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Gentile PA, Gualtieri L, Izzo S, Luka K, Lauro A, Salvati B. Une Liaison Dangereuse: Spontaneous Pyeloduodenal Fistula. Dig Dis Sci 2023; 68:1106-1111. [PMID: 36805907 DOI: 10.1007/s10620-023-07828-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 02/23/2023]
Abstract
We describe the case of a 76-year-old woman with a spontaneous nephroduodenal fistula. The patient was initially evaluated for gastrointestinal and urinary symptoms associated with fever and anemia, after which she was admitted with the diagnosis of right chronic pyelonephritis, hydronephrosis, and renal lithiasis. The fistula was diagnosed incidentally by percutaneous pyelography during a right nephrostomy and was later confirmed with an abdominal CT scan. A multidisciplinary decision was made to surgically treat the fistula (right nephrectomy plus duodenal repair); the surgery had a short-term positive outcome. We report a systematic review of the literature related to spontaneous pyeloduodenal fistulæ and their treatments.
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Affiliation(s)
| | - Loredana Gualtieri
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Silvia Izzo
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Klaudia Luka
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Augusto Lauro
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Bruno Salvati
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
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Ketsuwan C, Pimpanit N, Phengsalae Y, Leenanupunth C, Kongchareonsombat W, Sangkum P. Peri-Operative Factors Affecting Blood Transfusion Requirements During PCNL: A Retrospective Non-Randomized Study. Res Rep Urol 2020; 12:279-285. [PMID: 32802804 PMCID: PMC7383108 DOI: 10.2147/rru.s261888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/13/2020] [Indexed: 11/23/2022] Open
Abstract
Background Percutaneous nephrolithotomy (PCNL) is accepted as the gold standard of care for the treatment of large renal calculi. Kidney hemorrhage, which requires blood transfusion, is one of the most common complications after percutaneous kidney stone surgery. Objective To evaluate perioperative factors associated with transfusion requirements during PCNL. Materials and Methods A total of 226 patients with kidney calculi undergoing PCNL between January 2011 and December 2019 were reviewed retrospectively. We analyzed the impact of perioperative clinical factors on the necessity of blood transfusion during PCNL. Results The overall blood transfusion rate was 9.29%. Multiple perioperative determinants were significantly correlated with the application of packed red blood cells (PRCs), including larger stone size (p = 0.006), multiple tract punctures (p = 0.029), presence of staghorn calculi (p = 0.026), and long operative time (OT; p = 0.017). Multivariate analysis demonstrated that only multiple tract punctures independently affected blood transfusion requirements during PCNL (p = 0.038). Conclusion In accordance with the present study, only the multiple tract punctures were associated with blood transfusion requirements in PCNL.
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Affiliation(s)
- Chinnakhet Ketsuwan
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Narutsama Pimpanit
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yada Phengsalae
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Charoen Leenanupunth
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wisoot Kongchareonsombat
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Premsant Sangkum
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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El Tayeb MM, Borofsky MS, Lingeman JE. The Circle Nephrostomy Tube: An Attractive Nephrostomy Drainage System Following Complex Percutaneous Nephrolithotomy. Urology 2017; 103:251-255. [PMID: 28108324 DOI: 10.1016/j.urology.2017.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/09/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe our experience with the circle nephrostomy tube (NT) (Cook Medical), a drainage system uniquely designed for use after multiple-access percutaneous nephrolithotomy (PNL). METHODS A retrospective review of 1317 consecutive patients undergoing 1599 PNLs at IU Health Methodist Hospital was performed. All multiple access cases utilizing circle NTs were reviewed and analyzed. The method of insertion of circle NT was demonstrated. RESULTS A total of 1843 accesses were obtained in 1599 renal units (RUs): 380 upper pole, 129 interpolar, and 1334 lower pole. Multiple accesses in this series were required in 282 RUs (17.6%). Following multiple-access PNL, circle NTs, Cope loop, and reentry Malecot NTs were inserted in 91 RUs (32.3%), 208 RUs (73.8%), and 31 RUs (11%), respectively. None of the patients who had circle NT experienced clogging, dislodgement, or obstruction of the tube. The cost of circle, Cope loop, and Malecot NTs are 121.73 USD, 95.20 USD, and 81 USD, respectively. CONCLUSION Circle NTs are easy to insert, secure, cost-effective compared with inserting two NTs. Circle NTs provide excellent drainage and facilitate secondary procedures.
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Carpentier X, Meria P, Bensalah K, Chabannes E, Estrade V, Denis E, Yonneau L, Mozer P, Hadjadj H, Hoznek A, Traxer O. Mise au point sur la prise en charge des calculs du rein en 2013. Comité Lithiase de l’Association française d’urologie. Prog Urol 2014; 24:319-26. [DOI: 10.1016/j.purol.2013.09.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 09/25/2013] [Accepted: 09/26/2013] [Indexed: 01/29/2023]
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Postpercutaneous nephrolithotomy nephrostogram: is it mandatory? A single center experience. Adv Urol 2014; 2014:423730. [PMID: 24639870 PMCID: PMC3930164 DOI: 10.1155/2014/423730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 10/27/2013] [Accepted: 11/14/2013] [Indexed: 11/25/2022] Open
Abstract
Aims and Objective. “Postpercutaneous nephrolithotomy nephrostogram” (PPNN) is routinely performed in most of the centers. No published series could be found in the literature without post percutaneous nephrolithotomy nephrostogram. Hence, the aim of our study is to highlight that post percutaneous nephrolithotomy nephrostogram is not mandatory and it only adds to cost and morbidity without adding any information in the management of such patients. Methods. It was a prospective study from 2005 to 2012, conducted in our institute. It included 119 patients of renal stones who underwent percutaneous nephrolithotomy performed under the guidance of a single surgeon. Postoperative nephrostogram was not done in any of the patients. Results. Complete stone clearance was achieved in 97.5% of patients and 2.5% of patients needed two to three sessions of ESWL later on. None of the patients needed second look percutaneous nephrolithotomy or nephrostogram. Conclusion. Postpercutaneous nephrolithotomy nephrostogram increases chances of infection, inconvenience, contrast related complications, and cost, with no added advantage over plain X-ray KUB, and it should not be done as a routine investigation prior to the removal of PCN tube in patients with complete stone clearance.
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Lee JK, Kim BS, Park YK. Predictive factors for bleeding during percutaneous nephrolithotomy. Korean J Urol 2013; 54:448-53. [PMID: 23878687 PMCID: PMC3715708 DOI: 10.4111/kju.2013.54.7.448] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 05/13/2013] [Indexed: 12/01/2022] Open
Abstract
Purpose Although percutaneous nephrolithotomy (PCNL) has been accepted as a standard method for the management of large renal stones, the incidence of renal hemorrhage is relatively high. This study investigated the variables that affect bleeding during PCNL. Materials and Methods The medical records of 370 patients who underwent PCNL by a single surgeon from January 2005 to December 2010 were reviewed retrospectively. All patients were divided into two groups according to median blood loss (lesser bleeding group and higher bleeding group). Various clinical and perioperative factors including age, sex, stone size and position, degree of hydronephrosis, operative time, underlying disease, history of anticoagulant medication, presence of previous nephrostomy catheter, stone composition, and thickness of the renal cortex were assessed. For statistical assessment, univariate and multivariate logistic regression analyses were used. Results The mean patient age was 48.8 years (range, 22 to 75 years). Forty-three patients (11.6%) received a transfusion and 9 patients (2.4%) underwent angioembolization after surgery. The mean blood loss was 511.8±341.3 mL. Body mass index (BMI), stone size, stone position, operation time, and degree of preoperative hydronephrosis were predictive factors for severe bleeding during PCNL. Conclusions On the basis of the results achieved by a single surgeon, staghorn stones, high BMI, large stones, prolonged operation time, and absence of hydronephrosis were significantly associated with the risk of severe bleeding during PCNL.
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Affiliation(s)
- Jeong Kuk Lee
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
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Andonian S, Okhunov Z, Shapiro EY, Smith AD, Okeke Z. Diagnostic utility and clinical value of postpercutaneous nephrolithotomy nephrostogram. J Endourol 2011; 24:1427-30. [PMID: 20677992 DOI: 10.1089/end.2010.0173] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE After percutaneous nephrolithotomy (PCNL), the current standard of care is to obtain a nephrostogram before removal of the nephrostomy tube to rule out distal ureteral obstruction. The aim of this study was to determine whether nephrostogram findings predict prolonged urinary drainage and postoperative ureteral stent insertion. PATIENTS AND METHODS Data for all patients who had nephrostomy tubes inserted post-PCNL between January and December 2006 were retrospectively reviewed. Patients with radiolucent stones, concomitant procedures, or caliceal diverticula were excluded. All nephrostograms were reviewed to identify distal ureteral obstruction without evidence of residual fragments. The Fisher's exact test was used. RESULTS Fifty patients who underwent 51 PCNLs were included in the study (one patient had bilateral PCNLs). Nephrostograms were performed on median postoperative day (POD) 2 (range POD 2-8), and tubes were removed on median POD 2 (range POD 2-10). In 14 (27%) patients who had distal ureteral obstruction without ureteral stones, the nephrostomy tube was removed on the same day of nephrostography. Eight (16%) patients experienced a prolonged urinary leak (>24 hours). While obstruction on the nephrostogram predicted prolonged urinary leak (36% vs 8%; P = 0.02), none of these obstructed patients needed postoperative ureteral stent placement. A patient with a horseshoe kidney without distal ureteral obstruction had his nephrostomy removed on POD 2. He presented on POD 7 with prolonged urinary leakage and needed readmission with ureteral stent placement and Foley catheterization. CONCLUSION While distal obstruction seems to predict prolonged urinary leakage (more than 24 hours), it may not necessitate ureteral stent placement or prolonged nephrostomy drainage because blood clot or ureterovesical junction edema resolve spontaneously with expectant management.
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Affiliation(s)
- Sero Andonian
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York 11040, USA
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Aslam MZ, Thwaini A, Duggan B, Hameed A, Mulholland C, O'Kane H, Thompson T. Urologists versus radiologists made PCNL tracts: the U.K. experience. ACTA ACUST UNITED AC 2010; 39:217-21. [PMID: 21161520 DOI: 10.1007/s00240-010-0338-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Accepted: 10/20/2010] [Indexed: 11/26/2022]
Abstract
We aim to explore the practice of who makes the PCNL tract in the U.K. and Northern Ireland as well as presenting our data for two different approaches to PCNL tracts in Northern Ireland. A national questionnaire survey was carried out across the National Health Services hospitals in U.K. In addition, a retrospective analysis of 134 PCNL cases was carried out. Group I included 103 (77%) cases with urologist-made tracts, while group II included 31 (23%) cases with radiologists-made tracts. The survey suggested that 45% (42) of the hospitals adopted a radiologist-made tract, 44% (41) use urologist-made tract, while the remaining 11% (11) use both. Most of the radiologists' performed tracts in our series were for complex cases. Failed access occurred in 6 (5.8%) in group I and none in Group II. The overall stone-free rate was 92 and 50% for group I and II, respectively. There is a better stone clearance rate in Group I (p = 0.0016). This however is likely to be attributed to the complexity of the cases in group II. However, urologist made percutaneous tract is safe and efficacious but a team approach with radiology is needed for more complex cases.
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Shahrour W, Andonian S. Ambulatory Percutaneous Nephrolithotomy: Initial Series. Urology 2010; 76:1288-92. [PMID: 21130245 DOI: 10.1016/j.urology.2010.08.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 07/24/2010] [Accepted: 08/02/2010] [Indexed: 11/19/2022]
Affiliation(s)
- Walid Shahrour
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Rastinehad AR, Andonian S, Smith AD, Siegel DN. Management of hemorrhagic complications associated with percutaneous nephrolithotomy. J Endourol 2009; 23:1763-7. [PMID: 19747040 DOI: 10.1089/end.2009.1548] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Urologists have witnessed replacement of complex open surgical procedures with minimally invasive therapies over the past quarter century. Nothing personifies this more than an anatrophic nephrolithotomy in the management of kidney stones. The Boyce procedure, once the gold standard for staghorn calculi, is rarely performed. Percutaneous nephrolithotomy (PCNL) has become the gold standard procedure for large renal stones and staghorns. This article will review the hemorrhagic complications that are associated with PCNL and the necessary therapeutic interventions.
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Affiliation(s)
- Ardeshir R Rastinehad
- The Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System , New Hyde Park, NY, USA
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Schuster TK, Smaldone MC, Averch TD, Ost MC. Percutaneous Nephrolithotomy in Children. J Endourol 2009; 23:1699-705. [DOI: 10.1089/end.2009.0198] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tina K. Schuster
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Marc C. Smaldone
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Timothy D. Averch
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michael C. Ost
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Affiliation(s)
- P Alken
- Urologische Universitätsklinik, Ruprecht-Karls-Universität Heidelberg, Klinikum, Theodor-Kutzer-Ufer 1-3, 68135 Mannheim.
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Traxer O, Lechevallier E, Saussine C. Calcul caliciel inférieur. Prog Urol 2008; 18:972-6. [DOI: 10.1016/j.purol.2008.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 09/02/2008] [Indexed: 10/21/2022]
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Kim JA, Kwak KH. Acute Pulmonary Edema after Simultaneous Bilateral Percutaneous Nephrolithotomy - A case report -. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.53.2.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jee Ahn Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyung Hwa Kwak
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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Lee HN, Yoon HN, Shim BS. The Trend Change of Incidence and Treatment of Urolithiasis between the 1980s and 2000s. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.1.40] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ha Na Lee
- Department of Urology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Ha Na Yoon
- Department of Urology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Bong Suk Shim
- Department of Urology, College of Medicine, Ewha Womans University, Seoul, Korea
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Abstract
OBJECTIVE To assess the safety and outcome of paediatric percutaneous nephrolithotomy (PCNL) for atypical cases and compare the results with 'standard' unilateral paediatric PCNL. PATIENTS AND METHODS We retrospectively reviewed children who had had a PCNL between December 1997 and December 2004. Patients were grouped as follows: group 1, aged >5-16 years with normal anatomy and normal renal function undergoing unilateral PCNL or staged bilateral PCNL; group 2, < or = 5 years with normal anatomy and renal function undergoing unilateral PCNL; group 3, undergoing bilateral simultaneous PCNL; group 4, impaired renal function in addition to renal stone disease; group 5, renal anatomical abnormality with calculi in the same kidney. Demographics, stone profile, procedure and outcome indicators were analysed for each group. RESULTS In all, 188 consecutive PCNLs in 169 children were included (mean age 3.3-10.3 years, mean stone burden 19.1-33.3 mm in the five groups). The mean duration of PCNL was 69-115 min. Stone clearance was satisfactory with single tract access in 90-100% of patients. Transient postoperative fever was the commonest complication (12.5-51%) followed by hyponatraemia and hypokalaemia. Blood transfusion was required in 0-7.7%. The mean stone clearance rates were 47-90% in the five groups; additional extracorporeal shockwave lithotripsy increased the cumulative clearance rates to 90-100%. CONCLUSION PCNL is safe for treating renal stones, with excellent results and minimal complications. Comparable results are achieved in the very young child, children with anatomically abnormal kidneys, children with impaired renal function and children with bilateral renal stones undergoing simultaneous bilateral PCNL. Hence none of these factors should be considered as relative contraindications.
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Affiliation(s)
- Lubna Samad
- Paediatric Urology, The Kidney Centre Postgraduate Training Institute, Karachi, Pakistan.
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Park BH, Han YM, Kim YG. Comparison of the Two-stage Procedure with the One-stage Procedure for Percutaneous Nephrolithotomy. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.5.512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Bong Hee Park
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
| | - Young Min Han
- Department of Radiology, Chonbuk National University Medical School, Jeonju, Korea
| | - Young Gon Kim
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
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Nk SK, Kota GK, Gopalakrishnan G. The role of retrocolonic saline injection to obtain access for percutaneous nephrostomy in a pelvic kidney. BJU Int 2005; 95:1115-6. [PMID: 15839944 DOI: 10.1111/j.1464-410x.2005.05477.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Shyam Kumar Nk
- Department of Radiology, Christian Medical College, Vellore, India.
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Kim SC, Tinmouth WW, Kuo RL, Paterson RF, Lingeman JE. Using and Choosing a Nephrostomy Tube after Percutaneous Nephrolithotomy for Large or Complex Stone Disease: A Treatment Strategy. J Endourol 2005; 19:348-52. [PMID: 15865526 DOI: 10.1089/end.2005.19.348] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Percutaneous nephrolithotomy (PCNL) is a well-accepted technique for removal of large or complex renal calculi. However, little attention has been paid to strategies for nephrostomy tube (NT) selection. We reviewed the reasons for selecting three types of NT after PCNL for large or complex stone disease. PATIENTS AND METHODS A series of 106 consecutive renal units undergoing PCNL for stone burdens >2 cm by a single surgeon (JEL) were reviewed. Noncontrast CT (NCCT) was carried out on postoperative day 1, and secondary procedures were performed if fragments remained. The NTs studied were 8.5F and 10F Cope loops (CP), 20F reentry Malecot catheters (REM), and 20F circle loops (CL). Patient demographics, access site and number, complications, and stone type were examined. "Stone free" was defined as a negative NCCT or negative second-look PCNL. RESULTS A total of 134 accesses were created in 106 renal units: 35 upper, 7 mid, and 92 lower; however, only 111 NTs were placed: 85 CP (76.6%), 19 REM (17.1%), and 7 CL (6.3%). Sixteen accesses were performed tubeless; all but two were in the upper pole. All 16 of these renal units had a concomitant NT placed in the lower pole. Multiple sites were accessed in 21 patients; 7 of these patients had CL placed. Five of ten patients with spinal-cord injury had REM/CL placed. Nineteen REM were placed: 10 for drainage of infection, and 9 for difficult anatomy. All renal units were rendered stone free: 31.1% with a single procedure and 95.6% with one or two procedures. There were no difficulties with drainage or access for secondary PCNL regardless of the NT employed. Complications included two hydrothoraces, one arteriovenous fistula, and one ureteral perforation. Three of four renal units in patients requiring transfusions underwent bilateral PCNL, and at least one renal unit required multiple accesses. Of kidneys with infection stones, 57.1% required REM or CL; only 12.0% of nonstruvite stones necessitated REM or CL. CONCLUSIONS All patients having PCNL done for complex stone disease should have an NT placed; however, small (8.5F-10F) CP suffice in most cases and can provide greater patient comfort. To minimize pleural morbidity, tubeless upper-pole access should be considered if the kidney is judged to be stone free at the conclusion of PCNL. Circle loops are useful when multiple accesses are necessary, whereas REM are appropriate if access is difficult, gross residual stone remains, or pain is not an issue (i.e., spinal-cord injury).
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Affiliation(s)
- Samuel C Kim
- Methodist Hospital Institute for Kidney Stone Disease, Indiana University School of Medicine, 1801 N. Senate Boulevard #220, Indianapolis, IN 46202, USA.
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Affiliation(s)
- Robert Marcovich
- Department of Urology, University of Texas Health Sciences Center, San Antonio, Texas 78229-3900, USA.
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Casale P, Grady RW, Joyner BD, Zeltser IS, Kuo RL, Mitchell ME. Transperitoneal laparoscopic pyelolithotomy after failed percutaneous access in the pediatric patient. J Urol 2004; 172:680-3; discussion 683. [PMID: 15247760 DOI: 10.1097/01.ju.0000129462.23322.e0] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE We present our experience with transperitoneal laparoscopic pyelolithotomy in pediatric patients in whom percutaneous renal access failed and the stone burden warranted open intervention. MATERIAL AND METHODS A transperitoneal laparoscopic approach was used for pyelolithotomy in 8 patients 3 months to 10 years old (mean age 4 years). Percutaneous access failed secondary to a nondilated system and/or an occluding lower pole calculus. Inclusion criteria were failed percutaneous access secondary to a nondilated system and/or stone occlusion of the lower pole system and failed shock wave lithotripsy or a stone burden of greater than 2.5 cm2. A posterior pelviotomy was made. Stones in the renal pelvis were removed with rigid graspers under direct laparoscopic vision. A flexible cystoscope was introduced through a port if caliceal stones were present. The renal pelvis was reconstructed. A watertight anastomosis was verified. RESULTS Average operative time was 1.6 hours (range 0.8 to 2.3). Mean hospital stay was 2.15 days (range 2 to 3). A range of 1 to 3 stones (median of 1) were removed and the mean stone burden was 2.9 cm2. No intraoperative complications were noted. Stone analysis revealed 3 patients with calcium oxalate stones, 1 with a calcium phosphate stone and 4 with cysteine stones. There was 1 patient with stone recurrence at a mean followup of 12 months (range 3 to 20). Thus, the overall long-term stone-free rate was 87.5%. CONCLUSIONS Transperitoneal laparoscopic pyelolithotomy is feasible when percutaneous access fails and open pyelolithotomy is considered due to a large stone burden.
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Affiliation(s)
- Pasquale Casale
- Seattle Children's Hospital, University of Washington, 98105-0371, USA.
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Albala DM, Assimos DG, Clayman RV, Denstedt JD, Grasso M, Gutierrez-Aceves J, Kahn RI, Leveillee RJ, Lingeman JE, Macaluso JN, Munch LC, Nakada SY, Newman RC, Pearle MS, Preminger GM, Teichman J, Woods JR. Lower pole I: a prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis-initial results. J Urol 2001; 166:2072-80. [PMID: 11696709 DOI: 10.1016/s0022-5347(05)65508-5] [Citation(s) in RCA: 367] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE The efficacy of shock wave lithotripsy and percutaneous stone removal for the treatment of symptomatic lower pole renal calculi was determined. MATERIALS AND METHODS A prospective randomized, multicenter clinical trial was performed comparing shock wave lithotripsy and percutaneous stone removal for symptomatic lower pole only renal calculi 30 mm. or less. RESULTS Of 128 patients enrolled in the study 60 with a mean stone size of 14.43 mm. were randomized to percutaneous stone removal (58 treated, 2 awaiting treatment) and 68 with a mean stone size of 14.03 mm. were randomized to shock wave lithotripsy (64 treated, 4 awaiting treatment). Followup at 3 months was available for 88% of treated patients. The 3-month postoperative stone-free rates overall were 95% for percutaneous removal versus 37% lithotripsy (p <0.001). Shock wave lithotripsy results varied inversely with stone burden while percutaneous stone-free rates were independent of stone burden. Stone clearance from the lower pole following shock wave lithotripsy was particularly problematic for calculi greater than 10 mm. in diameter with only 7 of 33 (21%) patients becoming stone-free. Re-treatment was necessary in 10 (16%) lithotripsy and 5 (9%) percutaneous cases. There were 9 treatment failures in the lithotripsy group and none in the percutaneous group. Ancillary treatment was necessary in 13% of lithotripsy and 2% percutaneous cases. Morbidity was low overall and did not differ significantly between the groups (percutaneous stone removal 22%, shock wave lithotripsy 11%, p =0.087). In the shock wave lithotripsy group there was no difference in lower pole anatomical measurements between kidneys in which complete stone clearance did or did not occur. CONCLUSIONS Stone clearance from the lower pole following shock wave lithotripsy is poor, especially for stones greater than 10 mm. in diameter. Calculi greater than 10 mm. in diameter are better managed initially with percutaneous removal due to its high degree of efficacy and acceptably low morbidity.
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Lopes Neto AC, Tobias-Machado M, Juliano RV, Lipay MA, Borrelli M, Wroclawski ER. Duodenal damage complicating percutaneous access to kidney. SAO PAULO MED J 2000; 118:116-7. [PMID: 10887388 DOI: 10.1590/s1516-31802000000400008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
CONTEXT Since the first percutaneous nephrostomy performed by Goodwin in 1954, technical advances in accessing the kidneys via percutaneous puncture have increased the use of this procedure and thus the complications too. Among these complications, digestive tract damage is not common. DESIGN Case report. CASE REPORT We report a duodenal lesion that was corrected using surgical exploration and we touch on the therapeutic options, which may be conservative or interventionist. We chose conservative treatment, which has been approached in diverse manners in the literature.
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Agrawal MS, Aron M, Asopa HS. Endourological renal salvage in patients with calculus nephropathy and advanced uraemia. BJU Int 1999; 84:252-6. [PMID: 10468716 DOI: 10.1046/j.1464-410x.1999.00159.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To document our experience with percutaneous nephrolithotripsy (PCNL) for the treatment of calculus nephropathy and advanced renal failure. PATIENTS AND METHODS Between October 1989 and April 1996, 78 patients with calculus nephropathy (51 males and 27 females, mean age 42 years, range 16-67; mean serum creatinine level 663.8 micromol/L, range 282.8-1449.7) were treated in our department. Forty-six of the patients had bilateral upper urinary calculi, while the remaining 32 had a solitary functioning kidney obstructed by stone. Thirty-two patients had a normal urine output, 26 were oliguric and 20 presented with anuria. A preliminary percutaneous nephrostomy (PCN) was performed under local anaesthesia in 64 patients, and stone retrieved subsequently through the same nephrostomy track after improvement in their uraemic status. In the remaining 14 patients, the stones were removed at the first session. Of the 46 patients with bilateral stones, 21 underwent stone retrieval by PCNL on the contralateral side after an interval of 2-3 weeks, while 25 patients underwent simultaneous JJ stenting on the contralateral side, followed, after improvement in uraemic status, by delayed PCNL or extracorporeal shock wave lithotripsy on that side. RESULTS There were three deaths, caused by overwhelming sepsis; 64 of the remaining 75 patients recovered well from uraemia, while 11 showed no improvement, suggesting irreversible renal damage. Complications included five patients with nonfatal sepsis and five with secondary haemorrhage. At the last follow-up 2.5-9 years after presentation, the mean serum creatinine level (271.3 micromol/L) was significantly better than the mean preoperative level. Six patients are on maintenance haemodialysis. CONCLUSIONS It is not uncommon in developing countries for patients with urolithiasis to present with advanced uraemia caused by long-standing obstruction, almost invariably complicated by infection. A percutaneous endourological approach offers the best hope for these patients, and in our experience a significant percentage of these cases can be salvaged.
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Affiliation(s)
- M S Agrawal
- Urology Division, Department of Surgery, S.N. Medical College, Agra, India
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29
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Wong MY. Evolving technique of percutaneous nephrolithotomy in a developing country: Singapore General Hospital experience. J Endourol 1998; 12:397-401. [PMID: 9847058 DOI: 10.1089/end.1998.12.397] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
At our institution, percutaneous nephrolithotomy (PCNL) is the preferred treatment modality for renal calculi with a large stone burden (example, staghorn calculi) and renal calculi which have failed extracorporeal shockwave lithotripsy (SWL). The aim of this paper is to present the technical refinements in PCNL and the results obtained by a single surgeon. From June 1995 to July 1997, 135 PCNL procedures were performed on 114 renal units. The mean age of the patients in the series was 51 years. The PCNL was performed on 28 complete staghorn calculi (25%), 24 partial staghorn calculi (21%), 25 large renal calculi (22%), 26 impacted ureteropelvic junction calculi (22%), 5 impacted ureteral stones (4%), and 6 symptomatic lower-pole calculi (5%). Most patients (97%) had a successful outcome (82% stone-free and 15% only insignificant residual fragments). Of the four failures, three had previous open renal split operations. The average postoperative stay was 5.2 days. Only one patient (0.7%) had urosepsis, and another had an arteriovenous fistula and was the only patient to require blood transfusion in our series. Only 21% (n = 24) required SWL after PCNL, and one patient required ureteroscopy. Technical refinements in PCNL include: (1) single-stage PCNL with percutaneous access obtained by the urologist in the operating room; (2) flexible endoscopy to inspect the whole pelvicaliceal system systematically; (3) liberal use of secondary PCNL to ensure stone-free status; and decreased reliance on SWL after PCNL. The trend is to rely on PCNL monotherapy to manage staghorn calculi rather than PCNL and SWL combination therapy.
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Affiliation(s)
- M Y Wong
- Department of Urology, Singapore General Hospital, Republic of Singapore
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30
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Ginsberg DA, Stein JP, Grossfeld GD, Tarter T, Skinner DG. Traumatic pyeloduodenal fistula: a case report and review of the literature. Urology 1996; 47:588-91. [PMID: 8638375 DOI: 10.1016/s0090-4295(99)80502-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A case of a traumatic pyeloduodenal fistula secondary to a gunshot wound is reported. After initial conservative management failed, the fistula tract was surgically excised without removal of the involved kidney. Previous treatments of pyeloduodenal fistulas secondary to gunshot wounds have involved nephrectomy. We present the first case of a pyeloduodenal fistula secondary to gunshot wound managed without nephrectomy along with a review of the literature regarding traumatic pyeloduodenal fistula.
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Affiliation(s)
- D A Ginsberg
- Department of Urology, University of Southern California, School of Medicine, Los Angeles, USA
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31
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Ahmed M, Reeve R. Iatrogenic duodeno-cutaneous fistula at percutaneous nephrolithotomy managed conservatively. ACTA ACUST UNITED AC 1995. [DOI: 10.1111/j.1464-410x.1995.tb07365.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kerbl K, Clayman RV, Chandhoke PS, Urban DA, De Leo BC, Carbone JM. Percutaneous stone removal with the patient in a flank position. J Urol 1994; 151:686-8. [PMID: 8308982 DOI: 10.1016/s0022-5347(17)35048-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We report a case of percutaneous removal of a staghorn calculus that was accomplished in a morbidly obese patient while he was in a full flank position. In this position, the stone could be successfully accessed and fragmented without compromising the pulmonary status of the patient.
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Affiliation(s)
- K Kerbl
- Department of Surgery (Division of Urology), Washington University School of Medicine, St. Louis, Missouri
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33
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Bleacher JC, Boline GB, Decter RM, Conter RL. Pyeloduodenal fistula: a previously undescribed complication of Stamm gastrostomy. J Pediatr Surg 1993; 28:1579-81. [PMID: 8301498 DOI: 10.1016/0022-3468(93)90104-s] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A variety of complications have been described after placement of a Stamm gastrostomy in infants and children, including gastric volvulus, pancreatitis, jaundice, gastroduodenal mucosal intussusception with gastric outlet obstruction, and even aortogastric fistula. However, this is the first report of pyeloduodenal fistula after Stamm gastrostomy in a 4 1/2-month-old boy. The child successfully underwent nonoperative therapy; he was treated by withdrawing the gastrostomy tube (Foley catheter) from the renal pelvis, bowel rest, and total parenteral nutrition. After the case presentation is a brief review of this rare entity, with its clinical presentation and pathophysiological differences between adult and pediatric cases. Various treatment options, both operative and nonoperative, are also described.
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Affiliation(s)
- J C Bleacher
- Department of Surgery, Pennsylvania State University, College of Medicine, Milton S. Hershey Medical Center, Hershey 17033
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Abstract
Despite the advent of extracorporeal shock wave lithotripsy, percutaneous nephrolithotripsy still plays a prominent role in the management of large and staghorn renal calculi. Modalities available for intracorporeal lithotripsy include ultrasound, electrohydraulic, and laser. I report my experience with the Swiss Lithoclast in performing percutaneous nephrolithotripsy in 45 patients. The advantages of this device in percutaneous stone removal include its rapidity, safety, ease of use, and usefulness in clearing the initial calix during staghorn stone removal.
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Affiliation(s)
- J D Denstedt
- Division of Urology, University of Western Ontario, London, Canada
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35
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Grasso M, Nord R, Bagley DH. Prone split leg and flank roll positioning: simultaneous antegrade and retrograde access to the upper urinary tract. J Endourol 1993; 7:307-10. [PMID: 8252024 DOI: 10.1089/end.1993.7.307] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The simultaneous endoscopic approach to upper urinary tract pathology in both an antegrade and retrograde fashion can be cumbersome. The prone split leg and flank roll positions allow such simultaneous access. Of 111 patients in whom the prone split leg position was employed, 41% were treated with simultaneous antegrade and retrograde endoscopy in a two-team approach. Treating large staghorn calculi in this manner, one team debulked the stone burden accessible through the flank nephroscopically, while another team approached the remainder of the stone burden using the pulsed-dye laser ureteroscopically in a retrograde manner. The flank roll position was employed in 15 patients who presented with percutaneous nephrostomies and were deemed treatable preoperatively in a retrograde manner. They were positioned in this manner to allow intraoperative access to the percutaneous nephrostomy tract. Nine of these patients required antegrade treatment. The application of these two positions and the concept of the two-team approach added to the efficiency of treating not only staghorn calculi, but other upper tract pathology. Simultaneous procedures require at least two skilled endoscopists as well as dual light sources, various lithotrites, and several rigid and flexible endoscopes.
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Affiliation(s)
- M Grasso
- Department of Urology, Loma Linda University Medical Center, CA
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36
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el-Kenawy MR, el-Kappany HA, el-Diasty TA, Ghoneim MA. Percutaneous nephrolithotripsy for renal stones in over 1000 patients. BRITISH JOURNAL OF UROLOGY 1992; 69:470-5. [PMID: 1623373 DOI: 10.1111/j.1464-410x.1992.tb15590.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Over a period of 5 consecutive years, 1039 renal units were treated by percutaneous nephrolithotripsy for stone disease of the kidney. The success rate was 93.7%. Residual stones remained in 4.2% of patients and in 2.1% we failed to remove the stones. The complication rate was 17.8%. Complications were treated conservatively in most cases but nephrectomy was required on one occasion to control severe bleeding. The average hospital stay was 6.9 days. Follow-up of 339 renal units (333 patients), for a minimum of 60 months, revealed minor late sequelae such as pelviureteric junction obstruction in 1 patient (0.3%) and post-catheterisation strictures of the anterior urethra in 4 (1.2%). Stone recurrence was observed in 9.1% of patients. Percutaneous nephrolithotripsy is an effective, safe treatment for renal stones with minimal late sequelae and is still required even in the era of extracorporeal shock wave lithotripsy.
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37
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LEE CHIK, SMITH ARTHURD. Percutaneous Transperitoneal Approach to the Pelvic Kidney for Endourologic Removal of Calculus: Three Cases with Two Successes. J Endourol 1992. [DOI: 10.1089/end.1992.6.133] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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38
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Morris DB, Siegelbaum MH, Pollack HM, Kendall AR, Gerber WL. Renoduodenal fistula in a patient with chronic nephrostomy drainage: a case report. J Urol 1991; 146:835-7. [PMID: 1875505 DOI: 10.1016/s0022-5347(17)37935-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We describe the occurrence of a renoduodenal fistula related to a nephrostomy tube in a patient with xanthogranulomatous pyelonephritis and renal calculi. The patient was successfully treated by nephrectomy. Etiological, diagnostic and therapeutic aspects are discussed.
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Affiliation(s)
- D B Morris
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania 19140
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39
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Travis DG, Tan HL, Webb DR. Single-increment dilatation for percutaneous renal surgery: an experimental study. BRITISH JOURNAL OF UROLOGY 1991; 68:144-7. [PMID: 1884139 DOI: 10.1111/j.1464-410x.1991.tb15282.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Renal nephrostomy track dilatation is an integral part of percutaneous renal surgery. The traditional method has employed sequential dilators of increasing size, or balloon dilatation. This study used a canine model to investigate the effects of single-increment renal track dilatation to 24 F and compares it with the conventional techniques. Single-increment dilatation proved to be a safe technique with minimal haemorrhage or parenchymal damage and healing at 6 weeks by a fine linear scar. It was as safe as conventional techniques. We believe this study proves that single-stage dilatation is a safe technique for use in humans.
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Affiliation(s)
- D G Travis
- Department of Urology, Royal Children's Hospital, Melbourne, Australia
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40
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Culkin DJ, Wheeler JS, Nemchausky BA, Fruin RC, Canning JR. Percutaneous nephrolithotomy: spinal cord injury vs. ambulatory patients. THE JOURNAL OF THE AMERICAN PARAPLEGIA SOCIETY 1990; 13:4-6. [PMID: 2335778 DOI: 10.1080/01952307.1990.11735806] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
One hundred patients, 35 with spinal cord injury (SCI) and 65 who were ambulatory, underwent percutaneous nephrolithotomy (PNL). Success of complete stone excision, operative morbidity and mortality were compared in the two patient populations. Stone size and complexity were evaluated by X-ray and a single-stage PNL was done using general anesthesia, bi-planar C-arm fluoroscopy, Amplatz renofascial dilators, and two guide wires. Eleven percent of the patients had previously-placed percutaneous nephrostomy tubes for hydronephrosis and/or pyonephrosis. In the ambulatory group, 98.5% (64/65) were stone-free after the procedure as compared to 85.7% (31/35) in the SCI group. The success rate in those patients who followed postoperative instructions exceeded 96% in both groups of patients. One operative mortality, related to infectious complications, occurred in the SCI group. Major morbidity in the SCI population consisted of three perirenal abscesses, a hydrothorax, an aspiration pneumonia, a respiratory arrest and a nephro-colonic fistula for a rate of 20% (7/35), or 7% of all patients. One major complication, a nephroduodenal fistula, occurred in the ambulatory population. Four patients, three of whom were SCI, required open surgery related to infectious complications. Other significant complications consisted of hemorrhage requiring transfusion, and fever (101.5 degrees F). Minor complications included dislodged nephrostomy tubes, retained stones, and ureteral edema causing obstruction. These complications were three times more common in the SCI population. Percutaneous nephrolithotomy is an effective surgical means for stone removal for SCI and ambulatory patients. The SCI patient has a high incidence of infectious complications causing increased morbidity and mortality.
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HORAN JOHNJ, O'BRIEN WALTERM, PAHIRA JOHNJ. Repeated Percutaneous Nephrolithotomy in Patient with Recurrent Cystine Lithiasis: Preservation of Renal Function. J Endourol 1990. [DOI: 10.1089/end.1990.4.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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43
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Ryan PC, Kiely EA, Grainger R, Moloney M, Fitzpatrick JM, Hurley GD, Butler MR. Endoscopic treatment of urinary tract calculi. Ir J Med Sci 1989; 158:141-3. [PMID: 2767929 DOI: 10.1007/bf02943054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Removal of urinary tract calculi by endourological techniques is now widely practised and has reduced the indications for open surgical removal to a minority of cases. A review of 270 consecutive patients who presented to the Meath Hospital Urology department with urinary tract calculi and were treated by percutaneous or transurethral endoscopy is herein reported. The rates of successful clearance of renal (95%) and ureteric (78%) calculi compare well with previous reports. The majority of complications were minor and a low overall complication rate was experienced at ureterorenoscopy. In our experience, endourological treatment of urinary tract calculi is successful, efficient and safe and is the recommended approach to urinary tract calculi that require surgical intervention.
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44
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Desmond JM, Evans SE, Couch A, Morewood DJ. Pyeloduodenal fistulae. A report of two cases and review of the literature. Clin Radiol 1989; 40:267-70. [PMID: 2666006 DOI: 10.1016/s0009-9260(89)80194-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Two cases of pyeloduodenal fistula are described. Previously reported cases are reviewed with discussion of clinical aspects and the role of various radiological investigations. Conservative management with internal ureteric stenting (intraoperative or percutaneous) is suggested as an alternative to nephrectomy.
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Affiliation(s)
- J M Desmond
- Department of Radiology, Royal Liverpool Hospital, UK
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45
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HOCKLEY NANCYM, LINGEMAN JAMESE, HUTCHINSON CINDYL. Relative Efficacy of Extracorporeal Shock Wave Lithotripsy and Percutaneous Nephrostolithotomy in the Management of Cystine Calculi. J Endourol 1989. [DOI: 10.1089/end.1989.3.273] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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46
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Streem SB. Kidney stones. How new technology has improved management. Postgrad Med 1988; 84:77-8, 81-9. [PMID: 2904142 DOI: 10.1080/00325481.1988.11700510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In the past decade, techniques allowing noninvasive or relatively noninvasive treatment of kidney stones have replaced standard surgical management for most patients. Extracorporeal shock wave lithotripsy is suitable for the majority of patients with calculi in the upper or mid urinary tract. Ultrasonic lithotripsy can be used to fragment large staghorn or cystine calculi and is suitable for morbidly obese patients. The tunable pulsed dye laser is also gaining a role in the treatment of selected patients. All three techniques require only a short hospital stay.
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Affiliation(s)
- S B Streem
- Section of Stone Disease and Endourology A100, Cleveland Clinic Foundation, OH 44195
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47
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Abstract
The nonoperative management of a nephrocolic fistula that resulted from percutaneous nephrostolithotomy is reported. Adequate urinary drainage, removal of the nephrostomy tube, use of an elemental diet and antibiotic coverage are advocated.
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Affiliation(s)
- R Appel
- Urology Service, Naval Hospital, San Diego, California
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48
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Abstract
Management of urolithiasis in children remains a challenge despite newer technological innovations. During the last 3 years we have treated 19 children with a combination of extracorporeal shock wave lithotripsy, percutaneous stone extraction and ureteroscopy, as well as with traditional methods. The newer technological methods perfected in adults are equally applicable to children in experienced hands.
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Affiliation(s)
- P Shepherd
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
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49
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Weinberg JJ, Snyder JA, Smith AD. Mechanical Extraction of Stones with Rigid Ureteroscopes. Urol Clin North Am 1988. [DOI: 10.1016/s0094-0143(21)01574-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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50
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Netto NR, Lemos GC, De Almeida Claro JF, Palma PC. Comparison between percutaneous nephrolithotomy and open stone procedures. Int Urol Nephrol 1988; 20:225-30. [PMID: 3403189 DOI: 10.1007/bf02549508] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A total of 205 patients have undergone stone extraction surgery. Three groups were studied: in 70 patients the stones were removed by flank incision, in 20 patients by posterior incision and 80 patients were treated by percutaneous nephrolithotomy. Patients submitted to percutaneous nephrolithotomy had a shorter hospitalization, operative time and a significantly reduced period of recuperation, allowing earlier return to work and decreased disability. Narcotic drugs were demanded in a lower amount in the percutaneous nephrolithotomy group.
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Affiliation(s)
- N R Netto
- Division of Urology, University of Campinas Medical School Unicamp, São Paulo, Brazil
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