ABSTRACT
PURPOSE: to identify risk factors for urinary septic shock in patients who underwent percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: Data from PCNL procedures performed between January 2009 and February 2020 were retrospectively analyzed. The study included all patients over 18 years old with kidney stones larger than 15 mm who underwent PCNL. Patients who underwent mini-PCNL or combined surgeries, such as ureteroscopy or bilateral procedures, were not included in the study. Logistic regression was conducted to determine the risk factors for urinary septic shock within 30 days post-operation in patients who underwent PCNL. RESULTS: Urinary septic shock was observed in 8 out of the 1,424 patients analyzed (0.56%). The presence of comorbidities, evaluated using the Charlson Comorbidity Index (CCI) (OR 1.46 [CI 95% 1.15-1.86], p=0.01), larger stones (41.0 mm [IQR 30.0-47.5 mm] vs. 24.0 mm [IQR 17.0-35.0 mm], OR 1.03 [CI 95% 1.01-1.06], p=0.04), and a positive preoperative urine culture (OR 8.53 [CI 95% 1.71-42.45], p < 0.01) were shown to significantly increase the risk of postoperative urinary septic shock. Patients with a CCI > 2, larger stones (≥ 35 mm), and a positive preoperative urine culture were at even higher risk of urinary septic shock (OR 15.40 [CI 95% 1.77-134.21], p=0.01). CONCLUSION: Patients with larger stones, positive preoperative urine culture, and a higher CCI are at risk for urinary septic shock after PCNL. These findings are of utmost importance for optimizing the perioperative care of these patients to prevent life-threatening complications.
Subject(s)
Kidney Calculi , Nephrolithotomy, Percutaneous , Postoperative Complications , Shock, Septic , Humans , Shock, Septic/etiology , Nephrolithotomy, Percutaneous/adverse effects , Female , Male , Risk Factors , Retrospective Studies , Middle Aged , Kidney Calculi/surgery , Adult , Postoperative Complications/etiology , Aged , Logistic ModelsABSTRACT
Double-J (DJ) stents are most commonly used urological tools these days. Serious complications may occur when stents are left in place for longer duration. We present a case of a woman in her 40s with a forgotten DJ stent for 4 years, leading to complications such as encrustations, bladder and renal stone formation. The patient underwent a comprehensive endourological approach, including endoscopic cystolithotomy and left-sided percutaneous nephrolithotomy. The case highlights the importance of timely stent removal to prevent complications such as encrustations and stone formation. Patient education and counselling are crucial to avoid poor compliance and the associated risks of forgotten stents. This case underscores the significance of a multidisciplinary approach and emphasises the need for proactive measures to prevent such complications, including the implementation of a stent placement registry.
Subject(s)
Device Removal , Stents , Humans , Female , Stents/adverse effects , Device Removal/methods , Adult , Nephrolithotomy, Percutaneous/adverse effects , Nephrolithotomy, Percutaneous/methods , Kidney Calculi/surgery , Foreign Bodies/surgery , Foreign Bodies/diagnostic imagingABSTRACT
INTRODUCTION: Although rare, guidewire fractures can occur during interventional procedures. In most cases, the fractured guidewire segment can be removed. PATIENT CONCERNS: We report the case of a 54-year-old woman who experienced a guidewire fracture during percutaneous nephrostomy (PCN) for percutaneous nephrolithotomy to remove renal stones. DIAGNOSIS: Nephrolithiasis. INTERVENTIONS: PCN and percutaneous nephrolithotomy. OUTCOMES: In this case, the remaining segment could not be removed and caused inflammation and infection. However, her symptoms improved with inpatient treatment. Therefore, she was discharged from the hospital and followed up for 5 years. CONCLUSION: When performing PCN to remove renal stones, the possibility of a guidewire fracture must be considered. If resistance or scraping is felt while handling the guidewire, then it should be replaced.
Subject(s)
Nephrolithotomy, Percutaneous , Nephrostomy, Percutaneous , Humans , Female , Middle Aged , Nephrolithotomy, Percutaneous/adverse effects , Nephrolithotomy, Percutaneous/methods , Nephrolithotomy, Percutaneous/instrumentation , Nephrostomy, Percutaneous/adverse effects , Nephrostomy, Percutaneous/instrumentation , Nephrostomy, Percutaneous/methods , Kidney Calculi/surgery , Equipment FailureABSTRACT
To evaluate whether different positions are advantageous for hemodynamics and respiratory balance in patients undergoing percutaneous nephrolithotomy (PCNL) procedures. Pre- and postoperative arterial blood gas data obtained during spontaneous breathing for 67 prone (Group 1) and 56 supine (Group 2) patients undergoing PCNL were analyzed. Additionally data on all patients' gender, age, body mass index, stone size, access and surgical duration, volume of irrigation fluid, length of hospital stay, requirement for blood transfusion, and residual stones were recorded: There were no differences between the groups in terms of age, stone size, operation time, access time, radiation exposure, transfusion requirements, stone-free rate, and length of hospitalization. A statistically significant pH decrease was observed in both groups in the postoperative period (p = 0.001 and p = 0.001, respectively). There was a statistically significant increase in pCO2 values in both groups in the postoperative period (p = 0.001 and p = 0.024, respectively), and that increase did not differ significantly between the groups (p = 0.624). A statistically significant decrease in pO2 and SpO2 values was observed in both groups in the postoperative period compared to the preoperative period. Again, no statistical difference was observed between the groups for these values. There was a statistically significant decrease in bicarbonate in both groups period (p < 0.001 and p = 0.001, respectively). Hemodynamics and the respiratory balance of the patient are impaired in both prone and supine positions. Neither position is superior to the other in this respect.
Subject(s)
Blood Gas Analysis , Hemodynamics , Kidney Calculi , Nephrolithotomy, Percutaneous , Humans , Supine Position/physiology , Male , Female , Prone Position/physiology , Middle Aged , Adult , Nephrolithotomy, Percutaneous/methods , Nephrolithotomy, Percutaneous/adverse effects , Kidney Calculi/surgery , Kidney Calculi/blood , Patient Positioning , Aged , Postoperative Period , Retrospective StudiesABSTRACT
Robotic pyelolithotomy continues to gain attention as an alternative to percutaneous nephrolithotomy (PCNL) for managing complex renal stones. We performed a single-arm meta-analysis and systematically searched the English-language literature published in PubMed, Web of Science, Scopus, and Google Scholar databases up to June 2024. The risk of non-randomized bias was assessed using ROBINS-I, and the quality of the literature was assessed using MINORS (Methodological Index for Non-Randomized Studies). Merger parameters were calculated using Stata16/SE under a random-effects model. Five non-comparative single-arm studies were included in the meta-analysis. Results showed that the operative time for robotic pyelolithotomy was 168.10 min (95% CI 133.63, 202.56). The hospital stay was 2.63 days (95% CI 0.96, 4.29), and blood loss was 44.13 ml (95% CI 19.76, 68.51). The stone clearance rate was 87% (95% CI 79-93%). The incidence of minor postoperative complications (Clavien grade I-II) was 23.7% (95% CI 13.4-35.8%), and the incidence of major complications (Clavien grade ≥ III) was 7% (95% CI 0.3-20.7%).The safety and efficacy of robotic pyelolithotomy in treating complex renal stones are acceptable, but future large prospective cohort studies are needed to validate the treatment.
Subject(s)
Kidney Calculi , Operative Time , Robotic Surgical Procedures , Humans , Kidney Calculi/surgery , Robotic Surgical Procedures/methods , Robotic Surgical Procedures/adverse effects , Treatment Outcome , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Nephrolithotomy, Percutaneous/methods , Nephrolithotomy, Percutaneous/adverse effects , Length of Stay/statistics & numerical data , Kidney Pelvis/surgery , Blood Loss, Surgical/statistics & numerical data , Female , MaleABSTRACT
INTRODUCTION: With the continuous advancement of medical imaging, 3D printing technology is emerging. This technology allows for the representation of complex objects in a model form. This research aims to delve into the irreplaceable value of percutaneous nephrolithotomy (PCNL) in conjunction with 3D printed models in urinary stone surgery. This forward-looking approach provides doctors with a new perspective, enabling them to plan and execute surgeries with greater precision, ultimately delivering a safer and more efficient treatment experience for patients. We evaluated the literature on PCNL for the kidney stones with the introduction of 3D printing models and conducted a meta-analysis. The assessed parameters included stone clearance rate, operation time, hospital stay, blood loss, puncture accuracy, and the rate of complications. EVIDENCE ACQUISITION: We systematically searched the EMBASE, PubMed, Cochrane Library, SCIE, and Chinese Biomedical Literature Search databases for articles related to PCNL (Percutaneous Nephrolithotomy) with 3D printing models from January 2000 to January 2023. Data were managed and screened using Excel . Meta-analysis was performed for operation time, stone clearance rate, blood loss, puncture accuracy, length of hospital stay, and complications in PCNL combined with 3D printing model for kidney stone treatment. The quality of included articles was assessed using the risk of bias tool by the Cochrane Collaboration. Sensitivity analysis was conducted to assess the reliability of the results. Data were recorded using StataSE 17 software, and publication bias was examined using Egger's linear regression test. EVIDENCE SYNTHESIS: We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to conduct a systematic search and screening of literature relevant to the use of 3D printed models in the treatment of kidney stones. We conducted an extensive literature search across several major academic databases, including EMBASE, PubMed, Cochrane Library, SCIE, and Chinese Biomedical Literature Search databases, to ensure comprehensive coverage of relevant studies. Following the PRISMA process of screening and analysis, we ultimately included 10 randomized controlled trials with a combined sample of 608 for systematic review. CONCLUSIONS: Across these studies, we identified the introduction of 3D printing models prior to surgery for kidney stones resulted in significant advantages for the experimental group compared to the control group in terms of operation time, stone clearance rates, puncture accuracy, hospital stay, blood loss, and the incidence of complications, providing valuable insights for further research and clinical practice.
Subject(s)
Kidney Calculi , Nephrolithotomy, Percutaneous , Printing, Three-Dimensional , Humans , Nephrolithotomy, Percutaneous/methods , Nephrolithotomy, Percutaneous/adverse effects , Kidney Calculi/surgery , Models, AnatomicABSTRACT
OBJECTIVE: The objective of this study was to develop and evaluate the performance of machine learning models for predicting the possibility of systemic inflammatory response syndrome (SIRS) following percutaneous nephrolithotomy (PCNL). METHODS: We retrospectively reviewed the clinical data of 337 patients who received PCNL between May 2020 and June 2022. In our study, 80% of the data were used as the training set, and the remaining data were used as the testing set. Separate prediction models based on the six machine learning algorithms were created using the training set. The predictive performance of each machine learning model was determined by the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity and specificity using the testing set. We used coefficients to interpret the contribution of each variable to the predictive performance. RESULTS: Among the six machine learning algorithms, the support vector machine (SVM) delivered the best performance with accuracy of 0.868, AUC of 0.942 (95% CI 0.890-0.994) in the testing set. Further analysis using the SVM model showed that prealbumin contributed the most to the prediction of the outcome, followed by preoperative urine culture, systemic immune-inflammation (SII), neutrophil to lymphocyte ratio (NLR), staghorn stones, fibrinogen, operation time, preoperative urine white blood cell (WBC), preoperative urea nitrogen, hydronephrosis, stone burden, sex and preoperative lymphocyte count. CONCLUSION: Machine learning-based prediction models can accurately predict the possibility of SIRS after PCNL in advance by learning patient clinical data, and should be used to guide surgeons in clinical decision-making.
Subject(s)
Machine Learning , Nephrolithotomy, Percutaneous , Postoperative Complications , Systemic Inflammatory Response Syndrome , Humans , Systemic Inflammatory Response Syndrome/etiology , Systemic Inflammatory Response Syndrome/diagnosis , Nephrolithotomy, Percutaneous/adverse effects , Female , Male , Retrospective Studies , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/diagnosis , Adult , Predictive Value of Tests , Aged , Kidney Calculi/surgeryABSTRACT
OBJECTIVE: To investigate the efficacy and safety of mini-track, mini-nephroscopy and mini-ultrasonic probe percutaneous nephrolithotomy (3mPCNL) for the treatment of 1.5-2.5 cm kidney stones. METHODS: The perioperative data and postoperative follow-up data of a total of 25 patients with about 1.5-2.5 cm kidney stones who underwent 3mPCNL under ultrasound guidance in Peking University People's Hospital from November 2023 to January 2024 were retrospectively analyzed. During the matching period, the 25 patients with 1.5-2.5 cm kidney stones receiving standard percutaneous nephrolithotomy (sPCNL) were matched one-to-one according to the criterion that the absolute difference of the maximum diameter of stones between the two groups was less than 1 mm. The operative time, renal function changes, postoperative stone-free rate, hemoglobin changes, and complication rate of the two treatments were compared, and then the effectiveness and safety of 3mPCNL were preliminarily analyzed. RESULTS: There were no significant differences in mean age, preoperative median creatinine, preoperative mean hemoglobin, preoperative mean hematocrit, median stone maximum diameter, and median stone CT density between the 3mPCNL group and the sPCNL group. The median operation time in the 3mPCNL group was 60.0 (45.0-110.0) min, with no statistical significance compared with the sPCNL group, and all the patients underwent single-channel operations. The mean hemoglobin after operation in the 3mPCNL group was (115.3±15.5) mmol/L, and there was no significant difference between the preoperative group and the sPCNL group, and the mean hemoglobin decreased significantly between the sPCNL group and the sPCNL group [(9.5±2.2) mmol/L vs. (10.1±1.9) mmol/L]. The mean hematocrit after operation was (28.0±5.2)%, and the difference was statistically significant compared with that before operation (t=2.414, P=0.020). The mean hematocrit drop was not statistically signi-ficant compared with the sPCNL group (2.3% vs. 2.7%). The median serum creatinine in the 3mPCNL group was 74.0 (51.0-118.0) µmol/L after operation, and the difference was statistically significant compared with that before operation (Z=-2.980, P=0.005). The stone-free rate in the 3mPCNL group and the sPCNL group was 96.0% and 97.3%, respectively, and the mean hospital stay was (4.3± 1.4) d and (5.5±2.0) d, respectively, with the statistical significance (t=0.192, P=0.025). After the operation, one patient in sPCNL group had massive hemorrhage after the nephrostomy tube was removed, which was improved after selective renal artery embolization. One patient in the 3mPCNL group developed mild perirenal hematoma, which was improved after conservative treatment, and no complications were observed in the other patients. CONCLUSION: 3mPCNL in the treatment of 1.5-2.5 cm kidney stones can achieve an effective rate comparable to sPCNL, and can achieve the ideal stone-free rate in a shorter operative time with a lower rate of surgery-related complications.
Subject(s)
Kidney Calculi , Nephrolithotomy, Percutaneous , Humans , Kidney Calculi/surgery , Nephrolithotomy, Percutaneous/methods , Nephrolithotomy, Percutaneous/adverse effects , Retrospective Studies , Treatment Outcome , Operative Time , Male , Female , Middle AgedABSTRACT
Mayo adhesive probability (MAP) score is one of the commonest tool to predict the adherence status of perirenal fat. The association between MAP score and intraoperative hemorrhage in patients undergoing micropercutaneous nephrolithotomy was comfirmed in a recent well designed study. We aimed to investigate if MAP score may predict the possibility for significant intraoperative bleeding in supine percutaneous nephrolithotomy (PCNL) performed with a 26 Fr rigid nephroscope. In this observational retrospective study, demographic, clinical, laboratory, radiological, perioperative (operation duration, hospitalization, intraoperative bleeding, success) and MAP score (perinephric fat stranding, posterior perinephric fat thickness and total MAP score) data of all patients who underwent supine PCNL between June 2021 and July 2023 were evaluated. The patients were divided into 2 groups according to their MAP scores (79 [54.1%] patients with MAP score < 3 [low MAP score] and 67 [54.1%] patients with MAP score ≥ 3 [high MAP score]). The rate of patients with intraoperative bleeding was 47.8% in the patient group with a high MAP score, while it was 22.8% in the patient group with a low MAP score (p = 0.002). In multivariate logistic regression analysis, anticoagulant drug use history (OR = 2.525; 95% CI = 1.025-6.224; p = 0.044), presence of multiple stones (OR = 3.015; 95% CI = 1.205-7.543; p = 0.018), calyx localization of the stone (OR = 2.871;95% CI = 1.166-7.068; p = 0.022), higher renal parenchymal thickness (OR = 1.119; 95% CI = 1.049-1.193; p = 0.001) and MAP score > 3 (OR = 3.486; 95% CI = 1.579-7.696; p = 0.002) were defined as independent risk factors for significant intraoperative bleeding. In clinical practice, the MAP score can be used to predict bleeding before PCNL.
Subject(s)
Blood Loss, Surgical , Kidney Calculi , Nephrolithotomy, Percutaneous , Humans , Male , Female , Nephrolithotomy, Percutaneous/adverse effects , Nephrolithotomy, Percutaneous/methods , Retrospective Studies , Middle Aged , Adult , Kidney Calculi/surgery , Blood Loss, Surgical/statistics & numerical data , Predictive Value of TestsABSTRACT
Impacted proximal ureteral stones (IPUS) present challenging clinical scenarios due to their persistent nature and associated complications. While ureterorenoscopy (URS) lithotripsy is recommended as the primary treatment, controversies exist regarding the optimal management of such stones. In this retrospective analysis, we compared the operative outcomes and long-term results of transperitoneal laparoscopic ureterolithotomy (LU) and percutaneous nephrolithotomy (PCNL) for IPUS larger than 15 mm. Propensity score matching (PSM) was employed to mitigate potential selection biases. Following PSM, 83 patients in each cohort exhibited comparable baseline characteristics. LU demonstrated a superior surgical success rate (100% vs. 96.4%, p = 0.244) and significantly lower perioperative hemoglobin decline (0.6 ± 0.4 g/dL vs. 1.5 ± 0.7 g/dL, p = 0.036) compared to PCNL. Additionally, LU exhibited a higher stone-free rate after 2 months (100% vs. 91.6%, p = 0.043), but a longer duration of catheterization (7.4 ± 1.2 days vs. 3.5 ± 2.2 days vs., p = 0.011). Conversely, PCNL was associated with a higher incidence of total complications (21.7% vs. 9.6%, p = 0.033) and stone recurrence during a mean period of 40-month follow-up (20.5% vs. 8.4%, p = 0.027). Transperitoneal LU and PCNL represent effective interventions for managing IPUS exceeding 15 mm. Notably, LU emerges as a preferable option over PCNL, offering superior stone clearance rates, reduced perioperative complications, and lower recurrence rates.
Subject(s)
Laparoscopy , Nephrolithotomy, Percutaneous , Propensity Score , Ureteral Calculi , Humans , Nephrolithotomy, Percutaneous/methods , Nephrolithotomy, Percutaneous/adverse effects , Male , Female , Retrospective Studies , Ureteral Calculi/surgery , Laparoscopy/methods , Laparoscopy/adverse effects , Middle Aged , Adult , Follow-Up Studies , Treatment Outcome , Time Factors , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Peritoneum/surgeryABSTRACT
BACKGROUND: To evaluate the incidence of metabolic syndrome (MetS) in patients with unilateral and bilateral staghorn calculi (SC) and evaluate the impact on the outcome of percutaneous nephrolithotomy (PCNL). METHODS: The clinical data of patients who underwent PCNL for the treatment of SC between 2019 and 2022 were retrospectively reviewed. SC was divided into unilateral and bilateral. The incidence of MetS was compared between the patients with unilateral SC and the patients with bilateral SC, and the impact on the outcome of PCNL was assessed. RESULTS: A total of 1778 patients underwent PCNL between 2019 and 2022. After screening computed tomography, 379 patients were confirmed to have SC, finally, leaving 310 patients with follow-up and complete data to be included in the study. Eighty-four had bilateral SC and 226 had unilateral SC. The patients with bilateral SC had a significantly higher body mass index and higher rates of complete staghorn stones and metabolic syndrome. Higher body mass index, hypertension, diabetes mellitus, hyperlipidaemia, and MetS were present in 62.58%, 44.84%, 21.94%, 60.65% and 27.42% of all patients, respectively. The number of MetS components remained significantly associated with bilateral SC. Specifically, when the number of MetS components increases from 0 to 3-4, the likelihood of developing bilateral staghorn calculi increases by 21.967 times. Eighty-five patients with MetS( +) had a higher rate of overall complications (number (N)(%), 29 (34.12) vs.33 (14.46), P < 0.001) and a comparable stone-free rate to 225 MetS(-) patients. Multivariable analysis confirmed that hyperlipidaemia (P = 0.044, odds ratio [OR] = 1.991, 95% confidence interval [CI] 1.020-3.888) and MetS (P = 0.005, OR = 2.427, 95% CI 1.316-4.477) were independent risk factors for overall complications. CONCLUSIONS: MetS is correlated with the formation of bilateral SC and is the main predictor for complications of PCNL especially for low-grade complications (I-II).
Subject(s)
Metabolic Syndrome , Nephrolithotomy, Percutaneous , Staghorn Calculi , Humans , Metabolic Syndrome/complications , Metabolic Syndrome/epidemiology , Male , Nephrolithotomy, Percutaneous/adverse effects , Female , Middle Aged , Retrospective Studies , Incidence , Staghorn Calculi/surgery , Adult , Treatment Outcome , Aged , Postoperative Complications/epidemiology , Postoperative Complications/etiologyABSTRACT
OBJECTIVE: This study aimed to compare the results of retrograde intrarenal surgery (RIRS) and mini-percutaneous nephrolithotomy (mini-PCNL) for the treatment of 1-2 cm kidney stones in pediatric patients. METHODS: The records of patients under the age of 18 years who were diagnosed with unilateral 1-2 cm kidney stones for the first time and underwent endoscopic surgery between February 2008 and April 2022 were retrospectively examined. The patients were divided into two groups: mini-PCNL and RIRS surgery. Parameters such as age, gender, number of stones, side, size and localization were examined. The main endpoint of the study was to compare stone-free rates (SFR) one month after both surgeries. Surgery and fluoroscopy times, postoperative hospital stay, hemoglobin decrease and complication rates were compared between the groups. SFR was evaluated one month after surgery by direct urinary system radiography and USG or CT. RESULTS: A total of 58 patients were included in the study. There were 35 patients in the mini-PCNL group and 23 patients in the RIRS group. Table 1 shows the demographic and clinical characteristics of both groups. There was no significant difference between the groups in terms of age, gender, stone size, location, side and density. Calcium oxalate stones were observed at a higher rate in both groups. Mean fluoroscopy time was higher in the mini-PCNL group (p = 0.001). The mean surgery time was lower in the mini-PCNL group (p = 0.024). The mean hemoglobin decrease was greater in the percutaneous group (p = 0.039). There were no differences between the groups in terms of postoperative hospital stay, complication rates, and SFR one month after surgery. CONCLUSION: Although mini-PCNL seems to be more advantageous in terms of operation time compared to RIRS, it is disadvantageous in terms of average fluoroscopy time, radiation received and average hemoglobin decrease.
Subject(s)
Kidney Calculi , Nephrolithotomy, Percutaneous , Humans , Kidney Calculi/surgery , Female , Male , Child , Retrospective Studies , Nephrolithotomy, Percutaneous/methods , Nephrolithotomy, Percutaneous/adverse effects , Adolescent , Treatment Outcome , Child, Preschool , Operative Time , Length of Stay , FluoroscopyABSTRACT
BACKGROUND: This systematic review and meta-analysis aimed to evaluate the efficiency and safety of percutaneous nephrolithotomy (PCNL) between flank position and prone position for the treatment of renal stones. METHODS: PubMed, Embase, OVID, and Cochrane Library were comprehensively searched from their inception to Jul 2024. Randomized and nonrandomized trials evaluating renal calculi patients who underwent PCNL via flank position or prone position were included. Data extraction and quality assessment were conducted by two independent reviewers. The outcomes and complications of both groups were compared in this meta-analysis. RESULTS: This review involved five articles (554 patients). Specifically, four articles were randomized controlled trials, and the remaining publication was prospective cohort study. No significant difference was found in stone-free rate between the flank group and prone group after the PCNL procedure. Similarly, the percutaneous access time, operative time, and hospital stay of flank position had no significant difference compared with the prone group. There was no significant difference in the comparison of complication rates between the flank group and the prone group. Although further analysis indicated that patients in the prone position suffered more hemoglobin drop than the flank group, no significant difference was found in the hemorrhage and blood transfusion rates. CONCLUSIONS: Both surgical positions were appropriate for most PCNL procedures and had shown similar efficacy and safety. In practice, the optimal choice should be made according to the patients' conditions and urologists' acquaintance.
Subject(s)
Kidney Calculi , Nephrolithotomy, Percutaneous , Patient Positioning , Humans , Nephrolithotomy, Percutaneous/methods , Nephrolithotomy, Percutaneous/adverse effects , Prone Position , Patient Positioning/methods , Kidney Calculi/surgery , Treatment Outcome , Postoperative Complications/epidemiologyABSTRACT
To assess the safety and effectiveness of tubed versus tubeless percutaneous nephrolithotomy (PCNL) after tract inspection and bipolar cauterization of the significant bleeders. Patients who were scheduled for PCNL were screened for enrollment in this prospective randomized controlled trial. The patients were randomly assigned to one of two groups; Group 1 received tubeless PCNL with endoscopic inspection of the access tract using bipolar cauterization of the significant bleeders only, while Group 2 had a nephrostomy tube was inserted without tract inspection. We excluded patients with multiple tracts, stone clearance failure, and significant collecting system perforation. We recorded blood loss, hemoglobin drop after 6 h, postoperative analgesia requirements, hospital stay, and the need for angioembolization. A total of 110 patients completed the study. There were no significant differences between the two groups in in terms of demographic characteristics. Likewise, there was no significant difference in the mean decrease in hemoglobin after 6 h and the frequency of blood transfusion. However, the incidence of hematuria within the first 6 h (p = 0.008), postoperative pain scale (p = 0.0001), the rate of analgesia requirement (p = 0.0001) and prolonged hospital stay (p = 0.0001) were significantly higher in Group 2. Only 9 cases of tract screened patients (16% of group 1) required cauterization. Tubeless PCNL with tract inspection and cauterization of bleeders can provide a safer tubeless PCNL with less postoperative pain, analgesia requirement, and same-day discharge.
Subject(s)
Kidney Calculi , Nephrolithotomy, Percutaneous , Humans , Male , Female , Nephrolithotomy, Percutaneous/adverse effects , Nephrolithotomy, Percutaneous/methods , Nephrolithotomy, Percutaneous/instrumentation , Middle Aged , Adult , Prospective Studies , Kidney Calculi/surgery , Length of Stay/statistics & numerical data , Pain, Postoperative/etiology , Treatment Outcome , Blood Loss, Surgical/statistics & numerical data , Hematuria/etiology , Hematuria/epidemiologyABSTRACT
PURPOSE: To compare the efficacy, safety and advantages of the total tubeless (TT) percutaneous nephrolithotomy (PCNL) and standard PCNL in the supine position. METHODS: This study was carried out at Izmir Tepecik Health Application and Research Center. A total of 87 patients were examined. Forty-three patients who underwent TT procedure were defined as Group 1, and 44 patients who underwent standard procedure with a nephrostomy tube were defined as Group 2. Two techniques were evaluated with demographic data and outcome parameters. Univariate regression analyses were performed in these data sets for the parameters that predicted the TT procedure. RESULTS: The demographic data of the groups and all characteristics of the stones were similar. When the results were examined, the stone-free rates detected by non-contrast computed tomography (CT) in the postoperative 1st month were similar between the groups. Complication rates and secondary intervention rates were similar. Operation and fluoroscopy times were shorter in group 1, which were not statistically significant. Postoperative hemoglobin decreased, and creatinine values were similar. In Group 1, mean postoperative visual analog scale (VAS) scores and the percentage of VAS reporting > 5 points for pain level measurement were lower and statistically significant. In the univariate analysis of the factors predicting the TT procedure, no significant results were found in any parameter. CONCLUSION: Performing TT PCNL in the supine position in selected patients reduces postoperative pain without affecting the complication rates as in prone PCNL. Our study is the first to compare TT and standard PCNL in supine position.
Subject(s)
Kidney Calculi , Nephrolithotomy, Percutaneous , Humans , Nephrolithotomy, Percutaneous/methods , Nephrolithotomy, Percutaneous/adverse effects , Male , Female , Supine Position , Middle Aged , Adult , Kidney Calculi/surgery , Treatment Outcome , Patient Positioning/methods , AgedABSTRACT
BACKGROUND: Percutaneous nephrolithotomy (PCNL) is the first treatment for complex renal and/or ureteral calculi. This paper presents a case of hemorrhagic shock resulting from diaphragm injury due to PCNL, which has not been reported so far. CASE PRESENTATION: A 55-year-old Asian woman presented with a 2 × 2 cm calculus located in the upper calyx of the right kidney. After her uncomplicated PCNL operation, the patient's blood pressure decreased to less than 90/60 mmHg, and her hemoglobin level dropped from 128 g/L to 76 g/L. Physical examination and bedside ultrasound indicated a small amount of pleural effusion. Subsequently, a diagnostic puncture of the chest cavity was performed and revealed the presence of fresh blood. Therefore, thoracic closed drainage was conducted, and 950 mL of fresh blood was drained through a drainage tube. Intraoperatively, observation showed that the nephrostomy tube had penetrated the kidney through the diaphragm. The nephrostomy tube was subsequently removed, and the diaphragm was repaired. CONCLUSIONS: Hemorrhagic shock due to diaphragm injury is an unusual complication after PCNL. This complication should be considered if pleural effusion is present and if blood pressure progressively drops with no other obvious explanation. The recommended treatments include diagnostic thoracentesis and thoracic exploration.
Subject(s)
Diaphragm , Nephrolithotomy, Percutaneous , Shock, Hemorrhagic , Humans , Shock, Hemorrhagic/etiology , Female , Middle Aged , Nephrolithotomy, Percutaneous/adverse effects , Diaphragm/injuries , Kidney Calculi/surgeryABSTRACT
INTRODUCTION: Financial toxicity has been described in stone formers; however, little is understood regarding its causes and how it may relate to stone surgery. We therefore aimed to longitudinally describe markers of financial strain in stone formers from the preoperative to postoperative time points. METHODS: A prospective cohort study was conducted from January 2022 to April 2023. Patients were enrolled in the waiting area prior to undergoing elective ureteroscopy or percutaneous nephrolithotomy. Participants completed The Commonwealth Fund's Biennial Health Insurance Survey at this time point and at 30 days postoperatively. Items were preselected from the survey to capture markers of financial strain due to health care costs. RESULTS: One hundred nine participants were enrolled. White (70%), college-educated (62%), and privately insured (72%) patients comprised the majority of participants. Despite these traditionally protective sociodemographic features, 42% of patients reported some marker of financial strain at the preoperative time point. Patients with Medicaid reported even higher financial stress (67%). Furthermore, 46% of patients did not know their deductible amount. Response rate was low at 30 days postoperatively (35%) but suggested some patients were experiencing new financial strains. CONCLUSIONS: This paper shows that a significant proportion of stone patients are already displaying markers of financial strain from health care bills even prior to surgery as well as poor understanding of the costs they may incur. This makes them vulnerable to experiencing financial toxicity postoperatively and emphasizes the importance of understanding all contributing factors when developing future strategies to intervene in financial toxicity.
Subject(s)
Financial Stress , Humans , Male , Female , Prospective Studies , Middle Aged , Adult , Ureteroscopy/adverse effects , Ureteroscopy/economics , Kidney Calculi/surgery , Kidney Calculi/economics , Nephrolithotomy, Percutaneous/adverse effects , Nephrolithotomy, Percutaneous/economics , AgedABSTRACT
BACKGROUND: With improvements in endoscopic surgery, open surgical procedures for urinary system stones have cleared the path for the use of less invasive treatment modalities in patients with pediatric kidney stone disease. Extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS) are among the treatment options available. OBJECTIVE: To prospectively evaluate the outcomes of mini-percutaneous nephrolithotomy and retrograde intrarenal surgery (RIRS) for children ≤10 years of age with upper urinary tract calculus (1-2.5 cm). STUDY DESIGN: Sixty pediatric patients with single or multiple renal stones (1-2.5 cm in diameter) were collected prospectively and equally divided into two groups to undergo RIRS or mini-PCNL. The operative and postoperative outcomes of both groups were analyzed. RESULTS: The groups' mean ages and genders were comparable. The mean stone size for the RIRS group was 1.86 cm and 1.69 cm for the PCNL group (P = 0.449). The PCNL group had statistically longer mean fluoroscopy and hospitalization times. The stone-free rates (SFRs) after a single procedure were 27 (90%) in the PCNL group and 25 (83.33%) in the RIRS group (P = 0.706). The UAS was placed in 13 (43.33%) patients in the RIRS group. In the RIRS group, 14 (46.67%) children required preoperative DJ stent application to passively dilate the ureteric orifice. As regard post DJ stenting, 13 (46%) cases applied DJ in the mini PCNL group. major complications were observed in either group. Minor complication (Clavien 1-3) rates were 16.66% and 13.33% for the PCNL and RIRS groups, respectively. There were no differences found between the RIRS and mini-PCNL groups regarding operative time. The mean cost of RIRS was $703.96 and $537.03 for the mini-PCNL. CONCLUSION: According to the results of this study, mini-PCNL and RIRS are effective procedures for treating renal stones in children up to 2.5 cm with comparable success and complication rates. Hospital stay, radiation exposure, and fluoroscopy time are significantly lower in RIRS than in the mini PCNL technique. Although RIRS is effective, a major disadvantage is the greater requirement for JJ stent insertion either before or after the procedure and the consequent need for a second procedure for removal.
Subject(s)
Kidney Calculi , Nephrolithotomy, Percutaneous , Humans , Male , Female , Nephrolithotomy, Percutaneous/methods , Nephrolithotomy, Percutaneous/adverse effects , Kidney Calculi/surgery , Child , Prospective Studies , Treatment Outcome , Child, Preschool , Infant , Follow-Up StudiesABSTRACT
INTRODUCTION: Decision-making for complex pediatric urinary system stone disease is still a challenge for pediatric urologists. The interest in supine percutaneous nephrolithotomy (PCNL) is increasing among centers to achieve high surgical success rates with less morbidity. Despite advanced retrograde intrarenal surgery armamentarium, percutaneous approaches remain the first-line surgical treatment modality for >2 cm and complex renal stones. There are no comparative studies yet in the literature for pediatric endoscopic combined intrarenal surgery (ECIRS) OBJECTIVE: In this study, we aimed to contribute to the literature by evaluating the safety and efficacy of ECIRS by comparing it with PCNL. STUDY DESIGN: Patients under 18 years of age who underwent PCNL and ECIRS for urinary tract stone disease at our Pediatric Urology department between 2012 and 2024 were included. Preoperative (demographic characteristics, stone characteristics, biochemical parameters), perioperative (duration of surgery, number of accesses, lasing and fluoroscopy times, endoscopic and fluoroscopic stone-free rates) and postoperative (hospital stay, urinary tract infection, complication and radiological stone-free rates) parameters were retrospectively evaluated. RESULTS: A total of 68 children [28 (41%) girls and 40 (59%) boys] aged 5 (0-17) years were included in the study. ECIRS was performed in 19 (28%), supine in 28 (41%) and prone PCNL in 21 (30%) patients. Age (p = 0.029), Guy's stone score (p < 0.001), S.T.O.N.E. (p < 0.001), and Seoul National University Renal Stone Complexity (S-ReSC) scores (p = 0.001) for preoperative parameters were found to be higher in ECIRS group over both PCNL methods (Summary Table). However, Clinical Research Office of the Endourological Society (CROES) score was seen lower for ECIRS group patients compared to other groups (p = 0.028). Surgery time (in favor of supine over prone PCNL), fluoroscopy time (in favor of ECIRS and Supine PCNL over Prone PCNL), preferred laser type (prone PCNL group was mostly performed with holmium laser, whereas other groups were balanced between Holmium and Thulium Fiber Laser) and exit strategy (the preferred exit strategy was DJ Stent in most of the ECIRS patients, whereas nephrostomy tube was used in some of the PCNL group) showed significant difference among the groups as perioperative parameters (p = 0.042, <0.001, <0.001, <0.001, respectively). Surgery time was lower for supine PCNL compared to prone PCNL. For postoperative parameters, stone-free rates, complication rates and urinary tract infections were similar between the 3 groups, while a difference was detected in terms of length of hospital stay in favor of ECIRS over both supine and prone PCNL (p = 0.006). DISCUSSION: The current trial suggests that stone-free and complication rates of ECIRS and supine PCNL were similar in the pediatric complex stone patients. Although, the stones in the ECIRS group we found to be more complex. Also, ECIRS was superior to PCNL in terms of fluoroscopy exposure and hospital stay. CONCLUSION: With the widespread use of new generation ureteral access sheaths and flexible ureterorenoscopes, ECIRS may have an important role in treatment of complex pediatric kidney stones.