Optical puncture combined with balloon dilation PCNL vs. conventional puncture dilation PCNL for kidney stones without hydronephrosis: a retrospective study

Ultrasound-guided percutaneous nephrolithotomy without indwelling ureteral catheter in older adults with upper urinary calculi: A retrospective study

Retention of ureteral catheter to establish artificial hydronephrosis is a routine step of percutaneous nephrolithotomy procedure, which can improve the success rate of puncture, but it can prolong the procedure time and increase the risk of postoperative infection, especially for immunocompromised elderly patients. Therefore, this study aims to investigate the safety and effectiveness of ultrasound-guided percutaneous nephrolithotomy without indwelling ureteral catheter for older patients with upper urinary calculi. The clinical data of 119 older patients admitted to the Affiliated Hospital of Jining Medical University for percutaneous nephrolithotomy from January 2019 to December 2021 were retrospectively analyzed. The patients were divided into study and control groups according to whether the physician decided to use ureteral catheter during the procedure, and the differences in the success rate of one-time puncture, operative time, single-stage stone removal rate, postoperative hospital stay, and complication rate were compared between the 2 groups. There were no significant differences in the success rate of one-time puncture and single-stage stone removal rate between the 2 groups (P > .05). The operation time were significantly shorter in the study group [(30.0-61.0) minute vs (54.8-106.8) minute, P = .00], and the intraoperative bleeding was less in the study group [(5-20) mL vs (10-30) mL, P = .03]. The postoperative hospital stay was shorter in the study group [(2.5-4.0) days vs (3.0-5.0) days, P = .00], and the medical expenses were lower in the study group [(17,309.5-22,652.7) yuan vs (19,148.0-24,407.6) yuan, P = .02]. The incidence of systemic inflammatory response syndrome was lower in the study group (3.5% vs 19.4%, P = .007). There were no statistically significant differences in complications such as postoperative fever, renal artery embolism and blood transfusion between the two groups (P > .05). Ultrasound-guided percutaneous nephrolithotomy without indwelling ureteral catheter for elderly patients with upper urinary stones is safe and feasible.

A novel spherical-headed fascial dilator is feasible for second-stage ultrasound guided percutaneous nephrolithotomy: A pilot study

Objective

In second-stage percutaneous nephrolithotomy (PCNL), because the hydronephrosis has been decompressed, the dilated renal pelvis has resolved and the space is small. Consequently, introduction of the tip of the Amplatz dilator can cause injury to the opposite side of the renal-pelvic mucosa. In this study, we report the experimental and initial clinical performance of a spherical-headed fascial dilator developed specifically for second-stage PCNL.

Methods

The novel spherical-headed dilator was compared with existing tapered-headed dilators in configuration and in puncture resistance utilizing a static puncture test. Subsequently, a pilot clinical study was conducted during which patients scheduled to undergo second-stage PCNL from June 2019 to October 2019 in our center were enrolled. A typical ultrasound guided PCNL procedure was performed with the exception that the new spherical-headed fascial dilator was substituted for a tapered-headed one.

Results

Experimentally, stab resistance against polyethylene film was significantly increased using the novel spherical-headed dilator compared to the traditional tapered-headed dilators (p<0.005). In the clinical study, the novel dilators were successfully introduced into the renal pelvis and passed down the collecting system in all eight second-stage PCNL cases. There were no cases of renal pelvic perforation or brisk hemorrhage nor need for transfusion.

Conclusion

The design of the novel spherical-headed fascial dilator avoided the concentration of pressure at the tapered tip of the current Amplatz dilator by increasing the contact area and uniformly distributing and diffusing the pressure. Therefore, it is feasible to use the spherical-headed fascial dilator for second-stage PCNL.