Pelvic Stones Research Articles

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Objectives: Objectives of the study are to evaluate extracorporeal shock waveslithotripsy (ESWL) with and without double-J-ureteric stent in 2-3 cm renal stone. Study Design:Comparative study. Place and Duration of Study: This study was out conducted at LithotripsyCenter, Department of Urology & Renal Transplantation, KEMU/ Mayo Hospital, Lahore, fromJune 2015to May 2016.”Methodology: This study consisted of 60 patients admitted. Allpatients were divided into two equal groups. Thirty patients of kidney stones were included ingroup A, who were treated by ESWL without double-j-ureteric stent. Group B, who were treatedby ESWL with prior double-j-ureteric stent insertion. Detailed History was taken from all thepatients with special regard to the renal stone pain. Detailed Clinical examination of the patientwas done and recorded in proforma. Systemic review was also done to see any co-morbidity.All patients underwent for base line and specific investigations” like Urinalysis Pre-ESWL andat monthly intervals post ESWL, mid-stream urine examination for Gram’s staining; culture andsensitivity were performed in selected patients, renal ultrasonography, Plain X-Ray KUB andintravenous Urography. Inclusion criteria were that all patients from both sexes between theages of 15-45 years suffering from renal stones 2-3cm will be included in the study. In Exclusioncriteria; patients are unfit for general anesthesia, advance cardiac diseases, bleeding disorders,pregnant women, lower ureteral stones, malignancy and severe urinary infection. Results: 60patients, there were 40 males and 20 females, with male to female ratio of 2:1. Minimum of 15year to 45 years in both group. Mean age was 32+ 2.1years. 38(63.33%) of patients has 2.5-3 cm stone and 22(36.66%) patients has 2-2.5cm stone. Commonest location of stone was34(57%) cases were lying in calyces followed by pelvis stones which accounted for 26(43%)stones. The average number of retreatment sessions was 2 to 3 sessions, ranged 1 to 5sessions. The majority 39 (65%) patients needed one & two sessions. Three & four sessionswere used in 17 (28.33%) and in five session 04(06%) cases needed. Stone clearance observed5 to 45days in 2 to 2.5 cm stone. Means clearance were seen 35+4.6 days in without Double-J-Ureteric Stent while 29+3.8 days in with Double-J-Ureteric Stent. Conclusion: In conclusionour study revealed that The extra corporeal shock waves lithotripsy with double-j-ureteric stentis safe, effective and with less complication rate then without double-j-ureteric stent.

MP68-14 SUPINE MINI PCNL – ARE WE LOOKING AT A RECOURSE TO STANDARD PCNL? - A SINGLE CENTER EXPERIENCE

You have accessJournal of UrologyStone Disease: Surgical Therapy VI1 Apr 2017MP68-14 SUPINE MINI PCNL – ARE WE LOOKING AT A RECOURSE TO STANDARD PCNL? - A SINGLE CENTER EXPERIENCE Arunkumar Balakrishnan, Kulthe Ramesh Seetharam Bhat, Priyank Shah R, and Gaurav Gyvi Arunkumar BalakrishnanArunkumar Balakrishnan More articles by this author , Kulthe Ramesh Seetharam BhatKulthe Ramesh Seetharam Bhat More articles by this author , Priyank Shah RPriyank Shah R More articles by this author , and Gaurav GyviGaurav Gyvi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2330AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A standard Percutaneous Nephrolithotomy is the standard of care for renal calculus especially those more than 2 cm, which involves the patient in prone position with percutaneous access. In addition to this technique various techniques of using miniaturised scopes and instruments have been described in both prone and supine position. We present our series of mini PCNL in supine postion. A observational study was done to evaluate the efficacy, safety and outcomes of supine mini PCNL(smPCNL) in our patients METHODS 200 patients underwent smPCNL over a period of 3 years including both retrsospective and prospective cohorts were analysed. Data collection included stone size & location, anaesthesia & operative time, use of stent/ureteric catheter, length of hospital stay, stone clearance & complications. Cases were performed using mini PCNL set, in Galdakao-modified Supine Valdivia / modified supine position using fluoroscopy. Success was defined as patients free of stones or with residual stone fragments <5mm. RESULTS The mean stone size was 2.7 cm. There were 36 cases with stone located in a single calyx, while 4 case with stones in multiple calyces . Pelvic stones were 50 in number, while pelvi-calyceal/pelvi-uretric stones were 61 in number. 28 upper uretric stones with 17 bilateral renal unit stones were present; while there were 4 each of upper calyceal diverticulum stone and upper ureter plus calyceal stone. 93% of the cases required a single puncture while frequency of lower calyceal and middle calyceal puncture was 53% and 42 % respectively. Complete stone clearance was achieved in 190 cases (95%) with 10 cases having residual fragments which were treated with ESWL. 30 cases had simultaneous PCNL & URS for stone clearance. 75% cases were totally tubeless. Mean hospital stay was 2.15 days & overall complication rate was 9% which included bleeding, sepsis etc.5% of patients were discharged from the day care room. CONCLUSIONS smPCNL is safe and effective in suitable patients and offers good stone clearance with minimal morbidity. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e923-e924 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Arunkumar Balakrishnan More articles by this author Kulthe Ramesh Seetharam Bhat More articles by this author Priyank Shah R More articles by this author Gaurav Gyvi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD42-01 IMPACT OF PREOPERATIVE ALPHA-ADRENERGIC ANTAGONISTS ON URETERAL ACCESS SHEATH INSERTION FORCE AND THE UPPER LIMIT OF FORCE TO AVOID URETERAL MUCOSAL INJURY: A RANDOMIZED-CONTROLLED STUDY

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology II1 Apr 2017PD42-01 IMPACT OF PREOPERATIVE ALPHA-ADRENERGIC ANTAGONISTS ON URETERAL ACCESS SHEATH INSERTION FORCE AND THE UPPER LIMIT OF FORCE TO AVOID URETERAL MUCOSAL INJURY: A RANDOMIZED-CONTROLLED STUDY Kyo Chul Koo, Joon Ho Yoon, No-Cheol Park, Jongsoo Lee, Jong Won Kim, Jae Yong Jeong, Sung Ku Kang, Jong Chan Kim, Kwang Suk Lee, Do Kyung Kim, Chang Hee Hong, and Byung Ha Chung Kyo Chul KooKyo Chul Koo More articles by this author , Joon Ho YoonJoon Ho Yoon More articles by this author , No-Cheol ParkNo-Cheol Park More articles by this author , Jongsoo LeeJongsoo Lee More articles by this author , Jong Won KimJong Won Kim More articles by this author , Jae Yong JeongJae Yong Jeong More articles by this author , Sung Ku KangSung Ku Kang More articles by this author , Jong Chan KimJong Chan Kim More articles by this author , Kwang Suk LeeKwang Suk Lee More articles by this author , Do Kyung KimDo Kyung Kim More articles by this author , Chang Hee HongChang Hee Hong More articles by this author , and Byung Ha ChungByung Ha Chung More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1893AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Primary access of the ureteral access sheath (UAS) is not always possible and often excessive force is exerted, thereby increasing the risk of ureteral injury. A randomized controlled trial was performed to investigate the efficacy of preoperative α-blockade on reducing UAS insertion forces (UASIF) and to appreciate the upper limit of UASIF to avoid ureteral injury. METHODS From December 2015 to October 2016, 88 patients with ureteropelvic junction or renal pelvis stones planned for retrograde intrarenal surgery (RIRS) were prospectively enrolled. Patients were randomly assigned to a control group (n=37) or to an experimental group who received α-blockade with tamsulosin 0.4 mg q.d. for seven days prior to RIRS (n=39). Pre-stented patients were excluded from randomization (n=12). A homemade UASIF gauge was adapted to measure the maximal UASIF at the ureterovesical junction (UVJ) and the proximal ureter. The degree of mucosal injury was recorded. RESULTS UASIF of the α-blockade group was significantly lower than controls at the UVJ (260.1±180.2 g vs. 524.2±237.5 g; p=0.017), however, not at the proximal ureter (367.2±175.2 g vs. 647.7±294.3 g; p=0.054). The α-blockade group exhibited comparable UASIF with the pre-stented group at the UVJ (260.1±180.2 g vs. 99.8±19.9 g; p=0.149) and the proximal ureter (367.2±175.2 g vs. 131.4±75.2 g; p=0.081). The rate of mucosal injury was lower in the α-blockade group compared to controls (p=0.028). Mucosal injury (≥grade 2) did not occur in cases with UASIF <600 g. UASIF was lower in females and patients aged ≥70 years compared to the counterparts (p=0.008 and p=0.021, respectively). Female gender and preoperative α-blockade were independent predictors of lower risks of ureteral injury. CONCLUSIONS Preoperative α-blockade mimics the effect of pre-stenting and reduces maximum UASIF and consequent risk of ureteral injury. If the UASIF exceeds 600g, the procedure could be terminated with stent placement and followed later by pre-stented RIRS. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e812 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Kyo Chul Koo More articles by this author Joon Ho Yoon More articles by this author No-Cheol Park More articles by this author Jongsoo Lee More articles by this author Jong Won Kim More articles by this author Jae Yong Jeong More articles by this author Sung Ku Kang More articles by this author Jong Chan Kim More articles by this author Kwang Suk Lee More articles by this author Do Kyung Kim More articles by this author Chang Hee Hong More articles by this author Byung Ha Chung More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

419 - Transperitoneal laparoscopic pyelolithotomy versus retrograde intrarenal surgery for treatment of renal pelvis stones in horseshoe kidneys: A prospective randomized study

419 - Transperitoneal laparoscopic pyelolithotomy versus retrograde intrarenal surgery for treatment of renal pelvis stones in horseshoe kidneys: A prospective randomized study

The comparative study of retroperitoneal laparoscopic pyelolithotomy and percutaneous nephrolithotomy in treating renal pelvic stone

Objective To evaluate the efficacy of the retroperitoneal laparoscopic pyelolithotomy (RLP) and the percutaneous nephrolithotomy (PCNL) in treating renal pelvic stone. Methods The data of 89 patients diagnosed as renal pelvic stone were retrospectively reviewed from January 2009 to July 2016, of whom 43 patients underwent RLP and 46 underwent PCNL. Statistical analysis was performed regarding operation time, blood loss, mean hospital stay, complication rate, and stone-free rate. Results The operation time in RLP group and PCNL group was (117.5±16.7) min and (118.3±16.6) min, respectively, and there was no significant difference (P=0.547). For the two groups, the mean hospital stay was (4.5±0.5)d and (6.1±0.9)d, the mean hemoglobin decrease was (4.5±1.2)g/L and (18.1±3.4)g/L, the post-operative blood transfusion rate was 2.3% and 14.0%, the post-operative septic shock rate was 0 and 9.3%, respectively, with significant difference between the two groups (P<0.05). The stone-free rate in both groups was 97.7% and 95.3% with no significant difference (P=0.557). Conclusions RLP has the advantages of quick recovery, less blood loss and lower complication rate than PCNL. It could be a minimally invasive option for the treatment of renal pelvic stone. Key words: Kidney calculi; Retroperitoneal laparoscopic pyelolithotomy(RLP); Percutaneous nephrolithotomy(PCNL); Treatment

Comparative Study of Surgical Approaches for Renal Pelvic Stones in a Northern Rural Medical College

Comparative Study of Surgical Approaches for Renal Pelvic Stones in a Northern Rural Medical College

Comparative Study of Surgical Approaches for Renal Pelvic Stones in a Northern Rural Medical College

Comparative Study of Surgical Approaches for Renal Pelvic Stones in a Northern Rural Medical College

Comparison of renal pelvic pressure and postoperative fever incidence between standard- and mini-tract percutaneous nephrolithotomy

This study was proposed to compare the clinical effectiveness of mini-tract percutaneous nephrolithotomy (MPCNL) with standard-tract percutaneous nephrolithotomy (SPCNL) and verify whether MPCNL is associated with both higher renal pelvic pressure (RPP) and incidence of postoperative fever. A total of 228 patients with kidney stone were randomly allocated to the MPCNL group (n=114) and SPCNL group (n=114). Both intraoperative and postoperative indexes along with the incidence of complications were compared between the two treatment groups. RPP was measured using a baroreceptor which was connected to an open-ended ureteric catheter during the operation of percutaneous nephrolithotomy. The MPCNL group exhibited significantly longer average operation time, more average amount of flush water, and lesser average amount of bleeding during the operation than the SPCNL group (p<0.05). Moreover, significantly lesser average amount of postoperative serum creatinine, shorter average hospital stay, and more average amount of postoperative hemoglobin were observed in the MPCNL group than in the SPCNL group (p<0.05). MPCNL were more applicable to clear caliceal stones (p<0.05), whereas SPCNL were more effective for the removal of simple pelvic stones. The difference in the incidence of postoperative fever between the two treatment groups also appeared to be significant (p<0.05). Logistic regression provided solid evidence that both RPP and its accumulation time at which RPP≥30 mmHg significantly affected the incidence of postoperative fever. MPCNL was correlated with both higher RPP and increased likelihood of postoperative fever compared with SPCNL.

Percutaneous Stone Manipulation.

Percutaneous stone manipulation by direct ultrasound disintegration, extraction or chemolysis was done on 34 patients. A total of 15 patients presented with an operatively established nephrostomy, while percutaneous nephrostomy and subsequent dilation of the nephrostomy channel were done in 19. The rate of complete stone clearance was 19 of 20 stones after percutaneous nephrostomy and 8 of 16 stones in the group with an operatively established nephrostomy. The primary goal, to remove obstructing pelvic stones, was achieved in all cases. There were no untoward side effects, such as back pressure damage owing to flushing of the collecting system during ultrasound disintegration, or persistent infection. Complications in 3 patients were managed conservatively.

Tubeless percutaneous nephrolithotomy (pcnl) in renal allografts: a case report and mini-review

Urinary lithiasis in transplanted kidney is a relatively uncommon complication. However, it may lead to a significant morbidity and loss of renal function. The report presents the case of a 32-year-old male renal-transplant recipient, with a stone in renal pelvis who was treated successfully by tubeless percutaneous nephrolithotomy (PCNL). The patient is currently stone free with no complication. This article also reviews in brief the treatment of this rare complication. Reviewing the literature showed that PCNL is safe and feasible procedure for treating nephrolithiasis in a transplanted kidney.

A study on the adverse effects of extracorporeal shockwave lithotripsy (ESWL) for renal stones

Objective To study the reason and the preventive measures that adverse effects of extracorporeal shockwave lithotripsy (ESWL) for renal stones during treatment. Methods From April 2015 to January 2016, 165 patients who underwent ESWL treatment for renal stones were enrolled this retrospective study. All patients were in supine position. Direction of shockwave was by the path of preabdomen. The adverse effects during treatment were observed. The related factors were analyzed by Logistic regression analysis . Results There were 70 cases(42.4%) with pain, 10 cases(6.1%) with cold sweat, 8 cases (4.8%) with accelerated heart rate, 5 cases(3.0%)with descent of heart rate, 2 cases (1.2%) with nausea and vomiting. In the univariate Logistic regression analysis, four variables (BMI, history of ESWL treatment, stone location and energy) were found showing statistical significance. Multivariate Logistic regression analysis showed that the final significant related factors were BMI<24.0 kg/m2(OR=4.155, CI 1.373-12.571), history of ESWL treatment(OR=0.163, CI 0.058-0.454), stone in pelvis(OR=123.051, CI 17.638-858.439), stone in middle calyceal(OR=169.171, CI 29.677-964.343), energy 86.3-94.7J(OR=0.094, CI 0.025-0.362). Conclusions Pain was the most common adverse effect during the treatment of ESWL. Stone location (pelvis and middle calyceal) was an independent risk factor, BMI<24.0 kg/m2 was one of the related risk factors. Both energy 86.3-94.7J and history of ESWL treatment were preventive factors. Key words: Extracorporeal shockwave lithotripsy; Pain; Adverse effects; Risk factors; Preventive measures

Has the pelvic renal stone position inside the upper loop of JJ stent any influence on the extracorporeal shock wave lithotripsy results?

Background JJ stents are often encountered in patients with pelvic renal stones referred for shock wave lithotripsy, most of them being placed either for obstructive renal pelvic stones or for ureteric stones mobilized retrograde during the JJ stent insertion. The aim of the study was to determine whether the relative stone position in the upper loop of the JJ stent during extracorporeal shock wave lithotripsy (SWL) influences the efficiency of the procedure. The study was designed as a prospective cohort study on 162 patients addressing the same urological department, with single renal pelvic stone (primary or mobilized to the renal pelvis during the insertion of JJ stent), smaller than 15 mm, with JJ stent, treated by SWL using a second generation spark gap lithotripter, 18 kV, 3000 waves/session. Patients were divided in three groups according to the relative position of the stone to the upper loop of the JJ stent as appears on plain X-ray: stone-inside-loop, loop-crossing-stone and stone-outside the loop. The SWL success rate was the primary outcome of the study. p Value, Chi square and Kruskal–Wallis tests were used for statistical analysis.ResultsFor stone-inside-loop cases, SWL efficiency was 22.7 versus 42 % for all the other cases (p = 0.002). Other factors for decreased SWL success rate were: higher stone radio-opacity, larger JJ of stent and obese patients. Study limitation is represented by the relative small study group and by the evaluation of stone density using plain X-ray instead of computer tomography.ConclusionsFor pelvic renal stones having the same density characteristics studied by plain X-ray, the SWL efficiency is lower in stone-inside-loop cases comparing with the other positions. The overall stone free rate for renal pelvic stones could be explained by the second generation lithotripter used for all procedures.

Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones: a prospective study.

Objectives Bleeding is the most common complication of percutaneous nephrolithotomy (PCNL). Injudicious transfusion is frequently performed in current practice, even though it is not always needed. This study aimed to identify the predictive factors of blood loss in the PCNL procedure and evaluate the perioperative transfusion practice. Methods A prospective study of PCNL was randomly performed by two consultants of endo-urology at our institution. The inclusion criteria were adults with kidney pelvic stones >20 mm or stone in inferior calyx >10 mm or staghorn stone. Those with coagulopathy, under anti-coagulant treatment or open conversion were excluded. A full blood count was taken at baseline and during 12, 24, 36, 72-hours post-operatively. Factors such as stone burden, sex, body surface area, shifting of hematocrit level and amount of blood transfused were analyzed statistically using line regression to identify the predictive factors of total blood loss (TBL). Results Eighty-five patients were enrolled in this study. Mean TBL was 560.92 ± 428.43 mL for both endo-urology surgeons. Stone burden was the most influential factor for TBL (p=0.037). Our results revealed that TBL (mL) = -153.379 + 0.229 × stone burden (mm2) + 0.203 x baseline serum hematocrit (%); thus considerably predicted the need for blood transfusion. A total of 87.1% patients did not receive perioperative transfusion, 3.5% received intra-operative transfusion, 7.1% received post-operative transfusion, 23% had both intra and post-operative transfusion, resulting in a cross-matched transfusion ratio of 7.72. Mean perioperative blood transfused was 356.00 ± 145.88 mL.

Ultra-mini percutaneous nephrolithotomy for the treatment of renal or upper ureteral stones (report of 32 cases)

Objective To investigate the efficacy and safety of ultra-mini percutaneous nephrolithotomy for the treatment of renal or upper ureteral stones. Methods The data of 32 patients diagnosed as renal or upper ureteral stones were retrospectively reviewed, who underwent ultra-mini percutaneous nephrolithotomy from June to October, 2015, including 29 kidney stones, 3 upper ureteral stones, of which 21 single stone, 7 multiple stones, and 4 staghorn stones.There were 8 cases with inferior calyx stones , 10 with renal pelvis stones, 3 with upper ureteral stones, 10 with renal pelvis stones plus inferior calyx stones and 1 with renal pelvis stones plus upper calyx stones.The mean stone size was (20.1±7.6) mm (ranging from 10 to 41mm). The mean Hounsfield unit (HU) was (1 125.9±225.9 ) Hu (ranging from 520 to 1 550Hu). In this cohort, 13 cases had mild hydronephrosis, 2 moderate hydronephrosis, 1 severe hydronephrosis while no hydronephrosis identified in the other 16 patients. One case had concomitant kidney and ureter duplication malformation, and 1 case had residual stones after laparoscopic nephrolithotomy. Results All of the patients were treated by single tract UMP. Among them, middle calyceal puncture was performed in 9 cases, and the other 23 cases underwent lower calyceal puncture, including 4 cases of intercostal puncture, and 28 subcostal puncture. The mean operating time was(30.3±15.0)min (ranging from 10 to 90 min). The mean postoperative hospital stay was (1.9±1.0) days (ranging from 1 to 5 days). The mean hemoglobin decrease was(14.6±8.4)g/L (ranging from 1 to 46 g/L). No analgesics were used. Peri-operative complication rate was 3.13% (1/32) with 1 case of collection system perforation. There was no fever, severe bleeding, urinary extravasation, pleural injury, or blood transfusion. The SFR was 93.75% (30/32) and 96.88% (31/32) on the first day and the first month after the operation, respectively. Conclusions UMP could be a safe and effective method for the treatment of renal or upper ureteral stones, especially for inferior calyceal stones less than 2cm. It offers high stone clearance rate, minimally invasiveness, quick recovery, short length of hospital stay and improved quality of life. Key words: Kidney stone; Upper ureteral stone; Ultra-mini percutaneous nephrolithotomy; Percutaneous nephrolithotomy

Does Transient Cessation of Antiplatelet Medication Prior to Shock Wave Lithotripsy Have Any Safety Concern: Evaluation of the Short Term Safety Results

Objective: The study aimed to evaluate the true safety of transient cessation of the antiplatelet medication before extracorporeal shock wave lithotripsy (SWL) on bleeding-related complications. Patients and Methods: Forty cases undergoing SWL for renal pelvic stones were included and depending on the use of antiplatelet medication they were divided into 2 groups namely: group 1, cases under antiplatelet medication in whom the medication was stopped before ESWL; and group 2, cases without any antiplatelet medication. Comparative evaluation of patient, stone and treatment-related parameters were done in both groups. Results: Although microscopic hematuria was present in all cases, the incidence of macroscopic hematuria was higher in cases undergoing antiplatelet medication when compared with the other cases. Regarding the microscopic hematuria again, the mean number erythrocytes per field of analysis was significantly higher in group 1 cases. The mean value of the hematoma size was similar in both groups. Conclusion: Our findings indicate that SWL can be applied safely in patients under antiplatelet therapy following the cessation of medication for a certain period of time. However, among the cases treated with this concept in our study, we clearly observed that the incidence of procedure-related hematoma formation and macroscopic hematuria were more common in such cases than in the normal ones.

Comparison of safety and efficacy of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in patients with large renal pelvic stones: a meta-analysis

To compare percutaneous nephrolithotomy (PCNL) and laparoscopic pyelolithotomy (LP) for surgical management for large (>2 cm) renal stones. We searched MEDLINE, Cochrane, and EMBASE databases until March 11, 2015, using...

Lower calyceal and renal pelvic stones in preschool children: A comparative study of mini-percutaneous nephrolithotomy versus extracorporeal shockwave lithotripsy.

To compare outcomes of the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy for lower calyceal and renal pelvic stones in preschool children. From January 2010 to December 2014, single renal pelvic or lower calyceal calculi 10-25 mm in size in children (age ≤6 years) treated by either extracorporeal shockwave lithotripsy (64 patients) or the mini-percutaneous nephrolithotripsy technique (54 patients) were included. Extracorporeal shockwave lithotripsy was carried out by using a Dornier electromagnetic lithotripter. The mini-percutaneous nephrolithotripsy technique was through 14-Fr renal access using a 9.5-Fr semirigid ureteroscope with holmium:yttrium aluminium garnet lithotripsy. The two study groups were compared using Mann-Whitney, χ(2) -test or Fisher's exact test. Stone parameters were similar in the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy groups in all patients, and in the pelvic (39 Miniperc, 52 extracorporeal shockwave lithotripsy) and lower calyceal (15 Miniperc, 12 extracorporeal shockwave lithotripsy) subgroups. Stone-free rates in the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy groups were 88.9% versus 43.8% (P < 0.001) and 94.4% versus 81.2% (P = 0.032) after first and last sessions, respectively. In the renal pelvis, they were 87.2% versus 50% (P < 0.001) and 94.9% versus 84.6% (P = 0.179), whereas in the lower calyx, they were 93.3% versus 16.7% (P < 0.001) and 93.3% versus 66.7% (P = 0.139) after first and last sessions, respectively. Retreatment rates in the mini-percutaneous nephrolithotripsy technique versus extracorporeal shockwave lithotripsy were 7.4% versus 50% (P < 0.001), 7.7% versus 46.2% (P < 0.001), and 6.7% versus 66.7% (P = 0.003) in all patients, renal pelvic and lower calyceal stones, respectively. No significant difference was found in complications (P = 0.521). Auxiliary procedures were required in 9.4% and 1.9% of children in the extracorporeal shockwave lithotripsy and mini-percutaneous nephrolithotripsy technique groups, respectively. The mini-percutaneous nephrolithotripsy technique has significantly higher stone-free rates than extracorporeal shockwave lithotripsy for renal pelvic and lower calyceal stones (10-25 mm), with a lower retreatment rate and without a significant increase in complications.

The effect of Double J stent in the treatment of renal pelvis stones larger than ten mm in the children under 13 years of age using Extracorporeal Shock Wave Lithotripsy

The effect of Double J stent in the treatment of renal pelvis stones larger than ten mm in the children under 13 years of age using Extracorporeal Shock Wave Lithotripsy

Super mini-percutaneous nephrolithotomy (SMP) by ultrasound-guided for pediatric kidney stones

Objective To evaluate the safety and efficacy of super mini-percutaneous nephrolithotomy (SMP) by ultrasound-guided renal access in pediatric with renal calculus. Methods From May to August 2015, 20 pediatric patients with upper tract stones underwent the SMP by ultrasound guidance.The patients aged 11-144 months , median age 31.5 months, The stone size ranged 0.8-2.5 cm, mean(1.48±0.59) cm. Among the 20 children, single pelvis stones were in 8, multiple stones in 10 and upper ureter stones in 2. All patients had no previous surgery treatment. The SMP system consists of a F6.0-7.5 nephroscope and a modified F12-14 access sheath with suction-evacuation function. Nephrostomy tract dilation was performed up to F12-14 and lithotripsy procedure was performed by using pneumatic lithotripter. Nephrostomy tube or double J stent was placed only if clinically indicated. Results The stone size was 0.8-2.5 cm, mean(1.48±0.59)cm. Among the 20 children, there were 8 patients with single pelvis stone, 10 with multiple stones and 2 with upper ureter stones. All the patients were completed successfully without surgery conversion. Mean operative time ranged 6-40 minutes , mean( 17.6±11.6) minutes. The stone free rate was 100% after the evaluation in the postoperative day. The hemoglobin drop was 2-16 g/L, mean(7.6±4.1) g/L. No major complications occurred, neither patient required transfusion. The tubeless PCNL without double J stents and nephrostomy tubes placed were achieved in all patients. Only 14 patients had a ureter catheter placement for one day. The average hospital stay ranged 1-4 days, mean (2.4±0.8) days. Conclusions SMP could be a safe and effective treatment for kidney stone up to 2.0 cm in pediatric cases with advantages of short recovery time, high stone free rate and no catheter placement. SMP could be the ideal procedure for children with upper urinary tract calculus. Key words: Pediatric; Upper urinary; Calculus; Super mini-percutaneous nephrolithotomy(SMP)

Effect of anxiety and pain on success of shockwave lithotripsy (SWL) for treatment of proximal ureteral and renal pelvic stones.

The aim of this study is to evaluate the impact of anxiety and pain on success of shockwave lithotripsy (SWL) for treatment of proximal ureteral and renal pelvic stones smaller than 15mm. One hundred thirty-two patients with proximal ureteral or renal pelvic stones <15mm who were treated by a SWL and forty controls were enrolled in the study. State-trait anxiety inventory (STAI) was used to assess anxiety of the controls and patients (before every SWL session). Pains of the patients were measured by a visual analog scale (VAS) at three times (T) of the sessions (T11 at 11 kV, T15 at 15 kV and T end of treatment). The mean STAI scores of the patients at the first SWL session and controls were 40.61±8.71 and 36.11±8.18, respectively (p<0.05). There was statistically positive moderate relationship between STAI and VAS scores at the first SWL session. The mean size of stone in men and women were 11.16±2.88 and 11.00±3.41, respectively (p=0.88). In the first session, the mean STAI and VAS scores of the men were significantly lower than the women. The stone-free rate (SFR) of SWL was 72.7% in this study. The SFR of SWL in the men and women were 78 and 64%, respectively (p<0.05). Our data showed that the severity of anxiety and pain in the women were higher than the men. SFR of SWL in the men was higher than the women. The severity of anxiety and pain in the patients may affect SFR of SWL.