Ureteroscopy-assisted Retrograde Nephrostomy Research Articles

Ureteroscopy-assisted retrograde nephrostomy (UARN) for staghorn calculi in the horseshoe kidney

Ureteroscopy-assisted retrograde nephrostomy (UARN) for staghorn calculi in the horseshoe kidney

Ureteroscopy assisted retrograde nephrostomy (UARN) in patient with lower pole renal stone

Introduction: We previously reported a new technique, ureteroscopy-assisted retrograde nephrostomy (UArN) for percutaneous nephrolithotomy (PcNL). this case report describes a new approach for treating renal stones in the lower calyx using the UArN technique. case report: A 68-year-old female was referred to our department for the treatment of a right renal stone. We performed PcNL using the technique for UArN. conclusions: We herein report a new technique using UArN for lower pole renal stones. this method may represent a new treatment option for renal stones in the lower calyx.

Ureteroscopy-assisted retrograde nephrostomy (UARN) for the patients with cerebrotendinous xanthomatosis

Introduction: Ureteroscopy-assisted retrograde nephrostomy (UArN) makes it is possible to continuously visualize dilation of the ureter from the site of puncture to insertion of the nephroaccess sheath, with minimal complications and effective for percutaneous nephrolithotripsy (PcNL). case report: A 43-year-old male with cerebrotendinous xanthomatosis (ctX) was referred to our department to undergo PcNL for a diagnosis of a right kidney stone. In July 2012, the patient was admitted to our department for PcNL to treat a right renal staghorn calculus. We performed PcNL using the technique of UArN. the operative time was 195 minutes, and the chemical composition of the stone was calcium oxalate. conclusion: UArN is effective for the case who have large renal stone with complications of ctX.

Body mass index predicts outcome of ureteroscopy-assisted retrograde nephrostomy for percutaneous nephrolithotomy.

Several clinical series of retrograde nephrostomy for percutaneous nephrolithotomy (PCNL) have been published over the past 30 years demonstrating good outcomes and safety. We previously reported our adaptation of the Lawson technique, wherein we deploy the puncture wire through a flexible ureteroscope. We herein aim to clarify the performance characteristics of this nephrostomy creation technique. Institutional Review Board approval and informed consent were obtained. A ureteroscopy-assisted retrograde nephrostomy (UARN) procedure was performed as described previously. Data were collected prospectively. Multiple patient and operative factors were evaluated for association with UARN success and nephrostomy creation time: body mass index (BMI), skin-to-stone distance, Guy's score, Clinical Research of the Endourological Society nephrolithometric score, hydronephrosis, stone burden, location of nephrostomy, exit from a stone-bearing calix, and use of holmium laser to access calix. Nephrostomy was successful in 49/52 UARN procedures (94%). Only single access was placed: upper-18, mid-27, and lower-7. Median BMI was 29 kg/m(2) and median time for nephrostomy creation was 39 minutes. Fluoroscopy time for the entire PCNL including nephrostomy creation was 84 and 16 seconds for case numbers 1-25 and 26-52, respectively. By stepwise linear regression, variables correlating with nephrostomy creation time were BMI (r(2)=0.219), stone burden (r(2)=0.094), use of holmium laser to access calix (r(2)=0.104), and total r(2) linear=0.416. UARN is an intuitive safe procedure that offers dramatic reductions in fluoroscopy times. UARN is best suited to cases requiring only one nephrostomy tract. Upper pole access is commonly performed with a subcostal technique to navigate the puncture wire below the ribs. Increasing BMI best predicts longer nephrostomy creation times; procedure failure was associated with BMI exceeding 40 kg/m(2). UARN is a robust technique for nephrostomy creation in appropriately selected patients.

PD36-07 URETEROSCOPY-ASSISTED RETROGRADE NEPHROSTOMY; A 150 CASE EXPERIENCE

You have accessJournal of UrologyStone Disease: New Technology I1 Apr 2014PD36-07 URETEROSCOPY-ASSISTED RETROGRADE NEPHROSTOMY; A 150 CASE EXPERIENCE Takashi Kawahara, Hiroki Ito, Hiroshi Miyamoto, Hiroji Uemura, Yoshinobu Kubota, and Junichi Matsuzaki Takashi KawaharaTakashi Kawahara More articles by this author , Hiroki ItoHiroki Ito More articles by this author , Hiroshi MiyamotoHiroshi Miyamoto More articles by this author , Hiroji UemuraHiroji Uemura More articles by this author , Yoshinobu KubotaYoshinobu Kubota More articles by this author , and Junichi MatsuzakiJunichi Matsuzaki More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2444AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previously introduced a new procedure of ureteroscopy-assisted retrograde nephrostomy (UARN). Since 2011 we have applied this procedure to 150 cases. In this study, we show outcomes of UARN. METHODS Under general anesthesia with epidural anesthesia, patients were placed in a Galdakao-modified Valdivia position. A flexible ureteroscopy (URS) with an inserted ureteral access sheath was inserted into the ureter, while ensuring that the rigid URS does not encounter either ureteral stenosis or ureteral stones. We carefully observed the target calculi and defined the appropriate renal calyx to puncture. Thereafter, a Lawson retrograde nephrostomy puncture wire was set into the flexible URS which approached the desired renal calyx. The route from the renal calyx to the exit skin was confirmed under fluoroscopy. To avoid injuries to the spleen, liver, intestines, and pleural cavity, the puncture was performed after performing ultrasonography. The puncture wire was able to pass through the muscle easily and "tented" the skin at the posterior axially line. The skin was incised, and the needle was then delivered. Next, the dilator was placed by the puncture wire, which was advanced through the skin, subcutaneous fat, abdominal wall musculatue, and perinephic fat until it reached the renal parenchyma. A percutaneous nephron access sheath was passed over the balloon dilator into the calyx under ureteroscopic guidance, and the balloon was removed. RESULTS From April 2009 to August 2013, a total of 150 patients underwent UARN of these, UARN was successfully performed in 116 cases (77.3%). No major or minor complications were observed. This study includes the following complicated cases: complete staghorn calculus (n=8), horseshoe kidney (n=4), incomplete double ureter (n=2), huge obese patients (n=3); patients who underwent urinary diversion (n=1), and patients who underwent anatrophic nehphrolithotomy (n=1). CONCLUSIONS Our results suggest that UARN is a safe and effective procedure. More importantly, UARN can be also easily performed in complicated cases. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e903-e904 Peer Review Report Advertisement Copyright & Permissions© 2014MetricsAuthor Information Takashi Kawahara More articles by this author Hiroki Ito More articles by this author Hiroshi Miyamoto More articles by this author Hiroji Uemura More articles by this author Yoshinobu Kubota More articles by this author Junichi Matsuzaki More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Effectiveness of Ureteroscopy-Assisted Retrograde Nephrostomy (UARN) for Percutaneous Nephrolithotomy (PCNL)

ObjectiveTo determine the impact of ureteroscopy-assisted retrograde nephrostomy (UARN) during percutaneous nephrolithotomy (PCNL).Materials and MethodsFrom April 2009 to September 2011, a total of 50 patients underwent PCNL for large renal stones (stone burden >2 cm). We performed UARN in the Galdakao-modified Valdivia position for 27 patients (UARN PCNL) and ultrasonography-assisted percutaneous nephrostomy in the prone position for 23 patients (prone PCNL).ResultsUARN PCNL significantly improved the stone-free rate (81.5% vs 52.2%) and the rate of residual stones (<4 mm, 92.6% vs 65.2%, P<0.05). The median length of the operation was significantly shorter for UARN PCNL, at 160 min, compared to 299 min for prone PCNL (P<0.001). There was one intraoperative complication in prone PCNL, namely a hemorrhage that resulted in stopping the initial treatment, but it was cured conservatively. The postoperative complications included a high grade fever that persisted for three days in two UARN PCNL patients (7.4%) and six prone PCNL patients (26.1%). The Clavien grading scores showed significantly lower postoperative complications for UARN PCNL compared to prone PCNL.ConclusionUARN is associated with a higher stone-free rate, shorter operation time, and fewer complications during PCNL than prone PCNL.

Ureteroscopy-assisted retrograde nephrostomy for lower calyx calculi in horseshoe kidney: two case reports

IntroductionWe previously reported on the effectiveness of ureteroscopy-assisted retrograde nephrostomy during percutaneous nephrolithotomy and report two cases of lower calyx calculi in horseshoe kidney that were successfully treated with ureteroscopy-assisted retrograde nephrostomy. During the ureteroscopy-assisted retrograde nephrostomy procedure, a ureteroscope is advanced in the desired calyx and a Lawson retrograde nephrostomy puncture wire is inserted. The wire is advanced through the calyx to exit the skin. The wire is then used for the percutaneous dilation.Case presentationCase 1 was a 68-year-old man who was shown on radiography to have left lower calyx calculi (19 × 15mm, 7 × 5mm, and 7 × 3mm) in horseshoe kidney. Case 2 was a 36-year-old woman shown on radiography to have a left lower calyx calculus (10 × 8mm) in horseshoe kidney.ConclusionsBoth patients were stone-free after ureteroscopy-assisted retrograde nephrostomy during percutaneous nephrolithotomy. Ureteroscopy-assisted retrograde nephrostomy is a promising procedure for safely and effectively treating lower calyx stones in horseshoe kidney.

Ureteroscopy-Assisted Retrograde Nephrostomy

Introduction: Lawson et al first developed retrograde nephrostomy in 1983.1 Hunter et al reported 30 cases of retrograde nephrostomy in 1985.2 Ureteroscopy (URS)-assisted retrograde nephrostomy (UARN) was reported as a new technique for percutaneous nephrolithotomy (PCNL) in 2011, and this institute performed more than 30 cases of UARN.3 This video presents the details of the UARN technique based on this experience. Materials and Methods: The patient is placed in the Galdakao-modified Valdivia position under general and epidural anesthesia.4 A ureteral access sheath (UAS) is inserted and a flexible ureteroscope (Flex-X2®; Karl Storz) is inserted through the UAS. The target calculi are carefully observed to identify the appropriate renal calyx to be punctured. A Lawson retrograde nephrostomy puncture wire (Lawson Retrograde Nephrostomy Wire Puncture Set; COOK Urological) is carefully set into the flexible URS. The flexible ureteroscope approaches the desired renal calyx again, and the route from the renal calyx to the exit skin is then confirmed under fluoroscopy. The puncture is performed under ultrasonography after rechecking the preoperative computed tomography to avoid injury to the spleen, liver, intestines, or pleural cavity. The puncture wire passes through the muscle easily and tents the skin at the posterior axillary line. The skin is incised and the needle is delivered. Next, 22G and 18G needle dilators are placed over the puncture wire, which is advanced through the skin, subcutaneous fat, abdominal wall musculature, and perinephric fat until it reaches the renal parenchyma. The catheter is dilated up to 12F and a safety guidewire is placed through the UAS. A 30F percutaneous nephroaccess sheath (NAS; X-Force®N30 Nephrostomy Balloon Dilation Catheter; BARD) is passed over the balloon into the calyx under ureteroscopic and fluoroscopic guidance, and then the balloon is removed. PCNL is then performed. Results: A total of 32 patients were treated by UARN from September 2010 to November 2011. According to this procedure, 81.3% of the patients achieved a stone-free outcome and there were no blood transfusions or any complications in patients with a Clavien score of two or more. The median operation time was 160 minutes. Nephrostomy was therefore not performed on patients who achieved a stone-free outcome, and ureteral stents were put in place at the conclusion of this procedure in all patients.5 UARN was abandoned in one case because of URS mechanical trouble. These patients included two cases of horseshoe kidney, one case of complete staghorn calculi, and two cases of obese patients. Conclusions: UARN is considered to be the most suitable procedure for puncturing the middle calix. UARN is a safe, effective, and minimally invasive procedure for PCNL because continuous observation can be obtained with URS. No competing financial interests exist. Runtime of video: 5 mins 17 secs

V1719 FLEXIBLE URETEROSCOPY-ASSISTED RETROGRADE NEPHROSTOMY FOR PCNL

You have accessJournal of UrologyTransplantation, Urolithiasis & Hydronephrosis1 Apr 2012V1719 FLEXIBLE URETEROSCOPY-ASSISTED RETROGRADE NEPHROSTOMY FOR PCNL Jason B. Wynberg, Joshua Z. Vicena, Scott A. Salmon, and Vince N. Hannosh Jason B. WynbergJason B. Wynberg Detroit, MI More articles by this author , Joshua Z. VicenaJoshua Z. Vicena Detroit, MI More articles by this author , Scott A. SalmonScott A. Salmon Detroit, MI More articles by this author , and Vince N. HannoshVince N. Hannosh Detroit, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1678AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We adapted the COOK® Lawson retrograde nephrostomy puncture wire for deployment through the operating channel of a flexible ureteroscope. We present our initial experience with this technique. METHODS Patients were placed under general anesthesia and positioned in Galdakao-Modified Supine Valdivia position. Previously placed ureteric stent was removed and flexible ureteroscopy was performed with ureteral access sheath and safety wire in place. Flexible ureteroscope was advanced into selected calyx and trajectory for puncture wire deployment was evaluated with 2-plane fluoroscopy. Laser was applied to stone if needed to enter selected calyx. Surgeon held ureteroscope position while assistant passed puncture wire into working channel until tip emerged from scope. Assistant then released pin-vise lock and advanced puncture wire in 1 cm increments under fluoroscopic guidance until wire emerged from flank. A 5F, 30 cm coaxial transitional dilating catheter (Vascular Solutions, Inc.) was used as an exchange catheter at the flank and advanced over puncture wire into ureter. Puncture wire, inner catheter from coaxial set and ureteroscope were removed. A 0.038” wire was advanced antegrade through outer catheter of coaxial set until wire emerged out of ureteric access sheath. Outer coaxial was then removed from flank, 0.038” wire was secured at flank and urethra. 5F catheter was advanced into ureter for retrograde imaging during PCNL prior to removing access sheath. Foley catheter was placed in the bladder. PCNL was then performed in same position. RESULTS Procedure was successful in 8/9 patients – in one patient, puncture wire tract was not dilated due to high kidney, nearby pleura. Mean BMI - 31.5; mean stone diameter 2.5 x 1.7 cm, and mean 1.3 stones per kidney. Only one access was performed in all patients with mean 2.3 wire passages to achieve acceptable wire passage. Laser lithotripsy was required in one case to grant access to selected calyx. All dilated punctures were behind the posterior axillary line. For nephrostomy + PCNL: procedure - mean 153 min., fluoro - mean 2 min. 48 s. Five patients were stone free; two required subsequent ureteroscopy. No complications were noted in this series. CONCLUSIONS This technique is safe, intuitive, and builds on modern urologists' endoscopy skills. We found it easy to teach to residents. Careful pre-op review of adjacent organs on CT scan to establish a safe course for wire passage is critical for establishing patient eligibility. We found this procedure more difficult in obese patients. We contemplate a complementary role for this technique alongside antegrade methods. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e693 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jason B. Wynberg Detroit, MI More articles by this author Joshua Z. Vicena Detroit, MI More articles by this author Scott A. Salmon Detroit, MI More articles by this author Vince N. Hannosh Detroit, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Ureteroscopy-assisted retrograde nephrostomy for an obese patient

Obesity is associated with increased surgical morbidity and mortality. We previously reported on the usefulness of ureteroscopy assisted retrograde nephrostomy (UARN) and here we report a case of renal calculi successfully treated with UARN during percutaneous nephrolithotomy (PCNL) in an obese patient. A 63-year-old female with left renal calculi was referred to Department of Urology, Ohguchi Higashi General Hospital. Her body mass index was 34.0 kg/m2. Stone fragments were completely extracted. URS-assisted puncture from the renal collecting system to the skin under fluoroscopic guidance was a safe and easy procedure in our obese patient.

Ureteroscopy-Assisted Retrograde Nephrostomy (UARN) after Anatrophic Nephrolithotomy.

Introduction. Open surgical anatrophic nephrolithotomy (ANL) had been the standard treatment for large renal calculi prior to the development of endoscopic devices and endoscopic techniques. A previous report described the efficacy of ureteroscopy-assisted retrograde nephrostomy (UARN) and presented a case of renal calculi successfully treated with UARN during percutaneous nephrolithotomy (PCNL) in a patient after ANL. Case Presentation. A 61-year-old male with left renal calculi was referred for further treatment. The patient was placed under general and epidural anesthesia, in a Galdakao-modified Valdivia position. A flexible ureteroscope (URS) was inserted, and a Lawson retrograde nephrostomy puncture wire was advanced into the flexible URS. The puncture wire then followed the route from the renal pelvis to the exit skin. Calculus fragmentation was undertaken using a pneumatic lithotripter. Conclusions. UARN for PCNL was therefore found to be a safe, effective, and appropriate treatment for a patient presenting with renal calculi after undergoing ANL.