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1.
Int Braz J Urol ; 45(6): 1153-1160, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808403

RESUMO

PURPOSE: To identify the factors increased fluoroscopy time during percutaneous nephrolithotomy and investigate the relationship between the 3D segmentation volume ratio of stone to renal collecting system and fluoroscopy time. MATERIALS AND METHODS: Data from 102 patients who underwent percutaneous nephrolithotomy were analyzed retrospectively. Volume segmentation of both the renal collecting system and stones were obtained from 3D segmentation software with the images on CT data. Analyzed stone volume (ASV), renal collecting system volume (RCSV) measured and the ASV-to-RCSV ratio was calculated. Several parameters were evaluated for their predictive ability with regard to fl uoroscopy time. RESULTS: The stone-free rate was 55.9% after the percutaneous nephrolithotomy. Complications occurred in 31(30.4%) patients. The mean fluoroscopy time was 199.4±151.1 seconds. The fl uoroscopy time was significantly associated with the ASV-to-RCSV ratio (p<0.001, r=0.614). The single tract was used in 77 ( 75.5%) cases while multiple tracts were used in 25 (24.5%) cases. Fluoroscopy time was significantly associated with multiple access (p<0.001, r=0.689). On univariate linear regression analysis, longer fluoroscopy time was related with increased stone size, increased stone volume, increased number of access, increased calyx number with stone, increased ASV-to-RCSV, increased operative time and decreased stone essence. On multivariate linear regression analysis, the number of access and the ASV-to-RCSV were independent predictors of fluoroscopy time during percutaneous nephrolithotomy. CONCLUSIONS: The distribution of the stone burden volume in the pelvicalyceal system is a significant predictor for prolonged fluoroscopy time during percutaneous nephrolithotomy. Measures to decrease FT could be benefi cial in patients with a high ASV-to-RCSV ratio for precise preoperative planning.


Assuntos
Fluoroscopia/métodos , Cálculos Renais/patologia , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Adulto , Índice de Massa Corporal , Intervalo Livre de Doença , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Exposição à Radiação , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento
2.
Medicine (Baltimore) ; 98(48): e18165, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770263

RESUMO

RATIONALE: Crossed renal ectopia (CRE) is a rare congenital anomaly that is frequently associated with gastrointestinal, cardiovascular, genital and bone malformations. To the best of our knowledge, only 35 cases of crossed renal ectopia involving calculi and 30 cases of CRE associated with renal carcinoma have been reported to date. PATIENT CONCERNS: Here, we present 2 cases of crossed renal ectopia. A 59-year-old woman with diabetes presented to our hospital with abdominal pain. The second patient was a 24-year-old woman who complained with abdominal pain with a duration of 1 day. DIAGNOSES: On the basis of abdominal ultrasonography, we suspected a solitary kidney both in the two patients. Combined with retrograde pyelography and 3D computed tomography, case 1 was diagnosed as an S-shaped right-to-left crossed-fused ectopic kidney with many stones in the left (normal) renal pelvis and case 2 was confirmed to have lump right-to-left crossed-fused renal ectopia with two 3-mm stones in the renal pelvis of the 2 kidneys. INTERVENTIONS: Case 1 underwent percutaneous nephrolithotomy while case 2 refused to undergo surgery and underwent conservative treatment for pain relief. OUTCOMES: Two patients have been followed up and have no stones recurrence. LESSONS: Crossed fused renal ectopia is easily misdiagnosed as a solitary kidney. CRE is so rare that the recognition of the disease needs to be improved and effective treatment should be taken timely. According to the two cases and literature review, minimally invasive surgery has become increasingly common to treat CRE with stones and carcinoma.


Assuntos
Dor Abdominal , Rim Fundido , Cálculos Renais , Rim , Nefrolitotomia Percutânea/métodos , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Diagnóstico Diferencial , Erros de Diagnóstico/prevenção & controle , Feminino , Rim Fundido/complicações , Rim Fundido/diagnóstico , Rim Fundido/fisiopatologia , Humanos , Rim/anormalidades , Rim/diagnóstico por imagem , Rim/cirurgia , Cálculos Renais/complicações , Cálculos Renais/diagnóstico , Cálculos Renais/fisiopatologia , Cálculos Renais/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia/métodos , Urografia/métodos
3.
Urology ; 134: 62-65, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31536740

RESUMO

OBJECTIVE: To evaluate feasibility of percutaneous nephrolithotomy (PCNL) for complex nephrolithiasis in patients 80 years of age and older compared to younger individuals. METHODS: From an institutional IRB-approved database, 1,647 patients were identified who underwent PCNL from 1999 to 2019. Patients were stratified by age: group 1 (20-59), group 2 (60-79), and group 3 (>80). Statistics were performed using chi-square and ANOVA to compare outcomes. RESULTS: Of the 1,647 patients, median age was 46, 66, and 83, respectively (P <0.0001). Three patients within group 3 were 90 or older. Females made up 54%, 46%, 56% of patients (P = 0.02). Average stone size with SD was 2.6 ± 2.2, 2.5 ± 2.3, 2.2± 1.9 cm for each group (P = 0.06). Mean preoperative hemoglobin (Hgb) was significantly lower in the 80+ group (13.8, 13.4, 13.1 g/dL, P <.0001). Change in Hgb was not significantly different. There were more Clavien II-IV complications (10.4, 14.4, 28.8%; P = 0.02) and transfusions (2.3, 4.7, 10.2%; P <0.001) in the elderly. The most common complications in the 80+ group were bleeding related (10.1%). No difference in readmission rates or ICU admissions was noted. CONCLUSION: PCNL is feasible in the extremely elderly; however with a higher rate of complications and longer hospitalizations. No long-term sequelae or deaths in the 80 and older cohort were seen. This study allows us to appropriately counsel older patients on a realistic postoperative course and supports use of PCNL as the best means of long-term survival.


Assuntos
Cálculos Renais , Nefrolitotomia Percutânea , Hemorragia Pós-Operatória , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Hemoglobinas/análise , Humanos , Cálculos Renais/sangue , Cálculos Renais/epidemiologia , Cálculos Renais/cirurgia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/métodos , Hemorragia Pós-Operatória/sangue , Hemorragia Pós-Operatória/mortalidade , Hemorragia Pós-Operatória/terapia , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Estados Unidos/epidemiologia
4.
Urology ; 134: 66-71, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31487511

RESUMO

OBJECTIVE: To analyze the outcomes of upper pole access during percutaneous nephrolithotomy (PCNL), an option pole often avoided due to the concern for pleural injury. METHODS: We retrospectively collected data on patients undergoing PCNL at our institution. Patients were divided into 3 groups according to access: supracostal upper calyx (group 1), subcostal upper calyx (group 2), and nonupper calyx (group 3). Preoperative imaging was reviewed to assess stone burden, Hounsfield units (HU), location, and Guy's Stone Score. Patients were considered stone-free if residual fragments were 3 mm or smaller on CT scan. RESULTS: We analyzed 329 PCNLs (left: 174; right: 155). Stones had a median size of 32 mm, 800 HU, and Guy's Stone Score of 2. Groups 1, 2, and 3 had 119, 108, and 102 patients, respectively. The 90-day complication rate was 20.4% (7.9% Clavien 3-4). Group 1 patients, with higher BMI and larger stones, had higher SFR than group 3 (89.9% vs 79.4%, P = .038), but with a significantly higher risk of complications (P = .001). Within group 1, left PCNL (7.0% vs 24.2%, P = .016) and BMI ≥30 (6.9% vs 25.0%, P = .013) carried a lower risk of chest tube insertion. There was no difference in complications between groups 2 and 3 (1.9% vs 2.9%). CONCLUSION: Upper pole access is safe and effective, particularly if done below the ribs. Supracostal access is an effective option to achieve higher stone-free rates in complex stones, while carrying a risk of significant hydrothorax, particularly on the right side and in nonobese patients.


Assuntos
Hidrotórax , Complicações Intraoperatórias , Cálculos Renais , Nefrolitotomia Percutânea , Pleura/lesões , Cuidados Pré-Operatórios/métodos , Adulto , Índice de Massa Corporal , Feminino , Humanos , Hidrotórax/etiologia , Hidrotórax/prevenção & controle , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/métodos , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos , Estados Unidos
5.
Urology ; 133: 245-246, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376473

RESUMO

INTRODUCTION: Ultrasound guidance for percutaneous nephrolithotomy (PCNL) has gained acceptance amongst urologists given its numerous advantages over fluoroscopy. While traditionally performed in the prone position, this video demonstrates a step-by-step approach to performing PCNL in the supine position, solely under ultrasound guidance. MATERIALS AND METHODS: Once in the modified supine (Galdakao-modified Valdivia) position, important anatomic landmarks are identified. It is important to first orient the ultrasound probe such that its cranial side corresponds to the left of the ultrasound screen. After optimizing a target calyx, keeping the needle in the imaging plane of the probe facilitates renal access. Tract dilation under ultrasound guidance is then achieved by keeping the wire and dilators in the same imaging plane. RESULTS: The 11th and 12th ribs, paraspinous muscle, iliac crest, midaxillary line, and costal margin are the anatomic landmarks that orient the probe to the location of the kidney. Placing the ultrasound probe in the midaxillary line, parallel to the 11th rib allows the operator to identify key renal landmarks: the renal cortex, peri-pelvic fat, collecting system, kidney stone with its associated postacoustic shadow, and the intended target calyx. Controlling the needle is easiest in the longitudinal view, as the needle can be visualized from skin to target. Dilation under ultrasound relies on keeping the wire in view. The tip of the 10-French dilator is based on the location where the wire image disappears as the dilator advances. The balloon dilator tip is visualized on ultrasound reaching the appropriate depth just inside the collecting system, at which time balloon inflation results in complete dilation of the tract. CONCLUSIONS: This video provides a step-by-step approach demonstrating that PCNL can be performed in the supine position using only ultrasound-guidance. This approach facilitates renal access in this position and obviates the need for radiation exposure.


Assuntos
Nefrolitotomia Percutânea/métodos , Posicionamento do Paciente/métodos , Ultrassonografia de Intervenção , Dilatação , Humanos , Decúbito Dorsal
6.
Int Braz J Urol ; 45(5): 956-964, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31408287

RESUMO

PURPOSE: We aimed to compare the outcomes of supine and prone miniaturized percutaneous nephrolithotomy (m-PNL) in the treatment of lower pole, middle pole and renal pelvic stones. MATERIALS AND METHODS: 54 patients who performed supine m-PNL between January 2017 and March 2018 and 498 patients who performed prone m-PNL between April 2015 and January 2018 were included in the study. Of the 498 patients, 108 matching 1: 2 in terms of age, gender, body mass index, American Association of Anesthesiology score, stone size, stone localization and hydronephrosis according to the supine m-PNL group were selected as prone m-PNL group. The patients with solitary kidney, upper pole stone, urinary system anomaly or skeletal malformation and pediatric patients (<18 years old) were excluded from the study. The success was defined as 'complete stone clearance' and was determined according to the 1st month computed tomography. RESULTS: The operation time and fluoroscopy time in supine m-PNL was significantly shorter than prone m-PNL group (58.1±45.9 vs. 80.1±40.0 min and 3.0±1.7 min vs. 4.9±4.5 min, p=0.025 and p=0.01, respectively). When post-operative complications were compared according to the modified Clavien-Dindo classification, overall and subgroup complication rates were comparable between groups. There was no significant difference between the groups in terms of the success rates (supine m-PNL; 72.2%, prone m-PNL; 71.3%, p=0.902). CONCLUSIONS: Supine m-PNL procedure is more advantageous in terms of operation time and fluoroscopy time in the treatment of lower pole, middle pole and renal pelvic stones.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Posicionamento do Paciente/métodos , Decúbito Ventral , Decúbito Dorsal , Adulto , Feminino , Fluoroscopia/métodos , Humanos , Cálculos Renais/patologia , Pelve Renal/cirurgia , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Duração da Cirurgia , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Resultado do Tratamento
7.
Med Sci Monit ; 25: 5878-5885, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31389405

RESUMO

BACKGROUND Advances in percutaneous nephrolithotomy (PCNL) have resulted in smaller devices that cause less trauma and bleeding, while flexible ureterorenoscopy (f-URS) allows access to any calyces. These methods are often used in isolation, but used in combination they may improve treatment of complex renal calculi. This study assessed the effectiveness and complications of f-URS combined with super-mini-PCNL (SMP) to treat complex renal calculi. MATERIAL AND METHODS A retrospective cohort analysis was made of patients with unilateral complex renal stones treated between March 2013 and December 2016. Patients were grouped according to surgical procedure: SMP (SMP Group), f-URS holmium laser lithotripsy (f-URS Group), and combined SMP and f-URS (Combined Group). The postoperative complications and complete stone-free rate were analyzed and compared among the 3 groups. RESULTS A total of 140 patients with complex renal stones were included: 40 patients in the SMP Group, 55 in the f-URS Group, and 45 in the Combined Group. The complete stone-free rate 3 days after the procedure was 77.5% in the SMP Group, 78.2% in the f-URS Group, and 97.8% in the Combined Group (p=0.010). The operation time, intraoperative blood loss, and hospitalization time of the Combined Group were all significantly lower than those in the SMP Group but higher than those in the f-URS Group. The follow-up was 9 months (range, 6-12 months). There were no medium-term complications reported. CONCLUSIONS SMP combined with f-URS holmium laser lithotripsy in the prone position is an effective treatment for complex renal calculi.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Ureteroscopia/métodos , Adulto , Idoso , Perda Sanguínea Cirúrgica , Estudos de Coortes , Feminino , Humanos , Rim/patologia , Cálculos Renais/terapia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias , Decúbito Ventral , Estudos Retrospectivos , Resultado do Tratamento
8.
Urologiia ; (2): 31-35, 2019 Jun.
Artigo em Russo | MEDLINE | ID: mdl-31162898

RESUMO

AIM: To evaluate feasibility and efficiency of simultaneous bilateral supine mini-percutaneous nephrolithotomy in patients with bilateral kidney stones. MATERIALS AND METHODS: A total of 79 patients were included in prospective, randomized study. Single-stage bilateral supine mini-percutaneous nephrolithotomy was performed in the main group (n=37), while in control group (n=42) staged mini-percutaneous nephrolithotomy was done. All interventions were performed in supine position. A type and severity of postoperative complications, changes in biomarkers of acute kidney injury including serum creatinine, glomerular filtration rate (GFR) and cystatin C level were evaluated. The follow-up was 6 months. RESULTS: Stone-free rate in main and control groups was 89.1% and 88.9%, respectively, while the mean duration of the surgery was 82.76 and 140.14 minutes, respectively (p<0.05). There were no significant differences in the type and rate of postoperative complications between groups. Recovery time was significantly shorter in the main group (8.44 vs. 17,76+/-2,41 days, respectively [p<0.05]). There were significant changes in serum creatinine and cystatin C levels on 1st day after surgery compared to baseline values and between groups. However, the level of GFR didnt significantly change in both groups. After 1 month, an increase in GFR in the main group was 6.9% in comparison with 6.8% in control group. CONCLUSION: Our study demonstrates that simultaneous bilateral mini-percutaneous nephrolithotomy is a safe and effective treatment option for patients with bilateral kidney stones.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Estudos de Viabilidade , Humanos , Estudos Prospectivos , Resultado do Tratamento
9.
Prog Urol ; 29(8-9): 432-439, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31196827

RESUMO

INTRODUCTION: The aim of the study is to investigate the factors predictive of surgical outcomes of PCNL and to compare the predictability and accuracy of the Guy's stone score, STONE nephrolithometry, CROES nomogram and S-ReSC score. PATIENTS AND METHODS: We reviewed retrospectively the surgical outcomes recorded consecutively and imaging data of preoperative computed tomography scans of patients who underwent PCNL from 2013 to 2016. Patients with asymptomatic residual fragments<4mm were considered stone-free. Preoperative abdominopelvic computerized tomography images of the patients were reviewed and scored according The Guy's stone score, STONE nephrolithometry, CROES nomogram, S-ReSC score by one urologist. RESULTS: A total of 157 PCNLs were reviewed. The overall stone-free rate was 59% (92/157) with a complication rate of 22% (35/157). Stone Burden<542mm3 is significantly associated with stone-free rate (SFR) (P=0.001). On univariate analysis, all the scoring systems were identified as significant factors in terms of SFR. The Guy's Stone Score, the CROES score and the S-ReSC score were associated with complications (P<0.02). The multivariate logistic regression analysis showed that the CROES score was identified as a significant factor in terms of SFR and complications (P<0.01). The area under the receiver operating characteristic (ROC) curves for stone burden, the Guy's, STONE score, CROES core and S-ReSC scores showed good results (0.737/0.674/0.762/0.746/0.710) respectively. CONCLUSION: Although the four scoring systems were significantly associated with SFR, the STONE score was a significant predictive factor for SFR and complications after PCNL. LEVEL OF EVIDENCE: 3.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/epidemiologia , Tomografia Computadorizada por Raios X , Adulto , Humanos , Pessoa de Meia-Idade , Nomogramas , Estudos Retrospectivos , Resultado do Tratamento
10.
Pan Afr Med J ; 32: 110, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31223400

RESUMO

This study aims to discuss the role of open surgery in the treatment of renal lithiasis, including coralliform stones, with the advent of new less invasive techniques. We report a series of 53 cases of coralliform stones whose data were collected in our Hospital during a period of 7 years, from January 2011 to January 2018. The patients underwent open nephrolithotomy by lombotomy. The mean post-operative length of stay was 10 days. The immediate and early postoperative outcomes were simple in 36 patients, 6 patients underwent blood transfusion, 2 had severe sepsis in the postoperative period, 5 had infection of the wall and 4 had urinary fistula, secondarily managed by endoscopic drainage. Residual stones were found in 9 cases (16.9%). Stones were essentially treated by extracorporeal lithotripsy. Late outcomes were characterized by renal atrophy in 2 patients, lithiasic recurrence in 9 patients, an improvement in creatinine clearance in 9 patients and a slight worsening in 5 patients. Open surgery presents the risk of multiple complications and it is not recommended for first-line treatment of renal lithiasis. However it is important to determine which patients would benefit from open nephrolithotomy.


Assuntos
Cálculos Renais/cirurgia , Litotripsia/métodos , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/epidemiologia , Transfusão de Sangue/estatística & dados numéricos , Drenagem/métodos , Endoscopia/métodos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Sepse/epidemiologia , Resultado do Tratamento , Fístula Urinária/epidemiologia
11.
Urology ; 131: 53-56, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31132426

RESUMO

OBJECTIVE: To characterize current practice patterns of urologists in the management of intravenous (IV) contrast allergy in the setting of endourologic procedures. METHODS: A survey was administered to all members of the Endourological Society to assess management of IV contrast allergy prior to ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL). Treatment regimens, reports of adverse outcomes, and demographics of respondents were also collected. Data were analyzed using chi-square tests. RESULTS: The response rate was 15% (325/2100). A total of 21% and 28% of respondents reported giving prophylaxis prior to URS and PCNL, respectively. Nearly 3% of respondents reported having observed a severe adverse reaction to intraluminal contrast in the past. Approximately half reported giving prophylaxis only 1 hour prior to the procedure. Most respondents (77%) completed a fellowship, the most common being endourology. Chi-square analysis revealed a significant difference between giving prophylaxis for URS or PCNL and the respective case volumes (for URS, X2 = 8.3, P= .004; for PCNL, X2 = 8.5, P= .003) where urologists with the lowest and highest case volumes were more likely to give prophylaxis (Fig. 1). There was no significant difference between giving prophylaxis for URS or PCNL and recency of residency, fellowship training, practice setting, or practice type. CONCLUSION: Most urologists do not give prophylaxis for patients with IV contrast allergy prior to URS and PCNL. Further studies are needed to evaluate the necessity of prophylaxis as well as to establish clear guidelines.


Assuntos
Meios de Contraste/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/prevenção & controle , Nefrolitotomia Percutânea/métodos , Padrões de Prática Médica/tendências , Ureteroscopia/métodos , Urologia , Meios de Contraste/administração & dosagem , Pesquisas sobre Serviços de Saúde , Humanos , Injeções Intravenosas
12.
Int Braz J Urol ; 45(4): 765-774, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31136109

RESUMO

OBJECTIVES: To primarily evaluate the functional outcomes of PCNL for bilateral renal calculi/calculi in solitary functioning kidney with Chronic Kidney Disease(CKD). To identify factors affecting the renal replacement therapy following PCNL. MATERIALS AND METHODS: Patients with bilateral renal calculi/calculi in solitary kidney and CKD (eGFR<60/s.creatinine>2) and Good Performance Status [Eastern Cooperative Oncology Group (ECOG): 0-2] were included in the study. RESULTS: A total of 60 patients with CKD who had bilateral renal calculi/calculi in solitary functioning kidney underwent PCNL. At 6 months, eGFR improved or stabilized in 45 (75%) patients, while in 15 (25%) patients eGFR deteriorated. A total of 5 (14.28%) and 2 (25%) patients of CKD stage 4 and 5 respectively had improvement in eGFR as well as CKD stage. Fourteen (82.35%), 21 (60%), 3 (37.5%) patients of CKD stage 3, 4, 5 had improvement in eGFR but not signifi cant enough to cause stage migration. Again 3 (17.65%), 9 ( 40%) and 3 (37.5%) patients of CKD stage 3, 4, 5 had reduction in eGFR but not signifi cant enough to cause stage migration. None of the patients had worsening of CKD stage. Preoperative CKD stage and eGFR were compared with measurements made at the fi nal follow up visit (6 months). CONCLUSION: Our results indicate that most patients of renal calculi with CKD show improvement or stabilization of renal function with aggressive stone removal. Improvement is more in patients who have mild to moderate CKD. Aggressive management of comorbidities, peri-operative UTI and complications may delay or avoid progression of CKD status in such patients.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Insuficiência Renal Crônica/cirurgia , Adolescente , Adulto , Idoso , Criança , Creatinina/sangue , Receptores ErbB/sangue , Estudos de Viabilidade , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Cálculos Renais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Insuficiência Renal Crônica/fisiopatologia , Reprodutibilidade dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Urinálise , Adulto Jovem
13.
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
14.
Urol Clin North Am ; 46(2): 225-243, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30961856

RESUMO

Although advances in percutaneous nephrolithotomy have occurred, the initial renal access remains a challenging and high-risk step. This risk and technical difficulty have resulted in a minority of urologists obtaining their own access. Therefore, continued innovation in access techniques that simplify the procedure, lower risk, and reduce radiation exposure is needed. This article provides a high-level overview of recent advances in percutaneous renal access. The techniques are organized based on approach (antegrade or retrograde) and the imaging modality used, such as fluoroscopy, ultrasonography, computed tomography, and other novel techniques (laser, electromagnetic, and robotics).


Assuntos
Fluoroscopia/métodos , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Ultrassonografia de Intervenção/métodos , Radiação Eletromagnética , Humanos , Imagem Tridimensional , Terapia a Laser , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Assistida por Computador , Tomografia Computadorizada por Raios X/instrumentação , Ureteroscopia/métodos , Urologia
15.
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
16.
Actas urol. esp ; 43(3): 111-117, abr. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-181168

RESUMO

Contexto y objetivos: El tratamiento de primera elección para litiasis > 2 cm es la nefrolitotomía percutánea (NLP), dejando a la ureteroscopia flexible (URS-F) como una segunda opción. En la presente revisión se evaluaron la tasa libre de litiasis y las complicaciones de ambas técnicas en el tratamiento de litiasis de tamaño entre 2 y 3 cm. Material y métodos: Revisión sistemática de estudios que compararon las dos técnicas. Fueron excluidos aquellos estudios que no fueran comparativos, los realizados en población pediátrica o con litiasis menores de 2 cm o mayores de 3 cm. Dos investigadores realizaron independientemente la búsqueda, obteniendo 5 estudios que abarcaban un total de 815 pacientes: 252 pertenecieron al grupo de URS-F y 563 al de NLP. Cuatro fueron retrospectivos y uno fue prospectivo no aleatorizado. Resultados: La tasa libre de litiasis osciló entre el 47,0 y el 95,0% para la URS-F y entre el 87,0 y el 100% para la NLP. La tasa de complicaciones fue del 8,8-29,0% en la URS-F y del 11,9-27,0% en la NLP. La URS-F requirió un número mayor de procedimientos y tuvo un menor descenso de hemoglobina y ascenso de creatinina en comparación con la NLP. Conclusiones: La tasa libre de litiasis fue mayor en la NLP, aunque la URS-F podría alcanzar unos resultados comparables a expensas de realizar varios procedimientos. Ambas técnicas tienen una frecuencia de complicaciones similar, pero con más alteraciones analíticas posquirúrgicas en el grupo de NLP


Context and objectives: The first-line treatment for > 2 cm lithiasis is percutaneous nephrolithotomy (PNL), leaving flexible ureteroscopy (FURS) as a second option. In the present review, the stone-free rate and the complications of both techniques were evaluated in the treatment of 2-3 cm stones. Material and methods: Systematic review of studies that compared both techniques. Studies that were not comparative, as well as those carried out in the paediatric population or with < 2 cm or > 3 cm stones, were excluded. Two researchers independently performed the investigation, obtaining 5 studies that made up a total of 815 patients: 252 belonged to the FURS group and 563 to the PNL group. Four studies were retrospective, and one was non-randomised prospective. Results: Stone-free rate ranged between 47.0% and 95.0% for the FURS and between 87.0% and 100% for the PNL. The complication rate was 8.8-29.0% in the FURS and 11.9-27.0% in the PNL. FURS required a greater number of procedures, and had a lower decrease in haemoglobin and creatinine rise compared to PNL. Conclusions: The stone-free rate was higher for PNL, although the FURS could reach comparable results at the expense of performing several procedures. Both techniques have a similar frequency of complications, but the PNL has more postsurgical analytical alterations


Assuntos
Humanos , Nefrolitíase/cirurgia , Nefrolitotomia Percutânea/métodos , Ureteroscopia/métodos , Complicações Pós-Operatórias , Estudos Retrospectivos , Estudos Prospectivos
17.
Actas urol. esp ; 43(3): 131-136, abr. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-181171

RESUMO

Objetivo: Las complicaciones infecciosas (CI) tras la nefrolitotomía percutánea (NLPC) pueden llegar a ser de gravedad. Nuestro objetivo fue analizar factores predictores preoperatorios de CI tras la NLPC. Materiales y métodos: Se incluyó en un estudio prospectivo a un total de 203 pacientes que se trataron con NLPC entre enero de 2013 y febrero de 2016. Se definió CI postoperatoria como infección urinaria/pielonefritis, síndrome de respuesta inflamatoria sistémica o sepsis. Las variables analizadas fueron: edad, sexo, número, lado y tamaño (cm) de la litiasis; unidades Hounsfield, diabetes (insulinodependiente o no), cultivo de orina preoperatorio, bacteria aislada, multitrayecto, índice de masa corporal y tiempo quirúrgico (min). Se llevó a cabo un análisis multivariante (regresión logística). Resultados: Se produjeron CI en 30 pacientes (14,8%): en 9 de ellos (4,4%) se presentó infección urinaria, en 14 (6,9%) síndrome de respuesta inflamatoria sistémica y en 7 (3,5%) sepsis. Además, 13 (43,3%) tenían un cultivo de orina preoperatorio negativo, 15 (50%) positivo y en 2 (6,7%) no estaba disponible. En la regresión logística, el tamaño de la litiasis, la diabetes insulinodependiente y el sexo femenino resultaron factores predictores independientes de CI (OR: 1,03; 14,6 y 7,8, respectivamente; p = 0,0001). Conclusiones: Pacientes con litiasis de mayor tamaño, diabéticos insulinodependientes y mujeres deberían ser aconsejados de forma preoperatoria sobre el riesgo de CI tras la NLPC, y ser estrechamente seguidos tras la cirugía. Además, un cultivo de orina preoperatorio negativo no ofrece fiabilidad suficiente para excluir el riesgo de CI


Objective: Infectious complications (IC) following percutaneous nephrolithotomy surgery (PCNL) can be life-threatening. Our objective was to analyze preoperative predictors of IC in PCNL. Materials and methods: A total of 203 patients who underwent PCNL were included in a prospective study between January 2013 and February 2016. A postoperative IC was defined as urinary infection/pyelonephritis, systemic inflammatory response syndrome or sepsis. The variables analyzed were age, gender, number, size (cm) and side of stone; Hounsfield units, diabetes (insulin dependent or not), preoperative culture, isolated bacteria, multitract, body mass index and surgical time (min). A multivariate forward stepwise (logistic regression) was performed. Results: IC occurred in 30 patients (14.8%): 9 (4.4%) had urinary infection, 14 (6.9%) systemic inflammatory response syndrome and 7 (3.5%) sepsis. In addition, 13 (43.3%) had negative preoperative urine culture, 15 (50%) positive and in 2 (6.7%) was not available. On the logistic regression analysis, stone size (cm), insulin dependent diabetes and female sex were independently associated with increased risk of IC (odds ratio [OR] 1.03, 14.6 and 7.8, respectively; p = 0.0001). Conclusions: Patients with large stone burdens, insulin–dependentdiabetes condition and female gender, should be counselled properly regarding postoperative infection risks and closely followed up to diagnose IC (specially sepsis) soon enough. Negative preoperative urine culture seems not reliable enough to exclude an infectious complication according to our results


Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/prevenção & controle , Infecções Urinárias/fisiopatologia , Pielonefrite/fisiopatologia , Sepse/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Estudos Prospectivos , Análise Multivariada , Urinálise/métodos , Prognóstico , Litíase/complicações , Diabetes Mellitus Tipo 1/complicações
18.
Urology ; 128: 31-37, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30902696

RESUMO

OBJECTIVES: To evaluate the safety, efficacy, adverse events, and feasibility of ultrasound guided percutaneous nephrolithotomy (US-PCNL) in the management of large renal stones in supine and prone positions and to point out the practical considerations related to these techniques in comparison with standard PCNL. PATIENTS AND METHODS: This study was conducted between August 2013 to September 2018 as a prospective randomized and controlled study. A total of 392 consecutive patients with nephrolithiasis >2 cm were randomly assigned to undergo ultrasound PCNL in prone (P-US-PCNL) (132 patients); supine position (S-US-PCNL) (129 patients) or conventional PCNL (C-PCNL) (131 patients). The preoperative parameters, the intraoperative findings, operative time, hospital stay, perioperative morbidities, stone free rate, and related data were recorded. RESULTS: The demographic and the baseline characteristics were comparable in all study groups. The mean number of trails and time for successful puncture in P-US-PCNL, S-US-PCNL, and C-PCNL were 1.9 ± 1, 2.3 ± 1.2, and 1.7±1, respectively (P < .001), and 15.8 ± 5.8, 19.3 ± 9.4, and 16.5 ± 8.1 seconds, respectively (P < .001). The operation time was 69 ± 22, 75 ± 23, and 72 ± 27 minutes, respectively, (P > .05). The mean nephrostomy time and length of hospital stay were 3 ± 1.3, 3.4 ± 1.5, 3.2 ± 1.2 hours, respectively, and 3.8 ± 1.5, 4.1 ± 1.5, 3.9 ± 1.3 days, respectively (P > .05). The mean percentage decrease in hemoglobin concentration was 1.65 ± 0.66, 1.77 ± 0.78, and 2.1 ± 0.9, respectively (P < .001), overall stone clearance was 88%, 79%, and 85%, respectively (P > .05). Complications were acceptable and similar between groups. CONCLUSION: US-PCNL either in prone or supine position is as effective, feasible, and safe as C-PCNL with zero radiation exposure.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Posicionamento do Paciente/métodos , Decúbito Ventral , Decúbito Dorsal , Cirurgia Assistida por Computador/métodos , Ultrassonografia/métodos , Adulto , Feminino , Seguimentos , Humanos , Cálculos Renais/diagnóstico , Tempo de Internação/tendências , Masculino , Duração da Cirurgia , Estudos Prospectivos , Resultado do Tratamento
19.
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
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