Complicaciones de la nefrolitotomía percutánea como tratamiento de la litiasis renal coraliforme

RESUMEN Introducción: La nefrolitotomía percutánea es la primera opción terapéutica para la litiasis renal coraliforme. Objetivo: Caracterizar a los pacientes con complicaciones de la nefrolitotomía percutánea para el tratamiento de la litiasis renal coraliforme. Método: Se estudió una serie de 191 pacientes, operados mediante nefrolitotomía percutánea. Variables estudiadas: tipo de litiasis coraliforme, posición para la técnica, condición de libre de litiasis después de la operación, presencia de complicaciones, momento, tipo y grado según clasificación de Clavien-Dindo. Se hallaron frecuencias absolutas, relativas y se utilizó el test de ji cuadrado para determinar asociación entre variables. Resultados: El 86,9 % tenía menos de 60 años, 67,0 % eran masculinos, 61,7 % presentaba comorbilidades. La litiasis coraliforme era parcial o total (30,3 % y 46,5 %, respectivamente). En 60,2 % afectaba el riñón izquierdo; 58,1 % se operaron en supino y 70,2 % quedaron libre de litiasis con la nefrolitotomía percutánea monoterapéutica. Ocurrieron complicaciones en 19,9 %; 16,2 % fueron postoperatorias, 14,1 % infecciosas, 7,8 % Clavien-Dindo I y 5,2 % IIIb. El tipo de litiasis y la posición de la nefrolitotomía percutánea no se asociaron con las complicaciones (p> 0,05). El grado de la complicación no se relacionó con el tipo de litiasis (p> 0,05). Conclusiones: Las complicaciones postoperatorias más frecuentes son las relacionadas con la infección y el sangrado; predominan ligeramente en los pacientes con litiasis coraliformes parcial, total y en los operados en supino; el grado Clavien-Dindo de las complicaciones, es mayor en las litiasis coraliformes más complejas.

ABSTRACT Introduction: Percutaneous nephrolithotomy is the first therapeutic option for staghorn kidney stones. Objective: To characterize patients with complications of percutaneous nephrolithotomy for the treatment of staghorn renal lithiasis. Method: A series of 191 patients, operated by percutaneous nephrolithotomy, was studied. Variables studied: type of staghorn lithiasis, position for the technique, stone-free condition after the operation, presence of complications, time, type and grade according to the Clavien-Dindo classification. Absolute and relative frequencies were found and the chi-square test was used to determine the association between variables. Results: 86.9 % were less than 60 years old, 67,0 % were male, 61,7 % had comorbidities. The staghorn lithiasis was partial or total (30,3 % and 46,5 %, respectively). In 60,2 % it affected the left kidney; 58.1 % underwent supine surgery and 70,2 % were stone free with monotherapeutic percutaneous nephrolithotomy. Complications occurred in 19,9 %; 16,2 % were postoperative, 14,1 % infectious, 7,8 % Clavien-Dindo I, and 5,2 % IIIb. The type of lithiasis and the position of the percutaneous nephrolithotomy were not associated with complications (p> 0,05). The degree of complication was not related to the type of lithiasis (p> 0,05). Conclusions: The most frequent postoperative complications are those related to infection and bleeding; they slightly predominate in patients with partial and total staghorn stones and in those operated on in the supine position; the Clavien-Dindo grade of complications is higher in the more complex staghorn stones.

Case report of staghorn calculi in a pediatric patient / Relato de caso de cálculo coraliforme em paciente pediátrico

ABSTRACT This article reports a case of large volume asymptomatic staghorn calculus, and a brief revision of this rare pathology is done. A two-yearold male patient was diagnosed with staghorn calculus and hydronephrosis in the left kidney. The patient underwent surgical therapy with pyelolithotomy, pyeloplasty and placement of a double-J catheter, without complications. Staghorn calculi occupy the pelvis and renal calyces. Their incidence in children is lower than in adults. The average age at diagnosis is between 7 and 10 years. The etiology for calculi is diverse; in children under 4 years, it is especially related with infectious factors and hydronephrosis. The standard procedure for treatment is percutaneous nephrolithotomy.

RESUMEN Presentamos un caso de cálculo del tipo coraliforme de gran volumen, asintomático, y una revisión de esa enfermedad grave. Reportamos el caso de un paciente masculino, de dos años de edad, diagnosticado con cálculo coraliforme e hidronefrosis en riñón izquierdo. Se realizó tratamiento quirúrgico, a base de pielolitotomía, pieloplastia y colocación de un catéter doble J, sin complicaciones. El cálculo coraliforme ocupa la pelvis y los cálices renales. Su incidencia es menor en niños, con media de 7-10 años en el diagnóstico. La etiología es diversa; en menores de 4 años, se refiere específicamente a factores infecciosos e hidronefrosis. El tratamiento estándar es la nefrolitotomía percutánea.

RESUMO Este relato ilustra um caso de cálculo do tipo coraliforme de grande volume, assintomático, acompanhado de uma revisão dessa grave patologia. Relatamos o caso de um paciente do sexo masculino, dois anos de idade, diagnosticado com cálculo coraliforme e hidronefrose em rim esquerdo. Instituiu-se terapêutica cirúrgica, com realização de pielolitotomia, pieloplastia e colocação de cateter duplo-J sem intercorrências. Cálculo renal coraliforme ocupa a pelve e os cálices renais. Sua incidência é menor em crianças, sendo a média de diagnóstico entre 7 e 10 anos. A etiologia é ampla; em menores de 4 anos, relaciona-se especialmente com fatores infecciosos e hidronefrose. O tratamento padrão é a nefrolitotomia percutânea.

Prospective Study Of 200 Cases Of Staghorn Calculus- A Single Centre Experience.

Background: Staghorn stones are large branching stones that fill the renal pelvis and renal calyces and they can be complete or partial depending on the occupancy of the collecting system. . PCNL is a demanding procedure mainly for staghorn stones and may require multilple percutaneous tracts or multilple sessions of PCNL for complete clearance of stones. Hence ; we planned the present study to analyse patients undergoing PCNL for staghorn calculi. Material and Methods: In present study 200 patients underwent PCNL for the treatment of staghorn kidney stones. After exclusion criteria patients were selected and underwent standard PCNL. Preoperative , Intraoperative and Postoperative data was collected. Results: Out of 200 patients 95 (47.5%) were males and 105 (52.5%) patients were females. 120 patients (60%) were diagnosed with partial staghorn calculi whereas 80(40%) patients were diagnosed as complete staghorn Calculi. 37.5% patients were rendered stone free through single access port whereas 62.5% required multiple access port for PCNL in which 57.5% needed 2 access ports, 3% needed 3 access ports and only 2% needed 4 access ports for PCNL. 24 (12%) patients required 2nd stage procedure for residual stones and 1 (0.5%) patient become stone free after 3rd stage PCNL. Bleeding requiring blood transfusion was the most common complication in 21% patients. Whereas fever, hemothorax, hydrothorax, paralytic ileus were encountered in 12%,0.5%,0.5% and 4% patients respectively. Conclusion: For staghorn calculus PCNLis safe and effective procedure with acceptable morbidity and without mortality. Now PCNLhas almost replaced the open surgeries like pyelolithotomy , nephrolithotomy . with experience staghorn calculus can now be managed by minimum invasive technique like PCNL with no scar , no risk of incisional hernia , lesser hospital stay and minimum morbidity compared to open procedures

Pyeloduodenal Fistula Caused by Renal Calculi / 대한소화기학회지

A fistula between the renal pelvis and duodenum (pyeloduodenal fistula) is very rare. It can occur spontaneously or after trauma to one of these organs. A spontaneous pyeloduodenal fistula is usually caused by chronic inflammation, including reactions to foreign bodies, nephrolithiasis, benign and malignant neoplasms, as well as pyogenic infections. The main treatment to date has been surgery. We encountered one case of pyeloduodenal fistula found during an evaluation for abdominal discomfort in a 39-year-old female. Pyeloduodenal fistula was diagnosed by upper gastrointestinal endoscopy and abdominal computed tomography, and it was caused by direct invasion of nephrolithiasis. Surgical operation was recommended, but the patient refused. The patient has been free of symptoms for four years. Herein, we report an unusual case of pyeloduodenal fistula without surgical management and relevant literature review.

Clinical efficacy analysis of flexible ureteroscopic lithotripsy combined with percutaneous nephrolithotomy treating for patients with staghorn calculi / 临床外科杂志

Objective To investigate the clinical efficacy of flexible ureteroscopic lithotripsy combined with percutaneous nephrolithotomy treating for partial staghorn calculi.Methods 84 patients diagnosed as partial staghorn calculi in our hospital were randomly divided into group A and B with each group 42 patients.Patients in group A received the conventional minimally invasive percutaneous nephrolithotomy in the prone position,and patients in group B received the percutaneous nephrolithotomy combined with flexible ureteroscopic lithotripsy in the modified Valdivia position.The post-operative stone free rate and complications were recorded.Results The surgery time in group B was longer than that in group A [(106.44±18.46)min vs(83.69±10.29)min],with statistically significant difference(P38.5℃),but there was no notably difference between the two group(P>0.05).Conclusion Compared with the regular percutaneous nephrolithotomy,flexible ureteroscopic lithotripsy combined with percutaneous nephrolithotomy treating partial staghorn calculi has the shorter operation time,the less blood volume and the higher first stone free rate.Furthermore,the combination method did not significantly increasing the incidence of patient's complication.

Experience of standard access assisted MPCNL combined with EMS for the treatment of staghorn calculi accompanied with pyonephrosis / 中国内镜杂志

Objective To investigate the efficacy and safety of standard access assisted minimally access percutaneous nephrolithotomy (MPCNL) combined with EMS lithotripsy system in treatment of staghorn caculi accompanied with pyonephrosis. Methods From October 2015 to May 2017, we retrospectively analyzed the clinical data of 53 patients of staghorn calculi accompanied with pyonephrosis (55 sides, 2 patients with bilateral) were treated with using the special urology ultrasound, kidney dome puncture path method method to do standard channel assisted MPCNL combined with EMS. To summarize the operation time, stone clearance rate, postoperative hospital stay, postoperative blood transfusion rate and complications. Results 53 patients had a total of 55 kidneys had been established first-staged F24 channels,and successfully gravel stone. The operation time was (82.3 ± 22.5) min; 72.7% of the renal had been established first-staged F24 channels assisted F16/18 dual channel;18.2% for the first phase F24 and secondary phase F16/18 of the dual or multi-channel; 9.1% PCNL combined with retrograde flexible ureteroscope; 4 cases of extracorporeal shock wave lithotripsy. The initial stone-free rate was 70.9% (39/55), total stone-free rate was 89.1% (49/55). 2 patients with postoperative blood transfusion, 1 case of super-selective renal artery embolization to stop bleeding, 3 patients had postoperative fever, 1 case of septic shock, 2 cases of conservative treatment of a small amount of liquid chest, 1 case of apparent low back pain due to urine extravasation, given pain medication.no other serious complications. Conclusions By special urology ultrasound probe guide, use the kidney dome puncture path method to do standard channel assisted MPCNL combined with EMS for the treatment of staghorn calculi accompanied with pyonephrosis, its benefits in high stone-free rate, low renal pelvis pressure, high security rate, low complication rate and so on. Therefore, it is worthy of clinical application.

Comparison and analysis of advantages and disadvantages of rigid and flexible ureteroscopy in treatment of renal multiple stones or staghorn calculi / 中国内镜杂志

Objective Comparing and analyzing the advantages and disadvantages of rigid and flexible ureteroscopy in treatment of renal multiple stones or staghorn calculi. Methods 80 patients of renal multiple stones and staghorn calculi from May 2012 to March 2015 were randomly divided into two groups, group A: flexible ureteroscopy as adjuvant technique of balloon dilatation to establish standards channel of rigid nephrolithotripsy, group B: rigid ureteroscopy as auxiliary to flexible ureteroscopy nephrolithotomy. Clinical data of the two groups including operative time, blood loss, stones clearance rate, hospital stay and other indicators of surgical complications were comparatively analyzed. Results TAll the patients received successful surgical procedures. The operation time in group A was 50.4 min, gravel time was 25.6 min, while operation time in group B was 90.3 min, gravel time was 70.3 min. The differences between the two groups was statistically significant. Other indicators such as blood loss, stones clearance rate, complication rate showed no statistical significance. Conclusion Combined techniques of rigid and flexible ureteroscopy was proceeded widely to improve stone clearance rate when dealing with multiple stones and staghorn calculi, while rigid-ureterscopy-based combination has advantages of shorter operation time and this combination should be promoted in top units.

F16 Single-tract Minimally Invasive Percutaneous Nephrolithotomy Combined with Flexible Ureteroscopy for the Treatment of Complex Renal Staghorn Calculi / 中国微创外科杂志

Objective To evaluate the efficacy and safety of application of F 16 single-tract minimally invasive percutaneous nephrolithotomy ( MPCNL) combined with flexible ureteroscopy for the treatment of complex renal staghorn calculi . Methods From May 2009 to September 2012, 35 patients with complex renal staghorn calculi were treated by F 16 single-tract MPCNL combined with flexible ureteroscopy in this hospital .All the patients underwent MPCNL at the first-stage, and 5-7 days afterwards a second-stage operation was performed by using flexible ureteroscopy .The fragments of stones were removed from the MPCNL tract .For patients diagnosed as having residual stones , a third-stage reoperation of MPCNL combined with flexible ureteroscopy was given . Results Twenty-one patients were stone-free after the second-stage operation , 12 patients were stone-free after the third-stage operation , and the remaining 2 patients with residual stones were given drug administration for stone removal and were clarified as stone -free within 1 month of follow-up.No serious intraoperative or postoperative complications such as hemorrhage or infectious shock occurred .Follow-up reviews for 3 -6 months in the 35 patients found no residual stones or recurrence . Conclusion F16 single-tract MPCNL combined with flexible ureteroscopy is an effect and safe procedure for complex renal staghorn calculi .

Percutaneous nephrostolithotomy with ballon dilation treated staghorn calculi in 89 cases / 国际外科学杂志

Objective To investigate the efficacy of percutaneous renal access with balloon dilation for staghorn calculi.Methods Eighty-nine cases with PCNL were enrolled from February 2012 to March 2015.Clinical data including the time for setting the renal access, operation time, residual stone rate, complications were analyzed.Results Eighty-nine cases established nephrostomy tracts successfully.The average time for setting the renal access was (5.7 ± 1.0) min (4-8 min).The average of operation time was (62.6 ± 14.1) min (37-87min).The average of Hemoglobin decline rate was (6.3 ± 2.5)％ (2.8％-16.9％).The residual stone rate was 12.5％.Conclusions PCNL with ballon dilation is a fast, safe and effective means for staghorn calculi.It is worth using for staghorn calculi.

Efficacy and safety of percutaneous nephrolithotomy in middle renal calices for treatment of staghorn stones / 中国医师进修杂志

Objective To evaluate the efficacy and safety of percutaneous nephrolithotomy(PCNL) by middle renal calice used as main access for the treatment of staghorn stones with the combination of pneumatic and ultrasonic lithotrite.Methods Clinical data of 73 patients underwent PCNL by middle renal calices as main access with 57 incomplete staghorn stones and 35 complete staghorn stones.The rate of stone removal and complications were the main points of the analysis.Results Seventy-two cases underwent first session PCNL by single access tract(middle calices),3 cases underwent first session PCNL by double access tracts (2 cases by middle and lower calices,1 case by upper and middle calices).Of these patients,1 case had fragments with no further treatment,16 cases underwent second session PCNL.All were treated by single access tract (middle calices) and 2 cases had extracorporeal shock wave lithotripsy before the second PCNL.Seventy-six cases composed of 27 complete staghorn stones and 49 incomplete staghorn stones had no residual fragments with the stones removal rate 82.6％ (76/92).Hemoglobin dropped 1-4 g/L,11 cases and 3 cases were given blood transfusion in the operation procedure and post operation respectively.One case developed pyelonephritis and 1 case had split renal dysfunction with peri-parenchyma infection.Conclusions By middle calices as a main access to perform PCNL for staghorn stones is effective and safe.Using pneumatic and ultrasonic lithotrite will be very useful with high stones free rate and short procedure time and less complication.

Surgical cooperation of percutaneous nephrolithotomy under flexible ureteroscope in the treatment of staghorn calculi / 现代临床护理

ObjectiveTo summarize the experience of percutaneous nephrolithotomy under flexible ureteroscope in the treatment of staghorn calculi.Method The clinical data of 30 patieits with staghorn calculi undergoing percutaneous nephrolithotomy under flexible ureteroscope were reviewed for summarizing the surgical cooperation experience.Results All operations were successful,with the clearance rates of stage one and stage two calculi 86.0% and 95.0%,respectively.There occurred one case of massive hemorrhage,but no cases of kidney perforation,peritoneal perforation,liquid pneumothorax or organ damage.Conclusion Well-prepared surgical cooperation,full mastery of surgical procedures and skilled cooperation can increase surgical efficiency and safety by shortening surgical duration.

Efficacy and safety of ultrasound-guided upper-pole access percutaneous nephrolithotomy for the treatment of renal staghorn calculi / 局解手术学杂志

s: Objective To investigate the efficacy and safety of ultrasound-guided upper-pole access percutaneous nephrolithotomy (PCNL) for the treatment of renal staghorn calculi. Methods From October 2008 to July 2012,193 cases of renal staghorn calculi treated with ultrasound-guided upper-pole access PCNL were reviewed. Among the 193 cases,74 cases were complete staghorn calculi while the other 119 cases were partial staghorn calculi, and the calculi diameter was 2. 5 to 9. 0 cm. All the 193 cases were treated through upper-pole ac-cess successfully,70 accesses were accomplished below the 12th rib,while the other 123 accesses were accomplished between the 11th adn 12th rib. Disintegration of the stone was accomplished using Holmium laser. Results The mean operative time was 70 min (45~150 min), single tract was used in 186 cases, and double tracts were used in the other 7 cases. The stone clearance rate for one session was 72. 0%(139/193),and the total stone clearance rate was 88. 1%(170/193). Transfusion was required in 6 patients, while 2 patients with signifi-cant bleeding were treated with selective renal arterial embolization. Hydrothorax occured in 4 patients, and closed thoracic drainage was re-quired in 2 of them. 20 patients had fever, and they recovered after effective antibiotic treatment. No patients had injury to the lung or other viscera. Conclusion Upper-pole access offers optimal visibility and convenience for rigid ureteroscope to achieve a high rate of stone-free status and operating time reduce. Ultrasound guided upper-pole access PCNL should be attempted in selected cases of renal staghorn stone.

Comparison of Cyberwand dual probe lithotriptor and Swiss lithoclast master in ultrasonically guided percutaneous nephrolithotomy for renal staghorn calculi / 中南大学学报(医学版)

Objective:To evaluate and compare the effciency and safety of Cyberwand dual probe lithotriptor and Swiss lithoclast master in percutaneous nephrolithotomy for renal staghorn calculi. Methods:A total of 138 patients with renal staghorn calculi were divided randomly into a Cyberwand dual probe lithotripter group (Group A, n=71) and a Swiss lithoclast master group(Group B, n=67). hTe data for operative time, blood loss volume, one-stage calculus clearance rate, hospitalization time, cost of hospitalization and complication in the two groups were collected and compared. Results: The renal access was established successfully and the one-stage percutaneous nephrolithotomy (PCNL) was performed in the 2 groups. There was no significant difference in the size of stones, the age of patients and the complications between the 2 groups before the operations. Intraoperative gravel time in the Group A was signiifcantly shorter than that in the Group B (77.14±21.39 vs 84.25±20.62, P=0.049). There was no significant difference in the one-staged stone clearance rate, blood loss volume in the operation between the 2 groups. hTe one-staged stone clearance rate in the 2 groups were 67.6%(48/71) and 70.1%(47/67) respectively, with no signiifcant difference (P=0.854). Conclusion:Two lithotrities were safe and effcient for renal staghorn calculi. But comparing with Swiss lithoclast master, Cyberwand dual probe lithotriptor is more effcient and convenient.

Safety and Efficacy of Percutaneous Nephrolithotomy for Staghorn Calculi in Patients 70 Years and Older

BACKGROUND: The aim of this study was to analyze the safety and efficacy of percutaneous nephrolithotomy (PNL) for staghorn calculi in patients 70 years and older. METHODS: From March 1990 to December 2011, 76 patients with staghorn calculi underwent PNL. They divided into two groups according to age: 70 years and older (group I, n=32) and younger than 70 years (group II, n=46). Preoperative parameters (stone type, stone volume, concomitant diseases, and preoperative urine culture results) and perioperative parameters (operative time, complication rate, transfusion rate, and success rate) were evaluated. Additionally, we analyzed the composition of the urinary stones using the chemical analysis method. RESULTS: There were no significant differences between the groups for stone size, urine culture rate, operative time, success rate, and complication rate. But comorbidity, American Society of Anaesthesiology score, postoperative hemoglobin level, and transfusion rate were different (p<0.05). There were no serious complications or deaths. Magnesium ammonium phosphate component was found in 53.1% of group I and 60.9% of group II. CONCLUSION: Outcomes of PNL for staghorn calculi in patients 70 years and older were comparable to those seen in younger patients. PNL for this condition can be considered a safe and effective surgical option for appropriately selected elderly patients.

Muscle Cramps in Old Adults: Clinical Features and Pathophysiology

Muscle cramps are defined as painful, spasmodic, involuntary skeletal muscle contractions during or immediately after physical exercise. Muscle cramps have a typical clinical presentation, as the definition and the diagnosis is made based on a typical history together with the findings on clinical examination. Muscle cramps are self-extinguishing within seconds to minutes or relieved by stretching, and is often accompanied by a palpable knotting of the muscle. Old adults are prone to get muscle cramps, which may occur in patients with diseases, but also occur often in healthy subjects with no history of nervous system or metabolic disorders. Comorbidity and multiple medications, including diuretics due to an underlying disease, can be a part of the reason in old adults. We reviewed articles regarding the etiology of muscle cramps and introduced a new hypothesis of 'altered neuromuscular control', which has been documented recently.

Colour Doppler guide the percutaneous nephrolithotomy for Staghorn calculi / 中国综合临床

Objective To evaluate the safety and efficacy of colour doppler in guiding the percutaneous nephrolithotomy(PCNL) for Staghom calculi.Methods The clinical records of 46 patients with renal calculi who underwent PCNL were retrospectively analyzed.Patients' mean age was 43 years old,and the range of diameter of stone was 3.0 -7.5 cm.Among these cases,29 cases had complete staghorn calculus.One case had isolated kidney stone.And the other 6 patients had open surgery history.Using Colour Doppler guidance,the percutaneous nephrolithotomy for renal calculi was conducted.Results F22 percutaneous channel was successfully established in 55 sides of 46 patients,with the first and the second phase surgeries of 41 and 14 sides respectively.Single-,double- and three-channel PCNL were performed in 38,16,and 1 sides respectively.Abdominal x-ray conducted at 3 -4 days post operation revealed residual stones on 18 sides,with the range of 0.4 -2.0 cm in diameter.Second-phase lithotripsy was conducted on 14 sides of patients.After the first and the second phases of surgery,4 sides having residual stones ranging 0.6 - 1.0 cm,underwent extracorporeal shock wave lithotripsy.Ater the third-phase surgery,the diameters of residual stones were much less than 0.5 cm and patients were treated with medication.The total rate of clearance was 87.0％ (48/55).The duration of surgery was 65 - 160 minutes and 95 minutes on average.One patient having delayed bleeding was cured with selective renal artery embolization.There were no complications such as nephrectomy,deaths,pleural or intestinal damage during the period of study.Patients were followed up for 3 to 18 months.Six of 9 patients with renal insufficiency recovered after surgery.The serum creatinine in the remaining 3 patients ranged 185 -220 μmol/L Conclusion Colour Doppler-guided percutaneous nephrolithotomy for renal calculi is safe and effective.

Pielonefritis xantogranulomatosa: Nuestra experiencia en 6 casos / Xanthogranulomatous pyelonephritis: Six case reports

Introducción. La pielonefritis xantogranulomatosa (PX) es una forma de infección crónica del parénquima renal. Objetivos. Describir las características imagenológicas de la PX. Materiales y Métodos. Se realizó un análisis retrospectivo de una serie de 6 casos de PX confirmados. Resultados. Se describieron los hallazgos imagenológicos de los casos mencionados. Discusión. Las manifestaciones clínicas sugieren la afección renal y las imágenes orientan hacia su probable diagnóstico. El proceso se extiende frecuentemente al espacio perirrenal. La TC es muy útil, ya que los hallazgos de la ecografía y la urografía pueden ser inespecíficos. En la TC, la PX se asocia con la presencia de un gran cálculo, un aumento del tamaño renal o de un segmento, la pobre o nula eliminación del medio de contraste y la presencia de masas focales de baja atenuación (-10 a +30 UH), cuyas paredes realzan con la administración del contraste endovenoso. Conclusiones. El diagnóstico se sospecha cuando se combinan la unilateralidad, la presencia de litiasis, el aumento de tamaño del riñón, la ausencia de eliminación del medio de contraste, la presencia de masas de baja atenuación y la afectación del espacio perirrenal.

Introduction. Xanthogranulomatous Pyelonephritis (XP) is a chronic infection of the renal parenchyma. Objectives. To analyze the imaging features of XP. Materials and Methods. We conducted a retrospective analysis of 6 confirmed cases of XP. Results. We described the imaging findings of the abovementioned cases. Discussion. Clinical manifestations suggest renal disease and imaging leads to probable diagnosis. The process often extends to the perirenal space. CT is very useful because sonographic and urographic findings may be nonspecific. In CT scans, XP is associated with the presence of a large calculus, enlargement of the kidney or of a segment , poor or no elimination of the contrast agent and the presence of focal masses of low attenuation (-10 to 15UH) whose walls are enhanced after the administration of intravenous contrast. Conclusions. Diagnosis is suspected when there is a combination of unilaterality, lithiasis, increased size of the kidney, no elimination of contrast medium, masses of low attenuation and perirenal space involvement.

Clinical Experiences of Extracorporeal Shock Wave Lithotripsy Monotherapy in the Treatment of the Staghorn Calculi / 대한비뇨기과학회지

We reviewed 26 patients with staghorn calculi to determine whether extracorporeal shock wave lithotripsy (ESWL) monotherapy with Dornier MPL-9000X lithotriptor is a successful alternative to the classical approaches. Of the staghorn calculi 5 cases were complete and 21 cases were incomplete staghorn. Double-J ureteral stents were placed in 24 of 26 patients before the ESWL. Of 15 patients with stone volume less than 20ml, 12(80%) showed stone-free after 5.7 mean session of ESWL. Of 11 patients with stone volume more than 20 ml, 7 (64%) became stone-free after 7.1 mean session of ESWL. The post-ESWL complications were flank pain in 9 patients (35%), gross hematuria in 24 (92%), high fever in 3 (13%) and steinstrasse in 24 (92%). Frank pain and high fever were managed successfully with analgesics and antibiotics. Gross hematuria disappeared spontaneously within 2 days. For the steinstrasse, the stone fragments passed spontaneously in 15 cases (62.5%) and ESWL to the steinstrasse was needed in other 9 cases (37.5%). Though the treatment of choice for the staghorn stones is combination therapy (PNL and ESWL) at the present, we experienced good results by ESWL monotherapy in staghorn calculi with Dornier MPL-9000X.

Review or Ureteral Obstruction during ESWL Monotherapy without Ureteral Stenting for Staghorn Calculi / 대한비뇨기과학회지

ESWL monotherapy has been considered a valid initial treatment for staghorn calculi. In an effort to reduce post-ESWL obstruction, many urologists place ureteral stents before ESWL. The use of ureteral stents has proved to contribute to successful stone passage and to reduce post- ESWL morbidity but there also have been reports of complications that might have been caused by indwelling ureteral stents. From January 1989 to December 1995, we reviewed 29 patients with ureteral obstruction after ESWL (EDAP LT-01 & 02) monotherapy without ureteral stenting in 47 patients with staghorn calculi. Ureteral obstruction was occurred in 29 patients (61.7%); 16 (55.2%) in the upper ureter, 11 (37.9%) in the lower ureter, and 2 (6.9%) in the mid-ureter. Steinstrasse was occurred in 13 patients (13/29, 44.8%); 8 (61.5%) in the lower ureter, 4 (30.7%) in the upper ureter, and 1 (7.7%) in the mid-ureter. Ureteral obstruction was occurred regardless of the size of the staghorn calculi(length, breadth, volume). The method of resolving ureteral obstruction was additional ESWL (21 patients, 72.4%), and auxillary procedures including PCN (4 patients, 13.8%), push up procedure (1 patient, 3.4%), push up & double J stenting (1 patient, 3.4%), and ureterolithotomy (2 patient, 6.9%). Mean number of session of ESWL resolving ureteral obstruction was 3.27. Overall complete stone-free rate of staghorn calculi was 55.3%(26 patients). Our results indicate that postoperative ureteral obstruction is easily relieved without major complication by additional ESWL or auxillary procedures. Therefore, ie believe that ESWL monotherapy without ureteral stenting may be adequate treatment modality of staghorn calculi.

A Case of Squamous Cell Carcinoma of the Renal Pelvis Associated with Staghorn Calculi / 대한비뇨기과학회지

Squamous cell carcinoma of the renal pelvis is an uncommon tumor, comprising about 0.5-2% of all primary malignant tumor of the kidney. The patients of this disease usually presented late with extensive local infiltration. In addition, poor response to surgery, radiotherapy and chemotherapy result in a poor prognosis and short survival. We report a patient of squamous cell carcinoma of renal pelvis with staghorn calculi in a 66-year-old woman who had a history of right sided renal colic and palpable abdominal mass.