ABSTRACT
Objective@#To evaluate the safety and effectiveness of ultrasound-guided percutaneous nephrolithotomy (PCNL) accessed by SVOF-principle and two-step puncture techniques.@*Methods@#A total of 838 cases with upper urinary stones underwent percutaneous nephrolithotomy successfully accessed by ultrasound-guided between June 2007 and December 2015 at Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. Of all cases were divided in two groups: hydronephrosis calyces puncture group include 425 cases and SVOF-principle puncture group include 413 cases. The access establishment time, operation time, stone free rate (SFR), postoperative complications, and postoperative hospitalization time between the two groups we compared by t test or χ2 test.@*Results@#Statistically significant differences were observed between hydronephrosis calyces puncture group and SVOF-principle puncturegroup in the first access establishment time ((16.5±8.4) minutes vs. (11.2±5.9) minutes, t=3.931, P=0.013), one-stage SFR (74.3% vs. 85.7%, χ2=16.868, P=0.000), postoperative hospitalization time ((6.4±2.1) days vs. (4.8±1.8)days, t=4.574, P=0.000), transfusion rate (7.1% vs. 2.9%, χ2=8.027, P=0.006), and embolization rate (3.3% vs. 1.0%, χ2=5.390, P=0.020). There were no statistically significant differences in operation time, total SFR, postoperative fever and sever infection between these two groups (all P>0.05). In both two groups, no serious complications such as peripheral organ injury and death occurred.@*Conclusions@#PCNL accessed guided by ultrasound with SVOF-principle and two-step puncture techniques has advantages of quick puncture location, high stone free rate, fewer complications and fast recovery. This technique is an effective and safe treatment option for upper urinary stones and deserved promotion and application in clinic.
ABSTRACT
Objective To investigate the causes of bleeding due to arterial injury after minimally invasive percutaneous nephrolithotomy (mPCNL).Methods We retrospectively analyzed the clinical data of 2 980 patients who underwent ultrasound-guided mPCNL between January 2012,and January 2017,in our hospital.Among them,1 853 were male and 1 127 were female.Age from17 to 76 years old,average age was (45.7 ± 24.1) years.The calculi size was from 1.5 to 4.2 cm,average of (2.62 ± 1.08) cm.There were 2 478 kidney stones and 502 cases of ureteral calculi.Besides,727 cases with mild hydronephrosis,1 971 cases with moderate hydronephrosis,282 cases with severe hydronephrosis;480 patients with urinary tract infection;103 patients with renal empyema or acute renal failure;63 patients with cardiovascular and cerebrovascular stent implantation;214 patients with diabetes mellitus.Results In this study,all of the patients were established percutaneous renal tract successfully,indwelling drainage tube (6 ± 2)d,and postoperative hemorrhage in 117 cases,of which 29 patients suffered from bleeding due to arterial injury and DSA showed 20 cases with acute arterial injury,5 cases with pseudo-aneurysm,and 4 cases with arteriovenous fistula.However,all these cases were rehabilitated after the treatment of super-selective renal artery embolization.The rates of arterial injury of renal calyx access and pelvic access were 0.39％ (10/2 535) and 4.27％ (19/445),respectively.The rate of arterial injury in renal pelvic access was significantly higher than renal calyx access of PCNL (P ＜ 0.05).The rates of arterial injury in lower,middle,upper calyx access were 0.38％ (1/267),0.40％ (6/1 516),0.40％ (3/752),respectively.There was no significant effect of different renal calyx on postoperative arterial injury rate of mPCNL(P ＞0.05).All the percutaneous renal accesses were dilated with Amplatz sheaths,and the arterial injury rate of F16-18 and F20-22 tracts in the calyx access were 0.35％ (5/1 446),0.46％ (5/1 089),respectively,with no significant difference in size of calyx access associated with rate of arterial injury after mPCNL(P ＞0.05).The arterial injury rates of F16-18 and F20-22 tracts in the pelvic access were 1.98％ (5/253) and 7.29％ (14/192),respectively.There was significant difference in the size of the pelvic access in the rate of arterial injury after mPCNL(P ＜ 0.05).In addition,the arterial injury rate of single tract PCNL was 0.94％ (25/2 653) as compared to 1.22％ (4/327) in multi-tracts PCNL.There was no significant difference in the rate of arterial injury between single and multi-tracts PCNL(P ＞ 0.05).Conclusions The puncture of the renal pelvis and size of renal pelvis tract significantly increased the probability of postoperative bleeding due to arterial injury.
ABSTRACT
Immunotherapy which has been in practice for more than 20 years proves effective for the treatment of metastatic renal cell carcinoma (mRCC). Anti-angiogenesis-targeted therapy has recently been identified as a promising therapeutic strategy for mRCC. This study was aimed to evaluate the effectiveness of vascular endothelial growth factor (VEGF) pathway-targeted therapy for mRCC by comparing its effectiveness with that of immunotherapy. The electronic databases were searched. Randomized controlled trials (RCTs) on comparison of VEGF inhibiting drugs (sorafenib, sunitinib and bevacizumab) with interferon (IFN) or placebo for mRCC treatment were included. Data were pooled to meta-analyze. A total of 7 RCTs with 3451 patients were involved. The results showed that anti-VEGF agents improved progression-free survival (PFS) and offered substantial clinical benefits to patients with mRCC. Among them, sunitinib had a higher overall response rate (ORR) than IFN (47% versus 12%, P<0.000001). Bevacizumab plus IFN produced a superior PFS [risk ratio (RR): 0.86, 95% confidence interval (CI): 0.76-0.97; P=0.01] and ORR (RR: 2.19; 95% CI: 1.72-2.78; P<0.00001) in patients with mRCC over IFN, but it yielded an increase by 31% in the risk of serious toxic effects (RR: 1.31; 95% CI: 1.20-1.43; P<0.00001) as compared with IFN. The overall survival (OS) was extended by sorafenib (17.8 months) and sunitinib (26.4 months) as compared with IFN (13 months). It was concluded that compared with IFN therapy, VEGF pathway-targeted therapies improved PFS and achieved significant therapeutic benefits in mRCC. However, the risk to benefit ratio of these agents needs to be further evaluated.