Comparison of the outcomes of complete supine percutaneous nephrolithotomy in patients with radiopaque and radiolucent kidney stones

Ureterolithiasis in Human Immunodeficiency Virus (HIV) Patients Treated with Single-Use Ureteroscope: A Case Report

BACKGROUND The number of HIV-positive patients is increasing worldwide. Such patients with upper urinary tract stones have been treated primarily with flexible ureteroscopy. CASE REPORT Two patients with HIV and upper urinary tract stones were treated with a single-use digital flexible ureteroscope between July 2021 and January 2022. Both cases were treated by transurethral ureteroscope lithotripsy with a Guangzhou Redpine single-use digital flexible ureteroscope. This is also the first reported case of using a disposable ureteral flexible scope to manage a patient with upper urinary tract stones in combination with HIV. The holmium laser power was set to 0.2-0.6j/20-50 Hz for fragmentation and 1.0-1.5j/10-20 Hz for the dusting of the stones. Renal stones larger than 1 cm were dusted to around 1 cm first, and then a lithotripsy basket was used to remove them. The f5 Polaris Ultra ureteral stent was implanted during the procedure. The operations went smoothly. Four weeks after surgery, CT scans revealed a 4 mm stone remnant in one case, and the ureteral stent was removed in both cases. After 3 months, a kidney, ureter, and bladder X-ray revealed no stones remaining in the case that had earlier shown a 4 mm stone residual. In both cases, the stone composition was made up of calcium oxalate monohydrate and calcium oxalate dihydrate stones. CONCLUSIONS A single-use flexible ureteroscope has a proven clinical benefit in treating HIV-combined upper urinary tract stones. After the operations, there were no urinary infections, bleeding, or other complications in either patient.

Fluoroscopy screening time and radiation dose during complete supine percutaneous nephrolithotomy

PURPOSE

Fluoroscopy-guided percutaneous nephrolithotomy (PCNL) is procedure of choice for treatment of large urinary tract calculi. This study aimed to investigate the affecting factors on fluoroscopy screening time (FST) and radiation dose (RD) of patients undergoing complete supine percutaneous nephrolithotomy (csPCNL).

METHODS

Analytic cross-sectional study was performed on 355 patients who underwent csPCNL. The correlation between the FST and RD and patients' demographics, stone characteristics, preoperative, intraoperative and postoperative parameters were assessed. Multivariate regression analysis was used to explore various parameters which affect FST and RD.

RESULTS

Of all 355 patients, 191 (54.65%) were male and 161 were (45.35%) female with mean age of 48.29 ± 12.38 (16-82) years. BMI was 27.61 ± 4.53 (16.61-39.00) kg/m². The mean operative time was 45.87 ± 18.29 min with mean FST of 101.72 ± 62.00 s. BMI, operative time, success rate, complications, stone number, and tract number had a significant relationship with FST and RD (P < 0.05). On multivariate analysis, BMI, tract number and success rate were found to be independent predictors for FST and RD. Age, gender, operation side, GFR, target calyx, lithotripsy history, stone opacity, size and site, stone configuration and distribution, and hydronephrosis did not have any correlation with FST and RD (P > 0.05).

CONCLUSION

BMI, success rate and tract number can be significant predictor for FST and RD during csPCNL. Identifying the affecting factors on FST and RD can help the surgeon to minimize the danger of radiation exposure by predicting and preoperative planning.