Staghorn Kidney Stones Research Articles

Domestic single-port robot-assisted laparoscopic surgery for pyelotomy combined with shockwave lithotripsy: the first case report

Introduction and Importance: Kidney stones are a common condition treated in urology departments and rank first among hospitalized patients. Staghorn kidney stones are a particular type of kidney stone that fill or occupy most of the renal collecting system. They have a large stone load and are often associated with recurrent urinary tract infections and chronic renal insufficiency. Case presentation: The authors report a case of single-port robot-assisted laparoscopic pyelotomy combined with EMS (Electromagnetic Shockwave Lithotripsy) for surgical stone removal, and discuss and analyze it based on published literature. A 75-year-old woman visited our hospital in January 2024 due to right waist pain and hematuria. Computed Tomography (CT) indicated a stone ~6.1×5.8×3.5 cm in the right renal pelvis and calyces. Staghorn kidney stones are challenging to remove surgically, have a low stone clearance rate, and are prone to recurrence, making them one of the most difficult issues in urological surgery. Combined treatment effectively reduces the number of skin-renal passages, decreases the occurrence of injuries and complications, and improves the success rate of lithotripsy and the stone-free rate. Therefore, the patient underwent single-port robot-assisted laparoscopic pyelotomy combined with EMS surgical lithotomy and was discharged 7 days after the operation. There were no complications postoperation, and follow-up showed that the stones were completely cleared without any residue. Clinical discussion: The treatment of staghorn kidney stones requires a comprehensive approach to reduce the number of skin-renal passages and the occurrence of complications. Single-port robot-assisted pyelotomy combined with EMS lithotripsy can ensure the effectiveness of the surgery while reducing risks and enhancing patient recovery. Conclusion: For staghorn kidney stones, single-port robot-assisted pyelotomy combined with EMS stone removal is a safe and effective procedure with a beautiful incision, fewer complications, and excellent patient outcomes.

Deafness and Bilateral Staghorn Kidney Stones in a Young Patient

Deafness and Bilateral Staghorn Kidney Stones in a Young Patient

Robotic pyelolithotomy for the treatment of large renal stones: a single-center experience over seven years.

Urolithiasis prevalence varies globally between 1-20%, influenced by regional factors. Robotic pyelolithotomy (RPL) presents an interesting alternative to PCNL, considered the gold standard for symptomatic stones smaller than 20 mm, as it carries a risk of significant complications. However, studies on RPL are limited, especially in anatomically complex cases, where RPL proves to be particularly useful. The study aims to update and review outcomes of RPL in a high-volume robotic center. A retrospective analysis of 153 patients treated with RPL for staghorn kidney stones at a single center from February 2016 to December 2023 was conducted. Data including demographics, preoperative renal function, stone characteristics, operative and postoperative outcomes, and costs were collected. Stone-free rates (SFR) and complications were assessed at follow-up intervals up to 12 months post-surgery. The study showed an initial 3-month stone-free rate (SFR) of 93.5%, which decreased to 83.5% at 12-months. This trend may reflect new stone formation rather than procedure failure. Sub-analysis revealed a significant difference in SFR between patients with pelvic and pyelocalyceal stones at each follow-up. Multivariate regression analysis identified in the pyelocalyceal group that higher BMI and larger stones were associated with higher failure rates at both 6 and 12 months. RPL is a safe and effective treatment for large renal stones, offering a high SFR and low complication rate. It is particularly beneficial in cases with complex anatomy or requiring concurrent renal procedures. However, patient selection is crucial, considering factors like stone location and size. Further research is needed to compare RPL with other treatment methods.

V04-11 THE CHALLENGING CASE OF A STAG HORN CYSTINE STONE AND A DISLOCATED URETERAL STENT IN A 18-MONTH-OLD PATIENT: VACUUM-ASSISTED MINI-PCNL AND ROBOTIC SURGERY TO THE RESCUE

You have accessJournal of UrologyCME1 Apr 2023V04-11 THE CHALLENGING CASE OF A STAG HORN CYSTINE STONE AND A DISLOCATED URETERAL STENT IN A 18-MONTH-OLD PATIENT: VACUUM-ASSISTED MINI-PCNL AND ROBOTIC SURGERY TO THE RESCUE Dario Guido Minoli, Carolina Bebi, Michele Gnech, Erika Adalgisa De Marco, Irene Paraboschi, Stefano Paolo Zanetti, Giancarlo Albo, Filippo Molinari, Emanuele Montanari, Gianantonio Manzoni, and Alfredo Berrettini Dario Guido MinoliDario Guido Minoli More articles by this author , Carolina BebiCarolina Bebi More articles by this author , Michele GnechMichele Gnech More articles by this author , Erika Adalgisa De MarcoErika Adalgisa De Marco More articles by this author , Irene ParaboschiIrene Paraboschi More articles by this author , Stefano Paolo ZanettiStefano Paolo Zanetti More articles by this author , Giancarlo AlboGiancarlo Albo More articles by this author , Filippo MolinariFilippo Molinari More articles by this author , Emanuele MontanariEmanuele Montanari More articles by this author , Gianantonio ManzoniGianantonio Manzoni More articles by this author , and Alfredo BerrettiniAlfredo Berrettini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003252.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We present the case of an 18-month-old female patient brought to the emergency department of a foreign hospital due to anuria. She was diagnosed with bilateral staghorn kidney stones and Acute Kidney Injury (AKI) (Creatinine 5.47 mg/dL) and underwent bilateral ureteral JJ stent placement. METHODS: The patient was then referred to our centre where we performed a low-dose CT scan, documenting bilateral staghorn stones and dislocation of the proximal end of the right stent in the retroperitoneum. We planned a vacuum-assisted right-sided mini-PCNL (16 Ch ClearPetra set, 12 Ch MIP Storz endoscope and 550 um Ho:YAG laser fiber) and endoscopic JJ stent removal. RESULTS: We achieved complete clearance of the urolithiasis and visualised the site of exit of the JJ stent from the ureter, 1-2 cm below the ureteropelvic junction. Unfortunately, we were unable to safely remove the device endoscopically as the proximal pigtail appeared to be stuck and very close to major vessels when pulling the distal end with endoscopic graspers under fluoroscopic vision. We reported no post-operative complications. The stone composition was cystine 100%. A week later we performed a robot-assisted procedure with a transperitoneal approach to remove the dislocated JJ stent. Removal under direct vision was possible. Few weeks later, a left mini-PCNL was performed to obtain complete stone removal. CONCLUSIONS: The use of miniaturised vacuum-assisted technologies and robotic-assisted surgery greatly aids in the management of complex cases, especially in very young children affected by cystine stones, for whom reducing invasiveness is paramount. Source of Funding: no © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e341 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dario Guido Minoli More articles by this author Carolina Bebi More articles by this author Michele Gnech More articles by this author Erika Adalgisa De Marco More articles by this author Irene Paraboschi More articles by this author Stefano Paolo Zanetti More articles by this author Giancarlo Albo More articles by this author Filippo Molinari More articles by this author Emanuele Montanari More articles by this author Gianantonio Manzoni More articles by this author Alfredo Berrettini More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison of the Conventional PNL with Ecirs in the Treatment of Complete Staghorn Kidney Stones.

To analyse the results of conventional percutaneous nephrolithotomy (PNL) and endoscopic combined intrarenal surgery (ECIRS) in treating complete staghorn kidney calculi. A comparative study. Place and Duration of the Study:Department of Urology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey, between January 2007 and January 2022. Clinical data and surgical outcomes of the adult patients who underwent conventional PNL or ECIRS were retrospectively reviewed. Two patient groups were compared regarding the fluoroscopy time, the number of access, surgical time, duration of hospitalisation, haemoglobin (Hb) reduction, complication, and stone-free rates. Results:There were 132 renal units in the conventional PNL (Group 1) and 45 renal units in the ECIRS group (Group 2). The comparative analysis revealed that fluoroscopy time, surgical time, duration of hospital stay, number of access, and the Hb drop were significantly lower in the ECIRS group compared to the conventional PNL group. Although stone-free rates were 48.5% in Group 1 and 64.4% in Group 2, p=0.064 and p>0.05 respectively). The median value of the complication grade was 1 (1-7) in Group 1 and 1 (1-5) in Group 2, (U=2446.5, p=0.026). Conclusion:The ECIRS is a successful and more secure surgical method for treating complete staghorn stones than PNL. PNL, ECIRS, Staghorn, Kidney, Stone.

Evaluation of nephrolithometric scoring systems to predict outcomes and complications of percutaneous nephrolithotomy for staghorn stone

Background/Aim: Urinary system stone disease develops with a frequency of 1-20 % in the general population. There are various surgical methods and percutaneous nephrolithotomy (PCNL) is a commonly used treatment method, especially in large, staghorn kidney stones. Aim of this study was compare stone nomograms in forecasting operative and complicating parameters subsequent to PCNL in staghorn stones. Methods: The study analysed 66 patients with staghorn stones who underwent PCNL between 2017 and 2022, retrospectively. The researcher evaluated the Guy, S.T.O.N.E. and CROSS nephrolithotomy scores in patients using non-contrast computed tomography. The Clavien Dindo Classification was used to evaluate the surgical complication. Results: The mean stone burden, GUY, S.T.O.N.E. and CROES scores were 1114.9 ± 520.18 mm²; 3.64 ± 0.48; 10.11 ± 1.2 and 142.9 ± 31.99, respectively. Total stone-free status (SFS) was achieved in 37.9 % of the patients, while the median stone clearance rate was 93.74 (50-100). While no statistical significance was observed between GUY score and SFS, it was observed in S.T.O.N.E. and CROES scores (p = 0.020 and 0.004, respectively). ROC analysis showed that CROES and S.T.O.N.E. scoring systems and the stone burden parameter showed similar accuracy in the estimation of SFS. The results showed that only the S.T.O.N.E. score showed a significant relationship with the presence of complications (p = 0.034). Conclusion: If the percutaneous nephrolithotomy for staghorn stones in question is, current scoring systems alone couldn't be predictive for postoperative outcomes and degree of complications. Further large scale multicentre prospective studies are needful.

Роль интраоперационного внутрилоханочного давления в течении послеоперационного периода перкутанной нефролитотрипсии у больных с мочекаменной болезнью.

Introduction. Percutaneous and endourological surgeries are the most common interventions for nephrolytiasis in urologists’ practice. During the operation, it is important to maintain the right balance between sufficient flow of irrigation fluid for adequate visualization and safe intrarenal pressure. Intraoperative increase in intrarenal pressure is associated with the development of purulent-inflammatory complications in the postoperative period. The aim of the study. To substantiate the expediency of intraoperative monitoring of intrarenal pressure, as well as to assess the risks of postoperative complications after percutaneous nephrolithotripsy. Materials and methods. The study included 250 patients with staghorn kidney stones. In the first group (n=120) percutaneous nephrolithotripsy (PCNL) was performed according to the standard procedure with a puncture canal diameter of 30-32 Сh. The second group included 130 patients who underwent percutaneous nephrolithotripsy using a mini nephroscope (mPCNL) with a working channel diameter of 16 Ch. To achieve the aim of our study, we have developed a method for determining intrapelvic pressure, implemented using a miniature pressure sensor, which is installed directly into the pelvis at the time of the calycopelvical system puncture. During the surgery, the intrapelvic pressure was constantly monitored according to the method we proposed. Results. The lowest values of intrapelvic pressure were recorded when performing PCNL with the installation of an Amplatz sheath exceeding the size of the nephroscope by 2 or more Ch. When performing mPNLT, the installation of a ureteral catheter allows minimizing the increase in intrapelvic pressure. Hyperthermia in the postoperative period significantly depends on an increased intrarenal pressure and the presence of an infectious agent in the renal system. Separately performed urine cultures from the pelvic and bladder with obstruction of even minimal severity may have significant differences. In patients of mini-PNLT group intraoperative intrapelvic pressure was significantly higher (p≤0.05). The frequency of fever and exacerbation of calculous pyelonephritis is significantly higher in group of standart PNLT (p < 0.05), which is explained by greater traumatization of the renal parenchyma when creating a working fistula. Conclusion. The proposed method allows the most accurate intrasurgery monitoring of intrarenal pressure during minimally invasive surgical treatment of kidney stones in order to minimize the frequency of infectious and inflammatory complications.

The High Risk Factors and Preventive Measures of Percutaneous Nephrolithotomy under the Guidance of B-Ultrasound in the Treatment of Postoperative Renal Calculi.

Objective The aim of this study is to explore and analyze the high risk factors and preventive measures of percutaneous nephrolithotomy under the guidance of B-ultrasound in the treatment of postoperative renal calculi. Methods The clinical data of 220 patients with renal calculi admitted to our hospital from 2018 to October 2021 were retrospectively analyzed. All patients were treated with percutaneous nephrolithotomy n = 36) and nonbleeding group (n = 184), comparing the personal data, disease-related data, surgical operation related data of the two groups of patients, single factor and logistic multifactor regression analysis to explore the influence of B-guided percutaneous. Nephrolithotomy is a high-risk factor for postoperative bleeding in patients with kidney stones, and preventive measures are based on high-risk factors. Results There was no significant difference in the proportion of patients with different genders, whether they had renal surgery, whether they had hypertension, and those with postoperative hepatic insufficiency in the hemorrhagic group and the nonbleeding group (p > 0.05). There was no significant difference in age and body mass index between the bleeding group and the nonbleeding group (p > 0.05). The proportion of patients with diabetes in the bleeding group was higher than that in the nonbleeding group, and the difference between the groups was statistically significant (p < 0.05). Compared with the nonbleeding group, the bleeding group had a higher proportion of patients with calculus diameter ≥2 cm. The proportion of patients with staghorn calculi in the bleeding group was higher than that in the nonbleeding group. The difference between the groups was statistically significant (p < 0.05). There was no significant difference in the proportion of patients with hemorrhage, single or multiple renal stones, and ureteral stones in the hemorrhage group compared with the nonbleeding group (p > 0.05). Compared with the nonbleeding group, the proportion of patients with bleeding in the first stage was higher, and the proportion of patients with operation time >90 min was higher. The difference between the groups was statistically significant (p < 0.05). There was no significant difference in the proportion of patients in the bleeding group compared with the nonbleeding group (p > 0.05). Using Logic multifactorial regression analysis, independent risk factors for bleeding after percutaneous nephrolithotomy under ultrasound-guided bovery include diabetes mellitus, stone diameter, staghorn kidney stones, surgical timing, and staging surgery (p < 0.05). Conclusion The independent high-risk factors affecting bleeding after percutaneous nephrolithotomy guided by B-ultrasound include diabetes, stone diameter, staghorn type kidney stones, operation time, and staged surgery. According to this, effective preventive measures can effectively reduce the operation and the occurrence of postbleeding.

V2 - Laparoscopic extended pyelolithotomy for treatment of a complete staghorn kidney stone: A case report

V2 - Laparoscopic extended pyelolithotomy for treatment of a complete staghorn kidney stone: A case report

PCNL Combined with 3D Printing Technology for the Treatment of Complex Staghorn Kidney Stones.

Objective To explore the clinical application value of percutaneous nephrolithotripsy (PCNL) combined with 3D printing technology in the treatment of complex staghorn kidney stones. Methods From January 2018 to February 2020, a total of 72 patients with complex staghorn kidney stones admitted to our center were divided into experimental group (3D printing group) and control group (computed tomography, CT, imaging group)) according to the random block method, and a prospective cohort study was conducted. Preoperative computed tomography urography (CTU) examination was performed on all patients in the two groups, and the original CT scan Digital Imaging and Communications in Medicine (DICOM) data of patients in the experimental group were separately extracted for three-dimensional reconstruction and 3D model printing and designed a doctor-patient communication evaluation score table. The two groups were compared in score table, puncture location time, total operation time, consistency between estimated calyx and target calyx, incidence of surgical complications, stone free rate, postoperative recovery, and other aspects. Results Both groups completed preoperative CTU examination and showed good kidney and stone morphology. In the experimental group, all 3D printed models were completed and the internal anatomical structure could be clearly displayed. Simulation puncture and relevant measurement parameters could be obtained. The experimental group was significantly better than the control group in doctor-patient communication evaluation score, puncture location time, target calyx consistency, and stone free rate (p < 0.05), and there was no statistical difference in total operation time, postoperative complications, and postoperative recovery. Conclusions Individualized 3D printing technology can fully evaluate and design percutaneous renal access and stone clearing strategies before surgery. Compared with traditional preoperative imaging evaluation, 3D printing makes PCNL more accurate and efficient in the treatment of complex staghorn shaped kidney stones, with a high stone free rate at the first stage and better doctor-patient communication satisfaction.

Single Versus Multiple Mini-tract Percutaneous Nephrolithotomy for Staghorn Renal Stone

Purpose: Percutaneous nephrolithotomy (PCNL) is the standard procedure used for large kidney stones, and multiple tracts of PCNL are applied to achieve better stone clearance. However, the creation of multiple tracts may have the potential risk of bleeding and higher complication rates compared with single-tract procedures. We reviewed our experience managing staghorn calculi with multiple tracts compared with a single tract. Materials and Methods: Records of 36 patients with staghorn calculi who underwent PCNL at our institution between January 2018 and April 2020 were reviewed retrospectively. Nineteen patients were managed by single-tract access (Group 1), and 17 patients underwent multiple-tract access (Group 2). Both groups were compared in terms of perioperative findings and postoperative outcomes. Results: The mean number of percutaneous accesses in the multiple-tract group was 2.88, with most patients requiring two tracts. The mean duration of fluoroscopy screening and operative time was longer in Group 2. Stone-free rates were 59% and 70.5% in Groups 1 and 2, respectively. The mean hospital stay was similar in both groups. Complications included blood transfusion, resulting from a hemoglobin drop of 2.15 ± 0.96 and 1.59 ± 0.69 g/dL in Groups 1 and 2, respectively. Mean pre- and post-operative creatinine concentrations were 1.212 and 1.211 mg/dL in Group 1 and 1.206 and 1.157 mg/dL in Group 2. Mean changes in creatinine values were not statistically significant between the groups. Clavien–Dindo Classification Grade II complications included urosepsis and blood transfusion, which occurred in five patients in Group 1 and three in Group 2. Pseudoaneurysm attributed to Grade III complications occurred in one patient in Group 1. Conclusion: Multiple-tract access during PCNL is a safe and efficient method to manipulate staghorn kidney stones. Mini PCNL with multiple-tract access is a successful alternative to deal with staghorn stones involving multiple calyces.

Open Pyelolithotomy in a Pelvic Ectopic Kidney: Case Report and Current Literature Review

BACKGROUND: Advances in urology have significantly reduced the indications for open surgery to treat staghorn kidney stones. Nevertheless, according to our experience, open surgery is still the preferred treatment for rare cases of the ectopic pelvic kidney.&#x0D; CASE PRESENTATION: A 49-year-old man complained about pain in the lower umbilical region for five months. The pain drastically changed into a sharp pain two months before. The vital sign is normal; on physical examination, the palpation of the suprapubic area elicits pain when pressed, no mass is detected. The abdominal computed tomography without contrast showed a right ectopic kidney located anteriorly of the fifth lumbar to the second sacrum. There was also mild hydronephrosis (grade I) and staghorn stones measuring 4 cm x 2.3 cm. The stone was surgically treated with open pyelolithotomy through a midline infra umbilical incision. The patient was discharged five days postoperatively without distinct complications.&#x0D; CONCLUSION: Open surgery can represent a valid alternative in the treatment of kidney stones of very selected cases, including anomalous kidneys, in a setting where resources are limited.

Сочетание лапароскопической пиелолитотомии с резекцией почки при ипсилатеральных коралловидном камне и опухоли

OBJECTIVE To discuss the feasibility, safety, and effectiveness of conventional laparoscopic partial nephrectomy combined with pyelolithotomy for patients with ipsilateral renal tumor and staghorn kidney stone. MATERIALS AND METHODS Retrospective multicentral comparative study. Group Combo was presented by patients with the mentioned combined pathology (n=15). Group Standart (n=69) formed from common patients who underwent standard lap partial nephrectomy for renal tumor in the absence of kidney stones. Perioperative factors and results were studied and compared. Video presentation of combined surgical technique is available at: https://youtu.be/fAfYJDvGzsU. RESULTS Of all patients, no positive margins, no conversions to open surgery or nephrectomy & any complications Clavien >III were detected. There were no any significant differences between the two groups except for OR time (150 [120; 210] vs 130 [100; 180] min; p=0,001). Differences between indexes of WIT (16,27+/-3,8 vs 15,9+/-4,5 min; p=0,107), EBL (200 [150; 300] vs 200 [150; 300] cc; p=0,981), length of stay (7 [6;9] vs 8[6;9] days; p=0,611), intraop complications (0,00 vs 4,3%; p=0,411) and values of postop Clavien III rate (0,00 vs 4,3%; p=0,411) for Combo & Standart respectively were comparable as well as oncological outcomes. Stone-free rate for combined procedures reached 93,3%. CONCLUSION conventional laparoscopic partial nephrectomy combined with pyelolithotomy for patients with ipsilateral renal tumor and staghorn kidney stone is safe and efficient alternative to 2-step treatment of this rare disease.

Renal Squamous Cell Carcinoma due to Staghorn Kidney Stone-Case Report

: Renal squamous cell carcinoma (SCC) is a rare malignancy of the urinary system, which normally spreads from its origin to the renal parenchyma. So far, various reasons, including stones, infections, and urinary tract radiotherapy have been considered for this type of malignancy. These tumors are usually diagnosed at an advanced stage; thus, the life expectancy of these patients is not long. This report tends to present a 52-year-old patient with a staghorn kidney stone and subsequent renal SCC in the right kidney.

Tubeless percutaneous nephrolithotomy (PCNL) as a standard treatment: observations from a tertiary care hospital

Aim: To observe the safety and efficacy of tubeless percutaneous nephrolithotomy (PCNL). Materials and methods: Since January 2016 to 2019, 210 consecutive tubeless PCNL performed at our hospital were enrolled into this retrospective chart review. The average age of the patients (134 males and 76 females) was 57 ± 11.8 years, and 7 patients were between 8 to 12 years. The stone characteristics were 71 pelvic or calyceal solitary stones, 62 non-complete staghorn kidney stones, 17 ureteral stones, 32 kidney + ureteral stones (concomitant kidney and ureteral stones), and 28 complete staghorn stones. Mean stone size range 3. 5+2.8[range 0.7cm to 11.8 cm]. Patient’s position was prone. Tract size varied from 26 F to 30 F and number of tracts varied single tract to 4 tracts. Results: The average operative time was 85.0 ± 29.4 minutes. Average hospital stay was 21.7 hrs (6 patients had longer stay due to fever) and the blood transfusion rate was 1.4%. Postoperative fever was noted in 19 (9.02%) patients, no urosepsis was noted. No Pulmonary complications and mortality noted. No re exploration was done. No major leak was noted. Angioembolisation rate 0.95%. We did not use any haemoseal ent or cautery in the tracts. Conclusion: PNT serves purpose of relook PCNL and drainage of urine if there is pyonephrosis or surgeon has doubt about PUJ competency like edema, perforation etc., but other factors like bleeding, fever, sepsis, AV aneurysm, AV fistula, pulmonary complications if puncture is in upper calyx, mortality are comparable to standard PCNL and advantage of tubeless PCNL are reduced post-operative pain which leads to lesser analgesia requirement, less apprehension as no tube is there, therefore more comfort, early discharge and indirectly less hospital expenses, early return to work. Our observation is that Tubeless PCNL is effective and safe. There is limitation of our study that our sample size is small and it is not a case-control study, therefore significance was not established.

A Multi-institutional Review of Single-access Percutaneous Nephrolithotomy for Complex Staghorn Stones

BackgroundWith the heterogeneous distribution of novel surgical technologies and variable physician training, there is a need to re-evaluate contemporary outcomes of percutaneous nephrolithotomy (PCNL) for complex staghorn stones. ObjectiveTo evaluate contemporary outcomes of guideline-supported treatment for patients with staghorn kidney stones using single-access PCNL in multiple North American centers. Design, setting and participantsWe performed a multi-institutional retrospective review of staghorn stones managed from January 1, 2017 to January 1, 2019, inclusive. We excluded patients with more than a single percutaneous access per renal unit and those who underwent a concomitant contralateral procedure. Outcome measurements and statistical analysisSafety (Clavien-Dindo complications) and efficacy in terms of a strictly defined stone-free rate were examined for single-access PCNL performed on staghorn stones with a Guy’s stone score of 3–4. Results and limitationsWe evaluated 301 patients meeting the inclusion criteria with an average age of 57 yr (range 18–87). All stones had a Guy’s stone score of 3 (36.2%) or 4 (63.8%). The mean (± standard deviation) stone burden was 191.4 ± 49.8 mm2. Of the 297 patients (98.6%) who underwent computed tomography on postoperative day 1, 132 (44.4%) showed no residual stone, 111 (37.3%) had a largest fragment <4 mm, and 54 (18.2%) had a fragment ≥4 mm after primary single-access PCNL. Secondary procedures were performed in 117 patients (38.9%). Imaging at 3 mo demonstrated that 210/257 patients (82%) were stone-free. The overall complication rate was 17.9%, with 11 patients (3.7%) experiencing Clavien-Dindo grade ≥3 complications. ConclusionsSingle-access PCNL for complex staghorn stones is safe and effective. High stone-free rates with minimal morbidity are achievable with current techniques. Patient summaryThis study confirms that single-access percutaneous nephrolithotomy provides excellent outcomes in the treatment of complex kidney stones. This surgical technique has both safe and effective outcomes that are reproducible across multiple centers in North America.

Осложнения перкутанной нефролитотрипсии: диагностика и лечение

Percutaneous nephrolithotomy (PCNL) is the gold standard treatment of large and staghorn kidney stones. Despite technological progress and improvement of PCNL technique, this procedure is associated with complications and in some cases remain a challenge for endourologists. According to the time, complications can be divided into intra- and postoperative. Intraoperative complications include bleeding, injury of the renal collecting system, visceral organs, pulmonary complications, thromboembolic disorders, extrarenal migration of the stone fragments and incorrect nephrostomy tube placement. Postoperative complications include infection and sepsis, bleeding, persistent urinary fistula, infundibular stenosis and death of the patient. The different recommendations that might be useful for the timely diagnosis of various complications in patients undergoing PCNL are provided in the review. Additionally, information on treatment algorithms is included.

The role of intraoperative kidney mucosal biopsy on screening of squamous cell carcinoma of the kidney in nephrolithiasis patients with stones larger than 20 mm

Introduction: Renal pelvic squamous cell carcinoma is a very rare tumor, with a prevalence &lt;1% of all urinary tract tumors, about 0.5–8% of all kidney tumors, and the average age is 50–70 years. Although the incidence of renal squamous cell carcinoma is less common than renal cell carcinoma and renal transitional cell carcinoma, due to its more aggressive nature renal squamous cell carcinoma is often found intraoperatively and is already in an advanced stage or metastasis. The relevant medical history of squamous cell carcinoma is pyelonephritis, chronic nephrolithiasis, and a history of kidney stone surgery. Data which was obtained from previous research at Hasan Sadikin Hospital, from January 2014–December 2017, found the incidence of renal squamous cell carcinoma from nephrectomy procedures was 6%. Methods: This study was a cross-sectional study with a correlative analytic study, samples were taken consecutively from biopsy of kidney mucosa intraoperatively in hospitalized patients with kidney stones with size larger than 20 mm at the Department of Urology, Hasan Sadikin Hospital Bandung, which performed open kidney surgery or percutaneous nephrolithotomy from January–May 2019. Results: The number of samples in this study were from 30 patients, consisting of 16 males and 14 females. Five patients underwent open kidney surgery and 25 patients underwent percutaneous nephrolithotomy surgery, with an average of age of 49.5±11.8 years and 63.3% of patients were aged from 40–60 years. In this study, one patient (3.3%) showed squamous cell carcinoma of the kidney, a 57-year-old male patient with a left staghorn kidney stone who underwent left percutaneous nephrolithotomy surgery. Conclusion: There is a benefit for intraoperative kidney mucosal biopsy as a screening for squamous cell carcinoma of the kidney in nephrolithiasis patients with stones larger than 20 mm. Level of evidence: 3

Case Report: An occurrence of steinstrasse in retrograde intra renal surgery (RIRS) for large staghorn kidney stone: a difficult experience in managing surgical outcomes

Immediate removal of staghorn kidney stones is important to prevent life-threatening complications. With the advancement of endoscopic technology, retrograde intrarenal surgery (RIRS) is now an alternate treatment to the standard percutaneous nephrolithotomy (PCNL) for stones removal. However, when used to treat large stones (&gt;3cm), RIRS can cause the formation steinstrasse (SS). Here, we present the case of a 68-year-old man with multiple stones in the collecting system of the right kidney after initial treatment with RIRS. After two years of multiple interventions, the SS was completely removed. To prevent this complication in patients, a detailed assessment of the stone (size, location) and renal anatomy should be completed before RIRS is performed.

Ultrasound-Guided Minimally Invasive Percutaneous Nephrolithotomy is Effective in the Management of Pediatric Upper Ureteral and Renal Stones

Aim To evaluate the outcome of ultrasound (US)-guided minimally invasive percutaneous nephrolithotomy (MPCNL) in the management of upper ureteral and renal stones in pediatric patients. Methods We collected data of 112 pediatric patients who were admitted to the xxxx between March 2006 and December 2016 and treated by US-guided MPCNL. Our cohort included upper ureter stones (n = 11), single kidney stones (n = 46), multiple kidney stones (n = 56), and staghorn kidney stones (n = 12). Results Patients were between 0.5 and 13 years old with stone sizes from 10 to 50 mm. Operation duration ranged from 15 to 195 minutes. On average, the nephrostomy tube could be removed after 3.9 days and patients were discharged after 6.5 days. We found that hemoglobin concentration decreased in 34 patients after surgery by 1 to 37.8 g/L. Using US-guided MPCNL, the initial stone-free rate (SFR) was 86.4% and resulted in a final SFR of 95.2%. However, postoperative complications occurred in 18 patients including > 38.5 °C fever in 17 cases and reactive pleural effusion in one case. Blood transfusion was not required in all cases and no sepsis, kidney loss, ureteral stricture, and adjacent organ injury were observed. Follow-up after an average of 8.5 months showed normal renal function without hydronephrosis. However, recurrence of stones > 4 mm was found in 11 patients. Conclusions US-guided MPCNL showed an excellent SFR and low complication rate in the management of pediatric patients with upper ureteral and renal stones.