Flexible ureteroscopy in management of asymptomatic calyceal calculi in flight attendants / 第二军医大学学报

Objective To evaluate the value of flexible ureteroscopy (F-URS) in managing asymptomatic calyceal calculi for flight attendants. Methods We retrospectively analyzed the clinical data of 8 flight attendants who were surgically treated for asymptomatic calyceal calculi at our hospital from January 2008 to May 2012. The demographic information, disease characteristics, and perioperative information were collected. Results Eight patients had a total of 37 intrarenal calculi, with bilateral renal stones found in 2 patients. The mean number of stones per kidney in our patients was 3.7+0.7 (range 3-5). The mean size of individual stone was (4.5+1.5) mm (range 2-8 mm). The mean stone size per kidney was (16.8 ± 4.7) mm (range 6-20 mm). The mean operation time was (45.0+7.6) min (range 30-56 min) and the average postoperative hospital stay was (1.8+0.5) d (range 1-2 d). Mean time lost from work due to F-URS was (13.0+1.1) d (range 12-15 d). No severe complications occurred during the operation. Stone free rate was 100% at 2 weeks after treatment as showed by a follow-up CT scan. Conclusion F-URS with holmium laser is a safe, effective and minimally invasive procedure, and may serve as a first-line therapy for asymptomatic calyceal calculi for flight attendants.

Cicatrização renal após nefrectomia parcial laparoscópica sem fechamento do sistema coletor em porcos / Kidney healing after laparoscopic partial nephrectomy without collecting system closure in pigs

Introdução: Embora alguns estudos tenham descrito as semelhanças e diferenças anatômicas entre o rim humano e o rim suíno, pouco é conhecido sobre a cicatrização renal neste animal. O conhecimento da cicatrização do rim do porco é especialmente importante em procedimentos cirúrgicos que incisem o tecido renal e o sistema coletor, como é o caso da nefrectomia parcial. O objetivo do presente trabalho é estudar a cicatrização renal em porcos após nefrectomia parcial laparoscópica sem o fechamento do sistema coletor. Materiais e Métodos: Quatorze porcos machos com peso médio de 30 kg foram submetidos à nefrectomia parcial laparoscópica esquerda, removendo 25% do comprimento renal no pólo caudal (n=7) ou no pólo cranial (n=7). A técnica cirúrgica empregada envolveu acesso laparoscópico transperitoneal, clampeamento em bloco dos vasos renais, excisão do tecido renal com tesoura a frio e aplicação de energia monopolar para hemostasia do parênquima, deixando o sistema coletor aberto. Os animais foram avaliados clinicamente por 14 dias e então foram mortos. Níveis séricos de creatinina e uréia foram obtidos antes e em diferentes momentos após a cirurgia. São relatados ainda os achados de necropsia, pielografia retrógrada ex vivo e aspectos histológicos dos pólos renais operados. Resultados: Os níveis séricos de uréia e creatinina tiveram leve aumento inicial retornando aos valores pré-operatórios durante o período avaliado. Durante a necropsia verificou-se que não houve extravasamento de urina a partir do rim operado e que este se cobriu com tecido fibroso, aderindo-se aos tecidos adjacentes. Nas pielografias retrógradas não foi verificado nenhum extravasamento de contraste pelos pólos operados. Os achados histológicos mostraram grande deposição de colágeno tipo I sobre o pólo renal operado, vedando-o completamente. Conclusão: O rim suíno não é um bom modelo para pesquisas ou treinamento cirúrgico em que a cicatrização do sistema coletor seja um aspecto importante.

Introduction: Although some studies have described similarities and diferences between human and pig kidney anatomy, little is known regarding renal healing in this animal model. The knowledge of pig kidney healing is especially important in surgical procedures which incise the renal parenchyma and collecting system, such as partial nephrectomy. The aim of this study is to access kidney in pigs after laparoscopic partial nephrectomy without closuring of the collecting system. Materials and Methods: Fourteen male pigs with mean weight of 30 kg were submitted to left partial laparoscopic nephrectomy, removing 25% of the kidney length at caudal pole (n=7) or at cranial pole (n=7). Briefly, the surgical technique involved a transperitoneal laparoscopic access, en bloc vascular clamping of renal artery an vein, tissue excision with cold scissor and monopolar energy parenchyma hemostasis, leaving the collecting system opened. The animals were clinically evaluated during fourteen days, and afterwards were killed. Serum levels of creatinine and urea were assessed prior and at different moments after surgery. Necropsy findings, retrograde ex vivo pyelogram and histological aspects of operated renal poles are also described. Results: Serum creatinine and urea showed a slight initial increase with a gradual return to preoperative levels during the evaluated period. At necropsy, no signs of urine leakage were found and kidneys were covered by a fibrous tissue with adherences to adjacent organs. Also, in the retrograde pyelograms obtained, we did not find contrast medium leakage by operated poles. Histological findings showed great deposition of type I collagen over operated renal pole, sealing it completely. Conclusion: The pig kidney is not an adequate experimental model for research and training of surgery on which collecting system healing is an important aspect to be considered.

Clinical analysis of influencing factors of fluid extravasation in patients with calyceal calculi treated by ureteroscopic holmium laser lithotripsy / 中华泌尿外科杂志

Objective To explore the underlying clinical factors and precautionary measures of fluid extravasation in patients with calyceal calculi treated by ureteroscopic holmium laser lithotripsy.Methods A retrospective review was made on clinical records of 138 patients with calyceal calculi receiving retrograde ureteroscopic holmium laser lithotripsy from May 2005 to March 2009. The relevance was studied between the occurance of fluid extravasation complications and various clinical factors using x2 test and binary Logistic regression. The clinical factors included patients' sexes, age groups (＜30 years, 30-50 years, ＞50 years), history of treatment (ESWL or open surgery) for upper urinary tract calculi, preoperative upper urinary tract infection, intraoperative placement of ureteral catheter and the length of procedure duration (＜ 50 min, 50-80 min, ＞ 80 min). Results Fluid extravasation complications occurred in 24 patients. The sexes and age groups were irrelevant to the occurance of fluid extravasation complications; while history of ESWL or open surgery and preoperative infection in upper urinary tract, without intraoperative ureteral catheter placement and long duration of procedure were responsible for the higher rates of the fluid extravasation complications.Conclusion Reasonable selection of patients and timing of operation, regular intraoperative ureteral catheter placement and control the length of procedure duration help to reduce fluid extravasation during retrograde ureteroscopic lithotripsy.

Can infundibular height predict the clearance of lower pole calyceal stone after extracorporeal shockwave lithotripsy?

PURPOSE: To evaluate the efficacy of extracorporeal shock wave lithotripsy (SWL) on lower calyceal calculi in relation to the renal anatomical factors and determine which of these factors can be used to select patients who will benefit from SWL. MATERIAL AND METHODS: We analyzed retrospectively 78 patients with single radiopaque lower calyceal stones treated with SWL. The patients were evaluated 3 months after lithotripsy with a simple abdominal X-ray and a kidney ultrasound scan. The success of the treatment, removal of all fragments, was correlated with renal anatomical factors measured in the pre-treatment intravenous urography: infundibulopelvic angle, lower infundibulum width, lower infundibulum length, ratio length/width, infundibulum height, and number of minor calyces in the lower calyceal group. RESULTS: Three months after SWL treatment, 39 patients were stone-free (NR group) and 39 had residual fragments (R group). Both groups presented no differences in relation to infundibulopelvic angle, width and length of the lower calyceal infundibulum, length/width ratio of the lower infundibulum or number of lower calyces. Height of the infundibulum, described as the distance between the line passing through the lowest part of the calyx containing the calculus and the highest point of the lower lip of renal pelvis, was the only parameter in which significant differences (p = 0.002) were found between the NR and R groups. CONCLUSIONS: Lower Infundibular height could be a good measurement tool for deciding which patients with lower calyceal lithiasis would benefit from SWL treatment. Height of less than 22 mm suggests a good outcome from lithotripsy.

Treatment of renal calyceal stricture and atresia through antegrade percutaneous nephrostomy by Holmi-um laser / 中华泌尿外科杂志

Objective To evaluate the clinical efficacy and safety of Holmium laser in the treat ment of calyceal stricture and atresia through antegrade percutaneous nephrostomy. Methods Ante grade percutaneous nephrostomy was performed in 68 patients with calyceal stricture and atresiathrough a rigid 8/9.8 F ureteroscope. The stricture and atresia was incised in a linear fashion by theHolmium laser with a 550 mm fiber. After completion of the incision,a double J ureteral stent wasplaced for 6-8 weeks and nephrostomy tube was kept for 7 days thereafter. Patients were then fol lowed up with IVU and/or ultrasound at 3-6 month intervals. Results The mean operative timewas 90 min,ranged from 80 to 120 min. The mean postoperative hospital stay was 8 d(7-9d). Hy dronephrosis was significantly improved in 38 cases in an average follow up of 9 months (4-26 months). Repeated laser incision was performed to 4 treatment failures and all turned out to be suc cessful. Conclusions The Holmium laser treatment through antegrade percutaneous nephrostomyfor calyceal stricture and atresia has characteristics of minimal invasion,short hospital stay,good effi cacy in short term and repeated cases. This procedure to be used as the first choice for patients withgood renal function and mild hydronephrosis,especially accompanied with renal calculus.

The Factors Affecting Stone Clearance after Shock Wave Lithotripsy for Lower Calyceal Stones / 대한비뇨기과학회지

PURPOSE: The influence of the stone size and spatial anatomy of the lower pole was evaluated in relation to the stone clearance after shock wave lithotripsy (SWL) for lower calyceal stones. MATERIALS AND METHODS: SWL monotherapy was performed in 44 patients, with lower calyceal stone, using a Dornier Compact-S lithotriptor. The study was comprised of a retrospective analysis of 44 patients. The patients were divided into 2 groups, 33 who were considered to be clear of fragments 3 months after SWL, and 11 who had residual stones. The infundibulopelvic angle, infundibular width and length of lower calyces were determined from intravenous urograms. The stone-free status was assessed 3 months after the last shock wave lithotripsy session. RESULTS: The mean lower calyceal stone size, lower calyceal infundibulopelvic angle and lower calyceal infundibular length and width were 10.2mm, 32.2 degrees, 27.3mm and 5.7mm, respectively. The overall success rate was 75.0%. Success rates for the patients with an infundibulopelvic angle more than 30 degrees and less than 30 degrees were 85.2 and 52.9% respectively. For those with infundibular length more than 30mm and less than 30mm were 78.3 and 71.4%, respectively. For those with an infundibular width more than 5mm and less than 5mm were 76.5 and 74.1%, respectively. CONCLUSIONS: A low calyceal infundibulopelvic angle and the stone size had significant impacts on the stone clearance following shock wave lithotripsy. However, the infundibular length and width were not statistically significant factors associated with the stone clearance. Further examination of the lower pole renal anatomy, with a search for other contributing factors, is still warranted.

Incision of renal calices for the treatment of complex intrarenal sinus renal calculi / 中华泌尿外科杂志

Objective To explore the effect of incision of the cervix renal calices for the treatment of complex intrarenal sinus renal calculi. Methods 52 cases of complex intrarenal sinus renal calculi with upper and/or lower calyx serious hydrops treated by incision of the cervix renal calices were studied.There were 38 men and 14 women.The mean age was 43 years (range,21 to 70 years).The mean diameter of the stones was 4.2 cm. Results The stones were totally removed in 44 cases.8 cases with residual stones were treated by percutaneous nephrolithotomy. The residual stones were totally removed in 4 cases while other 4 cases accepted further treatment with extracorporeal shock wave lithotripsy (ESWL).No blood transfusion and postoperative bleeding were observed.24 cases were followed up of 0.5 to 4 years.KUB plus IVU were conducted postoperatively which showed improved hydronephrosis.No intrarenal stricture and renal calculi recurrence were observed. Conclusions The procedure has advantages of less bleeding,preservating more renal function,less postoperative complications,which has a good application in the treatment of complex intrarenal sinus renal calculi with upper and/or lower calyx serious hydrops.

Incision of the intrarenal sinus supplemented by a postrenal pole segmental incision removal of huge calculus / 临床外科杂志

Objective To evaluate the surgical treatment of huge staghorn stones. Method The clinic dates of 184 cases treated with an incision of the infrarenal sinus supplemented by a postrenal low pole segmental incision were studied. Result 184 cases were all successful.Conclusion We conclude that this method, need no interruption of renal blood flow had advantages of simple procedure less bleeding, completely removing calculi, protecting renal function.

Treatment of renal lower caliceal calculi with minimally invasive percutaneous nephrolithotomy / 中华泌尿外科杂志

Objective To investigate the clinical outcomes of minimally invasive percutaneous nephrolithotomy(MPCNL)in the treatment of lower caliceal calculi.Methods We retrospectively re- viewed the clinical outcomes and complications of 33 patients who underwent MPCNL for lower caliceal cal- culi from March 2001 to April 2005.The average diameter of the calculi was 2.8 cm.Single tract nephrosto- my was performed in all 33 cases;among them renal access was obtained through a middle calyx in 10 cases and a lower calyx in 23.Nine cases had F14 renal access;and 24 cases,F16.Results Of 33 cases,28 (85%)achieved stone-free at 1 session.A second-look was needed in 3 cases due to intraoperative bleed- ing;ESWL,in 1 case with residual,calculi;no treatment,in 1 case with residual calculi＜4 ram.The mean operative time was 93 min;mean blood loss was 113 ml;mean hospital stay was 11 d.Blood transfusion was needed in 1 patient who suffered from hepatic cirrhosis preoperatively;another experienced severe bleeding 7 d after operation and was cured with hyperselective spongia gelatinosa embolization of the renal artery.Fol- low-up was available in 19 cases for 2-48 months,and no recurrence of renal calculi was noted.Conclu- sions Minimally invasive percutaneous nepbrolithotomy has advantages of safety,less invasion,and easy re- covery for the treatment of lower caliceal calculi.