Comparison of the effect of miniaturized and standard percutaneous nephrolithotomy on renal function assessed with DMSA scintigraphy.

INTRODUCTION AND OBJECTIVES: We aimed to present a clinical study that compares standard and miniaturized percutaneous nephrolithotomy (PNL) effects on kidney function with scintigraphic imaging in primary kidney stone patients. MATERIALS AND METHODS: One hundred four patients were included in this prospective study between May 2014 and February 2017. Eligible patients were divided into two groups miniaturized PNL (mPNL) and standard PNL (sPNL) with matched-pair analysis (1:1 scenario). Technetium-99m Dimercaptosuccinic Acid cortical scintigraphy imaging was performed before and after the operation. RESULTS: There were no differences between the two groups in terms of success rate (mPNL (63.5%) vs. sPNL (71.2%), p=0.403), serum creatinine, glomerular filtration rate, split renal functions pre- and postoperatively (p≥0.05). There was no relationship between the type of operation and new scar formation (p=0.780). The rates of serious complication (grades 3 and 4 according to modified Clavien-Dindo Classification) were higher in sPNL (p=0.034). Stone burden, duration of operation, hemoglobin drop, multiple access, blood transfusion, and angioembolization were higher in patients with scarred kidneys (p<0.001, p=0.008, p=0.004, p<0.001, p=0.003, p=0.001, respectively). In multivariate analysis, only multiple access was found statistically significant for predicting new scar formation (p<0.001, OR: 24.28). CONCLUSIONS: Miniaturized and standard PNL are reliable and successful operations for treating large kidney stones. No significant difference was found between the operation types regarding a decrease in renal function.

Effect of JJ stent on outcomes of extracorporeal shock wave lithotripsy treatment of moderate sized renal pelvic stones: A randomized prospective study. / Resultados de LEOCH con o sin catéter para el tratamiento de cálculos en la pelvis renal: un estudio aleatorizado.

PURPOSE: To evaluate the effect of JJ stents on SWL treatment of moderate (15-25mm) renal pelvic stones. MATERIALS AND METHODS: Between January 2016 and December 2017, a total of 152 adult patients who were planned to undergo SWL for a single radiopaque renal pelvic stone were included in the study. Patients with solitary kidney, congenital abnormality, skeletal tract abnormalities, previous urinary system surgery, hydronephrosis (grade 2 or more), untreated urinary tract infection, bleeding disorder, and suspected pregnancy were excluded. The remaining 114 patients were randomly divided into two groups; non-stented and stented. Twenty-two patients whose stone could not be fragmented despite 3 consecutive sessions were also excluded from the study. A total of 92 patients (54 non-stented and 38 stented) were included in the final analysis. RESULTS: There was no significant difference in terms of age, sex, body mass index, renal parancyhimal thickness, hydronephrosis, skin-to-stone distance, Hounsfield units, and stone size between the groups. Success was significantly higher in the stented group than in the non-stented group (71% vs. 39%, P=.002). In stone-free patients, the number of emergency department visits and analgesic tablet consumption was significantly lower in the stented group than in the non-stented group (P<.001 and P<.001, respectively). In non- stone-free patients, analgesic tablet consumption was significantly lower in the stented group than in the non-stented group (P=.004). CONCLUSIONS: Pre-stenting before SWL treatment of moderate sized renal pelvic stones has some advantages in terms of success, emergency service visits, and analgesic tablet consumption.

Comparación entre el efecto de la nefrolitotomía percutánea miniaturizada vs. convencional en la función renal evaluada mediante gammagrafía renal con DMSA / Comparison of the effect of miniaturized and standard percutaneous nephrolithotomy on renal function assessed with DMSA scintigraphy

Introducción y objetivos Nos propusimos realizar un estudio clínico para comparar los efectos de la nefrolitotomía percutánea (NLP) convencional y miniaturizada sobre la función renal evaluada mediante imágenes de gammagrafía en pacientes con cálculos renales primarios. Materiales y métodos Se incluyeron 104 pacientes en este estudio prospectivo entre mayo de 2014 y febrero de 2017. Los pacientes elegibles se dividieron en dos grupos: NLP miniaturizada (NLPm) y NLP convencional (NLPc) mediante muestras emparejadas (escenario 1:1). Se realizó una gammagrafía cortical con ácido dimercaptosuccínico de tecnecio-99m antes y después de la intervención. Resultados No hubo diferencias entre los dos grupos en cuanto a las tasas de éxito (NLPm [63,5%] frente a NLPc [71,2%], p=0,403), creatinina sérica, tasa de filtración glomerular, funciones renales diferenciales evaluadas antes y después de la intervención (p≥0,05). No hubo relación entre el tipo de procedimiento y la formación de nuevo tejido cicatricial (p=0,780). Las tasas de complicaciones graves (grados 3 y 4 según la clasificación de Clavien-Dindo modificada) fueron más altas en la NLPc (p=0,034). La carga litiásica, el tiempo quirúrgico, el descenso de la hemoglobina, los accesos múltiples, la transfusión de sangre y la angioembolización fueron mayores en los pacientes con riñones cicatrizados (p<0,001, p=0,008, p=0,004, p<0,001, p=0,003, p=0,001, respectivamente). En el análisis multivariante, sólo el acceso múltiple resultó estadísticamente significativo para predecir la formación de tejido cicatricial nuevo (p<0,001, OR: 24,28). Conclusiones La NLP miniaturizada y la convencional son intervenciones fiables y efectivas para el tratamiento de cálculos renales de gran tamaño. No se encontraron diferencias significativas entre los dos procedimientos en cuanto a la disminución de la función renal (AU)

Introduction and Objectives We aimed to present a clinical study that compares standard and miniaturized percutaneous nephrolithotomy (PNL) effects on kidney function with scintigraphic imaging in primary kidney stone patients. Materials and Methods One hundred four patients were included in this prospective study between May 2014 and February 2017. Eligible patients were divided into two groups miniaturized PNL (mPNL) and standard PNL (sPNL) with matched-pair analysis (1:1 scenario). Technetium-99m Dimercaptosuccinic Acid cortical scintigraphy imaging was performed before and after the operation. Results There were no differences between the two groups in terms of success rate (mPNL(63.5%) vs. sPNL(71.2%), p=0.403), serum creatinine, glomerular filtration rate, split renal functions pre- and postoperatively (p≥0.05). There was no relationship between the type of operation and new scar formation (p=0.780). The rates of serious complication (grades 3 and 4 according to modified Clavien-Dindo Classification) were higher in sPNL (p=0.034). Stone burden, duration of operation, hemoglobin drop, multiple access, blood transfusion, and angioembolization were higher in patients with scarred kidneys (p<0.001, p=0.008, p=0.004, p<0.001, p=0.003, p=0.001, respectively). In multivariate analysis, only multiple access was found statistically significant for predicting new scar formation (p<0.001, OR:24.28). Conclusions Miniaturized and standard PNL are reliable and successful operations for treating large kidney stones. No significant difference was found between the operation types regarding a decrease in renal function (AU)

Resultados de LEOCH con o sin catéter para el tratamiento de cálculos en la pelvis renal: un estudio aleatorizado / Effect of JJ stent on outcomes of extracorporeal shock wave lithotripsy treatment of moderate sized renal pelvic stones: A randomized prospective study

Objetivo: Evaluar el efecto de la colocación del catéter doble J en el tratamiento con LEOCH de los cálculos en la pelvis renal de tamaño moderado (15-25 mm). Materiales y métodos: Entre enero de 2016 y diciembre de 2017, se incluyó en el estudio a un total de 152 pacientes adultos que serían tratados con LEOCH por un solo cálculo radiopaco localizado en la pelvis renal. Se excluyeron los pacientes con riñón solitario, anomalía congénita, anomalía del sistema esquelético, cirugía previa del tracto urinario, hidronefrosis (grado 2 o superior), infección del tracto urinario sin tratar, trastorno hemorrágico y sospecha de embarazo. Los 114 pacientes restantes se dividieron aleatoriamente en 2 grupos: cateterizados y no cateterizados. Veintidós pacientes cuyo cálculo no pudo fragmentarse después de 3 sesiones consecutivas también fueron excluidos del estudio. Un total de 92 pacientes (54 no cateterizados y 38 cateterizados) se incluyeron en el análisis final. Resultados: No hubo diferencias significativas entre los grupos respecto a edad, sexo, índice de masa corporal, grosor parenquimal renal, hidronefrosis, distancia piel-cálculo, unidades Hounsfield y tamaño del cálculo. El éxito fue significativamente mayor en el grupo cateterizado que en el grupo no cateterizado (71 vs. 39%; p = 0,002). En pacientes libres de cálculos, el número de visitas al servicio de urgencias y el consumo de analgésicos fue significativamente menor en el grupo cateterizados que en el grupo no cateterizados (p < 0,001 y p < 0,001, respectivamente). En pacientes no libres de cálculos, el consumo de analgésicos fue significativamente menor en el grupo cateterizados que en el grupo no cateterizados (p = 0,004). Conclusiones: La colocación de catéter antes del tratamiento con LEOCH para cálculos en la pelvis renal de tamaño moderado tiene algunas ventajas en términos de éxito, visitas al servicio de urgencias y consumo de analgésicos

Purpose: To evaluate the effect of JJ stents on SWL treatment of moderate (15-25mm) renal pelvic stones. Materials and methods: Between January 2016 and December 2017, a total of 152 adult patients who were planned to undergo SWL for a single radiopaque renal pelvic stone were included in the study. Patients with solitary kidney, congenital abnormality, skeletal tract abnormalities, previous urinary system surgery, hydronephrosis (grade 2 or more), untreated urinary tract infection, bleeding disorder, and suspected pregnancy were excluded. The remaining 114 patients were randomly divided into two groups; non-stented and stented. Twenty-two patients whose stone could not be fragmented despite 3 consecutive sessions were also excluded from the study. A total of 92 patients (54 non-stented and 38 stented) were included in the final analysis. Results: There was no significant difference in terms of age, sex, body mass index, renal parancyhimal thickness, hydronephrosis, skin-to-stone distance, Hounsfield units, and stone size between the groups. Success was significantly higher in the stented group than in the non-stented group (71% vs. 39%, P = .002). In stone-free patients, the number of emergency department visits and analgesic tablet consumption was significantly lower in the stented group than in the non-stented group (P < .001 and P < .001, respectively). In non- stone-free patients, analgesic tablet consumption was significantly lower in the stented group than in the non-stented group (P = .004). Conclusions: Pre-stenting before SWL treatment of moderate sized renal pelvic stones has some advantages in terms of success, emergency service visits, and analgesic tablet consumption