scholarly journals The Outcomes of Minimally Invasive Percutaneous Nephrolithotomy with Different Access Sizes for the Single Renal Stone ≤25 mm: A Randomized Prospective Study

2021 ◽  
pp. 1-6
Author(s):  
Weimin Yu ◽  
Yuan Ruan ◽  
Zhuang Xiong ◽  
Yunlong Zhang ◽  
Ting Rao ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Controlled Trial ◽  
Demographic Data ◽  
Operation Time ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Minimally Invasive Percutaneous Nephrolithotomy ◽  
Free Rate

<b><i>Objectives:</i></b> The aim of this study was to provide a randomized controlled trial comparing the outcomes of different access sizes used in the solo ultrasonic-guided minimally invasive percutaneous nephrolithotomy (mini-PCNL). <b><i>Methods:</i></b> From January 2018 to December 2019, a total of 160 cases with single renal stones of &#x3c;25 mm were randomized to undergo mini-PCNLs with Fr16, Fr18, Fr20, or Fr22 accesses. All accesses were established with the axis of the target calyx as the marker for puncture location and then expanded to the desired size. Hemoglobin reduction, operative time, stone-free rate, complications, etc., were all recorded and assessed. <b><i>Results:</i></b> The demographic data were similar, and there were no significantly intergroup differences in stone-free rate, complications, and hospital stay time. The hemoglobin reduction was comparable and was 0.9 ± 0.6, 0.9 ± 0.7, 1.0 ± 0.5, and 1.1 ± 0.7 g/dL for the groups Fr16, Fr18, Fr20, and Fr22, respectively. The operative time was 53.4 ± 14.5, 48.5 ± 15.2, 42.8 ± 13.3, and 43.3 ± 13.1 min for the 4 groups, which decreased significantly from group Fr16 to Fr20, but there was no significant difference between Fr20 and Fr22 groups. <b><i>Conclusions:</i></b> The axis of target calyx is a reliable marker for establishment of percutaneous renal access under ultrasonic guidance. The surgical outcomes of different access sizes were comparable, but the operation time was significantly shortened with the increase of size. However, Fr22 was not more efficient than Fr20.

Double-Sheath Vacuum Suction Minimally Invasive Percutaneous Nephrolithotomy for Management of Large Renal Stones

2021 ◽  
pp. 1-5
Author(s):  
Zhong-Hua Wu ◽  
Yong-Zhi Wang ◽  
Tong-Zu Liu ◽  
Xing-Huan Wang ◽  
Hang Zheng ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Percutaneous Nephrolithotomy ◽  
Operation Time ◽  
Renal Stones ◽  
Vacuum Suction ◽  
Conventional Procedure ◽  
Outer Sheath ◽  
Stone Free Rate ◽  
Minimally Invasive Percutaneous Nephrolithotomy ◽  
Free Rate

<b><i>Objectives:</i></b> This study aimed to describe a novel double-sheath vacuum suction minimally invasive percutaneous nephrolithotomy (mini-PCNL) to overcome the deficiencies of the conventional procedure. <b><i>Patients and Methods:</i></b> Between March 2019 and December 2019, 65 patients (37 males and 28 females) with a mean age of 41 years (range 23–69) underwent mini-PCNL with double-sheath vacuum suction. It consisted of an F20 Y-shaped sheath as an outer sheath and an F16 Y-shaped sheath as an inner sheath, in which the inner sheath was longer than the outer sheath. The oblique arm of the outer sheath and the inner sheath was connected to the perfusion inflow and the vacuum suction, respectively. A 550-μm holmium-YAG laser was introduced for stone fragmentation through the working channel of the mini-nephroscope, which was no longer connected to the perfusion fluid. <b><i>Results:</i></b> All procedures were successful. Mean operation time was 50.2 min (range 39–83). Mean hemoglobin decrease was 5.2 g/L (range 1.0–15.5), and no patient needed a blood transfusion. One patient (1.5%) with low fever (&#x3c;38°C) at day 1 had returned to normal at day 2 without administration of antibiotics. There were no Clavien grade 2–4 complications. Mean postoperative hospital stay was 2.4 days (range 2–6). The initial stone-free rate of PCNL was 81.53% (53 of 65 patients). One month after surgery, the final stone-free rate increased to 90.77% (59/65 patients). <b><i>Conclusions:</i></b> The double-sheath vacuum suction mini-PCNL is a safe and effective modality for large renal stones, which might increase the efficiency of stone extraction with low intrapelvic pressure.

scholarly journals Study of the safety and efficacy of minimally invasive percutaneous nephrolithotomy in the management of large and complex renal stone

2020 ◽  
Vol 7 (3) ◽  
pp. 725
Author(s):  
Rushabhkumar C. Somani ◽  
Chirag K. Sangada
Keyword(s):  
Minimally Invasive ◽  
Percutaneous Nephrolithotomy ◽  
Renal Pelvis ◽  
Urinary Calculi ◽  
P Value ◽  
Safety And Efficacy ◽  
Stone Free Rate ◽  
Duration Of Surgery ◽  
Minimally Invasive Percutaneous Nephrolithotomy ◽  
Free Rate

Background: Nephrolithiasis is highly prevalent across all demographic groups in the india and beyond, and its incidence rates are rising. In addition to the morbidity of the acute event, stone disease often becomes a lifelong problem that requires preventative therapy to diminish ongoing morbidity. Objective of this study to evaluate the safety and efficacy of minimally invasive percutaneous nephrolithotomy (PCNL) in the management of large and complex renal stone.Methods: This retrospective study includes 75 renal calculi patients with 100 renal units with large and complicated stone >20 mm. Stones were classified into simple (isolated renal pelvis or isolated calyceal stones) or complex (partial or complete stag horn stones, renal pelvis stones with accompanying calyceal stones). Then various parameter like decrease haemoglobin, surgical complication, creatinine level, duration of surgery etc were compared between simple and complex stones patients by calculation p value using online student t test calculator. P value less than 0.01 considered as a difference of significance.Results: The mean stone size was 35.5±20.37 mm and mean operative duration was 60±35.3 min. In all, cases 60 (80%) were stone-free after the first procedure and another 10 needed an auxiliary procedure (5 second-look PCNL, 3 extracorporeal shockwave lithotripsy-ESWL, 2 ureterorenoscopy, and) to become stone-free, resulting in a 93.33% stone-free rate. Complications occurred in 9 procedures (12%).Conclusions: From this study, it would be concluded that Minimally invasive PCNL provided significantly higher stone-free rate and efficiency quotient for management of urinary calculi. Overall complications are usually observed in patients having intraoperative hypotension and increased intra operative time.

scholarly journals Minimally Invasive Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery for Upper Urinary Stones: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-14 ◽  
Author(s):  
Hongyang Jiang ◽  
Zhe Yu ◽  
Liping Chen ◽  
Tao Wang ◽  
Zhuo Liu ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Minimally Invasive ◽  
Percutaneous Nephrolithotomy ◽  
Meta Analysis ◽  
Urinary Calculi ◽  
Operation Time ◽  
Urinary Stones ◽  
Retrograde Intrarenal Surgery ◽  
Significant Difference ◽  
Minimally Invasive Percutaneous Nephrolithotomy

Minimally invasive percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) are both alternatives for PCNL to treat renal calculi. This study is aimed at comparing the stone-free rate (SFR) and other surgery parameters of two approaches for treating upper urinary calculi. We performed this meta-analysis in September 2016 by searching studies about mini-PCNL and RIRS for treating upper urinary calculi in various databases, and RevMan v.5.3 was applied. Three randomized controlled trials and ten nonrandomized trials were included, involving a total of 1317 patients. Meta-analysis showed that mini-PCNL group led to a higher SFR [odds ratio: 1.96; 95% confidence interval: 1.46–2.64; P<0.00001] but brought a larger postoperative decrease in hemoglobin levels compared with RIRS. RIRS provided a shorter hospital time. There was no significant difference in operation time. Higher postoperative complications were detected in the mini-PCNL, but the difference was not significant. Grade I and III complications did not vary between two procedures, but grade II complications were of lower incidence in RIRS group. In the light of these results, compared with RIRS, mini-PCNL provided significantly higher SFR and efficiency quotient for managing calculi; however, it resulted in higher incidence of postoperative complications, larger hemoglobin drops, and longer hospital stay.

scholarly journals Bilateral simultaneous percutaneous nephrolithotomy versus staged approach: a critical analysis of complications and renal function

2020 ◽  
Vol 66 (12) ◽  
pp. 1696-1701
Author(s):  
Fabio C. M. Torricelli ◽  
Regina S. Carvalho ◽  
Giovanni S. Marchini ◽  
Alexandre Danilovic ◽  
Fabio C. Vicentini ◽  
...  
Keyword(s):  
Renal Function ◽  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Safe Procedure ◽  
Stone Free Rate ◽  
Significant Difference ◽  
The Impact ◽  
Free Rate

SUMMARY INTRODUCTION: Patients with bilateral kidney stones and burdened by large stones are challenging cases for endourologists. Simultaneous bilateral percutaneous nephrolithotomy (sbPCNL) is an option; however, it may be accompanied by important morbidity. An alternative is a staged PCNL, operating one side each time. Herein, we compare the impact of sbPCNL and staged PCNL on complication rates and renal function. METHODS: Patients who underwent sbPCNL or staged bilateral PCNL with a frame time of 6 months were searched in our prospectively collected kidney stone database. Groups were compared for age, gender, body mass index (BMI), comorbidities (classification by the American Society of Anesthesiology - ASA), stone size, Guy's score, stone-free status, renal function, blood loss, blood transfusion rate, complication rate, and length of hospital stay. RESULTS: Twenty-six patients and 52 kidney units were enrolled. The mean operative time was 134.7 min. Only 11.3% of cases had complications, all of them minor (Clavien ≤ 2). Overall, the stone-free rate was 61.50%. Comparing the groups, there was a significantly longer operative time in the sbPCNL group (172.5 vs. 126.3 min; p=0.016), as well as a higher transfusion rate (12.5% vs. 5.6%; p=0.036). There was no statistically significant difference in creatinine levels between the groups. Regarding the stone-free rate, there was a significantly higher proportion of patients in the staged PCNL group (64.9% vs. 43.8%; p=0.012). CONCLUSION: sbPCNL is a safe procedure; however, when compared to staged procedures it has a higher transfusion and lower stone-free rate.

scholarly journals Transverse Versus Longitudinal Uterine Incision in Abdominal Myomectomy: A Randomized Controlled trial

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A Elguindy ◽  
H Hemeda ◽  
M Esmat ◽  
M Nawara ◽  
A M F Metwally
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Controlled Trial ◽  
Demographic Data ◽  
Operative Blood Loss ◽  
Postoperative Fever ◽  
Abdominal Myomectomy ◽  
Randomized Controlled ◽  
Uterine Incision ◽  
Significant Difference

Abstract Objective The Aim of the study is to compare between transverse and longitudinal uterine incision in abdominal myomectomy regarding intraoperative blood loss Design: A randomized Controlled interventional study. Setting Ain Shams Maternity teaching hospital. Patients and methods 52 patients undergoing abdominal myomectomy for single myoma were involved The patients were randomized into two groups that showed no significant difference in demographic data, characters of myoma or indication of surgery Results Our results proved that there was no significant difference between both incisions regarding intra-operative blood loss, need for blood transfusion, post-operative Hgb drop, operative time or incidence of postoperative fever. Conclusion Transverse uterine incision for myomectomy does not cause more blood loss than longitudinal incision. There is no difference between both incisions in operative time or postoperative complications Trial identifier: NCT03009812, MY-789

Percutaneous-Based Management of Staghorn Calculi in Solitary Kidney: Combined Mini Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery

2014 ◽  
Vol 94 (1) ◽  
pp. 70-73 ◽  
Author(s):  
Wen Zhong ◽  
Zhijian Zhao ◽  
Liang Wang ◽  
Sunil Swami ◽  
Guohua Zeng
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Operation Time ◽  
Solitary Kidney ◽  
Retrograde Intrarenal Surgery ◽  
Staghorn Calculi ◽  
Combined Use ◽  
Stone Free Rate ◽  
Group 2 ◽  
Free Rate ◽  
Group 1

Introduction: Mini percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) are well-established techniques with little morbidity. The combined use of standard PCNL and the mini-PCNL or the RIRS technique was evaluated and compared to investigate their own role in the management of staghorn calculi in solitary kidney. Materials and Methods: 23 patients received combined standard PCNL and mini-PCNL (group 1), and 22 patients received combined standard PCNL and RIRS (group 2). The treatment results and complications were evaluated and compared. Results: The mean operation time was 128.8 ± 9.1 min in group 1 and 109.8 ± 10.7 min in group 2 (p < 0.001). The decrease in hemoglobin level in group 1 was significantly higher than that in group 2 (3.5 ± 0.6 vs. 2.1 ± 0.5 g/dl, p < 0.001). The final stone-free rate was significantly higher (p = 0.038) in group 2 (90.9%) than in group 1 (65.2%). Conclusions: Combined standard PCNL and RIRS technique can extract the majority of staghorn calculi quickly by PCNL with EMS Lithoclast, and RIRS used simultaneously can reduce the need for multiple tracts and therefore reduce blood loss and potential morbidity related to multiple tracts, shorten the operation time and achieve a high stone-free rate.

scholarly journals Ultrasonography-Guided Percutaneous Nephrolithotomy for the Treatment of Urolithiasis in Patients with Scoliosis

2012 ◽  
Vol 97 (2) ◽  
pp. 182-188 ◽  
Author(s):  
Hongyan Li ◽  
Zhuo Zhang ◽  
Hai Li ◽  
Yuanyuan Xing ◽  
Gang Zhang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Single Session ◽  
Minimally Invasive Percutaneous Nephrolithotomy ◽  
The Mean ◽  
Ultrasonographic Guidance ◽  
Mean Time ◽  
Treatment Of Urolithiasis

Abstract We examined the surgical outcomes of minimally invasive percutaneous nephrolithotomy (MPCNL) in scoliotic patients with complicating urolithiasis. Two patients with scoliosis were hospitalized for MPNCL due to upper tract urolithiasis. Calyx puncture was performed in the prone position under ultrasonographic guidance. The renal access route was established using a set of 8F to 16F dilators, and a transpyelic ballistic lithotriptor was used to fragment the calculi. The stone burdens in the 2 patients were 410 mm2 and 500 mm2. The entire operative time was 40 to 70 minutes, and the mean time of establishing percutaneous access was 20 minutes. The calculi were completely removed by single-session pneumatic lithotripsy. The 2 patients recovered from MPCNL uneventfully, and the follow-up radiologic examinations identified no stone residual or recurrence. MPCNL is a minimally invasive modality that is effective and safe for the treatment of urolithiasis in patients with scoliosis.

scholarly journals Prospective study on standard and totally tubeless percutaneous nephrolithotomy

2019 ◽  
Vol 6 (11) ◽  
pp. 3972
Author(s):  
V. Vishnu Vardhana Reddy ◽  
Amar Kumar Repaka
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Elective Surgery ◽  
Demographic Data ◽  
Operation Time ◽  
Patient Comfort ◽  
Standard Group ◽  
Early Return ◽  
Significant Difference ◽  
Analgesia Requirement ◽  
Tubeless Percutaneous Nephrolithotomy

Background: With the improvement of instrumentation and experience of percutaneous nephrolithotomy (PCNL), several modifications to the procedure have taken place in order to reduce the morbidity and early return to normal lifestyle. This study aimed to compare the totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy techniques.Methods: It is a prospective randomized, clinical trial done on 60 patients was patients older than 20 years and younger than 60 years who were chosen for elective surgery of kidney stones via the PCNL technique. Patients were divided into two groups, standard PCNL (with a nephrostomy tube) and totally tubeless PCNL (no ureter stents or ureteric catheters).Results: Demographic data is matched in two groups of patients. The mean operation time was slightly longer in the standard group (108 minutes) than in the totally tubeless group (102 minutes), but there was no statistically significant difference. There was no significant difference between the two groups with regard to serum creatinine change or blood loss. Haemoglobin drop, hospital stay, Pain score and analgesia requirement was significantly less in the totally tubeless group. 4 patients in each group had bleeding postoperatively. Only five patients developed pyrexia in the postoperative period. The differences in the need for blood transfusion and postoperative pyrexia were not found to be statistically significant. 19 in standard group and 2 patients in totally tubeless group developed urine leak, found to be statistically significant.Conclusions: Author can conclude that the tubeless procedure has fewer complications, improved postoperative patient comfort, shorter hospitalization, and a reduced need for analgesics. 

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