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ABSTRACT Background: Success rates in endourological procedures, notably percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS), have demonstrated suboptimal outcomes, leading to more reinterventions and radiation exposure. Recently, the use of intraoperative computed tomography (ICT) scans has been hypothesized as a promising solution for improving outcomes in endourology procedures. With this considered, we conducted a comprehensive systematic review and meta-analysis encompassing all available studies that evaluate the impact of the use of intraoperative CT scans on surgical outcomes compared to conventional fluoroscopic-guided procedures. Methods: This systematic review was conducted in accordance with PRISMA guidelines. Multiple databases were systematically searched up to December of 2023. This study aimed to directly compare the use of an ICT scan with the standard non-ICT-guided procedure. The primary endpoint of interest was success rate, and the secondary endpoints were complications and reintervention rates, while radiation exposure was also evaluated. Data extraction and quality assessment were performed following Cochrane recommendations. Data was presented as an Odds ratio with 95%CI across trials and a random-effects model was selected for pooling of data. Results: A comprehensive search yielded 533 studies, resulting in the selection of 3 cohorts including 327 patients (103 ICT vs 224 in non-ICT). Primary outcome was significantly higher in the experimental group versus the control group (84.5% vs 41.4% respectively, 307 patients; 95% CI [3.61, 12.72]; p<0.00001; I2=0). Reintervention rates also decreased from 32.6% in the control to 12.6% in the ICT group (OR 0.34; 95%CI [0.12,0.94]; p =0.04; I2= 48%), whereas complication rates did not exhibit significant differences. Radiation exposure was also significantly reduced in two of the included studies. Conclusion: This meta-analysis highlights a favorable outcome with intraoperative CT scan use in PCNL procedures, showing a considerable increase in SFR when compared to standard fluoroscopy and nephroscopy. Despite limited studies, our synthesis underscores the potential of ICT scans to significantly reduce residual stones and their consequences for endourology patients, as reinterventions and follow-up ionizing radiation studies.
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ABSTRACT Purpose: This study aims to evaluate the safety and efficacy of ultrasound-guided balloon dilation compared to non-balloon dilation for percutaneous nephrolithotomy (PCNL). Materials and methods: A systematic review and meta-analysis were conducted by searching PubMed, EMBASE, and the Cochrane Library. Results were filtered using predefined inclusion and exclusion criteria as described and meta-analysis was performed using Review Manager 5.4 software. Results: A total of six studies involving 1189 patients who underwent PCNL were included. The meta-analysis results demonstrated that compared to non-balloon dilation, balloon dilation was associated with reduced haemoglobin drop [mean difference (MD) = -0.26, 95% CI = -0.40 ~ -0.12, P = 0.0002], decreased transfusion rate [odds ratio (OR) = 0.47, 95% CI = 0.24 ~ 0.92, P = 0.03], shorter tract establishment time (MD = -1.30, 95% CI = -1.87 ~ -0.72, P < 0.0001) and shorter operation time (MD = -5.23, 95% CI = -10.19 ~ -0.27, P = 0.04). Conclusions: Overall, ultrasound-guided balloon dilatation offered several advantages in PCNL procedures. It facilitated faster access establishment, as evidenced by shorter access creation time. Additionally, it reduced the risk of kidney injury by minimizing postoperative haemoglobin drop and decreasing the need for transfusions. Moreover, it enhanced the efficiency of surgery by reducing the operation time. However, it is important to note that the quality of some included studies was subpar, as they did not adequately control for confounding factors that may affect the outcomes. Therefore, further research is necessary to validate and strengthen these findings.
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Objective To compare the therapeutic effects of flexible ureteroscope(FURS),super-mini percutaneous nephrolithotomy(SMP),and microstomy percutaneous nephrolithotomy(MPCNL)in the treatment of 2-3 cm lower calyceal calculi.Methods Clinical data of 209 patients with 2-3 cm lower calyceal calculi in our hospital from January 2017 to September 2022 were retrospectively analyzed.Among them,65 patients were treated with Olympus electronic FURS(FURS group),62 patients were treated with SMP for stone removal(SMP group),and 82 patients were treated with MPCNL(MPCNL group).The one-session stone-free rate(SFR),operation time,hemoglobin decrease at postoperation immediately,rate of postoperative delayed bleeding,postoperative hospital stay,postoperative fever,and hospitalization cost were compared between the three groups.Results There were significant differences in operation time,postoperative hospital stay,hospitalization costs and one-session SFR among the three groups(P<0.05).The one-session SFR in the MPCNL group(89.0%,73/82)was significantly higher than that in the FURS group(72.3%,47/65;P =0.009).The operation time in the MPCNL group was(38.8±7.6)min,significantly shorter than that in the FURS group[(52.3±7.2)min,P =0.000]and the SMP group[(47.5±7.8)min,P =0.001].The hemoglobin decrease at postoperation immediately in the FURS group was(1.5±0.5)g/L,significantly lower than that in the SMP group[(5.0±1.6)g/L,P = 0.000]and MPCNL group[(6.3±1.8)g/L,P =0.000].The postoperative hospital stay in the FURS group was(2.2±0.5)d,significantly shorter than that in the SMP group[(3.5±0.8)d,P =0.000]and the MPCNL group[(5.3±1.4)d,P =0.000].The hospitalization cost of the FURS group was(22 543.4±1600.4)yuan,significantly lower than that of the SMP group[(26 837.7±2003.9)yuan,P =0.000]and the MPCNL group[(26 784.4±2086.9)yuan,P =0.000],but there was no significant difference between the SMP group and the MPCNL group(P =0.869).There was no significant difference in the incidence of postoperative fever among the three groups(χ2 = 0.462,P = 0.784).Conclusions FURS,SMP,and MPCNL are all effective methods for the treatment of 2-3 cm lower calyceal calculi.FURS has the least intraoperative bleeding,the shortest hospital stay,the lowest hospitalization cost,the lowest one-session stone-free rate,and the longest operation time.MPCNL has the shortest operation time,the highest one-session SFR,the most intraoperative bleeding,and the longest hospital stay.
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Objective To explore the application effect of prone split-leg position in percutaneous nephrolithotomy(PCNL).Methods A total of 79 patients with upper urinary tract stones who underwent surgery in our department from July 2021 to July 2022 were selected.According to the surgical position,the patients were divided into prone split-leg position group(n =35)and traditional prone position group(n =44).The two groups were compared regarding operation time,intraoperative blood loss,postoperative and preoperative hemoglobin changes,postoperative complications,one-stage stone free rate,and duration of hospitalization.Results The prone split-leg position group had significantly shorter operative time and higher one-stage stone free rate than those in the traditional prone position group[(69.6±20.7)min vs.(90.5±35.3)min,t =-3.280,P =0.002;97.1%(34/35)vs.79.5%(35/44),χ2 =3.984,P =0.037].There were 1 case of infection,3 cases of fever,and 1 case of bleeding in the prone split-leg position group,while 4 cases of postoperative fever and 2 cases of bleeding in the traditional prone position group,without significant difference in the incidence of complications between the two groups(χ2 =0.000,P =1.000).There were no statistical differences in intraoperative blood loss,number of working channel,hemoglobin changes,and duration of hospitalization(P>0.05).Conclusion Prone split-leg position PCNL can shorten the operation time,improve the one-stage stone free rate,and will not increase the risk of postoperative complications,with good safety and effectiveness.
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【Objective】 To identify the best surgical treatment for patients with calculous pyonephrosis by evaluating the clinical effectiveness of percutaneous nephrolithotripsy (PCNL) in stageⅠ, percutaneous nephrostomy (PCN) in stageⅠ, and percutaneous nephrolithotripsy in stageⅡ. 【Methods】 For publications published between Jan.2012 and Oct.2022, we thoroughly examined the databases of PubMed, Cochrane Library, Web of Science, EMBASE, CNKI, Wanfang, and VIP.We then chosed the literature based on the inclusion and exclusion criteria.After data were retrieved and literature quality was assessed, Review Manager software (RevMan 5.4.3, Cochrane Collaboration, Oxford, UK) was utilized to Meta-analysis. 【Results】 Out of 688 participants across 105 researches, we chosed 11 trials.Among them, 341 patients received both stageⅠPCN and stage ⅡPCNL (hereinafter referred to as phase ⅡPCNL), while 347 patients received stageⅠPCNL.According to the results of the Meta-analysis, there was no discernible difference between stage Ⅰ PCNL and stage Ⅱ PCNL in terms of stone clearance rate (P=0.95), operation duration (P=0.48), postoperative septic shock (P=0.36), or perirenal effusion infection (P=0.27).There were significant differences between stage Ⅰ PCNL and stage Ⅱ PCNL in fever (P=0.03), indwelling nephrostomy tube time (P=0.01), hospitalization costs (P=0.01), hospitalization time (P=0.01), and postoperative hospitalization time (P=0.02).The following two regimens were comparable in terms of stone clearance rate, operating time, postoperative perirenal effusion infection, and septic shock for patients with calculous pyonephrosis.Despite the fact that there were more patients who developed fever after stage ⅠPCNL, hospitalization costs were lower, indwelling nephrostomy tube time, overall hospitalization time, and postoperative hospitalization time were all reduced. 【Conclusion】 ⅠPCNL was affordable, safe, and successful for treating renal and upper ureteral calculi with pyonephrosis, and it had some promotional value in clinical practice.
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【Objective】 To compare the clinical efficacy of high frequency holmium laser in the treatment of 2-3 cm renal calculi by minimally invasive percutaneous nephrolithotomy (mPCNL) and retrograde intrarenal surgery (RIRS). 【Methods】 The clinical data of 105 patients with a solitary 2-3 cm renal calculus treated during Oct. 2020 and Oct. 2022 were retrospectively analyzed. The patients were divided into two groups, including 52 cases in the RIRS group and 53 cases in the mPCNL group. The one-stage stone clearance rate, operation time, hemoglobin decline within 24 hours, inflammatory indicators within 24 hours after operation, postoperative complications, hospital stay and hospitalization costs were compared between the two groups. 【Results】 There were no significant differences in the preoperative general data, one-stage stone clearance rate, inflammatory indicators within 24 hours and incidence of postoperative complications between the two groups (P>0.05). The RIRS group had less decrease of hemoglobin than the mPCNL group [(6.35±2.00) g/L vs. (12.25±5.72) g/L, P=0.001], shorter hospital stay [(5.13±0.82) d vs. (7.92±1.59) d, P<0.001], lower hospitalization costs [(15 221.52±796.46) yuan vs. (19 514.51±909.98) yuan, P<0.001], but longer operation time [(58.17±7.67) min vs. (49.60±4.52) min, P<0.001]. 【Conclusion】 Both mPCNL and RIRS are safe and effective in the treatment of 2-3 cm renal calculi with 40-80 Hz holmium laser, and the one-stage stone clearance rate is similar. Although RIRS needed longer operation time than mPCNL, it has the advantages of less surgical trauma, faster postoperative recovery and shorter hospital stay, and is more prospective in the treatment of 2-3 cm renal calculi.
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【Objective】 To explore the risk factors of severe postoperative hemorrhage in patients with staghorn renal calculi treated with mini-percutaneous nephrolithotomy (M-PCNL), and to construct a Bayesian network model to predict postoperative hemorrhage. 【Methods】 A retrospective analysis was conducted on 160 patients with staghorn renal calculi who were treated with M-PCNL by surgeons with equivalent qualifications at the First Affiliated Hospital of Xinxiang Medical College during Jan. 2020 and Jan. 2022.A computer-generated random number method was used to divide them into a modeling group (120 cases) and a validation group (40 cases).Patients in the modeling group were divided into severe bleeding group (38 cases) and non-severe bleeding group (82 cases).The general information of the two groups was compared, and the independent risk factors of severe postoperative hemorrhage were analyzed.A Bayesian network model was constructed using R software, the inference prediction was conducted using Netica software, and the performance of the model was evaluated with receiver operating characteristic (ROC) curve. 【Results】 Multivariate logistic regression analysis showed that renal insufficiency (OR: 2.845, 95%CI: 1.563-6.515), mixmum diameter of stones ≥2 cm (OR: 2.063, 95%CI: 1.824-4.555), operation time ≥90 minutes (OR: 3.632, 95%CI: 2.365-7.11), one-stage operation (OR: 2.321, 95%CI: 1.874-6.332), and multi-channel stone removal (OR: 1.842, 95%CI: 1.366-3.687) were independent risk factors of postoperative severe hemorrhage (P<0.05).Based on the above parameters, a Bayesian network model was established, which was then evaluated with the modeling and validation groups internally and externally.The AUC of the modeling group was 0.879 (95%CI: 0.804-0.931, P<0.001), with sensitivity and specificity being 87.68% and 89.63%, respectively.The AUC of the validation group was 0.875(95%CI: 0.818-0.908, P<0.001), with sensitivity and specificity being 87.55% and 89.40%, respectively.The model showed good discrimination. 【Conclusion】 Renal dysfunction, mixmum diameter of stones ≥2 cm, operation time ≥90 minutes, one-stage operation, and multi-channel stone removal are risk factors of severe hemorrhage in patients after M-PCNL.The prediction model has good predictive ability and can effectively describe the complex mechanism between diseases and risk factors.
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【Objective】 To analyze the predictive value of serum β-defensin-3 (HBD-3) and decoy receptor 3 (DCR3) for urinary tract infection after percutaneous nephrolithotomy (PCNL) in patients with complex kidney calculi. 【Methods】 A prospective study was conducted on 112 patients treated with PCNL at our hospital during Jan.2020 and Dec.2022.The patients were divided into the non-infection group (52 cases) and infection group (60 cases).The general data, HBD-3 and DCR3 levels of the two groups were compared.Receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of C reactive protein (CRP), procalcitonin (PCT), HBD-3 and DCR3 levels for postoperative urinary tract infection. 【Results】 Compared with the non-infection group, the infection group had higher levels of HBD-3 [(0.77±0.08) ng/mL vs. (1.36±0.25) ng/mL, P=0.001] and DCR3 [(4.68±0.53) ng/mL vs.(13.21±0.28) ng/mL, P=0.001].Multivariate logistic regression showed that a history of urinary tract surgery, preoperative urinary tract infection, operation time, catheterization time, stone load, type of antibiotics, concomitant renal dysfunction, intraoperative channel type, CRP, PCT, HBD-3 and DCR3 were risk factors of postoperative urinary tract infection (P<0.05).The ROC curve showed that the accuracy of CRP, PCT, and CRP plus PCT were 70.54%, 72.32%, and 78.57%, respectively; the accuracy of HBD-3, DCR3, and HBD-3 plus DCR3 were 69.64%, 75.89%, and 86.61%, respectively. 【Conclusion】 Postoperative urinary tract infection in patients with complex kidney calculi is associated with multiple factors, especially high expression levels of HBD-3 and DCR3.Combined detection has high predictive value.
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Introduction@#There is a limited data on the incidence of pediatric urolithiasis in the Philippines as well as studies on how it is managed. With the advent of endourology, there is already an evident shift from open stone surgery to minimally invasive surgery as first line in the treatment of pediatric urolithiasis. A tertiary referral center in the country caters to most pediatric urolithiasis cases in the country and offers the different minimally invasive modalities outlined in the latest guidelines. This study aimed to review the different minimally invasive therapeutic modalities for pediatric urolithiasis and its outcomes in the past ten years in a tertiary referral center in the Philippines.@*Methods@#This retrospective study was conducted through charts review of all pediatric patients (0-18 years) who underwent stone surgery from January 2012 to December 2022. Demographic and clinical data, stone characteristics, types of stone surgery, and outcomes were obtained.@*Results@#A total of 87 pediatric patients (54 boys, 33 girls) with 105 urolithiases were analyzed. The patients had a mean age of 13 years, with an interquartile range (IQR) spanning from 6 to 18 years. Among them, 62.07% were male, while 37.93% were female. The most prevalent symptom reported was flank pain, affecting 41.38% of the patients, followed by urinary tract infections (UTI) (11.49%) and gross hematuria (8.05%). For the management, 82.86% of the patients underwent minimally invasive stone procedures with extracorporeal shockwave lithotripsy (ESWL) as the most common procedure (44.76%) and ureterolithiases as the most common stone (43.81%). On the other hand, 17.14% of the subjects underwent open stone surgery done mostly on cystolithiases and large ureterolithiases (38.89% each). All patients recovered and were discharged post operatively.@*Conclusion@#The institution practices minimally invasive approaches in the majority of pediatric patients with urolithiasis. Open stone surgery is reserved for patient with large complex stones and those with anatomic abnormalities.
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Child , Lithotripsy , UreteroscopyABSTRACT
@#Objective To compare the effects of three kinds of artificial hydronephrosis in percutaneous nephrolithotomy.Methods A total of 120 patients who underwent single-tract percutaneous nephrolithotomy in the Eighth Hospital of Wuhan from May 2020 to April 2022 were selected and divided equally into three groups according to different methods of artificial hydronephrosis.Patients in group A were received preoperative indwelling ureteral catheter and injection of normal saline through ureteral catheter to dilate renal pelvis and form artificial hydronephrosis.Patients in Group B were placed with double J catheters before surgery,and the bladder was filled with physiological saline through the catheter.The renal pelvis was dilated through the double J catheters,resulting in artificial hydronephrosis.Patients in Group C were received intravenous injection of furosemide and stimulated diuretic method to actively dilate renal pelvis to form hydronephrosis.The one-time puncture success rate,channel establishment time,overall operation time,stone clearance rate and incidence of surgical complications of percutaneous nephrolithotomy after hydronephrosis were compared among the three groups.Results The operation was successfully completed in the three groups.There was no significant difference in the one-time puncture success rate and channel establishment time between group A and group B(P>0.05),which were all higher than group C(P<0.05).The overall operation time of group B was shorter than that of group A and group C(P<0.05).There were no significant differences in stone clearance rate and surgical complications among the three groups(P>0.05).Conclusion Preoperative indwelling of double J tubes to create artificial kidney hydronephrosis has advantages such as high success rate of one-time puncture,short channel establishment time,and surgical time.
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ABSTRACT Purpose: To investigate the risk factors associated with adverse outcomes in patients with residual stones after percutaneous nephrolithotomy (PCNL) and to establish a nomogram to predict the probability of adverse outcomes based on these risk factors. Methods: We conducted a retrospective review of 233 patients who underwent PCNL for upper urinary tract calculi and had postoperative residual stones. The patients were divided into two groups according to whether adverse outcomes occurred, and the risk factors for adverse outcomes were explored by univariate and multivariate analyses. Finally, we created a nomogram for predicting the risk of adverse outcomes in patients with residual stones after PCNL. Results: In this study, adverse outcomes occurred in 125 (53.6%) patients. Multivariate logistic regression analysis indicated that the independent risk factors for adverse outcomes were the diameter of the postoperative residual stones (P < 0.001), a positive urine culture (P = 0.022), and previous stone surgery (P = 0.004). The above independent risk factors were used as variables to construct the nomogram. The nomogram model was internally validated. The calculated concordance index was 0.772. The Hosmer- Lemeshow goodness-of-fit test was performed (P > 0.05). The area under the ROC curve of this model was 0.772. Conclusions: Larger diameter of residual stones, positive urine culture, and previous stone surgery were significant predictors associated with adverse outcomes in patients with residual stones after PCNL. Our nomogram could help to assess the risk of adverse outcomes quickly and effectively in patients with residual stones after PCNL
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ABSTRACT Purpose The aim of this meta-analysis is to assess the efficacy of extended dose of preoperative antibiotics to reduce infectious risk in patients undergoing percutaneous nephrolithotomy (PCNL). Materials and Methods A literature search for prospective case-control studies or randomized controlled trials was done. PICO framework was used. Population: adult patients that underwent to PCNL; Intervention: extended dose preoperative antibiotic prophylaxis before PCNL; Control: short dose preoperative antibiotic prophylaxis before PCNL; and Outcome: systemic inflammatory response syndrome (SIRS) or sepsis, fever after PCNL and positive intraoperative urine and stone culture. This meta-analysis was registered in PROSPERO database under the number: CRD42022359589. Results Three RCT and two prospective studies (475 patients) were included. SIRS/sepsis outcome was retrieved from all studies included. Seven days preoperative oral antibiotics for PCNL was a protective factor for developing SIRS/sepsis (OR 0.366, 95% CI 0.234 - 0.527, p < 0.001). There was no statistical association between seven-day use of antibiotics and fever (OR 0.592, 95% CI 0.147 - 2.388, p = 0.462). Patients who received seven days preoperative antibiotics had lower positive intraoperative urine culture (OR 0.284, 95% CI 0.120 - 0.674, p = 0.004) and stone culture (OR 0.351, 95% CI 0.185 - 0.663, p = 0.001) than the control group. Conclusion one week of prophylactic oral antibiotics based on local bacterial sensitivity pattern plus a dose of intravenous antibiotics at the time of surgery in patients undergoing PCNL reduces the risk of infection.
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Prone positioning in percutaneous nephrolithotomy is more and more being replaced by supine positioning now a days for its various benefits. This is a prospective study which does Comparative study on percutaneous nephrolithotomy in supine versus prone position and their various outcomes were analysed. There were totally 100 patients included in the study with 50 patients each group (supine versus prone). 57 were male and 43 female patients. Age ranging from 18 to 70 years. Right side stones were 58 and left side was 42. Age, gender and side of stones were similar between two groups. Stone burden were 2.6cm and 2.9cm for supine and prone group respectively. But average operating time were 63.5 minutes ( 35 to 120 minutes) for supine group versus 80 minutes ( 45 to 160 minutes) for prone group. fluoroscopy time was 18.9 minutes for supine group versus 29.4 minutes for prone group. Clearance rate in our study were pretty good in both groups around 90% in both groups (90% vs 88%). five had complications in form of sepsis and bleeding requiring blood transfusion in both groups. Five in supine group and six in prone group required second procedures. Thus Supine percutaneous nephrolithotomy group had significant advantage in terms of less operative duration and less fluoroscopy time than prone percutaneous nephrolithotomy . The stone clearance and complication rates were similar in both the groups.
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Objective:To compare the efficacy and safety of percutaneous nephrolithotomy (PCNL) with negative pressure suction sheath and PCNL with traditional expanded sheath in the treatment of infectious renal calculus.Methods:From May 2019 to June 2022 in our department, 35 patients with infectious renal calculus who received PCNL with negative pressure suction sheath (negative pressure sheath group, NPS group) and another 35 patients with infectious renal calculus who received PCNL with traditional expanded sheath (control group) were determined in our research. Propensity score matching (PSM) was conducted. Preoperative clinical data of the 2 groups was similar and there were no statistical differences between the 2 groups in the age [(45.5±6.8)vs. (44.9±7.3) years old, P=0.723], gender (man/woman 19/16 cases vs. 21/14 cases, P=0.629), body mass index(BMI) [(24.2±4.2)kg/m 2vs. (24.5±3.9)kg/m 2, P=0.758], American Society of Anesthesiologists risk score(ASA) (grade 1/grade 2: 30/5 cases vs. 29/6 cases, P=0.743), sides of calculus (left/right: 18/17 cases vs. left 17/18 cases, P=0.811), Guy’s stone score (grade Ⅰ/Ⅱ/Ⅲ: 3/25/7 cases vs. 1/29/5 cases, P=0.443), CT value of calculus [(629.2±98.8)HU vs. (608.5±105.1)HU, P=0.399], urinary leucocyte (-/+ /+ + : 29/5/1 cases vs. 28/5/2 cases, P=0.839), hypertension(3 cases vs. 5 cases, P=0.707), diabetes(2 cases vs. 2 cases, P=1.000). The ureteral catheter on the affected side was indwelled in the lithotomy position, and ultrasound guided positioning puncture was performed on the affected renal side of the posterior axillary line in the prone position. The puncture channel was established and then expanded to F20 successively, and the lithotriptic sheath was placed to establish the lithotriptic channel. Compared with the traditional expanded sheath, the negative pressure suction sheath was different in that the collateral suction channel was added on the main gravel channel and connected with continuous negative pressure suction. The negative pressure was 40 kPa. All patients were treated with pneumatic ballistic lithotripsy combined with holmium laser. KUB was performed within 1 week after surgery. We defined stone removal as either no residual stones or clinically insignificant residual stones (≤4 mm) which did not cause urinary obstruction. The intraoperative duration of operation and postoperative clinical parameters [white blood cell(WBC), procalcitonin(PCT), C-reactive protein(CRP), hemoglobin(Hb), stone clearance rate] and incidence of perioperative complications were compared between the 2 groups. Results:The operation time of NPS group was lower than that in control group [(35.6±19.5)min vs. (45.4±20.2)min, P<0.05]. The proportion of patients with increased WBC, PCT and CRP in blood after operation in NPS group was lower than that in control group, and there were (WBC: 25.7% vs. 54.3%, P<0.05), (PCT: 42.9% vs.68.6%, P<0.05) and (CRP: 62.9% vs.85.7%, P<0.05) respectively. There was no significant difference in the proportion of patients with decreased Hb postoperatively between the 2 groups (2.9% vs. 8.6%, P=0.607). There was no significant difference in calculus clearance rate postoperatively between the 2 groups (97.1% vs. 94.3%, P=1.000). Postoperative calculus component analysis of the 2 groups suggested that all patients had infected calculus dominated by ammonium magnesium phosphate and phosphate apatite. The incidence of perioperative complications in NPS group was lower than that in control group (22.9% vs. 51.4%, P<0.05). The proportion of patients with fever (body temperature>37.5℃) postoperatively in NPS group was lower than that in control group (14.3% vs. 37.1%, P<0.05). There were 2 and 3 patients respectively required upgraded antibiotic therapy after operation in the 2 groups ( P=1.000). There was one patient respectively with urinary tract obstruction and renal colic due to blood clots postoperatively in each group ( P=1.000). There was one patient with urinary sepsis in control group after operation ( P=0.476). Conclusions:Compared with PCNL with traditional expanded sheath, PCNL with negative pressure suction sheath can save operation time for infectious renal calculus, and reduce the incidence of postoperative infection and perioperative complications. Therefore, the safety of negative pressure suction sheath is higher. However, there is no difference in stone clearance rate between them.
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Objective:To explore the factors associated with severe bleeding after percutaneous nephrolithotomy (PCNL) in male patients and evaluate the efficacy of interventional embolization.Methods:A retrospective case series study was conducted at Nankai Hospital of Tianjin, China, from January 2018 to October 2021. The clinical data of 230 male patients with upper urinary tract stones were analyzed. The observation indicators included age, hypertension, diabetes, renal function abnormalities, history of preoperative anticoagulant use, stone size, stone type, number of puncture channels, operation time and degree of hydronephrosis. To describe the clinical characteristics of bleeding after percutaneous nephrolithotomy in men, and analyze the factors associated with severe bleeding after PCNL. Single factor analysis was performed using the Chi-square ( χ2) test, and multivariate analysis was performed using logistic regression analysis. Results:Univariate analysis showed that diabetes mellitus ( χ2=4.90, P=0.027), abnormal renal function ( χ2=18.32, P<0.001), history of preoperative oral anticoagulants ( χ2=5.10, P=0.024), abnormal bleeding and coagulation function ( χ2=8.22, P=0.004) and the number of puncture channels ( χ2=22.08, P<0.001) were the related factors affecting bleeding after PCNL. Multivariate logistic regression analysis showed that diabetes mellitus ( P=0.032), abnormal renal function ( P<0.001), and the number of puncture channels ( P<0.001) were the independent risk factors of bleeding after PCNL. Of the 28 patients with bleeding after PCNL, 25 were treated with interventional embolization, with a technical success rate of 100.0% and a clinical success rate of 89.3%. Conclusions:For patients with renal calculi and comorbid diabetes, renal function abnormalities, and multiple punctures, relevant preventive measures should be actively administered before PCNL to reduce the risk of postoperative bleeding. For patients with severe bleeding of the kidney after PCNL, TAE is a safe and effective minimally invasive treatment method.
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Objective To evaluate the efficacy and safety of external ureteral catheterization of tubeless mini-percutaneous nephrolithotomy(mini-PCNL)in the treatment of single urinary calculus.Methods Clinical data of 21 patients with single renal or upper ureteral calculi treated with tubeless mini-PCNL from June 2021 to December 2022 were retrospectively analyzed.Among them,there were16 cases of kidney stones and5 cases of upper ureteral stones.The length of stones was1.5-3.5 cm(mean,2.07±0.56 cm).The ureteral catheter was indwelled by cystoscope and retained for catheterization,and the ureteral catheter and catheterization were fixed.If there were no residual stones after mini-PCNL,the Peel-away sheath was removed and the incision was sutured.Results All the operations were successfully completed,and the catheterization and ureteral catheter were removed 3-5 days after operation.There were slight gross hematuria in all the cases,fever in 3 cases,perirenal hematoma in 4 cases,and no urinary extravasation postoperatively.One month after discharge,B-ultrasonography or CT scanning showed no lithiasis,urinary cyst or hematoma formation around the kidney.Conclusion In selected cases(single and non-staghorn stones,without intraoperative stone residue or ureteral stenosis),external ureteral catheterization of tubeless mini-PCNL is safe and effective.
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Objective:To evaluate the clinical efficacy and safety of retrograde intrarenal surgery(RIRS) and miniaturized percutaneous nephrolithotomy(mini-PCNL) in the treatment of lower pole kidney stones with a diameter <1.5 cm.Methods:The data of 95 patients with lower pole kidney stones with a diameter <1.5 cm treated in Renmin Hospital of Wuhan University from June 2017 to October 2020 were retrospectively analyzed. According to different surgical methods, the patients were divided into RIRS group and mini-PCNL group. There were 51 cases in RIRS group and 44 cases in mini-PCNL group. There was no significant difference in age [(48.2±11.4) years vs. (46.4±14.1) years], body mass index [(21.9±2.4) kg/m 2 vs. (20.7±3.2) kg/m 2], gender [male/female: 37/14 vs. 24/20], stone CT [(746.42±164.24)HU vs. (858.62±148.72)HU], creatinine [(71.3±21.6)μmol/L vs. (63.5±20.3)μmol/L], stone location (left/right: 26/25 vs. 23/21), stone diameter [(10.5±2.1) mm vs. (12.5±2.4) mm], infundibulopelvic angle [(43.32±9.42) degrees vs. (43.82±10.34) degrees], infundibular length [(24.92±4.85)mm vs. (24.37±5.26)mm] and infundibular [(9.26±3.04)mm vs.(9.46±2.94)mm] between the two groups ( P>0.05). The operation time, stone-free rate, hospital stay and postoperative complications between the two groups were compared. Results:Compared with the mini-PCNL group, the RIRS group had significantly smaller decrease in postoperative hemoglobin [(1.53±0.92) g/L vs. (4.54±2.46) g/L, P<0.05], the postoperative hospital stay was shorter [(2.52±0.94) d vs. (4.51±1.25)d, P<0.05], and postoperative visual analogue score was lower [(2.43±0.92) vs. (3.24±0.76), P<0.05]. The operation time of the mini-PCNL group was shorter than that of the RIRS group [(42.32±13.28) min vs. (54.24±14.43)min, P<0.05]. There was no significant difference in postoperative complications [5.9% (3/51) vs. 11.4% (5/44), P>0.05], postoperative cveatinine [(71.3±21.6) μmol/L vs. (63.5±20.3) μmol/L, P>0.05], postoperative intestinal function recovery time [(25.46±10.28)h vs. (32.43±9.25)h, P>0.05] and stone-free rate [92.2% (47/51) vs. 97.7% (43/ 44), P>0.05] between the two groups. Conclusions:Both RIRS and mini-PCNL are effective and safe minimally invasive treatments for lower pole kidney stones with a diameter < 1.5 cm. RIRS has shorter operation time, less blood loss, lower pain score and faster postoperative recovery.
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Objective:To compare the efficacy of ultrasound combined with endoscopy and ultrasound combined with X-ray guided percutaneous nephrolithotomy(PCNL) in the treatment of complex renal calculi.Methods:The clinical data of 119 patients with complex kidney stones treated by ultrasound combined with endoscopy or ultrasound combined with X-ray guided PCNL in the Second Affiliated Hospital of Anhui Medical University from March 2019 to February 2022 were analyzed retrospectively. According to different guidance methods, they were divided into ultrasound combined with endoscopic guidance group and ultrasound combined with X-ray guidance group.There was no significant difference in age [(53.9±14.2) years vs. (55.6±13.5) years], gender (male/female: 38/21 vs. 30/30), body mass index [(25.0±3.7) kg/m 2 vs. (24.8±3.8)kg/m 2], stone location (left/right: 34/25 vs. 31/29), maximum diameter of renal stones [(31.9±8.3)mm vs. (33.9±13.5)mm], kidney stones maximum cross-sectional area [(601.5±242.5)mm 2 vs. (632.6±278.9)mm 2], number of renal calices involved (3.5±0.9 vs. 3.6±1.3), S. T.O.N.E. scores (9.4±1.0 vs. 9.7±1.4), Guy's grade(Ⅲ/Ⅳ: 45/14 vs. 41/19), preoperative hemoglobin [(125.2±21.5)g/L vs. (125.6±18.4)g/L], serum creatinine[(89.1±33.8) μmol/L vs. (81.9±27.1) μmol/L], urinary tract infection (43/59 vs. 47/60)and positive urinary bacterial culture (12/59 vs.11/60) between the two groups(all P>0.05). The patients in the ultrasound combined with endoscopic guidance group were placed in the modified prone split-leg position. Flexible ureteroscope retrograde into the renal pelvis, combined with ultrasound to determine the best puncture calices. The channels were established and stones were removed under the guidance of ultrasound and endoscopy. In the ultrasound combined with X-ray guidance group, the F5 ureteral catheter was placed retrogradely into the operative side ureter under the lithotomy position. Then the patient changed to prone position and the target calices were punctured under the guidance of ultrasound and X-ray. Through anterograde or retrograde injection of contrast medium, the puncture position was determined to enter in the center of the calicean dome, and the channel establishment process and stone removal are monitored. The operative results and postoperative data were recorded. Results:The average operation time in the ultrasound combined with endoscopic guidance group was significantly shorter than that in the ultrasound combined with X-ray guidance group [(90.2 ± 34.5) min vs. (129.4 ± 43.0) min, P < 0.001]. There was no significant difference in the success rates of initial channel establishment [94.0% (63/67) vs. 87.7% (107/122), P = 0.167], the time of single channel establishment [(7.7 ± 1.9) min vs. (7.7 ± 1.4) min, P =0.765], serum creatinine on the first day after operation[ (89.3±33.6) μmol/L vs. (82.9±27.0) μmol/L, P=0.257] and postoperative hospital stay[(5.3±1.6) d vs.(5.4±1.7) d, P=0.883]. In contrast, patients in ultrasound combined with X-ray guidance group had higher stone free rate [93.3% (56/60) vs. 81.4% (48/59), P=0.049] and lower reoperation rate [3.3% (2/60) vs. 15.3% (9/59), P=0.025]. The mean hemoglobin decrease value of ultrasound combined with endoscopic guidance group was significantly lower than ultrasound combined with X-ray guidance group on the first day after operation [(8.7±6.3) g/L vs. (16.8±6.9) g/L, P<0.001]. The complication rate of ultrasound combined with endoscopic guidance group was significantly lower than that of ultrasound combined with X-ray guidance group [5.1% (3/59) vs. 16.7% (10/60), P = 0.043]. Conclusions:Ultrasound combined with endoscopic guidance PCNL does not need to change body position during operation and has fewer puncture channels, thus saving operation time and reducing complications. It is more suitable for patients with isolated kidney or easy bleeding. Ultrasound combined with X-ray guidance is conducive to the establishment of multi-channel, the stone clearance rate is high and the reoperation rate is low, which is suitable for patients with good health and more renal calices involved with stones.
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Although percutaneous nephrolithotomy (PCNL) is widely applied, there are also some serious complications, and the regional application in is uneven. In order to standardize the development and promotion of PCNL, the International Alliance of Urolithiasis(IAU) has developed the first professional guideline on PCNL. IAU-PCNL guideline covers all aspects of the whole PCNL procedure, including preoperative preparation, operation process, observation and prevention of complications, etc. The present paper would like to interpret the key contents of the IAU-PCNL guideline.
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Objective:To explore the effect of Quercus Salicina Extract Capsulese on preventing the formation of adherent stones on ureteral stent tube after percutaneous nephrolithotomy (PCNL).Methods:The clinical data of 186 patients who underwent PCNL due to unilateral renal stone in the Affiliated Hospital of Xuzhou Medical University from October 2018 to April 2020 were retrospectively analyzed. All of the patients were indwelling 6 F ureteral stent tube during operation. After postoperative reexamination of kidneys, ureters and bladder, it was confirmed that the postoperative residual stones were clinically meaningless stones (maximum diameter ≤ 4 mm). According to postoperative medication, they were divided into drug group ( n=62) and control group ( n=124). Patients in the drug group were given oral Quercus Salicina Extract Capsules, while patients in the control group did not take the drug. Both groups received the same health education and dietary guidance after operation. The formation of adherent stones on ureteral stent tube was observed when the ureteral stent tube was removed 6 weeks after PCNL. Meanwhile, the adverse reaction, complication and treatment satisfaction of the patients were recorded during the period of taking the drug. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for comparison between groups; the Chi-square test was used to compare the count data between groups. Results:When the ureteral stent tube was removed 6 weeks after PCNL, the weight of adherent stones on ureteral stent tube in the drug group was (334.20±26.65) mg for male, and (336.00±25.64) mg for female. In the control group, the weight of adherent stones on ureteral stent tube was (374.11±42.28) mg for male, (374.42±42.44) mg for female. The weight of adherent stones on ureteral stent tube in the drug group was significantly lighter than that in the control group, and the difference was statistically significant ( P<0.01). The drug group had no obvious serious adverse reaction during the period of taking the drug. At the same time, the complications of the drug group during the intubation period were significantly less than the control group, and the difference was statistically significant ( P=0.040). The satisfaction of patients in the drug group was 93.5%, and that in the control group was 82.3%. The difference was statistically significant between the two groups ( P=0.036). Conclusion:Quercus Salicina Extract Capsules can effectively prevent the occurrence of adherent stones on ureteral stent tube after PCNL, and there are no serious adverse reaction, which is worthy of clinical promotion.