Counter-Irrigation as a Novel Technique versus the Standard Technique in Percutaneous Nephrolithotomy: A Prospective Randomized Trial

2021 ◽  
pp. 1-7
Author(s):  
Ahmed El-Sakka ◽  
Abdelnaser Elgamasy ◽  
Karim Sallam ◽  
Mohamed G. Soliman
Keyword(s):  
Blood Transfusion ◽  
Hospital Stay ◽  
Randomized Trial ◽  
Percutaneous Nephrolithotomy ◽  
Standard Technique ◽  
Prospective Randomized Trial ◽  
Stone Free Rate ◽  
Group A ◽  
Group B ◽  
Free Rate

<b><i>Objective:</i></b> This study aimed to evaluate the efficacy of our counter-irrigation technique versus the standard technique in percutaneous nephrolithotomy (PCNL) by assessment of the stone-free rate after the procedures and its safety in terms of comparing the intraoperative time, Hb deficit, blood transfusion, length of hospital stay, auxiliary procedures, and perioperative complications with that of the standard one. <b><i>Methods:</i></b> This prospective randomized trial was conducted on patients with renal stone 2–3 cm in diameter without contraindications to PCNL. The patients were randomized into group A in which the counter-irrigation technique has been performed and group B who were managed by the standard technique. The preoperative characteristics including demographic data and stone parameters were compared between both groups. The primary outcome was the stone-free rate assessed by noncontrast spiral CT after 3 months. The secondary outcome included intraoperative time, Hb deficit, blood transfusion, hospital stay, auxiliary procedure required, and rate of complications. <b><i>Results:</i></b> Forty-eight patients were included in this study. Overall, no significant difference was observed between both groups regarding preoperative characteristics, Hb deficit, and complication rate. Operative time was significantly shorter in group B (<i>p</i> = 0.001). None of our patients required blood transfusion. The stone-free rates at 3 months were significantly better in group A (95% for group A and 70% for group B, <i>p</i> = 0.04). <b><i>Conclusions:</i></b> Our results indicate that our counter-irrigation technique has lower stone migration with subsequent significantly better stone-free rate versus the standard technique. We can recommend this technique as a potentially valid option for cases with large stone burden when the access to the upper calyx is feasible to minimize significant residual fragments.

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 A prospective comparative study of ureterorenoscopy with and without DJ stenting for the management of ureteric stones

2021 ◽  
Vol 8 (12) ◽  
pp. 3606
Author(s):  
Dinesh Prasad ◽  
Yogesh Satani ◽  
Shivam Singh ◽  
Darpen Gajera
Keyword(s):  
Comparative Study ◽  
Hospital Stay ◽  
Operative Time ◽  
Ureteral Stones ◽  
Safe Alternative ◽  
Stone Free Rate ◽  
Group A ◽  
Prospective Comparative Study ◽  
Group B ◽  
Free Rate

Background: Urolithiasis is the most common urological disease. Surgical treatment of ureteral stones consists of four minimally invasive modalities including ESWL, URS, PCNL, and laparoscopic or robotic-assisted stone surgery. URS and ESWL are the most widely used techniques. However, the use of ureteral stents for the treatment of ureteral stones is still controversial. Herein, we did a comparative study of URS with and without DJ stenting for the management of ureteric stones. Objectives of current study were to compare prevalence of post-operative complications in patients undergoing ureterorenoscopy without ureteral stenting as compared to patients undergoing stenting procedure, to study the frequency of morbidity in patients during post -operative period in both ‘stent’ and ‘no stent’ groups. Stone free-rate, operative time, complications, hospital stay and need for re-treatment in both groups will be determined.Methods: 50 patients with ureteric stones admitted in our hospital-SMIMER fulfilling our inclusion and exclusion criteria were randomly divided in two groups- patients in group A (25) underwent URS without DJ stenting and group B (25) underwent URS with DJ stenting.Results: URS without DJ stenting had less operative time, less postoperative complications like pain, requirement of analgesia, hematuria, UTI, dysuria, fever, less readmission rate and less hospital stay, similar stone free rate compared to URS with DJ stenting but it requires higher surgical endoscopy skills with urological expertise.Conclusions: Thus, after adequate training, URS without DJ stenting can be recommended as a safe alternative procedure than URS with DJ stenting for management of ureteric stones. 

scholarly journals Efficacy and safety of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for treatment of large renal stones: a meta-analysis

2021 ◽  
Vol 49 (1) ◽  
pp. 030006052098313
Author(s):  
Tie Mao ◽  
Na Wei ◽  
Jing Yu ◽  
Yinghui Lu
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Percutaneous Nephrolithotomy ◽  
Meta Analysis ◽  
Renal Stones ◽  
Efficacy And Safety ◽  
Complementary Treatment ◽  
Laparoscopic Pyelolithotomy ◽  
Stone Free Rate ◽  
Free Rate

Background We aimed to compare the efficacy and safety of laparoscopic pyelolithotomy (LPL) versus percutaneous nephrolithotomy (PCNL) for treating renal stones larger than 2 cm. Methods We searched the PubMed, Embase, Web of Science, SinoMed, and Chinese National Knowledge Infrastructure databases for studies that compared the surgical outcomes of LPL and PCNL. We conducted a meta-analysis of the retrieved studies, expressed as weighted mean difference or risk ratios with 95% confidence intervals. Results We included 25 studies (1831 patients). LPL was associated with a significantly higher stone-free rate, lower rates of blood loss, complementary treatment, blood transfusion, and complications, and less reduction in hemoglobin level compared with PCNL. LPL and PCNL were similar in terms of duration of hospital stay, conversion rate, changes in glomerular filtration rate and creatinine level, and mean time of postoperative analgesia. However, LPL was associated with a longer operation time than PCNL. Conclusion LPL appears to be more effective and safer than PCNL in patients with large renal stones, by increasing the stone-free rate and reducing blood loss, complementary treatment, blood transfusion, and complications compared with PCNL. LPL may thus be a useful modality for treating patients with large renal stones.

scholarly journals Infective complications after percutaneous nephrolithotomy in relation to preoperative urine culture status

2019 ◽  
Vol 6 (1) ◽  
pp. 8-13
Author(s):  
Birendra Kumar Yadav ◽  
Robin Bahadur Basnet ◽  
Anil Shrestha ◽  
Parish Mani Shrestha
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Urine Culture ◽  
Operation Time ◽  
Group A ◽  
One Year ◽  
Group B ◽  
Stone Characteristics ◽  
Negative Urine Culture ◽  
Infective Complications

Introductions: Fever and sepsis after percutaneous nephrolithotomy (PCNL) secondary to urinary tract infection is a major determinant of overall post PCNL complications. This study aims to analyse infective complications after PCNL in relation to pre-operative urine culture status. Methods: A comparative analysis of post PCNL infective complications in pre-operative urine culture positive (Group A) and negative (Group B) was done for one year during June 2017 to May 2018 in department of urology, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal. Demographics, stone characteristics, mean operative time, post-operative hospital stay and post-operative complications as per Modified Clavien classification were compared between the two groups. Results: Out of total 136 PCNL patients, 51 were in Group A and 85 in Group B. Infective complications were significantly high, 28 (54.90%) in group A compared to 20 (23.53%) in group B, p=0.004. The most common isolate was Escherichia coli 19 (37.25%), sensitive to amikacin 37 (72.55%). The mean operation time, transfusion and hospital stay was not statically different in two groups. Morality occurred in 1 (1.96%) in group A. Conclusions: Infective complications were significantly high after PCNL in patients with preoperative positive urine culture, even when it was treated to sterile with sensitive antibiotics, compared to patients with preoperative negative urine culture.

scholarly journals Introducing in clinical practice a new laser suction handpiece for percutaneous nephrolithotomy

2021 ◽  
pp. 039156032110318
Author(s):  
Noam Bar-Yaakov ◽  
Haim Hertzberg ◽  
Ron Marom ◽  
Jemal Jikia ◽  
Roy Mano ◽  
...  
Keyword(s):  
Operative Time ◽  
Statistical Significance ◽  
Hounsfield Units ◽  
Stone Size ◽  
Stone Clearance ◽  
Stone Free Rate ◽  
Average Operative Time ◽  
Group A ◽  
Group B ◽  
Free Rate

Objective: To assess a novel combined laser suction handpiece (LSH) for performing PCNL in a clinical setting. Methods: The study comprised 40 consecutive PCNLs performed between May 2019 and February 2020. The first 20 procedures (Group A) were performed with conventional ultrasonic or pneumatic devices and the other 20 (Group B) were performed with the use of the new LSH. All patients were treated by tubeless supine PCNL. The groups were compared for demographics, clinical data, operative time, lithotrite effectiveness, stone clearance rate (SCR), and outcome. Results: Groups A and B were similar in age, and in stone size, complexity, and density (Hounsfield units) ( p < 0.05). The average operative time was 99 and 78 min, SCR 143 and 200 mm3/min, hospital stay 1.6 and 1.1 days, and stone-free rate 90% and 95%, respectively. Despite a trend toward better results with the new LSH, none of these comparisons reached statistical significance. Ineffective lithotripsy with the initial device (ultrasonic) requiring conversion to another modality (ballistic) occurred in six (30%) procedures in Group A, while all procedures were effectively accomplished with the LSH in Group B ( p = 0.02). There were two complications in Group A and none in Group B ( p > 0.05). Conclusions: The LSH is as effective and safe as the traditional lithotrites for performing PCNLs. This new tool completes the capabilities of the holmium laser high-power machines, enabling them to serve as the sole platform for all endourological treatments.

scholarly journals Supine versus prone position in percutaneous nephrolithotomy: a systematic review and meta-analysis

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 231
Author(s):  
Ponco Birowo ◽  
William Tendi ◽  
Indah S. Widyahening ◽  
Nur Rasyid ◽  
Widi Atmoko
Keyword(s):  
Hospital Stay ◽  
Prone Position ◽  
Percutaneous Nephrolithotomy ◽  
Complication Rate ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Major Complication ◽  
Stone Free Rate ◽  
Major Complication Rate ◽  
Free Rate

Background: The decision for using supine or prone position in percutaneous nephrolithotomy (PCNL) is still debatable. The aim of this study is to compare the efficacy and safety profile of the supine and prone position when performing PCNL. Methods: A systematic electronic search was performed using the database from MEDLINE, Cochrane library and Google Scholar from January 2009 to November 2019. The outcomes assessed were stone free rate, major complication rate, length of hospital stay and mean operation time. Results: A total of 11 articles were included in qualitative and quantitative analysis. The efficacy of PCNL in supine position as determined by stone free rate is significantly lower than in prone position (OR: 0.74; 95% CI: 0.66 – 0.83; p<0.00001), However, major complication rate is also lower in the supine group compared with the prone group (OR: 0.70; 95% CI: 0.51 – 0.96; p=0.03). There is no statistically significant difference in the length of hospital stay and mean operation time between both groups. Conclusion: Prone position leads to a higher stone free rate, but also a higher rate of major complication. Thus, the decision of using which position during PCNL should be based on the surgeon’s experience and clinical aspects of the patients.

scholarly journals Factors Affecting Transfusion During Percutaneous Nephrolithotomy: A Retrospective Study of 665 Cases

2021 ◽  
Author(s):  
Hong Zhao ◽  
Jun-Sheng Li ◽  
Li Li ◽  
Hang Wang ◽  
Yi Miao ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Percutaneous Nephrolithotomy ◽  
Open Surgery ◽  
Transfusion Rate ◽  
Preoperative Hemoglobin ◽  
Stone Burden ◽  
Stone Free Rate ◽  
History Of ◽  
Stone Type ◽  
Free Rate

Abstract Purpose: To evaluate the aspects affecting transfusion following percutaneous nephrolithotomy (PCNL).Background: From 2016 to 2019, 665 patients underwent PCNL for removal of renal calculi in our center. Complications, including hemorrhages, have been reported. Twenty-three patients (3.5%) have received a blood transfusion and twelve (1.9%) were treated by hyper-selective embolization. We focus on the influencing factors related to postoperative blood transfusion. The factors analyzed were (age, sex, hypertension, diabetes, serum creatinine level, preoperative hemoglobin, and use of anticoagulants or antiplatelet medications); renal and stone factors (previous surgery, abnormal anatomy, stone side, stone burden, stone type); and surgical features: (access number, the calyx of puncture and stone-free rate). These data were analyzed for the presence of bleeding.Results: Among individual factors, preoperative hemoglobin level (P<0.001), and urinary infection (P<0.001) were significantly correlated with blood transfusion. Among renal and stone factors, only previous history of open surgery was significantly correlated with blood transfusion (P<0.05). Stone type or stone burden does not correlate with transfusion. There was also no statistically significant correlation between surgical features and bleeding, and a lower stone-free rate reported for transfusion group.Conclusion: The obtained results demonstrated that PCNL is a safer surgery in a high volume center, but anemic conditions, infections and history of open surgery will significantly increase transfusion rate following PCNL.

scholarly journals Micropercutaneous Laser Lithotripsy: How to Improve Stone Free Rate

2020 ◽  
Vol 2 (4) ◽  
Keyword(s):  
Kidney Stones ◽  
Laser Lithotripsy ◽  
Ureteral Access Sheath ◽  
Endoscopic Control ◽  
Extracorporeal Shock Wave ◽  
Stone Free Rate ◽  
Group A ◽  
Thulium Fiber Laser ◽  
Group B ◽  
Free Rate

Introduction: Micropercutaneous Nephrolithotomy is a novel technique with the creation of a 4.85-8F working channel. The advantage of micro-PCNL is the possibility of kidney puncture under direct endoscopic control. Materials and Methods: 99 patients aged 47,3 ± 16.9 years were included in the study. 78 patients had isolated kidney stones (78.8%). The stone size ranged from 8 to 38 mm (13.9 ± 5.4 mm). Group A included stones smaller than 15 mm (57 patients, 57,6%) and Group B included stones larger than 15 mm (42 patients, 42,4%). A 4.85 F percutaneous sheath was used in 38 (38,4%) patients, 8 F sheath was used in 61 (61,6%) patients. A holmium laser for lithotripsy was used in 46.5% cases, the thulium fiber laser in 53.5%. Results: The average surgery time was 39,9 ± 13.7 min (from 13 to 75 min). A stone-free rate (SFR) for patients of both groups was 88.8%. A Double-J stent was placed in 39 (39.4%) patients. In one case conversion to the mini-PCNL was done. In four cases (4%) retrograde stone manipulations were performed through ureteral access sheath. 5 (5.1%) patients required the second micro-PCNL tract. 3 (3%) patients required stenting postoperatively. In 7.1% of cases the episode of acute pyelonephritis developed. In 7 cases (7,1%), Extracorporeal Shock Wave Lithotripsy was required due to residual stones. Conclusions: We recommend using the laser micro-PCNL for the category of patients with severe comorbidities, including coagulopathy. The micro-PCNL could be safely performed in patients with kidney stones larger than 1.5 cm.

Ultrasonographic versus Fluoroscopic Access for Percutaneous Nephrolithotomy: A Meta-Analysis

2015 ◽  
Vol 95 (1) ◽  
pp. 15-25 ◽  
Author(s):  
Kun Wang ◽  
Peijin Zhang ◽  
Xianlin Xu ◽  
Min Fan
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Percutaneous Nephrolithotomy ◽  
Meta Analysis ◽  
Biomedical Literature ◽  
Controlled Trials ◽  
Intraoperative Blood Loss ◽  
Stone Free Rate ◽  
Operative Complications ◽  
Free Rate

Objective: To assess the safety and efficacy of ultrasonographic vs. fluoroscopic access for percutaneous nephrolithotomy (PCNL). Methods: Medline (PubMed), Embase, Ovid, Cochrane, and the Chinese Biomedical Literature databases were searched to identify clinically controlled trials (CCTs) and randomized controlled trials (RCTs) that compared ultrasonographic access with fluoroscopic access for PCNL. RevMan 5.1 software and Stat Manager V4.1 software were used for the meta-analysis. Results: Five RCTs and nine CCTs were included in our study, which contained a total of 3,019 patients. Of these, 1,574 (52%) had undergone ultrasonographic access, and 1,445 (48%) had undergone fluoroscopic access. The pooled results revealed that the ultrasonographic access patients had shorter duration of access (min) by 2.56 min (weighted mean difference (WMD) = −2.56, 95% confidence interval (CI): −4.40 to −0.72, p = 0.006). There was a higher stone-free rate in the ultrasonographic access group (odds ratio (OR) = 1.26, 95% CI: 1.02-1.55, p = 0.03), as well as a lower rate of operative complications (OR = 0.72, 95% CI: 0.56-0.93, p = 0.01), reduced intraoperative blood loss (ml) (WMD = −14.55 ml, 95% CI: −27.65 to −1.46, p = 0.03), and a lower rate of blood transfusion requirement (OR = 0.39, 95% CI: 0.24-0.63, p = 0.0001). Sensitivity and subgroup analyses were also performed. Conclusion: Except for no radiation exposure, our meta-analysis revealed that ultrasonographic access had many advantages, such as a shorter access time, reduced intraoperative blood loss, a lower rate of operative complications, a lower rate of blood transfusion, and a higher stone-free rate. Because of these significant advantages, we recommend the use of ultrasonographic access for PCNL.

The feasibility of one-day length of hospital stay after pediatric percutaneous nephrolithotomy

2021 ◽  
pp. 039156032199359
Author(s):  
Mohammed Saber-Khalah ◽  
A.M. Reyad ◽  
Wael Gamal ◽  
Hazem Elmoghazy ◽  
Ahmed Mamdouh Abd Elhamed ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Surgical Complications ◽  
Length Of Hospital Stay ◽  
Day Length ◽  
P Value ◽  
Stone Free Rate ◽  
Tube Removal ◽  
Free Rate

Purpose: To evaluate the safety of one-day length of hospital stay (LOS) after pediatric percutaneous nephrolithotomy (PNL), and to study the predictors of LOS. Methods: A retrospective study included pediatric patients who PNL for renal calculi more than 1 cm between January 2016 and October 2019. PNL was performed in prone position. The nephrostomy tubes and ureteric catheters were removed on the second day and patients were discharged if there was no perforation or significant residual stones. The stone free rate, LOS and the surgical complications were reported. Bivariate and multivariate analysis were used to predict the LOS. Results: 220 patients were identified. The median age (range) was eight (Range: 3–17) years. Stone free rate was achieved in 200 patients (91%) of patients, while residual fragments were detected in 20 patients (9%). Complications, they were reported in 50 (22.7%) patients. 184 (83.6%) of patients stayed at the hospital for only 1 day, while 36 (16. 4%) stayed more than 1 day. Of 36 patients who stayed more than one-day, 34 had complications ( p value <0.001). On multivariate analysis, surgical complications was found to be the only predictor of longer LOS ( p value <0.001). Conclusion: Early nephrostomy tube removal and 1-day length of hospital stay could be a safe option after pediatric PNL. Surgical complications is a statistically significant predictor of longer LOS.

Sign in / Sign up

Export Citation Format

Share Document