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Objective:To investigate the clinical efficacy and safety of transurethral flexible ureteroscopy combined with single channel minimally invasive percutaneous nephroscopy in the treatment of complex renal calculi.Methods:A total of 72 patients with complex renal calculi admitted to Beijing Friendship Hospital, Capital Medical University from November 2019 to April 2022 were prospective selected, which were randomly divided into study group and control group by the random number table method, with 36 cases in each group. The control group underwent single channel minimally invasive percutaneous nephrolithotomy, while the study group underwent transurethral flexible ureteroscopy combined with single channel minimally invasive percutaneous nephrolithotomy. The perioperative indexes (operation time, postoperative hospital stay, intraoperative blood loss), stone removal effect, renal function indicators [blood urea nitrogen (BUN), serum creatinine (SCr)] and complication rate were compared between the two groups. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for inter-group comparison. The Chi-square test or Fisher exact probability method were used to compare the count data of two groups. Results:The operation time [(101.05±11.34) min vs (107.84±10.28) min] and postoperative hospital stay [(8.54±3.15) d vs (12.36±4.08) d] in the study group were significantly shorter than those in the control group, and the difference were statistically significant ( P<0.05). The amount of intraoperative bleeding was close to that in the control group, but the difference was not statistically significant ( P>0.05). The primary stone clearance rate and summary stone clearance rate in the study group were 91.67% (33/36) and 100.0% (36/36), respectively, which were significantly higher than 69.44% (25/36) and 83.33% (30/36) in the control group, and the differences were statistically significant ( P<0.05). The postoperative BUN and SCr levels in the study group were (5.24±0.31) mmol/L and (90.65±25.57) μmol/L, respectively, the control group was (7.69±0.78) mmol/L and (131.96±37.80) μmol/L, respectively. BUN and SCr levels in the study group were significantly lower than those in the control group, and the differences were statistically significant ( P<0.05). The total incidence of postoperative complications in the study group was significantly lower than that in the control group (5.56% vs 16.67%), and the difference was statistically significant ( P<0.05). Conclusion:Transurethral flexible ureteroscopy combined with single channel minimally invasive percutaneous nephroscopy is an ideal method for the treatment of complex renal calculi, which has good removal effect, less complications and helps to improve renal function.
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INTRODUCTION AND OBJECTIVES@#Percutaneous nephrolithotripsy (PCNL) is the first-line treatment for stone burden >2 cm. The aim of this study was to determine factors that would affect stone free rates after PCNL. Preoperative and intra-operative variables were correlated to the patient’s post-operative outcomes to find a link, or lack thereof, to stone-free outcomes.@*METHODS@#A retrospective study of patients who underwent primary PCNL was done over a 1-year period. The association of the stone characteristics (based on Guy stone score), stone burden, operative time, lithotripsy time, number of access tracts, and location of access tracts to the stone-free status were analyzed.@*RESULTS@#One hundred thirty patients who underwent PCNL were included in this study. Stone free rate was 77.69% (101/130) while 23 of the 29 patients with residual stones (22%) (29/130) required further treatment. The 30-day overall morbidity rate was 8.46% (11/130). Guy stone score (GSS) and stone burden were found to be significantly associated with stone-free status. Patients with GSS grade I had the highest stone-free rate of 95.45% while patients with GSS Grade IV had the lowest stone-free rate at 30.00%. After multivariate analysis, stone burden (OR 1.176; 95% CI 1.084- 1.275; p 0.00) and GSS 4 (OR 15.374; 95% CI 1.164- 202.980; p 0.04) were significant independent risk factors for stone-free status.@*CONCLUSION@#Stone clearance and complication rate after PCNL of the present study were 78% and 8.5%, respectively, comparable with published data. A higher Guy’s stone score and a higher stone burden were significantly associated with retained stones post-PCNL.
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Objective To evaluate the effect of micropercutaneous nephrolithotomy(microperc) for treatment of renal calculi with self-made F 4.8 optic puncture needle combined with ureteral access sheath.Methods There were 23 patients undergoing microperc with the self-made device from June 2016 to April 2017,Male,12 cases,female,11 cases.The mean ±SD (range) patient age was (49 ±14) years(28-67 years),stone volume was (1.7 ± 0.6) cm (1.0-3.0 cm) and stone density was (934.5 ± 282.7) HU (357-1 500 HU).The self-made all-seeing system consists of a puncture needle (F4.85) and two 3-way connector allowing the insertion of a flexible microoptic system,laser fiber and attaching to irrigation system.Single tract with one puncture with ultrasound guide was fit to treat the calices containing calculi or calices at one stage operation.The course of puncture could be " all-see" on the display which was connected with flexible microoptic system.After stone fragmentation,the procedure was terminated in tubeless fashion.Ureteral double J stent was inserted in order to prevent postoperative complications.The factors analysed were demographic variables including age,sex,stone volume,stone density [Hounsfield units (HU)] and stone location,and intra-and peri-operative variables such as operating time,drop in haemoglobin level,stone clearance and complications.Results Conversion to PCNL was required in one patient because intraoperative bleeding obscured vision.The mean ± SD (range) operation duration was (46.2 ± 19.9) min (20-120 min),pain score was 2.8 ± 1.2(1-6),hemoglobin decrease was 6.6 g/L,and in hospital time was (2.9 ± 0.8) d (2-5 d),respectively.No patient required blood transfusion.Stone-free rate at 1 and 3 months postoperation was 90.9％ (20/22) and 100 ％ (22/22),respectively.Two who suffered hematuria (Clavien Ⅰ)underwent conservative treatment and recorered well.One suffered urinary tract infections (Clavien Ⅱ) and was treated with antibiotics.There were no major complications.Conclusions Mircoperc with the self-made device and ureteral access sheath in management of renal calculi is feasible and effective.
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Objective To evaluate the clinical value of a new optic puncture needle designed by our department for renal calculi treatment. Methods There were 8 patients undergoing micro-PCNL with the new device from June 2016 to February 2017. Values of basic demographic data ,operation time ,pain score ,drop in hemoglobin and complications were recorded. Results The mean stone size,operation time,pain score,drop in hemoglobin,and in-hospital time was(21.9 ± 7.3)mm,(43.6 ± 13.6)min,2.8 ± 1.3,7.0 g/L[(133.2 ± 10.3 g/L vs.(123.2 ± 13.9)g/L,P>0.05]and(3.1 ± 1.0)d,respectively. No patient required blood transfusion. Stone-free rate at 1 and 3 months post-operation were 87.5%(7/8)and 100%(8/8),respectively. One suffered urinary tract infections( ClavienⅠ)and was treated with antibiotics. There were no major complications. Conclusion The new device for treatment of renal calculi is feasible and effective.
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Objective To evaluate the clinical value of a new optic puncture needle designed by our department for renal calculi treatment. Methods There were 8 patients undergoing micro-PCNL with the new device from June 2016 to February 2017. Values of basic demographic data ,operation time ,pain score ,drop in hemoglobin and complications were recorded. Results The mean stone size,operation time,pain score,drop in hemoglobin,and in-hospital time was(21.9 ± 7.3)mm,(43.6 ± 13.6)min,2.8 ± 1.3,7.0 g/L[(133.2 ± 10.3 g/L vs.(123.2 ± 13.9)g/L,P>0.05]and(3.1 ± 1.0)d,respectively. No patient required blood transfusion. Stone-free rate at 1 and 3 months post-operation were 87.5%(7/8)and 100%(8/8),respectively. One suffered urinary tract infections( ClavienⅠ)and was treated with antibiotics. There were no major complications. Conclusion The new device for treatment of renal calculi is feasible and effective.
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Objective To evaluate the risk factors of septic shock after mini-percutaneous nephrolithotripsy (mPCNL). Methods Clinical data of 1 590 cases who underwent mPCNL from January 2013 to December 2014 were retrospectively analyzed. The x2 test and logistic regression were used to identify the key risk factors for septic shock after mPCNL. Results Of the 1 590 patients, 18 patients suffered septic shock, including 6 male patients and 12 fe﹣male patients. Their mean age was (45.6 ± 13.5) years (28 ~ 69 years). White cell in urine was 100 percent, the stone diameter ranged from 1.5 to 5.0 cm, unichannel for 15 cases while multichannel for 3 cases, the operation du﹣ration ranged from 45 to 200 min, mean (87.0 ± 56.0) min. 2 in 18 cases died in multiple organ failure, the others recovered till discharged. In x2 test, female gender (P = 0.001), (+++ ~ ++++) white cells in urine (P= 0.042), un-preoperative nephrostomy drainage (P=0.041) had significant association with septic shock after mPCNL. While in multivariate analysis, female gender ( O? = 5.471, 95 % CI: 0.756~21.452, P< 0.05) and un-preoperative nephrostomy drainage (O? =3.106, 95%CI:1.283~7.907, P<0.05) were identified as independent risk factors for septic shock after mPCNL. Conclusions Female gender and un-preoperative nephrostomy drainage are the key risk factors for septic shock after mPCNL.
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ObjectiveTo evaluate the efficacy of biapenem in percutaneous nephrolithotripsy for the prevention and control infections.MethodsA retrospective study was accomplished.The clinical data of 68 patients with PCNL which used biapenem for prevention and control infection from Aug 2009 to Feb 2011 in the hospital of Hubei Provincial Corps of CAPF were collected,the treatment effect of biapenem in percutaneous nephrolithotripsy was evaluated.Results57 cases use the injection biapenem each 0.3g,2 times a day intravenously 7 to 14 days could effectively prevent postoperative infections in perioperative period;11 cases of urinary infection and systemic inflammatory response syndrome after pereutaneous nephrolithotripsy use injection biapenem each 0.3g,every 8-hour intravenously 7 to 14 days,were effective treatment of postoperative infections.ConclusionBiapenem was effective in the prevention of infection in percutaneous nephrolithotripsy.
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ObjectiveTo summarize the research and manufacturing ideas of precise positioning instrument and its feasibility and safety in the minimally invasive percutaneous nephrolithotripsy.Methods The precise positioning instrument was preliminarily made by integrating ruler with protractor.Fifty cases of kidney stones or upper ureteral stones were recruited in the study.There were 32 males and 18 females with mean age of 47 years (21 -75 years).Of them,6 cases had open surgery history and 31 cases had different degrees of hydronephrosis.The distance from the mid-point of renal pelvis to the plane of the dorsal surface and the distance from the incident point of the mid-point of pelvis on the dorsal surface to spinous process were measured by ruler on the preoperative CT images.According to the measured results,the point,angle,direction and depth of needle were calculated by geometric formula,and then fix position puncture and percutaneous puncture channel expansion were completed by precise positioning instrument and calibrated by Carm X-ray machine.ResultsThe puncture channels were established successfully in all of the 50 cases.Forty-six cases were punctured successfully by just one try,and the success rate of one puncture only was 92.0％.C-arm was used in none of the cases during the channel establishing process.Each patient was Xrayed 1 -3 times,and the average was 1.4 times.Targeting deflection or renal pelvis injury occurred in none of these cases.ConclusionThe application of the homemade precise positioning instrument is a safe and quick method for the establishment of puncture channel during percutaneous nephrolithotripsy,meanwhile the surgeons can reduce the exposure to radiation.
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Objective To provide basis of preventing and treating complications by monitoring plasma colloid osmotic pressure and blood clotting function during anesthesia of percutaneous nephrolithotomy (PCNL).Methods 30 patients with upper urinary calculus were equally and randomly divided into two groups according to the different anesthesia method. In General anesthesia group, Midazolam 0. 1 mg/kg、diprivan 1.5mg/kg、Vecuronium bromide 0. 15mg/kg、fentanyl 4μg/kg were used to guide and forane 1 ～ 1.3MAC were used to keep inhalation anesthesia. In lumbar-epidural anesthesia group T12～12 or T12 ～ L1 epidural anesthesia with 0.75% ropivacaine 8 ～ 10 ml and L2～4 lumbar anesthesia with bupivacaine 10mg were used. Plasma colloid osnotic pressure, central venous pressure and TEG were detected at the beginning and at the end of operation and fluid consumption were compared between the two groups. Results There was no obvious difference between the two groups. In both groups ,COP was obviously reduced and CVP was improved after the operation which significantly different with those pre-operation ( all P <0. 01 ). R value reduced significantly(P <0. 05). There were 10 patients complicated with chilling, unconffortability,or anxiety. Conclusion During anesthesia of percutaneous nephrolithotomy, with operation time going on, COP reduced obviously, which increased the risk of heart failure, pulmonary edema, etc. but had no effect on blood clotting.
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Fístula arteriovenosa (FAV) é uma rara complicação pós-nefrolitotripsia percutãnea (NLP). Apresentamos o caso de um paciente de 70 anos, sexo masculino, que apresentou sangramento maciço após NLP, tratado por angioembolização renal superseletiva com implante de stent. Após a embolização, houve resolução do sangramento. FAV é uam complicação incomum da NLP, que pode ser tratada com sucesso com angioembolização.
Arteriovenous fistula (AVF) is a rare complication after percutaneous nephrolithotomy (PNL). We present the case of a 70-year-old male who had massive bleeding after NLP, angioembolização treated by superselective renal stent implantation. After embolization, there was resolution of bleeding. AVF is uam uncommon complication of NLP, which can be treated successfully with angioembolização.
Subject(s)
Humans , Male , Aged , Arteriovenous Malformations/diagnosis , Arteriovenous Malformations/therapy , Nephrolithiasis/surgery , Nephrolithiasis/pathology , Nephrostomy, Percutaneous/instrumentation , Nephrostomy, Percutaneous , AngiographyABSTRACT
Objective To evaluate the method, clinical efficacy and safety of one phase treat-ment of renal calculi associated with pyonephrosis by percutaneous nephrolithotripsy(PCNL) by pneu-matic combined with ultrasonic lithotriptor. Methods Sixty-six cases of renal calculi accompanied with pyonephrosis were treated with PCNL. The renal calyx was punctured under ultrasound gui-dance, then the tract was dilated from F8 to F16 by peel-away vascular access sheathes. After the in-sertion of the flexible sheath, metallic dilator was inserted and the flexible sheath was pulled out. The tract was dilated by metallic sheath to F21 and the operation sheath and nephroseope were placed into working tract. EMS III LithoClast Master was used. Ultrasonic powered lithotriptor probe with suc-tion was used to clear the liquor puris and calculus fragments with low-pressure or no-pressure. The combined pneumatic and ultrasonic powered lithotriptor was used to break and clear the calculi. Re-salts Of the 66 cases, there was no bacteremia or pyaemia intraoperatively and postoperatively. And there was no other severe complication occurred intraoperatively. One phase PCNL was successfully completed in 60 cases. Other 4 cases had residual calculi less than 1.5 em in diameter and received ESWL to break the calculi, 2 cases had bigger residual calculi and accepted second PCNL 1 week after the first intervention. In the follow-up period, the 3 month post-operative serum Cr was 56-203 μmol/L with an average decrease of 40 μmol/L, GFR was 5.0-56.2 ml/min with an average increase of 23.6 ml/min compared with the pre-operative data. At 6 months postoperative serum Cr was 56-158 μmol/L with average decrease of 31 μmol/L, GFR was 5.0-79.2 ml/min with an average in-crease of 30.2 ml/min. Conclusion Application of PCNL in the treatment of patients with renal cal-culi accompanied with pyonephrosis is safe, cost-effective and clinically efficient by pneumatic com-bined with ultrasonic lithotriptor.
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Objective To investigate the causes and preventive measures for failure and complications of minimally invasive percutaneous nephrolithotomy (mPCNL). Methods From January 2005 to October 2008,totally 353 cases of mPNCL were performed in our hospital. Among the cases,30 patients experienced failure of the surgery or postoperative complications. The data of the 30 patients were analyzed retrospectively in this study. Results Of the 30 cases,puncture failure occurred in 5 patients,while 2 of them were converted to open surgery,and the other 3 were treated by a second puncture successfully; Zebra wire extrusion was found in 5 cases,who were then cured by re-puncture or a second operation; in 3 patients,the wire or PCN tube was moved into the renal vein (2 cases) or the colon (1 case) without causing bleeding or intestinal fistula,the cases were cured afterwards by a second operation; 3 patients developed hydrothorax and then was cured by chest drainage; postoperative arteriovenous fistula was detected in 2 patients,who were cured by interventional therapy; in 5 days after the operation,one patient developed massive hemorrhage from the PCN tube when driving cars,and then recovered by clipping the PCN tube and hemostasis; another patient showed hemorrhage and infection due to extraction of the PCN tube,and open surgery was carried out to cure this patient. Conclusions Failure of puncture and Zebra wire extrusion are most common causes of failure of mPCNL. Whereas,post-mPCNL complications is often caused by unskillful surgeons or noncompliant patients.
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Objective To study the characteristics and diagnosis of renal sinus lipomatosis (RSL) complicated with renal staghorn calculi, and report our preliminary experience on percutaneous nephrolithotripsy for the disease. Methods A total of 547 patients with complex renal calculi were admitted to our hospital from January 2005 to June 2007. In 2 of them, RSL complicated with renal staghorn calculi was diagnosed by B-ultrasonography, CT, and MRI. Both the patients were female, aged 42 and 82 years respectively. B-ultrasonography-guided percutaneous nephrolithotripsy was performed on the two patients without removing the kidneys.Results Totally, 7 ml and 5 ml of stones were removed respectively from the two patients by percutaneous nephrolithotripsy. No retained calculi were found by KUB performed one week postoperation. Biopsy of the submucosal fat obtained from the renal pelvis during the operation showed hyperplasia and fibrosis of fatty tissues and inflammatory effusion. The patients were followed up for half a year, during which no recurrence of renal calculi occurred, and no abnormal fatty tissues were found at the renal sinus or surrounding the kidney. Conclusions Imaging examination is valuable for the diagnosis of RSL. B-ultrasonography-guided percutaneous nephrolithotripsy is safe and effective for RSL complicated with renal calculi.
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Objective To study the effect of mini percutaneous nephrolithotripsy (MPCNL) for non-nephredema kidney calculi. Methods A total of 47 patients with non-nephredema kidney calculi were enrolled in this study. Physiological saline solution was infused into the kidney through a ureteral catheter to induce hydronephrosis. C-arm X-ray machine was employed in percutaneous puncture and Wolf EMS was used to smash the calculi. Results The mean operation time was (120?35) min.The calculi were removed through one passage in 38 cases,through two passages in 6, and three passages in 3. Among the 47 patients, the MPCNL was performed once in 35, and twice in 12. The stone-free rate was 83.0% (39/47) and final stone-free rate was 93.6% (44/47). No complications were noted in all the patients. Conclusions Highly skilled technique is necessary in MPCNL for non-nephredema kidney calculi. The MPCNL is a safe, minimally invasive, and effective method. By using MPCNL, patients have less trauma, lower rate of calculi remaining, and quick recovery. As long as the surgeons are familiar with the technique of MPCNL and the anatomy of non-nephredema kidney, the therapeutic outcome can be as good as that in the patients with nephredema renal calculi.
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PURPOSE: Percutaneous nephroureterolithotripsy is one of alternative methods for the treatment of upper ureteral stones which are impacted in ureter or unresponsive to repeated extracorporeal shock wave lithotripsy(SWL). We evaluated the factors influencing the success rate of percutaneous nephroureterolithotripsy based on clinical data. MATERIALS AND METHODS: 107 patients(2 with bilateral) were included in this study. We reviewed the medical records and analyzed the factors ; stone size, laterality, location, site of percutaneous puncture, presence of pyuria, body weight, previous procedure(open surgery or SWL), and the experience of operator. RESULTS: The overall success rate of percutaneous nephroureterolithotripsy was 85.3%(93 of 109 cases). The location of stone and the experience of operator influenced the success rate of operation. The stones located above the lower pole level were obviously more successful than those located below it(57/62, 91.9% versus 36/47, 76.6%, p<0.05). In the late period of the operator`s experience, the success rate was significantly increased than that in the early period(51/58, 87.9% versus 40/51, 78.4%, p<0.05). But the stone size, laterality, site of percutaneous puncture, presence of pyuria, body weight and previous procedure didn`t influence the success rate. The average operation time was 93 minutes, average radiation exposure time was 2.2 minutes, and average hospital stay was 5.4 days. Most of the complications such as bleeding, urinary tract infection and pneumothorax were managed successfully with conservative treatments. CONCLUSIONS: Upper ureteral stones, which are impacted in ureter or unresponsive to repeated SWL can be successfully managed with percutaneous procedures. The stone location and the experience of operator are considered to be the major factors influencing the success rate.