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Mehra K, Satpathy P, Joshi A, Manikandan R. Percutaneous Nephrolithotomy in Patients with Chronic Kidney Disease: A Systematic Review. Urol Int 2022; 106:461-468. [PMID: 35045417 DOI: 10.1159/000520266] [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: 06/15/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Renal calculi in chronic kidney disease (CKD) are not uncommon. Percutaneous nephrolithotomy (PCNL) is a standard treatment for large renal calculi. PCNL in CKD has been a subject of debate as it may improve the renal function with stone clearance but may be associated with an increased complication rate. Studying the impact of PCNL in CKD patients is of utmost significance. OBJECTIVE The aim of the study was to evaluate the efficacy and safety of PCNL in patients with renal insufficiency in order to provide clinicians expected outcomes to effectively counsel patients. METHODS We performed a systematic review of clinical trials reporting the outcomes of PCNL in CKD patients. The search was performed in MEDLINE, EMBASE, Cochrane Library, CINAHL, Google Scholar, and Web of Science. All studies with a minimum of 15 patients carried out in the last 20 years were selected. A total of 13 studies involving 2,192 patients were included for final analysis. The pre-operative and post-operative renal function was compared. Post-procedure complications were analysed. Evidence Analysis: The majority of patients in all studies except one had either improvement or stabilization in renal function. The complication rate was 31.9%, which was more than that in patients with normal renal function. CONCLUSION Our review suggested that the majority of the patients of renal calculus with renal insufficiency are benefitted with PCNL in improving or preserving the renal function. But the post-operative complications are more in CKD and increases as the severity of renal insufficiency increases.
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Affiliation(s)
- Ketan Mehra
- Department of Urology, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Parameshwar Satpathy
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Ankur Joshi
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Ramanitharan Manikandan
- Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Talwar HS, Mittal A, Panwar VK, Tosh JM, Singh G, Ranjan R, Ghorai RP, Kumar S, Navriya S, Mandal À. Efficacy and safety of percutaneous nephrolithotomy in patients with chronic kidney disease: Outcomes from a tertiary care center. J Endourol 2021; 36:600-609. [PMID: 34861766 DOI: 10.1089/end.2021.0514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The management of renal stone disease in the presence of chronic kidney disease is a challenging scenario, both in terms of surgical safety as well as perioperative outcomes. The aim of the present study is to study the efficacy, safety, and outcomes of percutaneous nephrolithotomy in patients with chronic kidney disease. MATERIALS AND METHODS A prospective study was conducted including adult patients with renal stone disease and a creatinine clearance of <90ml/min (Stage 2 CKD or more) who underwent percutaneous nephrolithotomy. Pre-operative and post-operative serum creatinine and glomerular filtration rates were compared. Patients were divided into CKD stages 1-5 having creatinine clearance >90ml/min, 60-90ml/min, 30-60ml/min, 15-30ml/min and <15ml/min respectively. Based on up migration or down migration of CKD stages, patients were classified as improved, deteriorated or stable. Peri-operative complications and outcomes were also compared. RESULTS A total of 185 patients with CKD stage less than or equal to 2 underwent PCNL. The mean age of the patients was 43.24+/-14.32 years. The mean preoperative estimated glomerular filtration rate was 62.88±23.42mL/min/1.73m2. Pre-operative CKD stage distribution was as follows: stage 2-121(65.4%), stage 3-34(18.4%), stage 4-24(13%) and stage 5-6(3.2%). On last follow-up of patients, the mean creatinine was 1.07±0.65 mg/dL and the mean eGFR was 82.75±31.22 mL/min/1.73m2. The median change in creatinine and mean change in GFR was 0.23 (0.16-0.27) g/dL and 19.87 ± 19.77 mL/min/1.73 m2 respectively. Improvement in kidney function with a stage down migration was seen in 115 cases(62.2%), slight improvement with no change in stage in 69 cases(37.3%) and deterioration of CKD stage was present in one case(0.5%). CONCLUSION Percutaneous nephrolithotomy is associated with favourable functional outcomes in chronic kidney disease patients including severe CKD(stage IV and V). Improvement or stabilization of CKD stage was seen in 99.5% patients post PCNL.
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Affiliation(s)
- Harkirat Singh Talwar
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Ankur Mittal
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Vikas Kumar Panwar
- All India Institute of Medical Sciences - Rishikesh, 442339, Virbhadra, Rishikesh, Rishikesh, India, 249203;
| | - Jyoti Mohan Tosh
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Gurpremjit Singh
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Rohit Ranjan
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Rudra Prasad Ghorai
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Sunil Kumar
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Shivcharan Navriya
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Àrup Mandal
- All India Institute of Medical Sciences - Rishikesh, 442339, Urology, Rishikesh, Uttarakhand, India;
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Percutaneous nephrolithotomy versus extracorporeal shock wave lithotripsy for renal insufficiency. World J Urol 2021; 39:4477-4482. [PMID: 34076752 DOI: 10.1007/s00345-021-03751-0] [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: 09/24/2020] [Accepted: 05/28/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To assess the effect and outcome of percutaneous nephrolithotomy (PNL) versus extracorporeal shock wave lithotripsy (SWL) in patients with renal insufficiency. PATIENTS AND METHODS A prospective randomized clinical study of 104 renal insufficiency patients with renal stones (serum creatinine 2-4 mg/dl and eGFR < 60 ml/min/1.73 m2 more than 3 months) randomized into two groups: Group A underwent PNL; Group B underwent shock wave lithotripsy (SWL). Treatment effects and outcomes compared between the two groups. RESULTS Between Group A of 50 patients and Group B of 54 cases, demographic data showed no statistically significant differences. The stone-free rate was 84% in Group A versus 26.6% in Group B after the first SWL session. After completion of all SWL sessions, the rate was 88.9% for Group B. Comparing pre and postoperative results of Group A, there is significant improvement of serum creatinine concentrations by 9.1% (p = 0.001), significant improvement of creatinine clearance (p = 0.000) and eGFR (p = 0.003). Although regarding Group B preoperatively and 3 months after SWL there is significant improvement by 8.7% (p = 0.0001), which is less than that of Group A, there is also, improvement of eGFR by 6.7% (p = 0.001), which is less than the eGFR improvement in Group A (12.3%). But there is no statistically significant difference is noted for creatinine clearance in Group B (p = 0.09). CONCLUSION The outcomes for PNL and SWL in patients with renal insufficiency and renal stones are encouraging as minimally invasive procedures with no negative effects on kidney function.
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Yarimoglu S, Aydin ME, Sahan M, Koras O, Erdemoglu O, Polat S, Sefik E, Celik S, Degirmenci T. Effect of Renal Function on Success and Complications of Percutaneous Nephrolithotomy. YENI ÜROLOJI DERGISI 2021. [DOI: 10.33719/yud.2021;16-1-748024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective: In this study, we aimed to compare the success and complication rates of percutaneous nephrolithotomy (PCNL) according to preoperative glomerular filtration rates (GFR) of patients who underwent PCNLdue to kidney stones.
Material and Methods: Between January 2012 and December 2016, 794 patients who underwent PCNL due to kidney Stones were evaluated retrospectively. Preoperative GFR values of patients were calculated according to Cockcroft –Gault formula. The patients with preoperative GFR values>90 ml/min, 60-90 ml/min, 30-60 ml/min were respectively defined as group-1, group-2 and group-3. Preoperative and perioperative values, Stone free rates and complication rates were compared between the groups. Postoperatively , <4 mm residual stone was identified as success.
Results: There were 466 patients in Group-1, 259 in Group-2 and 67 patients in Group-3.
The mean preoperative GFR values of the patients were 118.53 ml/min, 77.76 ml/min and 48.52 ml/min, respectively in group-1, group-2 and group-3 (p <0.001).The mean age of the patients was 62.8±11.47, 51.86±11.10, and60.31±12.7, respectively, in group-1, group-2 and group-3 (p<0.001).The mean Stone burden of the patients were 497.34±518.60 mm2, 517.6±493.8 mm2and 711.06±679.07 mm2, respectively, in group-1, group-2 and group-3 (p=0.013). The number of patients identified with success after surgery was 355 (86.2%), 195 (76.1%) and 50 (74.6%) in group-1, group-2 and group-3, respectively (p = 0.542). The number of patients who develop complications was 114 (%24.65), 57 (%22) and 11 (%16.4) in group-1, group-2 and group-3, respectively (p=0.310).
Conclusion: Preoperative GFR valuesare not lonely sufficient to predict success and complications after PCNL.
Keywords: Percutaneous nephrolithotomy, renal function, renal stone, glomerular filtration rates
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Affiliation(s)
- Serkan Yarimoglu
- HSU Izmir Bozyaka Training and Research Hospital, Department of Urology, Izmir, Turkey
| | - Mehmet Erhan Aydin
- Dr.Yasar Eryilmaz Dogubayazit State Hospital, Department of Urology, Agri, Turkey
| | - Murat Sahan
- HSU Izmir Bozyaka Training and Research Hospital, Department of Urology, Izmir, Turkey
| | - Omer Koras
- Mustafa Kemalpaşa Central Hospital, Department of Urology, Bursa, Turkey
| | - Onur Erdemoglu
- HSU Izmir Bozyaka Training and Research Hospital, Department of Urology, Izmir, Turkey
| | - Salih Polat
- Amasya University Faculty of Medicine, Department of Urology, Amasya, Turkey
| | - Ertugrul Sefik
- HSU Izmir Bozyaka Training and Research Hospital, Department of Urology, Izmir, Turkey
| | - Serdar Celik
- HSU Izmir Bozyaka Training and Research Hospital, Department of Urology, Izmir, Turkey
| | - Tansu Degirmenci
- HSU Izmir Bozyaka Training and Research Hospital, Department of Urology, Izmir, Turkey
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Are Routine Laboratory Investigations Necessary Following Percutaneous Nephrolithotomy? Urology 2020; 143:80-84. [DOI: 10.1016/j.urology.2020.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 11/18/2022]
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Ramachandra M, Somani BK. Safety and feasibility of percutaneous nephrolithotomy (PCNL) during pregnancy: A review of literature. Turk J Urol 2020; 46:89-94. [PMID: 32134719 DOI: 10.5152/tud.2020.20002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/11/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Management of nephrolithiasis during pregnancy can be challenging because of the potential risks to the mother and fetus. Diagnosis and treatment can be a dilemma owing to the anatomical and physiological changes, besides the limitation in the use of X-rays. The aim of this article was to identify any case series or case reports where percutaneous nephrolithotomy (PCNL) was used as a treatment modality for nephrolithiasis in pregnancy. MATERIAL AND METHODS A review of the literature was performed using Medline, EMBASE, CINAHL, and Scopus from 1990 to October 2019. A search was conducted using the following search terms: "urolithiasis," "renal stones," "stone disease," "kidney stones," "pregnancy," "pregnant," "percutaneous nephrolithotomy," "PNL," and "PCNL." The initial search strategy retrieved 52 articles, but after going through them, only 7 were suitable for inclusion in this review. RESULTS Overall, seven studies reported regarding 16 patients who underwent PCNL procedure during pregnancy. The patients were aged 18-34 years and had the procedure between 11 and 32 weeks of gestation. Most stones were in the renal pelvis or pelvic-ureteric junction and sized 8-40 mm, with the most common indication for the intervention being refractory pain. Most treatments used ultrasound guidance, and X-ray fluoroscopy was employed only in two cases. No complications occurred to the mother or fetus in any of the case reports, suggesting that PCNL is a safe and feasible treatment for patients with persistent symptoms when conservative treatment has failed. CONCLUSION All the reported cases of PCNL achieved stone-free status with no complications. Although PCNL has been evidenced to be safe, it must be performed by experienced endourologists after careful consultation with the obstetricians. Patient counseling and multidisciplinary team decision-making are paramount in such complex scenarios.
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Affiliation(s)
- Meghana Ramachandra
- Urological Surgery Department, University Hospital Southampton NHS Trust, Southampton, UK
| | - Bhaskar K Somani
- Urological Surgery Department, University Hospital Southampton NHS Trust, Southampton, UK
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Pietropaolo A, Reeves T, Aboumarzouk O, Kallidonis P, Ozsoy M, Skolarikos A, Tailly T, Liatsikos E, Traxer O, Somani BK. Endourologic Management (PCNL, URS, SWL) of Stones in Solitary Kidney: A Systematic Review from European Association of Urologists Young Academic Urologists and Uro-Technology Groups. J Endourol 2019; 34:7-17. [PMID: 31456421 DOI: 10.1089/end.2019.0455] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Urolithiasis in solitary kidney (SK) presents significant management dilemma as any insult to the kidney or its drainage can lead to significant morbidity. The treatment options include shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), and ureteroscopy (URS). Our aim was to conduct a systematic review of literature on all available endourologic techniques reporting on the management of stones in an SK. Materials and Methods: We conducted a systematic review according to the Cochrane and PRISMA checklist for all English-language articles from inception to December 2018. All studies with a minimum of 10 patients that reported on endourologic management (SWL, PCNL, or URS) were included. Data were extracted for patient and stone demographics, outcomes including stone-free rate (SFR), adverse events, and renal function. Results: After an initial search of 553 articles, 27 were included for the final review (10 PCNL, 1 mini-PCNL, 9 URS, 1 SWL, and 6 comparative studies). The choice of treatment seemed to be based on stone size, with PCNL, URS, and SWL offered for mean stone sizes between 25-50, 10-28, and 12-15 mm, respectively. PCNL, URS, and SWL were reported in 1445, 792, and 186 patients, respectively, with a final SFR of 67%-97.7%, 43%-100%, and 73%-80% and a complication rate of 26.4%, 15%, and 16.7% across the three groups. The renal function deterioration was reported in 4/16 PCNL studies and in 1/15 URS studies, while it remained unaffected in the SWL study. Conclusions: Our review shows a rise of endourologic techniques in the management of stones in SK. Although PCNL was used for larger stones, it had a higher risk of major complications, including blood transfusion. While a good SFR was obtained for patients irrespective of the treatment modality, the selected intervention needs to be balanced with its safety profile and the need for ancillary procedures.
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Affiliation(s)
- Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Thomas Reeves
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Omar Aboumarzouk
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | - Mehmet Ozsoy
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Andreas Skolarikos
- 2nd Department of Urology, University of Athens, Sismanoglio Hospital, Athens, Greece
| | - Thomas Tailly
- Department of Urology, University Hospitals Ghent, Ghent, Belgium
| | | | - Olivier Traxer
- Tenon Hospital, Pierre and Marie Curie University, Paris, France
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
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Suntharasivam T, Mukherjee A, Luk A, Aboumarzouk O, Somani B, Rai BP. The role of robotic surgery in the management of renal tract calculi. Transl Androl Urol 2019; 8:S457-S460. [PMID: 31656752 DOI: 10.21037/tau.2019.04.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The role of robotic assisted surgery in contemporary urolithiasis management is in its infancy. The mainstay in the management of renal tract calculi remains ureterorenoscopy (URS), extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL). However, in rare clinical circumstances, such as large impacted pelvic and ureteric calculi, endo-urological techniques may not be adequate. Furthermore, patient may have a synchronous pathology such as pelvi-ureteric obstruction which preferably should be concurrently treated with the renal calculi in a single sitting. Robotic assisted laparoscopic ureterolithotomy (RALU), robotic assisted laparoscopic pyelolithotomy (RPL) with or without concurrent pyeloplasty and Robotic assisted laparoscopic anatrophic nephrolithotomy have all been described for complex stones. Additionally, technical challenges with a flexible ureteroscopy (FURS) have led to the development of robotic assisted flexible ureteroscopes. In the article we summarize the role of robotic assisted surgery in complex renal tract calculi.
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Affiliation(s)
| | | | - Angus Luk
- Department of Urology, Freeman Hospital, Newcastle, UK
| | - Omar Aboumarzouk
- NHS Greater Glasgow and Clyde, Queen Elizabeth University Hospital, Glasgow, UK
| | - Bhaskar Somani
- University Hospital Southampton NHS Trust, Southampton, UK
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Abstract
Urolithiasis commonly affects cats and dogs. The American College of Veterinary Internal Medicine established guidelines for the treatment of uroliths that reflect modern techniques prioritizing minimally invasive procedures with an emphasis on prevention strategies to limit morbidity and mortality. Extracorporeal shockwave lithotripsy and endoscopic nephrolithotomy constitute some of the minimally invasive treatment modalities available for upper urinary tract uroliths. Cystoscopic-guided basket retrieval, cystoscopic-guided laser lithotripsy, and percutaneous cystolithotomy are minimally invasive options for the management of lower urinary tract uroliths. Following stone removal, prevention strategies are essential to help reduce morbidity and mortality associated with stone recurrence.
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Pietropaolo A, Jones P, Whitehurst L, Rai BP, Geraghty R, Somani BK. Efficacy and Safety of Ureteroscopy for Stone Disease in a Solitary Kidney: Findings From a Systematic Review. Urology 2018; 119:17-22. [DOI: 10.1016/j.urology.2018.03.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/10/2018] [Accepted: 03/24/2018] [Indexed: 12/22/2022]
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Wei C, Zhang Y, Pokhrel G, Liu X, Gan J, Yu X, Ye Z, Wang S. Research progress of percutaneous nephrolithotomy. Int Urol Nephrol 2018; 50:807-817. [PMID: 29556901 DOI: 10.1007/s11255-018-1847-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/12/2018] [Indexed: 12/29/2022]
Abstract
Percutaneous nephrolithotomy (PCNL) is generally accepted as the gold standard treatment for the treatment of large kidney stones (> 2 cm). For nearly 40 years, with the continuous progress of technology and the constant updating of ideas, PCNL has made great progress. In this review, we discuss the current research progress, recent advancement and hot spot of the whole process of PCNL including anesthesia, position, puncture, dilation, lithotripsy approaches, perfusate, tube placement, hospitalization time, drug, treatment of residual stones, prognosis judgment and operation evaluation by summarizing the related research in this article.
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Affiliation(s)
- Chao Wei
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Yucong Zhang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Gaurab Pokhrel
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Xiaming Liu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Jiahua Gan
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Xiao Yu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China.
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Goel A. Round-up. Indian J Urol 2017; 33:183-185. [PMID: 28717265 PMCID: PMC5508426 DOI: 10.4103/iju.iju_186_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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