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1.
Urol Clin North Am ; 46(2): 207-213, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30961854

RESUMO

Percutaneous nephrolithotomy is the treatment of choice for large renal stones. Larger, straight access tracts allow for use of rigid pneumatic and ultrasonic lithotripsy devices. Through advanced technologies, more efficient fragmentation has become possible, allowing for a variety of treatment options depending on stone location, size, and composition. As novel methods of lithotripsy enter the clinical sphere, it is a requirement that the operating urologist understand the available surgical options and the associated mechanisms used to best treat their patients. This article discusses the mechanisms of basic pneumatic and ultrasonic devices, and examines the data regarding current and novel combination lithotrites.


Assuntos
Litotripsia/instrumentação , Litotripsia/tendências , Terapia por Ultrassom/instrumentação , Ar Comprimido/uso terapêutico , Gases/uso terapêutico , Humanos , Invenções/tendências , Litotripsia/métodos , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/métodos , Nefrolitotomia Percutânea/tendências , Terapia por Ultrassom/métodos , Terapia por Ultrassom/tendências
2.
Urol Clin North Am ; 46(2): 303-313, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30961862

RESUMO

Diagnosis, treatment, and follow-up are all influential in determining the overall cost to the health care system for kidney stones. New innovations in the field of nephrolithiasis have been abundant, including disposable ureteroscopes, ultrasound-guided approaches to percutaneous nephrolithotomy, and advanced laser lithotripters. Identifying cost-effective treatment strategies encourages practitioners to be thoughtful about providing value-based high-quality care and remains on important principle in the treatment of urinary stone disease.


Assuntos
Análise Custo-Benefício , Cálculos Renais/economia , Cálculos Renais/cirurgia , Efeitos Psicossociais da Doença , Assistência à Saúde/economia , Diagnóstico por Imagem/economia , Equipamentos Descartáveis/economia , Custos de Cuidados de Saúde , Humanos , Invenções/economia , Cálculos Renais/epidemiologia , Cálculos Renais/prevenção & controle , Terapia a Laser/economia , Terapia a Laser/instrumentação , Litotripsia/economia , Nefrolitíase/economia , Nefrolitíase/epidemiologia , Nefrolitíase/prevenção & controle , Nefrolitíase/cirurgia , Nefrolitotomia Percutânea/economia , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/métodos , Fibras Ópticas/economia , Ureteroscopia/economia , Ureteroscopia/instrumentação
3.
Int Braz J Urol ; 45(3): 581-587, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30901169

RESUMO

INTRODUCTION: The main aim of stone surgery is to establish stone free status. Performing fl exible nephroscopy is an effective tool in this manner. The aim of this study was to evaluate the role of retrograde fl exible nephroscopy for detection of residual fragments following percutaneous nephrolithotomy (PNL) in comparison with antegrade approach. MATERIALS AND METHODS: Data of 137 patients underwent ECIRS was collected prospectively. In all cases following stone clearance, collecting system was checked for residual fragments. First antegrade than retrograde fl exible nephroscopy was performed and success rates to reach all calices and detection of residual fragments were noted. All patients underwent CT and success rate of antegrade and retrograde approaches were compared. PPV and NPV of retrograde approach to detect residual fragments were calculated. RESULTS: Antegrade and retrograde nephroscopy successfully accessed all of the calices in 101 (73.7%) and 130 (94.9%) patients respectively (p<0.0001). Residual fragments were observed in 18 (13.1%) patients following antegrade fl exible nephroscopy. Retrograde approach identifi ed residual stones in 17 more cases. These cases were treated with fl exible nephroscopy or secondary percutaneous tract. Postoperative CT revealed residual stones in 10 (7.3%) patients. PPV and NPV of retrograde fl exible nephroscopy were 83.3% and 96.2%. CONCLUSIONS: Flexible nephroscopy effectively detects residual fragments following PNL. Retrograde approach was more successful than antegrade approach to reach all calices. We recommend performing retrograde fl exible nephroscopy following PNL especially in complex cases as it has the potential to increase SFR, decrease the need for second look surgery and unnecessary postoperative imaging.


Assuntos
Endoscopia/métodos , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Adulto , Endoscopia/instrumentação , Desenho de Equipamento , Feminino , Humanos , Cálculos Renais/diagnóstico por imagem , Cálices Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/instrumentação , Estudos Prospectivos , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
4.
Aktuelle Urol ; 50(1): 71-75, 2019 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-30517968

RESUMO

Over the last decade, several devices for percutaneous nephrolithotomy with smaller diameters have been introduced in order to reduce renal trauma. Recent studies have found comparable stone free rates but also exhibit the same rate of postoperative fever and septicaemia. One possible cause is the influence of irrigation fluid during stone treatment procedures. The purpose of this ex vivo study was to compare two new miniaturised PNL nephroscopy sheaths with an outer sheath diameter of 9.5 F and 12 F to the well-established MIP M Set (17.5 F) by Karl Storz. MATERIAL AND METHODS: The new devices were tested in a perfused organ model of fresh porcine kidneys with different irrigation pressures, applied either by gravitation or the use of a pressure pump (Uromat E.A.S.I. Pump, Karl Storz, Tuttlingen, Germany).In addition, the 9.5 F sheath was examined for active irrigation evacuation, i. e. suction of irrigation fluid through a mono-J-catheter. An urodynamic pressure probe measured intrapelvic pressure levels throughout the procedures. RESULTS: Regardless of the sheath diameters used, the intrapelvic pressure did not exceed 40 cmH2O (30 mmHg) when applying moderate irrigation pressure levels, either by pump or gravitation. The active suction of irrigation fluid from the kidney basin via the mono-J-catheter had no measurable impact on the detected intrarenal pressures. A crucial increase in the intrapelvic pressure was detected only when using the 9.5 F sheath in combination with applying high irrigation pressures. CONCLUSION: The newly designed miniaturised MIP sets maintain the favourable pressure features of the earlier 17.5 MIP sheath. Although the diameter has been reduced to 12F or 9.5 F, the intrapelvic pressures remained below 40 cmH2O when regular irrigation settings by gravitation or pump irrigation were used.


Assuntos
Teste de Materiais , Nefrolitotomia Percutânea/instrumentação , Urodinâmica , Animais , Desenho de Equipamento , Humanos , Miniaturização , Pressão , Suínos , Irrigação Terapêutica
5.
Int J Urol ; 26(2): 223-228, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30430662

RESUMO

OBJECTIVES: To share our 10-year experience of tract creation by using plasma vaporization compared with metal dilatation in percutaneous nephrolithotomy. METHODS: We retrospectively reviewed the medical records of 230 patients who had undergone 244 percutaneous nephrolithotomy procedures at Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, from January 2007 to December 2016, and divided the patients into the plasma (n = 130) and metal (n = 114) groups. All patients underwent percutaneous nephrolithotomy by either a bipolar resectoscope mounted with a plasma vaporization button electrode or metal dilatation for tract creation. Propensity score matching was applied to reduce selection bias. Perioperative and postoperative data analysis included procedure time, length of hospital stay, blood transfusion rate, any early and late complications, stone-free rate, renal function, and time of need for pain control. RESULTS: Before propensity score matching, there were significantly shorter hospital stay (2.6 vs 3.8 days, P < 0.01), less operating time (66.1 vs 108.1 min, P < 0.01) and no blood transfusion rate (0 vs 4 [3.5%], P = 0.031) in the plasma vaporization group. After propensity score matching, there was no statistically significant difference in the patients' baseline characteristics. There were significantly shorter hospital stay (odds ratio 0.46, 95% confidence interval 0.32-0.66; P < 0.001) and shorter average operating time (odds ratio 0.98, 95% confidence interval 0.97-0.99, P < 0.001) in the plasma vaporization group. CONCLUSIONS: In comparison with metal dilatation, the plasma vaporization technique is a safe and effective method for creating the nephrostomy tract for percutaneous nephrolithotomy, based on shorter postoperative stay, less operating time, zero blood transfusion rate, acceptable stone-free rate and no major complications.


Assuntos
Dilatação/métodos , Cálculos Renais/cirurgia , Terapia a Laser/métodos , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Transfusão de Sangue/estatística & dados numéricos , Dilatação/efeitos adversos , Dilatação/instrumentação , Eletrodos , Estudos de Viabilidade , Feminino , Humanos , Terapia a Laser/efeitos adversos , Terapia a Laser/instrumentação , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/instrumentação , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Pontuação de Propensão , Estudos Retrospectivos , Taiwan/epidemiologia , Resultado do Tratamento
6.
Int Urol Nephrol ; 51(1): 17-25, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30474783

RESUMO

PURPOSE: We describe a novel technique that uses mathematical calculation software, 3-dimensional (3D) modeling and augmented reality (AR) technology for access during percutaneous nephrolithotomy (PCNL) and report our first preliminary results in two different ex-vivo models. METHODS: Novel software was created in order to calculate access point and angle by using pre-operative computed tomography (CT) obtained in 50 patients. Two scans, 27 s and 10 min after injection of contrast agent, were taken in prone PCNL position. By using DICOM objects, mathematical and software functions were developed to measure distance of stone from reference electrodes. Vectoral 3D modeling was performed to calculate the access point, direction angle and access angle. With specific programs and AR, 3D modeling was placed virtually onto real object, and the calculated access point and an access needle according to the calculated direction angle and access angle were displayed virtually on the object on the screen of tablet. RESULTS: The system was tested on two different models-a stone placed in a gel cushion, and a stone inserted in a bovine kidney that was placed in a chicken-for twice, and correct access point and angle were achieved at every time. Accuracy of insertion of needle was checked by feeling crepitation on stone surface and observing tip of needle touching stone in a control CT scan. CONCLUSIONS: This novel device, which uses software-based mathematical calculation, 3D modeling and AR, seems to ensure a correct access point and angle for PCNL. Further research is required to test its accuracy and safety in humans.


Assuntos
Imagem Tridimensional/métodos , Cálculos Renais/cirurgia , Rim/cirurgia , Modelos Anatômicos , Nefrolitotomia Percutânea , Animais , Bovinos , Estudos de Viabilidade , Humanos , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/métodos , Desenho de Programas de Computador , Tomografia Computadorizada por Raios X/métodos
7.
Urol Int ; 102(2): 160-166, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30415255

RESUMO

OBJECTIVE: To compare outcomes and postoperative quality of life (QoL) among patients with kidney stone who received mini-percutaneous nephrolithotomy (mPCNL), partial tubeless mPCNL or mPCNL with ureter catheter in a prospective randomized clinical trial. METHODS: From May 2017 to December 2017, 60 patients with kidney stone who underwent mPCNL were randomized into 3 groups: Group I (mPCNL), Group II (partial tubeless mPCNL), Group III (mPCNL with ureter catheter). We evaluated perioperative characteristics, stone clearance, analgesic requirements and QoL by using the Wisconsin Stone QOL questionnaire. RESULTS: The age, gender, stone diameter, body mass index, length of operation, drop in hemoglobin and stone-free rates for the 3 groups were similar among these groups. However, the postoperative visual analog scale and the analgesic requirement in Group II were significantly the lowest (p < 0.05). According to Wisconsin Stone QOL questionnaire, compared to Group I, statistical significant difference in the QoL was seen in Group II and III, indicating a meaningful and immediate improvement in the postoperative QoL following mPCNL. CONCLUSION: Compared with standard and partial tubeless mPCNL, mPCNL with ureter catheter is a safe and useful form of mPCNL, which can offer better QoL and is more cost effective.


Assuntos
Cálculos Renais/terapia , Nefrolitotomia Percutânea/instrumentação , Qualidade de Vida , Cateterismo Urinário/instrumentação , Cateteres Urinários , Adulto , Idoso , Analgésicos/uso terapêutico , China , Desenho de Equipamento , Feminino , Humanos , Cálculos Renais/diagnóstico , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Cateterismo Urinário/efeitos adversos
8.
Urol Int ; 102(2): 153-159, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30352443

RESUMO

OBJECTIVE: To compare the efficacy of new percutaneous technique ("ultra-mini PCNL", UMP), shock wave lithotripsy (SWL) and flexible ureteroscopy (FURS) on the treatment of 1-2 cm lower pole kidney stones, and to determine the advantages and disadvantages of each method. MATERIALS AND METHODS: This prospective study was based on data collected from the files of patients between March 2015 and March 2017. This study recruited a total of 180 patients with single radio-opaque lower caliceal calculi of 1-2 cm. All patients were randomly divided into 3 groups: group A was treated with UMP, group B was treated with FURS by using holmium laser and group C was treated with SWL by using the electromagnetic lithotripter. The average age, sex, size of the stone, the time of operation, the rate of no stone, the time of hospitalization, the rate of retreatment, the cost and the complications of the 3 groups were compared. The success of the operation was defined as no residual stone or < 0.3 cm on computed tomography at 3 months postoperatively. RESULTS: The stone burdens of the groups were equivalent. The re-treatment rate in group C was significantly higher than that in group A and B (30 vs. 1.6%, 5%). The average operating time in group B (93.35 ± 21.64 min) was statistically significantly longer than that in group A and C (68.58 ± 15.82 min, 46.33 ± 5.81 min). Although the time of hospitalization of group A (5.32 ± 1.20 day) was longer than that of group B (3.22 ± 0.52 day) and C (1.08 ± 0.28 day; p < 0.05). The stone-free rate (SFR) in UMP, FURS, SWL were 98, 92, and 73% respectively; the highest SFR was in the UMP group (p < 0.05). The complication rates were evaluated by using the Clavien grading system, which were determined to be 16.67% in UMP, 6.67% in SWL and 8.33% in FURS. In particular, the complications of GI and GII were more common in group A (p < 0.05). CONCLUSIONS: UMP, FURS, and SWL are all safe and effective in the treatment of 1-2 cm lower pole kidney stones. UMP and FURS had a better SFR than SWL, but the time of hospitalization in UMP group was longer and there were more complications in the UMP group. In addition, the operation time of FURS is longer as compared to UMP and SWL, and there is a higher rate of postoperative fever. The invasiveness and cost of SWL were lower than that of UMP and FURS, but the re-treatment rate was higher.


Assuntos
Histeroscopia/instrumentação , Cálculos Renais/cirurgia , Lasers de Estado Sólido , Litotripsia a Laser/instrumentação , Nefrolitotomia Percutânea/instrumentação , Ureteroscópios , Adulto , China , Desenho de Equipamento , Feminino , Humanos , Histeroscopia/efeitos adversos , Cálculos Renais/diagnóstico por imagem , Tempo de Internação , Litotripsia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Nefrolitotomia Percutânea/efeitos adversos , Duração da Cirurgia , Maleabilidade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Indução de Remissão , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
9.
Urolithiasis ; 47(2): 207-214, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29549382

RESUMO

To compare the outcome of mini-percutaneous nephrolithotomy (Mini-PNL) versus standard-PNL for renal stones. Retrospective study was performed between March 2010 and May 2013 for patients treated by Mini-PNL or standard-PNL through 18 and 30 Fr tracts, respectively, using pneumatic lithotripsy. Semirigid ureteroscope (8.5/11.5 Fr) was used for Mini-PNL and 24 Fr nephroscope for standard-PNL. Both groups were compared in stone free rate(SFR), complications and operative time using Student-t, Mann-Whitney, Chi square or Fisher's exact tests as appropriate in addition to logistic regression analysis. P < 0.05 was considered statistically significant. Mini-PNL (378) and standard-PNL (151) were nearly comparable in patients and stones criteria including stone burden (3.77 ± 2.21 vs 3.77 ± 2.43 cm2; respectively). There was no significant difference in number of tracts or supracostal puncture. Mini-PNL had longer operative time (68.6 ± 29.09 vs 60.49 ± 11.38 min; p = 0.434), significantly shorter hospital stay (2.43 ± 1.46 vs 4.29 ± 1.28 days) and significantly higher rate of tubeless PNL (75.1 vs 4.6%). Complications were significantly higher in standard-PNL (7.9 vs 20.5%; p < 0.001). SFR was significantly lower in Mini-PNL (89.9 vs 96%; p = 0.022). This significant difference was found with multiple stones and large stone burden (> 2 cm2), but the SFR was comparable between both groups with single stone or stone burden ≤ 2 cm. Logistic regression analysis confirmed significantly higher complications and SFR with standard-PNL but with significantly shorter operative time. Mini-PNL has significantly lower SFR when compared to standard-PNL (but clinically comparable) with markedly reduced complications and hospital stay. Most of cases can be performed tubeless. The significant difference in SFR was found with multiple stones or large stone burden (> 2 cm2), but not with single stones or stone burden ≤ 2 cm2.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Ureteroscópios , Adulto , Idoso , Feminino , Seguimentos , Humanos , Rim/diagnóstico por imagem , Rim/cirurgia , Cálculos Renais/diagnóstico por imagem , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/métodos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
10.
Urolithiasis ; 47(2): 201-206, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29497768

RESUMO

The objectives of the study are to compare the safety and efficacy of "all-seeing needle" optical puncture system micro-percutaneous nephrolithotomy (micro-PCNL) and flexible ureterorenoscopy (FURS) for the treatment of lower calyceal stones of ≤ 2 cm and to determine the advantages and disadvantages of each. 116 patients in total with lower calyceal stones of ≤ 2 cm were randomly divided into two equal groups, "all-seeing needle" optical puncture system micro-PCNL and FURS. In both groups, holmium laser was utilized for lithotripsy. The perioperative parameters were compared between the two groups. Compared to the "all-seeing needle" micro-PCNL group, the mean operative time was significantly longer in the FURS group (P = 0.000). However, there was no significant difference between the two groups with respect to mean hemoglobin reduction (P = 0.087), complications (P = 0.731) and LOS (P = 0.856). The overall SFR of the "all-seeing needle" micro-PCNL group and FURS group was 84.5% (49/58) and 79.3% (46/58), respectively, without any significant difference between the groups (P = 0.469). For treating lower calyceal stones of ≤ 2 cm, the "all-seeing needle" micro-PCNL group had shorter operative time than FURS, while no significant differences between the two groups with respect to mean hemoglobin reduction, complications, LOS and SFR were found.


Assuntos
Cálculos Renais/terapia , Litotripsia a Laser/efeitos adversos , Nefrolitotomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Ureteroscopia/efeitos adversos , Adulto , Feminino , Humanos , Cálculos Renais/patologia , Cálices Renais/patologia , Cálices Renais/cirurgia , Lasers de Estado Sólido , Tempo de Internação/estatística & dados numéricos , Litotripsia a Laser/instrumentação , Litotripsia a Laser/métodos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/métodos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Resultado do Tratamento , Ureteroscopia/instrumentação , Ureteroscopia/métodos
11.
Urolithiasis ; 47(3): 273-278, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29484468

RESUMO

Allograft lithiasis is a rare urologic complication of renal transplantation (RT). Our aim is to present our experience with minimally invasive surgical treatment of allograft lithiasis in our series of live-donor renal transplant recipients. In a retrospective analysis of 3758 consecutive live-donor RTs performed in our center between November 2009 and January 2017, the results of minimally invasive surgery for the treatment of renal graft lithiasis diagnosed at follow-up were evaluated. Twenty-two (0.58%) patients underwent minimally invasive surgery for renal graft lithiasis. The mean age was 41.6 years, and duration between RT and surgical intervention was 27.3 months (range 3-67). The mean stone size was 11.6 mm (range 4-29). Stones were located in the urethra in 1, bladder in 2, ureter in 9, renal pelvis in 7 and calices in 3 patients. Surgical treatment included percutaneous nephrolithotomy in 1, cystoscopic lithotripsy in 3, flexible ureteroscopic lithotripsy in 6 and rigid ureteroscopic lithotripsy in 12 patients. No major complications were observed. One patient (4.5%) who underwent flexible ureteroscopy developed postoperative urinary tract infection. All patients were stone-free except two (9%) patients who required a second-look procedure after flexible ureteroscopic lithotripsy for residual stones. Stone recurrence was not observed in any patient during a mean follow-up duration of 30.2 months (range 8-84). Renal transplant lithiasis is uncommon and minimally invasive surgical treatment is rarely performed for its treatment. Endourological surgery may be performed safely, effectively and with a high success rate in these patients.


Assuntos
Transplante de Rim/efeitos adversos , Litotripsia/efeitos adversos , Nefrolitíase/cirurgia , Nefrolitotomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Adulto , Aloenxertos/patologia , Aloenxertos/cirurgia , Feminino , Seguimentos , Humanos , Rim/patologia , Rim/cirurgia , Litotripsia/instrumentação , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , Nefrolitíase/patologia , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscópios , Adulto Jovem
12.
Int J Urol ; 26(2): 172-183, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30575154

RESUMO

Urinary stone disease, or urolithiasis, is a very common disease with increasing prevalence and incidence. With the advancement of endoscopic techniques, the treatment outcomes of ureteroscopy (or transureteral lithotripsy) and percutaneous nephrolithotomy are continuously improving. In recent years, there have been many new developments in the field, including new endoscopy design, more effective auxiliary tools, improvement in treatment protocols, introduction of robotic technology, combining both ureteroscopy and percutaneous nephrolithotomy (endoscopic combined intrarenal surgery or transureteral lithotripsy-assisted percutaneous nephrolithotomy), improvement in laser technology, and so on. All these new inputs will further improve the treatment efficacy and safety of the procedures, thus benefiting our patients. In the present review, we briefly go through the main steps of ureteroscopy and percutaneous nephrolithotomy, with a concise description and application of these new advances.


Assuntos
Litotripsia/métodos , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/prevenção & controle , Ureteroscopia/métodos , Urolitíase/terapia , Humanos , Litotripsia/efeitos adversos , Litotripsia/instrumentação , Litotripsia/tendências , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/tendências , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Ureteroscopia/efeitos adversos , Ureteroscopia/instrumentação , Ureteroscopia/tendências
13.
Urol Int ; 101(2): 143-149, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29649833

RESUMO

OBJECTIVES: To investigate the safety, efficacy, and practicability of minimally invasive percutaneous nephrolithotomy (MPCNL) with the aid of a patented irrigation clearance system in treating renal staghorn calculi. METHODS: From August 2009 to July 2014, 4 hospitals had executed a prospective multicenter study with a total of 912 cases. The patients were randomly divided into 3 groups: suctioning MPCNL, standard percutaneous nephrolithotomy (PCNL), and traditional MPCNL groups. Multiple operative and perioperative parameters were compared. RESULTS: Blood loss and intrapelvic pressure in the suctioning MPCNL group were significantly less than those in the standard PCNL group. The average operation time, intrapelvic pressure, and amount of bleeding in the suctioning MPCNL group were better than those in the traditional MPCNL group. The suctioning MPCNL used one tract more frequently and 2 or 3 tracts less frequently than the standard MPCNL and traditional MPCNL groups. The stone-free rate by one surgery in the suctioning MPCNL group was significantly higher than that in standard PCNL and traditional MPNCL groups. CONCLUSIONS: Suctioning MPCNL using our patented system shows several advantages in treating renal staghorn calculi, including minimal invasion, shorter operation time, lower intrapelvic pressure, less bleeding and the need for a smaller number of -percutaneous tracts, and higher stone clearance rate by one -surgery.


Assuntos
Nefrolitotomia Percutânea/instrumentação , Cálculos Coraliformes/cirurgia , Equipamentos Cirúrgicos , Irrigação Terapêutica/instrumentação , Adulto , China , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Fatores de Risco , Cálculos Coraliformes/diagnóstico por imagem , Sucção , Irrigação Terapêutica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
14.
J Endourol ; 32(4): 350-353, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29385812

RESUMO

OBJECTIVE: To determine how sheath and endoscope size affect intrarenal pelvic pressures and risk of postoperative infectious complications comparing "Mini" vs "Standard" percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: Uropathogenic Escherichia coli were grown and 109 of them were instilled into the porcine renal pelvis through retrograde access for 1 hour. Percutaneous access utilized a 14/16F 20 cm ureteral access sheath for the Mini arm and a 30F sheath for the Standard arm. Nephroscopy was simulated utilizing either an 8/9.8F semirigid ureteroscope or 26F nephroscope for 1 hour while intrarenal pelvic pressure was continuously monitored. Blood and tissue cultures of kidney, liver, and spleen biopsies were plated and incubated and positive cultures were confirmed with polymerase chain reaction. RESULTS: Intrapelvic pressures were higher in the Mini group, 18.76 ± 5.82 mm Hg vs 13.56 ± 5.82 mm Hg (p < 0.0001). Time spent above 30 mm Hg was greater in the Mini arm, 117.0 seconds vs 66.1 seconds (p = 0.0452). All pigs had positive kidney tissue cultures whereas spleen cultures were positive in 100% and 60% of pigs in the Mini and Standard arms, respectively (p = 0.0253); 90% and 30% had positive liver tissue culture in the Mini and Standard arms, respectively (p = 0.0062). Blood cultures were positive in 30% of pigs in the Mini arm compared with none in the Standard arm (p = 0.0603). CONCLUSION: Mini-PCNL was associated with higher intrarenal pressures and higher risk of end organ bacterial seeding in the setting of an infected collecting system. This suggests a higher potential for infectious complications in a clinical setting.


Assuntos
Rim/microbiologia , Fígado/microbiologia , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/instrumentação , Baço/microbiologia , Animais , Endoscopia/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Pelve Renal/microbiologia , Masculino , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/microbiologia , Pressão , Suínos , Ureteroscópios/efeitos adversos
15.
World J Urol ; 36(7): 1149-1155, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29455253

RESUMO

OBJECTIVES: To assess for usefulness and validity evidence for incorporating the C-Arm Trainer (CAT) simulator into the annual AUA hands on course for training percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: The course started with a didactic session followed by four stations for training the "bull's eye" technique using the CAT simulator. Each station included a pre-test, 30-min practice on the simulator, and post-test. All participants were assessed using a 4-item checklist. All participants were asked to fill in a qualitative self-assessment questionnaire after the pre- and the post-test, and respond to a course evaluation questionnaire and post-course survey. RESULTS: A total of 38 physicians, who attended the hands on course, voluntarily participated in the study. Only 21.1% had previous practice on PCNL simulators. Compared with the results of the checklist total score and the qualitative self-assessment questionnaire scores after the pre-test, there was significant improvement in the checklist total score (p < 0.001), temporal demands (p = 0.003), situational stress (p = 0.003, and performance (0.003) after the post-test. A total of 14 (36%) participants responded to the course evaluation questionnaire, 50% evaluated the course as excellent, 28.6% as very good, and 21.4% as good. Unfortunately, only five (13%) participants responded to the post-course survey, 4/5 implemented the new competencies and knowledge into their practice, and 3/5 have attempted to obtain fluoroscopic guided PCA without assistance. CONCLUSION: The CAT simulator was considered useful for training the percutaneous renal access procedure. There was significant improvement in the qualitative and quantitative assessment parameters after the post-test compared with the pre-test.


Assuntos
Nefrolitotomia Percutânea/educação , Nefrolitotomia Percutânea/instrumentação , Treinamento por Simulação/métodos , Adulto , Lista de Checagem , Competência Clínica , Feminino , Fluoroscopia , Humanos , Cálices Renais/diagnóstico por imagem , Masculino , Estudos Prospectivos , Ultrassonografia de Intervenção
18.
Urolithiasis ; 46(3): 297-302, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28585181

RESUMO

Percutaneous nephrolithotomy (PCNL) is a commonly used type of minimally invasive treatment in kidney stone surgeries. Surgical success is assessed according to residual stone amount after surgery. The purpose of this study is to compare the two methods' success and practicality that are applied after the fracture of the stone in the patients who applied PCNL and which enable the removal of the residual stones. Among 102 patients who underwent a single-session of PCNL at our department between June 2015 and November 2016 were evaluated. Previously identified irrigation method and our aspiration method which described used in post-operative patients divided into two groups of residual fragments was assessed by computed tomography. The results were evaluated in statistical analyses. Significant p was accepted as p < 0.05. The age and gender distribution of patients in the irrigation and aspiration groups did not differ significantly (p > 0.05). In irrigation and aspiration groups, stone size did not differ significantly (p > 0.05). The amount of residue stones and dust remaining in the irrigation group was significantly higher (p < 0.05) than the aspiration group. Although many methods have been tried before, we think that the aspiration method we have described is a cheaper, more effective and feasible option.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Adolescente , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/instrumentação , Estudos Prospectivos , Estudos Retrospectivos , Sucção/efeitos adversos , Sucção/economia , Sucção/métodos , Irrigação Terapêutica/efeitos adversos , Irrigação Terapêutica/economia , Irrigação Terapêutica/métodos , Resultado do Tratamento , Adulto Jovem
19.
J Urol ; 199(1): 193-199, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28807646

RESUMO

PURPOSE: Renal pelvic pressure may vary during percutaneous nephrolithotomy. We sought to determine the relationship of postoperative pain to endoscope caliber, renal pelvic pressure and hospital stay. MATERIALS AND METHODS: We reviewed the records of 20 percutaneous nephrolithotomies done under ureteroscopic guidance with renal pelvic pressure monitoring. The ureteroscope working channel was connected to a pressure transducer and used to determine renal pelvic pressure at baseline, when irrigating with a 26Fr rigid nephroscope and a 16Fr flexible nephroscope, and during suction. Patient demographics, operative characteristics, Likert pain scores and length of hospital stay were compared as stratified by average renal pelvic pressure. The Mann-Whitney U and Fisher exact tests were used with p <0.05 considered significant. RESULTS: A total of 220 measurements were recorded in 20 patients undergoing single access percutaneous nephrolithotomy. Mean patient age was 55.2 years (range 20 to 77) and mean body mass index was 32.4 kg/m2 (range 18 to 53.3). Rigid nephroscopy resulted in significantly higher average renal pelvic pressure than flexible nephroscopy (30.3 vs 12.9 mm Hg, p = 0.007). Average renal pelvic pressure was 30 mm Hg or greater in 7 patients (35%) undergoing rigid nephroscopy and in none (0%) undergoing flexible nephroscopy (p <0.01). Patients exposed to an average renal pelvic pressure of 30 mm Hg or greater during rigid nephroscopy had significantly higher average pain scores (p = 0.004) and longer hospital stays (p = 0.04) than patients with renal pelvic pressure less than 30 mm Hg. Average renal pelvic pressure 30 mm Hg or greater during rigid nephroscopy was also associated with a longer skin to calyx distance (105.5 vs 79.7 mm, p = 0.03). CONCLUSIONS: Knowledge of the factors that influence renal pelvic pressure and methods to control pressure extremes may improve patient outcomes during percutaneous nephrolithotomy.


Assuntos
Cálculos Renais/cirurgia , Pelve Renal/fisiopatologia , Tempo de Internação/estatística & dados numéricos , Nefrolitotomia Percutânea/efeitos adversos , Dor Pós-Operatória/epidemiologia , Adulto , Idoso , Feminino , Humanos , Pelve Renal/cirurgia , Masculino , Manometria/instrumentação , Manometria/métodos , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/métodos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Pressão , Estudos Prospectivos , Resultado do Tratamento , Ureteroscópios , Adulto Jovem
20.
Int J Urol ; 25(2): 121-133, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29136679

RESUMO

Current development of endoscopic technology, lithotripters, and stone-retrieval devices has expanded the indications for retrograde and antegrade endoscopic therapy in the management of urolithiasis. This technology has also resulted in minimally invasive therapy. As surgeons' experience of endourological procedures with the newer instruments has become integrated, the surgical technique and indications for urolithiasis have also changed in the past few years. The present review provides an overview of endourological procedures for upper urinary tract stones and the key points related to surgical techniques.


Assuntos
Litotripsia/métodos , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/prevenção & controle , Ureteroscopia/métodos , Urolitíase/cirurgia , Humanos , Litotripsia/efeitos adversos , Litotripsia/instrumentação , Litotripsia/tendências , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/tendências , Posicionamento do Paciente/instrumentação , Posicionamento do Paciente/métodos , Cuidados Pós-Operatórios/instrumentação , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/tendências , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/instrumentação , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/tendências , Stents , Resultado do Tratamento , Ureteroscopia/efeitos adversos , Ureteroscopia/instrumentação , Ureteroscopia/tendências
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