PD18-01 NATURAL HISTORY OF RESIDUAL FRAGMENTS AFTER PERCUTANEOUS NEPHROLITHOTOMY (PCNL)
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You have accessJournal of UrologyStone Disease: Surgical Therapy II1 Apr 2016PD18-01 NATURAL HISTORY OF RESIDUAL FRAGMENTS AFTER PERCUTANEOUS NEPHROLITHOTOMY (PCNL) Daniel Olvera-Posada, Sohrab Naushad Ali, Husain Alenezi, Marie Dion, John D. Denstedt, and Hassan Razvi Daniel Olvera-PosadaDaniel Olvera-Posada More articles by this author , Sohrab Naushad AliSohrab Naushad Ali More articles by this author , Husain AleneziHusain Alenezi More articles by this author , Marie DionMarie Dion More articles by this author , John D. DenstedtJohn D. Denstedt More articles by this author , and Hassan RazviHassan Razvi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1180AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES PCNL is considered the treatment of choice for large renal calculi. Depending on the definition used, the stone free rate after PCNL is approximately 80-90%. Recently, the term clinically insignificant residual fragments (CIRF), defined as fragments ≤ 4 mm, has been used to describe the persistence of stones that may not have further clinical impact. The purpose of this study is to determine the natural history of residual fragments (RF) after PCNL performed in our centre. METHODS From 2006 to 2013, we assessed all patients with a postoperative CT scan revealing residual stones, and did not undergo second look nephroscopy or other immediate ancillary procedures. Only patients with at least 12 months of clinical follow up were included. Number, size, largest diameter, location and composition of RF were evaluated. Primary end points were divided into radiological, clinical and therapeutic. Regression analysis was performed to evaluate risk factors for intervention during follow up. Kaplan-Meier curves were used to calculate the probability of remaining treatment-free. RESULTS A total of 781 PCNLs were performed during the 8-year period of the study. Of 202 patients with postoperative CT scan, only 44 patients had RF. Mean follow up was 58.8 months (15.4-104.9). Mean largest diameter of the RF was 5.8 mm (1-12mm) and 19 patients (43.2%) had CIRF. The mean largest diameter of RF at date of treatment or last follow up visit was 12 mm (2-45 mm), and 84% of the stones increased in size. Only 4 patients had radiological evidence of stone passage. Almost half of the patients (21/44) remained asymptomatic. The 5-year probability to remain intervention-free was 30.8%. 70.4% (31/44) patients underwent an intervention during follow up. Five patients required urgent intervention. Fragments ≥ 5 mm were more likely to require treatment compared to CIRF (84 vs 52.6%, p=0.044). Size of RF ≥ 5mm (OR 4.7, 95% CI 1.17-19.12, p=0.029) and lower pole location (OR 3.9, 95% CI 1.004-15.24, p=0.049) were associated with an increased risk for intervention. The probability of an intervention was significantly higher in patients with RF ≥ 5 mm compared to CIRF (p=0.021) as well those with struvite/apatite compared to other stone composition (p=0.005). CONCLUSIONS Despite the size of the residual fragments, the vast majority of patients with RF will require an intervention during long term follow up. Residual fragments after PCNL ≥ 5 mm, lower pole location or struvite/apatite composition are associated with an increased risk of intervention during follow up. Spontaneous passage is an uncommon event. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e403-e404 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Daniel Olvera-Posada More articles by this author Sohrab Naushad Ali More articles by this author Husain Alenezi More articles by this author Marie Dion More articles by this author John D. Denstedt More articles by this author Hassan Razvi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...Objective: The aim of this study was to compare the postoperative outcomes of patients receiving standard percutaneous nephrolithotomy (S-PCNL) and modified mini percutaneous nephrolithotomy (MM-PCNL) in Yala Hospital. Material and Method: We collected data from 117 patients who underwent S-PCNL or MM-PCNL from 2013-2018. We compared the data of patient characteristics, laboratory results, and postoperative outcomes, such as operative times, duration of catheter, blood transfusion rate, duration of hospitalization, stone free rate and complication rate between the S-PCNL and MM-PCNL groups. Results: There were no significant differences in operative time, blood transfusion rate, stone free rate and complication rate between the 2 groups. However, the duration of catheter and hospitalization in the MM-PCNL group was significantly shorter than in the S-PCNL group. Conclusion: Hence, we confirmed that MM-PCNL could be used as an alternative procedure to Mini-PCNL for the management of renal stones in other tertiary hospitals which already have the equipment for S-PCNL by modifying that equipment, as we have shown.
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Purpose:To assess the feasibility and available of 4 different ways to develop renal tract percutaneous nephrolithotomy.Method:116 cases with calculus of upper urinary tract were reported. 65 cases were established the renal tract of percutaneous nephrolithotomy guided by the portable fluoroscopic imaging system, and 35 cases by ultrasound B. 16 cases were established the renal tract of percutaneous nephrolithotomy by direct puncture, and 4 cases were established the renal tract of percutaneous nephrolithotomy by a small incisions.Result:112 cases were successfully established the renal tract of percutaneous nephrolithotomy, and 4 cases were failed. The rate of residual stone was 15.2. The average length of stay is 6.5 days.Conclusion:The different way can be used in different situation.
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Background: Percutaneous nephrolithotomy has become the standard procedure for large renal stones but still remains highly challenging due to complications such as bleeding and sepsis, even though it has high stone free rate (SFR). We report the early outcomes of more than 1000 percutaneous nephrolithotomys done in our center.Methods: A retrospective study of all patients undergoing percutaneous nephrolithotomy from January 2010 to December 2017 in single institution was conducted. All cases were stratified into three groups based on tract size; standard percutaneous nephrolithotomy with tract size ? 22 F, mini percutaneous nephrolithotomy with tract size 15 – 20 F and ultramini percutaneous nephrolithotomy with tract size ? 14 F. Age, gender, stone complexity using Guy’s stone score, stone size, operative time, hemoglobin drop, hospital stay, early major and minor complications were reviewed.Results: A total of 1074 patients had undergone percutaneous nephrolithotomy among which, 578 patients were standard percutaneous nephrolithotomy, 433 mini percutaneous nephrolithotomy and 63 had undergone ultramini percutaneous nephrolithotomy. There was even distribution of patients with Guy’s stone score 1 and 2 in all three groups. However, majority of patients with Guy’s stone score 3 underwent standard percutaneous nephrolithotomy or mini percutaneous nephrolithotomy and no patients with Guy’s stone score 4 underwent ultramini percutaneous nephrolithotomy. Age group, gender and operative time were comparable between the groups; however, significant difference was noted in terms of less hemoglobin drop and shorter hospital stay (p-value < 0.05) in the miniaturized percutaneous nephrolithotomy group. Complications were found to be fewer in mini percutaneous nephrolithotomy and ultramini percutaneous nephrolithotomy group in comparison to standard percutaneous nephrolithotomy.Conclusions: Miniaturization of tract size significantly decreases post-operative complication rates, blood loss and hospital stay while maintaining high stone free rates in well selected patients undergoing Percutaneous nephrolithotomy.Keywords: Endourology; percutaneous nephrolithotomy; PNL; urolithiasis.
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To evaluate the feasibility and efficacy of percutaneous renal puncture in percutaneous nephrolithotomy guided by novel needle-tracking ultrasound system.From may to october 2013, 16 cases of percutaneous nephrolithotomy were performed under the guidance of ultrasound system. The clinical data including the time of completing percutaneous renal puncture, the color of urine sucked out from the kidney calices, and the complications were analyzed retrospectively.Of the 16 patients, 18 percutaneous renal access were established guided by ultrasound system. All of them were successtul for the first time, and the average time of completing percutaneous renal punctures was (26.90 ± 11.37) s (15 to 54 s). After the operation, the hemoglobin decreased by (9.56 ± 5.27)%(1.41% to 24.06%), and no complications occurred except for postoperative fever in 2 case.The novel ultrasound system is a safe and effective technique that can reduce the technical difficulty of percutaneous renal puncture in percutaneous nephrolithotomy.
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Background and Purpose: The consequences of open nephrolithotomy are scar tissue around the kidney and in the retroperitoneum and distortion of the pelvicaliceal anatomy that may affect the techniques and outcome of percutaneous nephrolithotomy (PCNL). We compared the results and complications of patients undergoing PCNL who had and had not previously undergone open nephrolithotomy. Patients and Methods: A total of 178 calculi in 175 patients who had previously had open nephrolithotomy (group I) and 178 calculi in 175 patients who had never had a renal operation (group II) were treated with PCNL. The average time between open nephrolithotomy and PCNL was 8.5 years (range 4 months–22 years). In both groups, PCNL was done by a standard technique with serial Amplatz dilator enlargement of the tract to 30F. Upper-pole access under fluoroscopic guidance was done in most patients. The operative time, success rate, hospital stay, and complications in the two groups were compared. Results: The stone-free rates were 80.3% and 82.6% in groups I and II, respectively, and the rate of residual fragments ≤4 mm was 14.6% and 8.4%. The operative time, success rate, hospital stay, and complications did not differ significantly in the two groups. Conclusion: Percutaneous nephrolithotomy is effective and safe in patients who have previously had open nephrolithotomy with no more complications than are seen with PCNL of kidneys that have not been operated on.
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Nephrology
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Objective To explore the safety of totally tubeless percutaneous nephrolithotomy in the treatment of renal calculi and compare postoperative complications of totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy.Methods The clinical data of 60 cases treated by totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy,20 cases were included in totally tubeless percutaneous nephrolithotomy and 40 cases were included in standard percutaneous nephrolithotomy,its postoperative complications were analyzed retrospectively.Results There was no statistic significance between the postoperative complications such as hemorrhage,infection,urinous infiltration and bladder indisposition.conclusion Totally tubeless percutaneous nephrolithotomy is safe for the treatment of upper urinary tract calculi.It is considered as a less pain method for patients and can be generally applied but the operation indication should be chosen strictly.
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Mini-percutaneous nephrolithotomy is a recent advancement in the field of kidney stone treatment; however, its role has not been completely established. We aimed to compare the outcomes of initial Mini-percutaneous nephrolithotomy and flexible ureteroscopy.A retrospective review of consecutive mini-percutaneous procedures was performed. Inclusion criteria were as follows: all percutaneous nephrolithotomy procedures performed with an access sheath up to 24Fr, kidney stone burdens up to 1550 mm3; and the presence of postoperative computed tomography (for control). The data collected for Mini-percutaneous nephrolithotomy procedures were paired 1:2 with patients treated with flexible ureteroscopy for stones between 100 and 1550 mm3, and with postoperative computed tomography for control. A 14Fr Mini-percutaneous nephrolithotomy set was used. The stone-free rate was defined as the absence of fragments on the control computed tomography, whereas success was limited to 2-mm residual fragments. Statistical analysis was performed using SPSS version 19.A total of 63 patients met the inclusion criteria (42 with flexible ureteroscopy and 21 with mini-percutaneous nephrolithotomy). Demographic data were comparable. The stone-free rate and success were similar between the groups (76.2 vs. 66.7%, p=0.42 and 90.5 vs. 85.7%, p=0.57). The complication rate was also similar (26.1 vs. 9.6%, p=0.188), but Mini-percutaneous nephrolithotomy had longer hospitalization and fluoroscopy time (p=0.001 in both).Our initial study of Mini-percutaneous nephrolithotomy showed that it is a promising procedure, with outcomes similar to flexible ureteroscopy, but with higher inpatient numbers and fluoroscopy times. A larger study population size and better equipment may improve the outcomes of mini-percutaneous nephrolithotomy.
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Objective:To explore the clinical effect of mini-percutaneous nephrolithotomy(MPCNL) for nephrolithiasis in pediatric patients.Methods:We retrospectively reviewed the clinical records of 58 cases of children who underwent percutaneous nephrolithotomy procedures for renal calcali from 2005 to 2007.Antegrade percutaneous access was obtained in all children and the tract was dilated to F16 that was used to remove stones.Results:A total of percutaneous nephrolithotomy procedures were performed.Average operative time was 67 minutes(range from 25 to 100) a 95% stone-free rate was achieved using percutaneous nephrolithotomy.No severe complications were noted.Conclusions:MPCNL is safe and effective for children and considered a viable option.
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