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Almeras C, Abid N, Meria P. 2022 Recommendations of the AFU Lithiasis Committee: Extracorporeal shock wave lithotripsy (ESWL). Prog Urol 2023; 33:812-824. [PMID: 37918981 DOI: 10.1016/j.purol.2023.08.011] [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: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
Extracorporeal shock wave lithotripsy (ESWL) is a minimally invasive technique for the fragmentation of urinary tract stones using shock waves under fluoroscopic and/or ultrasound guidance. ESWL results depend on the indication (stone size/composition, clinical context) and also on how it is performed. The stone structure, nature and density (Hounsfield units; evaluated by CT without contrast agent) influence the fragmentation achieved by ESWL. The upper size limit of kidney stones has been lowered to 15mm (1.68cm3) due to the increased risk of steinstrasse with larger sizes and the potential need of anesthesia and ureteral stenting. Conversely, the development of endourological technologies allows a finer stone fragmentation and/or better elimination, thus reducing the risk of steinstrasse and decreasing the potential number of sessions or additional interventions. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendations method (CPR) and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis [EAU 2022]) and their adaptability to the French context.
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Affiliation(s)
- C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, Paris, France.
| | - N Abid
- Edouard Herriot Hospital, Department of Urology and Transplantation Surgery, Hospices Civils de Lyon, Lyon, France
| | - P Meria
- Service d'urologie, hôpital Saint-Louis, AP-HP-Centre Université Paris Cité, Paris, France
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Berhe T, Hassen SM, Gebrehiwot FG, Mummed FO, Issack FH, Dino MS, Akkasa SS, Zerihun GA, Gebreselassie KH. Fused Supernumerary Kidney with Single Pelvis and Ureter; Presenting with Stones: A Case Report and Literature Review. Res Rep Urol 2022; 13:853-857. [PMID: 34993158 PMCID: PMC8711840 DOI: 10.2147/rru.s347328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/15/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction A supernumerary kidney is an extremely rare congenital anomaly, defined as the presence of one or more extra kidneys. Thus far, there have been less than 100 cases reported in the medical literature. It has its capsule, vascular supply, and collecting system. It frequently causes diagnostic challenges in clinical practice. The supernumerary kidney can be symptomatic due to the presence of stone. Case Presentation We present a case of a 19-year-old male patient who came to our clinic with the complaint of abdominal pain. On computed tomography urography (CTU), he was found to have a caudally located left fused supernumerary kidney with a separate vascular supply. Both left kidneys had a separately draining calyceal systems uniting at the left renal pelvis and drained by a single ureter. Multiple left renal stones (largest measures 4cm x 2.2cm) in both kidneys were also seen. The stones were removed surgically by doing pyelolithotomy and radial nephrolithotomy. The patient was doing well during follow-up visits with the improvement of abdominal pain. Conclusion Supernumerary kidney is a very rare congenital renal anomaly. This case is even unique, because of the fused supernumerary kidney and the presence of a single left renal pelvis and ureter. Imaging is very essential for planning surgical intervention. Stones in such kidneys can be managed with nephrolithotomy and/or pyelolithotomy.
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Affiliation(s)
- Tekleberhan Berhe
- Urology Unit, Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Seid Mohammed Hassen
- Urology Unit, Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Ferid Ousman Mummed
- Urology Unit, Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Feysel Hassen Issack
- Urology Unit, Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Masresha Solomon Dino
- Urology Unit, Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Sena Sefera Akkasa
- Urology Unit, Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Getachew Adamu Zerihun
- Urology Unit, Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Yi X, Cao D, You P, Xiong X, Zheng X, Jin T, Peng G, Xu H, Liao D, Wei Q, Li H, Yang L, Ai J. Comparison of the Efficacy and Safety of Extracorporeal Shock Wave Lithotripsy and Flexible Ureteroscopy for Treatment of Urolithiasis in Horseshoe Kidney Patients: A Systematic Review and Meta-Analysis. Front Surg 2021; 8:726233. [PMID: 34760915 PMCID: PMC8572974 DOI: 10.3389/fsurg.2021.726233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/20/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Urolithiasis is the most common complication of horseshoe kidney (HK), which can be treated by extracorporeal shock wave lithotripsy (ESWL), flexible ureteroscopy (FURS), and percutaneous nephrolithotomy (PCNL). When comparing treatments of ESWL and FURS, it is unclear which is more efficient and safe. The objective of this study was to compare the efficacy and safety of FURS and SWL for the treatment of urolithiasis in HK patients. Methods: A systematic search of the Web of Science, PubMed, and EMBASE was performed in February 2021. Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias in each study. Results: Five studies published between 2008 and 2018 were synthesized in the present meta-analysis. The study revealed that FURS compared with SWL had greater initial and overall stone-free rates (SFRs). Risk ratios (RRs) were 2.46 (P < 0.00001) in initial SFRs, 1.36 (P = 0.02) in overall SFRs. No differences were found in the retreatment ratio, RRs were 0.49 (P = 0.43). In addition, no major complications were encountered, and all the complications were mild to moderate. Conclusion: The study demonstrated that FURS and SWL are effective and safe treatments for patients with HK with stones (<20 mm). Moreover, FURS has greater clearance rates and lower complication rates than SWL.
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Affiliation(s)
- Xianyanling Yi
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Dehong Cao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Pinghong You
- Department of Urology, People's Hospital of Deyang City, Deyang, China
| | - Xingyu Xiong
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaonan Zheng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Jin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ge Peng
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
| | - Hang Xu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Dazhou Liao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianzhong Ai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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Fawzy AM, Abdelkafy AA, Elahawy MM, Abdelgawad AH, Hasanein MGS, Abdelgawad AT, Magdi Ali M, Fathelbab TK, Galal EM. Contralateral Coupling During Extracorporeal Shockwave Lithotripsy for Stones in Ectopic Kidney: Is It Feasible? J Endourol 2021; 35:1090-1096. [PMID: 33544033 DOI: 10.1089/end.2020.1064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Extracorporeal shockwave lithotripsy (SWL) results in a lower stone-free rate (SFR) for ectopic kidneys when using the standard technique, directing the shock wave from the same side of the stone; however, this may not be the optimal approach when the ectopic kidney is located more medial and anterior than the normally positioned kidney. Thus, contralateral coupling where waves come from the opposite direction may result in a better outcome. We tested the feasibility and outcome of contralateral coupling during SWL for stone in ectopic kidney. Materials and Methods: We prospectively recruited 20 patients with simple renal ectopia, who presented with renal stones that were amenable for SWL in the period between 2014 and 2018 at outpatient clinic of urology department, Minia University. Patients received SWL in Private Nile SWL Center were included to benefit from the ability of the electromagnetic SWL lithotripter. We did SWL in a supine position, and then contralateral coupling was performed from the opposite side of the affected kidney, rather than using the standard ipsilateral coupling approach. The SFR and various pre-, intra-, and postprocedural SWL variables were assessed, including stone characteristics, body habitus, shock wave numbers, and auxiliary measures. Count and percentages were calculated. Results: The mean stone radius was 14.7 mm with a mean S.T.O.N.E. (size, topography, obstructions, number of stones, and evaluation of HUs) of 9.6 points. Effective SWL was achieved in 80% of cases, 65% of them were stone free with effective single SWL session in 56% of cases. Hematuria, infection, and obstruction occurred in 50%, 20%, and 15% cases, respectively. One case required ureteral stent insertion. Conclusions: SWL applied through contralateral coupling is feasible, with comparable safety profile to the standard ipsilateral approach. Better SFR was achieved with the contralateral approach, in fewer sessions. However, the recruitment of more cases is necessary.
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Affiliation(s)
- Ahmed M Fawzy
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt.,Nile SWL Center, Minia, Egypt
| | - Amr Abdelhameed Abdelkafy
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt
| | - Mamdouh Mohamed Elahawy
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt
| | - Ahmed Hakeem Abdelgawad
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt
| | - Mohammed G S Hasanein
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt.,Nile SWL Center, Minia, Egypt
| | - Asmaa Taha Abdelgawad
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt
| | - Mostafa Magdi Ali
- Department of Urology, School of Medicine, Minia University, Minia, Egypt
| | - Tarek Khalaf Fathelbab
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt.,Nile SWL Center, Minia, Egypt
| | - Ehab Mohamed Galal
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt
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Ding J, Huang Y, Gu S, Chen Y, Peng J, Bai Q, Ye M, Qi J. Flexible Ureteroscopic Management of Horseshoe Kidney Renal Calculi. Int Braz J Urol 2016; 41:683-9. [PMID: 26401860 PMCID: PMC4756996 DOI: 10.1590/s1677-5538.ibju.2014.0086] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 10/23/2014] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate the clinical efficacy of flexible ureteroscope (F-URS) combined with holmium laser lithotripter in treating renal calculi in horseshoe kidney. MATERIALS AND METHODS From November 2010 to December 2013, the medical history and charts of sixteen patients (mean age 42.9 ± 11.6 years, range 26-66 years), including 13 males and 3 females were analyzed retrospectively. Mean stone burden was 29 ± 8 mm (range 17-42 mm2). Mean stone digitized surface area (DSA) was 321 ± 94 mm2 (range 180-538 mm2). Under spinal anesthesia in a modified lithotomy position with the head down, rigid ureteroscope was placed firstly into the ureter to reach the level of the pelvis, a zebra guide wire was inserted and following the removal of the rigid ureteroscope, an ureteral access sheath was positioned along the guide wire, then passed the URF P-5 flexible ureteroscope into the renal cavities over the guidewire. After locating the stones, holmium laser lithotripsy was performed. RESULTS The average operative time was 92 ± 16 minutes (range 74-127 min.). No major complications were encountered. Ten patients obtained stone-free status with one session, four obtained stone-free status after two sessions. Single session stone-free rate was 62.5%, overall stone-free rate was 87.5%. Two patients have small residual stones in the lower pole. CONCLUSIONS F-URS combined with holmium laser lithotripter and nitinol basket, is safe and effective in dealing with moderate stone diameter (<30 mm) in HSKs with high clearance rates and low complication rates.
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Affiliation(s)
- Jie Ding
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunteng Huang
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Siping Gu
- Micro-Invasive Surgery Center, Shishi Overseas Chinese Hospital, Fujian, China
| | - Yifan Chen
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Peng
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Bai
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Ye
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Qi
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Yin Z, Wei YB, Liang BL, Zhou KQ, Gao YL, Yan B, Wang Z, Yang JR. Initial experiences with laparoscopy and flexible ureteroscopy combination pyeloplasty in management of ectopic pelvic kidney with stone and ureter-pelvic junction obstruction. Urolithiasis 2015; 43:255-60. [PMID: 25666341 DOI: 10.1007/s00240-015-0753-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/07/2015] [Indexed: 10/24/2022]
Abstract
To demonstrate the safety and efficacy of combine laparoscopy and flexible ureteroscopy to treat ectopic pelvic kidneys with ureteropelvic junction obstruction (UPJO) and stones. 16 patients of ectopic pelvic kidneys with ureteropelvic junction obstruction and stones were treated with laparoscopy and flexible ureteroscopy (FURS). The operative time, required dose of tramadol, visual analog pain scale (VAPS), postoperative day, stone-free rates (SFRs), perioperative complications, and serum creatinine were evaluated. The SFRs were evaluated with noncontrasted renal computed tomography (CT). Intravenous pyelography (IVP) and CT scan were used to evaluate the UPJO. Stone-free status was defined as absence of stone fragments in kidney or the size of that is less than 3 mm. Operation time from 118 to 225 min, average time (171 ± 28) min; lithotomy time from 16 to 45 min, average time (32 ± 6) min. Average tramadol required at the first day postoperation was (118 ± 49.6) mg; at the second day was (78 ± 24.8) mg. VAPS score at 24 h (5.0 ± 0.7), VAPS score at 48 h (2.5 ± 0.8). Postoperative day (3.9 ± 0.6) days. Stone-free rate was 100%. Average serum creatinine was (88.7 ± 24.3) mol/L before surgery and (92.8 ± 21.6) mol/L after surgery. No major complication. No stone and obstruction recurrence in the follow-up of average 29.3 months. Combined FUR and LC is a good option for patient of ectopic pelvic kidney with renal stone and UPJO. From our initial experience, the SFRs and the effect of pyeloplasty are satisfactory and without major complication, the operative time is acceptable.
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Affiliation(s)
- Zhuo Yin
- Department of Urology, Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan, China,
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Bozkurt OF, Tepeler A, Sninsky B, Ozyuvali E, Ziypak T, Atis G, Daggulli M, Resorlu B, Caskurlu T, Unsal A. Flexible ureterorenoscopy for the treatment of kidney stone within pelvic ectopic kidney. Urology 2014; 84:1285-9. [PMID: 25288574 DOI: 10.1016/j.urology.2014.07.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 06/03/2014] [Accepted: 07/22/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To present the outcomes of flexible ureterorenoscopy (F-URS) and laser lithotripsy for the treatment of calculi within pelvic ectopic kidney (PEK). PATIENTS AND METHODS We retrospectively reviewed the medical records of 26 patients with calculi in PEK treated with F-URS in 5 referral hospitals between 2010 and 2013. Patient demographics and stone characteristics (age, sex, body mass index, stone size, location, history of shock wave lithotripsy or kidney surgery), and perioperative measures (duration of operation, fluoroscopic imaging, and hospitalization and success and complication rates) were reviewed. RESULTS A total of 26 patients with mean age of 41.1 ± 15.8 years (7-72 years) were included in the study. The mean stone size was 17.0 ± 5.1 mm (10-28 mm). The mean procedure and fluoroscopy times were calculated as 52.1 ± 27.7 minutes (30-120 minutes) and 54.8 ± 48.9 seconds (10-180 seconds), respectively. The mean length of hospital stay was 2.7 ± 1.8 days (1-9 days). Treatment was deemed successful in 22 patients (84.6%). Ureteroscopy failed in 4 patients (15.4%) due to impaired passage of fragments (n = 3) or inability to reach the stone secondary to the location in an isolated lower calyx (n = 1). Minor postoperative complications were observed in 5 patients (19.2%; persistent hematuria [n = 1], fever [n = 1], renal colic [n = 2], and urinary tract infection [n = 1]). No severe complications or mortality occurred. CONCLUSION Our results suggest that F-URS is a safe and effective minimally invasive treatment modality for small- and medium-sized stones in PEK.
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Affiliation(s)
- Omer Faruk Bozkurt
- Department of Urology, Kecioren Teaching and Research Hospital, Ankara, Turkey
| | - Abdulkadir Tepeler
- Department of Urology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey; Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI.
| | - Brian Sninsky
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Ekrem Ozyuvali
- Department of Urology, Kecioren Teaching and Research Hospital, Ankara, Turkey
| | - Tevfik Ziypak
- Department of Urology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Gokhan Atis
- Department of Urology, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
| | - Mansur Daggulli
- Department of Urology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Berkan Resorlu
- Department of Urology, Kecioren Teaching and Research Hospital, Ankara, Turkey
| | - Turhan Caskurlu
- Department of Urology, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
| | - Ali Unsal
- Department of Urology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Giusti G, Proietti S, Peschechera R, Taverna G, Sortino G, Cindolo L, Graziotti P. Sky is no limit for ureteroscopy: extending the indications and special circumstances. World J Urol 2014; 33:257-73. [DOI: 10.1007/s00345-014-1345-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 05/14/2014] [Indexed: 12/19/2022] Open
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Oğuz U, Balci M, Atis G, Bozkurt OF, Tuncel A, Halis F, Aslan Y, Yildirim IO, Senocak C, Yordam M, Atan A, Caskurlu T, Unsal A. Retrograde intrarenal surgery in patients with isolated anomaly of kidney rotation. Urolithiasis 2013; 42:141-7. [PMID: 24253539 DOI: 10.1007/s00240-013-0625-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 11/06/2013] [Indexed: 11/30/2022]
Abstract
The purpose of the study was to investigate feasibility of retrograde intrarenal surgery (RIRS) in patients with isolated anomaly of kidney rotation with kidney stones. We retrospectively reviewed the medical records of patients who underwent RIRS due to kidney stones in three referral hospitals. Twenty-four patients who had kidney rotation were included in this study. The patients with horseshoe kidney or pelvic kidney were not included in the study. The patients were evaluated for final success 1 month after surgery. Success was defined as stone-free or fragment smaller than 3 mm. Mean age of patients was 39.5 years (1-71 years) and male/female ratio was 3:1. Mean stone size was 13.46 mm (5-30 mm). Twelve (50 %) patients had the operation on the right side and other 12 (50 %) patients had on the left side. Eighteen (75 %) patients were stone-free after single procedure. And stone-free rate increased to 83.3 % after additional treatment procedures. When we compared the successful and failed procedures, gender, stone side and size, preoperative hydronephrosis, access sheet usage, ureteral double-J stent insertion were not statistically significant in two groups. We did not confront major complication. RIRS seems to be an effective and safe treatment option for renal stones in patients with isolated anomaly of kidney rotation.
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Affiliation(s)
- Ural Oğuz
- Department of Urology, Kecioren Training and Research Hospital, Ankara, Turkey,
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Alomar M, Alenezi H. Computed tomography-guided transgluteal percutaneous nephrolithotripsy in an ectopic pelvic kidney: novel technique. J Endourol 2013; 27:398-401. [PMID: 23094671 DOI: 10.1089/end.2012.0464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Management of stones in the ectopic pelvic kidney can be very challenging. Treatment of each patient should be individualized. We describe a new approach that is CT-guided transgluteal percutaneous nephrolithotripsy (PCNL). CASE AND TECHNIQUE A 19-year-old male presented with symptomatic right ectopic pelvic kidney stones. He was treated with CT-guided transgluteal PCNL. The patient was stone free at postoperative day 1. No major complications were observed, and the patient was discharged home on postoperative day 2. CONCLUSION CT-guided transgluteal PCNL is a safe and effective option for selected patients with ectopic pelvic kidney stones.
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Affiliation(s)
- Mohammad Alomar
- Urology Division, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
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El-Nahas AR, Shokeir AA. Minimally Invasive Treatment of Calculi in Renal Anomalies. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Molimard B, Al-Qahtani S, Lakmichi A, Sejiny M, Gil-Diez de Medina S, Carpentier X, Traxer O. Flexible ureterorenoscopy with holmium laser in horseshoe kidneys. Urology 2010; 76:1334-7. [PMID: 20573385 DOI: 10.1016/j.urology.2010.02.072] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 02/09/2010] [Accepted: 02/09/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To assess the outcome of flexible ureterorenoscopy (F-URS) with the holmium laser in treating stones in the horseshoe kidney (HSK). METHODS We retrospectively reviewed the records of 17 patients with a HSK stone (17 renal units) who had undergone F-URS with the holmium laser from December 2004 to May 2009. The presenting symptoms were renal colic, urinary tract infection, or hematuria. F-URS was used in as an alternative after the failure of shock wave lithotripsy in 8 patients (47%) and percutaneous nephrolithotomy failure in 4 patients (23.5%). Follow-up examination was performed after 4-6 weeks with plain radiography and either renal ultrasonography or noncontrast computed tomography. Success was defined as stone-free status or residual fragments <3 mm. The use of auxiliary procedures was considered to indicate treatment failure. RESULTS A total of 17 patients were included in the present study (3 females and 14 males). Their age was 16-52 years (mean age ± SD 34.7 ± 6.3). The HSK stone location was 7 mixed caliceal, 3 mixed pelvic and caliceal, and 7 pelvic. The average stone burden was 16 mm (range 7-35). The overall number of procedures was 25 (mean 1.5 procedures/patient). Of the 17 patients, 15 (88.2%) were rendered stone free. CONCLUSIONS The results of our study have shown that F-URS with the holmium laser is an efficient minimal invasive procedure for treating HSK stones.
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Affiliation(s)
- Benoit Molimard
- Department of Urology, Tenon University Hospital, Pierre and Marie Curie University, Paris, France
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14
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Affiliation(s)
- Vincent G Bird
- Department of Urology, Miller School of Medicine, University of Miami, Dominion Tower, Miami, FL 33136, USA.
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Tefekli A, Muslumanoglu AY. Percutaneous Nephrolithotomy in Renal Anomalies of Fusion, Ectopia, Rotation, Hypoplasia, and Pelvicalyceal Aberration: Uniformity in Heterogeneity. J Endourol 2009; 23:609-14. [PMID: 17338627 DOI: 10.1089/end.2007.0430] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Symons SJ, Ramachandran A, Kurien A, Baiysha R, Desai MR. Urolithiasis in the horseshoe kidney: a single-centre experience. BJU Int 2008; 102:1676-80. [PMID: 18782315 DOI: 10.1111/j.1464-410x.2008.07987.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To report the operative management and subsequent stone-free rates of patients with urolithiasis in a horseshoe kidney and treated at one centre. PATIENTS AND METHODS We retrospectively reviewed all patients presenting to our centre with a horseshoe kidney and urolithiasis over a 15-year period. The stone burden, surgical management, complications and stone clearance rates were recorded. RESULTS In all, 55 patients with urolithiasis in horseshoe kidney were treated. Percutaneous nephrolithotomy (PCNL) was used in 60 renal units in 47 patients. Five patients had extracorporeal shock wave lithotripsy (ESWL), two had flexible ureteroscopy and one had a laparoscopic pyelolithotomy for a stone extending into the isthmus. PCNL was used for large stones (mean digitized surface area = 614.32 mm(2)) and required one to four stages to achieve an overall stone clearance rate of 88%. Stones were cleared at one sitting in 77% of PCNL procedures, completely cleared in two-thirds of patients treated by ESWL, and in both who had flexible ureteroscopy and the one treated with laparoscopic pyelolithotomy. Complications were minimal, with 15% minor and 3% major complications in the PCNL group only. CONCLUSION Appropriate management of urolithiasis within the horseshoe kidney depends not only on stone burden, but also on stone location, calyceal configuration and malrotation. Stones can be cleared successfully in almost all patients providing that all techniques are available to the operating surgeon.
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Affiliation(s)
- Stephanie J Symons
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
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17
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Mousavi-Bahar SH, Amir-Zargar MA, Gholamrezaie HR. Laparoscopic assisted percutaneous nephrolithotomy in ectopic pelvic kidneys. Int J Urol 2008; 15:276-8. [PMID: 18304232 DOI: 10.1111/j.1442-2042.2007.01985.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Three patients underwent laparoscopic assisted percutaneous nephrolithotomy (PNL). A kidneys, ureter and bladder (KUB), and intravenous pyelogram (IVP) of the first patient showed a 3 cm calculus in a right side ectopic pelvic kidney overlying on the sacrum. The second patient had bilateral ectopic kidneys. The right kidney was located in the true pelvis without calculi and the left kidney was located in the iliac cavity with a 2.5 cm calculus in the renal pelvis. The third one had a 4 cm stone in the infundibulum of the upper calyx of the left pelvic ectopic kidney. All of them had a history of failed shock wave lithotripsy after two sessions. Then the patients were scheduled for laparoscopic assisted percutaneous removal of calculi. Under fluoroscopic control the best access route was located and the kidney was punctured. A 24F nephroscope was introduced and all calculi were disintegrated and removed. Operating time was 150, 120 and 110 min in cases 1, 2 and 3, respectively. Complete stone clearance was documented with a plain X-ray KUB film and ultrasonography. Finally the patients underwent IVP three months following the operation. They were all well and there were no early or late complications.
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18
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Tiselius HG, Ringdén I. Stone Treatment Index: A Mathematical Summary of the Procedure for Removal of Stones from the Urinary Tract. J Endourol 2007; 21:1261-9. [DOI: 10.1089/end.2007.0048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hans-Göran Tiselius
- Renal Stone Unit, Department of Urology, Karolinska University Hospital, Huddinge, Sweden
- Division of Urology, Department of Clinical Science, Intervention and Technology, Karolinska Insitutet, Stockholm, Sweden
| | - Ida Ringdén
- Renal Stone Unit, Department of Urology, Karolinska University Hospital, Huddinge, Sweden
- Division of Urology, Department of Clinical Science, Intervention and Technology, Karolinska Insitutet, Stockholm, Sweden
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Mosavi-Bahar SH, Amirzargar MA, Rahnavardi M, Moghaddam SMH, Babbolhavaeji H, Amirhasani S. Percutaneous Nephrolithotomy in Patients with Kidney Malformations. J Endourol 2007; 21:520-4. [PMID: 17523906 DOI: 10.1089/end.2006.0349] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Percutaneous nephrolithotomy (PCNL) for complex calculi within malformed kidneys can be challenging because of the abnormal anatomy. We present our 7-year experience with PCNL in such patients. PATIENTS AND METHODS We performed PCNL on 16 patients with complex calculi and anomalous kidneys, including 7 with horseshoe kidneys, 5 with rotation anomalies, 3 with ectopic kidneys, and 1 with a small kidney. After appropriate preoperative evaluation, the procedure was performed by choosing either anterior or posterior approaches depending on the kidney anomaly. When required, ultrasonography, laparoscopy, or both were used, as well as fluoroscopy to control the procedures. RESULTS A single-stage PCNL resulted in complete clearance in 13 patients (81%). A second-look procedure, alone or followed by shockwave lithotripsy, conferred stone clearance in one patient with a malrotated kidney and two with staghorn calculi in horseshoe kidneys. More than one tract was needed in two patients. The procedure was guided by laparoscopy in two patients with calculi in ectopic left kidneys. Serious complications were not encountered. CONCLUSION Patients with malformed kidneys and complex calculi can be managed safely and effectively with PCNL when they are properly selected and appropriately assessed before operation.
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Lusch A, Koen M, Becker T, Engelhardt PF, Riccabona M. [Pelvic kidney in childhood. Specific features, concomitant pathologies and useful diagnostic investigations]. Urologe A 2007; 46:132-6. [PMID: 17221248 DOI: 10.1007/s00120-006-1245-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In a retrospective analysis we studied the case histories of 31 children who had been seen in our department for investigation of pelvic ectopic kidney between January 1994 and June 2005. The evaluation of each involved the medical history, ultrasound examination, VCUG, and DMSA scan or MAG3 diuresis renogram. Of the 31 children, 21 (67.7%) had initially been referred to our department for further investigation and clarification because renal agenesis was suspected. In the remaining 10 (32.3%) children the pelvic kidney was an incidental finding observed during investigation of various other conditions. Overall, 7 (22.6%) of the 31 were symptomatic (recurrent urinary tract infections, abdominal pain, hypertension, hydronephrosis), while 77.4% (24/31) were completely free of symptoms at the time of follow-up. Ultrasound revealed that the ectopic kidney was on the left in 64.5% (20/31) of these cases. Nuclear scans performed both at the time of the initial diagnosis and at follow-up were available for 11 of the 31 children and showed a mild improvement of the partial function of the pelvic kidney, from a mean of 25.6% to a mean of 34.6%. In conclusion, whenever renal agenesis is suspected on ultrasonographic examination, the investigator should first consider renal ectopia; ultrasound examination with the bladder full is the definitive diagnostic procedure. For asymptomatic cases we recommend regular ultrasound monitoring of the kidney -- at first every 6 months and later once a year. In cases with complex anatomy MRI is a suitable method for further diagnostic work-up.
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Affiliation(s)
- A Lusch
- Urologische Universitätsklinik Mannheim.
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21
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Abstract
PURPOSE OF REVIEW Congenital abnormities in urology are very common. Horseshoe, malrotated and ectopic kidneys, as well as duplex systems, are the most frequent in this respect. The combination of both abnormalities and stones is of clinical importance. The question is asked if standard procedures for stones apply also to stones in abnormal kidneys. RECENT FINDINGS In general, open surgery, extracorporeal shock-wave lithotripsy, percutaneous procedures, endoscopic procedures and laparoscopy are possible procedures in both normal and abnormal kidneys. The importance of ureteric pelvic junction obstruction has to be taken into account and a metabolic work-up remains important. SUMMARY The trend for treatment of stones in abnormal kidneys goes towards endoscopical and laparoscopical procedures, whereas a combination of both seems to be appropriate in many cases.
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Matlaga BR, Kim SC, Watkins SL, Kuo RL, Munch LC, Lingeman JE. Percutaneous nephrolithotomy for ectopic kidneys: over, around, or through. Urology 2006; 67:513-7. [PMID: 16504255 DOI: 10.1016/j.urology.2005.09.056] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2005] [Revised: 09/02/2005] [Accepted: 09/29/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The treatment of patients with complex urolithiasis in ectopic kidneys can be challenging. Because the location of an ectopic kidney can vary, each case requires a unique and, at times, unconventional approach. We reviewed the techniques we have developed to treat such patients, including laparoscopic-assisted tubeless, transhepatic, and transiliac percutaneous nephrolithotomy (PNL). METHODS We performed a retrospective analysis of all patients with congenital pelvic kidneys who underwent PNL at our institution. Six patients underwent laparoscopic-assisted PNL, one underwent transiliac PNL, and one underwent transhepatic PNL. All laparoscopic-assisted procedures were performed tubeless, with an internalized ureteral stent placed at the conclusion of the procedure. RESULTS All patients underwent successful PNL. On computed tomography, performed on the morning of postoperative day 1, all patients who underwent laparoscopic-assisted PNL were stone free. The patients who underwent transiliac PNL and transhepatic PNL required secondary procedures to attain a stone-free status. The mean length of hospitalization was 3 days for the laparoscopic-assisted cohort, 1 day for the transhepatic patient, and 3 days for the transiliac patient. CONCLUSIONS For the patient with a large or complex stone burden in an ectopic kidney, laparoscopic-assisted PNL is the optimal treatment. Performing such a procedure tubeless may be associated with a reduced hospital stay. For those patients with a hostile peritoneal cavity owing to prior surgical exploration, consideration should be given to a more individualized approach.
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Affiliation(s)
- Brian R Matlaga
- Methodist Hospital Institute for Kidney Stone Disease, Indiana University School of Medicine, Kidney Stone Institute, Indianapolis, Indiana, USA
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23
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Tokgöz H, Sen I, Tan MO, Onaran M, Biri H, Bozkirli I. Extracorporeal Shock Wave Lithotripsy in L-shaped Kidneys: Report of Two Cases. Int Urol Nephrol 2005; 37:685-9. [PMID: 16362579 DOI: 10.1007/s11255-005-8436-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The L-shaped or tandem kidney is a type of crossed ectopia with fusion in which the crossed kidney assumes a transverse position during its attachment to the inferior pole of the other kidney. Calculus formation is a well-known sequel of congenital abnormalities of the urinary tract and we like to present two patients harbouring calculi in L-shaped kidneys treated by extracorporeal shock wave lithotripsy (ESWL). The first patient had a calculus in renal pelvis of the transverse kidney. The second case had multiple calculi in renal pelvis and calices of the vertically positioned kidney. After three sessions, first patient was stone free, whereas no fragmentation in the second case. As a conclusion, ESWL might be an option for L-shaped kidneys.
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Affiliation(s)
- Hüsnü Tokgöz
- Faculty of Medicine, Department of Urology, Gazi University, Ankara, Turkey
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Weizer AZ, Springhart WP, Ekeruo WO, Matlaga BR, Tan YH, Assimos DG, Preminger GM. Ureteroscopic management of renal calculi in anomalous kidneys. Urology 2005; 65:265-9. [PMID: 15708035 DOI: 10.1016/j.urology.2004.09.055] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2004] [Accepted: 09/02/2004] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To review our experience with ureteroscopy in treating patients with renal calculi in anomalous kidneys and to evaluate the efficacy of this approach. METHODS Eight patients with renal calculi in anomalous kidneys who were managed by ureteroscopic procedures were identified. Demographic information, preoperative stone burden, operative information (ureteroscope size, lithotrite used, instruments used, duration of surgery, complications, stenting), follow-up imaging, and complications were obtained from the medical record. This information was analyzed to determine the most frequently used instruments and stone-free rates. RESULTS Our cohort consisted of 4 patients with horseshoe kidneys (HSK) and 4 patients with pelvic kidneys (PK) (6 male, 2 female, mean age, 50.6 years). The average preoperative stone burden of the 11 treated calculi was 1.4 cm, with 5 stones located in the renal pelvis, 2 in the upper pole, and 4 in lower pole calyces. A 7.5F flexible ureteroscope, holmium laser lithotripsy, and nitinol baskets and graspers were used in all patients. Six patients had complete clearance of the stone on postoperative imaging (75% HSK, 75% PK), with 88% of patients asymptomatic after their procedure. No patients required additional surgical intervention. CONCLUSIONS Flexible ureteroscopy with holmium laser lithotripsy and the use of nitinol baskets and graspers provides a reasonable alternative to shock wave lithotripsy in the management of patients harboring renal calculi in anomalous kidneys. In addition, ureteroscopy can be considered a primary option for managing select patients with symptomatic stones in PKs before a percutaneous surgical approach.
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Affiliation(s)
- Alon Z Weizer
- The Comprehensive Kidney Stone Center, The Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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Tunc L, Tokgoz H, Tan MO, Kupeli B, Karaoglan U, Bozkirli I. Stones in anomalous kidneys: results of treatment by shock wave lithotripsy in 150 patients. Int J Urol 2005; 11:831-6. [PMID: 15479286 DOI: 10.1111/j.1442-2042.2004.00916.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the efficacy of shock wave lithotripsy (SWL) in anomalous kidneys. METHODS From October 1990 to October 2002, 150 patients (93 men and 57 women) with anomalous urinary tracts, including 45 horseshoe kidneys, 57 duplex kidneys, 30 malrotated kidneys, 14 pelvic and four crossed ectopic kidneys were treated with SWL for urolithiasis at the Gazi University Faculty of Medicine. Shock wave lithotripsy was performed with Siemens Lithostar plus (Siemans, Erlanger, Germany) device and all procedures were carried under fluoroscopic control. RESULTS The mean shock wave number and intensity received by the patients was 3770 (range, 1380-4100) shocks and 18.4 (range, 16.1-19) kV per session, respectively. The minimum success rate was obtained in patients with lower calyceal (50%) followed by middle calyceal (60%) calculi. The stone-free rate decreased and the number of sessions per patient increased with increasing stone diameter (dm). In patients with a stone dm > 30 mm, only 34% could be stone-free, compared to a rate of 92% for calculi dm < 10 mm. The overall stone free rate at the third month was 68%. The best stone-free rates were obtained in patients with ureteral duplication (80.7%). The stone-free rates in horseshoe, malrotated, pelvic and crossed ectopic kidneys were found to be 66.7%, 56.7%, 57.2% and 25%, respectively. CONCLUSION Shock wave lithotripsy might be an effective and minimally invasive treatment alternative in stone-bearing anomalous kidneys. The type of anomaly, stone burden and localization seem to be the main parameters effecting the treatment success.
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Affiliation(s)
- Lutfi Tunc
- Department of Urology, Gazi University Faculty of Medicine, Ankara, Turkey.
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Nakada SY, Ono Y, Shah O, Pietrow PK, Sundaram CP, Ramakumar S. Controversial Cases in Endourology. J Endourol 2004; 18:848-52. [PMID: 15659917 DOI: 10.1089/end.2004.18.848] [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: 11/12/2022] Open
Affiliation(s)
- Stephen Y Nakada
- Department of Surgery, Division of Urology, The University of Wisconsin Medical School, G5/339 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-3236, USA.
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Abstract
Although ureteroscopic treatment of renal calculi is safe and effective. it is relatively inefficient compared with ESWL and PCNL. It should be considered primary therapy for patients with lower pole stones who have adverse ESWL characteristics and patients who are not suitable candidates for PCNL. There are also numerous clinical situations, as outlined previously, where the ureteroscopic approach is favored over other treatment modalities.
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Affiliation(s)
- J Erik Busby
- Department of Urology, University of California, Davis, 4860 Y Street, Suite 3500, Sacramento, CA 95817, USA
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28
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Marcovich R, Smith AD. Renal pelvic stones: choosing shock wave lithotripsy or percutaneous nephrolithotomy. Int Braz J Urol 2003; 29:195-207. [PMID: 15745522 DOI: 10.1590/s1677-55382003000300002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2002] [Accepted: 10/10/2002] [Indexed: 11/22/2022] Open
Abstract
Introduction of minimally invasive techniques has revolutionized the surgical management of renal calculi. Extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy are now both well-established procedures. Each modality has advantages and disadvantages, and the application of each should be based on well-defined factors. These variables include stone factors such as number, size, and composition; factors related to the stone's environment, including the stone's location, spatial anatomy of the renal collecting system, presence of hydronephrosis, and other anatomic variables, such as the presence of calyceal diverticula and renal anomalies; and clinical or patient factors like morbid obesity, the presence of a solitary kidney, and renal insufficiency. The morbidity of each procedure in relation to its efficacy should be taken in to account. This article will review current knowledge and suggest an algorithm for the rational management of renal calculi with shock wave lithotripsy and percutaneous nephrolithotomy.
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Affiliation(s)
- Robert Marcovich
- Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040-1496, USA.
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29
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Abstract
The surgical management of urinary calculus disease has changed dramatically in the past two decades. Minimally invasive options have made open stone surgery nearly obsolete. The development of shock wave lithotripsy, percutaneous nephrostolithotomy techniques and intracorporeal lithotripsy devices has conferred unprecedented management tools for upper tract stones. Moreover, transfusion rates, hospital costs, and convalescence periods have been markedly reduced when compared to open surgery. Likewise, the advent of fiberoptic technology has resulted in miniaturization of ureteroscopes making access to the entire collecting system possible from either a retrograde or antegrade approach. With experience, successful stone retrieval has occurred in upwards of 90% of cases, again with minimal complications. The subspecialty of Endourology has emerged over the past 20 years and significantly changed the management of urinary tract calculi within this short period of time. Further advancements in shock wave and laser technology, training modules and the development of more durable endoscopes may prove beneficial in providing even better stone treatments with a reduction in morbidity.
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Affiliation(s)
- Brian K Auge
- Division of Urology, Department of Surgery, Comprehensive Kidney Stone Center, Box 3167, Room 1572D, White Zone, Duke University Medical Center, Durham, NC 27710, USA
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