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Nizzardo M, Albo G, Ripa F, Zino E, De Lorenzis E, Boeri L, Longo F, Montanari E, Zanetti SP. Assessment of Effectiveness and Safety of Aspiration-Assisted Nephrostomic Access Sheaths in PCNL and Intrarenal Pressures Evaluation: A Systematic Review of the Literature. J Clin Med 2024; 13:2558. [PMID: 38731086 PMCID: PMC11084567 DOI: 10.3390/jcm13092558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Different suction-assisted nephrostomic sheaths have been developed for percutaneous nephrolithotomy (PCNL). Objectives: (1) To examine PCNL techniques performed with different aspiration-assisted sheaths (Clear Petra® sheath, Superperc, SuperminiPCNL, and a miniPCNL patented sheath), with specific regard to effectiveness and safety outcomes in adult and paediatric patients; (2) to extrapolate intrarenal pressure (IRP) data during these procedures. Methods: A systematic literature search was performed in accordance with PRISMA guidelines. Relevant articles up to 8 February 2024 were included. Results: Twenty-five studies were selected, thirteen retrospective and twelve prospective. The use of four different aspirating sheaths for miniPCNL was reported: Clear Petra® sheath, Superperc, SuperminiPCNL, and a miniPCNL patented sheath. Stone free rates (SFRs) across techniques ranged from 71.3% to 100%, and complication rates from 1.5% to 38.9%. Infectious complication rates varied from 0 to 27.8% and bleeding complication rates from 0 to 8.9%. Most complications were low grade ones. The trend among studies comparing aspiration- and non-aspiration-assisted miniPCNL was towards equivalent or better SFRs and lower overall infectious and bleeding complication rates in suction techniques. Operation time was consistently lower in suction procedures, with a mean shortening of the procedural time of 19 min. Seven studies reported IRP values during suction miniPCNL. Two studies reported satisfactory SFRs and adequate safety profiles in paediatric patient cohorts. Conclusions: MiniPCNL with aspirating sheaths appears to be safe and effective in both adult and paediatric patients. A trend towards a reduction of overall infectious and bleeding complications with respect to non-suction procedures is evident, with comparable or better SFRs and consistently shorter operative times. The IRP profile seems to be safe with the aid of aspirating sheaths. However, high quality evidence on this topic is still lacking.
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Affiliation(s)
- Marco Nizzardo
- Department of Urology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Giancarlo Albo
- Department of Urology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Francesco Ripa
- Department of Urology, Whittington Health NHS Trust, London N19 5NF, UK
| | - Ester Zino
- Department of Urology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Elisa De Lorenzis
- Department of Urology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Luca Boeri
- Department of Urology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Fabrizio Longo
- Department of Urology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Emanuele Montanari
- Department of Urology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Stefano Paolo Zanetti
- Department of Urology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Ibis MA, Özsoy AF, Özkaya MF, Erdem E, Erkmen S, Güler AD, Gökce Mİ. Comparison of lithotripsy methods during mini-PNL: is there a role for ballistic lithotripsy in the era of high-power lasers. BMC Urol 2024; 24:54. [PMID: 38454412 PMCID: PMC10921753 DOI: 10.1186/s12894-024-01443-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/01/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND For renal stones > 20 mm, percutaneous nephrolithotomy (PNL) offers the best stone clearance rates with acceptable complication rates. This study aimed to compare the efficiency of high-power holmium YAG laser and ballistic lithotripsy during mini-PNL. METHODS Data from 880 patients who underwent mini-PNL for renal stones was investigated retrospectively. The study utilized propensity score matching to create two groups: laser lithotripsy (n = 440) and ballistic lithotripsy (n = 440). The groups were matched based on stone size, Guy's stone score, and stone density. The main objectives of the study were to assess the stone-free rate (SFR), duration of surgery, and complication rates. RESULTS The average age of the population was 51.4 ± 7.1 years, with a mean stone size of 28.6 ± 8.3 mm and a mean stone density of 1205 ± 159 HU. There were no significant differences between the groups. The SFRs of the laser lithotripsy and ballistic lithotripsy were 92.5% and 90.2%, respectively (p = 0.23). The laser lithotripsy group had a notably shorter surgery time (40.1 ± 6.3 min) compared to the ballistic lithotripsy group (55.6 ± 9.9 min) (p = 0.03). Complication rates were similar (p = 0.67). CONCLUSIONS Our study shows that a high-power holmium YAG laser provides quicker operation time compared to ballistic lithotripsy. However, ballistic lithotripsy is still an effective and safe option for stone fragmentation during mini-PNL. In places where a high-power holmium YAG laser is not available, ballistic lithotripters are still a safe, effective, and affordable option for mini-PNL.
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Affiliation(s)
- Muhammed Arif Ibis
- Department of Urology, Ankara University School of Medicine, Adnan Saygun Caddesi, Ankara, Altındağ, Turkey.
| | - Ahmet Furkan Özsoy
- Department of Urology, Ankara University School of Medicine, Adnan Saygun Caddesi, Ankara, Altındağ, Turkey
| | - Mehmet Fatih Özkaya
- Department of Urology, Ankara University School of Medicine, Adnan Saygun Caddesi, Ankara, Altındağ, Turkey
| | - Emre Erdem
- Department of Urology, Ankara University School of Medicine, Adnan Saygun Caddesi, Ankara, Altındağ, Turkey
| | - Serhat Erkmen
- Department of Urology, Ankara University School of Medicine, Adnan Saygun Caddesi, Ankara, Altındağ, Turkey
| | - Ahmet Doruk Güler
- Department of Urology, Ankara University School of Medicine, Adnan Saygun Caddesi, Ankara, Altındağ, Turkey
| | - Mehmet İlker Gökce
- Department of Urology, Ankara University School of Medicine, Adnan Saygun Caddesi, Ankara, Altındağ, Turkey
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He Q, Wei X, Wu E, Luo R, Yu L, Liang W. Comparison of percutaneous nephrolithotomy and flexible ureterorenoscopy in the treatment of single upper ureteral calculi measuring 1 to 2 centimeters: a retrospective study. BMC Urol 2024; 24:23. [PMID: 38281932 PMCID: PMC10822141 DOI: 10.1186/s12894-024-01408-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 01/16/2024] [Indexed: 01/30/2024] Open
Abstract
PURPOSE To compare the efficacy and safety of micropercutaneous nephrolithotomy (MPCNL) and flexible ureteroscopy (FURS) in the treatment of single upper ureteral calculi measuring 1 to 2 centimeters. METHODS This study is a retrospective analysis that combines a review of medical records with an outcomes management database. A total of 163 patients who underwent MPCNL and 137 patients who had FURS were identified between January 2017 and December 2021. Demographic data, operation time, hospitalization time, stone-free rate, and complication rate were collected and analyzed. RESULTS Preoperative general data of sex, age, BMI, serum creatinine, time of stone existence, stone hardness, stone diameter, preoperative hydronephrosis, and preoperative infection of the MPCNL group have no statistically significant difference with that of the FURS group. All MPCNL or FURS operations in both groups were successfully completed without any instances of reoperation or conversion to another surgical procedure. Patients who underwent MPCNL had a considerably reduced operation time (49.6 vs. 72.4 min; P<0.001), but a higher duration of hospitalization (9.1 vs. 3.9 days; P<0.001) compared to those who underwent FURS. The stone-free rate in the MPCNL group was superior to that of the FURS group, with a percentage of 90.8% compared to 71.5% (P<0.001). There was no statistically significant disparity in the rate of complications between the two groups (13.5% vs. 15.3%; P = 0.741). CONCLUSION Both MPCNL and FURS are viable and secure surgical choices for individuals with solitary upper ureteral calculi measuring 1 to 2 cm. The FURS procedure resulted in a shorter duration of hospitalization compared to MPCNL. However, it had a comparatively lower rate of successfully removing the stones and required a longer duration for the operation.There were no substantial disparities observed in the complication rate between the two groups.FURS is the preferable option for treating uncomplicated upper ureteral calculi, whereas MPCNL is the preferable option for treating complicated upper ureteral calculi.Prior to making treatment options, it is crucial to take into account the expertise of surgeons, the quality of the equipment, and the preferences of the patient. TRIAL REGISTRATION No.
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Affiliation(s)
- Qinghua He
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, 124 Yuejin Road, Liuzhou, 545000, Guangxi Province, China
| | - Xuedong Wei
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, 124 Yuejin Road, Liuzhou, 545000, Guangxi Province, China
| | - Eran Wu
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, 124 Yuejin Road, Liuzhou, 545000, Guangxi Province, China
| | - Raoshan Luo
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, 124 Yuejin Road, Liuzhou, 545000, Guangxi Province, China
| | - Lizhi Yu
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, 124 Yuejin Road, Liuzhou, 545000, Guangxi Province, China
| | - Weiming Liang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, 124 Yuejin Road, Liuzhou, 545000, Guangxi Province, China.
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Xu ZH, Du GY, Zhao YJ, Wang HY, Chen GJ, Tao C, Yan X. Single-center experience of micro-perc in the treatment of children with 1.0-2.0 cm sized kidney stones in the Galdakao-modified supine Valdivia position. World J Urol 2023; 41:837-841. [PMID: 36749393 DOI: 10.1007/s00345-023-04289-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/30/2022] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE We aimed to explore the applicability and safety of micro-percutaneous nephrolithotomy (micro-perc) in the treatment of children with kidney stones in the Galdakao-modified supine Valdivia (GMSV) position under the guidance of whole-course ultrasound. MATERIALS AND METHODS Patients were aged < 18 years in the GMSV position who underwent micro-perc for kidney stones under ultrasound guidance between August 2020 and May 2022 at our institution were reviewed retrospectively. RESULTS A total of 23 patients, 15 males and 8 females, received micro-perc. The average stone size was 1.6 cm (range 1.1-2.0 cm). Among them, 12 patients had left kidney stones, 10 patients had right kidney stones, and 1 patient had bilateral kidney stones. The mean operative time was 55.3 min (range 35-86 min). The mean hospital stay was 2.9 days (range 2-4 days). The mean hemoglobin decrease was 1.7 g/L (range 0.9-3.2 g/L). A total of 17 patients had complete stone clearance at 48 h postoperatively. A total of 22 patients had complete stone clearance at 2 weeks postoperatively. CONCLUSION Our results demonstrate that micro-perc under ultrasound guidance is a safe and effective method for the treatment of children with kidney stones in the GMSV position. Further research is warranted to confirm these results.
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Affiliation(s)
- Zi-Hao Xu
- Department of Urology, Pediatric Urolith Center, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang Province, China
| | - Geng-Yu Du
- Department of Urology, Pediatric Urolith Center, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang Province, China
| | - Yi-Jun Zhao
- Department of Urology, Pediatric Urolith Center, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang Province, China
| | - Heng-You Wang
- Department of Urology, Pediatric Urolith Center, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang Province, China
| | - Guang-Jie Chen
- Department of Urology, Pediatric Urolith Center, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang Province, China
| | - Chang Tao
- Department of Urology, Pediatric Urolith Center, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang Province, China
| | - Xiang Yan
- Department of Urology, Pediatric Urolith Center, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang Province, China.
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Yuan Y, Liang YN, Li KF, Ho YR, Wu QL, Zhao Z. A meta-analysis: retrograde intrarenal surgery vs. percutaneous nephrolithotomy in children. Front Pediatr 2023; 11:1086345. [PMID: 37205217 PMCID: PMC10185757 DOI: 10.3389/fped.2023.1086345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Backgrounds The increasing prevalence of pediatric kidney stones worldwide makes minimally invasive lithotripsy like retrograde intrarenal surgery (RIRS) and percutaneous Nephrolithotomy (PCNL) more prevalent. However, their safety and efficacy are controversial. Consequently, a meta-analysis of the comparison between RIRS and PCNL is conducted. Methods Clinical trials were selected from PubMed, EMBASE, Scopus, and Cochrane Library databases. The data extraction and study quality assessment were performed by two individuals independently. The data relating to therapeutic effects were extracted and analyzed by Review manager 5.4. Results Thirteen studies involving 1,019 patients were included. The micro-PCNL excelled in stone-free rate (P = 0.003), postoperative fever rate (P = 0.02), and Clavien-Dindo II complications (P = 0.05). Notably, the mean age of the micro-PCNL group was younger than other groups (P = 0.0005). The operation time in mini-PCNL was longer than RIRS (P < 0.00001) but with high heterogeneity (I2 = 99%). There was no difference in Clavien-Dindo I, II, and III complications between the PCNL and the RIRS, but mini-PCNL showed a higher probability than RIRS in Clavien-Dindo I (P = 0.0008) and II complications (P = 0.007). Conclusions Compared with RIRS, micro-PCNL could be a better therapeutic option for kidney stones in children. Of note, more parameters should be analyzed to illustrate the efficacy of different minimally invasive surgeries for pediatric kidney stones due to poor cases in our study. Systematic Review Registration https://www.crd.york.ac.uk/prospero/#recordDetails, PROSPERO CRD42022323611.
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Affiliation(s)
- Yi Yuan
- Department of Pediatric Urology Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Yan-nei Liang
- Department of Pediatric Urology Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Kai-feng Li
- Department of Pediatric Urology Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Yi-ru Ho
- Department of Pediatric Urology Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Qian-long Wu
- Department of Pediatric Urology Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Zhang Zhao
- Department of Urology Surgery, Guangzhou Women and Children’s Medical Center of Guangzhou Medical University, Guangzhou, China
- Correspondence: Zhang Zhao
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Zeng G, Zhong W, Mazzon G, Choong S, Pearle M, Agrawal M, Scoffone CM, Fiori C, Gökce MI, Lam W, Petkova K, Sabuncu K, Gadzhiev N, Pietropaolo A, Emiliani E, Sarica K. International Alliance of Urolithiasis (IAU) Guideline on percutaneous nephrolithotomy. Minerva Urol Nephrol 2022; 74:653-668. [PMID: 35099162 DOI: 10.23736/s2724-6051.22.04752-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The International Alliance of Urolithiasis (IAU) would like to release the latest guideline on percutaneous nephrolithotomy (PCNL) and to provide a clinical framework for surgeons performing PCNLs. These recommendations were collected and appraised from a systematic review and assessment of the literature covering all aspects of PCNLs from the PubMed database between January 1, 1976, and July 31, 2021. Each generated recommendation was graded using a modified GRADE methodology. The quality of the evidence was graded using a classification system modified from the Oxford Center for Evidence-Based Medicine Levels of Evidence. Forty-seven recommendations were summarized and graded, which covered the following issues, indications and contraindications, stone complexity evaluation, preoperative imaging, antibiotic strategy, management of antithrombotic therapy, anesthesia, position, puncture, tracts, dilation, lithotripsy, intraoperative evaluation of residual stones, exit strategy, postoperative imaging and stone-free status evaluation, complications. The present guideline on PCNL was the first in the IAU series of urolithiasis management guidelines. The recommendations, tips and tricks across the PCNL procedures would provide adequate guidance for urologists performing PCNLs to ensure safety and efficiency in PCNLs.
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Affiliation(s)
- Guohua Zeng
- Department of Urology, Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wen Zhong
- Department of Urology, Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Simon Choong
- University College Hospital of London, Institute of Urology, London, UK
| | - Margaret Pearle
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Madhu Agrawal
- Department of Urology, Center for Minimally Invasive Endourology, Global Rainbow Healthcare, Agra, India
| | | | - Cristian Fiori
- Department of Urology, San Luigi Hospital, University of Turin, Turin, Italy
| | - Mehmet I Gökce
- Department of Urology, Faculty of Medicine, University of Ankara, Ankara, Turkey
| | - Wayne Lam
- Division of Urology, Queen Mary Hospital, Hong Kong, China
| | - Kremena Petkova
- Military Medical Academy, Department of Urology and Nephrology, Sofia, Bulgaria
| | - Kubilay Sabuncu
- Department of Urology, Karacabey State Hospital, Karacabey-Bursa, Turkey
| | - Nariman Gadzhiev
- Department of Urology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Esteban Emiliani
- Department of Urology, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Kemal Sarica
- Medical School, Department of Urology, Biruni University, Istanbul, Turkey -
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Tzelves L, Juliebø-Jones P, Manolitsis I, Bellos T, Mykoniatis I, Berdempes M, Markopoulos T, Lardas M, Zeeshan Hameed BM, Aggelopoulos P, Pietropaolo A, Somani B, Varkarakis I, Skolarikos A. Radiation protection measures during endourological therapies. Asian J Urol 2022. [PMID: 37538154 PMCID: PMC10394289 DOI: 10.1016/j.ajur.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective The objective of this narrative review was to search the existing literature for studies reporting measures to minimize radiation use during endoscopic management of stone disease and present ways of reducing the exposure of both patients and operating room staff. Methods A literature review in PubMed was performed to identify studies describing protocols or measures to reduce radiation received during endourological procedures from January 1970 to August 2022. Eligible studies were those that reported outcomes for ureteroscopy or percutaneous nephrolithotripsy regarding measures to minimize radiation doses used intraoperatively, performed either in real-life theatres or using phantoms. Both comparative and non-comparative studies were deemed eligible. Results Protection can be achieved initially at the level of diagnosis and follow-up of patients, which should be done following an algorithm and choice of more conservative imaging methods. Certain protocols, which follow principles for minimized fluoroscopy use should be implemented and urologists as well as operating room staff should be continuously trained regarding radiation damage and protection measures. Wearing protective lead equipment remains a cornerstone for personnel protection, while configuration of the operating room and adjusting X-ray machine settings can also significantly reduce radiation energy. Conclusion There are specific measures, which can be implemented to reduce radiation exposure. These include avoiding excessive use of computed tomography scans and X-rays during diagnosis and follow-up of urolithiasis patients. Intraoperative protocols with minimal fluoroscopy use can be employed. Staff training regarding dangers of radiation plays also a major role. Use and maintenance of protective equipment and setting up the operating room properly also serve towards this goal. Machine settings can be customized appropriately and finally continuously monitoring of exposure with dosimeters can be adopted.
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De Lorenzis E, Zanetti SP, Boeri L, Montanari E. Is There Still a Place for Percutaneous Nephrolithotomy in Current Times? J Clin Med 2022; 11:jcm11175157. [PMID: 36079083 PMCID: PMC9457409 DOI: 10.3390/jcm11175157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/20/2022] [Accepted: 08/29/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Percutaneous nephrolithotomy (PCNL) and its miniaturized modifications are usually considered the standard surgical options for large (>20 mm) staghorn and infected stones. Moreover, PCNL is a viable alternative to retrograde intrarenal surgery (RIRS) for smaller stones (<20 mm) in the presence of anatomical malformations or inaccessible lower pole stones. However, due to the advancements in laser and scope technology, RIRS is expanding its indications with the potential benefits of lower complications and a shorter hospital stay. Methods: A literature search using the PUBMED database from inception to June 2022 was performed to explore the current role of PCNL in endourology. The analysis involved a narrative synthesis. Results: PCNL confirmed its role in the treatment of large and complex stones; moreover, miniaturized PCNL has become more competitive, gaining space among classic indications of flexible ureteroscopy. Conclusions: considering all the evaluated subgroups, we can conclude that PCNL is an old fascinating procedure and is here to stay.
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Affiliation(s)
- Elisa De Lorenzis
- Department of Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda 15, 20122 Milan, Italy
- Correspondence:
| | - Stefano Paolo Zanetti
- Department of Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda 15, 20122 Milan, Italy
| | - Luca Boeri
- Department of Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda 15, 20122 Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda 15, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
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Zeng J, Zhang L, Chen X, He H, Li X. The treatment option for calyceal diverticulum stones: flexible ureteroscopy lithotripsy (FURL) or all-seeing needle-assisted percutaneous nephrolithotomy (PCNL)? Urolithiasis 2022; 50:743-749. [PMID: 35994081 DOI: 10.1007/s00240-022-01353-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/05/2022] [Indexed: 10/15/2022]
Abstract
The purpose of this study was to investigate the effectiveness and safety of flexible ureteroscopy lithotripsy (FURL) and all-seeing needle-assisted percutaneous nephrolithotomy (PCNL) for the treatment of calyceal diverticula (CD) stones. From June 2012 to November 2020, 24 patients, including 14 females and 10 males, with an average age of 45.6 ± 17.4 years were retrospectively reviewed in this study. Among these patients, 14 were treated with FURL, and 10 underwent all-seeing needle-assisted PCNL. The demographic data, perioperative parameters and complications, as well as follow-up data, were recorded. In the FURL group, the ostium of CD was not identified in two patients, and these patients were finally treated with all-seeing needle-assisted PCNL. The stone clearance rate (SCR) was 64.3%, and the mean blood loss was 0.9 ± 0.8 g/dL. The average operation time was 57.5 ± 17.4 min, and the mean hospital stay was 3.5 ± 1.4 days. A complete resolution of CD was observed in five (41.7%) patients over the average follow-up of 10.8 months. In terms of the all-seeing needle-assisted PCNL, the average operation time was 83.5 ± 32.4 min, and the mean hospital stay was 4.38 ± 2.25 days. The SCR reached 91.7%, and the blood loss was 1.7 ± 1.1 g/dL. Nine patients (75%) were observed to have complete CD resolution over an average of 12.2 months of follow-up. All complications were grade I and II in both the groups. CD stones can be treated minimally invasive and effectively by FURL and PCNL. The effect of FURL greatly depends on the location and anatomy of the diverticula. PCNL is more efficient, and its safety was improved with the help of the all-seeing needle assistance.
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Affiliation(s)
- Jin Zeng
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, No.277 Yanta West Road, Xi'an, 710061, China
| | - Lu Zhang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, No.277 Yanta West Road, Xi'an, 710061, China
| | - Xingfa Chen
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, No.277 Yanta West Road, Xi'an, 710061, China
| | - Hui He
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, No.277 Yanta West Road, Xi'an, 710061, China
| | - Xiang Li
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, No.277 Yanta West Road, Xi'an, 710061, China.
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10
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Paraboschi I, Gnech M, De Marco EA, Minoli DG, Bebi C, Zanetti SP, Manzoni G, Montanari E, Berrettini A. Pediatric Urolithiasis: Current Surgical Strategies and Future Perspectives. Front Pediatr 2022; 10:886425. [PMID: 35757114 PMCID: PMC9218273 DOI: 10.3389/fped.2022.886425] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/16/2022] [Indexed: 12/23/2022] Open
Abstract
New technological innovations and cutting-edge techniques have led to important changes in the surgical management of pediatric urolithiasis. Miniaturized technologies and minimally invasive approaches have been increasingly used in children with urinary stones to minimize surgical complications and improve patient outcomes. Moreover, the new computer technologies of the digital era have been opening new horizons for the preoperative planning and surgical treatment of children with urinary calculi. Three-dimensional modeling reconstructions, virtual, augmented, and mixed reality are rapidly approaching the surgical practice, equipping surgeons with powerful instruments to enhance the real-time intraoperative visualization of normal and pathological structures. The broad range of possibilities offered by these technological innovations in the adult population finds increasing applications in pediatrics, offering a more detailed visualization of small anatomical structures. This review illustrates the most promising techniques and devices to enhance the surgical treatment of pediatric urolithiasis in children, aiming to favor an early adoption and to stimulate more research on this topic.
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Affiliation(s)
- Irene Paraboschi
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michele Gnech
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Erika Adalgisa De Marco
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Guido Minoli
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carolina Bebi
- Department of Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Stefano Paolo Zanetti
- Department of Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Gianantonio Manzoni
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Alfredo Berrettini
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Keyu G, Shuaishuai L, Raj A, Shuofeng L, Shuai L, Yuan Z, Haitao Z, Junqi W. A 3D printing personalized percutaneous puncture guide access plate for percutaneous nephrolithotomy: a pilot study. BMC Urol 2021; 21:184. [PMID: 34952574 PMCID: PMC8705092 DOI: 10.1186/s12894-021-00945-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE CT-Urography combined with 3D printing technology, digital design, construction of individualized PCNL puncture guides, and preliminary analyze their efficacy, safety puncture positioning for PCNL. METHODS Twenty-two patients with renal calculi were randomly selected at the affiliated Hospital of Xuzhou Medical University during 2017-2018. We randomly divided the patients into two groups: in 10 experimental groups, we used our 3D printing personalized percutaneous puncture guide access plate for PCNL, and in the control group, 12 patients with standard USG guide PCNL. The accuracy of puncture position, puncture time, and intraoperative blood loss was compared. RESULTS In the experimental group, 10 patients with 3D printing personalized percutaneous puncture guide access plate. The puncture needle was accessed through the guide plate and verified by the color Doppler. The single puncture, needle position, and depth success rate were 100.00% (10/10). The angles were consistent with the preoperative design. In the control group, 12 patients via USG guided PCNL success rate was 75.00% (9/12). The puncture time and amount of hemorrhage was (7.78 ± 0.94) min and (49.31 ± 6.43) mL, and (9.04 ± 1.09) min and (60.08 ± 12.18) mL, respectively. The above data of the two groups were statistically significant (P < 0.05). CONCLUSION 3D printing personalized percutaneous nephrolithotomy guide plate for PCNL can improve PCNL renal puncture channel positioning accuracy, shorten puncture time, reduce intraoperative blood loss, bleeding-related complications and provide a new method for PCNL renal puncture positioning, which is worthy of further clinical exploration.
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Affiliation(s)
- Gao Keyu
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, China
| | | | - Ashok Raj
- Xuzhou Medical University, Xuzhou, 221000, China
| | - Li Shuofeng
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, China
| | - Liu Shuai
- Xuzhou Central Hospital, Xuzhou, 221000, China
| | - Zhang Yuan
- Xuzhou Children's Hospital, Xuzhou, 221000, China
| | - Zhu Haitao
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, China
| | - Wang Junqi
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, China.
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Abstract
Percutaneous nephrolithotomy (PCNL) remains the treatment of choice for large and complex renal stones. The technological advances over the past several decades gave birth to different varieties of minimally invasive PCNLs, including the mini-PCNL, ultra-mini PCNL, super mini-PCNL, and micro-PCNL, with indications being extended to stones even larger than 20 mm. This article provides an update of all these available techniques of miniaturized PCNL along with its anatomic and physiologic impact. This should assist urologists in providing a personalized approach to the patient based on various patient- and stone-related factors to provide the best of all available technology for treatment.
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Affiliation(s)
- Janak Desai
- Department of Urology, Samved Hospital, 2nd Floor, Navrangpura, Ahmedabad 380009, India.
| | - Hemendra N Shah
- Department of Urology, University of Miami Miller School of Medicine, 1150 NW 14(th) street, Suite 309, Miami, FL 33136, USA
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Zhang J, Kang N, Jiang Y, Zhang J. Microperc with Self-Assembled Fr 4.85 Visual Needle and Ureteral Access Sheath. J INVEST SURG 2021; 35:569-576. [PMID: 33761818 DOI: 10.1080/08941939.2021.1902024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Micropercutaneous nephrolithotomy (microperc) is the least invasive among percutaneous nephrolithotripsy (PCNL) procedures. Although microperc has a high stone-free rate and certain advantages over other methods, modifications may be needed to improve the technique. We describe our experience performing microperc using a self-assembled visual needle and ureteral access sheath (UAS). METHODS Between June 2016 and April 2019, the data of 30 patients with kidney stones undergoing microperc with our self-assembled 4.8 Fr visual needle combined with a UAS was retrospectively analyzed. Patients were placed in an obilique spine lithotomy position. RESULTS Two cases were excluded: one due to conversion to mini PCNL and the other required flexible ureteroscopy during microperc. The remaining 28 cases included 18 men and 10 women, age 38.4 ± 7.5 years, stone size 1.7 ± 0.4 cm, and stone density on CT 969 ± 233 HU. Operative time was 47 ± 9.9 minutes, visual analogue scale score of tract pain on postoperative day 1 was 2.5 ± 1.0, hemoglobin decrease was 6.4 ± 1.0 g/L, and hospital stay was 3.1 ± 0.8 days. There was 1 case of fever and urinary infection, 2 cases of hematuria, and 1 case of flank pain. All symptoms resolved after conservative or antibiotic treatment. On postoperative day 1, 12 (42.9%) caseswere stone-free. The stone-free rates at postoperative month 1 and 3 were 92.9% (26/28) and 100% (28/28), respectively. CONCLUSIONS Our self-assembled visual needle and UAS instrument is effective for microperc. Use of the UAS may improve the operative outcome.
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Affiliation(s)
- Jiqing Zhang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ning Kang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuguang Jiang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Junhui Zhang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Parente A, Ortiz R, Fernández-Bautista B, Burgos L, Angulo JM. Micro-Ureteroscopy as a Treatment of Renal Pelvis Lithiasis in Young Children. Front Pediatr 2021; 9:593743. [PMID: 34041205 PMCID: PMC8141860 DOI: 10.3389/fped.2021.593743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: Miniaturization of endoscopic instruments has allowed to improve the efficacy of kidney stone treatment in young children. Aim of the study is to evaluate the usefulness of microureteroscopy with 4.85F sheath in the treatment of renal stones in children. M&M: We present 4 cases of microureteroscopy in 3 younger than 3 years patients with renal pelvic stones. Lithiasis was unilateral in 2 female patients and bilateral in 1 male patient. Microureteroscopy was performed using a MicroPerc set 4.85F sheath, without placing a safety guide or dilating the meatus in 3 procedures. The lithotripter system used was Ho:YAG Laser with 200-μm fiber in all cases. Results: Mean operating time was 100 ± 16 min. There were no intraoperative complications. In all procedures, complete pulverization of the lithiasis was achieved, except in the coraliform lithiasis in which 5 mm residual lithiasis remained in the lower calyx. All patients were discharged 24 h after the intervention. Conclusion: Microureteroscopy can be considered a new alternative for treatment of selected cases of renal pelvic stones in infants and children.
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Affiliation(s)
| | - Ruben Ortiz
- Gregorio Marañón University Hospital, Madrid, Spain
| | | | - Laura Burgos
- Gregorio Marañón University Hospital, Madrid, Spain
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Halinski A, Steyaert H, Wojciech M, Sobolewski B, Haliński A. Endourology Methods in Pediatric Population for Kidney Stones Located in Lower Calyx: FlexURS vs. Micro PCNL (MicroPERC®). Front Pediatr 2021; 9:640995. [PMID: 34095024 PMCID: PMC8175969 DOI: 10.3389/fped.2021.640995] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 04/12/2021] [Indexed: 11/25/2022] Open
Abstract
Kidney stone disease in children is always a therapeutic challenge. It is a multifactorial condition and it should be approached, diagnosed and treated as such. One of the biggest challenges is kidney stones located in the lower renal calyx. There are currently three main surgical techniques to treat this condition: ESWL-Extracorporeal Shock Wave Lithotripsy, RIRS-Retrograde IntraRenal Surgery, and PCNL-PerCutaneous Nephro-Lithotripsy. In pediatric population, the most frequently used method is ESWL, and in the event of failure, endoscopic procedures are the second-best choice. In this article, a sample of 53 children admitted to a tertiary medical center was examined. Thirty-eight of those children underwent flexible URS, while the remaining 15-micro PCNL. The average size of the deposit in the former group was 12.2 mm, against 13.5 mm in the latter. The full Stone Free Rate (SFR) was achieved in RIRS at 84.21 and 86.7% in percutaneous nephrolithotripsy. Flexible ureterorenoscopy and MicroPERC are two comparably effective methods for treating lower calyx stones of any size. However, according to our data, flexible ureterorenoscopy carries a lower risk of complications and inpatient care (with the mean of 3 days). The learning curve for these procedures in pediatric urology is long and relies on a limited number of patients. The number of pediatric patients qualifying for these procedures is restricted also due to the high efficacy of extracorporeal shock wave lithotripsy in pediatric population. Radiation exposure is an important factor in every endoscopy procedure and should never exceed the limits set in the ALARA protocol. ESWL remains to this day the treatment of choice for stone disease in children and can be performed under ultrasound control. For many parents, it is a first-choice treatment preference for their child due to its greater apparent safety, although data on this remains insufficient. Prospective, randomized, multicenter trials are definitely needed.
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Affiliation(s)
- Adam Halinski
- Department of Pediatric Urology, Private Medical Center "Klinika Wisniowa", Zielona Góra, Poland.,Department of Clinical Genetics and Pathomorphology, Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland
| | - Henri Steyaert
- Department of Pediatric Surgery, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Magdalena Wojciech
- Department of Mathematical Statistics and Econometrics, Faculty of Mathematics, Computer Science and Econometrics, University of Zielona Góra, Zielona Góra, Poland
| | - Bartłomiej Sobolewski
- Department of Pediatric Urology, Private Medical Center "Klinika Wisniowa", Zielona Góra, Poland
| | - Andrzej Haliński
- Department of Pediatric Urology, Private Medical Center "Klinika Wisniowa", Zielona Góra, Poland
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Ong CSH, Biligere S, Mangat R, Thandapani K, Heng CT, Desai M, Sabnis RB, Sarica K, Scoffone C, Gauhar V. Micro endoscopic combined intrarenal surgery (microECIRS): A step-by-step guide. UROLOGY VIDEO JOURNAL 2020. [DOI: 10.1016/j.urolvj.2020.100063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Gu Z, Yang Y, Ding R, Wang M, Pu J, Chen J. Comparison of Retrograde Intrarenal Surgery and Micro-Percutaneous Nephrolithotomy for Kidney Stones: A Meta-Analysis. Urol Int 2020; 105:64-70. [PMID: 33227794 DOI: 10.1159/000506716] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 02/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Advances in micro-percutaneous nephrolithotomy (PCNL) for kidney stones have made it an alternative approach to the retrograde intrarenal surgery (RIRS) approach. Nevertheless, the superiority of micro-PCNL over RIRS is still under debate. The results are controversial. OBJECTIVES The purpose of this study was to systematically evaluate the clinical results in patients presenting with kidney stones treated with micro-PCNL or RIRS. METHODS A literature search was done for electronic databases to identify researches that compared micro-PCNL and RIRS till December 2019. The clinical outcome included complications, stone-free rates (SFRs), hemoglobin reduction, length of hospital stay, and operative time. RESULTS Five articles were included in our study. The pooled results revealed no statistical difference in the rate of complications (OR = 0.99, 95% CI = 0.57-1.74, p = 0.99), length of hospital stay (MD = -0.29, 95% CI = -0.82 to 0.24, p = 0.28), and operative time (MD = -6.63, 95% CI = -27.34 to 14.08, p = 0.53) between the 2 groups. However, significant difference was present in hemoglobin reduction (MD = -0.43, 95% CI = -0.55 to 0.30, p < 0.001) and the SFRs (OR = 0.59, 95% CI = 0.36-0.98, p = 0.04) when comparing RIRS with micro-PCNL. CONCLUSIONS Compared with micro-PCNL to treat kidney stones, RIRS is associated with better stone clearance and bearing higher hemoglobin loss. As the advantages of both technologies have been shown in some fields, the continuation of well-designed clinical trials may be necessary.
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Affiliation(s)
- Zhenhua Gu
- Department of Urology, Wuxi Traditional Chinese Medicine Hospital, Wuxi, China
| | - Yucheng Yang
- Department of Urology, Wuxi Traditional Chinese Medicine Hospital, Wuxi, China
| | - Rui Ding
- Department of Urology, Wuxi Traditional Chinese Medicine Hospital, Wuxi, China
| | - Meili Wang
- Department of Urology, Wuxi Traditional Chinese Medicine Hospital, Wuxi, China
| | - Jianming Pu
- Department of Urology, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China
| | - Jian Chen
- Department of Urology, Wuxi Traditional Chinese Medicine Hospital, Wuxi, China,
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Abstract
PURPOSE OF REVIEW To update laser lithotripsy advances in regard to new laser types and technologies as well as review contemporary laser safety concerns. RECENT FINDINGS The high prevalence of urolithiasis and the continuing miniaturization of scopes has encouraged the growth of laser lithotripsy technology. The holmium:yttrium-aluminum-garnet (Ho:YAG) laser has been used for over 20 years in endourology and has been extensively studied. Holmium laser power output is affected by a number of factors, including pulse energy, pulse frequency, and pulse width. Several recent experimental studies suggest that the new dual-phase Moses 'pulse modulation' technology, introduced in high-power laser machines, carries a potential to increase stone ablation efficiency and decrease stone retropulsion. A newly introduced thulium fiber laser (TFL) has been adapted to a very small laser fiber size and is able to generate very low pulse energy and very high pulse frequency. Both of these technologies promise to play a larger role in laser lithotripsy in the near future. However, more experimental and clinical studies are needed to expand on these early experimental findings. Even though laser lithotripsy is considered safe, precautions should be taken to avoid harmful or even catastrophic adverse events to the patient or the operating room staff. SUMMARY The Ho:YAG laser remains the clinical gold standard for laser lithotripsy for over the last two decades. High-power Ho:YAG laser machines with Moses technology have the potential to decrease stone retropulsion and enhance efficiency of laser ablation. The new TFL has a potential to compete with and perhaps even replace the Ho:YAG laser for laser lithotripsy. Safety precautions should be taken into consideration during laser lithotripsy.
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Vacuum-assisted mini-percutaneous nephrolithotomy: a new perspective in fragments clearance and intrarenal pressure control. World J Urol 2020; 39:1717-1723. [PMID: 32591902 PMCID: PMC8217021 DOI: 10.1007/s00345-020-03318-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/16/2020] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To describe the vacuum-assisted mini-percutaneous nephrolithotomy (vmPCNL) technique performed via the 16Ch ClearPetra sheath, to evaluate its outcomes and to analyze intrarenal pressure (IRP) fluctuations during surgery. METHODS Data from all consecutive vmPCNL procedures from September 2017 to October 2019 were prospectively collected. Data included patients' and stones characteristics, intra and peri-operative items, post-operative complications and stone clearance. Patients undergoing vmPCNL from March to October 2019 were submitted to IRP measurement during surgery. RESULTS A total of 122 vmPCNL procedures were performed. Median stone volume was 1.92 cm3. Median operative time was 90 min and median lithotripsy and lapaxy time was 28 min. Stone clearance rate was 71.3%. Thirty-one (25.2%) patients experienced post-operative complications, seven of which were Clavien 3. Postoperative fever occurred in nine (7.4%) patients and one (0.8%) needed a transfusion. No sepsis were observed. IRPs were measured in 22 procedures. Mean IRP was 15.3 cmH2O and median accumulative time with IRP > 40.78 cmH2O (pyelovenous backflow threshold) was 28.52 sec. Maximum IRP peaks were reached during the surgical steps when aspiration is closed (mainly pyelograms), whereas during lithotripsy and suction-mediated lapaxy, the threshold of 40.78 cmH2O was overcome in three procedures. CONCLUSIONS vmPCNL is a safe procedure with satisfactory stone clearance rates. Mean IRP was always lower than the threshold of pyelo-venous backflow and the accumulative time with IRP over this limit was short in most of the procedures. During lithotripsy and vacuum-mediated lapaxy, IRP rarely raised over the threshold.
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Rassweiler-Seyfried MC, Lima E, Ritter M, Klein JT, Michel MS. [Navigation systems for the percutaneous access to the kidney]. Urologe A 2020; 59:1017-1025. [PMID: 32533201 DOI: 10.1007/s00120-020-01250-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Percutaneous access to the renal pelvis still remains the most difficult step before nephrolitholapaxy (PCNL). New imaging techniques, such as 3D imaging and various navigation instruments such as electromagnetic, sonographic, CT-controlled and marker-based/iPAD try to simplify this step and reduce complications. OBJECTIVES In this review, various new techniques for puncturing the renal collecting system are presented and their advantages and disadvantages are evaluated. MATERIALS AND METHODS A systematic literature search was carried out in MEDLINE, whereby only puncture techniques that have already been evaluated in clinical studies were included. RESULTS Five different navigation methods for puncturing the renal pelvis before PCNL were found. CONCLUSION Intraoperative navigation can be useful when puncturing the collecting system. The combination of ultrasound and fluoroscopy currently remains the gold standard. However, there is still a need for further, primarily clinical, prospective studies to determine which new imaging technology and navigation systems will prevail and thus facilitate the access route to the kidney, especially in the case of special anatomical conditions.
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Affiliation(s)
- M-C Rassweiler-Seyfried
- Klinik für Urologie und Urochirurgie, Universitätsmedzin Mannheim, Theodor-Kutzer-Ufter 1-3, 68161, Mannheim, Deutschland.
| | - E Lima
- Department of Urology - Hospital of Braga, University of Minho, Campus de Gualtar, 4709-057, Braga, Portugal
| | - M Ritter
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - J-T Klein
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - M-S Michel
- Klinik für Urologie und Urochirurgie, Universitätsmedzin Mannheim, Theodor-Kutzer-Ufter 1-3, 68161, Mannheim, Deutschland
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Kallidonis P, Tsaturyan A, Lattarulo M, Liatsikos E. Minimally invasive percutaneous nephrolithotomy (PCNL): Techniques and outcomes. Turk J Urol 2020; 46:S58-S63. [PMID: 32525477 DOI: 10.5152/tud.2020.20161] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/15/2020] [Indexed: 02/03/2023]
Abstract
Minimally invasive percutaneous nephrolithotomy (PCNL) was introduced to decrease the morbidity of the standard PCNL (sPCNL). Thereafter, many modifications and techniques have been presented with the introduction of different miniaturized PCNL (mPCNL) techniques, such as micro-PCNL and ultra-mini-PCNL (UMP). As of present, none of the techniques has displaced the sPCNL. Nonetheless, mini-PCNL has continuously widening indications and has been proposed to have significant advantages over sPCNL. In the current review, each technique is presented while discussing the advantages and disadvantages of each approach. A comprehensive review of the current literature has been performed. Articles related to the topic were retrieved and critically analyzed. Less peri-operative bleeding and shorter hospital stay were the most important advantages advocated for mini-PCNL. Although the performance of mini-PCNL is safe, the utilization of micro-PCNL and UMP should be done with caution.
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Affiliation(s)
| | - Arman Tsaturyan
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - Marco Lattarulo
- Department of Urology, University Hospital of Patras, Patras, Greece
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Borofsky MS. EDITORIAL COMMENT. Urology 2020; 140:32-33. [DOI: 10.1016/j.urology.2019.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Emiliani E, Kanashiro A, Chi T, Pérez-Fentes DA, Manzo BO, Angerri O, Somani BK. Fluoroless Endourological Surgery for Stone Disease: a Review of the Literature—Tips and Tricks. Curr Urol Rep 2020; 21:27. [DOI: 10.1007/s11934-020-00979-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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What is the optimum lithotripsy method for high density stones during mini-PNL? Laser, ballistic or combination of both. Lasers Med Sci 2020; 35:1765-1768. [DOI: 10.1007/s10103-020-02971-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/22/2020] [Indexed: 12/23/2022]
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Wang JL, Cui ZY, Zhu SF, Yang WZ, Zhou HY, Zhang SQ, Fu ZS, Sun YF. Treatment of renal calculi without hydronephrosis using a standard channel assisted by a visual puncture system. J Int Med Res 2020; 48:300060519893869. [PMID: 31939324 PMCID: PMC7114277 DOI: 10.1177/0300060519893869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective To study the safety and efficacy of standard channel establishment using a visual puncture system in the treatment of renal calculi without hydronephrosis. Methods We retrospectively analyzed data from 46 patients undergoing percutaneous nephrolithotomy via a standard channel assisted by a visual puncture system, including number of punctures, duration of procedure, hemoglobin level after surgery, calculi clearance rate, and postoperative complications. Results Sixty-nine channels were established, including a single channel in 26 cases, double channel in 17 cases, and three channels in 3 cases. The mean number of punctures was 1.50, mean time to establish the standard channel was 2.6 minutes, and duration of surgery was 31.3 minutes. No significant change in hemoglobin was observed after surgery. Forty-three patients had no residual calculi and three had small residual calculi on the day after surgery, representing a first-phase clearance rate of 93.48% (43/46). No significant complications were observed. Conclusions Hemorrhage during operation can be significantly reduced by establishing a standard channel using a visual puncture system. Moreover, the number of standard channels can be reduced and the incidence of complications lowered using this approach, which should be adopted widely for the treatment of renal calculi without hydronephrosis.
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Affiliation(s)
- Ji-Liang Wang
- Medical College of Hebei University, Baoding, Hebei, P. R. China
| | - Zhen-Yu Cui
- Department of Urology, Affiliated Hospital of Hebei University, Baoding, Hebei, P. R. China
| | - Shi-Fan Zhu
- Unit 66069-79 of the PLA, Luoyang, Henan, P. R. China
| | - Wen-Zeng Yang
- Department of Urology, Affiliated Hospital of Hebei University, Baoding, Hebei, P. R. China
| | - Hong-Yue Zhou
- Department of Urology, Affiliated Hospital of Hebei University, Baoding, Hebei, P. R. China
| | - Shi-Qing Zhang
- Medical College of Hebei University, Baoding, Hebei, P. R. China
| | - Ze-Sheng Fu
- Medical College of Hebei University, Baoding, Hebei, P. R. China
| | - Yun-Fei Sun
- Medical College of Hebei University, Baoding, Hebei, P. R. China
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Destro F, Selvaggio GGO, Lima M, Riccipetitoni G, Klersy C, Di Salvo N, Marinoni F, Calcaterra V, Pelizzo G. Minimally Invasive Approaches in Pediatric Urolithiasis. The Experience of Two Italian Centers of Pediatric Surgery. Front Pediatr 2020; 8:377. [PMID: 32793523 PMCID: PMC7393988 DOI: 10.3389/fped.2020.00377] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/04/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Over the last 30 years, the incidence of pediatric urolithiasis (PU) has been increasing and the surgical management has evolved toward a minimally invasive approach (MIA). We reported the experience of two Centers of Pediatric Surgery in the management of PU, focusing on MIA as first choice in treatment. Methods: Data were retrospectively analyzed from October 2009 to October 2019 in children with urolithiasis who were admitted to two referral Italian Centers of Pediatric Surgery. Demographic and clinical data of the patients, features of the urolithiasis, type of surgery were considered. Results: Seventy patients (7.3 ± 5.0 years) with normal renal function were treated for calculi in the pyelocaliceal system (45.7%), ureter (34.3%), bladder (4.3%), urethra (1.4%), and multiple locations (14.3%). Size of calculi was >10 mm in 55.7% of cases (kidney>bladder/urethra>multiple>ureter, p = 0.01). Symptoms were present in 75.7% of patients. Family history was positive in 16.9% of cases. MIA was performed in 59 patients (84.3%): 11.8% shockwave lithotripsy (kidney>ureter>multiple); 32.2% ureteral retrograde surgery (ureteral>other localizations); 30.5% retrograde intrarenal surgery (kidney>other localizations); and 25.4% other procedures including percutaneous nephrolithotomy, cystoscopic bladder stone removal or laser cystolithotripsy (kidney>bladder>multiple). Preoperative stenting was necessary in 52.8% of cases. Four MIA procedures (6.9%, kidney>ureter/multiple) were converted to open surgery. Open surgery was required as first approach in 15.7% of patients (kidney>ureter>multiple) who needed urgent surgery or had associated congenital renal anomalies. In 18/70 of children (25.7%), with prevalence of stones in kidney and multiple location (p < 0.01), a second procedure completed the treatment (88.8% MIA). Intraoperative difficulties were recorded in 8.5% of cases, without difference between location and size of calculi. Late complications (5.7%) were related to displacement and infection of the ureteral stent. Conclusions: MIA resulted to be feasible in more than 75% of primary surgery and in more than 85% of cases requiring a second procedure. Preoperative stent was mandatory in more than 50% of children. The technological evolution allowed to overcome many of the technical difficulties related to the approach to the papilla and lower calyxes. Open surgery is reserved for selected cases and endoscopic surgery represents the best choice of treatment for PU.
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Affiliation(s)
- Francesca Destro
- Pediatric Surgery Unit, V. Buzzi Children's Hospital, Milan, Italy
| | | | - Mario Lima
- Pediatric Surgery Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Catherine Klersy
- Clinical Epidemiology & Biometry, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Neil Di Salvo
- Pediatric Surgery Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy.,Pediatric Unit, V. Buzzi Children's Hospital, Milan, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Unit, V. Buzzi Children's Hospital, Milan, Italy.,Department of Biomedical and Clinical Science L. Sacco, University of Milan, Milan, Italy
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Zhang B, Xie H, Hu Y, Liu C. The visual percutaneous nephrolithotomy versus the conventional percutaneous nephrolithotomy in treatment for renal stone. MINERVA UROL NEFROL 2019; 71:627-635. [DOI: 10.23736/s0393-2249.19.03465-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Zhou M, He X, Zhang Y, Yu W. Optical puncture combined with balloon dilation PCNL vs. conventional puncture dilation PCNL for kidney stones without hydronephrosis: a retrospective study. BMC Urol 2019; 19:122. [PMID: 31775711 PMCID: PMC6882241 DOI: 10.1186/s12894-019-0558-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/13/2019] [Indexed: 11/29/2022] Open
Abstract
Background Accurate puncture and dilation of the target kidney calices for percutaneous nephrolithotomy (PCNL) can be difficult. This study aimed to investigate the advantages of PCNL using optical puncture (i.e. the puncture is visualized on a screen as seen through the needle) combined with balloon dilation vs. conventional puncture methods. Methods This was a retrospective study of 58 consecutive patients with kidney stones without hydronephrosis and treated at the Minimally Invasive Urology Center of Zhejiang Provincial People’s Hospital between 10/2016 and 12/2017. Twenty-one patients underwent optical puncture combined with balloon dilation PCNL. Thirty-seven patients underwent conventional puncture instrument dilation PCNL (controls). Success rate, tubeless rate, blood loss, pain, and complications were compared between the two groups. Results The one-time puncture success rate (95.2% [20/21] vs. 67.6% [25/37], P = 0.02) and the postoperative tubeless rate (81.0% [17/21] vs. 54.1% [20/37], P = 0.04) were higher in the optical puncture group compared with controls. The average postoperative hemoglobin reduction was smaller (1.13 ± 0.63 vs. 1.56 ± 0.59 g/dL, P = 0.01), the postoperative VAS score was lower (1.6 ± 0.9 vs. 2.5 ± 1.2, P = 0.004), the rate of postoperative analgesic use was lower (14.3% [3/21] vs. 40.5% [15/37], P = 0.04), and the postoperative mean hospitalization days was shorter (3.7 ± 0.9 vs. 4.4 ± 0.8, P = 0.005) in the optical puncture group vs. controls. There was no case of urinary sepsis, blood transfusion, perirenal hematoma, pleural injury, and visceral organ damage. Conclusions Optical puncture combined with balloon dilation PCNL could be associated with good therapeutic effect and low frequency of complications for the treatment of kidney stones without hydronephrosis.
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Affiliation(s)
- Mi Zhou
- Department of Urology, Zhejiang Provincial People's Hospital/People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Xiang He
- Department of Urology, Zhejiang Provincial People's Hospital/People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Yuelong Zhang
- Department of Urology, Zhejiang Provincial People's Hospital/People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Weiwen Yu
- Department of Urology, Zhejiang Provincial People's Hospital/People's Hospital of Hangzhou Medical College, Hangzhou, China.
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Sultan S, Aba Umer S, Ahmed B, Naqvi SAA, Rizvi SAH. Update on Surgical Management of Pediatric Urolithiasis. Front Pediatr 2019; 7:252. [PMID: 31334207 PMCID: PMC6616131 DOI: 10.3389/fped.2019.00252] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/03/2019] [Indexed: 12/15/2022] Open
Abstract
Urolithiasis has always been a fascinating disease, even more so in children. There are many intriguing facets to this pathology. This article is a nonsystematic review to provide an update on the surgical management of pediatric urolithiasis. It highlights the pros and cons of various minimally invasive surgical options such as extracorporeal shockwave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), laparoscopy, and robotics. This article also describes the various intracorporeal disintegration technologies available to fragment the stone, including the newer advancements in laser technology. It also emphasizes the cost considerations especially with reference to the emerging economies. Thus, this manuscript guides how to select the least-invasive option for an individual patient, considering age and gender; stone size, location, and composition; and facilities and expertise available.
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Affiliation(s)
- Sajid Sultan
- Philip G. Ransley Department of Paediatric Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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31
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Baralo B, Samson P, Hoenig D, Smith A. Percutaneous kidney stone surgery and radiation exposure: A review. Asian J Urol 2019; 7:10-17. [PMID: 31970066 PMCID: PMC6962710 DOI: 10.1016/j.ajur.2019.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/06/2018] [Accepted: 10/08/2018] [Indexed: 11/30/2022] Open
Abstract
During the past 3 decades, radiation exposure (RE) has increased drastically among patients undergoing percutaneous nephrolithotomy (PCNL), thus potentially causing new cases of cancer each year. The effective dose received by patients comes from pre- and post-operative computed tomography (CT) and intraoperative fluoroscopy (FL). We reviewed literature to find novel techniques and approaches that help to decrease RE of patients and personnel. We performed PubMed search using keywords percutaneous nephrolithotomy, intraoperative fluoroscopy, radiation exposure, imaging, percutaneous access, ultrasound, computed tomography, endoscopy, reconstruction, innovations, and augmented reality. Forty-four relevant articles were included in this review. As much as 20% of patients with first diagnosed urolithiasis exceed background RE level almost 17-fold. For diagnosing purposes using low-dose and ultra-low-dose CT, as well as low-dose dual energy scan protocols can be efficient ways to decrease RE while maintaining decent accuracy. Patients with urinary stones can be effectively monitored with digital tomosynthesis, ultrasound alone or ultrasound combined with plain film of the abdomen. Percutaneous access (PCA) into the kidney can be performed with reduced or even no RE, using novel PCA methods. REs from conventional imaging techniques during diagnosis and treatment increase probability of non-stochastic radiation effects. Urologists should be aware of protocols that decrease RE from CT and FL in diagnosis and management of urinary stones. Consideration of recently developed imaging modalities and PCA techniques will also aid in adherence to the “as low as reasonably achievable” principle.
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Affiliation(s)
- Bohdan Baralo
- Urology Department, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Patrick Samson
- Department of Urology, Smith Institute for Urology, Northwell Health, New Hyde Park, NY, USA
| | - David Hoenig
- Department of Urology, Smith Institute for Urology, Northwell Health, New Hyde Park, NY, USA
| | - Arthur Smith
- Department of Urology, Smith Institute for Urology, Northwell Health, New Hyde Park, NY, USA
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Sabler IM, Katafigiotis I, Gofrit ON, Duvdevani M. Present indications and techniques of percutaneous nephrolithotomy: What the future holds? Asian J Urol 2018; 5:287-294. [PMID: 30364501 PMCID: PMC6197369 DOI: 10.1016/j.ajur.2018.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 04/10/2018] [Accepted: 05/25/2018] [Indexed: 12/12/2022] Open
Abstract
The purpose of the review was to present the latest updates on percutaneous nephrolithotomy (PCNL) procedure in terms of indications and evolving techniques, and to identify the advantages and disadvantages of each modality. The data for this review were collected after a thorough PubMed search in core clinical journals in English language. The key words included “PCNL” and “PNL” in combination with “indications”, “techniques”, “review” and “miniaturized PCNL”. Publications relevant to the subject were retrieved and critically reviewed. Current European and American Urology Association Nephrolithiasis Guidelines were included as well. The indications for standard PCNL have been changed through the past decade. Despite evolution of the procedure, innovations and the development of new technical approaches, the indications for miniaturized PCNL have not been standardized yet. There is a need for well-constructed randomized trials to explore the indications, complications and results for each evolving approach. A continuous reduction of tract size is not the only revolution of the last years. There is constant ongoing interest in developing new efficient miniature instruments, intracorporeal lithotripters and sophisticated tract creation methods. We can summarize that, PCNL represents a valuable well-known tool in the field of endourology. We should be open minded to future changes in surgical approaches and technological improvements.
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Affiliation(s)
- Itay M Sabler
- Department of Urology, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Ioannis Katafigiotis
- Department of Urology, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
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Clinical application of super-mini PCNL (SMP) in the treatment of upper urinary tract stones under ultrasound guidance. World J Urol 2018; 37:943-950. [PMID: 30167833 DOI: 10.1007/s00345-018-2465-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To present the safety and efficacy of totally ultrasonography-guided Super-mini percutaneous nephrolithotomy (SMP) in the treatment of upper urinary tract stones both in children and adults. PATIENTS AND METHODS We carried out SMP in 104 patients (including 48 children and 56 adults) with upper urinary tract stones between June 2015 and February 2017. All steps of renal access were performed by ultrasonography. The lithotripsy was performed using either Holmium laser or pneumatic lithotripter. Perioperative and postoperative parameters along with operative data were recorded in detail. RESULTS The mean age of children and adult patients were 4.4 ± 3.6 and 44.3 ± 15.7 years old, respectively. The stone burden was comparable for both groups (1.72 ± 0.66 vs 1.74 ± 0.56 cm, p = 0.852). Mean operation time was not significant different between two groups (p = 0.052), while the mean haemoglobin drop in children was much lower in adult patients (6.3 ± 6.9 vs 10.9 ± 8.69, p = 0.004). Both groups had similar SFRs in postoperative 1 day and at 1-month follow-up (p = 1.000, p = 0.912). Mean hospital stay of children and adult patients was 2.3 ± 0.8 and 2.2 ± 0.76 days (p = 0.484). The total complication rate was significantly lower in two groups (p = 1.000); none of the patients required blood transfusion. CONCLUSIONS Ultrasonography-guided SMP was a safe and effective treatment option for moderate-sized upper urinary tract stones, and has the advantage of preventing radiation hazard, especially for pediatric stone patients.
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Gupta S, Das SK, Pal DK. Total tubeless ultra-mini supine percutaneous nephrolithotomy: A feasibility study. Turk J Urol 2018; 44:323-328. [PMID: 29932402 DOI: 10.5152/tud.2018.48642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 03/05/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The ultra-mini percutaneous nephrolithotomy (PCNL) for treating low-volume renal nephrolithiasis is being used as an alternative modality to the conventional PCNL. However its use in the supine position has been scarcely reported. MATERIAL AND METHODS Patients who underwent ultra-mini PCNL in the supine position within the time frame of January 2017 to July 2017 were studied. All these patients had this as their first-line treatment. The patients had calculus limited to either a single calyx or just extending to the pelvis and the stone size was less than 2 cm in its maximal dimension. An 8.5 Fr operating nephroscope was used. The patients were positioned in the Galdakao modified Valdivia supine position. The stones were fragmented using Holmium-YAG laser. Various surgical outcomes including duration of the surgery, stone-free rate and any subsequent complications-if any-were analyzed. RESULTS The study includes a series of 14 patients with 15 renal units (one patient treated with bilateral renal stone disease). The mean age of the patients was 39.07 years and body mass index was 25.5 kg/m2. Intrarenal stone location was as follows: lower calyx, n=8; middle calyx, n=3, upper calyx, n=1, and pelvis, n=3. Median operative time was 52.66 min (range: 40-70) and the stone-free rate was 93.3%. Only one patient had residual fragments and needed subsequent extracorporeal shock wave lithotripsy. CONCLUSION Ultra-mini PCNL in supine position with a complete tubeless approach for renal stone disease is a safe method for treating low-volume disease. Studies with a larger cohort may be required to finally validate this technique.
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Affiliation(s)
- Sandeep Gupta
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Susanta Kumar Das
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Dilip Kumar Pal
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, India
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Basiri A, Shakiba B, Hoshyar H, Ansari A, Golshan A. Biplanar oblique access technique: A new approach to improve the success rate of percutaneous nephrolithotomy. Urologia 2018; 85:118-122. [DOI: 10.1177/0391560318772467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: Achieving suitable percutaneous access to the kidney is the most important step in percutaneous nephrolithotomy. The triangulation biplanar access technique under fluoroscopy is the standard method to achieve percutaneous renal access, but it is not successful in all cases. We used the new biplanar oblique access technique as a rescue method for the failed standard biplanar technique. The aim of this study was to evaluate the effects of this oblique access technique on access outcome. Methods: In total, 782 percutaneous nephrolithotomy procedures were performed under the standard triangulation biplanar technique. The biplanar access failed in 35 cases. Access failure was defined as no urine dropping from the needle or inability to insert the guide wire into the renal pelvis or selected calyx. In 28 failed access cases, the lower calyx was the targeted calyx. We used the oblique access technique for these cases. Initially, the arm of fluoroscopy was in the vertical position. Then the fluoroscopy device was rotated to 30° near the surgeon and 30° caudal to the patient and the needle was inserted into the appropriate calyx. Results: Percutaneous nephrolithotomy procedures were performed by the oblique access technique in 28 patients. Successful access was achieved in eight patients by the oblique technique (success access rate = 28.6%). No major or minor complication occurred in these patients. Conclusion: The oblique technique is an auxiliary method for accessing the lower calyx in cases which the standard triangular biplanar method has failed. As the failure rate of the biplanar technique is low, the oblique technique can be considered as a useful method for percutaneous access.
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Affiliation(s)
- Abbas Basiri
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnam Shakiba
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hasan Hoshyar
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anahita Ansari
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Golshan
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ibrahim A, Wollin D, Preminger G, Andonian S. Technique of Percutaneous Nephrolithotomy. J Endourol 2018; 32:S17-S27. [DOI: 10.1089/end.2018.0047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Ahmed Ibrahim
- Division of Urology, Department of Surgery, McGill University, Montreal, Canada
| | - Daniel Wollin
- Division of Urology, Department of Surgery, Duke University, Durham, North Carolina
| | - Glenn Preminger
- Division of Urology, Department of Surgery, Duke University, Durham, North Carolina
| | - Sero Andonian
- Division of Urology, Department of Surgery, McGill University, Montreal, Canada
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Jiang K, Chen H, Yu X, Chen Z, Ye Z, Yuan H. The "all-seeing needle" micro-PCNL versus flexible ureterorenoscopy for lower calyceal stones of ≤ 2 cm. Urolithiasis 2018; 47:201-206. [PMID: 29497768 DOI: 10.1007/s00240-018-1049-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 02/22/2018] [Indexed: 12/23/2022]
Abstract
The objectives of the study are to compare the safety and efficacy of "all-seeing needle" optical puncture system micro-percutaneous nephrolithotomy (micro-PCNL) and flexible ureterorenoscopy (FURS) for the treatment of lower calyceal stones of ≤ 2 cm and to determine the advantages and disadvantages of each. 116 patients in total with lower calyceal stones of ≤ 2 cm were randomly divided into two equal groups, "all-seeing needle" optical puncture system micro-PCNL and FURS. In both groups, holmium laser was utilized for lithotripsy. The perioperative parameters were compared between the two groups. Compared to the "all-seeing needle" micro-PCNL group, the mean operative time was significantly longer in the FURS group (P = 0.000). However, there was no significant difference between the two groups with respect to mean hemoglobin reduction (P = 0.087), complications (P = 0.731) and LOS (P = 0.856). The overall SFR of the "all-seeing needle" micro-PCNL group and FURS group was 84.5% (49/58) and 79.3% (46/58), respectively, without any significant difference between the groups (P = 0.469). For treating lower calyceal stones of ≤ 2 cm, the "all-seeing needle" micro-PCNL group had shorter operative time than FURS, while no significant differences between the two groups with respect to mean hemoglobin reduction, complications, LOS and SFR were found.
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Affiliation(s)
- Kehua Jiang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Department of Urology, The Central Hospital of Enshi Autonomous Prefecture, Enshi, Hubei, China
| | - Hongbo Chen
- Department of Urology, The Central Hospital of Enshi Autonomous Prefecture, Enshi, Hubei, China
| | - Xiao Yu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhiqiang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Huixing Yuan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Liu Y, AlSmadi J, Zhu W, Liu Y, Wu W, Fan J, Lan Y, Lam W, Zhong W, Zeng G. Comparison of super-mini PCNL (SMP) versus Miniperc for stones larger than 2 cm: a propensity score-matching study. World J Urol 2018; 36:955-961. [DOI: 10.1007/s00345-018-2197-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 01/19/2018] [Indexed: 12/23/2022] Open
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Abstract
Conventional PCNL leads to a high stone-free rate but is associated with a significant treatment morbidity. To decrease the morbidity of PCNL but to achieve an equal stone-free rate, in 2001 a miniaturised version of a conventional PCNL (Mini-PCNL) was introduced. Meanwhile numerous modifications of the Mini-PCNL were reported. The ongoing experience with the Mini-PCNL technique showed that Mini-PCNL is not only a miniaturisation but also a different method to remove the stones, as the stones come out of the calyceal system only by means of the irrigation flow without any further need of forceps or baskets. Due to a limited number of papers in the literature, the guidelines so far do not distinguish between conventional and Mini-PCNL, although the Mini-PCNL already became a frequent treatment modality in daily routine worldwide. From the current point of view, Mini-PCNL can be recommended to treat all kinds of upper urinary tract stones exceeding a diameter of 10 mm. In this context, Mini-PCNL is a treatment alternative to flexible ureterorenoscopy, SWL and conventional PCNL. The available literature shows that the morbidity of Mini-PCNL is less and the stone-free rate is equal to that of conventional PCNL. It seems that there is no limitation to Mini-PCNL in the treatment of upper urinary tract stones. The future will show what kind of further miniaturisation of the Mini-PCNL procedure will be appropriate.
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Affiliation(s)
- Sven Lahme
- Department of Urology, Center for minimally-invasive Therapy, Robotic-assisted Surgery, Siloah St. Trudpert Hospital, Wilferdinger Strasse 67, 75179, Pforzheim, Germany.
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"Microperc" micropercutaneous nephrolithotomy: a review of the literature. Urolithiasis 2017; 46:107-114. [PMID: 29218393 DOI: 10.1007/s00240-017-1021-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 11/11/2017] [Indexed: 10/18/2022]
Abstract
Recent years have seen innovations in working armamentarium of percutaneous nephrolithotomy (PCNL) leading to development of novel modifications such as miniperc, ultra miniperc, and microperc. Amongst these microperc appears to be least invasive and various authors, off late, have reported their experience with the technique. Literature on microperc was reviewed by a MEDLINE/PubMed search with articles in the English language since 2011 in published peer-reviewed journals. Articles comprised of case series, comparative, and noncomparative studies. Different facets encompassing the technique were analyzed including contemporary indications, technique and its modifications, outcomes, and comparison with other modalities. Technique is reported to be associated with high success rate (82-100%) and short hospital stay (1-2 days). Studies have reported minimal hemoglobin drop (0.1-1.4 gm%) and fewer complications of lower Clavien grades. Going small in PCNL has gone a long way to present day 4.85F puncture system. Utilization of this novel modification is on rise with larger case series and comparative analysis being reported in past 2 years. Technique boasts of high clearance rate, lower morbidity and short hospital stay. In the present era, this innovation in percutaneous stone management appears to be another milestone in quest for "knife to cannula to needle to nothing".
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Sen H, Seckiner I, Bayrak O, Dogan K, Erturhan S. A comparison of micro-PERC and retrograde intrarenal surgery results in pediatric patients with renal stones. J Pediatr Urol 2017; 13:619.e1-619.e5. [PMID: 28679474 DOI: 10.1016/j.jpurol.2017.04.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 04/02/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION With advancements in endoscopic surgery, open surgical techniques for urinary system stones have paved the way for the application of less invasive treatment modalities in patients with pediatric kidney stone disease. These treatment options include extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS). OBJECTIVE We aimed to compare the efficacy and safety of RIRS and micro-PCNL techniques in the surgical treatment of kidney stones in pediatric patients. STUDY DESIGN A total of 48 pediatric patients, who underwent RIRS or micro-PERC for pediatric kidney stone disease, were retrospectively analyzed. Urinalysis, urine culture, serum creatinine (Cr), blood urea nitrogen (BUN), calcium, phosphorus, parathyroid hormone, 24-hour urine sample, complete blood count (CBC), urinary system X-ray, kidney ureter bladder (KUB), and urinary system ultrasonography (USG) test results were evaluated prior to the procedure. Intravenous pyelography (IVP), non-contrast computed tomography (CT), and renal scintigraphy evaluations were also performed, if necessary. The patients were divided into two groups: micro-PERC group (n = 25) and RIRS group (n = 23). Data relating to the duration of the operation, duration of fluoroscopy, length of hospitalization, complication rates, and stone-free rates were recorded. RESULTS The mean ages of the micro-PERC and RIRS groups were 4 ± 2.3 and 10.9 ± 3 years, respectively (p = 0.001). However, the mean stone sizes were 12.2 ± 2.8 and 13.7 ± 3.5 mm, respectively (p > 0.05). The mean duration of operation was 75.1 ± 18.9 min in the micro-PERC group and 62.3 ± 15.3 min in the RIRS group (p > 0.05). In addition, the mean duration of fluoroscopy was 115 ± 35.4 s in the micro-PERC group and 39.9 ± 15.3 s in the RIRS group. The stone-free rates in the micro-PERC and RIRS groups following the procedure were reported to be 84% (21/25) and 82.6% (19/23), respectively (p > 0.05). In terms of the degree of preoperative hydronephrosis between the groups, the rates of mild and moderate-severe disease were 76% (19 out of 25) and 24% (6 out of 25), and 69.5% (16 out of 23) and 30.4% (7 out of 23) in the micro-PERC and RIRS groups, respectively. CONCLUSION In recent years, technological developments in minimally invasive procedures, such as micro-PERC and RIRS, have facilitated choices made by urologists in the effective and safe first-line treatment in pediatric patients.
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Affiliation(s)
- Haluk Sen
- Department of Urology, School of Medicine, Gaziantep University, Gaziantep, Turkey.
| | - Ilker Seckiner
- Department of Urology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Omer Bayrak
- Department of Urology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Kazim Dogan
- Department of Urology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Sakip Erturhan
- Department of Urology, School of Medicine, Gaziantep University, Gaziantep, Turkey
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Knoll T. Super-, perfect-, ultra-, micro-, mini-, …: does anybody benefit from miniaturized percutaneous nephrolithotomy? World J Urol 2017; 36:319-320. [DOI: 10.1007/s00345-017-2120-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/30/2017] [Indexed: 12/23/2022] Open
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Silay MS. Recent Advances in the Surgical Treatment of Pediatric Stone Disease Management. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.eursup.2017.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Amón Sesmero JH, Cepeda Delgado M, de la Cruz Martín B, Mainez Rodriguez JA, Alonso Fernández D, Rodriguez Tesedo V, Martín Way DA, Gutiérrez Aceves J. Small-calibre percutaneous nephrolithotomy (SC-PCNL). Therapeutic decision algorithm. Actas Urol Esp 2017; 41:552-561. [PMID: 28392115 DOI: 10.1016/j.acuro.2016.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/20/2016] [Accepted: 11/21/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The progressive reduction in the calibre of the tract in percutaneous kidney surgery to the point of miniaturisation has expanded its use to smaller stones that until now have been treated with extracorporeal shock wave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS). OBJECTIVE To provide an update on the various techniques of small-calibre nephrolithotomy (SC-PCNL) analyse their efficacy, safety and indications and determine their degree of implantation at this time. MATERIAL AND METHODS We performed a review in PubMed of Spanish and English medical literature on the various techniques of SC-PCNL. RESULTS The use of SC-PCNL has reduced the morbidity associated with standard PCNL, particularly bleeding, and has enabled tubeless nephrolithotomy with greater safety. There are various techniques with blurred terminology (Miniperc, Microperc, Mini-microperc, Ultraminiperc), which differ in terms of gauge employed and in certain technical aspects that require their indications be specified. Currently, SC-PCNL competes with techniques that are less invasive than standard PCNL such as ESWL and the RIRS in treating small stones, but the role of SC-PCNL is still not sufficiently understood and continues to be the subject of debate. CONCLUSIONS The indications for PCNL are expanding to small stone sizes due to the miniaturisation of the technique. PCNL competes in this field with ESWL and RIRS. Larder studies are needed to establish the specific indications for PCNL in treating nephrolithiasis.
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Affiliation(s)
- J H Amón Sesmero
- Servicio de Urología, Hospital Universitario Río Hortega. Valladolid, España.
| | - M Cepeda Delgado
- Servicio de Urología, Hospital Universitario Río Hortega. Valladolid, España
| | - B de la Cruz Martín
- Servicio de Urología, Hospital Universitario Río Hortega. Valladolid, España
| | | | - D Alonso Fernández
- Servicio de Urología, Hospital Universitario Río Hortega. Valladolid, España
| | - V Rodriguez Tesedo
- Servicio de Urología, Hospital Universitario Río Hortega. Valladolid, España
| | - D A Martín Way
- Servicio de Urología, Hospital Universitario Virgen de la Nieves, Granada, España
| | - J Gutiérrez Aceves
- Department of Urology, Wake Forest Baptist Medical Center , Winston Salem, North Carolina, EE. UU
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Lima E, Rodrigues PL, Mota P, Carvalho N, Dias E, Correia-Pinto J, Autorino R, Vilaça JL. Ureteroscopy-assisted Percutaneous Kidney Access Made Easy: First Clinical Experience with a Novel Navigation System Using Electromagnetic Guidance (IDEAL Stage 1). Eur Urol 2017; 72:610-616. [DOI: 10.1016/j.eururo.2017.03.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/07/2017] [Indexed: 02/07/2023]
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Cepeda M, Amón JH, Mainez JA, de la Cruz B, Rodríguez V, Alonso D, Martínez-Sagarra JM. Retrograde intrarenal surgery and micro-percutaneous nephrolithotomy for renal lithiasis smaller than 2 CM. Actas Urol Esp 2017; 41:516-521. [PMID: 28389028 DOI: 10.1016/j.acuro.2017.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/05/2017] [Accepted: 02/06/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Microperc is the upgraded form of percutaneous nephrolithotomy miniaturization. The aim of this study is to compare prospectively microperc and retrograde intrarenal surgery for the treatment of renal stones smaller than 2 cm. MATERIAL AND METHODS A comparative prospective study of both techniques was carried out between January 2014 and June 2015. Thirty-five patients were divided in two groups: Group A, 17 patients treated by retrograde intrarenal surgery and Group B, 18 patients treated by microperc. Stone clearance was assessed using CT scan 3 months after surgery. RESULTS Both groups were statistically comparable as demographic variables and stone size was similar (16.76 mm Group A vs 15.72 mm Group B). Success rate, hospital stay and JJ stenting were similar for both groups. There was no statistically significant difference regarding post-operatory complications: 17.64% Group A vs 5.56% Group B (p=0,062), all of them Clavien I and II. Surgical time was statistically different (63.82 min Group A vs 103.24 min Group B) as well as hemoglobin drop (0.62 g/dl Group A and 1.89 g/dl Group B). CONCLUSION Microperc is an effective and safe procedure for the treatment of renal lithiasis smaller than 2 cm, which makes it a good alternative to retrograde intrarenal surgery for this stone size. However, more prospective studies that include a larger cohort are necessary to confirm our results.
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Affiliation(s)
- M Cepeda
- Servicio de Urología, Hospital Universitario Río Hortega, Valladolid, España.
| | - J H Amón
- Servicio de Urología, Hospital Universitario Río Hortega, Valladolid, España
| | - J A Mainez
- Servicio de Urología, Hospital Universitario Río Hortega, Valladolid, España
| | - B de la Cruz
- Servicio de Urología, Hospital Universitario Río Hortega, Valladolid, España
| | - V Rodríguez
- Servicio de Urología, Hospital Universitario Río Hortega, Valladolid, España
| | - D Alonso
- Servicio de Urología, Hospital Universitario Río Hortega, Valladolid, España
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Persico N, Berrettini A, Fabietti I, Dallagiovanna C, Minoli D, Mosca F, Fedele L, Manzoni G. New minimally invasive technique for cystoscopic laser treatment of fetal ureterocele. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:124-127. [PMID: 27607564 DOI: 10.1002/uog.17296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/08/2016] [Accepted: 08/23/2016] [Indexed: 06/06/2023]
Abstract
Prenatal ultrasound detection of fetal ureterocele with bilateral hydroureteronephrosis, obstruction of the bladder outlet and progressive amniotic fluid reduction have been associated with a significant risk of end-stage chronic renal disease after birth. Fetal cystoscopic laser incision of the ureterocele, using standard 3.5-mm fetoscopic access to the amniotic cavity and the fetal bladder with the aim of relieving the bladder outflow obstruction to preserve renal function, has been reported previously in a case with a favorable outcome. We report on two additional cases of fetal ureterocele treated by cystoscopic laser decompression. In the first case, a standard 3.3-mm uterine entry was used. In the second case, a new approach was adopted using an 'all-seeing needle' 1.6-mm endoscope. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- N Persico
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A Berrettini
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - I Fabietti
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - C Dallagiovanna
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - D Minoli
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - F Mosca
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - L Fedele
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - G Manzoni
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Knoll T, Bach T, Humke U, Neisius A, Stein R, Schönthaler M, Wendt-Nordahl G. [S2k guidelines on diagnostics, therapy and metaphylaxis of urolithiasis (AWMF 043/025) : Compendium]. Urologe A 2017; 55:904-22. [PMID: 27325405 DOI: 10.1007/s00120-016-0133-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Every tenth German citizen will suffer from at least one urinary calculus during the lifetime. The diagnostics, treatment and follow-up treatment of urolithiasis are, therefore, part of the daily routine practice for all urologists in hospitals and private practices as well as in many other disciplines, such as general practitioners, internists, nephrologists and pediatricians. Although the diagnostics and therapy have experienced substantial alterations over the last 10 years, the possibilities of metabolic diagnostics and secondary prevention for patients at risk are, unfortunately and unjustly, in many places very poorly represented. The present S2k guidelines, which for the first time were established in an interdisciplinary consensus process, represent the current practical recommendations and, whenever possible, use tables and algorithms in order to facilitate easy reference in the routine daily work. Last but not least, this greatly simplifies the measures for metaphylaxis.
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Affiliation(s)
- T Knoll
- Urologische Klinik Sindelfingen, Klinikum Sindelfingen-Böblingen, Arthur-Gruber-Str. 70, 71065, Sindelfingen, Deutschland.
| | - T Bach
- Urologisches Zentrum Hamburg, Asklepios Klinikum Harburg, Hamburg, Deutschland
| | - U Humke
- Klinik für Urologie, Klinikum Stuttgart, Stuttgart, Deutschland
| | - A Neisius
- Klinik für Urologie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - R Stein
- Klinik für Urologie, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - M Schönthaler
- Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - G Wendt-Nordahl
- Urologische Klinik Sindelfingen, Klinikum Sindelfingen-Böblingen, Arthur-Gruber-Str. 70, 71065, Sindelfingen, Deutschland
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