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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.
Ureteroscopy-assisted retrograde nephrostomy for lower calyx calculi in horseshoe kidney: two case reports
Takashi Kawahara, Hiroki Ito, Hideyuki Terao, Katsuyuki Tanaka, Takehiko Ogawa, Hiroji Uemura, Yoshinobu Kubota, Junichi Matsuzaki
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-194
Abstract: Case 1 was a 68-year-old man who was shown on radiography to have left lower calyx calculi (19?×?15mm, 7?×?5mm, and 7?×?3mm) in horseshoe kidney. Case 2 was a 36-year-old woman shown on radiography to have a left lower calyx calculus (10?×?8mm) in horseshoe kidney.Both patients were stone-free after ureteroscopy-assisted retrograde nephrostomy during percutaneous nephrolithotomy. Ureteroscopy-assisted retrograde nephrostomy is a promising procedure for safely and effectively treating lower calyx stones in horseshoe kidney.
Outcomes of Percutaneous Nephrolithotomy with or without Nephrostomy Tube: A Comparative Study  [PDF]
Mohammad Ibrahim Ali, Prodyut Kumar Saha, Shafiqul Alam Chowdhury, Nahid Kamal, Mostafiger Rahman, Sazzad Hossain, Ripan Debnath, Mohammad Saruar Alam, A. K. M. Shahidur Rahman, Kamrul Islam
Journal of Biosciences and Medicines (JBM) , 2019, DOI: 10.4236/jbm.2019.73006
Abstract: Objectives: To compare the outcomes of Percutaneous Nephrolithotomy (PCNL) with or without nephrostomy tube. Materials & Methods: This prospective comparative study intended to compare the outcomes between PCNL without nephrostomy tube and PCNL with nephrostomy tube. A total of 50 cases of renal stone disease planned for PCNL in Dhaka Medical College Hospital from July 2015 to June 2017, were included in this study according to the statistical calculation. Cases were randomly allocated to group A (PCNL without nephrostomy tube) and group B (PCNL with nephrostomy tube). Each group consisted of 25 patients. The outcome variables were post operative pain, requirement of analgesic, leakage of urine and post operative hospital stay. Data were analyzed and compared by statistical tests. Results: No significant differences were found regarding age (p = 0.95), sex (p = 0.55) and operation time (p = 0.36) between two groups. Post operative pain (p < 0.0007) and analgesic requirement (p < 0.0001) were less in group A than group B cases. Leakage of urine is higher in group B in comparison to group A (p < 0.0001). Post operative hospital stay is shorter in group A than group B cases which is statistically significant (p < 0.0001). Conclusions: Percutaneous nephrolithotomy without nephrostomy tube is better than percutaneous nephrolithotomy with nephrostomy tube in selective cases. It significantly reduces post operativepain, analgesic requirement and postoperative hospital stay. So percutaneous nephrolithotomy without nephrostomy tube is safe and effective.
Indication to Open Anatrophic Nephrolithotomy in the Twenty-First Century: A Case Report  [PDF]
Alfredo Maria Bove,Emanuela Altobelli,Maurizio Buscarini
Case Reports in Urology , 2012, DOI: 10.1155/2012/851020
Abstract: Introduction. Advances in endourology have greatly reduced indications to open surgery in the treatment of staghorn kidney stones. Nevertheless in our experience, open surgery still represents the treatment of choice in rare cases. Case Report. A 71-year-old morbidly obese female patient complaining about occasional left flank pain, and recurrent cystitis for many years, presented bilateral staghorn kidney stones. Comorbidities were obesity (BMI 36.2), hypertension, type II diabetes, and chronic obstructive pulmunary disease (COPD) hyperlipidemia. Due to these comorbidities, endoscopic and laparoscopic approaches were not indicated. We offered the patient staged open anatrophic nephrolithotomy. Results. Operative time was 180 minutes. Blood loss was 500?cc. requiring one unit of packed red blood cells. Hospital stay was 7 days. The renal function was unaffected based on preoperative and postoperative serum creatinine levels. Stone-free status of the left kidney was confirmed after surgery with CT scan. Conclusions. Open surgery can represent a valid alterative in the treatment of staghorn kidney stones of very selected cases. A discussion of the current indications in the twenty-first century is presented. 1. Introduction Surgical management of nephrolithiasis has changed dramatically in the last few decades. While previously, the majority of patients required an open surgical approach, today less invasive procedures, such as extracorporeal shock waves lithotripsy (ESWL), ureterorenoscopy (URS), and percutaneous nephrolithotripsy (PNL), have promoted a rapid decrease of the use of open surgery for both ureteral and renal stones [1, 2]. The subsequent introduction of laparoscopic approach has almost eliminated the need for open operations in the treatment of renal and ureteral stones. Laparoscopy is needed in complex staghorn stones that would necessitate multiple, simultaneous or subsequent, percutaneous renal accesses [3–10]. Even if anatrophic nephrolithotomy is currently performed laparoscopically, in patients affected by severe cardiac or pulmonary diseases or with a previous laparotomy, laparoscopic approach may not be indicated. In the era of mininvasive treatments, laparotomy is rarely required, but it is important to recognize patients in whom open anatrophic nephrolithotomy could represent a valid choice of treatment [11]. This paper presents one of such patients as well as a discussion of the modern indications for this technique. 2. Case Report A 71-year-old female patient with a BMI of 36,2 was referred from General Medicine Department with
Indication to Open Anatrophic Nephrolithotomy in the Twenty-First Century: A Case Report
Alfredo Maria Bove,Emanuela Altobelli,Maurizio Buscarini
Case Reports in Urology , 2012, DOI: 10.1155/2012/851020
Abstract: Introduction. Advances in endourology have greatly reduced indications to open surgery in the treatment of staghorn kidney stones. Nevertheless in our experience, open surgery still represents the treatment of choice in rare cases. Case Report. A 71-year-old morbidly obese female patient complaining about occasional left flank pain, and recurrent cystitis for many years, presented bilateral staghorn kidney stones. Comorbidities were obesity (BMI 36.2), hypertension, type II diabetes, and chronic obstructive pulmunary disease (COPD) hyperlipidemia. Due to these comorbidities, endoscopic and laparoscopic approaches were not indicated. We offered the patient staged open anatrophic nephrolithotomy. Results. Operative time was 180 minutes. Blood loss was 500 cc. requiring one unit of packed red blood cells. Hospital stay was 7 days. The renal function was unaffected based on preoperative and postoperative serum creatinine levels. Stone-free status of the left kidney was confirmed after surgery with CT scan. Conclusions. Open surgery can represent a valid alterative in the treatment of staghorn kidney stones of very selected cases. A discussion of the current indications in the twenty-first century is presented.
Flexible ureteroscopy versus percutaneous nephrolithotomy as primary treatment for renal stones 2 cm or greater  [cached]
Akar EC,Knudsen BE
Reports in Medical Imaging , 2013,
Abstract: Erin Akar, Bodo E KnudsenDepartment of Urology, Ohio State University Wexner Medical Center, Columbus, OH, USAAbstract: The purpose of this review, based on the current evidence in the literature, is whether ureteroscopy (URS) is a comparable primary treatment option to the current gold standard of percutaneous nephrolithotomy (PCNL) for the treatment of large kidney stones 2 cm or greater. The lack of prospective randomized trials directly comparing URS and PCNL makes comparison challenging. The numerous studies are not standardized in terms of their definition of stone-free or how stone size is reported. In order to standardize comparison of results, we used a stone-free definition of <4 mm after one procedure per imaging of the author’s choice, since how each patient was imaged postoperatively was not reported. The results from the literature show that moderately large stones from 2 to 3 cm treated ureteroscopically have similar outcomes to PCNL. Stone-free rates with URS decrease when stone size is above 3 cm. Our interpretation of the literature suggests that a current limitation of URS is that multiple procedures for URS would be required to achieve comparable stone-free rates to PCNL, particularly for stones greater than 4 cm.Keywords: ureteroscopy, percutaneous nephrolithotomy, lithotripsy, urinary calculi
Does Bleeding During Percutaneous Nephrolithotomy Necessitate keeping the Nephrostomy Tube?A Randomized Controlled Clinical Trial
Masoud Etemadian,Mohammad Javad Soleimani,Ramin Haghighi,Mohammad Reza Zeighami
Urology Journal , 2011,
Abstract: PURPOSE: To compare outcomes in two groups of patients with kept and discarded nephrostomy tube after percutaneous nephrolithotomy (PCNL) complicated with bleeding. MATERIALS AND METHODS: Two hundred patients who had undergone PCNL complicated with hemorrhage were recruited in this study. Patients were randomly allocated to two groups: group A, who underwent tubeless PCNL and tract port was packed for 3 to 4 minutes after removing Amplatz sheath, and group B, for whom a 24-F nephrostomy tube was left in place at the end of the procedure. Patients were followed up for 3 months to check if bleeding occurred. RESULTS: The mean operation time was 68 ± 4.3 minutes in group A and 74 ± 5.6 minutes in group B (P = .098). The mean stone size was similar in groups A and B (36.26 ± 5.3 mm versus 35.35 ± 5.85 mm; P = .613). The mean hemoglobin drop was 3.65 ± 1.20 g/dL in group A and 3.13 ± 1.06 g/dL in group B. There was no significant difference between the mean of stonefree rate in groups A and B (92.58% ± 5.97versus 89.60% ± 8.3; P = .210). Patients in group A experienced a significantly less duration of hospitalization than group B (2.42 ± 0.84 days versus 3.70 ± 0.80 days; P < .001). CONCLUSION: In the absence of clear indication, nephrostomy tube insertion after PCNL does not seem to be beneficial, and its removal does not posepatients at any additional risk.
Flexible ureteroscopy versus percutaneous nephrolithotomy as primary treatment for renal stones 2 cm or greater
Akar EC, Knudsen BE
Reports in Medical Imaging , 2013, DOI: http://dx.doi.org/10.2147/RMI.S28852
Abstract: le ureteroscopy versus percutaneous nephrolithotomy as primary treatment for renal stones 2 cm or greater Review (522) Total Article Views Authors: Akar EC, Knudsen BE Published Date January 2013 Volume 2013:6 Pages 1 - 10 DOI: http://dx.doi.org/10.2147/RMI.S28852 Received: 26 August 2012 Accepted: 11 December 2012 Published: 18 January 2013 Erin Akar, Bodo E Knudsen Department of Urology, Ohio State University Wexner Medical Center, Columbus, OH, USA Abstract: The purpose of this review, based on the current evidence in the literature, is whether ureteroscopy (URS) is a comparable primary treatment option to the current gold standard of percutaneous nephrolithotomy (PCNL) for the treatment of large kidney stones 2 cm or greater. The lack of prospective randomized trials directly comparing URS and PCNL makes comparison challenging. The numerous studies are not standardized in terms of their definition of stone-free or how stone size is reported. In order to standardize comparison of results, we used a stone-free definition of <4 mm after one procedure per imaging of the author’s choice, since how each patient was imaged postoperatively was not reported. The results from the literature show that moderately large stones from 2 to 3 cm treated ureteroscopically have similar outcomes to PCNL. Stone-free rates with URS decrease when stone size is above 3 cm. Our interpretation of the literature suggests that a current limitation of URS is that multiple procedures for URS would be required to achieve comparable stone-free rates to PCNL, particularly for stones greater than 4 cm.
Does a prilocaine 2% injection into the nephrostomy tract have a role in acute pain management after a lower caliceal puncture during a percutaneous nephrolithotomy? A prospective randomized study with 100 patients  [cached]
Esat Kaan Akbay,G?khan Ko?,Nihat Devrim Filiz,S?tk? ün
Turkish Journal of Urology , 2012,
Abstract: Objective: The aim of this study is to evaluate the effect of a prilocaine 2% injection on the acute management of pain after a lower caliceal puncture during a percutaneous nephrolithotomy.Materials and Methods: In this prospective randomized study, which was conducted between March, 2009 and April, 2010, 100 patients who underwent percutaneous nephrolithotomy (PCNL) were enrolled in this study. In group 1, 10 ml of saline was infiltrated. In group 2, after the operation, 10 ml of prilocaine 2% was infiltrated into the layers instead of saline. The postoperative VAS scores at 2, 4 and 24 hours and the additional analgesia requests were noted and evaluated. As a rescue analgesia, meperidine 1 mg/kg was administered intramuscularly if necessary. Results: All of the patients requested additional analgesia within 2 hours of the operation. In 4 hours, however, 38 patients (76%) in group 1 and 14 patients (28%) in group 2 requested an additional analgesic. This difference was strongly significant (p=0.000). In 24 hours, 7 (14%) and 4 (8%) patients request additional analgesia in groups 1 and 2, respectively, which was not statistically significant (p=0.33).Conclusion: The results of our prospective randomized study suggest that the infiltration of prilocaine 2% near the nephrostomy tract has an effect on the acute management of pain after a lower caliceal puncture during PCNL.
Totally Tubeless Outpatient Percutaneous Nephrolithotomy: Initial Case Report  [PDF]
Darren Beiko,Meghana Samant,Thomas B. McGregor
Advances in Urology , 2009, DOI: 10.1155/2009/295825
Abstract: We report the first case of totally tubeless outpatient percutaneous nephrolithotomy (PCNL). Our patient was discharged home safely less than 4 hours following uncomplicated PCNL with no nephrostomy tube, ureteral stent, or urethral catheter. Follow-up the next day in clinic confirmed that the procedure was successful, as the patient was clinically well and stone free. To our knowledge, this is the first case report of totally tubeless (no nephrostomy, no ureteral stent) PCNL performed on a truly outpatient basis.
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