The safety and efficacy of ultrasound guided combined needle-perc and standard percutaneous nephrolithotomy in the treatment of staghorn stone / 中华泌尿外科杂志

Objective To summarize our preliminary clinical experience of ultrasound-guided needle-perc combined with standard percutaneous nephrolithotomy (PCNL) in the treatment of staghorn stones,and to analyze its safety and efficacy.Methods The clinical data of 65 patients with staghom stones treated by ultrasound-guided needle-perc combined with standard PCNL under general anesthesia with the patient in prone position from December 2017 to June 2019 were retrospectively reviewed.A total of 41 males and 24 females were included.The mean age was (53.5 + 8.9) years.The mean body mass index (BMI) was (25.1 ± 2.9) kg/m2,and the mean stone diameter was (10.9 ± 3.1) cm.Among them,there were 3 cases with bilateral staghorn stones,38 cases with complete staghorn calculi,36 cases with non-or mild preoperative hydronephrosis,12 cases with previous ipsilateral renal surgery,and 9 cases with solitary kidneys.Ultrasound-guided renal access and tract dilation were used to establish F24 standard channel.Pneumatic combined with ultrasonic lithotripsy with suction system was used to treat staghorn stones under nephroscope.Needle-perc consists of F4.2 needle-like metal sheath connected with a three-way tube.A 0.6 mm diameter video fiber,200 um holmium laser fiber and liquid perfusion device can be connected through the three-way tube respectively.The residual stone in the parallel calyx after standard PCNL were punctured by needle-perc under ultrasound guidance,and then the holmium laser fiber was used for lithotripsy.Results In this study,a total of 68 renal units were included.The median operative time was 79.8 minutes,ranging 45-129 minutes.The median decrease of hemoglobin on postoperative day 1 was 10.6 g/L,ranging 0-25.9 g/L.The median length of postoperative hospital stay was 5.5 days,ranging 4-7 days and the median time of tract establishment was 4.8 minutes,ranging 2.5-9.6 minutes.The median number of standard tract established was 1.5,ranging 1-3 and the median number of needle-perc punctured was 1.0,ranging 1-3.The total complication rate was 10.3％ (7 cases),including 5 cases of Clavien grade I,2 cases of postoperative fever,3 cases of analgesic use.There were 2 cases of Clavien grade II.All of them were blood transfusion.The initial stone free rate was 79.4％ (54/68).Of the 14 patients with residual stones,9 patients underwent second-stage operation,7 patients were stone free,and the final stone free rate was 89.7％ (61/68).Conclusions Ultrasound-guided needle-perc combined with standard PCNL is safe and effective in the treatment of staghorn stone.

The safety and efficacy of ultrasound guided combined needle-perc and standard percutaneous nephrolithotomy in the treatment of staghorn stone / 中华泌尿外科杂志

Objective@#To summarize our preliminary clinical experience of ultrasound-guided needle-perc combined with standard percutaneous nephrolithotomy (PCNL) in the treatment of staghorn stones, and to analyze its safety and efficacy.@*Methods@#The clinical data of 65 patients with staghorn stones treated by ultrasound-guided needle-perc combined with standard PCNL under general anesthesia with the patient in prone position from December 2017 to June 2019 were retrospectively reviewed. A total of 41 males and 24 females were included. The mean age was (53.5+ 8.9) years. The mean body mass index (BMI) was (25.1±2.9) kg/m2, and the mean stone diameter was (10.9±3.1) cm. Among them, there were 3 cases with bilateral staghorn stones, 38 cases with complete staghorn calculi, 36 cases with non- or mild preoperative hydronephrosis, 12 cases with previous ipsilateral renal surgery, and 9 cases with solitary kidneys. Ultrasound-guided renal access and tract dilation were used to establish F24 standard channel. Pneumatic combined with ultrasonic lithotripsy with suction system was used to treat staghorn stones under nephroscope. Needle-perc consists of F4.2 needle-like metal sheath connected with a three-way tube. A 0.6 mm diameter video fiber, 200 um holmium laser fiber and liquid perfusion device can be connected through the three-way tube respectively. The residual stone in the parallel calyx after standard PCNL were punctured by needle-perc under ultrasound guidance, and then the holmium laser fiber was used for lithotripsy.@*Results@#In this study, a total of 68 renal units were included. The median operative time was 79.8 minutes, ranging 45-129 minutes. The median decrease of hemoglobin on postoperative day 1 was 10.6 g/L, ranging 0-25.9 g/L. The median length of postoperative hospital stay was 5.5 days, ranging 4-7 days and the median time of tract establishment was 4.8 minutes, ranging 2.5-9.6 minutes. The median number of standard tract established was 1.5, ranging 1-3 and the median number of needle-perc punctured was 1.0, ranging 1-3. The total complication rate was 10.3% (7 cases), including 5 cases of Clavien grade Ⅰ, 2 cases of postoperative fever, 3 cases of analgesic use. There were 2 cases of Clavien grade Ⅱ. All of them were blood transfusion. The initial stone free rate was 79.4%(54/68). Of the 14 patients with residual stones, 9 patients underwent second-stage operation, 7 patients were stone free, and the final stone free rate was 89.7%(61/68).@*Conclusions@#Ultrasound-guided needle-perc combined with standard PCNL is safe and effective in the treatment of staghorn stone.

Extracorporeal Shock Wave Lithotripsy Monotherapy for Staghorn Stone with EDAP LT-02 Lithotriptor / 대한비뇨기과학회지

PURPOSE: The clinical efficacy of extracorporeal shock wave lithotripsy (ESWL) monotherapy with EDAP LT-02 (LT-02) lithotriptor for staghorn stone was estimated. MATERIALS AND METHODS: Thirty eight patients (39 renal units) with staghorn stone had been treated by ESWL monotherapy with LT-02 lithotriptor that had piezoelectric system with mounted C-arm and ultrasound unit (dual localization system) between Jan. 1996 and Dec. 2000. Success rate (SR) and stone free rate (SFR) were evaluated according to the stone type, volume and associated hydronephrosis. RESULTS: Overall SR and SFR were 56% and 38%. SR (SFR) of complete and incomplete staghorn stone were 57 (36%) and 56 (40%). SR (SFR) of stone under and over 20ml of volume were 53 (40%) and 58 (38%). SR (SFR) according to the associated hydronephrosis were 78 (57%), 44 (27%), and 42 (27%) in patients with no (group 1), mild (group 2), and severe hydronephrosis (group 3). SR (SFR) were not different in terms of stone type and volume but significantly low in patients with hydronephrosis. Auxillary procedures (percutaneous nephrostomy: 4 renal units, ureteral stent: 1 renal unit) were required in 5 renal units due to complete ureteral obstruction. CONCLUSIONS: In spite of low SR and SFR and multiple treatment sessions, we consider ESWL monotherapy to be a minimally invasive alternative treatment in patients with staghorn stone as outpatient procedure without the fear of ureteral stent, percutaneous nephrostomy and other auxillary procedures. Associated hydronephrosis is considered to be poor outcome factor of ESWL monotherapy in patients with staghorn stone.

Clinical Studies of Xanthogranulomatous Pyelonephritis / 대한비뇨기과학회지

PURPOSE: Because the preoperative diagnosis of xanthogranulomatous pyelonephritis (XGP) is difficult due to its similarities to other renal diseases, the diagnosis is made postoperatively in most patients. The aim of this study was to improve preoperative diagnosis of this disease. MATERIALS AND METHODS: We reviewed clinical characteristics, laboratory and radiological findings, preoperative diagnoses, and operative methods of 6 patients with XGP who underwent operation from March 1991 to July 1998. Mean age was 49.8 years (range 28 to 80) and male to female ratio was 1 to 2. RESULTS: All 6 patients had flank pain and urinary tract infection. Among 6 patients, there were 3 patients (50%) with renal staghorn stone and 1 (16.7%) with ureteropelvic junction stricture. No patient was diagnosed as XGP preoperatively. Three patients (50%) diagnosed as pyonephrosis with staghorn stone preopratively underwent simple nephrectomy and 2 patients diagnosed as renal mass preoperatively underwent radical nephrectomy. One patient diagnosed as renal abscess extended to retroperitoneum and psoas muscle preoperatively was diagnosed as XGP through intraoperative frozen section biopsy of renal tissue and underwent partial nephrectomy and drainage. CONCLUSIONS: Preoperative diagnosis of XGP will be raised through better understanding of the clinical characteristics and radiologic findings of this disease.

Extracorporeal Shock Wave Lithotripsy Monotherapy for Staghorn Stones / 대한비뇨기과학회지

PURPOSE: The clinical effectiveness of extracorporeal shock wave lithotripsy(SWL) monotherapy for staghorn stone was evaluated. MATERIALS AND METHODS: A total of 26 patients with staghorn stone treated by SWL monotherapy with Dornier MPL 9000 between April 1990 and December 1997 was reviewed. Dornier MPL 9000 lithotriptor was characterized by ultrasonic localization, automatic target system, water cushion and under water spark gap generation of shock wave. The number of treatment sessions for complete clearance, complications and ancillary procedures were compared regarding type and volume of the stone. RESULTS: All stones were completely fragmented and cleared without serious complications. The mean number of treatment sessions was 5.2 in incomplete type(16 cases) and 6.6 in complete type(10 cases). It was 5.5 in stones under 20ml(12 cases) and 5.9 in stones over 20ml(14 cases). The ureteral stent was indwelled before SWL in 22 cases. The complication after SWL included steinstrasse in 14 cases and high fever in 4 cases. SWL to steinstrasse was performed in 6 cases and push-up was needed in 8 cases. CONCLUSIONS: We conclude that, in spite of the high number of treatment sessions, SWL monotherapy for staghorn offers good results without serious complications.

Extracorporeal Shock Wave Lithotripsy Monotherapy for Staghorn Stones / 대한비뇨기과학회지

During recent 3 years, we reviewed 42 patients with staghorn stones, who underwent extracorporeal shock wave lithotripsy (ESWL) with the Wolf Piezolith 2300 lithotriptor, to deter- mine whether ESWL monotherapy is a successful alternative. The results were obtained as follows: 1. Of 42 patients 10 had complete staghorn stones with 88.7mL in mean volume and 32 incomplete staghorn stones with 22.6mL in mean volume. 2.Mean session of ESWL was 7.8 in overall cases(8.8 in complete staghorn stones and 7.5 in incomplete staghorn stones). The overall success rate was 66%(60% in the complete staghorn stone and 69% in the incomplete staghorn stone). 3. Of 10 patients with stone less than 15mL, 8(80 %) showed stone -free after 5 mean sessions. Of 12 patients with stone between 15mL to 25mL, 9(76%) revealed stone-free after 6.6 mean sessions. Of 11 patients with stone between 25mL to 50mL, 6(55%) showed stone-free after 10.1 mean sessions. Of 9 patients with stone more than 50mL, 5 (56% ) revealed stone-free after 9.4 mean sessions. 4. Twelve patients showed partial response and 2 patients non-response. Of these 14 patients 6 underwent Open surgery, 5 still had remnant stones and 3 were lost to follow up. 5. The post-ESWL complications were flank pain in 18 patients(43% ), gross hematuria in 11 (26%), high fever in 4(10%) and steinstrasse in 13(31%). We conclude that ESWL monotherapy for staghorn stones is considered to be a safe and effective modality, except for bringing partial response in some cases and requiring long durations to get stone-free.