scholarly journals Are Nephrostomy and Ureteral Stent Necessary after Multi-Access Percutaneous Nephrolithotomy?

2019 ◽  
Vol 13 (3) ◽  
pp. 141-144 ◽  
Author(s):  
Seyed Mohammad Kazem Aghamir ◽  
Reza Heidari ◽  
Seyedehsara Bayesh ◽  
Alborz Salavati ◽  
Reza Elmimehr
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Length Of Hospital Stay ◽  
Renal Stones ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Single Access ◽  
Group A ◽  
Group B ◽  
Multi Access ◽  
Tubeless Pcnl

Introduction: Totally tubeless percutaneous nephrolithotomy (PCNL) is a well-established technique used in single -access procedure nevertheless these results challenge the multi-access PCNL as a contra-indication to application of this technique. Aims: To compare complication rates and safety of use of this technique after multi-access PCNL. Methods: A Total of 130 patients with renal stones were enrolled in this cohort study. Totally tubeless PCNL with single access (Group A, n = 70) and multi-access (Group B, n = 60) were done and bleedings were assessed by measuring hemoglobin (Hb) drop, blood transfusion rate and need for angioembolization besides leakage rates which were also recorded. Results: In the 130 patients who underwent totally tubeless PCNL, no leakage from puncture site nor angioembolization cases were identified. There was no significant statistical differences between 2 groups regarding Hb drop (1.91 in single access versus 2.20 in multi-access), transfusion rate and length of hospital stay (p > 0.05). Stone-free rate was increased from 91% in single access to 97% in multi access by adding percutaneous access sites (from 91% in single access to 97% in multi-access). Conclusions: Multi-access totally tubeless PCNL seems feasible and has comparable complication rates including Hb drop besides providing the advantage of higher stone-free rates using multi-access tracts.

Comparing Bleeding Complications of Double and Single Access Totally Tubeless PCNL: Is It Safe to Obtain More Accesses?

2015 ◽  
Vol 96 (1) ◽  
pp. 73-76 ◽  
Author(s):  
Seyed Mohammad Kazem Aghamir ◽  
Reza Elmimehr ◽  
Seyed Saeed Modaresi ◽  
Alborz Salavati
Keyword(s):  
Blood Transfusion ◽  
Renal Stones ◽  
Bleeding Complications ◽  
Transfusion Rate ◽  
Average Hospital ◽  
Single Access ◽  
Group A ◽  
Group B ◽  
Hemoglobin Drop ◽  
Tubeless Pcnl

Purpose: To assess bleeding complications in totally tubeless double-access percutaneous nephrolithotomy (PCNL) and compare it with the single-access method. Methods: One hundred and seven patients with large or scattered renal stones were enrolled in this cohort study. Totally tubeless PCNL with one access (group A, 70 cases) or two accesses (group B, 37 cases) was done and bleeding was assessed by measuring the hemoglobin drop of the patients, blood transfusion rate and need for performing angioembolization. Results: The mean (SD) hemoglobin drops in groups A and B were 1.97 (1.24) and 2.31 (1.24), respectively; p = 0.176. Blood transfusion rates in two groups were 7.1 and 10.8% (p = 0.716), respectively. None of our patients required angioembolization. The average hemoglobin drop and blood transfusion rate with double tracts were approximately near to those in single tract group and in acceptable ranges. The average hospital stay in groups A and B were 3.1 and 3.2 days (p = 0.074), respectively. There was no leakage from puncture site/s and stone free rates in the two groups were 85.7 and 97.3% (p = 0.093). Conclusion: Totally tubeless double-access PCNL is feasible and bleeding complications are comparable to single access totally tubeless PCNL making it an effective strategy to achieve more stone free rates.

scholarly journals Comparison of tubeless versus tubed percutaneous nephrolithotomy

2018 ◽  
Vol 8 (1) ◽  
pp. 24-31
Author(s):  
Rajiv Shah ◽  
Nirmal Lamichhane ◽  
Sudeep Raj K.C.
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Renal Calculi ◽  
P Value ◽  
Transfusion Rate ◽  
Operative Complications ◽  
Group A ◽  
Group B ◽  
Tubeless Pcnl ◽  
Post Operative Complications

Percutaneous nephrolithotomy (PCNL) is an effective treatment for large renal calculi and usually a nephrostomy tube is placed in the kidney at the end of procedure to avoid post operative complications. This is to compare the outcome of tubeless PCNL versus tubed PCNL. In a randomized prospective study of sixty-four consecutive patients were enrolled and divided into two groups; A being tubeless group and B being nephrostomy group with 32 patients in each arm divided by quota sampling restricted block method with allocation ratio of 1:1. The mean age in group A was 36.69 ± 13.65 years and in group B was 38.09 ± 13.18 years with no significant p value (p = 0.501). Duration of hospital stay in group A was 3.63 ± 1.04 days and in group B was 6.34 ± 1.71 days with a significant p value (p = 0.001). In group A 31 (96.9%) and in group B 24 (75%) cases were not transfused with blood while 1 (3.1%) and 8 (25%) cases were transfused with blood with a significant p value (p = 0.026). The post operative complications were comparable in between two groups. Therefore tubeless PCNL reduces the hospital stay and blood transfusion rate with no obvious post operative complications.

scholarly journals Safety and Efficacy of Percutaneous Nephrolithotomy in The Treatment of Renal Stones in Children

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A M A Badran ◽  
Y M Kotb ◽  
M K A Tolba
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Stones ◽  
Urinary Stone ◽  
Stone Disease ◽  
Age Group ◽  
Intraoperative Blood Loss ◽  
Urinary Stone Disease ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract Background the incidence of urinary stone disease has been increased due to the change in dietary habits, lifestyle factors and obesity. The prevalence of urinary stone disease was reported as 11.1% in the adult population, while the prevalence in children varies with age, it is approximately 2-3%. Open surgery was the only surgical treatment option in the past, now most pediatric urinary stones can be treated effectively by other procedures as extracorporial shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS) and laparoscopy. Aim of the Study to assess the safety and efficacy of percutaneous nephrolithotomy in the treatment of renal stones more than 15 mm in children aged 2-14 years old. Patients and Methods our study included 40 patients (28 males and 12 females) with a mean age (8.35 ± 3.69) with a range (2 to 14 years) managed by PCNL in 2 groups: Group A (Preschool age group): included 18 patients, 12 males (67%) and 6 females (33%) aged (2-6 years) managed by mini PCNL.Group B (School age group): included 22 patients, 16 male (73%) and 6 females (27%) aged (7-14 years) managed by standard PCNL. Results Success rate was nearly similar in both groups, it was 88.9% in group A and 95.5% in group B. Regarding the mean operative time it was 72.22 ± 12.63 in group A and 70.00 ± 15.74 in group B. Regarding the intraoperative blood loss it was more significant in group B with the mean intraoperative blood loss as 76.67 ± 15.34 in group A and 116.36 ± 22.79 in group B. Postoperative pain was more in group B than in group A, so 6 patients (33.3%) postoperative weak opiate analgesia in group A for less than 24 hours, while 16 patients (72.7%) needed postoperative weak opiate analgesia in group B. Hospital stay was 2.44 ± 0.51 in group A and 2.91 ± 1.02 in group B. Conclusion PCNL is a safe and effective procedure for management of renal stones in children, with accepted stone clearance rates and postoperative morbidity in addition to short hospital stay.

scholarly journals TUBELESS PERCUTANEOUS NEPHROLITHOTOMY;

2013 ◽  
Vol 20 (05) ◽  
pp. 787-792
Author(s):  
MUHAMMAD NASIR IBRAHIM ◽  
MUHAMMAD MUZAMMIL TAHIR ◽  
AMJAD ALI SADDIQUE ◽  
Mohammad Usman Khan
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Nephrostomy Tube ◽  
Dose Requirement ◽  
Ureteric Catheter ◽  
Analgesic Dose ◽  
Analgesia Requirement ◽  
Group A ◽  
Group B ◽  
Tubeless Pcnl

Revolutionary advances in the minimally invasive and non invasive management of stone disease over the past twodecades have greatly facilitated the removal of stones. Renal stone management moved from open surgery to minimally invasiveprocedures with the aim of achieving maximum stone clearance with the least morbidity and mortality. Percutaneous nephrolithotomy(PCNL) remains the most efficient procedure in all patient groups. Tubeless PCNL is increasing in popularity and the technique ofpercutaneous nephrolithotomy is in constant evolution. Nephrostomy tube has been implicated in causing postoperative discomfort orpain and morbidity. Nephrostomy-free or tubeless PCNL reduces postoperative pain and analgesia related to the drainage tube. Objective:To compare mean analgesia requirement with tubeless PCNL and standard PCNL in renal stone patients Study design: Randomizedcontrolled trial conducted at Shaikh Zayed Hospital Lahore from July 2010 to January 2011. Methods: 100 patients were divided into twogroups randomly by using random number tables i.e. 50 patients in group A and 50 patients in group B. Group A patients were operated bystandard PCNL method i.e. with Placement of nephrostomy tube and ureteric catheter and group B were operated by tubeless PCNL i.e.without nephrostomy tube but with ureteric catheter. The data was collected on attached predesigned computer based proforma. Results:The analgesic dose requirement in Group A was 116.50± 26.55mg and analgesic dose requirement in Group B was 73.00±30.24mg ofpethidine. So, analgesia requirement in both groups showed a significant difference (p<0.05). Conclusions: Tubeless PCNL can be usedwith a favorable outcome in renal stone patients, with the potential advantage of decreased analgesia requirement.

scholarly journals Influence of Aging in Outcomes of Patients Undergoing Percutaneous Nephrolithotomy for Staghorn Stones : A retrospective comparative study

2021 ◽  
Author(s):  
Murat Sahan ◽  
Serkan Yarımoğlu ◽  
Metin Savun ◽  
Onur Erdemoglu ◽  
Tansu Degirmenci
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Major Complication ◽  
Renal Stones ◽  
The Elderly ◽  
Treatment Method ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Number Of Patients ◽  
Group 2 ◽  
Group 1

Objective: To evaluate the effect of age on the success and complications of percutaneous nephrolithotomy (PCNL) in staghorn renal stones. Materials and Methods: The files of 182 patients who underwent single-access PCNL for staghorn renal stones between 2012 and 2017 were retrospectively analyzed. The patients were divided into two groups according to their age: those aged<65 years were defined as Group-1 and those aged≥65 years as Group-2. The demographic characteristics and perioperative and postoperative results were compared between the two groups. Results: Of the patients with staghorn renal stones,139 were in Group-1 and 43 were in Group-2. The mean age of the patients was 43.9±10.6 years for Group-1 and 67.8±2.1 years for Group-2(p=0.001). The amount of hemoglobin drop was statistically significantly higher in Group-1 (p=0.001). However, blood transfusion rate was higher in Group-2 than in Group-1 (18.6% and 7.2%, respectively). The stone-free rate was 54.7% in Group-1 and 67.4% in Group-2(p=0.139). According to the evaluation of the overall complication rates,34.5% of the patients in Group-1 and 46.5% of those in Group-2 developed complications(p=0.206). According to the Clavien scoring system, the rate of minor complications was found to be 22.3% in Group-1 and 41.9% in Group-2,and the difference was statistically significant (p=0.012). The major complication rates were determined as 4.7% and 12.2% for Group-1 and Group-2, respectively (p=0.155). The number of patients with Clavien grade-2 complications was statistically higher in the elderly patient group (p=0.019). Conclusions: PCNL can be used as an effective and safe treatment method in the treatment of complex stones in elderly patients.

scholarly journals Comparison of Standard Percutaneous Nephrolithotomy with Mini-Percutaneous Nephrolithotomy for Removal of Renal Stones in Adults

2021 ◽  
Vol 5 (2) ◽  
pp. 20-25
Author(s):  
Asif Alam Khan ◽  
Inam Malkani ◽  
Junaid Jameel Khattak ◽  
Hassan Mumtaz ◽  
Mubashir Mazhar ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Operative Time ◽  
Treatment Time ◽  
Renal Stones ◽  
Hemoglobin Level ◽  
Stone Clearance ◽  
Group A ◽  
The Mean ◽  
Group B

Renal stones are the third most common problem affecting about 10% of global population. The management of nephrolithiasis has undergone a complete transformation since the 1980s. Percutaneous nephrolithotomy (PCNL) has established itself an effective and safe technique that delivers high stone-free rate as well as overall shorter treatment time. We aim to compare the outcome of mini-PCNL with standard-PCNL in patients presenting with renal stones. In all, 90 patients fulfilled the selection criteria and randomized into two groups. Group A underwent mini-PCNL whereas Group B underwent standard-PCNL. Pre-operative hemoglobin level was recorded. Duration of procedure as well as drop in hemoglobin level was also recorded. A kidney, ureter, and bladder (KUB) X-ray was performed to confirm the presence of of stone and stone-free status. The mean age of patients in mini-PCNL group was 43.11 years and in standard-PCNL group, it was 36.91 years. The mean stone size in patients of mini-PCNL group was 29.53 mm and 31.58 mm in standard-PCNL group. The mean duration of renal stone in mini-PCNL group was 1.91 years and that in standard-PCNL group 1.80 years. The mean operative time in mini-PCNL group was 59.56 min and 61.22 min in standard-PCNL group. The mean fall in hemoglobin in mini-PCNL group was 0.38 g/dL and that in standard-PCNL group 0.51 g/dL. In mini-PCNL group, stone clearance was observed in 42 (93.3%) patients, while in standard-PCNL group, it was observed in 45 (100%) patients. This difference was insignificant (P > 0.05). Mini-PCNL and standard-PCNL have no significant differences in terms of outcome, operative time, and stone clearance, although fall in hemoglobin level was less in mini-PCNL group, which showed less blood loss in this group, thereby making it a more appropriate method for renal stone removal.  

scholarly journals Effects of perioperative enteral glutamine on surgical outcome in gastrointestinal cancer patients

2019 ◽  
Vol 6 (3) ◽  
pp. 903
Author(s):  
Raghavendra . ◽  
Raghupathi S.
Keyword(s):  
Hospital Stay ◽  
Anastomotic Leak ◽  
Gastrointestinal Cancer ◽  
Gastrointestinal Surgery ◽  
Length Of Hospital Stay ◽  
Complication Rates ◽  
Ultrasound Guided ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Previous trials have shown that perioperative glutamine could protect patients from infectious complications after gastrointestinal cancer operations.Methods: 54 patients with a planned elective operation for gastrointestinal cancer were divided into two groups: GROUP A: patients given glutamine enriched enteral nutrition perioperatively (n=27), GROUP B: patients given enteral feed without glutamine (n=27). Patients were assessed in terms of post-operative complications like infective complications, anastomotic leak, need for reintervention, length of hospital stay and mortality.Results: In group A seven patients and in group B six patients had surgical site infection post operatively (p=0.750). In group A five patients and in group B three patients had lung and urinary tract infection post operatively (p=0.444). In group A three patients and in group B five patients had intra-abdominal abscess/collection post operatively (p=0.444). In group A one patient and in group B three patients had anastomotic leak post operatively (p=0.299). In group A three patients and in group B three patients had reintervention in form of ultrasound guided aspiration and ultrasound guided pigtail aspiration for intra-abdominal collection (p=1.000). In group A and in group B mean length of hospital stay was 26 days and 23 days respectively (p=0.346). In group A and in group B mean length of post-operative hospital stay was 13 and 12 days respectively (p=0.642). There was no mortality in our study. No significant difference between the groups was found in complication rates, length of hospital stay.Conclusions: Routine perioperative glutamine to the patients undergoing major gastrointestinal surgery is not beneficial.

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.

scholarly journals IS RETROGRADE INTRARENAL SURGERY PREFEREABLE OVER MINI PERCUTANEOUS NEPHROLITHOTOMY IN PATIENTS WITH RENAL CALCULUS OF LESS THAN OR EQUAL TO 2 CM SIZE?

2020 ◽  
pp. 1-4
Author(s):  
Girish H M ◽  
Sanman K N ◽  
G G Laxman Prabhu ◽  
Ranjit Shetty
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Renal Calculus ◽  
Complication Rates ◽  
Operative Outcomes ◽  
Stone Free Rate ◽  
Group A ◽  
Laboratory Investigations ◽  
Group B ◽  
Free Rate

Objective: To compare intraoperative and post-operative outcomes between mini-percutaneous Nephrolithotomy (miniPCNL) and Retrograde intrarenoscopy (RIRS) groups. Materials and methods: A total of 66 patients were alternatively allocated to undergo miniPCNL (33patients, group A) and RIRS (33patients, group B) groups. All patients were evaluated by history, laboratory investigations, X-ray Kidney ureter bladder (KUB), Ultrasonography and computerized tomography (CT) scan to determine stone number, location and size. Operative time, stone free rate, duration of hospital stay and complications were compared between both groups. Results: Demographic parameters were comparable between two groups. Stone free rate was similar in both groups. Mean duration of procedure was less for miniPCNL when compared to RIRS with P < 0.0001. Duration of post-operative stay for miniPCNL was longer when compared to RIRS with P < 0.0001. Complications like intra operative bleeding, post-operative fever and blood transfusion were similar in both groups. The RIRS group patients experienced reasonably less pain postoperatively as per Visual analogue scale (VAS) score when compared to miniPCNL group with P < 0.0001. Conclusion: Though RIRS and miniPCNL have good and comparable stone free rate with low complication rates, favourable pain score and less hospital stay makes RIRS a preferred option over miniPCNL.

scholarly journals Percutaneous nephrolithotomy with or without nephrostomy tube

2018 ◽  
Vol 11 (2) ◽  
pp. 189
Author(s):  
Mohammed Aulad Hossain ◽  
S. M. Yunus Ali ◽  
Mohammad Saiful Islam ◽  
Mohammad Jahangir Alam ◽  
Mollah Md. Abu Sayed ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Renal Stones ◽  
Stone Disease ◽  
Nephrostomy Tube ◽  
Visual Analogue Pain ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B

<p class="Abstract">The study has been designed to compare the outcome of percutaneous nephrolithotomy with (Group A) or without nephrostomy tube (Group B) for the management of renal stone disease. JJ stents were given to all cases of both groups. Comparison of outcome between groups shows that urinary leakage time was significantly longer in Group B than that in Group A (24.0 ± 6.2 vs 7.3 ± 3.9 hours;  p&lt;0.001). Visual analogue pain score was also significantly high in Group B than in Group A (4.7 ± 0.8 vs 2.4 ± 0.5; p&lt;0.035). Patients in Group B stayed in hospital on an average 4 days, while the Group A patients stayed in hospital on an average 2.5 days (p&lt;0.029). The mean hemoglobin decrease in 24 hours in Group B and in Group A (0.5 ± 0.4 and 0.5 ± 0.4 respectively) did not show any significant difference (p&lt;0.895). In conclusion, percutaneous nephrolithotomy without nephrostomy tube can be practiced in the management of selective cases of renal stones diseases.</p>

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