Clinical efficacy and short-term outcome of combining flexible cystoscopy with percutaneous nephrolithotomy for complex renal stone management.

OBJECTIVE: This study aims to evaluate the clinical efficacy and short-term prognosis of using flexible cystoscopy with percutaneous nephrolithotomy to treat complex renal stones. METHODS: A retrospective analysis was conducted on patients with complex kidney stones treated at Gansu Provincial Hospital of TCM and Lanzhou City No. 2 People's Hospital from July 2019 to July 2022. The study divided the patients into a control group (n=95), who underwent percutaneous nephrolithotomy alone, and an observation group (n=109), who received additional holmium laser lithotripsy and cystoscopy. We compared stone clearance rates at 5 days and 1 month post-surgery, analyzed patient prognosis over a year based on stone recurrence, and assessed risk factors through logistic regression. Perioperative data, changes in renal function indiex 3 days post-surgery, and complication rates were also evaluated. RESULTS: The observation group exhibited a significantly higher stone clearance rate at 5 days post-surgery (P=0.002) compared to the control group, although no significant difference was observed at 1 month (P=0.823). The operative time was significantly shorter (P<0.001), and postoperative levels of BUA, Cys-c, and ß2-BMG were lower (P<0.05) in the observation group. Additionally, treatment regimen, BMI, and STONE score were influencing factors for stone recurrence within 1 year. CONCLUSION: Flexible cystoscopy combined with percutaneous nephrolithotomy offers superior short-term outcomes in the treatment of complex renal stones, including enhanced stone clearance, reduced operative time, and minimized renal function impairment shortly after surgery. Moreover, treatment approach, BMI, and STONE score play pivotal roles in predicting stone recurrence.

Does prior PCNL affect RIRS? A retrospective analysis of a single center data.

PURPOSE: The aim of this study is to investigate the results and safety of retrograde intrarenal surgery (RIRS) in patients who have previously undergone percutaneous nephrolithotomy (PCNL). METHODS: A retrospective analysis included patients who underwent RIRS for kidney stones between August 2018 and April 2023. Group 1 comprised 396 patients who underwent primary RIRS, while Group 2 included 231 individuals who had RIRS after previous PCNL. Evaluation parameters included preoperative characteristics, stone attributes, operative details, treatment outcomes, stone-free status, and complications. Statistical analysis utilized Student's t test, Mann-Whitney U test, and Pearson Chi-square test (p < 0.05). RESULTS: The mean age, body mass index, stone number, mean stone burden, and SFS were not statistically different between the groups. Lower pole stones were identified in 144 patients in Group 1 and 88 patients in Group 2 (p = 0.315). In Group 1 and Group 2, the mean operation time and fluoroscopy time were 65.23 ± 18.1 min, 81.32 ± 14.3 min, 26.34 ± 8.31 s, 46.61 ± 7.6 s, respectively, showing statistically significant differences between the groups (p = 0.013, p < 0.001, respectively). Infundibulum stenosis was identified and treated with a laser in 12% of Group 2 cases. Complications occurred in 12 patients in Group 1 and 14 patients in Group 2 (p = 0.136). CONCLUSION: A history of PCNL may contribute to extended operation times and increased fluoroscopy exposure in subsequent RIRS without significantly affecting postoperative SFS or complication rates.

Does success in percutaneous nephrolithotomy depend only on stone size? Analysis of the predictive capacity for success and complications of the current nephrolithometry scoring systems and their relationship with the stone surface.

OBJECTIVE: To analyze the predictive capacity of the nephrolithometry scoring systems (GSS, STONE, CROES and S-ReSC) and stone surface regarding success and complications following percutaneous nephrolithotomy (PCNL). METHODS: We studied 392 patients who had undergone PCNL in our center. Only patients with a non-contrast CT (n = 240) were finally included for analysis. The predictive capacities for success and complications of the different scoring systems were evaluated using ROC curves and their area under the curve (AUC). RESULTS: Regarding success, the S-ReSC system had the highest predictive capacity with an AUC of 0.681 (95% CI 0.610 - 0.751), followed by the CROES with 0.667 (95% CI 0.595 - 0.738), the STONE with 0.654 (95% CI 0.579 - 0.728) and finally the GSS with 0.626 (95% CI 0.555 - 0.698). The stone surface as a single variable had an AUC of 0.641 (95% CI 0.565 - 0.718). As for complications, the S-ReSC had the highest AUC with 0.664 (95% CI 0.57 - 0.758), followed by STONE with 0.663 (95% CI 0.572 - 0.755), GSS with 0.626 (95% CI 0.555). - 0.698) and CROES with 0.614 (95% CI 0.518 - 0.7). The stone surface alone had an AUC of 0.616 (95% CI 0.522 - 0.715). CONCLUSION: The nephrolithometry scales analyzed show a moderate predictive capacity for success and complications in patients undergoing PCNL in our center. Moreover, stone surface as an independent variable demonstrates moderate predictive capacity for both outcomes.

Propensity Score-Matched Analysis of Perioperative Outcomes of Supine versus Prone Percutaneous Nephrolithotomy.

Objective: To compare the perioperative outcomes of supine and prone percutaneous nephrolithotomy (PCNL). Methods: A retrospective search of a tertiary medical center database yielded 517 patients who underwent supine (n = 91) or prone (n = 426) PCNL between September 2015 and July 2020. Data on demographics, baseline clinical parameters, and stone burden were included as predictors in a logistic regression model, generating a set of propensity scores. Seventy patients after supine PCNL were propensity score-matched 1:1 with patients after prone PCNL and compared for operative time, perioperative complications, system complexity, and stone-free rate. Results: We found that the operative time was significantly shorter in the supine PCNL group than in the prone PCNL group (85.5 ± 25.2 min vs. 96.4 ± 25.8 min, respectively; p = 0.012). The majority of both groups had low-grade (I-II) complexity systems (85.6% and 88.6%, respectively), with no significant difference among all grade groups (p = 0.749). There were no significant differences between the supine and prone PCNL groups in terms of the overall perioperative complication rate (8.6% vs. 4.3%, respectively; p = 0.301) or stone-free rate (74.3 vs. 65.7%, respectively; p = 0.356), while the rate of blood transfusion was significantly higher in the supine group (p = 0.023). Conclusions: In our study, we used propensity score matching to compare patients who underwent PCNL in the supine or prone position, adjusting for selection bias. Supine PCNL was associated with a shorter operative time but a higher blood transfusion rate, with no differences in the overall complication and stone-free rates.

Assessment of Effectiveness and Safety of Aspiration-Assisted Nephrostomic Access Sheaths in PCNL and Intrarenal Pressures Evaluation: A Systematic Review of the Literature.

Background: Different suction-assisted nephrostomic sheaths have been developed for percutaneous nephrolithotomy (PCNL). Objectives: (1) To examine PCNL techniques performed with different aspiration-assisted sheaths (Clear Petra® sheath, Superperc, SuperminiPCNL, and a miniPCNL patented sheath), with specific regard to effectiveness and safety outcomes in adult and paediatric patients; (2) to extrapolate intrarenal pressure (IRP) data during these procedures. Methods: A systematic literature search was performed in accordance with PRISMA guidelines. Relevant articles up to 8 February 2024 were included. Results: Twenty-five studies were selected, thirteen retrospective and twelve prospective. The use of four different aspirating sheaths for miniPCNL was reported: Clear Petra® sheath, Superperc, SuperminiPCNL, and a miniPCNL patented sheath. Stone free rates (SFRs) across techniques ranged from 71.3% to 100%, and complication rates from 1.5% to 38.9%. Infectious complication rates varied from 0 to 27.8% and bleeding complication rates from 0 to 8.9%. Most complications were low grade ones. The trend among studies comparing aspiration- and non-aspiration-assisted miniPCNL was towards equivalent or better SFRs and lower overall infectious and bleeding complication rates in suction techniques. Operation time was consistently lower in suction procedures, with a mean shortening of the procedural time of 19 min. Seven studies reported IRP values during suction miniPCNL. Two studies reported satisfactory SFRs and adequate safety profiles in paediatric patient cohorts. Conclusions: MiniPCNL with aspirating sheaths appears to be safe and effective in both adult and paediatric patients. A trend towards a reduction of overall infectious and bleeding complications with respect to non-suction procedures is evident, with comparable or better SFRs and consistently shorter operative times. The IRP profile seems to be safe with the aid of aspirating sheaths. However, high quality evidence on this topic is still lacking.

Prevention of complications in endourological management of stones: What are the basic measures needed before, during, and after interventions?

Objective: This narrative review aims to describe measures to minimise the risk of complications during percutaneous nephrolithotomy (PCNL), ureteroscopy, and retrograde intrarenal surgery. Methods: A literature search was conducted from the PubMed/PMC database for papers published within the last 10 years (January 2012 to December 2022). Search terms included "ureteroscopy", "retrograde intrarenal surgery", "PCNL", "percutaneous nephrolithotomy", "complications", "sepsis", "infection", "bleed", "haemorrhage", and "hemorrhage". Key papers were identified and included meta-analyses, systematic reviews, guidelines, and primary research. The references of these papers were searched to identify any further relevant papers not included above. Results: The evidence is assimilated with the opinions of the authors to provide recommendations. Best practice pathways for patient care in the pre-operative, intra-operative, and post-operative periods are described, including the identification and management of residual stones. Key complications (sepsis and stent issues) that are relevant for any endourological procedure are then be discussed. Operation-specific considerations are then explored. Key measures for PCNL include optimising access to minimise the chance of bleeding or visceral injury. The role of endoscopic combined intrarenal surgery in this regard is discussed. Key measures for ureteroscopy and retrograde intrarenal surgery include planning and technique to minimise the risk of ureteric injury. The role of anaesthetic assessment is discussed. The importance of specific comorbidities on each step of the pathway is highlighted as examples. Conclusion: This review demonstrates that the principles of meticulous planning, interdisciplinary teamworking, and good operative technique can minimise the risk of complications in endourology.

The global, prevalence, and risk factors of postoperative fever after percutaneous nephrolithotomy: A systematic review and meta-analysis.

Objective: This study aimed to explore the global, prevalence, and risk factors of fever after percutaneous nephrolithotomy (PCNL) by conducting a systematic review and meta-analysis. Methods: The high-sensitivity searching was conducted without time limitation until December 30, 2020 in Web of Sciences, Scopus, and PubMed based on inclusion and exclusion criteria. Results: The prevalence rates of fever and sepsis among patient undergoing PCNL were estimated 9.5% (95% confidence interval [CI]: 9.3%-9.7%), and 4.5% (95% CI: 4.2%-4.8%), respectively. Nephrostomy tube was used in 9.96% (95% CI: 9.94%-9.97%) of patients. The mean preoperative white blood cells of patients were 6.401×109/L; 18.3% and 4.55% of patients were considered as the positive urinary culture and pyuria, respectively. About 20.4% of patients suffered from residual stones. The odds ratios (ORs) of fever in patients who suffering from diabetes mellitus, hydronephrosis, staghorn stones, and blood transfusion were 4.62 (95% CI: 2.95-7.26), 1.04 (95% CI: 0.81-1.34), 2.57 (95% CI: 0.93-7.11), and 2.65 (95% CI: 1.62-4.35), respectively. Patients who underwent PCNL in prone position were more likely to develop fever (OR: 1.23; 95% CI: 0.75-2.00) than patients in supine position. Conclusion: The current study showed that patients who suffer from diabetes mellitus, hydronephrosis, staghorn stones, nephrostomy tube or double-J stent, blood transfusion, and also patients who underwent PCNL in prone position surgery are more likely to develop a postoperative fever after PCNL.

Metabolic syndrome and the urinary microbiome of patients undergoing percutaneous nephrolithotomy.

Objective: To identify possible stone-promoting microbes, we compared the profiles of microbes grown from stones of patients with and without metabolic syndrome (MetS). The association between MetS and urinary stone disease is well established, but the exact pathophysiologic relationship remains unknown. Recent evidence suggests urinary tract dysbiosis may lead to increased nephrolithiasis risk. Methods: At the time of percutaneous nephrolithotomy, bladder urine and stone fragments were collected from patients with and without MetS. Both sample types were subjected to expanded quantitative urine culture (EQUC) and 16 S ribosomal RNA gene sequencing. Results: Fifty-seven patients included 12 controls (21.1%) and 45 MetS patients (78.9%). Both cohorts were similar with respect to demographics and non-MetS comorbidities. No controls had uric acid stone composition. By EQUC, bacteria were detected more frequently in MetS stones (42.2%) compared to controls (8.3%) (p=0.041). Bacteria also were more abundant in stones of MetS patients compared to controls. To validate our EQUC results, we performed 16 S ribosomal RNA gene sequencing. In 12/16 (75.0%) sequence-positive stones, EQUC reliably isolated at least one species of the sequenced genera. Bacteria were detected in both "infectious" and "non-infectious" stone compositions. Conclusion: Bacteria are more common and more abundant in MetS stones than control stones. Our findings support a role for bacteria in urinary stone disease for patients with MetS regardless of stone composition.

Prognostic Factors for Residual Lithiasis in Patients With Staghorn Calculi Undergoing Percutaneous Nephrolithotomy in the Maya Region of Yucatan, Mexico: A Case-Control Study.

BACKGROUND: Yucatan stands out as the state with the highest prevalence of urolithiasis in Mexico, placing significant demands on healthcare services, such as consultation and surgical intervention. Staghorn calculi are related to recurrent urinary tract infections, and their management is always surgical. The stone-free rate is a parameter used to measure the success of surgery, with residual stones considered those persisting four weeks after surgical management. There are understudied prognostic factors that can predict the success of achieving stone-free status, taking into account the number of stones, their location, and the anatomical variations of the patient's collecting system. The study aims to determine the prognostic factors for residual lithiasis in patients with staghorn calculi treated with percutaneous nephrolithotomy at the High Specialty Regional Hospital of the Yucatan Peninsula. METHODS: A case-control study was performed including 188 patients, aged 18 years or older, and diagnosed with staghorn calculus from January 2022 to June 2023, grouping the patients according to their stone-free rate evidence on postoperative computed tomography. Data were collected from the records of the Urology Department at a high-specialty hospital in Yucatan. The groups were analyzed, aiming to establish an association between preoperative factors and postoperative outcomes measured in terms of stone-free rate. RESULTS: A total of 188 patients with staghorn calculi were included, with a predominance in females (58.5%) and a mean age of 45.4 ± 11.9 years. The most common comorbidity was hypertension (29.8%), and 27.7% had a history of recurrent urinary tract infections. Regarding the Sampaio classification, B1 was the most prevalent in our population with 66 cases (35.1%), while Type A2 was the least common (13.8%). According to what was obtained through the multivariate logistic regression model, the calyceal anatomy Type A1 and A2 were associated with residual lithiasis (p= 0.016 OR: 2.994 CI: 1.223-7.331), and Grade IV was associated with a higher rate of residual lithiasis (p=0.005 CI: 1.586-13.100). A statistically significant association was found between stone burden and the presence of residual lithiasis (p=< 0.001). CONCLUSION: Guy's Score Grade IV showed a higher incidence of residual lithiasis, seemingly associated with stone burden, leading to the conclusion that both factors were categorized as predictors for the development of post-surgical residual lithiasis. Regarding anatomical variations according to Sampaio, it was observed that types A1 and A2 showed a lower rate of stone-free status. Therefore, we also consider them as variables that may influence the achievement of success in endourological management. Personalized patient assessment allows for more accurate prognostic factors, enabling a more comprehensive surgical planning in the presence of staghorn calculi.

Clinical Efficacy of 10 Min of Active Prewarming for Preserving Patient Body Temperature during Percutaneous Nephrolithotomy: A Prospective Randomized Controlled Trial.

Background: Percutaneous nephrolithotomy (PNL) poses a risk of hypothermia. Additionally, general anesthesia lowers the thresholds for shivering and vasoconstriction, which leads to dysfunction of central thermoregulation. Perioperative hypothermia is associated with adverse outcomes after surgery. In this study, we aimed to demonstrate that prewarming for 10 min can effectively prevent early hypothermia during PNL. Methods: A total of 68 patients scheduled for elective PNL were recruited to this study from January to June 2022, but two patients were excluded because of a change in the surgical plan. After randomization, patients in the prewarming group (n = 32) received warming using a forced-air warming device for 10 min in the preoperative area before being transferred to the operating room, while the controls (n = 34) did not. The incidence of hypothermia within the first hour after inducing general anesthesia was the primary outcome. Perioperative body temperatures and postoperative recovery findings were also evaluated. Results: Early intraoperative hypothermia decreased significantly more in the prewarming group than in the control group (9.4% vs. 41.2%, p = 0.003). Moreover, the net decrease in core body temperature during surgery was smaller in the prewarming group than in the control group (0.2 °C, vs. 0.5 °C, p = 0.003). In addition, the prewarmed patients had a lower incidence of postoperative shivering and a shorter post-anesthesia-care unit (PACU) stay (12.5% vs. 35.3%, p = 0.031; and 46 vs. 50 min, p = 0.038, respectively). Conclusions: Prewarming for 10 min decreased early hypothermia, preserved intraoperative body temperature, and improved postoperative recovery in the PACU.

[Colon injury during percutaneous nephrolithotomy (clinical case, literature review)].

Urolithiasis occupies one of the leading places in terms of the frequency of requests for urgent urological care and emergency hospitalization in specialized departments. Percutaneous surgery for urolithiasis, like any of the surgical methods, is associated with a number of specific and non-specific complications. Of course, the frequency of occurrence is dominated by hemorrhagic and inflammatory complications. But damage to the colon is quite rare and amounts to 0.3-0.4%. Focusing on the literature data, it is possible to identify risk factors for colon damage and clinical manifestations of this complication. Given the small clinical experience, both in the world and in the domestic literature, there is no recommendatory base for the management of patients with colon damage during percutaneous interventions. Publications available for analysis indicate the possibility of both an operative approach with the removal of a colostomy and conservative management of patients with such complications. The article presents a clinical observation of successful conservative management of a patient with damage to the descending colon during percutaneous nephrolithotomy. An assessment of risk factors for colon damage in this patient was given. Imaging methods are presented that confirm the presence of this complication and the resulting recovery during the follow-up examination.

Percutaneous nephrolithotomy or flexible ureteral lithotripsy, which one is better for patients with upper ureteral calculi of 1.5-2.0 cm in diameter.

PURPOSE: First research to evaluate the clinical efficacy and safety of flexible ureteral lithotripsy (FURSL) and percutaneous nephrolithotomy (PCNL) in the treatment of the upper ureteral stone is between 1.5 cm and 2.0 cm in diameter since there is no consensus with such ureteral stone yet. METHODS: From December 2018 to October 2022, 104 patients with calculi in the upper ureter received percutaneous nephrolithotomy (PCNL)or flexible ureteroscopic lithotripsy (FURSL) in our institution. The clinical data of the patients in the two groups were retrospectively searched. Stone removal rate, operation time, blood loss, postoperative pain score, postoperative inflammatory factor, postoperative complication rates and ureteral obstruction three months after the operation were compared between the two groups. RESULTS: A total of 104 patients were included in the study. The stone clearance rate and the secondary surgery rate were 88.89% and 7.41% in the FURSL group, the figures were 97.96% and 2.0% in the PCNL group (p = 0.067, 0.497). Regarding ureteral obstruction three months after the operation, there were 2 patients in FURSL group and 0 patients in PCNL group(p = 0.497).Compared to patients in FURSL group, patients in the PCNL group had shorter operation time(PCNL 71.81 ± 18.94 min vs. FURSL 86.80 ± 22.49 min, p = 0.0004), fewer complications(PCNL 20.37% vs. FURSL 6.12%), and lower postoperative inflammatory factor(p = 0.0004), yet they got more hemoglobin drop (PCNL 13.14 ± 9.81 g/L vs. FURSL 4.77 ± 3.55 g/L, p < 0.0001), higher postoperative pain scores(p = 0.0017) in the first three postoperative days and longer hospital stay (PCNL 4.96 ± 1.21 days vs. FURSL 3.60 ± 0.83 days). CONCLUSION: Both FURSL and PCNL were effective methods for treating upper ureteral stones of 1.5-2.0 cm in diameter given the extremely high stone clearance rate and a very low secondary surgery rate, as long as rare ureteral obstruction in medium-long term observation. Additionally, FURSL can effectively reduce surgical bleeding, postoperative pain, and hospital stay, while PCNL can decrease operation time, the risk of infection, and complications. Therefore, doctors could select suitable surgical treatment for those patients depending on their different clinical situations based on these findings.

Developing an Ex Vivo Pig Model for Teaching Ultrasound and Fluoroscopy-Guided Percutaneous Renal Access.

Introduction: Establishing percutaneous renal access is the key initial step to percutaneous nephrolithotomy; however, learning the technique during surgery for trainees is complicated by the number of approaches used to gain access, limited completion time during a breath hold. and attempt to minimize the number of passes through a kidney. There are many training models for percutaneous access commercially available all with their respective limitations. Our objective was to develop a low-cost, high-fidelity percutaneous access training model that addresses existing limitations and can be used with both ultrasound and fluoroscopy guidance. Methods: After a formal ethics exemption was attained, pig cadavers were harvested for flank, kidneys, and ureters. These were incorporated into a composite porcine tissue mould, created within a gelatin matrix. In the initial assessment, establishing percutaneous access under both ultrasound and fluoroscopy guidance was tested to refine usability. Once acceptable, its use during a training course was evaluated to assess impressions for use with ultrasound. Results: We were able to create a $45USD biodegradable model, which can facilitate percutaneous access using: fluoroscopy with intrarenal contrast; fluoroscopy with endoscopic guidance; and fluoro-less that is, ultrasound only. A cohort of 12 Canadian Postgraduate Year-3 residents who used the model for ultrasound access agreed that the model simulated a comparable tactile experience (58.33%) and anatomy (75%) to humans. Furthermore, majority of the residents agreed that model was easy to use with ultrasound guidance (91.67%), was a beneficial experience for their learning and future practice (83.33%) and if available would use to complement their intraoperative training (83.33%). Conclusion: We were able to develop a low-cost, preliminarily tested ex vivo pig model for percutaneous access compatible with multiple imaging modalities. We will continue refining our model and seek to understand its benefits when teaching percutaneous access to varying levels of learners.

Heavy as a rock or light as dust: a comparison between the perceived workload for extracorporeal shockwave lithotripsy, ureterorenoscopy and percutaneous nephrolithotomy.

Introduction: There are three common treatment options for kidney stones: extracorporeal shockwave lithotripsy (ESWL), ureterorenoscopy (URS) and percutaneous nephrolithotomy (PNL). The choice of treatment is based on stone- and patient-related characteristics. However, some stones are eligible for several approaches and the decision is made based on patient and urologist's preferences. This study evaluates which approach has the highest workload. Material and methods: Between March and August 2022, five members of the Amsterdam Endourology Research Group collected data from 22 ESWL, 31 URS and 22 PNL procedures. After each procedure, the SURG-TLX questionnaire was completed by the surgeon to evaluate workload. Six dimensions were scored for each procedure, including: mental demands, physical demands, temporal demands, task complexity, situational stress, and distractions. The total workload, and the median for each dimension, was calculated and compared for the three treatments. Results: ESWL scored significantly lower than URS for mental demands, physical demands, temporal demands, situational stress, distraction and total workload. However, task complexity did not differ significantly between the two techniques. Compared with PNL, ESWL scored significantly lower for all dimensions. Finally, PNL received significantly higher scores for mental demands, physical demands, temporal demands, situational stress, distractions and total workload than URS. Only task complexity showed no significant difference between both groups. Conclusions: Urologists perceive the highest workload during PNL, followed by URS and finally ESWL. A follow-up study is needed to identify stressors that increase perceived workload with the purpose to address these variables and as final objective to improve urologists' workload, patient safety and treatment outcomes.

Regional versus general anaesthesia in percutaneous nephrolithotomy: a systematic review and meta-analysis.

Introduction: Several studies have compared the safety and effectiveness of general and regional anaesthesia in percutaneous nephrolithotomy (PCNL). This study aimed to compare the perioperative and postoperative outcomes of general anaesthesia and regional anaesthesia for patients undergoing PCNL. Material and methods: For relevant articles, three electronic databases, including PubMed, Scopus, and Web of Science, were searched from their inception until March 2023. A meta-analysis has been reported in line with PRISMA 2020 and AMSTAR Guidelines. The risk ratio (RR) and mean difference (MD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CI). Results: The final cohort analysis, comprised 3871 cases of PCNL, (2154 regional anaesthesia and 1717 general anaesthesia). Compared to general anaesthesia, the regional anaesthesia group had a significantly shorter length of stay (MD = -0.34 days, 95% CI -0.56 to -0.12, p = 0.002), lower postoperative nausea and vomiting rates (RR = 0.16, 95% CI 0.03 to 0.80, p = 0.026), lower complications grade III-V rates (RR = 0.68, 95% CI 0.53 to 0.88, p = 0.004), and lower postoperative visual analogue pain score (VAS) at 1 hour (MD = -3.5, 95% CI -4.1 to -2.9, p <0.001). There were no significant differences in other outcomes between the two groups. Conclusions: Our results show that PCNL under regional anaesthesia is safe and feasible, with comparable results to those done under general anaesthesia. While patient selection is important, counselling and decision-making for these procedures must go hand in hand to achieve the best clinical outcome.

Flank versus prone position in percutaneous nephrolithotomy: a meta-analysis of randomized controlled studies.

The objective of this study is to assess the safety and efficacy of the flank position in percutaneous nephrolithotomy (PCNL). We searched PubMed, Embase, SCOPUS, the Cochrane database libraries, and the Chinese Biomedical Literature Database, and randomized controlled trials (RCTs) assessing PCNL in flank position are included in this meta-analysis. The related trials met the inclusion criteria were analyzed using RevMan 5.4. Seven randomized controlled trials were included, involving a total of 587 patients. We found that there was a lower decrease in hemoglobin levels in the flank position group compared to prone-position group (mean difference [MD] = - 0.15, 95% confidence interval (CI) - 0.22 to - 0.08, P < 0.00001). Moreover, our meta-analysis demonstrated no significant differences between groups regarding stone-free rate (relative risk [RR] = 1.00, 95% CI 0.93 to 1.06, P = 0.92), operative time(MD = 0.76, 95% CI - 5.31 to 6.83, P < 0.00001), hospital stay (MD = 0.03, 95% CI - 0.32 to 0.32, P < 0.00001), and complications Clavien grade I (RR = 1.01, 95% CI 0.98 to 1.05, P = 0.54), Clavien grade II (RR = 1, 95% CI 0.97 to 1.02, P = 0.78), and Clavien grade III (RR = 1, 95% CI 0.98 to 1.03, P = 0.77). The use of flank position for PCNL is associated with reduced hemoglobin change without an increase in complications. This positioning technique can be considered safe for patients with nephrolithiasis and may be particularly suitable for high-risk individuals such as those who are obese or have decreased cardiopulmonary function. However, further randomized trials are needed to confirm these findings.

Analysis of factors affecting intraoperative hemorrhage during percutaneous nephrolithotomy and establishment of nomogram model.

Intraoperative hemorrhage is an important factor affecting intraoperative safety and postoperative patient recovery in percutaneous nephrolithotomy (PCNL). This study aimed to identify the factors that influence intraoperative hemorrhage during PCNL and develop a predictive nomogram model based on these factors.A total of 118 patients who underwent PCNL at the Department of Urology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University from January 2021 to September 2023 was included in this study. The patients were divided into a hemorrhage group (58 cases) and a control group (60 cases) based on the decrease in hemoglobin levels after surgery. The clinical data of all patients were collected, and both univariate analysis and multivariate logistic regression analysis were conducted to identify the independent risk factors for intraoperative hemorrhage during PCNL. The independent risk factors were used to construct a nomogram model using R software. Additionally, receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA) were utilized to evaluate the model.Multivariate logistic regression analysis revealed that diabetes, long operation time and low psoas muscle mass index (PMI) were independent risk factors for intraoperative hemorrhage during PCNL (P < 0.05). A nomogram model was developed incorporating these factors, and the areas under the ROC curve (AUCs) in the training set and validation set were 0.740 (95% CI: 0.637-0.843) and 0.742 (95% CI: 0.554-0.931), respectively. The calibration curve and Hosmer-Lemeshow test (P = 0.719) of the model proved that the model was well fitted and calibrated. The results of the DCA showed that the model had high value for clinical application.Diabetes, long operation time and low PMI were found to be independent risk factors for intraoperative hemorrhage during PCNL. The nomogram model based on these factors can be used to predict the risk of intraoperative hemorrhage, which is beneficial for perioperative intervention in high-risk groups to improve the safety of surgery and reduce the incidence of postoperative complications.

A retrospective cohort study: evaluating the efficacy of standard versus tubeless percutaneous nephrolithotomy (PCNL) in pediatric patients up to 18 years old.

Percutaneous nephrolithotomy (PCNL) is an endourological method applied as the standard or tubeless method for kidney stone treatment. In a retrospective cohort study, 88 surgery units involving 75 children up to 18 years old with kidney stones who underwent the surgery for 8 years in Shahid Beheshti and Boo-ali hospitals in Hamadan with one of the two methods of standard or tubeless PCNL were evaluated and compared considering the success rate of operation, hemoglobin, hematocrit drop, need for medications, need for blood transfusion, duration of surgery, and the length of hospital stay. Among the 88 units studied, 47 cases were operated with the standard PCNL and 41 cases by tubeless method. In children operated by standard and tubeless PCNL, the complete success rate of operation was 87.2% and 100% (P = 0.006), the need for blood transfusion was 2.1% and 0% (P = 1.00), the need for opioids was 27.7% and 14.6% (P = 0.134), the decrease in hemoglobin was - 1.82 ± 0.94 and -1.30 ± 0.98 mg/dl (P = 0.024), the decrease in hematocrit was - 5.40 ± 2.66 and -3.52 ± 3.11 mg/dL (P = 0.003), the mean surgery duration was 109.30 ± 53.27 and 101.46 ± 31.92 min (P = 0.414), the duration of postoperative hospitalization was 3.38 ± 1.76 and 2.46 ± 1.27 days (P = 0.007), and the frequency of fever was 23.4% and 7.3% (P = 0.04), respectively. The success rate of kidney stone surgery in children with the tubeless PCNL is higher than the standard method, and its complications are lower.