ABSTRACT
OBJECTIVE@#To describe the outcomes of standard-sized tubeless PCNL (TSPCNL) in terms of clinical efficacy (stone-free rate, operative time and length of hospital stay) and safety (transfusion rate, infection and complications).@*METHODS@#A chart review was done on all patients who underwent standard-sized PCNL from 2017 to 2019. All cases of TSPCNL were identified. The patient and stone demographics were analyzed including intraoperative and postoperative outcomes. Complications were analyzed using the Clavien-Dindo classification.@*RESULTS@#Seventy-nine consecutive cases of prone, single-tract, upper pole access, tubeless PCNL were identified and analyzed. The mean age was 52.74±11.26 with a female to male ratio of 1:1.4. The Guy’s Stone Score showed 12 (15.2%) Grade 1; 23 (29.1%) Grade 2, 11(13. 9%) Grade 3 and 33 (41.8%) Grade 4 renal stones. Mean stone size was 33.7±14.1mm. The stone-free rate was 98.73%. The mean hemoglobin change was 13.6±13.9 g/L. The mean creatinine change was 2.65±23 umol/L. The mean length of hospital stay was 2.46±1.84 days. Twenty-four (30.4%) experienced significant pain, which required analgesics in the form of opioid derivatives. According to the modified Clavien-Dindo classification, 6/79 (7.6%) had Grade 1; 4/79 (5.1%) had Grade 2 and 2/79 (2.5%) had Grade 3 complications. There was no mortality.@*CONCLUSION@#The authors’ experience adds to the growing evidence that TSPCNL is a reasonable, efficient and safe approach for large volume nephrolithiasis. Clear indications are needed prior to nephrostomy tube placement after standard-sized PCNL.
ABSTRACT
Background: Plasmodium falciparum malaria is one of the major health problems in many tropical countries including India and due to increase in the drug resistance in India the incidence of complicated malaria has increased. Objectives: To study the renal complications of malaria. Materials and methods: 50 malaria positive cases with clinical renal disease were prospectively observed clinically and by laboratory investigations till the discharge. Results: Among the 50 malaria positive cases 41 (82 %) patients had p. falciparum infection, 4 (8%) had p. vivax and 5 (10%) had mixed infections. P. falciparum and mixed infection found to be responsible for ARF in 25 (89.28%), 3 (10.70%) respectively. Volume depletion was found to be the prominent cause (75%) of ARF, hyperbilirubinemia was noted in 64.28% of patients. Urinary abnormalities were noted in 24 (48%) cases, proteinuria in 20(40%), microscopic haematuria in 20 (40%), granular casts in 7 (14%). In the present study electrolyte abnormalities were noted in 46 (92%) of the patients. The overall mortality in the present study was 5 (10%). The cause of death was multi-factorial. MODS were the commonest cause of death. Conclusion: Renal complications were seen as the commonest complication of malaria. Early diagnosis, treatment specially the fluid management reduces the overall mortality