Complications of minimally-invasive percutaneous nephrolithotomy / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the occurrence and management of complications following minimally invasive percutaneous nephrolithotomy (MPCNL).</p><p><b>METHODS</b>The data of 4326 cases of MPCNL from January 2001 to February 2006 were reviewed, including 2451 male cases and 1875 female cases. Their age ranged from 4 to 82 years with a mean of 42 years. Of 4326 cases, 1221 cases had simple nephrolithiasis, 1735 staghorn nephrolithiasis, 386 upper ureterolithiasis, 90 serious stone street after extracorporeal shock wave lithotripsy, and 894 residual calculi after open surgery.</p><p><b>RESULTS</b>Among the 4326 cases of MPCNL, complications occurred in 445 cases (10.3%). Of the 445 cases, 20 had massive hemorrhage, 13 pleural injuries, 1 colonic perforation, 343 fever attacks (T > 38 degrees C), 13 septic shocks, 16 perinephric urinoma, 9 perinephric abscess, 26 renal perforating injuries, 1 guide wire misled into inferior vena cava, 3 died.</p><p><b>CONCLUSIONS</b>MPCNL is a minimally invasive operation. However, serious complications would occur if the procedure were ignored. The improvement in the prevention and management of complications can promote the application of this procedure.</p>

Endoluminal therapy for bilateral malignant ureteric obstruction / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the endourological technique in the treatment of bilateral malignant ureteric obstruction.</p><p><b>METHODS</b>The data of 43 patients (totally, 70 cases) with bilateral malignant ureteric obstruction treated with endoluminal therapy were reviewed retrospectively. Of 70 cases, 38 were treated by retrograde double-J stenting, 24 by minimally invasive percutaneous nephrotomy (MPCN) and 8 by antegrade double-J stenting.</p><p><b>RESULTS</b>All patients were followed up for an average of 12 months. The retrograde double-J stenting, MPCN and antegrade double-J stenting was successfully performed in 50.0% (19/38), 100.0% (24/24) and 62.5% (5/8), respectively. Technical failures in placing retrograde double-J stent were too difficult to identify the ureteric orifice (13/38) or failing to cross the obstruction site because of severe extraluminal compression (6/38). Failure in placing antegrade double-J stent was due to severe extraluminal compression (3/8). Dislodgment of nephrostomy tubes (11/19) was the major factor which limited the application of MPCN.</p><p><b>CONCLUSION</b>It is safe and effective to treat malignant ureteric obstruction with endourological technique, and suggested initially with retrograde double-J stenting. If malignant ureteric orifice occlusion or a severe extraluminal compression is showed in the imaging, MPCN or antegrade double-J stenting may be selected according to the site and the extent of obstruction.</p>