1
|
Zhong W, Osther P, Pearle M, Choong S, Mazzon G, Zhu W, Zhao Z, Gutierrez J, Smith D, Moussa M, Pal SK, Saltirov I, Ahmad M, Hamri SB, Chew B, Aquino A, Krambeck A, Khadgi S, Sur RL, Güven S, Gamal W, Li J, Liu Y, Ferretti S, Kamal W, Ye L, Bernardo N, Almousawi S, Abdelkareem M, Durutovic O, Kamphuis G, Maroccolo M, Ye Z, Alken P, Sarica K, Zeng G. International Alliance of Urolithiasis (IAU) guideline on staghorn calculi management. World J Urol 2024; 42:189. [PMID: 38526675 DOI: 10.1007/s00345-024-04816-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/16/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND The stone burden based management strategy reported in the guidelines published by different associations is well known for a long time. Staghorn calculi, representing the largest burden and most complex stones, is one of the most challenging cases to practicing urologists in clinical practice. The International Alliance of Urolithiasis (IAU) has released a series of guidelines on the management of urolithiasis. PURPOSE To develop a series of recommendations for the contemporary management management of staghorn calculi and to provide a clinical framework for urologists treating patients with these complex stones. METHODS A comprehensive literature search for articles published in English between 01/01/1976 and 31/12/2022 in the PubMed, OVID, Embase and Medline database is performed. A series of recommendations are developed and individually graded following the review of literature and panel discussion. RESULTS The definition, pathogenesis, pathophysiology, preoperative evaluation, intraoperative treatment strategies and procedural advice, early postoperative management, follow up and prevention of stone recurrence are summarized in the present document. CONCLUSION A series of recommendations regarding the management of staghorn calculi, along with related commentary and supporting documentation offered in the present guideline is intended to provide a clinical framework for the practicing urologists in the management of staghorn calculi.
Collapse
Affiliation(s)
- Wen Zhong
- Department of Urology and Key Laboratory of Guangdong, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Palle Osther
- Department of Urology, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark
| | - Margaret Pearle
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Simon Choong
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Wei Zhu
- Department of Urology and Key Laboratory of Guangdong, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhijian Zhao
- Department of Urology and Key Laboratory of Guangdong, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jorge Gutierrez
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Daron Smith
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Mohamad Moussa
- Department of Urology, Al Zahraa Hospital University Medical Center and Lebanese University, Beirut, Lebanon
| | | | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Mumtaz Ahmad
- Department of Urology, Ganga Ram Hospital, Ganga Ram Hospital and Fatima Jinnah Medical University, Lahore, Punjab, Pakistan
| | - Saeed Bin Hamri
- Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ben Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Albert Aquino
- Department of Urology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Amy Krambeck
- Department of Urology, The Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sanjay Khadgi
- Department of Urology, Vayodha Hospital, Kathmandu, Nepal
| | - Roger L Sur
- Department of Urology, University of California San Diego Comprehensive Kidney Stone Center, San Diego, CA, USA
| | - Selcuk Güven
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Wael Gamal
- Department of Urology, Sohag University Hospital, Sohâg, Egypt
| | - Jianxing Li
- Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yongda Liu
- Department of Urology and Key Laboratory of Guangdong, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Wissam Kamal
- Department of Urology, King Fahad Hospital, Jeddah, Saudi Arabia
| | - Liefu Ye
- Urology Department, Fujian Provincial Hospital, Fujian, China
| | - Norberto Bernardo
- Department of Urology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | - Shabir Almousawi
- Department of Urology, Sabah Al-Ahmad Urology Centre, Kuwait City, Kuwait
| | - Mohamed Abdelkareem
- Department of Urology, Hazm Mebaireek General Hospital (HMGH), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Otas Durutovic
- Department of Urology, Clinic of Urology, University of Belgrade, Belgrade, Serbia
| | - Guido Kamphuis
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
| | - Marcus Maroccolo
- Department of Urology, Hospital de Base of the Federal District, Brasília, Brazil
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peter Alken
- Department of Urology, University Clinic Mannheim, Mannheim, Germany.
| | - Kermal Sarica
- Department of Urology, Medical School, Biruni University, Istanbul, Turkey.
| | - Guohua Zeng
- Department of Urology and Key Laboratory of Guangdong, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| |
Collapse
|
2
|
Lim EJ, Teoh JY, Fong KY, Emiliani E, Gadzhiev N, Gorelov D, Tanidir Y, Sepulveda F, Al-Terki A, Khadgi S, Mahajan A, Ragoori D, Ramalingam G, Mohan VC, Ganpule AP, Kumar S, Castellani D, Monga M, Scoffone C, Vincentini FC, Traxer O, Somani BK, Gauhar V. Propensity score-matched analysis comparing retrograde intrarenal surgery with percutaneous nephrolithotomy in anomalous kidneys. Minerva Urol Nephrol 2022; 74:738-746. [PMID: 35147385 DOI: 10.23736/s2724-6051.22.04664-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Endourologic interventions for urolithiasis in patients with anomalous kidneys can be challenging, and comparisons between these interventions are not well studied. We aim to compare the safety, outcomes and complications of retrograde intrarenal surgery (RIRS) versus percutaneous nephrolithotomy (PCNL) in patients with urolithiasis in anomalous kidneys. METHODS A propensity score-matched pair analysis (PSM) was performed on pooled patient data from 20 centers. 569 patients with anomalous kidneys (horseshoe kidney [HSK], ectopic kidney, malrotated kidney) and urolithiasis who received either PCNL or RIRS as the primary modality of intervention from 2010 to 2020 were analyzed. Patients were matched based on calculated propensity scores by a regression model using age, sex, comorbidities, stone size, and renal anomaly type as co-variates. Multivariate logistic regression of factors (mode of treatment [PCNL or RIRS], comorbidities, stone size) and their effects on outcomes of stone-free rate (SFR), need to abandon surgery due to intraoperative difficulty, postoperative hematuria and sepsis and were analyzed when applicable. RESULTS After PSM, there were a total of 127 pairs in each group. Overall, PCNL conferred a higher SFR compared to RIRS (OR=3.69, 95% CI 1.91-7.46, P<0.001), particularly in HSK (OR=3.33, 95% CI 1.22-9.99, P=0.023), and ectopic kidneys (OR=18.10, 95% CI 3.62-147.63, P=0.002), with no significant difference in malrotated kidneys. There was no significant difference in postoperative sepsis observed. Surgery was abandoned more often in RIRS than PCNL (6.3% vs. 0%, P=0.014). Although PSM provides a robust analysis due to baseline differences in the unmatched cohorts, this study was limited by an inevitable degree of selection bias. CONCLUSIONS While both modalities are safe and efficacious, PCNL yields better SFR than RIRS in patients with anomalous kidneys, with no difference in postoperative sepsis rates. Patients may benefit from personalized management best carried out in high volume endourology centers.
Collapse
Affiliation(s)
- Ee J Lim
- Department of Urology, Singapore General Hospital, Singapore -
| | - Jeremy Y Teoh
- S.H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Khi Y Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Esteban Emiliani
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
| | - Dmitry Gorelov
- Department of Endourology, Saint-Petersburg State Medical University Hospital, Saint-Petersburg, Russia
| | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Fabio Sepulveda
- Department of Urology, Brigadeiro Hospital, São Paulo, Brazil
| | - Abdullatif Al-Terki
- Section of Urology, Department of Surgery, Al-Amiri Hospital, Kuwait City, Kuwait
| | | | | | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology and Urology, Banjara Hills, India
| | | | - Vaddi C Mohan
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, India
| | - Arvind P Ganpule
- Department of Urology, Urology Muljibhai Patel Urological Hospital, Nadiad, Gujarat
| | | | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of Marche, Ancona, Italy
| | - Manoj Monga
- Department of Urology, University of California, San Diego, CA, USA
| | | | | | - Olivier Traxer
- Sorbonne University, Department of Urology, Tenon Hospital, Paris, France
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | |
Collapse
|
3
|
Khadgi S, Gurung U, Pradhan B, Tripathi P. Comparison of Outcomes of Conventional Septoplasty Versus Endoscopic Septoplasty using Freer's Incision in Symptomatic Deviated Nasal Septum. Kathmandu Univ Med J (KUMJ) 2021; 19:339-344. [PMID: 36254421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Septoplasty techniques have evolved over the years with endoscopic septoplasty gaining popularity in the recent times. Objective To compare the outcomes of conventional septoplasty with endoscopic septoplasty using Freer's incision in symptomatic deviated nasal septum. Method It was a prospective, randomized and comparative study done at Department of ENTHead and Neck Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from July 2018 to August 2019. A total of 70 patients with symptomatic deviated nasal septum were allocated randomly into two groups. Group A underwent conventional septoplasty whilst Group B underwent endoscopic septoplasty using Freer's incision. Sino-nasal outcome test (SNOT-10) score was recorded pre-operatively and post -operatively between four to six weeks of surgery. Paired and independent 't' test for mean was used as a statistical tool. Result Out of 70 patients, 57(81.43%) were males and 13(18.57%) females. The age group mostly affected was in the third and fourth decades with total 47 patients (67.14%). In the conventional group, the pre-op mean SNOT-10 score was 11.46 (SD±3.6) while post-op mean SNOT-10 score was 2.60 (SD±1.9), the difference being statistically significant (p value 0.00001). Similarly, in the endoscopic group, pre-op mean SNOT10 score was 12.06 (SD±4.88) and post-op mean SNOT- 10 score was 3.37 (SD±2.71) with the difference being statistically significant (p value 0.00001). Comparison of post-operative mean SNOT-10 score between two techniques was not statistically significant (p value 0.17). Conclusion Both conventional and endoscopic septoplasty techniques using Freer's incision were equally effective in improving symptoms due to deviated nasal septum.
Collapse
Affiliation(s)
- S Khadgi
- Department of Head and Neck Oncology, B.P. Koirala Memorial Cancer Hospital, Bharatpur, Chitwan, Nepal
| | - U Gurung
- Department of ENT-Head and Neck Surgery, Tribhuvan University Teaching Hospital, Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - B Pradhan
- Department of ENT-Head and Neck Surgery, Tribhuvan University Teaching Hospital, Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - P Tripathi
- Department of ENT-Head and Neck Surgery, Tribhuvan University Teaching Hospital, Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| |
Collapse
|
4
|
Zeng G, Zhong W, Pearle M, Choong S, Chew B, Skolarikos A, Liatsikos E, Pal SK, Lahme S, Durutovic O, Farahat Y, Khadgi S, Desai M, Chi T, Smith D, Hoznek A, Papatsoris A, Desai J, Mazzon G, Somani B, Eisner B, Scoffone CM, Nguyen D, Ferretti S, Giusti G, Saltirov I, Maroccolo MV, Gökce MI, Straub M, Bernardo N, Lantin PL, Saulat S, Gamal W, Denstedt J, Ye Z, Sarica K. European Association of Urology Section of Urolithiasis and International Alliance of Urolithiasis Joint Consensus on Percutaneous Nephrolithotomy. Eur Urol Focus 2021; 8:588-597. [PMID: 33741299 DOI: 10.1016/j.euf.2021.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/10/2020] [Accepted: 03/02/2021] [Indexed: 02/07/2023]
Abstract
CONTEXT Although percutaneous nephrolithotomy (PCNL) has been performed for decades and has gone through many refinements, there are still concerns regarding its more widespread utilization because of the long learning curve and the potential risk of severe complications. Many technical details are not included in the guidelines because of their nature and research protocol. OBJECTIVE To achieve an expert consensus viewpoint on PCNL indications, preoperative patient preparation, surgical strategy, management and prevention of severe complications, postoperative management, and follow-up. EVIDENCE ACQUISITION An international panel of experts from the Urolithiasis Section of the European Association of Urology, International Alliance of Urolithiasis, and other urology associations was enrolled, and a prospectively conducted study, incorporating literature review, discussion on research gaps (RGs), and questionnaires and following data analysis, was performed to reach a consensus on PCNL. EVIDENCE SYNTHESIS The expert panel consisted of 36 specialists in PCNL from 20 countries all around the world. A consensus on PCNL was developed. The expert panel was not as large as expected, and the discussion on RGs did not bring in more supportive evidence in the present consensus. CONCLUSIONS Adequate preoperative preparation, especially elimination of urinary tract infection prior to PCNL, accurate puncture with guidance of fluoroscopy and/or ultrasonography or a combination, keeping a low intrarenal pressure, and shortening of operation time during PCNL are important technical requirements to ensure safety and efficiency in PCNL. PATIENT SUMMARY Percutaneous nephrolithotomy (PCNL) has been a well-established procedure for the management of upper urinary tract stones. However, according to an expert panel consensus, core technical aspects, as well as the urologist's experience, are critical to the safety and effectiveness of PCNL.
Collapse
Affiliation(s)
- Guohua Zeng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wen Zhong
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Margaret Pearle
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Simon Choong
- Institute of Urology, University College Hospital, London, UK
| | - Ben Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Evangelos Liatsikos
- Department of Urology, University Hospital of Patras, University of Patras, Patras, Greece
| | | | - Sven Lahme
- Department of Urology, Siloah St. Trudpert Hospital, Pforzheim, Germany
| | - Otas Durutovic
- Department of Urology, Clinic of Urology, University of Belgrade, Belgrade, Serbia
| | - Yasser Farahat
- Department of Urology, Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates
| | - Sanjay Khadgi
- Department of Urology, Vayodha Hospital, Kathmandu, Nepal
| | - Mahesh Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Thomas Chi
- Department of Urology, University of California, San Francisco, CA, USA
| | - Daron Smith
- Institute of Urology, University College Hospital, London, UK
| | - Andras Hoznek
- Department of Urology, Mondor Hospital, Créteil, France
| | | | - Janak Desai
- Department of Urology, Samved Hospital, Ahmedabad, India
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Brian Eisner
- Deparment of Urology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Stefania Ferretti
- Department of Urology, Hospital and University of Parma, Parma, Italy
| | - Guido Giusti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | | | - Mehmet Ilker Gökce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Michael Straub
- Department of Urology, Technical University Munich, Munich, Germany
| | - Norberto Bernardo
- Department of Urology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | | | - Sherjeel Saulat
- Department of Urology, Sindh Institution of Urology and Transplantation, Karachi, Pakistan
| | - Wael Gamal
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | - John Denstedt
- Division of Urology, Western University, London, Ontario, Canada
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Kemal Sarica
- Department of Urology, Biruni University, Medical School, Istanbul, Turkey.
| |
Collapse
|
5
|
Abstract
Objectives: In performing mini-percutaneous nephrolithotomy (PCNL), we aimed at achieving the trifecta of stone-free status and no complications in a single treatment session. We analyzed our experience to determine negative predictors for achieving these three-fold goals. Patients and Methods: The data of all consecutive patients who underwent tubeless mini-PCNL between July 2015 and March 2020 in two hospitals were retrospectively reviewed. Stone-free was defined as no residual stones. Complications were recorded and graded according to modified Clavien classification. Patients were divided into two groups according to the outcome (trifecta and non-trifecta). Factors affecting the outcome were compared between both groups by using univariate and multivariate analyses to detect independent unfavorable risk factors. Results: The study included 944 patients with mean age 40.2 years (standard deviation: 13.6). The stone-free rate after one session of mini-PCNL was 90.7%. Auxiliary procedures were needed in 14 patients (1.5%). Complications were observed in 76 patients (8.1%). Trifecta was achieved in 792 patients (84%). Independent unfavorable risk factors in multivariate analysis were number of caliceal groups affected by the stones (relative risks were 1.95 to 2.27 and 5.7 for one, two, and three caliceal groups respectively) and number of percutaneous tracts (relative risk was 2.2). Stone size and complexity were not significant predictors of missing trifecta in multivariate analysis. Conclusions: Mini-PCNL can achieve a high rate of trifecta (84%) for different stone sizes and complexities. Stones distribution in multiple caliceal groups and multiple tracts are the independent unfavorable risk factor.
Collapse
Affiliation(s)
- Ahmed R El-Nahas
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.,Urology Unit, AL-Amiri Hospital, Kuwait, Kuwait
| | - Sanjay Khadgi
- Department of Urology, Vayodha Hospital, Kathmandu, Nepal
| | | | | |
Collapse
|
6
|
Abstract
Objectives: To compare the outcomes of standard- and mini-percutaneous nephrolithotomy (PCNL) for the treatment of staghorn stones. Patients and Methods: The data of consecutive adult patients who underwent PCNL for the treatment of staghorn stones, between July 2015 and December 2019 from three hospitals, were retrospectively reviewed. All cases were performed in a prone position under fluoroscopic guidance. The nephrostomy tracts were dilatated to 30 F in standard-PCNL and to 18–20 F in mini-PCNL. Stones were fragmented with pneumatic lithotripsy in both groups. Fragments were removed with forceps in the standard-PCNL, while they were evacuated through the sheath using the vacuum clearance effect in mini-PCNL. A ureteric stent was inserted after mini-PCNL, while a nephrostomy tube was inserted after standard-PCNL. Results: The study included 153 patients; 70 underwent standard-PCNL and 83 underwent mini-PCNL. The stone-free rates of PCNL monotherapy were comparable for both groups (83% for mini-PCNL and 88.6% for standard-PCNL, P = 0.339). The incidence (12% vs 24.3%, P = 0.048) and severity of complications were significantly lesser with mini-PCNL (P = 0.031). Standard-PCNL was associated with increased rate of blood transfusion (12.9% vs 2.4%, P = 0.013) and a significant decrease in haemoglobin (P = 0.018). Hospital stay was significantly longer for standard-PCNL than mini-PCNL (median stay of 6 vs 3 days, P < 0.001). Conclusions: The efficacy of mini-PCNL was comparable to standard-PCNL in the treatment of staghorn stones. The advantages of mini-PCNL included a lesser incidence and severity of complications, and shorter hospital stay.
Collapse
Affiliation(s)
- Sanjay Khadgi
- Department of Urology, Vayodha Hospital, Kathmandu, Nepal
| | - Ahmed R El-Nahas
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.,Urology Unit, Al-Amiri Hospital, Kuwait City, Kuwait
| | | | | |
Collapse
|
7
|
Khadgi S, Darrad M, EL-Nahas AR, AL-Terki A. Tubeless mini-percutaneous nephrolithotomy for renal stones larger than 20 mm. Indian J Urol 2021; 37:54-58. [PMID: 33850356 PMCID: PMC8033236 DOI: 10.4103/iju.iju_271_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/25/2020] [Accepted: 08/23/2020] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION The aim of this study is to evaluate the outcomes of tubeless mini- percutaneous nephrolithotomy (PCNL) for the treatment of large (>20 mm) renal stones. PATIENTS AND METHODS This study included consecutive patients who underwent single-session tubeless mini-PCNL (tract size 16-20 F) for large (>20 mm) renal stones. Stone-free status meant complete clearance or residual fragments <4 mm. Complications were recorded and classified according to modified Clavien-Dindo classifications. Risk variables for significant residuals were determined with univariate (Chi-square and t-test) and multivariate logistic regression analyses. RESULTS Between July 2015 and November 2018, 225 patients were included. The mean age was 42.9 years; the mean stone size was 30.2 ± 9.6 mm and 75% of patients were males. A single renal stone was present in 54 patients (24%), multiple stones in 108 (48%), and staghorn stones in 63 (28%). The stone-free rate was 87.6%. The complication rate was 8.4% (Grade I-II in 7.5%, III in 0.9%). Three patients (1.3%) required blood transfusion. Independent risk factor for significant residual fragments was the presence of stones in multiple sites inside the pelvicalyceal system (relative risk: 13.44, 95% confidence interval: 1.78-101.43, P = 0.012). CONCLUSIONS Mini-PCNL is an effective and safe treatment option for patients with large renal stones (>20 mm). Stones located in multiple sites is the only predictor of significant residual stones.
Collapse
Affiliation(s)
- Sanjay Khadgi
- Department of Urology, Vayodha Hospital, Kathmandu, Nepal
| | - Maitrey Darrad
- Department of Urology, University Hospital Birmingham NHS Foundation Trust, Birmingham, England, United Kingdom
| | - Ahmed R. EL-Nahas
- Department of Surgery, Urology Unit, AL-Amiri Hospital, Kuwait City, Kuwait
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | | |
Collapse
|
8
|
de la Rosette J, Laguna P, Álvarez-Maestro M, Eto M, Mochtar CA, Albayrak S, Mendoza-Valdes A, Ong TA, Khadgi S, Al-Terki A, Bolton D, Gomez R, Klotz L, Kulkarni S, Tanguay S, Gravas S. Cross-continental comparison of safety and protection measures amongst urologists during COVID-19. Int J Urol 2020; 27:981-989. [PMID: 32772434 PMCID: PMC7436488 DOI: 10.1111/iju.14340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/06/2020] [Indexed: 01/15/2023]
Abstract
Objectives To determine the well‐being of urologists worldwide during the coronavirus disease 2019 pandemic, and whether they have adequate personal protective equipment knowledge and supplies appropriate to their clinical setting. Methods Urologists worldwide completed a Société Internationale d’Urologie online survey from 16 April 2020 until 1 May 2020. Analysis was carried out to evaluate their knowledge about protecting themselves and others in the workplace, including their confidence in their ability to remain safe at work, and any regional differences. Results There were 3488 respondents from 109 countries. Urologists who stated they were moderately comfortable that their work environment offers good protection against coronavirus disease 2019 showed a total mean satisfaction level of 5.99 (on a “0 = not at all” to “10 = very” scale). A large majority (86.33%) were confident about protecting themselves from coronavirus disease 2019 at work. However, only about one‐third reported their institution provided the required personal protective equipment (35.78%), and nearly half indicated their hospital has or had limited personal protective equipment availability (48.08%). Worldwide, a large majority of respondents answered affirmatively for testing the healthcare team (83.09%). Approximately half of the respondents (52.85%) across all regions indicated that all surgical team members face an equal risk of contracting coronavirus disease 2019 (52.85%). Nearly one‐third of respondents reported that they had experienced social avoidance (28.97%). Conclusions Our results show that urologists lack up‐to‐date knowledge of preferred protocols for personal protective equipment selection and use, social distancing, and coronavirus disease 2019 testing. These data can provide insights into functional domains from which other specialties could also benefit.
Collapse
Affiliation(s)
- Jean de la Rosette
- Department of Urology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Pilar Laguna
- Department of Urology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mario Álvarez-Maestro
- Department of Urology, La Paz University Hospital, Instituto de Investigación, Madrid, Spain
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Chaidir Arif Mochtar
- Department of Urology, Cipto Mangunkusumo Hospital, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Selami Albayrak
- Department of Urology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | | | - Teng Aik Ong
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjay Khadgi
- Department of Urology, Vayodha Hospitals, Kathmandu, Nepal
| | | | - Damien Bolton
- Department of Urology, The Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Reynaldo Gomez
- Universidad Andrés Bello, Hospital del Trabajador, Santiago, Chile
| | - Laurence Klotz
- Division of Urology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | | | - Simon Tanguay
- Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Stavros Gravas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | | |
Collapse
|
9
|
Shrestha BR, Khadgi S, Piya B. Unexpected Sudden Bouts of Coughing During Endourology Procedures: Sign of Impending Doom. Kathmandu Univ Med J (KUMJ) 2019; 17:350-351. [PMID: 33311049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Endourological procedures are commonly performed in our daily practice. Most of the time, this type of surgery is usually performed under regional anesthesia and is usually not associated with any complications. The irrigation pump used in such procedures consists of irrigating fluid flowing in high pressure. If left unnoticed, sometimes irrigating fluid can lead to passage of air into the patient venous system leading to air embolism. This can be a disastraous complication leading to even sudden mortality. Here we present a case of such incident where patient has sudden coughing followed by drop in oxygen saturation.
Collapse
Affiliation(s)
- B R Shrestha
- Department of Anaesthesia and Intensive Care, Kathmandu Medical College, Sinamangal, Nepal
| | - S Khadgi
- Department of Urosurgery, Venus Hospital, Kathmandu, Nepal
| | - B Piya
- Department of Anaesthesia and Intensive Care, Kathmandu Medical College, Sinamangal, Nepal
| |
Collapse
|
10
|
ElSheemy MS, Ghoneima W, Elmarakbi AA, Al-Kandari AM, Ibrahim H, Shrestha S, Khadgi S. Bilateral Single-session vs Staged Mini-percutaneous Nephrolithotomy for Renal Stones: A Comparative Study. Urology 2018; 120:62-67. [DOI: 10.1016/j.urology.2018.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/30/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
|
11
|
ElSheemy MS, Elmarakbi AA, Hytham M, Ibrahim H, Khadgi S, Al-Kandari AM. Mini vs standard percutaneous nephrolithotomy for renal stones: a comparative study. Urolithiasis 2018; 47:207-214. [PMID: 29549382 DOI: 10.1007/s00240-018-1055-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/05/2018] [Indexed: 11/25/2022]
Abstract
To compare the outcome of mini-percutaneous nephrolithotomy (Mini-PNL) versus standard-PNL for renal stones. Retrospective study was performed between March 2010 and May 2013 for patients treated by Mini-PNL or standard-PNL through 18 and 30 Fr tracts, respectively, using pneumatic lithotripsy. Semirigid ureteroscope (8.5/11.5 Fr) was used for Mini-PNL and 24 Fr nephroscope for standard-PNL. Both groups were compared in stone free rate(SFR), complications and operative time using Student-t, Mann-Whitney, Chi square or Fisher's exact tests as appropriate in addition to logistic regression analysis. P < 0.05 was considered statistically significant. Mini-PNL (378) and standard-PNL (151) were nearly comparable in patients and stones criteria including stone burden (3.77 ± 2.21 vs 3.77 ± 2.43 cm2; respectively). There was no significant difference in number of tracts or supracostal puncture. Mini-PNL had longer operative time (68.6 ± 29.09 vs 60.49 ± 11.38 min; p = 0.434), significantly shorter hospital stay (2.43 ± 1.46 vs 4.29 ± 1.28 days) and significantly higher rate of tubeless PNL (75.1 vs 4.6%). Complications were significantly higher in standard-PNL (7.9 vs 20.5%; p < 0.001). SFR was significantly lower in Mini-PNL (89.9 vs 96%; p = 0.022). This significant difference was found with multiple stones and large stone burden (> 2 cm2), but the SFR was comparable between both groups with single stone or stone burden ≤ 2 cm. Logistic regression analysis confirmed significantly higher complications and SFR with standard-PNL but with significantly shorter operative time. Mini-PNL has significantly lower SFR when compared to standard-PNL (but clinically comparable) with markedly reduced complications and hospital stay. Most of cases can be performed tubeless. The significant difference in SFR was found with multiple stones or large stone burden (> 2 cm2), but not with single stones or stone burden ≤ 2 cm2.
Collapse
Affiliation(s)
| | | | - Mohammed Hytham
- Urology department, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Hamdy Ibrahim
- Urology Department, Fayoum University, Fayoum, Egypt
| | - Sanjay Khadgi
- Vayodah and Venus International Hospitals, Kathmandu, Nepal
| | | |
Collapse
|
12
|
Khadgi S, Shrestha B, Ibrahim H, Shrestha S, ElSheemy MS, Al-Kandari AM. Mini-percutaneous nephrolithotomy for stones in anomalous-kidneys: a prospective study. Urolithiasis 2016; 45:407-414. [DOI: 10.1007/s00240-016-0926-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 09/27/2016] [Indexed: 11/30/2022]
|
13
|
Zeng G, Wan S, Zhao Z, Zhu J, Tuerxun A, Song C, Zhong L, Liu M, Xu K, Li H, Jiang Z, Khadgi S, Pal SK, Liu J, Zhang G, Liu Y, Wu W, Chen W, Sarica K. Super-mini percutaneous nephrolithotomy (SMP): a new concept in technique and instrumentation. BJU Int 2015. [PMID: 26220396 DOI: 10.1111/bju.13242] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Guohua Zeng
- Department of Urology; Guangdong Key Laboratory of Urology; Minimally Invasive Surgery Center; the First Affiliated Hospital of Guangzhou Medical University; Guangzhou China
| | - ShawPong Wan
- Chinese-American Urology Stone Center; First People's Hospital of Xiaoshan; Hangzhou China
| | - Zhijian Zhao
- Department of Urology; Guangdong Key Laboratory of Urology; Minimally Invasive Surgery Center; the First Affiliated Hospital of Guangzhou Medical University; Guangzhou China
| | - Jianguo Zhu
- Department of Urology; Guizhou Provincial People's Hospital; Guiyang China
| | - Aierken Tuerxun
- Department of Urology; the First People's Hospital of Kashi; Kashi Xinjiang China
| | - Chao Song
- Department of Urology; Hubei Provincial People's Hospital; Wuhan China
| | - Liang Zhong
- Department of Urology; Hospital of Traditional Chinese Medicine of Zhongshan; Zhongshan China
| | - Ming Liu
- Department of Urology; Changsha Centre Hospital; Changsha China
| | - Kewei Xu
- Department of Urology; Sun Yat-sen Memorial Hospital of Sun Yat-sen University; Guangzhou China
| | - Hulin Li
- Department of Urology; Zhujiang Hospital; Southern Medical University; Guangzhou China
| | - Zhiqiang Jiang
- Department of Urology; The third Xiangya Hospital of Xiangya Medical College; Central South University; Changsha China
| | - Sanjay Khadgi
- Department of Urology; Venus International Hospital (SK); Kathmandu Nepal
| | - Shashi K. Pal
- Department of Urology; Lions Kidney Hospital and Urology Research Institute; New Delhi India
| | - Jianjun Liu
- Department of Urology; the First Affiliated Hospital of Guangdong Medical College; Zhanjiang China
| | - Guoxi Zhang
- Department of Urology; the First Affiliated Hospital of Gannan Medical University; Ganzhou China
| | - Yongda Liu
- Department of Urology; Guangdong Key Laboratory of Urology; Minimally Invasive Surgery Center; the First Affiliated Hospital of Guangzhou Medical University; Guangzhou China
| | - Wenqi Wu
- Department of Urology; Guangdong Key Laboratory of Urology; Minimally Invasive Surgery Center; the First Affiliated Hospital of Guangzhou Medical University; Guangzhou China
| | - Wenzhong Chen
- Department of Urology; Guangdong Key Laboratory of Urology; Minimally Invasive Surgery Center; the First Affiliated Hospital of Guangzhou Medical University; Guangzhou China
| | - Kemal Sarica
- Department of Urology; Dr. Lutfi KIRDAR Kartal Research and Training Hospital; Istanbul Turkey
| |
Collapse
|
14
|
Zeng G, Zhao Z, Wan S, Khadgi S, Long Y, Zhang Y, Cao G, Yang X. Failure of Initial Renal Arterial Embolization for Severe Post-Percutaneous Nephrolithotomy Hemorrhage: A Multicenter Study of Risk Factors. J Urol 2013; 190:2133-8. [PMID: 23831314 DOI: 10.1016/j.juro.2013.06.085] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Guohua Zeng
- Department of Urology, Minimally Invasive Surgery Center, First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangdong, People's Republic of China
| | - Zhenhua Zhao
- Department of Urology, Minimally Invasive Surgery Center, First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangdong, People's Republic of China
| | - Shawpong Wan
- Department of Urology, Minimally Invasive Surgery Center, First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangdong, People's Republic of China
| | | | - Yongfu Long
- Department of Urology, Central Hospital of Shaoyang, Hunan, People's Republic of China
| | - Yonghai Zhang
- Department of Urology, Shantou Central Hospital, Guangdong, People's Republic of China
| | - Guocan Cao
- Department of Urology, Hunan Chenzhou No. 4 People's Hospital, Hunan, People's Republic of China
| | - Xiaoming Yang
- Department of Urology, Zhuzhou Kind Cardiovascular Disease Hospital, Hunan, People's Republic of China
| |
Collapse
|