Outcomes of percutaneous nephrolithotomy: Comparison of elderly and younger patients

Background and purpose Percutaneous nephrolithotomy (PCNL) in elderly patients is challenging due to the high prevalence of comorbidity and single kidney. We compared the results and complications of patients who were submitted to PCNL according to age (higher than and lower than 65 years old). Materials and Methods A total of 61 patients aged more than 65 years old (group I) and 385 patients aged 65 years old or less (group II) were treated with PCNL. PCNL was performed by a standard technique under fluoroscopic guidance. The operative time, length of hospital stay, success rate, auxiliary treatment and complications of both groups were compared. Results Patients older than 65 years old (group I) had more comorbidities mainly diabetes mellitus, hypertension and higher level of ASA classification (P < 0.001). The success rate was 85.24% and 86.24% of groups I and II, respectively. Four patients (6.56%) of group I and 55 patients (14.29%) of group II needed auxiliary treatment (P = 0.098). Among the complications, only sepsis was significantly higher in group I (6.56% of group I and 1.3% of group II, P = 0.007). The operative time, success rate, hospital stay and complications except sepsis episode did not significantly differ between the two groups. Conclusion Percutaneous nephrolithotomy is effective and safe in elderly patients even though with more comorbidities. Sepsis is the only more frequent common complication following PCNL in elderly. .

Efficacy and safety of percutaneous nephrolithotomy (PCNL): a prospective and randomized study comparing regional epidural anesthesia with general anesthesia

OBJECTIVE: To compare the efficacy and safety of regional epidural anesthesia and general anesthesia in patients who underwent PCNL. MATERIALS AND METHODS: Fifty patients submitted to percutaneous nephrolithotomy (PCNL) were randomized into two groups: Group I (N = 26) received general anesthesia and Group II (N = 24) received regional epidural anesthesia. Demographic and operative data including age, BMI, stone position, stone size, postoperative pain, amount of postoperative analgesic usage, length of hospital stay, patient satisfaction, preoperative and postoperative hemoglobin and hematocrit, adverse effects and surgical complications were compared between both groups. RESULTS: Average pain score at 1 hour. was 6.88 in group I and 3.12 in group II (p < 0.001), at 4 hours. 5.07 in group I and 3.42 in group II (p = 0.025). Less morphine was required in the regional epidural anesthesia group compared to the general anesthesia group. Higher satisfaction was found in the regional epidural group. 6 (23.07%) patients in Group I and 1 patient (4.19%) in Group II had postoperative nausea and vomiting, respectively (p = 0.05). Pain score at 12 hours, 24 hours, 48 hours, 72 hours, preoperative and postoperative hemoglobin and hematocrit, length of hospital stay, and adverse effects were no different between the two groups. CONCLUSION: Regional epidural anesthesia is an alternative technique for PCNL which achieves more patient satisfaction, less early postoperative pain and less adverse effects from medication with the same efficacy and safety compared to general anesthesia.

Alkaline citrate reduces stone recurrence and regrowth after shockwave lithotripsy and percutaneous nephrolithotomy

OBJECTIVE: To evaluate the preventive effects of alkaline citrate on stone recurrence as well as stone growth post-ESWL or PCNL in patients with calcium-containing stones. MATERIALS AND METHODS: A total of 76 patients with calcium calculi who were stone-free or had residual stones less than 4 mm following ESWL and PCNL were enrolled. All patients were independently randomized into two groups. The treated group (N = 39) was given 81 mEq per day of oral potassium-sodium citrate (27 mEq three times a day), and the untreated group (N = 37) serving as controls. Blood, twenty-four hour urine analysis, and plain KUB were measured and compared at the baseline and after 12 months. RESULTS: At baseline, hypocitraturia was found in 20 of 39 patients (46.05 percent) of Group I and 15 of 37 patients (40.5 percent) of Group II. At 12 months, hypocitraturia was found in 3 of 39 (7.69 percent) and 14 of 37 (37.83 percent) of Group I and Group II, respectively (p = 0.007). At the 12 month follow-up, of the stone-free group, 92.3 percent of the treated group and 57.7 percent of the control group were still stone free. Of the residual stone group, 30.8 percent and 9.1 percent of treated and control group were stone-free, respectively. The increased stone size found in 7.7 percent and 54.5 percent of treated and control groups, respectively. CONCLUSION: Sodium-potassium citrate provides positive effects on stone-forming activities in calcium stone patients suffering from urolithiasis following treatment with ESWL and PCNL procedures at the 12-month follow-up.

Preoperative laparoscopy in the management of the nonpalpable testis.

The purpose of laparoscopy in the management of the nonpalpable testis is to provide information regarding testicular presence and location to facilitate overall surgical management. Laparoscopy was performed at operation in 20 patients between 14 months to 21 years old (average 63 months), who had 22 nonpalpable testes. Of the testes 13 (59 per cent) were in the inguinal region or just proximal to the inguinal ring, 8 (36 per cent) were in a high intra-abdominal position and 1 (5 per cent) were absent. Anatomical localization of nonpalpable testes facilitated accurate planning of operative repair and the laparoscopy rendered exploration unnecessary in patients with intraabdominal vanishing testes syndrome, and laparoscopic orchiectomy is the treatment for the unilateral intraabdominal testes in patients more than 10 years old.

Ureteric obstruction by shotgun pellet "pellet colic".

Acute renal colic from retained missiles is an unusual and interesting delayed complication of missile injuries to the abdomen. It must be considered in patients who present with symptoms of renal colic following gunshot and shotgun wounds with retained missiles. We report a case of acute ureteral obstruction secondary to a migrating intraluminal projectile 3 days after a shotgun wound to the back.

Lower pole caliceal stone clearance after ESWL: the effect of infundibulopelvic angle.

Extracorporeal Shock Wave Lithotripsy (ESWL) represents the first choice therapy for renoureteral stone disease. Clinical controversy exists concerning the efficacy of ESWL for lower pole kidney stones. Nowadays, the factors that hinder the spontaneous passage of stone debris that results from ESWL of lower caliceal stone are the gravity-dependent position of the lower pole calices and particular features of the inferior-pole collecting system anatomy. We studied the influence of the lower infundibulo-pelvic in the success of ESWL of lower caliceal stones 10-20 millimeters in size in 50 patients with STORZ MODULITH SL-20 machine. At the mean follow-up of 6 months, only 44 per cent of the patients presenting with an infundibulo-pelvic angle of les than 90 degrees became stone free. On the other hand, 86 per cent of the patients presenting with an infundibulo-pelvic angle of greater than 90 degrees became stone free. Our data suggest that acute infundibulo-pelvic angle of the lower pole hinders the spontaneous passage of fragments after ESWL.