Number of Tracts or Stone Size: Which Influences Outcome of Percutaneous Nephrolithotomy for Staghorn Renal Stones?

2012 ◽  
Vol 89 (1) ◽  
pp. 103-106 ◽  
Author(s):  
Robab Maghsoudi ◽  
Masoud Etemadian ◽  
Pejman Shadpour ◽  
Mohammad Hadi Radfar ◽  
Hadi Ghasemi ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Stones ◽  
Stone Size

scholarly journals Safety and efficacy of Chinese minimally invasive percutaneous nephrolithotomy in the management of renal stones ≤ 2 cm: a single-center experience

2019 ◽  
Vol 25 (1) ◽  
Author(s):  
Elsayed M. Salih ◽  
Ibrahim Elsotohi ◽  
Hisham Elhelaly ◽  
Mohamed Elsalhy ◽  
Mourad M. Mourad
Keyword(s):  
Minimally Invasive ◽  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Renal Stones ◽  
Stone Size ◽  
Intraoperative Complication ◽  
Safety And Efficacy ◽  
Single Center Experience ◽  
Minimally Invasive Percutaneous Nephrolithotomy ◽  
The Mean

Abstract Background The goal for using smaller caliber instruments in PNL was to reduce the access-related complications and to decrease morbidity. The objective of this study was to evaluate the safety and efficacy of Chinese minimally invasive percutaneous nephrolithotomy (MIPNL) in the treatment of renal stones ≤ 20 mm. Results Sixty-seven patients completed the study protocol. The mean age was 41.10 ± 13.99 years (range 18–68 years). There were 43 (64%) male and 24 (36%) females. The mean stone size was ranged from 78.5 to 439.6 mm2 (mean ± SD 172.48 ± 69.54 mm2). The overall SFR was (82%). Twelve (18%) needed post-MIPNL auxiliary procedure, in the form of second MIPNL in 3 (4.5%) cases, SWL in 7 (10%), and RIRS in 2 (3%) cases. The intraoperative complication was present in four patients (5%) include bleeding necessitate blood transfusion in one patient (1.5%) and renal collecting system perforation 3 (4.5%). The postoperative complication was urine leakage 5 (7.5) and fever in 6 (9%) of patients. Conclusion Chinese MIPNL is safe and effective method for treatment of renal stone ≤ 20 mm size with satisfactory SFR and low complication rate when SWL failed or contraindicated. It is considered a feasible treatment alternative to standard PNL, in the absence of flexible URS or miniature nephroscope.

scholarly journals Variation of Fluoroscopic Radiation Dose during Endourological Procedures for Renal Stones

2020 ◽  
Vol 3 (1) ◽  
pp. 272-275
Author(s):  
Prakash Chhettri ◽  
Robin Bahadur Basnet ◽  
Anil Shrestha ◽  
Parash Mani Shrestha
Keyword(s):  
Radiation Dose ◽  
Percutaneous Nephrolithotomy ◽  
Prospective Observational Study ◽  
Renal Stones ◽  
Retrograde Intrarenal Surgery ◽  
Stone Size ◽  
Ureteral Access Sheath ◽  
Pelvicalyceal System ◽  
Ureteric Catheter ◽  
Fluoroscopic Time

Introduction: Fluoroscopic guidance is routine for endourological procedures like percutaneous nephrolithotomy and retrograde intrarenal surgery in vast majority of centers. It is used for the initial retrograde ureteral access to define the pelvicalyceal system, puncture of the desired calyx and dilatation of the tract, aid navigation of stones and calyces, and placement of guide wires and stents. Both the patient and operating staffs are exposed to the radiation during surgery. The purpose of this study is to measure that exposed fluoroscopic radiation dose during these procedures and make operating surgeons aware of their fluoroscopic habit. Materials and Methods: This is prospective observational study, who underwent percutaneous nephrolithotomy (n=60) and retrograde intrarenal surgery (n=43) in our institute between December 2017 and August 2018. Percutaneous nephrolithotomy was done in prone position with prior insertion of ureteric catheter. Retrograde intrarenal surgery was carried out with or without insertion of ureteral access sheath. Fluoroscopic time was taken from the insertion of the ureteric catheter or UAS to the completion of the procedure with double J stenting. Results: For percutaneous nephrolithotomy and retrograde intrarenal surgery group, mean stone size were 21.89 mm and 10.56 mm; mean fluoroscopic time were 117.95 s (range 24-350) and 31.83 s (range 3-103); mean fluoroscopic dose were 29.71 mGy and 6.19 mGy respectively. Introduction: Fluoroscopic guidance is routine for endourological procedures like percutaneous nephrolithotomy and retrograde intrarenal surgery in vast majority of centers. It is used for the initial retrograde ureteral access to define the pelvicalyceal system, puncture of the desired calyx and dilatation of the tract, aid navigation of stones and calyces, and placement of guide wires and stents. Both the patient and operating staffs are exposed to the radiation during surgery. The purpose of this study is to measure that exposed fluoroscopic radiation dose during these procedures and make operating surgeons aware of their fluoroscopic habit. Materials and Methods: This is prospective observational study, who underwent percutaneous nephrolithotomy (n=60) and retrograde intrarenal surgery (n=43) in our institute between December 2017 and August 2018. Percutaneous nephrolithotomy was done in prone position with prior insertion of ureteric catheter. Retrograde intrarenal surgery was carried out with or without insertion of ureteral access sheath. Fluoroscopic time was taken from the insertion of the ureteric catheter or UAS to the completion of the procedure with double J stenting. Results: For percutaneous nephrolithotomy and retrograde intrarenal surgery group, mean stone size were 21.89 mm and 10.56 mm; mean fluoroscopic time were 117.95 s (range 24-350) and 31.83 s (range 3-103); mean fluoroscopic dose were 29.71 mGy and 6.19 mGy respectively. Conclusions: Among the endourological procedures for renal stones, retrograde intrarenal surgery was associated with less fluoroscopic hazard than percutaneous nephrolithotomy. Awareness of fluoroscopic exposure duration and experience of a surgeon can minimize the radiation hazard during endourological procedures.

scholarly journals The Evaluation of Risk Factors for Postoperative Infectious Complications after Percutaneous Nephrolithotomy

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Tian Yang ◽  
Shenghua Liu ◽  
Jimeng Hu ◽  
Lujia Wang ◽  
Haowen Jiang
Keyword(s):  
Risk Factors ◽  
Serum Albumin ◽  
Percutaneous Nephrolithotomy ◽  
Protective Factor ◽  
Clinical Information ◽  
Renal Stones ◽  
Infectious Complications ◽  
Stone Size ◽  
Postoperative Fever ◽  
Detailed Clinical Information

This study was to evaluate the risk factors of infectious complications after percutaneous nephrolithotomy (PCNL) and build a prediction tool for postoperative complications based on the risk factors. A total of 110 male (67.1%) and 54 female (32.9%) patients who underwent PCNL for renal stones between 2010 and 2014 in our institute were included. A detailed clinical information and laboratory results were obtained from patients. Systemic inflammatory response syndrome (SIRS) and postoperative fever were recorded after PCNL surgery. In all, 45 cases (27.4%) developed SIRS and fever was observed in 20 cases (12.2%). In multivariate analysis, stone size (odds ratio, OR = 1.471,p=0.009) and urine white blood cell (WBC) (OR = 1.001,p=0.007) were related to the development of SIRS. Stone size (OR = 1.644,p=0.024), urine WBC (OR = 1.001,p=0.002) and serum albumin (OR = 0.807,p=0.021) were associated with postoperative fever. We concluded that patients with larger stone size and preoperative urinary tract infection might have a higher risk of developing SIRS and fever after operation, while a high-normal level of serum albumin might be the protective factor for postoperative fever.

scholarly journals Effectiveness and Safety of Percutaneous Nephrolithotomy (PCNL) in Malrotated Kidneys

2021 ◽  
Vol 15 (8) ◽  
pp. 2362-2365
Author(s):  
Sami ur Rehman ◽  
Liaqat Ali ◽  
Jehanzeb . ◽  
Muhammad Asif ◽  
Syed Arif ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Surgical Technique ◽  
Percutaneous Nephrolithotomy ◽  
Preoperative Evaluation ◽  
Renal Stones ◽  
Stone Size ◽  
Stone Clearance ◽  
Large Size ◽  
Group I ◽  
Staghorn Stone

Background and Aim: The renal stones of any size could be effectively managed through an essential surgical technique known as Percutaneous Nephrolithotomy (PCNL). The large size renal stones with abnormal kidneys imposed additional challenges for PNCL in anomalous kidneys. The present study aimed to evaluate the effectiveness and safety of Percutaneous Nephrolithotomy in malrotated kidneys. Place and Duration: Conducted at Urology department of Mian Gul Abdulhaq Jehanzeb Kidney Hospital Manglawar, Swat for duration of two years (from May 2019 to April 2021). Materials and Methods. This single-centered retrospective study was conducted on 80 patients who underwent percutaneous nephrolithotomy with malrotation kidneys. The individuals with anomalous kidneys and complex calculi were enrolled in this study. These patients had kidneys anomalies such as horseshoe kidneys, crossed fused ectopia, malrotation kidneys, pelvic and complete stone clearance. Posterior or anterior approaches were followed for the procedure after preoperative evaluation in kidney anomalies. Retrograde catheterization was carried out under spinal and general anesthesia with the patients. For all the patients, stone size and clearance were measured. Results: Of the total 80 kidneys anomalies patients, 55 (68.7%) were male and 25 (31.3%) were females. Overall mean age was 35.26 ± 13.51. The stone size varied from 1.3cm to 7 cm. Patients were categorized into two groups based on stone sizes such as group I (1.3-2.5 cm) had 42 (52.5%) and group II (25-7cm) 38 (47.5%) patients. The patients included renal pelvis 19 (23.6%), the pelvic ureteric junction (PUJ) 8 (10%), horseshoe kidneys 2 (2.5%), crossed fused ectopia 9 (11.3%), and malrotation kidneys 3 (3.8%).The stone clearance was completed in 77 (96.3%) patients. The statistically significant factor for complete clearance was the staghorn stone calculus. Conclusion: Percutaneous nephrolithotomy is a safe and effective procedure for large renal stones management in patients of anomalous kidneys. Higher renal stones clearance can be achieved with minimum morbidity by suitable preoperative evaluation and technical experts. Keywords: Malrotated kidney; Nephrostomy, Percutaneous; Nephrolithiasis; Abnormality

scholarly journals Percutaneous nephrolithotomy through superior calyceal approach - our experience

Pulse ◽  
1970 ◽  
Vol 3 (1) ◽  
pp. 4-6
Author(s):  
AU Shaikh ◽  
R Biswas ◽  
NUM Arif ◽  
N Miah ◽  
W Zaman
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Invasive Procedure ◽  
Renal Stones ◽  
Renal Calculi ◽  
Stone Size ◽  
Stone Clearance ◽  
X Ray ◽  
Percutaneous Punctures ◽  
Main Complication

Introduction: Percutaneous Nephrolithotomy (PCNL) is considered the treatment of choice for large (> 2 cm size) renal stones at present. Aim of this study was to evaluate the results of PCNL as monotherapy in our centre which were done through superior calyceal approach.Materials and Methods: Seventy five patients with three bilateral renal stone (total 78 renal units) that underwent PCNL through superior calyceal approach at Apollo Hospitals Dhaka from May 15, 2005 to December 15, 2007 were included in this retrospective study. Selected patients had renal stones more than 2 cm in size (average stone size 35 mm and surface area 750 mm2). Ultrasonogram, intravenous urogram and in some selected cases CT scan were done to detect the location and size of the stone. Urologist performed percutaneous punctures through superior calyx in prone position under fluoroscopic guidance and general anaesthesia were employed in all cases. Post-operative stone clearance was documented on plain X-ray KUB and ultrasonogram KUB.Results: PCNL was successfully (complete stone clearance and insignificant residue) carried out in 68 patients (69 renal units). Average stone clearance was 88.46%. No second look procedures were needed. Uro-sepsis was the main complication, occurred in 9 renal units (11.53 %) while urinary leakage/ fistula in 6.41%, significant bleeding in 6 renal units (7.69 %) and pleural breach with fluid in pleural cavity (hydrothorax) in 2 (2.6 %) cases. Mean blood transfusion was 1.2 units and mean hospital stay was 67 hours.Conclusion: Monotherapy with PCNL is highly effective in the treatment of large volume renal calculi and staghorn calculi using superior calyceal supracostal and subcostal approach. As a minimally invasive procedure, it is quite safe in experienced hand.Keywords: Percutaneous nephrolithotomy, Renal stone, Superior calyceal puncture, Staghorn calculiDOI: 10.3329/pulse.v3i1.6543Pulse Vol.3(1) July 2009 p4-6

scholarly journals Intraoperative flexible nephroscopy during percutaneous nephrolithotomy: An 8 years’ experience

2021 ◽  
Vol 37 (3) ◽  
Author(s):  
Yasir Masood ◽  
Nadeem Iqbal ◽  
Raja Mohsin Farooq ◽  
Sajid Iqbal ◽  
Faheemullah Khan
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Hounsfield Unit ◽  
Renal Stones ◽  
Stone Size ◽  
Group I ◽  
Stone Free Rate ◽  
Group Ii ◽  
Free Rate

Objectives: To see the effect of intra operative antegrade flexible nephroscopy during Percutaneous nephrolithotomy on stone free rate. Methods: We retrospectively reviewed electronic medical records of patients who underwent percutaneous nephrolithotomy from 2010 to 2017 for renal stones >2cm. Patients found eligible were divided in, Group-I who did not have intraoperative Flexible nephroscopy and Group-II who had flexible nephroscopy during percutaneous nephrolithotomy. All procedures were done by senior consultants. Variables like Mean age, side, stone size, skin to stone distance and Hounsfield unit were compared. Outcomes like Stone free rate, hospital stay and operative time were compared between the groups. Results: The study included 248 patients, consisting 85 (34.3%) females and 163 (65.7%) males. Mean age ± SD was 45.8±13.8 years. Both group were similar in characteristics like mean age, stone size, skin to stone distance and Hounsfield units. The overall stone free rate was 71%. It was not significantly different between the groups, 76% in Group-II vs. 67% in Group-I. However stone free rate markedly improved with flexible nephroscopy in patients with staghorn calculi. Mean operative time and hospital stay were similar between the groups. Conclusions: Intraoperative flexible nephroscopy during percutaneous nephrolithotomy significantly increases stone free rate in patients with staghorn stones. doi: https://doi.org/10.12669/pjms.37.3.3565 How to cite this:Masood Y, Iqbal N, Farooq RM, Iqbal S, Khan F. Intraoperative flexible nephroscopy during percutaneous nephrolithotomy: An 8 years’ experience. Pak J Med Sci. 2021;37(3):---------. doi: https://doi.org/10.12669/pjms.37.3.3565 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals CORRELATION BETWEEN S.T.O.N.E NEPHROLITHOMETRY SCORING IN PREDICTING FREE-STONE RATE AFTER PERCUTANEOUS NEPHROLITHOTOMY

2017 ◽  
Vol 24 (1) ◽  
Author(s):  
Karinda triharyu caesari Putri ◽  
Tarmono Djojodimejo ◽  
Fikri Rizaldi ◽  
Sunaryo Hardjowijoto
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Scoring System ◽  
Renal Stones ◽  
Stone Size ◽  
Residual Stone ◽  
Before And After ◽  
Operative Evaluation ◽  
Contrast Ct ◽  
Stone Density ◽  
Outcome Of Surgery

Objective: To investigate free-stone rate after Percutaneous Nephrolithotomy (PNL) using S.T.O.N.E nephrolitometry scoring system, with regards of stone size (S), skin-to-stone distance (T), obstruction degree (O), number of calyx involved (N), and stone density (E) in Non Contrast CT Scan (NCCT). Material & methods: This is an analytic observational study on patients with renal stones undergoing PNL. All patients underwent NCCT before and after PNL; each variables was measured and counted for a total score. Post-operative evaluation was done using NCCT. Results: Thirty patients met inclusion criteria, 19 (63.3%) were stone-free, and 11 (36.7%) were with residual stone. Among the five variables, stone size (p=0.005), number of calyx involved (p=0.002) affected the outcome of surgery, while skin-to-stone distance, obstruction degree, and stone density did not. The overall total score of S.T.O.N.E nephrolithometry is correlated with the outcome of PNL (p=0.001). Conclusion: S.T.O.N.E nephrolithometry is a simple scoring system, while it is also easy to use, and can be used to predict the free-stone rate after PNL.

Use of Amplatz Sheath in Percutaneous Nephrolithotomy and effect of its various sizes: Randomized Controlled Trial

2020 ◽  
Author(s):  
Adnan Siddiq
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Controlled Trial ◽  
Renal Stones ◽  
P Value ◽  
Common Source ◽  
Stone Size ◽  
Group A ◽  
Group B ◽  
Hemoglobin Drop

Background: Nephrostomy tract itself is the most common source of hemorrhage during percutaneous nephrolithotomy, which can be avoided by puncturing through the calyx with minimal angulation between calyceal system and the nephroscope shaft. Smaller the sheath diameter, lesser would be the bleeding. Our objective was to compare mean change in hemoglobin (HB) level in patients undergoing percutaneous nephrolithotomy (PCNL) with 24 versus 30 French Amplatz sheath. Methods: In this study, 142 patients were randomly divided into Group A undergoing procedure with 24 French Amplatz sheath; and Group B with 30 French sheath. At the end of procedure in both groups, nephrostomy tube was kept for 24 hours. On first post-operative day, patients’ HB was checked and compared with pre-operative data, along with blood transfusion rates. SPSS 20 was used for data analysis and p-value < 0.05 was considered significant. Results: Median age and interquartile range of Group-A and Group-B patients was (40; 18) and (41; 21) years respectively. While stone size of Group-A and Group-B patients reported as (2.0; 0.60) and (2.1; 0.70) cm. The operative time and interquartile ratio of Group-A and Group-B patients was (75; 45) and (85; 45) minutes and we found significant change in HB of Group-A (0.90; 0.80) with Group-B patients (1.90; 0.70) gm/dl respectively [p = 0.000]. Conclusion: It was observed that use of 24 French Amplatz sheath lead to less renal hemorrhage and less hemoglobin drop compared to standard 30 French Amplatz sheath. Thus, small size Amplatz sheath in percutaneous nephrolithotomy may be considered effective and safe option for treatment of renal stones.

Early multicentre experience of ultra-mini percutaneous nephrolithotomy in the UK

2016 ◽  
Vol 10 (2) ◽  
pp. 124-128 ◽  
Author(s):  
Ben Pullar ◽  
Eric Havranek ◽  
Tony J R Blacker ◽  
Sam N Datta ◽  
Bhaskar Somani ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Stones ◽  
Stone Disease ◽  
Stone Size ◽  
Novel Technique ◽  
Post Procedure ◽  
Central Database ◽  
The Uk ◽  
Percutaneous Renal Access ◽  
Patient Stone

Objectives: Ultra-mini percutaneous nephrolithotomy (UMP) is a novel technique recently introduced allowing percutaneous renal access to stones using a specially modified 11 or 13 Fr sheath, a 6 Fr nephroscope, and permits laser fragmentation and stone evacuation. This study aimed to review the early practice of UMP in the UK. Methods: All centres in the UK which had performed UMP were contacted to submit data. Data were submitted to a central database from nine centres around the UK who performed UMP between July 2013 and December 2014. Data were collected on patient, stone, operative factors and outcomes. Results: A total of 32 UMP cases were performed in the contributing centres. Stone size ranged from 7 mm×5 mm to 24 mm×24 mm across the 32 cases, with a mean of 13 mm×10 mm. Stone-free rates were excellent with 31/32 cases stone-free post procedure; 26/32 patients were left without a nephrostomy tube. Complications were uncommon; there were two Clavien 1 complications in this series (6%). Conclusion: This study has shown the efficacy of UMP during its introduction into UK practice. It is likely that UMP will become a useful addition to the armamentarium to treat renal stones, especially smaller stones in the lower pole calyx, and in specialised cases such as paediatric stone disease and in patients with stones in calyceal diverticulae.

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