Treatment Of Complex Renal Calculi Research Articles

The initial clinical application of standard PCNL combined with visual needle nephroscope in the treatment of complex renal calculi by holmium YAG laser: a retrospective case series study

This study aims to evaluate the feasibility, safety, and effectiveness of an optimized treatment approach for complex renal calculi, utilizing visual needle nephroscopy in conjunction with standard PCNL and holmium YAG laser. We collected data from 62 patients diagnosed with complex kidney stones who underwent this combined procedure using the visual needle nephroscope (Needle-perc®, Youcare Tech, Wuhan, China). The percutaneous nephroscopic working channel was established by visual needle nephroscope, and the primary channel was expanded to 20 F to treat most of the main body of the calculi with a 550 μm holmium laser fiber. Visual needle nephroscope was used to locate the renal calyx where the residual calculi were located for precise puncture as a secondary channel, and the residual stones were treated by a 200 μm holmium laser fiber. Clinical data were collected, and intraoperative variables, postoperative complications and outcomes were assessed. All 62 patients successfully completed the operation without severe complications. The S.T.O.N.E. score of 62 patients before operation was 10.5 ± 0.9 points and above, of which the N score was more than 2 points. The average operation time was (65.5 ± 12.7) minutes, and the average hospital stay was (7.3 ± 2.1) days. After operation, 2 patients developed a fever, which improved after symptomatic treatment by intravenous antibiotics. 4 patients had clinically significant residual fragments, and the stone-free rate of primary operation was 93.5% (58/62). The optimized operation for the treatment of complex renal calculi based on standard PCNL combined with visual needle nephroscope by holmium YAG laser has good feasibility, safety and effectiveness.

Learning curve of ultrasound-guided percutaneous nephrolithotripsy in the treatment of complex renal calculi.

This study was performed to investigate the learning curve of ultrasound-guided percutaneous nephrolithotripsy (PCNL) for the treatment of complex renal calculi. Seventy-two patients with complex renal stones who underwent ultrasound-guided PCNL by the same operator from November 2016 to September 2020 were retrospectively analyzed. The learning curve of PCNL for complex renal stones was analyzed using multifactorial cumulative sum (CUSUM) analysis and best-fit curves. The CUSUM best-fit curve peaked at Case 36, which represented the minimum number of cumulative cases required to cross the learning curve for this surgical procedure. Accordingly, the learning curve was divided into a learning improvement period (36 cases) and a proficiency phase (36 cases). Compared with the learning improvement period, the proficiency phase was characterized by a shorter puncture time and operation time, a smaller drop in the hemoglobin level, and a lower postoperative complication rate. The learning curve of PCNL for the treatment of complex renal calculi can be divided into a learning improvement period and a proficiency phase, and the minimum cumulative number of cases is 36.

Endoscopic combined intrarenal surgery in treatment of complex renal calculi

Endoscopic combined intrarenal surgery in treatment of complex renal calculi

A comparative study of ultrasound-guided percutaneous nephrolithotripsy and x-ray-guided percutaneous nephrolithotripsy in the treatment of complex renal calculi without hydronephrosis.

To compare and analyze the clinical effects of ultrasound-guided percutaneous nephrolithotripsy and X-ray-guided percutaneous nephrolithotripsy in the treatment of complex renal calculi without hydronephrosis. Eighty patients with multiple stones without hydronephrosis were admitted at Department of Ultrasound Diagnosis, The first medical center of Chinese PLA General Hospital from January 21, 2020 to December 21, 2020 randomly divided: into two groups: experimental group and control group, with 40 cases in each group. Patients in the experimental group were treated with ultrasound-guided percutaneous nephrolithotomy, while those in the control group were treated with X-ray-guided percutaneous nephrolithotomy. The differences in operation time, channel establishment time, channel number, blood loss and stone clearance rate between the two groups were compared and analyzed. Venous blood was drawn before surgery and on the first day after surgery, and serum creatinine, urea nitrogen, blood β2-microglobulin, blood uric acid and other renal indexes were detected. Moreover, renal parenchymal injury was compared between the two groups by renal static imaging, and the incidence of postoperative complications such as pain, fever, urination through incision and injury of surrounding organs were compared and analyzed. The operation time, channel establishment time, channel number and blood loss in the experimental group were significantly lower than those in the control group, with statistically significant differences (p<0.05). The postoperative renal injury score of the experimental group was 1.03±0.37, which was lower than 1.85±0.63 of the control group (p=0.00); Postoperative Cr, BUN, blood β 2-microglobulin and other indicators in the control group were significantly higher than those in the experimental group, with statistically significant differences (p<0.05). The incidence of peripheral organ injury in experimental group was lower than that in control group, with a statistically significant difference (p=0.04). Ultrasound-guided percutaneous nephrolithotomy is a safe and effective treatment regimen, boasting various advantages such as real-time monitoring of the surgical process, more accurate and clear channel establishment, avoidance of large vessel injury, shortening of surgical time, alleviation of kidney injury and reduction of surgical complications, which is more advantageous for the treatment of complex renal calculi.

Effect of Percutaneous Nephrolithotomy Combined with Needle Nephrolithotomy on Renal Function and Complication Rate in Patients with Complex Renal Calculi.

Objective To investigate the effect of percutaneous nephrolithotomy combined with needle nephrolithotomy on renal function and incidence of complications in patients with complex renal calculi. Methods From March 2020 to March 2022, 88 patients with complex renal calculi were enrolled and divided into two groups. Percutaneous nephrolithotomy (PCNL) was performed in the control group, and percutaneous nephrolithotomy combined with needle nephrolithotomy was performed in the study group. Perioperative conditions, renal function parameters such as blood urea nitrogen (BUN), serum creatinine (Scr), and cystatin C (CysC) levels, inflammatory factors such as C-reactive protein (CRP) and procalcitonin (PCT) levels before surgery and 1 day after surgery were determined. The incidence of complications was statistically analyzed between two groups. Results There was no significant difference in stone clearance rate between the two groups. The operation time and hospital stay in the study group were shorter than those in the control group. The intraoperative blood loss was less than that in the control group. The VAS score was lower than that in the control group. BUN, Scr, and CysC in the study group were not significantly different from those in the control group. CRP and PCT in the two groups at 1 d after surgery were higher than those before surgery, but CRP and PCT in the study group were lower than those in the control group. The incidence of complications in the study group was lower than that in the control group. Conclusion Percutaneous nephrolithotomy combined with needle nephrolithotomy is effective and safe in the treatment of complex renal calculi.

Effect of percutaneous nephrolithotripsy under guidance of B-ultrasound for the treatment of complex renal calculi.

The purpose of this study was to investigate the effect of percutaneous nephrolithotripsy guided by B-ultrasound in the treatment of complex renal calculi. A total of 82 patients with complex renal calculi were selected, who underwent percutaneous nephrolithotripsy guided by B-ultrasound. The average operation time was 101.52±8.35 minutes, the average intraoperative bleeding volume was 132.86±7.22 ml, the average hospital stay was 10.47 ±1.68 days, the primary calculi clearance rate was 85.37% (70 cases), and the secondary calculi clearance rate was 95.12% (78 cases). Postoperative complications occurred in 18 (21.95%) cases, including fever in 13 (15.85%), residual stone in 4 (4.88%), and delayed bleeding in 1 (1.22%) case. The findings show that percutaneous nephrolithotripsy guided by B-ultrasound is safe and effective in the treatment of complex renal calculi and is suitable for popularisation and application in primary hospitals.

Comment on "Comparison of safety and efficacy between single-tract and multiple-tract percutaneous nephrolithotomy treatment of complex renal calculi: a systematic review and meta-analysis"

article: Comment on “Comparison of safety and efficacy between single-tract and multiple-tract percutaneous nephrolithotomy treatment of complex renal calculi: a systematic review and meta-analysis” - Minerva Urology and Nephrology 2021 December;73(6):849-50 - Minerva Medica - Journals

Efficacy and safety of 3D printing-assisted percutaneous nephrolithotomy in complex renal calculi

This study evaluated the efficacy and safety of 3D printing technology combined with percutaneous nephrolithotomy in the treatment of complex renal calculi. Ninety patients with complex renal calculi were randomly divided into a 3D printing group (45 patients) and a control group (45 patients). In the 3D printing group, a patient-specific 1:1 3D printing model was established based on the patient's thin-layer CT scanning data. A 3D printing model was used for preoperative communication between doctors and patients. Preoperative puncture training, channel design, residual stone prediction, and percutaneous nephrolithotomy were performed under the guidance of a 3D printing model and B-ultrasound. The control group was treated with the conventional B-ultrasound-guided puncture method. Results suggest that there was a statistically significant difference between the two groups (P < 0.05). The overall score of the doctor-patient communication objects in the 3D printing group was 19.32 ± 1.57 points, and in the control group, it was 14.51 ± 2.13 points. The operation time of the 3D printing group was 103.21 ± 13.49 min, and that of the control group was 126.12 ± 25.87 min. The calculi clearance rate of the 3D printing group was 96%, while that of the control group was 80%. The incidence of postoperative complications was 6.67% in the 3D printing group and 22.22% in the control group. Compared with traditional percutaneous nephrolithotomy, 3D printing technology combined with percutaneous nephrolithotomy can significantly enhance the effectiveness of doctor–patient communication, shorten operation time, reduce operation bleeding, improve the stone clearance rate, reduce the incidence of complications and shorten the length of hospital stay. The proposed method is thus a safe and effective method to treat complex renal calculi.

Management of complex renal stones by a novel ureterorenoscope with vacuum suctioning system combined with flexible ureteroscope

Objective: To evaluate the feasibility and safety of Sotn ureterorenoscope combined with flexible ureteroscope on managing complex renal stones. Methods: Patients treated with the Sotn ureterorenoscope combined with flexible ureteroscope between January 2010 and December 2019 were employed from the Sun Yat-sen Memorial Hospital of Sun Yat-sen University and Jiangmen Wuyi Traditional Chinese Medicine Hospital. The patients' information of age, gender, comorbidities, stone characteristics (stone size, hounsfield units, stone composition, stone location, etc.), operative time and console time, stone-free rate (SFR), and perioperative complication rate were collected. The primary outcome was defined as primary SFR in 1 month of operation, and the secondary outcome was the perioperative complication rate. The differences in preoperative and postoperative data between patients with different kinds of stones were compared. Results: A total of 347 patients were included in the study, with 220 males and 127 females. The age [M(Q1,Q3)] was 51 (42, 58) years. There were 94 patients suffered from multiple renal stones and 253 patients with staghorn renal stones. The operative time and console time age [M(Q1,Q3)] for all patients were 87 (55, 115) min and 59 (27, 75) min, respectively. The primary SFR was 81.3% [83.8% for multiple renal stones and 74.5% for staghorn renal stones (P=0.048)]. Complications occurred in 80 patients (23.1%), of which 79 cases were classified as Clavien-Dindo grade 1-2, and 1 case (0.3%) was grade 3-4. For patients with multiple renal stone, compared with the residual stone group, the complete stone-free group had smaller stone size [15.5 (12.0, 21.0) vs 22.0 (17.5, 28.1) mm, P<0.001], and lower hounsfield units [920.0 (658.0, 1 172.5) vs 1 125.0 (944.9, 1 247.5), P=0.022]. Patients with complications had longer operative time than those without complications [60.0 (38.5, 90.0) vs 75.0 (51.3, 110.0) min, P=0.022]. The SFR was higher in patients with stones size ≤ 20 mm compared to those with stones size > 20 mm (91.8% vs 67.5%, P<0.001), while the difference in complication rate was not statistically significant (P>0.05). In the staghorn renal stones group, compared with the residual stone group, the complete stone-free group had smaller stone size [35.0 (25.8, 45.3) vs 53.5 (39.3, 67.5) mm, P<0.001]. Patients with complications had larger stone size than those without complications [43.5 (34.8, 56.5) vs 36.0 (27.0, 50.0) mm, P=0.007]. Patients with stone size ≤ 40 mm had higher SFR (87.5% vs 55.3%, P<0.001) and lower complication rate(10.7% vs 31.6%, P=0.012) compared to those with stone size >40 mm. Conclusion: Sotn ureterorenoscope combined with flexible ureteroscope is an effective and safe choice for the treatment of complex renal calculi.

Comparison of safety and efficacy between single-tract and multiple-tract percutaneous nephrolithotomy treatment of complex renal calculi: a systematic review and meta-analysis.

A systematic review and meta-analysis was conducted to explore the safety and efficacy of single-tract and multiple-tract percutaneous nephrolithotomy (PCNL) in complex renal calculi treatment. PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases (updated November 2020) were searched for studies assessing the effect of different numbers of tracts on cases that underwent PCNL. The search strategy and study selection process were managed according to the PRISMA statement. Five comparative studies were included in the meta-analysis. The multiple-tract PCNL group had a significantly increased total complications rate than the single-tract group (OR=2.35, 95% CI=1.71, 3.25; P<0.00001) with insignificant heterogeneity (I2=0%, P=0.52). Subgroup analysis showed there were different incidence of complications, mainly because the multiple-tract PCNL group was significantly associated with a higher rate of blood transfusion (OR=2.99, 95% CI=1.95, 4.57; P<0.00001) with insignificant heterogeneity (I2=9%, P=0.35). There were no differences in operation time (MD=12.04, 95% CI=6.36, 17.72; P<0.0001) or hospitalization (MD=0.54, 95% CI=0.14, 0.95, P=0.008). However, the single-tract group had a higher stone-free rate (OR=0.37, 95% CI=0.19, 0.74; P=0.005) with heterogeneity (I2=51%, P=0.08), as stones in the single-tract group were smaller than those in the multiple-tract group. The current research did not find that the multiple-tract group had a higher stone-free rate. Additionally, multiple-tract PCNL was associated with a higher incidence of blood transfusion and negative impact on renal function.

Treatment of Complex Renal Calculi by Digital Flexible Ureterorenoscopy Combined with Single-Tract Super-Mini Percutaneous Nephrolithotomy in Prone Position: A Retrospective Cohort Study.

BackgroundAdvances in percutaneous nephrolithotomy (PCNL) have resulted in smaller devices that cause less trauma and bleeding, while flexible ureterorenoscopy (f-URS) allows access to any calyces. These methods are often used in isolation, but used in combination they may improve treatment of complex renal calculi. This study assessed the effectiveness and complications of f-URS combined with super-mini-PCNL (SMP) to treat complex renal calculi.Material/MethodsA retrospective cohort analysis was made of patients with unilateral complex renal stones treated between March 2013 and December 2016. Patients were grouped according to surgical procedure: SMP (SMP Group), f-URS holmium laser lithotripsy (f-URS Group), and combined SMP and f-URS (Combined Group). The postoperative complications and complete stone-free rate were analyzed and compared among the 3 groups.ResultsA total of 140 patients with complex renal stones were included: 40 patients in the SMP Group, 55 in the f-URS Group, and 45 in the Combined Group. The complete stone-free rate 3 days after the procedure was 77.5% in the SMP Group, 78.2% in the f-URS Group, and 97.8% in the Combined Group (p=0.010). The operation time, intraoperative blood loss, and hospitalization time of the Combined Group were all significantly lower than those in the SMP Group but higher than those in the f-URS Group. The follow-up was 9 months (range, 6–12 months). There were no medium-term complications reported.ConclusionsSMP combined with f-URS holmium laser lithotripsy in the prone position is an effective treatment for complex renal calculi.

Design and implementation of optimal puncture pathway for percutaneous nephroscopy in 86 cases of complex renal calculi

Objective To investigate the safety and effectiveness of percutaneous nephrolithotomy(PCNL) with X-ray and ultrasound in the design and implementation of the best percutaneous puncture pathway for complex renal calculi. Methods Eighty-six patients with complex renal calculi treated in Shengjing Hospital Affiliated to China Medical University from May 2015 to May 2018 were collected.Before operation, CT/IVP was used to design the best percutaneous puncture pathway and selected the calices to be punctured.The intersection of the central axis of the calyx fornix, the neck of the calyx and the body surface were regarded as the puncture point on the body surface, and the connection between the central axis of the calyx fornix and the center of the calyx fornix was the puncture line.The ultrasound probe was placed slightly below the planned puncture point.According to the order of echolocation of hydronephrosis or hump-like calculi, two-step puncture was adopted to puncture the calyx along the central axis of the calyx dome and the calyx neck.The guide wire was retained and the channel was gradually expanded to F24 standard channel for ballistic or ultrasonic lithotripsy. Results Percutaneous puncture pathways were successfully established in 86 cases, 65 cases were single-channel and 21 cases were double-channel.The operation time(from puncture to indwelling nephrostomy) was (65.3±17.2)min, and the hemoglobin decreased in (10.1±4.5)g/L.The hospitalization time of the patients was (7.2±5.2)d.The first stage stone clearance rate was 74.4%(64/86), and the second stage stone clearance rate was 95.3%(82/86). Conclusion Combined with the advantages of X-ray and ultrasound, the puncture route shoud be designed by CT/IVP before operation, and puncture shoud be carried out under the guidance of ultrasound during operation.The best percutaneous puncture pathway can be established to complete the treatment of complex renal calculi. Key words: Kidney calculi; Urologic surgical procedures; Percutaneous nephrolithotomy; Nephrostomy, percutaneous; Diagnostic techniques, urological; Radiography; Ultrasonography; Punctures

Effect of percutaneous nephroscopy combined with flexible ureteroscope on BMG and BUA of complex renal calculi and its clinical efficacy

Objective To analyze the clinical effect and safety of percutaneous nephroscopy combined with soft ureteroscopy in the treatment of complicated renal calculi. Methods From January 2015 to October 2017, 120 cases of complicated renal calculi in our hospital were retrospectively selected. The patients in the control group were treated with minimally invasive percutaneous nephrolithotripsy and the patients in the observation group were treated with minimally invasive percutaneous nephrolithotomy combined with ureteral soft lithotripsy. The clinical effect of two groups was analyzed after treatment. Results Operation time, exhaust time, hospitalization time of the observation group were shorter than the control group, intraoperative bleeding was less than the control group (P 0.05). After the treatment, BMG, BUA, NGAL, Cys-C, hs-CRP, Ang I and Ang II levels of the observation group were lower than the control group (P<0.05), and the incidence of complications in the observation group was 8.33%, the control group was 21.67%, and the rate of complications in the observation group was lower than that of the control group (P<0.05). Conclusions Percutaneous nephrolithotomy combined with flexible ureteroscopy for the treatment of complex renal calculi can reduce blood loss, shorten hospitalization time, relieve stress reaction, and has little effect on renal function and safety. Key words: Kidney Calculi; Ureteroscopy; Nephrostomy, Percutaneous; beta 2-Microglobulin; Uric Acid

The effect of ultrasound guided multi-tract percutaneous nephrolithotomy in the treatment of complex renal calculi

Objective To investigate the clinical effect of ultrasound guided multi-tract percutaneous nephrolithotomy in the treatment of complex renal calculi. Methods A total of 300 patients in our hospital from January 2013 to December 2016 who underwent ultrasound guided percutaneous nephrolithotomy were retrospectively included in our study. One hundred and fifty patients were in the multi-tract group and the other 150 were in the single channel group. The operation time, estimated blood loss and nephrotomy tube stay time, the stone clearance rate and postoperative complications were compared. Results The basic and preoperative characteristics had no significant difference between the two groups, and the hospital stay time, incision infection and blood loss were similar in the two groups. But the stone clearance rate and nephrotomy tube stay time were significant shorter in ultrasound guided group(P<0.05)while the operation time was longer in multi-tract group. Conclusions The ultrasound guided multi-tract percutaneous nephrolithotomy were effective in treating complex renal calculi than single channel method and thus should be recommended in clinical practice. Key words: Kidney Calculi; Nephrostomy, Percutaneous; Ultrasonography

Laparoscopic - assisted percutaneous nephrolithotomy as an alternative in the treatment of complex renal calculi in patients with retrorenal colon.

Laparoscopic - assisted percutaneous nephrolithotomy as an alternative in the treatment of complex renal calculi in patients with retrorenal colon.

Multi-tract percutaneous nephrolithotomy combined with EMS lithotripsy for bilateral complex renal stones: our experience

BackgroundThe treatment of bilateral complex renal stones is a tough challenge for urologists. This study aimed to evaluate the efficiency and safety of bilateral ultrasonography-guided multi-tract percutaneous nephrolithotomy (PCNL) combined with EMS lithotripsy for the treatment of such cases.MethodsTwenty-seven patients suffering from bilateral complex renal calculi underwent t bilateral multi-tract PCNL. The PCNL began with the establishment of percutaneous nephrostomy access, which was achieved under ultrasound guidance followed by stone fragment and removal by EMS lithotripsy. The same processes were then performed on the ipsilateral and contralateral renal units until the operation terminated. Sheaths left in situ to provide the tracts for the two-stage and the three-stage PCNL procedures. Peri- and postoperative clinical data were collected and analysed.ResultsRenal stones of both sides were completely cleared within three PCNL sessions in 24 cases. Among them, four, thirteen, and seven cases underwent single, second-stage and third-stage procedures, respectively. The total stone-free rate was 88.9%. Three patients failed to receive complete stone clearance. Mean operation time was 78.7 (26–124) min, the mean estimated blood loss was 97.3 (30–250) ml, and the mean length of hospital stay was 18 (10–31) days. No patient required blood transfusion and postoperative fever occurred in 6 cases. Within the follow-up period, stone recurrence occurred in 6 patients.ConclusionsUltrasonography-guided multi-tract PCNL using EMS is an efficient method for the treatment of complex renal calculi. According to our experience, it is safe to make multiple tracts on both sides simultaneously.

Clinical analysis of percutaneous nephrolithotomy combined with flexible cystoscope in the treatment of complex renal calculi

Objective To evaluate the clnical value of percutaneous nephrolithotomy combined with flexible cystoscope in the treatment of complicated renal calculi.Methods Data of 53 cases of complex renal calculi treated with single channel percutaneous nephrolithotomy combined with flexible cystoscope from July 2011 to September 2013 were analyzed retrospectively.There were 31 males and 22 females.Their age ranged from 26 to 74 years with a mean age of 49 years.Thirty-two cases were located on the left side,19 cases right,2 cases bilateral,21 cases of staghorn calculi and 32 cases of multiple stones.All the stones were filled in 2 or more calyces,with 7 cases in upper ureteral stones at the same time and 2 cases in solitary kidney.The longest diameter of stones was between 2.5 cm to 4.6 cm,with an average of 3.7 cm.There were 39 cases with hydronephrosis and the separation of the collection system was 2.0-5.1 cm with an average of 3.8cm.The period which patients suffered from stones was from 1 month to 6 years.Fourteen cases underwent ESWL and 6 cases underwent open operation before percutaneous nephrolithotomy.All patients underwent single channel percutaneous nephrolithotomy under the guidance of color Doppler ultrasound,and the channel of puncture was expanded to 24 F.Results Fifty-three cases (55 sides) were performed successfully in one-stage sugery and the operation time was between 85 to 170 min,with an average of 119 min.The stone clearance rate was 89％ (49/55) and postoperative hemoglobin decreased 3.9-9.2 g/L with an average of 6.1 g/L.The hospitalization time was 8 to 12 days with an average of 9.2 days.Two cases had hemorrhage of about 500 ml after surgery and the renal hemorrhage stopped after clamping of renal fistula without blood transfusion.Two patients suffered from fever on surgery day and 1 patient on one day after surgery,and the body temperature returned to normal level after anti-infection treatment for 2 or 3 days.No renal perforation,fluid pneumothorax or damaged surrounding organs occurred.6 patients had residual stones,among which 2 were treated by two-stage operation and 4 were treated with extracorporeal shock wave lithotripsy.Conclusion Percutaneous nephrolithotomy combined with flexible cystoscope has little trauma and high stone clearance rate in the treatment of complex renal calculi with high clinical value. Key words: Percutaneous nephrolithotomy; Flexible cystoscope; Complex renal calculi

Does body mass index impact the outcomes of tubeless percutaneous nephrolithotomy?

To evaluate whether body mass index (BMI) has an impact on the outcomes of tubeless percutaneous nephrolithotomy (PCNL). We retrospectively reviewed patients who underwent tubeless PCNL at our institution from 2006 to 2011. Specifically, stone-free rates, complications, and hospital length of stay (LOS) were assessed. Patients were divided into four groups based on BMI: <25, 25-29.9, 30-34.9 and ≥35 kg/m(2) . Baseline characteristics and outcomes were compared between BMI groups. Multivariable logistic regressions were used to evaluate the independent contribution of BMI as a predictor of outcomes. We identified 268 patients who fulfilled study requirements. The overall stone-free and complication rates were 52.5% and 19.0%, respectively. Minor and severe complication comprised 10.4% and 8.6%, respectively. Univariate and multivariable analyses showed no association between BMI and stone-free or complication rates. However, patients with a normal BMI had significantly higher transfusion rates (P = 0.005), and were significantly more likely to have a prolonged LOS (≥2 days), when compared with an overweight BMI (P = 0.032) CONCLUSIONS: BMI did not impact the stone-free, or complication rates of tubeless PCNL. Normal BMI was found to be a risk factor for prolonged LOS, which may be due to an increase in clinically significant bleeding in this patient population. Tubeless PCNL appears to be a safe and effective procedure for the treatment of complex renal calculi, independent of BMI.

Observation of the effect of percutaneous nephrolithotomy with pneumatic and ultrasonic power guided by B-type ultrasound in the treatment of complex renal calculi

Objective To discuss the method and effect of B-type ultrasound guided percutaneous nephrolithotomy(PCNL) in the treatment of complex renal calculi.Methods The clinical data of 98 cases with complex renal calculi who underwent B-type ultrasound guided PCNL were retrospectively reviewed.Results The percutaneous renal access guided by B-type ultrasound was successfully established in all patients,of whom 15 patients were via two tracts,4 patients via three tracts and 10 patients with both sides.The average operation time was 95 minutes.The time of stone cleaning was about 15-150 minutes,average 85 minutes.10 cases needed blood transfusion because of intraoperative and postoperative bleeding,2 cases occured pseudoaneurysm (interventional selective renal artery embolization),2 cases occured hydropneumothorax (through the 11 intercostal approach),and 2 patients had sepsis,there were no abdominal visceral injury and other serious complications.Stones were cleared in 85 cases(86.7％),residual stone fragment was found in 8 cases,who received second PCNL or extracorporal shock wave lithotripsy.Conclusion PCNL with pneumatic and ultrasonic power guided by B-type ultrasound is an effective and safe way to treat complex renal calculi with the features of high stone clearance rate. Key words: Percutaneous nephrolithotomy ; Kidney calculi ; Surgical management; Ultrasonography

Nursing strategy on large channel percutaneous nephrostomy ltthotomy treatment of complex renal calculi

Objective To investigate the minimally invasive treatment of complex renal calculi nursing.Methods Retrospective analysis,from February 2009 to January 2011,50 regular channels percutaneous nephrolithotomy nephrostomy lithotomy patients(observation group)and from January 2007 to January 2009,the traditional opening of the regular 50 surgical treatment of complex renal calculi patients(control group)were selected,and length of stay,hospital costs,complications such as postoperative infection and other indicators were observed between the two groups.Results Successful rate of percutaneous nephrostomy large channel lithotomy in the observation group were 100％.Days in hospital(t =2.95,P ＜0.05),costs(t =11.68,P ＜0.05)and complication rate after operation(x2 =6.25,P ＜ 0.05)were significantly different between the two groups.Conclusions Comprehensive patient evaluation and preoperative psychological communication,close observation and meticulous condition postoperative care,help to promote patient recovery and improve the quality of care. Key words: Complex renal calculi; A major thoroughfare; Percutaneous nephrostomy lithotomy; Nursing