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1.
Arch Esp Urol ; 73(1): 26-31, 2020 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-31950920

RESUMO

OBJECTIVE: To evaluate the impact of a new renal lithiasis classification on the stone free rate. The new system would allow standarization of comparison between different series of percutaneous nephrolithotomy. MATERIAL AND METHODS: Patients undergoing NPCL between November 2011 and November 2016 were retrospectively analyzed. The stones were classified as simple (pelvic and/or calyceal stones that required a single access and/or use of a rigid nephroscope), complex (required the use of more than one percutaneous access and/or flexible instruments and/or combined access) and extremely complex (complete staghorn stones or anatomical alterations), according to the Ibarluzea-Llanes classification. Other variables analyzed were age, sex, diabetes, hypertension or taking anticoagulants, stones composition, placement of postoperative nephrostomy and surgical time. We performed a univariate and multivariate analysis using the chi-square or Fisher test and logistic regression. RESULTS: Sixty-nine procedures were included in 57 patients with a mean age of 51 years (13-84) and a mean follow-up time of 30 months. The stone free rate was 86%, 75% and 55% for a simple, complex or extremely complex stone, both at three months and a year. Only the stone type was associated with a worse stone free rate (p 0.03) with RR of 2.5 for a 95% CI. CONCLUSIONS: The Ibarluzea-Llanes clasification could be used as a new system for standarization of PCNL outcomes reporting.


Assuntos
Cálculos Renais , Nefrolitotomia Percutânea , Nefrostomia Percutânea , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Cálculos Renais/terapia , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
4.
Actas urol. esp ; 43(10): 521-525, dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185257

RESUMO

Objetivos: El objetivo de este estudio fue evaluar el rol de la aplicación de fluoroscopia en pacientes intervenidos mediante cirugía retrógrada intrarrenal y su efecto sobre los resultados quirúrgicos. Material y métodos: Los pacientes que ingresaron en nuestro centro con diagnóstico de cálculos renales se dividieron en 2 grupos. En el grupo 1 se utilizó fluoroscopia de rutina en todos los casos (n: 58). En el grupo 2 se ejecutó el mismo procedimiento sin fluoroscopia (n: 67). Posteriormente se compararon los resultados de los 2 grupos. Resultados: No hubo diferencias estadísticamente significativas entre los 2 grupos en términos de tiempo quirúrgico, tasa libre de cálculos, complicaciones, necesidad de analgésicos, requerimiento de nuevo tratamiento y escala visual analógica. Conclusión: El uso de fluoroscopia no altera la frecuencia de complicaciones ni la tasa libre de cálculos. Creemos que el uso de fluoroscopia no es indispensable en los casos en los que se consigue acceso a la pelvis renal (especialmente en procedimientos de ureteroscopia semirrígida) y que su uso debe ser limitado para evitar un aumento innecesario de exposición a la radiación


Objectives: The aim of this study was to evaluate the role of the use of fluoroscopy in patients undergoing retrograde intrarenal surgery and the effect on surgical outcomes. Material and methods: The patients who were admitted to our center with the diagnosis of kidney stones were divided into 2 groups. In group 1, routine fluoroscopy was used in all cases (n: 58). In group 2, the same procedure was performed without fluoroscopy (n: 67) and the results of the 2 groups were compared. Results: There were no statistically significant differences between the 2 groups in terms of operation time, stone-free rate, complication rate, need for analgesic and re-treatment requirement and Visual Analogic Scale score. Conclusion: The use of fluoroscopy does not alter the complication frequency and stone-free rate. We think that the use of fluoroscopy is not mandatory in cases in which renal pelvis access is achieved especially with semirigid ureteroscopy and that unnecessary fluoroscopy increases radiation exposure


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Fluoroscopia , Cálculos Renais/cirurgia , Avaliação de Resultado de Intervenções Terapêuticas , Nefrostomia Percutânea/métodos , Escala Visual Analógica , Ureteroscopia , Complicações Intraoperatórias , Procedimentos Cirúrgicos Urológicos/métodos
5.
Transplant Proc ; 51(9): 3084-3086, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31627914

RESUMO

A 72-year-old man with a past medical history notable for deceased renal transplant presented to the interventional radiology department for routine right lower quadrant renal transplant nephroureteral catheter exchange. The nephroureteral catheter was placed in 2016 because of the presence of a hematoma causing partial page kidney and hydronephrosis. An antegrade nephrostogram was notable for opacification of the small bowel instead of the renal collecting system. The patient then subsequently developed urinary retention and intractable abdominal pain. Because of the combination of events, it was deemed necessary for laparotomy and surgical repair of the small bowel. Intraoperative findings were notable for small bowel adhesion to the abdominal wall but otherwise no evidence of acute inflammatory changes. In this case report, we describe the first case of an idiopathically dislodged nephrostomy catheter to the small bowel from a transplanted kidney and its successful management.


Assuntos
Migração de Corpo Estranho , Intestino Delgado/patologia , Transplante de Rim/efeitos adversos , Nefrostomia Percutânea/efeitos adversos , Cateteres Urinários/efeitos adversos , Idoso , Migração de Corpo Estranho/patologia , Migração de Corpo Estranho/cirurgia , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Hidronefrose/etiologia , Hidronefrose/cirurgia , Masculino , Nefrostomia Percutânea/instrumentação
6.
Rev Lat Am Enfermagem ; 27: e3191, 2019.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-31596421

RESUMO

OBJECTIVE: to evaluate the impact on the quality of life as well as anxiety and pain in patients with nephrostomy tubes. METHOD: this is a longitudinal descriptive study performed on a sample of n=150 patients. To evaluate the quality of life, the EuroQol-5D questionnaire was used; anxiety was quantified by the Beck Anxiety Inventory; to study pain, a visual analogue scale was employed. RESULTS: statistically significant differences were found in the quality of life, with its worsening (r = 0.51; p <0.01) when evaluated at the first tube replacement. Patients presented mild to moderate anxiety before the procedure, which was reduced at the first tube replacement, although this difference was not significant (r = 0.028, p = 0.393). Finally, the degree of pain was also significantly reduced (r = 0.13, p<0.01) after six weeks. As for gender, women presented the worst values ​​in the three variables studied (worse quality of life and greater anxiety and pain). CONCLUSIONS: nephrostomy tubes have a negative impact on the patient's quality of life. During the time they live with these tubes, patients have mild to moderate pain and anxiety.


Assuntos
Transtornos de Ansiedade/psicologia , Nefrostomia Percutânea/efeitos adversos , Dor/etiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Nefrostomia Percutânea/enfermagem , Nefrostomia Percutânea/psicologia , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Inquéritos e Questionários
7.
Zhonghua Yi Xue Za Zhi ; 99(38): 3005-3007, 2019 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-31607033

RESUMO

Objective: To investigate the therapeutic effects of first phase renal puncture and drainage guided by B ultrasound and second phase percutaneous nephrolithotomy(PCNL) in the treatment of urinary calculi complicated with pyonephrosis. Methods: From January 2014 to April 2018, 28 patients with upper ureteral segment and kidney calculi complicated with pyonephrosis were collected. All patients received the pyonephrosis puncture under B ultrasound. After the inflammation was controlled and the clinical situation improved, the second phase was treated by PCNL. During the operation, routine in dwelling ureteral stent drainage and renal fistula wereperformed. The outcomes of the operation were observed. Results: A total of 28 cases were successfully punctured, the obstruction was relieved and the inflammation was controlled. Additionally, the second phase of PCNL surgery was successful, and there were no significant stone residues after PCNL. There were no complications such as severe systemic inflammatory response syndrome and severe hemorrhage. After 3 to 12 months of follow-up, renal function was restored to varying degrees, and there were no renal failure patients who needednephrectomy. Conclusions: Early diagnosis of urinary calculi complicated with pyonephrosis is the key to successful treatment. Active and effective B ultrasound-guided renal puncture and drainage, drainage of pus, and removal of urinary obstruction can improve the safety of the second phase of PCNL, and thus it attaches great importance to the treatment of pyonephrosis.


Assuntos
Cálculos Renais , Nefrolitotomia Percutânea , Nefrostomia Percutânea , Pionefrose , Drenagem , Humanos , Paracentese , Punções , Resultado do Tratamento
8.
Urologiia ; (4): 38-43, 2019 Sep.
Artigo em Russo | MEDLINE | ID: mdl-31535803

RESUMO

INTRODUCTION: Nephrostomy tube placed after percutaneous removal of kidney stones can cause pain and discomfort in the early postoperative period [1, 2]. A tubeless percutaneous nephrolithotomy (PCNL) is considered as alternative approach. However, the most serious complication after tubeless procedure is a development of active uncontrolled bleeding from percutaneous tract in the early postoperative period. AIM: To improve the results of surgical treatment of kidney stones by evaluation of efficiency of using hemostatic matrix during tubeless PCNL. MATERIALS AND METHODS: A total of 113 patients with large kidney stones undergone to the tubeless PCNL for the past 9 years in our clinic. The external or internal stent was put for the drainage of upper urinary tract for 2 and 14 days, respectively. All patients were divided into 2 groups, depending on severity of bleeding (group 1 - no bleeding vs. group 2 - mild bleeding). Each group was further divided into two subgroups based on the technique and type of drainage of upper urinary tract at the end of the surgery. In the main group (n=74) the hemostatic matrix based on lyophilized thrombin 2000 IU was injected in percutaneous tract at the end of the surgery. The control group included 39 patients who underwent mini-PCNL without using hemostatic matrix. The blood loss, intensity of urine leakage from percutaneous tract (duration, visual analog scale) and degree of fluid extravasation in pararenal fat estimated by US were evaluated. RESULTS: The mean operative time was 47.5+/-3.6 min (52, 58, 38 and 49 min in subgroup I, II, III and control group, respectively). Hemoglobin drop was 9.3+/-4.1, 12.1+/-7.5, 14.6+/-11.2 and 10.6+/-5.9 in subgroups I, II, III and in the control group, respectively, while duration of hematuria was 16.1, 20.3, 28.5 and 22.9 hours, respectively. Fluid extravasation in pararenal space was found in 1 out 7 patients in subgroup III and control group, respectively (p<0.05). The dilatation of collection system (after double-J) persisted in 18.1%, 20% 22.2% and 13.3% cases in subgroup I, II, III and control group, respectively. There were no significant differences in other evaluated parameters. In 1 case in the control group there was severe bleeding which required selective embolization of the renal artery. CONCLUSION: The use of hemostatic matrix is an additional important measure which allows to prevent active bleeding from the percutaneous tract in early postoperative period. Moreover, the hemostatic matrix contributes to the sealing of tract and reduces the risk of fluid extravasation in pararenal space after mini-PCNL.


Assuntos
Hemorragia/prevenção & controle , Nefrolitotomia Percutânea , Humanos , Cálculos Renais , Nefrostomia Percutânea
9.
Urologe A ; 58(11): 1289-1297, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31501985

RESUMO

Ureterorenoscopy and percutaneous nephrolitholapaxy are minimally invasive procedures and are the standard procedures for the treatment of kidney stones and ureteral calculi. To achieve an adequate view, in both methods an optimal and sufficient irrigation flow is necessary. The intrarenal pressure is influenced by the irrigation pressure and irrigation volume and has to be controlled. Pathologically elevated intrarenal pressure can lead to irreversible damage of the kidneys. Lasers are frequently used for stone fragmentation. It has been shown in studies that the laser energy can lead to an increase in the temperature and that thermal effects can also damage the kidneys. This article provides the surgeon with an overview about the effects of temperature and pressure changes during ureterorenoscopy and percutaneous nephrolitholapaxy and how damages can be avoided.


Assuntos
Temperatura Alta/efeitos adversos , Cálculos Renais/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Nefrostomia Percutânea/métodos , Pressão/efeitos adversos , Cálculos Ureterais/cirurgia , Ureteroscopia/métodos , Humanos , Cálculos Renais/diagnóstico , Resultado do Tratamento , Cálculos Ureterais/diagnóstico
10.
Biomed Res Int ; 2019: 8657609, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31355285

RESUMO

Objective: We aimed to investigate the role of antegrade irrigation via percutaneous nephrostomy on surgical outcomes in retrograde ureteroscopy in patients with upper ureter stones. Materials and Methods: In this retrospective study, we analyzed 134 patients who underwent retrograde semirigid ureteroscopy for upper ureter stones between August 2012 and December 2017. Patients were divided into two groups: retrograde irrigation group (conventional URS) and antegrade irrigation group (using percutaneous nephrostomy). Operation time, postoperative hospital stay, complications, and stone-free rate were measured for each patient after ureteroscopy. Results: The mean age in the retrograde irrigation and antegrade irrigation groups was 53.3 and 60.7 years, respectively (p=0.007). The operation time was 60.8 min vs. 43.0 min (p=0.002), and stone-free rate was 82.0 % vs. 95.5 % (p=0.033). Stone size, laterality, the proportion of male patients, and urinary tract infection prevalence were comparable between the groups. In the subgroup analysis of stone size >10 mm, the antegrade irrigation group had a shorter operation time and a higher stone-free rate. For stone size of 5-10 mm, operation time in the antegrade irrigation group was shorter and the stone-free rate between the two groups was comparable. Conclusion: Antegrade irrigation via percutaneous nephrostomy during ureteroscopy has a higher stone-free rate with a shorter operation time without an increased urinary tract infection risk. Therefore, if percutaneous nephrostomy is necessary before ureteroscopy, antegrade irrigation of external fluid via percutaneous nephrostomy is strongly recommended.


Assuntos
Ureter/cirurgia , Cálculos Ureterais/cirurgia , Doenças Ureterais/cirurgia , Infecções Urinárias/cirurgia , Adulto , Cateterismo , Feminino , Humanos , Litotripsia , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea/métodos , Irrigação Terapêutica/métodos , Resultado do Tratamento , Ureter/fisiopatologia , Cálculos Ureterais/fisiopatologia , Doenças Ureterais/fisiopatologia , Ureteroscopia , Infecções Urinárias/fisiopatologia
11.
BMC Urol ; 19(1): 50, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174519

RESUMO

BACKGROUND: Physicians doubt percutaneous nephrostomy (PCN) insertion on cancer related hydronephrosis patients causes tumor seeding and worse cancer control. In this article, we attempted to determine if preoperative PCN alters cancer control in upper tract urothelial cancer (UTUC) patients. METHODS: Retrospective analysis of UTUC patients in a single center from 2005 to 2015. Exclusion criteria included lymph node metastasis, and patients underwent perioperative adjuvant chemotherapy or radiotherapy. There were 664 patients in this analysis, with clinico-pathological data being collected retrospectively for Cox-regression statistical analysis. Outcomes were measured by local recurrence, distant metastasis and cancer-specific death with Kaplan-Meier curves. RESULTS: There were respectively 25 and 639 UTUC cancers in the preoperative PCN and non-PCN insertion groups with mean follow-up duration of 37.9 and 48.6 months, respectively. The preoperative PCN group consisted of 17 patients (68%) with tumor located in the ureter, while the PCN-negative group included 236 patients (36%) with tumor located in the ureter being statistically significant. These two groups were comparable in gender, age, follow-up duration, tumor stage, and pathological features of the UTUC. As for the cancer control in the PCN group, 4(16%), 1(4%) and 1(4%) had local recurrence, distant metastasis and cancer-specific death respectively; in the non-PCN group, 101(15.8%), 96(15%) and 72(11.2%) exhibited local recurrence, distant metastasis and cancer-specific death respectively. Statistical analysis showed no difference in oncologic outcomes between these two groups.(p = 0.804, 0.201 and 0.254). CONCLUSIONS: Preoperative percutaneous nephrostomy on upper-tract urothelial cancer poses little risk on tumor seeding and could be considered as part of treatment strategy if renal function preservation is needed.


Assuntos
Carcinoma de Células de Transição/cirurgia , Neoplasias Renais/cirurgia , Nefrostomia Percutânea/efeitos adversos , Neoplasias Ureterais/cirurgia , Idoso , Progressão da Doença , Feminino , Humanos , Masculino , Inoculação de Neoplasia , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios , Estudos Retrospectivos
12.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(3): 214-216, 2019 May 30.
Artigo em Chinês | MEDLINE | ID: mdl-31184082

RESUMO

Percutaneous renal puncture device has very important clinical value. Qualified percutaneous renal puncture device is one of the important ways to evaluate its safety and efficacy, and it is also an important prerequisite for the device to be marketed in China. When manufactuers test the product, the selection of representative products is suggested from the aspects of performance parameter, structure, material and production process.


Assuntos
Nefrostomia Percutânea , China , Humanos , Rim , Nefrostomia Percutânea/instrumentação , Punções
13.
Arch Esp Urol ; 72(4): 406-414, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31070137

RESUMO

OBJECTIVES: Micropercutaneous nephrolithotomy (microperc) is a new minimal-invasive technique.We aimed to investigate whether preoperative hydronephrosis has an impact on the stone-free rate of microperc. METHODS: In this study, 66 consecutive patients were included and divided into 2 groups:patients without preoperative hydronephrosis (group-1) and patients with preoperative hydronephrosis (group-2).Both groups were compared for age, gender, body mass index (BMI), stone burden, stone location, fluoroscopy and operative time, blood loss, stone-free rate and perioperative and postoperative complication rates. Parameters were analyzed using univariate and multivariate analyses for the stone-free rate. RESULTS: The mean age, gender, BMI, stone location, and blood loss were similar in both groups (p > 0.05). Stone burden in group-2 was greater than group-1 (p=0.011). In addition, mean fluoroscopy time in group-1 was found to be significantly lower (p < 0.05). However, operative time was comparable among the groups (p=0.169). Lastly, group-2 had a higher rate of perioperative and postoperative complication rates and lower success rate (p=0.023, p=0.027 and p=0.001, respectively). The success was significantly affected by hydronephrosis, stone burden and location (p < 0.05). Logistic regression analysis revealed that unsuccessful outcome was significantly associated only with the presence of hydronephrosis (OR 0.225,p=0.033). CONCLUSION: This study seems to suggest that presence of hydronephrosis is a major factor on the stone free rate of microperc procedures.


Assuntos
Hidronefrose , Cálculos Renais , Nefrolitotomia Percutânea , Nefrostomia Percutânea , Humanos , Hidronefrose/complicações , Cálculos Renais/terapia , Estudos Retrospectivos , Resultado do Tratamento
15.
Clin Exp Nephrol ; 23(8): 1087-1088, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31093823

RESUMO

We report a rare case of a huge internal iliac artery aneurysm (IAA) complicated by post-renal acute kidney injury. Huge internal IAA should be considered for one of differential diagnoses for post-renal acute kidney injury.


Assuntos
Lesão Renal Aguda/etiologia , Aneurisma Ilíaco/complicações , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/terapia , Idoso de 80 Anos ou mais , Humanos , Hidronefrose/etiologia , Aneurisma Ilíaco/diagnóstico por imagem , Masculino , Nefrostomia Percutânea , Resultado do Tratamento
16.
J Coll Physicians Surg Pak ; 29(6): 558-562, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31133157

RESUMO

OBJECTIVE: To investigate the risk factors that may cause urinary tract infection (UTI) in patients applied with retrograde intrarenal surgery (RIRS). STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Departments of Urology, Ankara Training and Research Hospital, Turkey, from September 2014 to April 2017. METHODOLOGY: A retrospective examination was made of patients who underwent RIRS. The patients were separated into 2 groups as those with no UTI in the postoperative period (Group 1) and those with UTI (Group 2). The groups were compared in respect of age, stone size, operating time, presence of residual stone, and body mass index. Continuous independent variables were compared using the Student's t-test and in the comparison of categorical variables, the Chisquare test was used. A value of p<0.05 was accepted as statistically significant. RESULTS: Group 1 comprised 169 patients with no UTI and Group 2, 20 patients with UTI. The mean operating time was 55.82 ±14.73 minutes in Group 1 and 75.5 ±23.9 minutes in Group 2 (p=0.002). In multivariate analysis, operating time was determined as an independent prognostic risk factor increasing the risk of infection (p=0.001). The cut-off value determined with ROC analysis was 61 minutes. When operating time exceeded 61 minutes, the infection risk was increased 11.1-fold (sensitivity 75%, specificity 76%, AUC 0.76). CONCLUSION: Operating time in patients applied with RIRS was determined to be an independent prognostic risk factor for UTI risk in the postoperative period. In patients where surgery lasts more than 1 hour, particular attention should be paid in respect of infection risk.


Assuntos
Cálculos Renais/cirurgia , Rim/cirurgia , Nefrostomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/etiologia , Sepse/etiologia , Cálculos Ureterais/cirurgia , Infecções Urinárias/etiologia , Adulto , Idoso , Feminino , Febre/etiologia , Humanos , Incidência , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea/métodos , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Sepse/epidemiologia , Resultado do Tratamento
17.
BMJ Case Rep ; 12(5)2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31129641

RESUMO

Percutaneous nephrostomy (PCN) catheter placement is a commonly performed procedure in the urological practice for various indications like percutaneous nephrolithotomy, pyonephrosis, infected hydronephrosis and after failed attempt of ureteric stenting. The nephrostomy catheter is usually associated with low complication and morbidity rate, but prolonged indwelling nephrostomy tube may be hazardous in some cases. We hereby report a case of squamous cell carcinoma of skin around the PCN, which was attributed to chronic inflammation and persistent irritation from a long-term neglected indwelling nephrostomy catheter for last 3 years. The patient was managed with wide local excision of skin carcinoma and ureterocalicostomy for pelviureteric junction stricture. The authors report the first documented case with aforementioned presentation.


Assuntos
Carcinoma de Células Escamosas/etiologia , Cateteres de Demora/efeitos adversos , Neoplasias Cutâneas/etiologia , Adulto , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Nefrostomia Percutânea/efeitos adversos , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologia
18.
Int J Surg ; 66: 62-71, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31034987

RESUMO

OBJECTIVE: To compare the safety and efficacy of percutaneous nephrolithotripsy (PCNL) in supine versus prone position for patients with renal or upper ureteral calculi. METHODS: A systematic search of Pubmed, Embase and Cochrane Central Register of Controlled Trials was performed to identify all eligible studies. All included randomized controlled trials (RCTs) were evaluated based on the inclusion and exclusion criteria. After quality assessment and date extraction, a meta-analysis was performed using RevMan 5.3 software. RESULTS: A total of 15 RCTs with 1474 patients were included in our meta-analysis. Pooled data showed that PCNL in supine position could significantly reduce the operative time [weighted mean difference (WMD) -12.02, 95% confidence interval (CI) -20.49 to -3.54, p = 0.005] and rate of fever [risk ratio (RR) 0.67, 95% CI 0.46 to 0.97, p = 0.03] compared to prone position. In addition, no significant differences could be found between groups in stone-free rate (p = 0.31), hospital stay (p = 0.59) and rate of overall complications (p = 0.11), mainly including urinary leakage (p = 0.83), pleural effusion (p = 0.74) and blood transfusion (p = 0.58). CONCLUSIONS: The current study found comparable stone-free rate and significant lower rate of postoperative fever in supine PCNL compared with prone PCNL. PCNL in supine position could be a safe and efficient choice for patients with renal or upper ureteral calculi.


Assuntos
Cálculos Renais/cirurgia , Nefrostomia Percutânea/métodos , Posicionamento do Paciente/métodos , Cálculos Ureterais/cirurgia , Adulto , Febre/etiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Nefrostomia Percutânea/efeitos adversos , Razão de Chances , Duração da Cirurgia , Complicações Pós-Operatórias , Decúbito Ventral , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Decúbito Dorsal , Resultado do Tratamento
20.
Urol Int ; 102(3): 356-359, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30917375

RESUMO

OBJECTIVES: To evaluate the safety and efficacy of percutaneous mini-nephrolithotomy (mini-PCNL) in children with complex staghorn stones. PATIENTS AND METHODS: We analyzed prospectively data of 28 children undergoing pediatric mini-PCNL during a period of 18 months. Stone complexity was defined according to the validated Guy's stone score (GSS). Our patients were GSS III and IV. All PCNL procedures were performed in the prone position, under fluoroscopic guidance, and in the same standardized fashion with F12 and F17 mini-nephroscopes. RESULTS: Eleven children were boys (total n = 28). Mean age was 7.25 ± 3.27 (2-14) years. Mean stone burden was 36.89 ± 8.002 (30-60) mm. GSS was in 57% grade III and in 43% grade IV. The initial stone-free rate was 78%, which increased to 89% after few ancillary procedures. Seventeen percent of children had major complications (1 hydrothorax, 4 blood transfusions). On statistical analysis, stone clearance rates were found inversely dependent on stone complexity (GSS; p < 0.025). Stone burden, number of tracts, and procedure time were associated with stone complexity (p < 0.000). In turn, stone complexity (p < 0.015) and the number of tracts (p < 0.049) were significantly associated with complications. CONCLUSION: Mini-PCNL is effective and safe for treating complex renal stones in pediatric patients. Complication rates are acceptable and predictably stable on comparison with the literature.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea , Cálculos Coraliformes/cirurgia , Adolescente , Transfusão de Sangue , Criança , Pré-Escolar , Feminino , Fluoroscopia/métodos , Humanos , Rim , Masculino , Nefrostomia Percutânea , Posicionamento do Paciente , Complicações Pós-Operatórias , Decúbito Ventral
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