ABSTRACT
Background: This work was intended to distinguish the results of Percutaneous Nephrolithotomy (PCNL) related to stone-free rates (SFR) by the varying body mass index (BMI) of the patients who subjected for lower calyx stone treatment (with a stone range of ≥2 cm). Materials and methods:Atotal of 287 patients who went through the PCNLfor kidney stones were selected for the study. Only patients treated at Shahid-Ghazi Hariri Surgical Specialties Hospital (Medical City) and Al-Qima Private Hospital (Baghdad) within the time frame of January 2015 to April 2018 selected for the study. Information on patients' BMI and SFR was collected and analyzed to compare and contrast the differences in obese patients. Results: The average age and BMI of the patients are 41 years old and 34kg/m2 respectively. For total mean stone size 2.2 cm. Besides that, the average value for height was 173cm and weight 101kg. The overall stone-free rate was 82% and the mean hospital stay was 115±51.21 min, Major complications were seen in 65 patients (22.6%). No statistically significant differences were found in SFR, age and stone side among the four groups. The stone-free rates (SFRs) of a single procedure for the groups were 85%, 79.3%, 79%, and 84%, respectively. Major complications were not observed either during or after the operations. Conclusion: The effectiveness of PCNLtreatment for removal of lower calyceal stone is influenced by the varying patients' BMI value and results in high SFR value
ABSTRACT
Objective To explore the feasibility and safety of visualization puncture combined with flexible ureteroscopy in the treatment of lower calyx stones.Method Visualization puncture combined with flexible ureteroscopy to treat the lower calyx stones was done in our center from January to August 2016 in our hospital.32 cases of patients were enrolled to have a retrospective analysis.There were 18 males and 14 females,aged from 25 to 65 years,with an average age of 43 years.The diameter of stone was 1.0-2.0 cm,with an average of (1.4 ± 0.6) cm.We used general anesthesia and then adjusted the surgery bed to operation side lateral elevation was 30 °-35.Flexible ureteroscopy with 200μm holmium laser was used firstly to break calculi as much as possible.Ultrasound-guided F4.8 visualization puncture system was used to establish F4.8 channel.The power option was 2001μm hohnium laser to crush calculus of the renal calculi to treat the calculus of the distal end of soft lens which still can not be touched by ureteroscopy.Routine nephrostomy tube was not placed.The soft ureter sheath F5 double-J tube,and indwelling balloon catheter were routinely placed.We removed the catheter after 1-2 days and the double J tube after 4 to 6 weeks.Results The flexible ureteroscopy lithotripsy operation time was 8-25 mins in all of the 32 patients.Visualization puncture channels were successfully established in 3-7 mins,and the visualized puncture stone search rate of 100％ (32/32).The success rate of first stage lithotripsy was 93.8％ (30/32).Two cases of lower calyx stones diverticulum diverted to PNCL due to poor visibility by bleeding.The operation time was 30-60 mins and the average of 45 mins.KUB review at day one after the surgery showed that there were residual stones in 5 cases.The stone free rate at one month after the surgery is 100.0％.The average postoperative hospital stay was (2.0 ± 1.5) days.There were uo bleeding,ureteral avulsion and perforation,septic shock,pleural effusion and intestinal injury and other serious complications.Conclusions Navigation ultrasound-guided visualization puncture combined with flexible ureteroscopy is safe and effective to treat lower calyx stones.
ABSTRACT
Objective To evaluate if the flexible ureteroscopy could treat stones located in lower calyx with the infundibulopelvic angle (IPA) less than 30°.Methods Thirty-six patients with inferior caliceal calculi on whom flexible ureteroscopic procedures were performed between November 2009 and June 2015 were reviewed.The mean age of the patients was 52.1 years (34-71),with the mean stone diameter of (1.5 ± 0.8) cm (1.2-2.6 cm).IPA was smaller than 30° in all 36 cases,which confirmed by CTU examination.IPA was less than 10° in 15 patients,between 11 ° and 20° in 13 patients and between 21 ° and 30° in 8 patients.Results The success rate was 63.9％ (23/36 patients) in patients with IPA smaller than 30° after first session of procedure,and the stone free rate reached 100％ after the second session of procedure.The mean operation duration was (95.5 ± 31.4) min(51-127 min).The mean hospital stay after operation was(4.1 ± 1.2)days (3-5 days).No major complications were recorded and no patients needed to convert to open surgery.Double J tube was removed after 4 weeks postoperatively.Patients were followed up for 4-12 months,during which ultrasound and CT scan were used for stone detection.Conclusions The small IPA (＜30°) negatively affected the SFR in the first session operation.However,its negative effect was solvable by using modern endoscopes.A complete stone clearance was achievable even in case of unfavorable anatomic conditions in experienced hand.
ABSTRACT
PURPOSE: Shock wave lithotripsy(SWL) has become the preferred modality of treatment for the most kidney stones. But there is a consensus that success rate of SWL is relatively poor for the lower caliceal stones. We assessed the influence of spatial anatomy of the lower calyx on stone clearance after SWL. MATERIALS AND METHODS: We retrospectively reviewed 92 patients with 5-20mm sized solitary lower caliceal stone who had undergone SWL between March 1992 and February 1998. The clearance rate at three months was compared according to lower pole anatomy, such as infundibulopelvic angle, infundibular length and infundibular width. RESULTS: Overall stone free rate was 59.8 percent. In 67 cases whose infundibulopelvic angle greater than 90 degree, stone free rate was 68.7 percent, whereas in 25 cases less than 90 degree, it was only 36.0 percent(p<0.05). In 36 cases whose infundibular length greater than 3cm stone free rate was 38.9 percent, whereas in 56 cases less than 3cm it was 73.2 percent(p<0.05). In 70 cases whose infundibular width greater than 5mm stone free rate was 57.1 percent, whereas in 22 cases less than 5mm it was 68.2 percent. CONCLUSIONS: The lower pole infudibulopelvic angle and infundibular length has a significant role in the stone clearance after SWL of lower caliceal stones. The infundibulopelvic angle less than 90 degree and infundibular length greater than 3cm are individually unfavorable factors. We believe that these anatomic factors have to be considered when the physician decides SWL as a first line treatment of lower caliceal stones.