scholarly journals THE EFFECTIVENESS OF ULTRASONIC LITHOTRIPTOR COMPARED TO COMBINED ULTRASONIC AND PNEUMATIC LITHOTRIPTOR IN PERCUTANEOUS NEPHROLITHOTOMY (PCNL) SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 28 (2) ◽  
pp. 179-186
Author(s):  
Anggana Suryatmana ◽  
Doddy M. Soebadi ◽  
Tarmono Djojodimedjo
Keyword(s):  
Statistical Model ◽  
Percutaneous Nephrolithotomy ◽  
Meta Analysis ◽  
Random Effect ◽  
Combination Group ◽  
Randomized Controlled ◽  
Stone Free Rate ◽  
Significant Difference ◽  
The Mean ◽  
Free Rate

Objective: To evaluate the effectiveness of the ultrasonic lithotriptor compared to the combined ultrasonic-pneumatic lithotriptor in percutaneous nephrolithotomy (PCNL). Material & Methods: A systematic search was conducted focusing on studies evaluating nephrolithiasis patients who underwent PCNL using pneumatic, ultrasonic, ultrasonic-pneumatic, or laser lithotriptor. The search was conducted in the PUBMED and Science-direct databases from early to September 2020. Results: There were 406 journals in the initial search. On further selection, 3 randomized controlled trials (RCT) were obtained, with a total of 251 patients. The stone-free rate of three studies had low heterogeneity, I2=0% (P=0.34), so a fixed effect statistical model was used. There was no significant difference (P=0.44) between the stone-free rates from the ultrasonic lithotriptor group and the combination with an odds ratio of 1.26 (95% CI = 0.70-2.26). High heterogeneity was obtained with I2=71% (P=0.03) for the mean fragmentation time, so random effect statistical model was used. There was no significant difference (P=0.56) between the mean fragmentation time of the ultrasonic lithotriptor and combination group with a mean difference of -3.69 (95% CI = -16.09-8.71). Conclusion: The ultrasonic lithotriptor did not have a significant difference in stone-free rate, and mean fragmentation time compared to the combined ultrasonic-pneumatic lithotriptor in PCNL. More RCT studies are needed.  

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.

Percutaneous nephrolithotomy of staghorn renal stones in pediatric patients using adult-sized instrument

2019 ◽  
Vol 86 (4) ◽  
pp. 211-215
Author(s):  
Akbar Nouralizadeh ◽  
Hamid Pakmanesh ◽  
Abbas Basiri ◽  
Mohammad Hadi Radfar ◽  
Behzad Narouie ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Pediatric Patients ◽  
Renal Stones ◽  
Adult Size ◽  
Efficacy And Safety ◽  
Double J Stent ◽  
Stone Free Rate ◽  
The Mean ◽  
Free Rate ◽  
Free Status

Introduction: In this study, we aimed to evaluate the safety and efficacy of the percutaneous nephrolithotomy procedure performed with adult-sized instruments in pediatric cases with staghorn kidney stone. Methods: We retrospectively evaluated the efficacy and safety of 94 percutaneous nephrolithotomy procedures performed during 15 years in a single center for 82 pediatric patients with staghorn calculi using adult-sized instruments (24-Fr nephroscope). Stone free status was defined as complete clearance of the stones or the presence of insignificant residual stones of <3 mm in diameter. Results: The mean age was 108 ± 53 months (range, 14–180 months). There were 39 patients (48%) with complete staghorn stones and 43 cases (52%) with partial staghorn. We fulfilled 91.4% of operations through a single access. The stone free rate was 86.6% after one percutaneous nephrolithotomy session. In total, seven patients referred for shock wave lithotripsy and four cases were scheduled for the second percutaneous nephrolithotomy session. Fever occurred in 18 patients (21%) and bleeding requiring transfusion in four children (5%). Prolonged leakage from nephrostomy site requiring anesthesia for double J stent placement occurred in one patient. No grade IV or V Clavien complication occurred. Conclusion: The success rate and complications of percutaneous nephrolithotomy with adult-size instruments in pediatric patients are acceptable.

scholarly journals Outcome and safety of upper pole versus non-upper pole single puncture PCNL for staghorn stones: a systematic review and meta-analysis

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 537
Author(s):  
Steven Gunawan ◽  
Ponco Birowo ◽  
Nur Rasyid ◽  
Widi Atmoko
Keyword(s):  
Meta Analysis ◽  
Direct Access ◽  
Risk Of Bleeding ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Complications Rate ◽  
Staghorn Stone ◽  
Review Manager ◽  
Free Rate ◽  
Staghorn Stones

Background: Staghorn stones are mostly treated by percutaneous nephrolithotomy (PCNL), either with an upper-pole (UP) or non-upper (lower- or middle-) pole (NP) approach. NP access has a lower risk of bleeding and thoracic complications but may not be sufficient for complete stone clearance. UP access is advocated as the preferred approach, because of direct access to the collecting system. However, it is associated with a higher complications rate, including pneumothorax and hydrothorax, and a higher risk of bleeding. This meta-analysis aimed to describe the outcomes and safety of PCNL for staghorn stones using UP and NP approaches. Methods: A systematic literature review was conducted using several databases such as: PubMed; EBSCO; Science Direct; Cochrane and Google Scholar. Data from all selected articles were extracted by two independent reviewers. Relevant parameters explored using Review Manager V5.3. Results: Five comparative studies of staghorn stones involving 384 renal units were analyzed; 176 cases used the UP approach and 208 the NP approach. There was no significant difference in stone-free rate between these approaches, with 74.4% undergoing the UP approach and 71.1% the NP approach considered stone-free (OR: 1.55; 95% CI: 0.92-2.63; P=0.10). The rate of thoracic complications (hydrothorax and pneumothorax) did not differ significantly (OR: 3.14; 95% CI: 0.63-15.62; P=0.16). However, we noted that 5 of 176 patients that underwent the UP approach experienced thoracic complications. The incidence of post-procedural fever and sepsis is similar (OR: 1.18; 95% CI: 0.52-2.64; P=0.69). Neither post-procedural urine leakage (OR: 2.03; 95% CI: 0.70-5.85; P=0.19) nor requirement of blood transfusions (OR: 0.49; 95% CI: 0.14-1.76; P=0.27) differed significantly. Conclusion: PCNL with UP access for staghorn stone has a similar stone-free rate to the NP approach. Thoracic complication rate which was believed to be higher in the UP group is also deemed similar with NP access.

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.

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.

scholarly journals Percutaneous nephrolithotomy versus open surgery for treatment of staghorn stones in pediatric patients

2014 ◽  
Vol 8 (11-12) ◽  
pp. 906 ◽  
Author(s):  
Ahmed R. EL-Nahas ◽  
Ahmed A Shokeir ◽  
Ahmed M Shoma ◽  
Ibrahim Eraky ◽  
Osama M Sarhan ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Open Surgery ◽  
Renal Stones ◽  
Small Sample ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Group 2 ◽  
Free Rate ◽  
Staghorn Stones

Introduction: We compare percutaneous nephrolithotomy (PCNL) and open surgery in the treatment of staghorn stones in children.Methods: We retrospectively reviewed the electronic records of children who underwent treatment for staghorn stones between September 2000 and August 2013. They were divided between Group 1 (patients who underwent PCNL) and Group 2 (patients who underwent open surgery). We compared stone-free and complications rates, need for multiple procedures, and hospital stay.Results: The study included 41 patients (35 boys and 6 girls), with mean age 7.4 ± 3.1 years (range: 2–15). Of these 41 patients, 26 had unilateral renal stone and 15 had bilateral renal stones. The total number of treated renal units was 56: 28 underwent PCNL and 28 underwent open surgery. The complication rate was comparable for both groups (32% for open surgery vs. 28.6%, p = 0.771). Multiple procedures were more needed in PCNL group (60.7% vs. 32% in open surgery, p = 0.032). The stone-free rate was 71.4% after PCNL and 78.6% after open surgery (p = 0.537). A significant difference was observed in shorter hospital stay after PCNL (5 vs. 8.8 days, p < 0.001). Our study’s limitations include its retrospective design and relatively small sample size.Conclusions: For the treatment of staghorn stones in children, PCNL was comparable to open surgery in complication and stone-free rates. PCNL had the advantage of a shorter hospital stay and open surgery showed a decreased need for multiple procedures. 

scholarly journals Factors affecting stone free rate of primary percutaneous nephrolithotomy on staghorn calculi: a single center experience of 15 years

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2106 ◽  
Author(s):  
Widi Atmoko ◽  
Ponco Birowo ◽  
Nur Rasyid
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Univariate Analysis ◽  
Staghorn Calculi ◽  
Stone Burden ◽  
Stone Free Rate ◽  
History Of ◽  
Renal Stone Surgery ◽  
The Mean ◽  
Free Rate

Objectives: Percutaneous nephrolithotomy on staghorn calculi is challenging for urologists because it is difficult to remove all of the stones. The purpose of this study was to evaluate the associated factors of stone-free rate after primary percutaneous nephrolithotomy on staghorn calculi in a large series of patients at a single, tertiary referral, endourologic stone center. Methods: We collected data from medical record between January 2000 and December 2015. A total of 345 primary percutaneous nephrolithotomy procedures were performed for patients with staghorn calculi. This study included both and made no distinction between partial and complete staghorn calculi. Stone-free is defined as the absence of residual stones after undergoing percutaneous nephrolithotomy for the first time. Significant factors from univariate analysis that correlated with stone-free rate after primary percutaneous nephrolithotomy of staghorn stone were further analyzed using multivariate regression analysis. Results: The mean patient age was 52.23±10.38 years. The stone-free rate of percutaneous nephrolithotomy monotherapy was 62.6%. The mean operating time was 79.55±34.46 minutes. The mean length of stay in hospital was 4.29±3.00 days. Using the chi-square test, history of ipsilateral open renal stone surgery (p = 0.01), stone burden (p = < 0.001), and type of anesthesia (p = 0.04) had a significant impact on the stone-free. From multivariate analysis, the history of ipsilateral open renal stone surgery [OR 0.48; 95% CI 0.28-0.81; p 0.01] and the stone burden [OR 0.28; 95% CI 0.18-0.45; p 0.00] were significant independent risk factors for stone-free.

scholarly journals Differences Effectiveness of Percutaneous Nephrolithotomy and Open Surgery in Staghorn Stone Patients: Systematic Review

2020 ◽  
Vol 4 (11) ◽  
pp. 381-385
Author(s):  
Ramandita Duta Dewangga ◽  
Tarmono Djojodimedjo ◽  
Dyah Erawati
Keyword(s):  
Systematic Review ◽  
Percutaneous Nephrolithotomy ◽  
Open Surgery ◽  
Meta Analysis ◽  
Number Of Patients ◽  
Stone Free Rate ◽  
Additional Therapy ◽  
Staghorn Stone ◽  
Free Rate ◽  
Staghorn Stones

This study purpose to analyze the differences in the effectiveness of PCNL and open surgery in patients with staghorn stones. We searched the literatures from PubMed and ScienceDirect from year 2005 until 2020. The method used in this study was a systematic review with a quantitative statistical approach (meta-analysis) using primary research data. From 4 studies there were 148 cases of PCNL and 98 cases of open surgery. PCNL had lower postoperative stone-free rate than open surgery (OR 0.168). PCNL had a lower final stone-free rate than open surgery (OR 0.603). The number of patients who had complications with PCNL was lower than open surgery (OR 0.451). The number of patients receiving blood transfusions on PCNL was lower than for open surgery (OR 0.494). Patients who received PCNL procedure required a shorter hospital stay than open surgery (MD -3,234). The number of patients who received additional therapy modalities on PCNL was lower than open surgery (OR 1.917). The conclusions obtained in this study indicate that there are differences in the effectiveness of PCNL and open surgery for patients with staghorn stones. Keywords: percutaneous nephrolithotomy; open surgery; staghorn stone

scholarly journals Comparative Study of Percutaneous Nephrolithotomy in Supine and Prone Positions

2021 ◽  
Vol 19 (1) ◽  
pp. 154-157
Author(s):  
Anup Chapagain ◽  
Robin Bahadur Basnet ◽  
Chitaranjan Shah ◽  
Arvind Kumar Shah ◽  
Parash Mani Shrestha ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Prone Position ◽  
Percutaneous Nephrolithotomy ◽  
Supine Position ◽  
Operative Duration ◽  
Stone Free Rate ◽  
The Mean ◽  
Group 2 ◽  
Free Rate ◽  
Group 1

Background: The aim of the study is the compare efficacy and safety of percutaneous nephrolithotomy in supine and prone positions. Percutaneous nephrolithotomy is conventionally performed in prone position but in recent years numbers of supine percutaneous nephrolithotomies is increasing globally.Methods: The hospital based cross-sectional observational study was conducted in the Department of Urology, Bir Hospital from July 2018 to January 2020. A total of 81 consecutive patients undergoing percutaneous nephrolithotomy were divided into two groups, with 38 patients in Supine (Group 1) and 43 patients in Prone (Group 2) positions, respectively. Patient’s demographics, access time, operative duration, stone free rate, radiation dose and duration, irrigation fluid volume, post-operative hemoglobin drop and complications were compared.Results: Demographic and stone characteristics were comparable in both groups. Supine Group (Group 1) had significantly shorter operative duration than Prone Group (Group 2), 44.63 ± 12.44minsvs 53.02 ±12.67mins (p< 0.04). The mean radiation duration was 99.11 ± 61.17secs in Group 1 and 108.40 ± 51.65 secs in Group 2 (p=0.46), respectively. Although the mean radiation dose was lower in Group 1 (375.1µGym2) than in Group 2 (465.7 µGym2), it was not statistically significant(p=0.24). The stone free rate at 1 month duration were comparable with 92.1% and 93.02% in Group 1 and Group 2 respectively (p=0.16). Overall complication rates were similar in both groups (15.7% in Group 1 vs 16.2% in Group 2), respectively. None of the patients in both groups had complications higher than Clavien IIIa.Conclusions: PCNL in supine position has significantly shorter operative time with similar complications and stone free rates as compared to prone position.Keywords: percutaneous nephrolithotomy; prone position; supine position

scholarly journals Percutaneous Nephrolithotomy With X-Ray Free Technique in Morbidlyobese Patients: Outcomes and Skills From A Large High-Volume Stone Management Center

2021 ◽  
Author(s):  
Bo Xiao ◽  
Xue Zeng ◽  
Chaoyue Ji ◽  
Gang Zhang ◽  
Weiguo Hu ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Intraoperative Complications ◽  
High Volume ◽  
Lateral Position ◽  
Morbidly Obese ◽  
Obese Patients ◽  
X Ray ◽  
Stone Free Rate ◽  
The Mean ◽  
Free Rate

Abstract Objectives This study was performed to investigate the feasibility and safety of complete ultrasound (US)-guided percutaneous nephrolithotomy (PNL) in morbidly obese patients and to introduce the US skills used in a high-volume stone management center. Methods We retrospectively reviewed consecutive patients with a body mass index (BMI) of ≥ 40 kg/m2 who underwent X-ray-free PNL for treatment of upper urinary tract stones from October 2013 to March 2020. The patients’ demographic information and intraoperative and postoperative parameters were collected and analyzed. Surgical complications were recorded and classified according to the modified Clavien classification system. Results In total, 52 patients were included. Their mean BMI was 45.5 kg/m2 (range, 40.3–61.6 kg/m2), and their mean age was 46 years (range, 28–58 years). The mean stone burden was 2.8 cm (range, 2.1–8.8 cm). Thirty-nine patients underwent surgery in the prone position, and the remaining 13 underwent surgery in the lateral position. All procedures were completed successfully with no major intraoperative complications. The mean operative duration was 68 min (range, 38–97 min). The mean time required for establishment of each access was 6.6 min (range, 3.5–14.7 min). No blood transfusion or embolization was needed for any patient. The initial stone-free rate was 80.8% (42/52 patients). Five patients required second-look PNL. Two patients underwent flexible ureteroscopic lithotripsy. The final stone-free rate was 90.4% (47/52 patients). Conclusions Complete US-guided PNL was technically feasible and safe in morbidly obese patients. The stone-free rate and complication rate were acceptable and comparable with those in non-obese patients.

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