrosis in patients with renal calculus disease?

The objective of the study is to identify factors predicting development of pyonephrosis in patients of renal calculus disease (RCD), as this knowledge is largely unknown. Patients of RCD without pyonephrosis (Group 1) or with pyonephrosis (Group 2) presenting between December 2013 and November 2015 were evaluated. All patients of RCD who had undergone either percutaneous nephrostomy (PCN) or surgical management (percutaneous nephrolithotomy/pyelolithotomy/nephrectomy) were included. Patients treated conservatively, by extracorporeal shock-wave lithotripsy and patients of bilateral RCD were excluded. Data regarding demography, co-morbidities, associated urologic disease, previous intervention, clinical presentation, urinary culture, renal function, grade of hydronephrosis, stone characteristics were collected. 501 patients were included (Group 1: 410; Group 2: 91). Mean age in years (35.02 versus 35.48), sex ratio (2.12:1 versus 2.25:1) and mean body mass index (kg/m2) (22.27 versus 22.15) were similar in both groups. Prevalence of diabetes mellitus (3.41% versus 3.29%, p=1.000) was similar. Group 2 patients had longer duration of symptoms (5.77 versus 8.96months, p<0.0001), associated urological diseases such as ipsilateral PUJO and ureteric calculus (4.63% versus 12.08%, p=0.0125), moderate/severe-grade hydronephrosis (49.75% versus 92.30%, p<0.0001), presence of staghorn calculus (20.73% versus 62.63%, p<0.0001), multiple calculi (48.29% versus 68.13% p=0.0007) and nonfunctioning kidney (1.70% versus 71.42%, p<0.0001) as predictors of pyonephrosis. In logistic multivariate analysis, additionally, past history of urological surgery (p=0.044) was found associated with pyonephrosis. Our study identified some conditions associated with patients of pyonephrosis. To prove their role as risk factors we recommend further studies.

Lithotrites and Postoperative Fever: Does Lithotrite Type Matter? Results from the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study

Objective: To compare the risks of fever from different lithotrites after percutaneous nephrolithotomy (PNL). Materials and Methods: The Clinical Research Office of the Endourological Society (CROES) PNL database is a prospective, multi-institutional, international PNL registry. Of 5,803 total patients, 4,968 received preoperative antibiotics, were supplied with complete information and included in this analysis. The lithotrites assessed included no fragmentation, ultrasonic, laser, pneumatic and combination ultrasonic/pneumatic. Risk of fever was estimated using multivariate logistic regression with adjustment for diabetes, steroid use, a history of positive urine culture, the presence of staghorn calculi or preoperative nephrostomy, stone burden and lithotrite. Results: The overall fever rate was 10%. Pneumatic lithotrites were used in 43% of the cohort, followed by ultrasonic (24%), combination ultrasonic/pneumatic (17.3%), no fragmentation (8.4%) and laser (7.3%). Fever rates were no different between patients who underwent no or any fragmentation (p = 0.117), nor among patients when stratified by lithotrite (p = 0.429). On multivariate analysis, fragmentation was not significantly associated with fever [Odds Ratio (OR) 1.17, p = 0.413], while diabetes (OR 1.32, p = 0.048), positive urine culture (OR 2.08, p < 0.001), staghorn calculi (OR 1.80, p < 0.001) and nephrostomy (OR 1.65, p < 0.001) increased fever risk. Fever risk among lithotrites did not differ (p ≥ 0.128). Conclusions: Risk of post-PNL fever was not significantly different among the various lithotrites used in the CROES PNL study.

Triggers of blood transfusion in percutaneous nephrolithotomy.

To determine the triggers of blood transfusion in patients undergoing percutaneous nephrolithotomy (PCNL). Observational study. The Aga Khan University Hospital, Karachi, from 1988 to 2007. The percutaneous surgery database was retrospectively reviewed to identify patients with postoperative haemorrhage and need for blood transfusion. Blood loss was estimated by the postoperative drop in haemoglobin factored by the quantity of any blood transfusion. Various patients and procedure-related factors were assessed for association with total blood loss or blood transfusion requirement using stepwise univariate, forward multivariate regression analysis. A total of 326 procedures were performed in 316 patients. Two hundred and thirty two procedures were included in the study. There were 167 males and 65 females. The mean age was 41+14 years. The mean haemoglobin drop was 1.68 +1.3 gm/dL. The overall blood transfusion rate was 14.2%. Stepwise multivariate regression analysis showed that female gender (p = 0.003), staghorn stone (p = 0.023), stone fragmentation with ultrasound (p = 0.054) and chronic renal failure (p = 0.001) were significantly predictive of the need for blood transfusion. Chronic renal failure, female gender, presence of staghorn calculi and stone fragmentation using ultrasonic device were predictive of blood transfusion in this cohort of patients.

Postoperative Infection Rates in Low Risk Patients Undergoing Percutaneous Nephrolithotomy With and Without Antibiotic Prophylaxis: A Matched Case Control Study

Current guidelines recommend prophylactic antibiotic therapy for all patients undergoing percutaneous nephrolithotomy. We examined the effects of antibiotic prophylaxis in patients undergoing percutaneous nephrolithotomy with negative preoperative urine cultures. Of the 5,803 patients in the CROES (Clinical Research Office of the Endourological Society) Percutaneous Nephrolithotomy Global Study database, a group of 162 patients undergoing percutaneous nephrolithotomy with a negative baseline urine culture who did not receive antibiotic prophylaxis were matched on preoperative nephrostomy, the presence of staghorn calculi and diabetes status with an equal number of patients who received antibiotic prophylaxis. Comparisons were made between the 2 groups in terms of operative and postoperative outcomes, including the incidence of fever and other complications. Patients who received antibiotic prophylaxis had a lower mean (SD) age at 44.9 (14.2) vs 50.1 (14.4) years (p = 0.001). They were also more likely to be in the prone position during the procedure (71.6% vs 39.5%, p <0.001) but less likely to receive postoperative stenting (17.3% vs 32.7%, p = 0.002) than those who did not receive prophylaxis. The 2 groups were comparable in terms of all other baseline characteristics and operative factors. Patients who received antibiotic prophylaxis were less likely to experience fever (2.5% vs 7.4%, p = 0.040) and other postoperative complications (1.9% vs 22.0%, p <0.0001), and had a higher stone-free rate after percutaneous nephrolithotomy (86.3% vs 74.4%, p = 0.006). Antibiotic prophylaxis of patients undergoing percutaneous nephrolithotomy with a negative baseline urine culture is associated with a significant reduction in the rate of postoperative fever and other complications.

Can Ultrasound and Computed Tomography Replace High-dose Urography in Patients with Impaired Renal Function?

Ninety-one patients with unexplained impaired renal function were investigated by high-dose urography, ultrasound and computed tomography (CT) without contrast. The aim was to evaluate the role of ultrasound and CT in renal failure, in particular their ability to define renal length and to show collecting system dilatation. In the majority of patients, renal length could be measured accurately by ultrasound. Measurements were less that those at urography because of the absence of magnification. Renal measurement by CT was not a sufficiently accurate indicator of renal length to be of clinical use. Both ultrasound and CT were sensitive detectors of collecting system dilatation: neither technique missed any case diagnosed by urography. However, in the presence of staghorn calculi or multiple cysts, neither ultrasound nor CT could exclude collecting system dilatation. CT was the only technique which demonstrated retroperitoneal nodes or fibrosis causing obstruction. It is proposed that the first investigation when renal function is impaired should be ultrasound, with plain films and renal tomograms to show calculi. CT should be reserved for those patients in whom ultrasound is not diagnostic or in whom ultrasound shows collecting system dilatation but does not demonstrate the cause. Using this scheme, ultrasound, plain radiography and CT would have demonstrated collecting system dilatation and, where appropriate, shown the cause of obstruction in 84 per cent of patients in this series. Only 16 per cent of patients would have required either high-dose urography or retrograde ureterograms.