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Objective:To investigate the predictive value of serum albumin (Alb) levels in the early postoperative period (within 1 hour) for urosepsis after minimally invasive percutaneous nephrolithotomy (mPCNL).Methods:The clinical data of 160 patients treated by single channel holmium laser mPCNL in urolithiasis treatment center of the second hospital of Tianjin Medical University from January 2019 to January 2020 were retrospectively analyzed. The patients were divided into the sepsis group and the non-sepsis group according to whether the patients developed urosepsis after the operation. There were 110 cases of male, and 50 cases of female, with average age of(51.8±11.9), including 68 cases with hypertension, 26 cases with diabetes, 12 patients with history of preoperative fever, 16 cases with history of endoscopic lithotomy surgery, 6 patients with preoperative catheter, 24 patients with positive preoperative urine culture, 12 patients with positive preoperative nitrite volume, 32 cases with preoperative routine urine leucocyte(+ + + ). The operative time and infusion volume were recorded during the operation. Blood samples were collected from all patients within 1 hour after surgery to detect blood routine and serum albumin (Alb), and the change of haemorrhagic white blood cells and serum albumin were calculated. Univariate and multivariate analyses were used to statistically analyze the relevant clinical parameters to identify the independent risk factors for urosepsis after mPCNL surgery. The ROC curve was established and the area under the comparison curve was calculated to analyze the predictive value of independent risk factors for postoperative urosepsis.Results:There were 13 patients (8.1%) in the sepsis group, including 7 males and 6 females, with an average age of (53.1±8.2) years. There were 147 patients (91.9%) in the non-sepsis group, including 103 males and 44 females, with an average age of (51.7±12.1)years. Single factor analysis showed the infectious stones (38.5% and 8.8%), surgery duration [(94.6±26.2)min and(63.6±24.5)min], a positive urine culture (46.2% and 12.2%), positive urinary nitrite (30.8% and 5.4%), strong positive urinary leukocyte (61.5% and 11.3%), postoperative albumin levels [(34.2±2.7)g/L and(40.7±6.2)g/L]and changes of serum albumin levels within one hour after surgery [(18.3±4.6)% and(3.8±14.3)%] between the sepsis group and the non-sepsis group had significant differences ( P<0.05). Multiariable logistic regression analysis showed the strong positive urine leucocyte ( OR=57.704, 95% CI 2.407-1383.427, P=0.012), postoperative blood leucocyte level within one hour after surgery ( OR=2.406, 95% CI 1.154-3.627, P=0.014) and the change of serum albumin levels after surgery ( OR=1.373, 95% CI 1.083-1.740, P=0.009) were independent risk factors for sepsis. ROC curve analysis indicated that the AUC of the change amplitude of serum albumin level was 0.926, which was significantly higher than the AUC of the qualitative results of blood leukocyte and the AUC of urinary leukocyte( P<0.01). Conclusions:The positive urinary leucocyte, the change of serum albumin levels after surgery within one hour and the leucocyte level are independent risk factors for postoperative urosepsis after mPCNL. The change of serum albumin level in the early postoperative period has a strong predictive value for the early diagnosis of postoperative sepsis.
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Objective To study the clinical effect of minimally invasive percutaneous nephrolithotomy in patients with diabetes mellitus and non-diabetic patients. Methods A retrospective analysis was performed to look into the clinical data of 2,796 patients undergoing downward F18minimally invasive percutaneous nephrolithotomy during May 2007 to June 2016 under X-ray guidance Among them,582 diabetic patients were assigned as the diatetes group,aged 26-82 years,279 male,303 female, 174 with pelvic stones,255 with multiple calculi,153 with staghorn calculi,fasting blood glucose 5.4~20.3 mmol/L,postprandial and 2 hours blood glucose 9.1~28.9 mmol/L. In the group,the results of preoperative fasting blood glucose,glycosylated hemoglobin,meal 2 hours blood glucose,diabetes mellitus immune and two others,were in line with diabetes diagnosis and typing standard, and the stones were tested by infrared spectrum analyzer for determination of chemical composition(P0.05),but the hospital stay in the diabetic group was significantly longer than that of the control group. In comparison of the stone compositions,therate of uric acid stones in the diabetic group was significantly higher than that of the control group (P < 0.05). Conclusion Minimally invasive percutaneous nephrolithotomy is safe and effective for the treatment of renal calculi in patients with diabetes mellitus. Diabetic patients are susceptive to uric acid stones and those patients at the poor control of blood glucose suffer from a higher recurrence of renal stones , which reminds the importance of doctors to educate the patients on the prevention of kidney stones.
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Objective To compare minimally invasive percutaneous nephroscope and channel percutaneous nephroscope clinical curative effect for the treatment of kidney stones.Methods According to the digital table, 1 10 cases of patients with renal stones were selected and randomly divided into the control group 58 cases and obser-vation group of 52 cases.The control group underwent big channel percutaneous nephrolithotomy(PCNL),the observa-tion group were treated by minimally invasive percutaneous nephrolithotomy(MPCNL).Compared the two groups of patients with stone size,operation time,bleeding volume,decreased hemoglobin values before and after operation,and one-staged stone clearance rate.The changes of renal function in the two groups of patients before and after operation were analyed.Results The two groups with operation were completed successfully,no bleeding and other operation condition happened.The operation hemorrhage of the control group was (118.7 ±31.3)mL,the operation hemorrhage of observation group was (56.8 ±31.7)mL,there was a significant difference between the two groups (t=-10.192, P0.05).Renal function of the two groups were not significantly changed before and after 4 weeks of opera-tion,the two groups showed no significant differences(P>0.05 ).Conclusion The curative effects of two kinds of operations are similar,but the amount of hemorrhage of minimally invasive nephrolithotomy is less.Two kinds of opera-tion methods had no significant effects on patients renal function.
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Objective To evaluate the efficacy and safety of application of F 16 single-tract minimally invasive percutaneous nephrolithotomy ( MPCNL) combined with flexible ureteroscopy for the treatment of complex renal staghorn calculi . Methods From May 2009 to September 2012, 35 patients with complex renal staghorn calculi were treated by F 16 single-tract MPCNL combined with flexible ureteroscopy in this hospital .All the patients underwent MPCNL at the first-stage, and 5-7 days afterwards a second-stage operation was performed by using flexible ureteroscopy .The fragments of stones were removed from the MPCNL tract .For patients diagnosed as having residual stones , a third-stage reoperation of MPCNL combined with flexible ureteroscopy was given . Results Twenty-one patients were stone-free after the second-stage operation , 12 patients were stone-free after the third-stage operation , and the remaining 2 patients with residual stones were given drug administration for stone removal and were clarified as stone -free within 1 month of follow-up.No serious intraoperative or postoperative complications such as hemorrhage or infectious shock occurred .Follow-up reviews for 3 -6 months in the 35 patients found no residual stones or recurrence . Conclusion F16 single-tract MPCNL combined with flexible ureteroscopy is an effect and safe procedure for complex renal staghorn calculi .
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Background & objectives: With the ethical concern about the dose of CT scan and wide use of CT in protocol of suspected renal colic, more attention has been paid to low dose CT. The aim of the present study was to make a comparison of unenhanced low-dose spiral CT localization with unenhanced standard-dose spiral CT in patients with upper urinary tract calculi for minimally invasive percutaneous nephrolithotomy (MPCNL) treatment. Methods: Twenty eight patients with ureter and renal calculus, preparing to take MPCNL, underwent both abdominal low-dose CT (25 mAs) and standard-dose CT (100 mAs). Low-dose CT and standard-dose CT were independently evaluated for the characterization of renal/ureteral calculi, perirenal adjacent organs, blood vessels, indirect signs of renal or ureteral calculus (renal enlargement, pyeloureteral dilatation), and the indices of localization (percutaneous puncture angulation and depth) used in the MPCNL procedure. Results: In all 28 patients, low-dose CT was 100 per cent coincidence 100 per cent sensitive and 100 per cent specific for depicting the location of the renal and ureteral calculus, renal enlargement, pyeloureteral dilatation, adjacent organs, and the presumptive puncture point and a 96.3 per cent coincidence 96 per cent sensitivity and 93 per cent specificity for blood vessel signs within the renal sinus, and with an obvious lower radiation exposure for patients when compared to standard-dose CT (P<0.05). The indices of puncture depth, puncture angulation, and maximum calculus transverse diameter on the axial surface showed no significant difference between the two doses of CT scans, with a significant variation in calculus visualization slice numbers (P<0.05). Interpretation & conclusions: Our findings show that unenhanced low-dose CT achieves a sensitivity and accuracy similar to that of standard-dose CT in assessing the localization of renal ureteral calculus and adjacent organs conditions and identifying the maximum calculus transverse diameter on the axial surface, percutaneous puncture depth, and angulation in patients, with a significant lower radiation exposure, who are to be treated by MPCNL, and can be used as an alternative localization method.
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Objective To evaluate the relationship between the early incidence of postoperative complications and renal pelvic pressure during minimally invasive percutaneous nephrolithotomy. Methods 133 renal calculi patients were monitored during MPCNL. Then the patients were separated into two groups according to the renal pelvic pressure,and the postoperative fever,the perirenal fluid and impairment of renal function were analyzed. Results The average body temperature was higher in high pelvic pressure group than that in low pelvic pressure group from the first day to the fourth day after operation(P<0. 05). The urinary protein of all patients raised obviously after the op-eration while it decreased gradually afterward. The urinary protein of the high pelvic pressure group was much higher than that of the low pel-vic pressure group in same day with a significant difference (P<0. 05). The incidence of perirenal fluid was much higher in high pelvic pres-sure group than that in low pelvic pressure group (P<0. 05). Conclusion The incidence of early postoperative complications was related to renal pelvic pressure during MPCNL.
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Objective To compare the safety and effects of retroperitoneal laparoscopic ureterolithotomy(RLU)and microinva-sive percutaneous nephrolithotomy with lithotomy (MPCNL)for treating complicated upper ureteral calculi and to explore the sur-gical indications and the technical key points.Methods The clinical data in 54 cases of complicated upper ureteral calculi from Mar. 2009 to Sep.2012 were retrospectively analyzed,31 cases adopted the MPCNL therapy (MPCNL group)and 23 cases received the RLU therapy(RLU group).The perioperative complications and the stone clearance rate were compared between the two groups. Results The mean operating time was (69.70±7.73)min in the RLU group and (46.50±7.09)min in the MPCNL group(t=-11.436,P=0.000);the intraoperative blood loss was (21.50±7.23)mL in the RLU group and (66.90±20.00)mL in the MPC-NL group(t=9.94,P=0.000),the MPCNL group was significantly higher than the RLU group;no statistically significant differ-ences were found in the occurrence rate of postoperative hyperpyrexia,the stone clearance rate,the occurrence rate of urinary leak-age and the length of hospital stay between the two groups.Conclusion Both MPCNL and RLU have high safety and satisfactory effects for treating complicated upper ureteral calculi.RLU has less intraoperative blood loss and long operation time.
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Objective To explore the safety and efficiency of patients with impacted upper ureter calculus combined with renal intrarenal infection treated by ureteroscopic pneumatic lithotripsy (URL ) and minimally invasive percutaneous nephrolithotomy (MPCNL) .Methods 126 cases of impacted upper ureteral calculi combined with renal intrarenal infection were treated in this hos-pita1 from July 2007 to July 2011 ,including 58 cases of URL ,68 cases of MPCNL .The success rate of primary lithotripsy ,stone-free rate ,postoperative adjuvant therapy ,operative time ,hospital stay ,incidence of postoperative complications and other data were analyzed .Results The success rate of group URL was 82 .76% (48/58) ,the success rate of group MPCNL was 100 .00% .The stone-free rate seven day after operation :URL was 62 .07% (36/58) ,MPCNL was 98 .53% (67/68)(P0 .05) .Conclusion It has higher successful rate and stone-free rate in patients with upper ureter calculus combined with renal intrarenal infection by MPCNL than those treated by URL .The safety and efficency of the former is better that of the latter .MPCNL can be the first choice for the upper ureter calculus combined with renal intrarenal infection .
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Objective To evaluate the medium-term outcomes of minimally invasive percutaneous nephrolithotomy in patients with renal function impairment.Methods Data of 811 patients who underwent minimally invasive percutaneous nephrolithotomy between Jan.2009 and Dec.2011 were retrospectively collected.Seventy-eight patients had a preoperative estimated GFR of 30-59 ml/(min · 1.73m2).The minimum follow-up was 1 year.Patients were divided into group 1 (improved or stable disease) and group 2 (worsened disease).Patient age was (42.8 ± 16.3) and (45.3 ± 14.2) separately,with male patients 41 and 7,female patients 25 and 5 respectively.Body mass index were (24.3 ± 4.1) kg/m2 and (25.4 ±5.2) kg/m2,history of open surgery or ESWL were 19 and 4.Mild hydronephrosis were 22 and 4.Staghorn stone were 22 and 5.Multiple access were 13 and 2.Operative time was (78.2 ± 30.4) min and (80.3 ±32.3) min.Stone-free rate 1 month postoperatively were recorded.Multiple regression analysis was used.Results The stone free rate at 1 month postoperatively was 85％ by CT scan.Preoperative eGFR was (38.4±12.8) ml/(min · 1.73m2),and 1 ycar postoperative eGFR was (45.1 ±15.8) ml/(min · 1.73m2)in 78 patients.Renal function had improved in 31％ of patients,but it remained the same or deteriorated in 54％ and 15％,respectively at 1 year follow-up.On multivariate regression analysis,diabetes was associated with the deterioration of renal function.Conclusions At medium-term follow-up,renal function was maintained or improved in 85％ of patients with chronic kidney disease who underwent minimally invasive percutaneous nephrolithotomy.Minimally invasive percutaneous nephrolithotomy could be an effective and safe option for the patients with chronic renal function impairment.Diabetes mellitus was independent predictive factor of renal function impairment.Therefore,patients with diabetes should be followed up carefully.Medical management is needed if necessassry.
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Objective To analyze the clinical indications,efficacy and safety of Chinese minimally invasive percutaneous nephrolithotomy (MPCNL) in treating upper urinary calculi based on our experience.Methods From June 1992 to September 2010,a total of 10,452 patients (6060 males and 4392 females)with a mean age of (47.6 ± 13.7) years (7 months-93 years) received MPCNL in our center.The mean stone burden was (777.4 ± 740.3) mm2 (20 - 4 080 mm2 ).The data of stone burden,operative techniques,operating time,stone-free rate,major complication,hospital stay and stone composition were investigated. Results Of the 10 452 cases,11 801 procedures were performed on 10 876 (5493 left and 5383right) renal units,including 10 102 first stage procedures,1604 secondary procedures,86 third procedures and 9 fourth procedures.There were 11 830 tracts established,including 373 (3.15％ ) tracts of 14 F,7867 (66.50％) tracts of 16 F and 3590 (30.35％) tracts of 18 F.There were 1207 (10.20％),9174(77.55％) and 1449 (12.25％) punctures located in upper,middle and lower pole,respectively.956(8.79％) renal units were managed with multiple tracts,which including 2 tracts in 846 (7.78％) units,3tracts in 85 (0.78％) units,4 tracts in 18 (0.17％) units and 5 tracts in 7 (0.06％) units.Pneumatic lithotripsy was used in 8563 (72.56％) procedures,Holmium:YAG laser lithotripsy was used in 2981(25.26％) procedures and Pneumatic lithotripsy + Holmium: YAG laser lithotripsy was used in 257(2.18％) procedures.762 (7.29％) cases needed ESWL to clean the stone after MPCNL.The average operating time was ( 101.3 ± 44.2) min ( 10 -240 min).The stone-free rate of MPCNL was 89.9％,which increased to 93％ by adjunctive ESWL.And the mean hospital stay was ( 13.2 ± 6.4) days (2 - 72 days).The major complications happened on 321 (3.07％) cases,including 294 (2.81％ ) cases of blood transfusion,12 (0.11％ ) cases of sepsis,2 (0.02％) cases of renal abscess,9 (0.09％) cases of pleura injury,2 (0.02％) cases of colon injury and 2 (0.02％) cases of death.53 (0.51％) cases needed selective renal arterial embolization to achieve hemostasis.The main stone compositions were analyzed in 4345 cases.Calcium oxalate,calcium phosphate,magnesium ammonium phosphate,uric acid,ammonium urate,carbapatite and cystin were 91.74％,90.33％,14.91％,17.77％,4.83％,8.47％ and 0.51％,respectively. Conclusions MPCNL is an effective and safe treatment option for all kinds of upper urinary calculi in patients at all ages with a high stone free rate and low major complication rate.
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Objective To evaluate mini-percutaneous nephrolithotomy in treating superior segmental ureteral calculi. Methods Two Hundred and thirty-six patients underwent mini-percutaneous nephrolithotomy with holmium laser for superior segmental ureteral calculi from May 2005 to May 2008, 133 male and 103 female. Their age ranged from 17 to 76 years old with a mean of 47. 2 years. Of the 236 patients,141 compli-cated with calculi in the left side and 88 cases in the right side,7 in the both sides. The calculi diameter ranged from 0. 7 cm to 2.2 cm and the mean diameter was 1.4 cm. One hundred and ninety-three patients had undergone ESWL from 1～6 times. Results Of the 236 patients,217 were rendered stone-free at 1 pro-cedure. Residual calculi were found in 12 cases after operation and drugs were used for treatment. The resid-ual calculi were removed after 1 month. Seven cases with residual calculi were treated by ESWL and the cal-culi were removed. The total stone clearance was 91.9%. The mean operation time was 31.3 min(rang from 19～52 min), and the mean hospital stay was 9.5 days(rang from 6 to 12 days). The main complications following operation included: durative hematuria in 25 cases relieved by haemostasis and diuresis treatment within 24 to 48 hours,pnstoperative fever in 141 cases within 24 hours of which 103 were relieved by antiin-flammatory and fluid replacement treatment within 24 to 48 hours. Thirty-eight cases were relieved by anti-inflammatory treatwent depending on urine culture results within 3 to 7 days. The postoperative pain in all patients was light. Conclusion Minimally invasive percutaneous nephrolithotomy with holmium laser under ultrasound guidance is simple,safe and effective in treating proximal ureteral calculi.
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Objective To investigate effectiveness of treatment of Upper urinary tract calculus by MPCNL application.Methods From May 2000 to May 2007,causing artificial kidney hydronephrosis for the affected kidney,established renal percutaneous channels(F16～18),which established the single channels of 202 cases,dual-channel of 14 cases,by Ureteroscopic Lithotripsy and holmium laser lithotripsy.Results 183 cases of 216 patients were One-time stone;33 cases were second stone.The average clearance rate is 90.32%,the average operation time is 79min,average valume of about bleeding is 80ml,the average hospitalization days are 8 days,kidney ostomy average stay 7.5 days.Of the operation,9 cases of obviously bleeding(4%)before and after operation,1 case uncontrollable bleeding after interventional treatment failure with Nephrectomy,others to stop beeding by symptomatic treatment,2 cases find urinary extravasation postoperative and cured by adjusting location of renal ostomy.Conclusion Minimally invasive percutaneous nephrolithotomy for the treatment of Upper urinary tract calculus is safe and effective for patients with less trauma,quicker recovery and high learance rate,the efficacy is satifactory.
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4 mm)in the kidney,and were then treated by ESWL combined with oral dissolution agents.The cure rate of this series was 97.7%(86/87).The patients were discharged from the hospital 4 to 16 days(mean,6.3 days)after the treatment.One patient developed massive hemorrhage and was then cured by selective embolization of the small renal vessels.86 patients were followed up for 3 to 18 months(mean,6.3 months),none of them had residual stones during this period.The symptoms of hydronephrosis was improved in all of the cases.Conclusions B-ultrasonography guided MPCNL with holmium:YAG laser is convenient,safe,and effective for upper urinary tract stone.
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Objective To discuss the efficacy of minimally invasive percutaneous nephrolithotomy(MPCNL) for residual or recurrent stones in the kidney or upper ureter after open surgery.Methods A total of 46 cases of residual or recurrent stones in the kidney or upper ureter after open surgery were included in the study.A pigtail catheter was inserted into the ureter transurethrally under ureteroscope to create an artificial hydronephrosis.Then a renal fistulization,usually on middle or upper calyx,was made.The stones were identified under ureteroscope,fragmented with a pneumatic ballistic lithotriptor,and extracted by using a grasping forceps.The renal fistulization tube was indwelled for drainage.Results The stones were completely removed on one session in 20 cases(43.4%),on two sessions in 15 cases(32.6%),and three in 8 cases(17.3%).Residual stones were seen in 3 cases(6.5%),with a size of 0.1 cm ? 0.1 cm ? 0.2 cm ～ 0.5 cm ? 0.5 cm ? 0.6 cm.Stones were removed through one working channel in 18 cases(39.1%),two channels in 20 cases(43.5%),and three channels in 8(17.4%).Conclusions The MPCNL is miuimally invasive and effective in the treatment of residual or recurrent stones after open surgery.
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Objective To explore the efficacy of outpatient treatment for residual ureteral calculi after minimally invasive percutaneous nephrolithotomy(MPCNL).Methods The treatments were conducted in an outpatient setting.The patients with residual ureteral calculi(
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Objective To investigate the efficacy of minimally invasive percutaneous nephrolithotomy(MPCNL) for impacted upper ureteric calculi.Methods Retro-urethral catheterization was conducted in the diseased ureter under cyctoscope.After a channel from the skin surface into the middle calyx was established under the guidance of X-ray or B ultrasonography,pneumatic lithotripsy was conducted to break up stones under ureteroscopy.Results The success rate of pneumatic lithotripsy was 100%.The rate of postoperative macroscopic hematuria was 55.1%(27/49).The symptom lasted one to three days in 26 cases,and 1 case had apparent hematuria with blood clot flowing out from nephrostomy tube,which lasted 8 days.10.2%(5/49) of cases was complicated with postoperative pyrexia.The stone-free rate in one week and one month postoperatively was 93.9%(46/49) 98.0%(48/49),respectively.Follow-up observations in 49 cases for 1-12 months(mean,5 months) showed no major complications.Conclusions MPCNL for impacted upper ureteral calculi has the advantages of simple performance,less complications and satisfactory efficacy.
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Objective To discuss the prevention and treatment of hemorrhage during or after minimally invasive percutaneous nephrolithotomy (PCNL). Methods Clinical data of 12 cases of hemorrhage during or after minimally invasive percutaneous nephrolithotomy from July 2005 to October 2005 in this hospital were retrospectively analyzed. Results Intraoperative hemorrhage occurred in 10 cases. The bleeding was stopped by pressure in 6 cases and a re-operation of open nephrolithotomy 5 days later was required in 4 cases. Postoperative hemorrhage was seen in 2 cases. The bleeding was successfully stopped by endoscopic electrocoagulation in 1 case and by interventional highly-selected embolization on the 4th day after operation in 1 case. Conclusions Prevention should be put first for hemorrhage during or after minimally invasive percutaneous nephrolithotomy. Accurate puncture and skillful tunnel expansion are the key to minimize the hemorrhage. Interventional embolization should be the first choice in case of massive or repeated bleeding.
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Objective To investigate surgical techniques of minimally invasive management for multiple calculi in the kidney and ureter. Methods Combined use of ureteroscopic lithotripsy(URSL) and minimally invasive percutaneous nephrolithotomy(MPCNL) was carried out in 21 patients with multiple calculi in homolateral kidney and ureter between January and October 2005 in this hospital.Results Percutaneous nephrostomy was required before the stone removal in 2 patients with pyonephrosis.Of the remaining 19 patients,all the ureteral calculi were completely removed on one session.And the renal calculi were removed by single session in 13 patients,by secondary percutaneous nephrolithotomy in 3 patients,and by tertiary nephrolithotomy in 2 patients.The combination treatment failed in 1 patient because of stricture of uretero-vesical orifice and a conversion to open surgery was needed.Conclusions Combination use of ureteroscopic lithotripsy and minimally invasive percutaneous nephrolithotomy is effective for the treatment of multiple calculi in homolateral kidney and ureter,offering advantages of minimal invasion,rapid recovery,and few complications.
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Objective To evaluate clinical effects of the transurethral ureteroscopic lithotripsy(URL) and minimally invasive percutaneous nephrolithotomy(MPCNL) in the management of upper ureteral stones.Methods Clinical data of 258 patients diagnosed as having upper ureteral calculi from January 2001 to December 2004 in this hospital were retrospectively analyzed.The patients were given either URL(225 patients) or MPCNL(33 patients).Results Of the URL,the stone-free rate on one session was 73.8%(166/225) and the failure rate was 26.2%(59/225).The causes for the failure included stone movement to the renal pelvic in 42 patients(18.7%,42/225),unsuccessful manipulation in 14 patients(6.2%,14/225),and conversions to open surgery because of ureteral perforation in 1 patient and ureteral rupture in 2 patients(1.3%,3/225).Of the MPCNL,the stone-free rate on one session was 100%(33/33).Conclusions The application of URL can be interfered with ureteral stricture and twist that are secondary to incarcerated ureteral stones.High stone-free rate,low incidence of complications,and satisfactory reliability can be expected using MPCNL,especially in patients with impacted ureteral calculi accompanied with secondary affection at the same side.
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Objective To assess the safety and effectiveness of minimally invasive percutaneous nephrolithotomy(MPCNL) in treating renal stones in patients with congenital anomalous kidneys.MethodsFrom January 2000 to November 2007 a total of 41 patients with renal stones complicated with congenital anomalous kidneys,including 12 cases of horseshoe kidneys,19 cases of duplex kidneys,and 10 cases of malrotated kidneys were treated by MPCNL in our hospital.Of the 41 patients,4 had upper calyx calculi,6 had middle calyx calculi,7 had lower calyx calculi,3 had pelvic calculi,4 had the upper segment calculi in duplex kidney,12 had multiple calculi,and 5 had staghorn calculi.The largest diameter of the stones ranged from 1.0 to 4.0 cm(mean 2.5 cm).Ureteral calculi that were found in 13 of the patients were treated at one time.ResultsThe procedure were completed in all of the cases with the operation time ranged from 45 to 210 minutes(mean 95 minutes),and blood loss ranged from 30 to 150 ml(mean 80 ml).The overall stone-free rate at one session was 85.4%(35/41).One of the duplex kidney cases and two of the horseshoe kidney cases were cured by a second operation.And two of the duplex kidney cases and one of the malrotated kidney cases were treated by ESWL after the MPCNL.One patient,who had malrotated kidney,suffered massive hemorrhage(800 ml) during the MPCNL,and was cured by selective embolization of the renal artery.No severe complications occurred in the other patients.The cases were followed up for 5-12 months,during the Period no patient had recurrence.ConclusionsMPCNL is safe and reliable for the treatment of stones in patients with congenital anomalous kidneys.The treatment must be individualized in terms of the type of the renal abnormalities,and the size and location of the stones.