Session Of Percutaneous Nephrolithotomy Research Articles

Efficacy and Safety of Supracostal Access for Mini Percutaneous Nephrolithotomy in Pediatric Patients

To evaluate the efficacy and safety of supracostal percutaneous nephrolithotomy (PCNL) through the 11th intercostal space and compare it with subcostal PCNL in children with renal calculi. Children with renal calculi who underwent PCNL between January 2010 and December 2017 were divided into 2 groups: supracostal PCNL (group 1) and subcostal PCNL (group 2). Stone location, stone burden, location of the access points, operative time, postoperative visual pain score, success rate, hospital stay, and complications according to the modified Clavien classification were compared. Comparison of medians was done using Mann Whitney U test and the means were compared using t test. Group 1 had 50 patients while group 2 had 60 patients. The stone-free rate was 84.0% and 85.0% in groups 1 and 2, respectively after 1 session of PCNL (P=.885). After auxiliary procedures, it increased to 96.0% and 96.6%, respectively (P=.852). The mean fall in hematocrit was 0.9% in group 1 and 1.5% in group 2 (P=.11) whereas the median pain score was 4 in group 1 and 3 in group 2 (P=.37). In all, 54 complications were recorded the commonest among which were grade I (81.5%). Twenty-nine complications were observed in group 1 while 25 complications were observed in group 2 (P=.088). One patient developed nephropleural fistula while another patient developed hydropneumothorax. Both belonged to group 1. Supracostal access for PCNL is an effective and safe alternative to subcostal access for children with renal calculi in terms of stone-free rate and complications.

Percutaneous nephrolithotomy of staghorn renal stones in pediatric patients using adult-sized instrument

In this study, we aimed to evaluate the safety and efficacy of the percutaneous nephrolithotomy procedure performed with adult-sized instruments in pediatric cases with staghorn kidney stone. We retrospectively evaluated the efficacy and safety of 94 percutaneous nephrolithotomy procedures performed during 15 years in a single center for 82 pediatric patients with staghorn calculi using adult-sized instruments (24-Fr nephroscope). Stone free status was defined as complete clearance of the stones or the presence of insignificant residual stones of <3 mm in diameter. The mean age was 108 ± 53 months (range, 14-180 months). There were 39 patients (48%) with complete staghorn stones and 43 cases (52%) with partial staghorn. We fulfilled 91.4% of operations through a single access. The stone free rate was 86.6% after one percutaneous nephrolithotomy session. In total, seven patients referred for shock wave lithotripsy and four cases were scheduled for the second percutaneous nephrolithotomy session. Fever occurred in 18 patients (21%) and bleeding requiring transfusion in four children (5%). Prolonged leakage from nephrostomy site requiring anesthesia for double J stent placement occurred in one patient. No grade IV or V Clavien complication occurred. The success rate and complications of percutaneous nephrolithotomy with adult-size instruments in pediatric patients are acceptable.

Supine percutaneous nephrolithotomy in children

Introduction: The stone disease in children shows wide geographic variations, and its incidence has increased worldwide in children of all ages. Percutaneous nephrolithotomy (PCNL) has gradually emerged as one of the standard treatment options for the management of renal stones >1.5 cm in pediatric cases. PCNL just like in adults has been performed in the prone position. Of late observing the successful use of supine position for PCNL in adults, pediatric urologists have been encouraged to use the supine access for PCNL in children. We report our early experience with supine PCNL in children. Materials and Methods: All children with symptomatic renal stones presenting to the pediatric urological services of our hospital were prospectively included into the study to undergo supine PCNL. Children with skeletal anomalies, bleeding diathesis, and active urinary tract infection were excluded from the study. Results: Ten children (six males and four females) with a mean age of 11.48 ± 2.08 years (9–18 years) underwent supine PCNL. The mean size of the stone was 22 mm (range 17–47 mm). The initial stone-free rate was 90% immediately after a single PCNL session. One child needed an additional extracorporeal shockwave lithotripsy session to clear a 7-mm fragment. The average operative time (from the beginning of the puncture trial to nephrostomy tube insertion) was 70 ± 5 min. Conclusions: Supine PCNL in children is feasible, safe, and an effective means for management of renal stones in the pediatric population.

Treatment for residual stones using flexible ureteroscopy and holmium laser lithotripsy after the management of complex calculi with single-tract percutaneous nephrolithotomy.

This study validated the effectiveness and safety of the treatment for residual stones using flexible ureteroscopy (fURS) and holmium laser (0.6-1.2J, 20-30Hz) lithotripsy via a fiber with a 200-μm core diameter and 0.22 numerical aperture (NA) after the management of complex calculi with single-tract percutaneous nephrolithotomy (PCNL). Between January 2014 and June 2016, 27 consecutive patients with complex calculi underwent fURS and holmium laser lithotripsy after a planned single-tract PCNL. Among the 27 patients with complex calculi, 9 had full staghorn calculi, 7 had partial staghorn calculi, and 11 had multiple calculi. After the first single-tract PCNL session, the mean stone size and mean stone surface area were 18.0 ± 10.7mm and 181.9 ± 172.2mm2, respectively. Treatment for residual stones with fURS and holmium laser lithotripsy was successfully completed and was performed without intraoperative complications. The mean operative time of the fURS procedure was 69.1 ± 23.6min, and the mean hospital stay was 5.3 ± 2.4days. The mean decrease in the hemoglobin level was 7.3 ± 6.5g/l. After the fURS procedure, the overall stone-free rate was 88.9%. The overall postoperative complication rate was 14.8% (Clavien grade I 11.1%; Clavien grade II 3.7%). The current approach tested here combines the advantages of both PCNL and fURS and effectively manages complex calculi with a high stone-free rate (SFR) (88.9%). This approach also reduced the number of treatment sessions, the number of percutaneous access tracts, and the blood loss and potential morbidity associated with multiple tracts.

Comparison on efficacy and safety of percutaneous nephrolithotomy for the treatment of renal stones: modified supine Valdivia versus prone position

Objective To compare the efficacy and safety of percutaneous nephrolithotomy (PCNL) in modified supine Valdivia and traditional prone positions for the treatment of renal stones. Methods Clinical data of 80 consecutive patients with renal calculi who accepted PCNL from December 2012 to September 2014 were retrospectively reviewed.They were divided into modified supine Valdivia group (n=44) and prone position group (n=36) according to the position during surgery.There was no significant difference between the 2 groups in age, sex, ASA class, stone location and size (P>0.05). Total operative time, ratio of multi-access, blood loss, perioperative complications and stone-free rate were compared between the 2 groups. Results All punctures were performed successfully.No case was converted to open surgery.No severe complications such as colon injury, pleura or peritoneum perforation, or death occurred intra- and post-operatively.In prone position, 1 patient was found to develop high intra-trachea pressure because of large stone burden and prolonged operative time (130 min). This procedure was stopped and the patient received the second session of PCNL 1 week later.The mean total operative time was significantly shorter in the modified supine than in the prone position (67.7±24.5 min versus 91.5±29.8 min, P 0.05). Conclusion PCNL in modified supine Valdivia is as safe and effective as that of prone position for the treatment of renal stones, but the former is more time-saving than the latter. Key words: Nephrostomy, percutaneous; Supine position; Prone position; Retrospective studies

Supracostal Approach for PCNL: Is 10th and 11th Intercostal Space Safe According to Clavien Classification System?

The purpose of this study was to evaluate the success and morbidity of percutaneous nephrolithotomy (PCNL) performed through the 11th and 10th intercostal space. Between March 2005 and February 2012, 612 patients underwent PCNL, 243 of whom had a supracostal access. The interspace between the 11th and 12th rib was used in 204 cases (group 1) and between the 10th and 11th interspaces in 39 cases (group 2). PCNL was performed using standard supracostal technique in all patients. The operative time, success rate, hospital stay, and complications according to the modified Clavien classification were compared between group 1 and group 2. The stone-free rate was 86.8% in group 1 and 84.6% in group 2 after one session of PCNL. Auxiliary procedures consisting of ureterorenoscopy (URS) and shock wave lithotripsy (SWL) were required in 5 and 7 patients, respectively, in group 1; and in 1 patient each in group 2 . After the auxiliary procedures, stone-free rates increased to 92.6% in group 1 and 89.7% in group 2. A total of 74 (30.4%) complications were documented in the 2 groups according to modified Clavien classification. Grade-I complications were recorded in 20 (8.2%), grade-II in 38 (15.6%), grade-IIIa in 13 (5.3%), and grade-IIIb in 2 (0.8%) patients; grade-IVa was recorded in 1 (0.4%) patient. There were no grade-IVb or grade-V complications. Overall complication rate was 30.9% in group 1 and 28.2% in group 2. Supracostal PCNL in selected cases is effective and safe with acceptable complications. The modified Clavien system provides a standardized grading system for complications of PCNL.

Multiple tracts percutaneous nephrolithotomy assisted by LithoClast master in one session for staghorn calculi: report of 117 cases

The objective of the study is to evaluate the safety, efficacy and outcome of multiple tracts percutaneous nephrolithotomy (PCNL) assisted by LithoClast master (the third-generation Electro Medical System) in one session for the treatment of staghorn calculi. From October 2011 to March 2013, 117 patients with staghorn calculi underwent multiple tracts PCNL in our hospital. The combined pneumatic and ultrasonic powered lithotripter (EMS LithoClast master) was used to fragment and remove the calculi. The data were retrospectively analyzed with regard to stone burden, number of tracts, operation time, total operative blood loss, postoperative hospital stay, complications rate, and stone clearance rate. A total of 142 renal units in 117 patients (63 men and 54 women) were treated. Of the 142 renal units, 77 (54.2 %) had complete staghorn calculi, and 65 (45.8 %) had partial staghorn calculi. A total of 416 tracts were established in the 142 renal units. The mean number of tracts used in a single renal unit was 2.8 (range 2-4), most required three tracts. The mean (range) operating time is 72 (55-130) min. The mean (range) duration of postoperative hospital stay is 5.5 (3-9) days. Mean estimated operative blood loss is 150 (60-350) mL. The complications included blood transfusion in 9 (7.7 %) patients, high fever in 12 (10.3 %), sepsis in 5 (4.3 %), hydrothorax in 4 (3.4 %), and pseudoaneurysm in 3 (2.6 %). A complete stone clearance rate of 87.2 % (102/117) was achieved after one session of PCNL. This rate increased to 94.0 % after a secondlook procedure. In conclusion, multiple tracts PCNL assisted by EMS LithoClast master in one session is safe and effective in achieving a great stone clearance rate with acceptable morbidity for the treatment of staghorn calculi.

Supplementary X-Ray for Ultrasound-Guided Percutaneous Nephrolithotomy in Supine Position versus Standard Technique: A Randomized Controlled Trial

Objectives: To compare the success and complication rates of sonography-guided supine percutaneous nephrolithotomy (PCNL) versus prone standard technique (fluoroscopic guidance) in a randomized controlled trial. Subjects and Methods: Between April 2009 and August 2011, 92 candidates for PCNL were randomly divided into two groups: 46 B-mode sonography-guided supine PCNL (group A) and 46 standard fluoroscopic-guided prone PCNL (group B). Demographic, clinical and perioperative patient characteristics were analyzed, and complications and success rates were compared between the two approaches. Results: Preoperative parameters were comparable in the two groups. The primary success rate was 79.0 and 65.2% in groups A and B, respectively, after one session of PCNL (p = 0.485). Sonography-guided access failed in 3 cases (failure rate 6.5% in group A vs. 0% in group B). Mean hospital stay (2.48 days for group A vs. 2.95 days for group B; p = 0.039) and mean nephrostomy tube stay time (1.79 days for group A vs. 2.56 days for group B; p = 0.007) were significantly prolonged in the standard technique. Postoperative fever was more prevalent in the standard PCNL group (p = 0.024), but no significant difference was observed in other complications between the two groups. Conclusion: In this study, sonography-guided supine PCNL was presented as a safe and effective technique, similar to standard PCNL, with comparable success and complication rates. In addition, using this technique eliminates the possible harmful impacts of radiation on the surgical team and decreases postoperative fever.

Efficacy and safety of percutaneous nephrolithotomy for treatment of staghorn stones in solitary kidney

To analyze efficacy and safety of percutaneous nephrolithotomy (PCNL) in the management of staghorn calculi with solitary kidney. Between April 2009 and December 2011, 13 patients with renal staghorn calculi in solitary kidney were treated by PCNL in our hospital. The therapeutic effects and complications were the main points of the analysis. Of the 13 patients, surgery time was 92-164 (117.2±21.5) min; 9 cases underwent PCNL through a single access tract, 4 cases through multi-access tracts. The stone removal rate in one session of PCNL was 76.9%, and the total clearance rate was 92.3%. Hemoglobin dropped 11-32 (16.4±4.6) g/L; one case required blood transfusion; no patient had embolism. Hospital stay was 5-10 (6.9±1.5) days postoperatively. Serum creatinine before PCNL in these patients was 83-237 (146.24±38.73) μmol/L compared to 81-242 (134.56±21.52) μmol/L by the end of the 1-month follow-up period (not statistically different). Similar findings were observed in glomerular filtration rates: before PCNL it was 42-114 (71.32±20.82) mL/min and by the end of the 1-month follow-up it was 55-117 (79.40±22.14) mL/min (not statistically different). PCNL is effective and safe for the treatment of staghorn stones in solitary kidney, and has advantages such as short surgical duration, fewer complications, rapid recovery, short hospital stay, effective stone removal rate, and so on.

Outcomes of Percutaneous Nephrolithotomy in Patients With Solitary Kidneys: A Single-center Experience

To evaluate the outcomes, complications, and early and late postoperative kidney function of percutaneous nephrolithotomy (PCNL) in patients with solitary kidneys. Between 2002 and 2009, 47 patients with a solitary kidney (congenital in 10 patients, 21.3%; contralateral nephrectomy in 22 patients, 46.8%; and nonfunctional kidney in 15 patients, 31.9%) underwent PCNL. Serum creatinine was measured preoperatively, on postoperative day 1, and at each follow-up visit at regular intervals. The 4-variable modification of diet in renal disease equation was used to calculate the estimated glomerular filtration rate (eGFR). The 5-stage classification of chronic kidney disease (CKD) was used according to the National Kidney Foundation published guidelines. Of 47 patients, 44 were followed least 6 months, whereas 3 patients were lost to follow-up. Success was achieved in 84.5% (40/47) of patients after 1 session of PCNL. Complex stones were detected in 32 (68.1%) patients. Among all patients, 23.4% (n = 11) of them required multiple accesses. Complications developed in 5 (10.6%) patients. At a mean follow-up time of 18.7 ± 11.8 (6-60) months, the overall success rate improved to 97.7% after auxiliary treatments. eGFR was 76.4 ± 27.1, 73.4 ± 26.1, and 83.5 ± 29.4 per 1.73 m(2) during preoperative period, immediate postoperative period, and at the last follow-up visit (>6 months), respectively (P < .001). According to CKD classification, kidney function was stable, improved and worse in 63.6% (n = 28), 29.5% (n = 13), and 6.8% (n = 3) of patients, respectively, compared with preoperative levels. PCNL is safe and has an acceptably low complication rate in patients with solitary kidneys. At long-term follow-up, renal function had stabilized or improved in more than 90% of patients with a solitary kidney after PCNL.

Tubeless Procedure is Most Important Factor in Reducing Length of Hospitalization After Percutaneous Nephrolithotomy: Results of Univariable and Multivariable Models

To evaluate the effects of kidney stones and patient-related parameters on the length of hospitalization (LOH), which is one important factor affecting the cost effectiveness of percutaneous nephrolithotomy (PCNL). Recently, increases in healthcare costs have highlighted the importance of evaluating the cost effectiveness of a treatment as much as its efficacy. During an 8-year period, the records of 1669 patients with renal calculi who underwent PCNL were reviewed retrospectively. Eleven patients with urosepsis were excluded from the present study. A total of 1658 patients were categorized into 2 groups (group 1 = ≤2 days; group 2 = >2 days) according to the median LOH (median = 2 days). Multivariate binary logistic regression analysis was used to detect the effects of independent variables, including the patient age, gender, body mass index, history of extracorporeal shock wave lithotripsy or open surgery, stone size and opacity, presence of hydronephrosis, and localization and number of accesses, on the LOH after PNL. Overall success was achieved in 86.2% of cases after one session of PCNL. The mean length of hospitalization was 2.89 ± 1.66 days (range, 1-21). According to the outcome of the multivariate analysis, diabetes (P = .0001, OR = 1.67), impaired kidney function (P = .03, OR = 1.64), stone size (P = .031, OR = 1.31), number of accesses (P = .001, OR = 1.59), intercostal access (P = .001, OR = 1.79), and tubeless procedure (P = .0001, OR = 0.23) were variables influencing LOH. The presence of diabetes, a large stone burden, intercostals access, multiple accesses, and impaired kidney function prolong the LOH after PCNL. The use of the tubeless procedure was able to diminish the LOH.

Comparison of Outcomes After Percutaneous Nephrolithotomy of Staghorn Calculi in Those with Single and Multiple Accesses

To analyze the early outcome after single tract vs multiple tracts percutaneous nephrolithotomy (PCNL) in the management of staghorn calculi. The records of 413 patients with staghorn calculi (223 [54%] had complete and 190 [46%] had partial) who underwent PCNL were reviewed retrospectively. A total of 244 (59%) patients were managed by single access (group 1); meanwhile, multiple accesses were necessary in 169 (41%) patients (group 2). Both groups were compared in terms of perioperative findings and postoperative outcomes. Patients and stone-related factors affecting the number of accesses performed were analyzed. The mean number of percutaneous accesses was 2.42 +/- 0.74 (range 2-6) in group 2. Mean durations of fluoroscopy screening time and operative time were significantly longer in group 2 (P = 0.002, P < 0.0001, respectively). Supracostal access was necessary in 30.7% in group 2 and in 6.9% in group 1 (P = 0.001). Success was achieved in 70.1% in group 1 and in 81.1% for group 2 after one session of PCNL (P = 0.012). The most common complication was bleeding for both groups, and it was higher in group 2 (P < 0.0001). The mean preoperative and postoperative creatinine concentrations were 1.03 mg/dL and 1.08 mg/dL in group 1, and 0.9 mg/dL and 1.03 mg/dL in group 2, respectively. The mean changes in creatinine values were not statistically significant between the groups (P = 0.16). The impact of PCNL using either single or multiple access tracts on renal function is similar and of a temporary nature. PCNL with multiple accesses is a highly successful alternative with considerable complication rates in the management of staghorn calculi.

Percutaneous Nephrolithotomy in Renal Anomalies of Fusion, Ectopia, Rotation, Hypoplasia, and Pelvicalyceal Aberration: Uniformity in Heterogeneity

Percutaneous nephrolithotomy (PCNL) in renal fusion, ectopia, renal rotational anomalies, renal hypoplasia, and pelvicaliceal aberration for complex calculi is challenging for fear of inaccessibility, vascular, colonic, and splanchnic injury. We report our experience with 48 such patients. From 2002 to July 2007, 48 patients (mean age, 28 years) underwent PCNL for mean stone size of 39 mm. Fourteen patients had malrotated kidneys, 12 patients had bifid renal pelvis with complete or incomplete double ureter, 10 horseshoe kidneys, 8 hypo plastic kidneys, 3 with crossed fused ectopia, and 1 had pelvic kidney. After appropriate evaluation, the procedure was performed in one session either in prone or supine position with or without nephrostomy tube making amendments to the conventional procedure as deemed necessary befitting the requirements. Complete stone clearance was achieved in 39 patients (81%) after single session of PCNL. Seven patients treated subsequently with extracorporeal shockwave lithotripsy (SWL) for residual stone also became stone free, achieving final stone-free status of 96%. Three patients had more than one tract creation; 25 patients had this procedure in supine position. Mean hospital stay was 3 days (range, 2-7 days). Three patients required transfusion, and two had perinephric collection. No incidence of bowel, vascular, and splanchnic injury was recorded. Stone analysis showed calcium oxalate composition in 83% calculi. Universal application of PCNL in all diverse situations like renal fusion, renal ectopia, renal malrotation, renal hypoplasia, and pelvicaliceal variations yields comparable results demanding firm resolve and mandatory surgical skill on behalf of the surgeon.