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 safety and efficacy of percutaneous nephrolithotomy (PCNL) in a new operative position, flank suspended supine position. Methods The new position hold affected flank suspended by raising the ipsilateral shoulder and haunch with two 3-liter saline bags, and set up waist bridge simultaneously. From March 2010 to October 2010, a series of 173 patients underwent PCNL with the new supine position under epidural anesthesia. The average age was (50± 11) years, and the average bulk of the stone was (2. 9±1.0) cm. All patients were placed in the new supine position. Under ultrasound guidance, the desired calix or pelvis was punctured near the posterior axillary line, then dilating the tract and establishing the 16 F or 20 F tract for PCNL. Results The pelvicaliceal system could be successfully approached in all patients. The procedure was well tolerated in all patients. Mean operation time was (86 ± 34) min. 80. 3% of the patients were rendered free of stones by the initial PCNL. Thirty-four cases had residual stones, and a second PCNL was performed in 16 cases to clear the residual stones. Only 1 patient required blood transfusion.None of the patients suffered visceral injury. Conclusion The new supine position is safe and effective for PCNL.