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Ureteroscopy-Assisted Retrograde Nephrostomy (UARN) after Anatrophic Nephrolithotomy
Takashi Kawahara,Hiroki Ito,Hideyuki Terao,Yoshitake Kato,Takehiko Ogawa,Hiroji Uemura,Yoshinobu Kubota,Junichi Matsuzaki
Case Reports in Medicine , 2012, DOI: 10.1155/2012/164963
Abstract: Introduction. Open surgical anatrophic nephrolithotomy (ANL) had been the standard treatment for large renal calculi prior to the development of endoscopic devices and endoscopic techniques. A previous report described the efficacy of ureteroscopy-assisted retrograde nephrostomy (UARN) and presented a case of renal calculi successfully treated with UARN during percutaneous nephrolithotomy (PCNL) in a patient after ANL. Case Presentation. A 61-year-old male with left renal calculi was referred for further treatment. The patient was placed under general and epidural anesthesia, in a Galdakao-modified Valdivia position. A flexible ureteroscope (URS) was inserted, and a Lawson retrograde nephrostomy puncture wire was advanced into the flexible URS. The puncture wire then followed the route from the renal pelvis to the exit skin. Calculus fragmentation was undertaken using a pneumatic lithotripter. Conclusions. UARN for PCNL was therefore found to be a safe, effective, and appropriate treatment for a patient presenting with renal calculi after undergoing ANL.
Percutaneous Nephrolithotomy of Kidney Calculi in Horseshoe Kidney  [cached]
Mohammad Reza Darabi Mahboub,Ali Ahanian,Maryam Zolfaghari
Urology Journal , 2007,
Abstract: Introduction: The aim of this study was to evaluate percutaneous nephrolithotomy (PCNL) in horseshoe kidneys with calculi. Materials and Methods: Between 1995 and 2005, we performed PCNL in 9 patients with horseshoe kidney. In 3 of them, there was a single calculus and the rest had multiple calculi in the pelvis and at least 1 in the calyxes. Ultrasonography, plain abdominal radiography, and intravenous urography (IVU) were performed in all patients. We used fluoroscopy for entering the system and then, pneumatic or ultrasonic lithotripsy was used. Results: In all except 1 patient (88.9%) we could access the system. Single calculi in 3 patients were removed. In 5 patients with multiple calculi, the calculus causing obstruction was removed, and in 3, the calculi located in the calyxes were removed too. Consequently, 66.7% were stone-free at the end of the procedure. In 2 patients, there were residual calculi in the calyxes and they underwent candidates for extracorporeal shockwave lithotripsy. Conclusion: Percutaneous nephrolithotomy can be used in patients with horseshoe kidney if the patient selection is appropriate and the surgeon is experienced enough. The success rate and complications are the same as the patients with normal anatomy. However, access to the lower calyx is more difficult due to its anatomic status.
Percutaneous nephrolithotomy in horseshoe Kidneys: is rigid nephroscopy sufficient tool for complete clearance? a case series study
Mohamed N El Ghoneimy, Ahmed S Kodera, Ashraf M Emran, Tamer Z Orban, Ahmed M Shaban, Mohamed M El Gammal
BMC Urology , 2009, DOI: 10.1186/1471-2490-9-17
Abstract: Between 2005 and 2009, we carried out PCNL (percutaneous nephrolithotomy) for calculi in horseshoe kidneys in 21 renal units (17 patients) in our department. The indications were large stone burden in 18 units and failed SWL(shock wave lithotripsy) in 3 renal units. All procedures were done under general anesthesia; using fluoroscopic guidance for localization and standard alkan dilatation followed by rigid nephroscopy and stone extraction with or without stone disintegration. We analyzed our results regarding the site and number of the required access, the intra and postoperative complications, the presence of any residual stones, as well as their location.The procedure was completed, using a single access tract in 20 renal units, with the site of puncture being the upper calyx in nine units and the posterior middle calyx in eleven units. Only in one renal unit, two access tracts (an upper and a lower calyceal) were required for completion and a supracostal puncture was required in another case. There was no significant intraoperative bleeding and no blood transfusion was required in any patient. A pelvic perforation occurred in one case, requiring longer PCN (percutaneous nephrostomy) drainage. One patient with infection stones suffered urosepsis postoperatively which was successfully managed. Three cases had residual stones, all located in the renal isthmus, all residuals were un approachable with the rigid instrument; resulting in a overall stone-free rate of 85.7% at discharge.Percutaneous nephrolithotomy is generally safe and successful in the management of stones in horseshoe kidneys. However, location of the stones in these patients is crucial to decide the proper tool for optimal stone clearance result.Horseshoe kidney occurs in about 1 in 400 persons [1]. As with other fusion anomalies, it is found more commonly in males. During embryogenesis, fusion of the lower poles prevents normal ascent and causes malrotation with anterior displacement of the collecti
Percutaneous Management of Urinary Calculi in Horseshoe Kidneys  [cached]
Heshmatollah Soufi Majidpour,Vahid Yousefinejad
Urology Journal , 2008,
Abstract: Urolithiasis in horseshoe kidney presents a unique challenge in decision-making and technical aspects of calculus treatment. We present our experience with a group of patients with symptomatic calculi in their horseshoe kidneys. We had 8 patients with 9 horseshoe kidneys bearing calculi. They all underwent percutaneous nephrolithotomy. The median size of the calculi was 21 mm (range, 12 to 45 mm). Auxiliary therapeutic procedures were required in 2 patients who had residual calculi on control imaging. The stone-free status was observed in 6 patients (75.0%) at discharge, and in 7 (87.5%) after 3 months of follow-up. Surgical complications included bleeding in 2 patients that was controlled with complete bed rest and blood transfusion, and pleural injury in 1 which was managed conservatively.
Effectiveness of Ureteroscopy-Assisted Retrograde Nephrostomy (UARN) for Percutaneous Nephrolithotomy (PCNL)  [PDF]
Takashi Kawahara, Hiroki Ito, Hideyuki Terao, Yoshitake Kato, Hiroji Uemura, Yoshinobu Kubota, Junichi Matsuzaki
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0052149
Abstract: Objective To determine the impact of ureteroscopy-assisted retrograde nephrostomy (UARN) during percutaneous nephrolithotomy (PCNL). Materials and Methods From April 2009 to September 2011, a total of 50 patients underwent PCNL for large renal stones (stone burden >2 cm). We performed UARN in the Galdakao-modified Valdivia position for 27 patients (UARN PCNL) and ultrasonography-assisted percutaneous nephrostomy in the prone position for 23 patients (prone PCNL). Results UARN PCNL significantly improved the stone-free rate (81.5% vs 52.2%) and the rate of residual stones (<4 mm, 92.6% vs 65.2%, P<0.05). The median length of the operation was significantly shorter for UARN PCNL, at 160 min, compared to 299 min for prone PCNL (P<0.001). There was one intraoperative complication in prone PCNL, namely a hemorrhage that resulted in stopping the initial treatment, but it was cured conservatively. The postoperative complications included a high grade fever that persisted for three days in two UARN PCNL patients (7.4%) and six prone PCNL patients (26.1%). The Clavien grading scores showed significantly lower postoperative complications for UARN PCNL compared to prone PCNL. Conclusion UARN is associated with a higher stone-free rate, shorter operation time, and fewer complications during PCNL than prone PCNL.
M.G. Andankar, P.N. Maheshwari, H.N. Shah, N.N. Trivedi, V.B. Kausik, R. Jain
African Journal of Urology , 2003,
Abstract: Objectives: To determine the feasibility, safety and success rate of bilateral single session rigid retrograde ureteroscopy (URS) for bilateral ureteral calculi. Patients and Methods: Thirty-five patients underwent bilateral single session ureteroscopic calculus removal. Results: Out of 70 renal units in 35 patients treated, clearance of the calculus was successful in the first session of ureteroscopy in 63 (90%). A total of 28 patients (80%) were completely rendered stone-free bilaterally in one operative session. Two patients needed a second session of URS, while five required ESWL for residual or migrated stone fragments. No major procedure-related complications were encountered in any of our patients. Conclusion: Bilateral single-session rigid URS for ureteral calculi is feasible, safe and effective. There is no significant increase in ureteroscopy-related complications. It spares the patients a second anaesthesia and a second procedure and, thus, reduces the total hospital stay, total expenditure and enables the patient to resume work earlier. L'Ureteroscopie Bilatérale en un Seul Temps pour Calcul Urétéral: Est-Elle S re et Efficace ? Objectifs: De déterminer la praticabilité, taux de s reté et de succès de l'ureteroscopie rétrograde rigide (URS) bilatérale en une session pour calculs urétéraux bilatéraux. Patients et méthodes: Trente-cinq patients ont subi une ureteroscopie bilatérale pour calculs de l'uretère en une simple session. Résultats: Sur 70 unités rénales chez 35 patients traités, le traitement du calcul était réussi en la première session d'ureteroscopie dans 63 cas (90%). Un total de 28 patients (80%) ont été complètement débarrassés de leurs calculs (stone-free) bilatéralement en une session effective. Deux patients ont eu besoin d'une deuxième session d'URS, alors que cinq exigeaient ESWL pour les fragments lithiasiques résiduels ou émigrés. Aucune complication n'a été notée chez aucun de nos patients. Conclusion: L'URS rigide bilatérale en simple-session pour calculs de l'uretère est faisable, s re et efficace. Il n'y a aucune augmentation significative des complications. Il épargne les patients d'une deuxième anesthésie et une deuxième URS et réduit, ainsi, le séjour à l'h pital, les dépenses de santé et permet au patient de reprendre le travail plus t t. African Journal of Urology Vol.9(3) 2003: 129-132
Symptomatic small non-obstructing lower ureteric calculi: comparison of ureteroscopy and extra corporeal shock wave lithotripsy.  [cached]
Andankar M,Maheshwari P,Saple A,Mehta V
Journal of Postgraduate Medicine , 2001,
Abstract: OBJECTIVE: To compare the success, efficacy and complications of ureteroscopy (URS) and extra corporeal shock wave lithotripsy (ESWL) for the treatment of symptomatic small non obstructing lower ureteric calculi. SUBJECTS AND METHODS: This prospective non-randomised study was conducted simultaneously at two urological referral centres, included 280 patients with symptomatic small (4-10 mm) lower ureteric calculi (situated below the sacroiliac joint), with good renal function on intravenous urography. Patients were offered both the treatment options. One hundred and sixty patients chose ureteroscopy, whereas 120 patients were treated by ESWL. Standard techniques of ureteroscopy and ESWL were employed. Patients were followed-up to assess the success rates and complications of the two procedures. RESULTS: Ureteroscopy achieved complete stone clearance in one session in 95% of patients. In six patients ureteroscopy had failed initially and was later accomplished in second session improving the success rate to 98.7%. Two patients had a proximal migration of calculus that needed ESWL. Of the 120 patients treated by ESWL, 90% achieved stone free status at three months. Ureteroscopy was needed for twelve patients (10%) where ESWL failed to achieve stone clearance. There were no significant ESWL related complications. ESWL was administered on outpatient basis, while patients needed hospitalisation and anaesthesia for ureteroscopy. CONCLUSION: ESWL can be the primary mode of treatment for symptomatic small non-obstructing lower ureteric calculi as it is minimally invasive and safe. Ureteroscopy can be offered to patients who demand immediate relief or when ESWL fails.
Treatment of ureteral calculi by ureteroscopy: experience of 100 cases at the Faculdade de Medicina do ABC (FMABC – Medical School)  [PDF]
Antonio Corrêa Lopes Neto,Marcello Machado Gava,Mário Henrique Elias de Mattos,Milton Borrelli
Einstein (S?o Paulo) , 2004,
Abstract: Objective: To report the experience of treating ureteral calculi byureteroscopy at the Faculdade de Medicina do ABC – SP, with anemphasis on the efficacy and safety of the method. Methods: Aretrospective analysis of 100 ureteroscopies performed fromJanuary 2001 to August 2003 in 98 patients with ureteral calculi.Results: A 91% success rate was observed with a single procedureusing this technique. Intracorporeal lithotripsy was necessary in61% of cases before removing the stone; in the remaining cases, itwas extracted with no disintegration. Endoscopic approach wasimpossible in only one patient who required conversion toconventional open surgery. The double-J stent was inserted in73.7% of procedures. Complications were observed in 8% of cases.Conclusion: The present study demonstrated results comparablewith those reported in large series in the literature. The high successrates, low morbidity, rapid convalescence and lack of estheticconsequences corroborate the role of ureteroscopy as an attractivealternative for treating ureteral calculi.
Extracorporeal shockwave lithotripsy versus ureteroscopy for distal ureteric calculi: efficacy and patient satisfaction
Ghalayini, Ibrahim F.;Al-Ghazo, Mohammed A.;Khader, Yousef S.;
International braz j urol , 2006, DOI: 10.1590/S1677-55382006000600006
Abstract: objective: we compared the efficacy of extracorporeal shock wave lithotripsy (eswl) and ureteroscopy (urs) for the treatment of distal ureteral calculi with respect to patient satisfaction. materials and mhetods: this is a prospective study where a total of 212 patients with solitary, radiopaque distal ureteral calculi were treated with eswl (n = 92) using dornier lithotriptor s (medtech europe gmbh) or urs (n = 120). patient and stone characteristics, treatment parameters, clinical outcomes, and patient satisfaction were assessed for each group. results: the 2 groups were comparable in regard to patient age, sex, stone size, and side of treatment. the stone-free status for eswl and urs at 3 months was 81.5% and 97.5%, respectively (p < 0.0001). in addition, 88% of patients who underwent eswl versus 20% who underwent urs were discharged home the day of procedure. minor complications occurred in 3.3% and 8.3% of the eswl and urs groups, respectively (p = 0.127). no ureteral perforation or stricture occurred in the urs group. postoperative flank pain and dysuria were more severe in the urs than eswl group, although the differences were not statistically significant (p = 0.16). patient satisfaction was high for both groups, including 94% for urs and 80% for eswl (p = 0.002). conclusions: urs is more effective than eswl for the treatment of distal ureteral calculi. eswl was more often performed on an outpatient basis, and showed a trend towards less flank pain and dysuria, fewer complications and quicker convalescence. patient satisfaction was significantly higher for urs according to the questionnaire used in this study.
Retrograde Flexible Ureteroscopic Approach for Pyelocaliceal Calculi  [cached]
Petrisor Geavlete,Seyed Abdulah Seyed Aghamiri,Razvan Multescu
Urology Journal , 2006,
Abstract: Introduction: Our goal was to investigate the efficacy of flexible ureteroscopy (FU) in the treatment of pyelocaliceal calculi. Materials and Methods: Between September 2002 and December 2004, a total of 41 patients with multiple (23 cases), pelvic (7 cases), and inferior caliceal (11 cases) SWL-resistant calculi underwent FU. We used a 7.5-F flexible ureteroscope with pressure irrigation and electro-hydraulic lithotripsy. The fragments were retrieved with triradiate graspers or tipless baskets. Results: A double J stent had been previously placed in 34% of the patients. Dilation of the ureteral orifice was necessary in 9.8%. The location of the calculi was renal pelvis, inferior calyx, and pelvis and calyxes in 7, 11, and 23 patients, respectively. The median operative time was 64 minutes for pyelocaliceal, 46 minutes for pelvic, and 39 minutes for inferior caliceal calculi. Complete stone clearance or good fragmentation (fragments less than 3 mm) was obtained in 71% of patients (57% for pyelocaliceal, 87% for pelvic, and 71% for inferior caliceal calculi). A successful outcome was achieved in 78%, 72%, and 49% for calculi sized 10 mm or smaller, 11 mm to 20 mm, and greater than 20 mm, respectively. Two or more procedures were required in 11 patients (27%). The complication rate was 7.3% (hematuria, persistent renal colic, and hyperthermia). Conclusion: Our experience shows that FU can be an effective approach in selected patients, especially those with kidney calculi that are resistant to SWL. However, percutaneous approach is a better alternative for calculi greater than 20 mm.
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