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Objective To evaluate the efficacy and safety of application of F 16 single-tract minimally invasive percutaneous nephrolithotomy ( MPCNL) combined with flexible ureteroscopy for the treatment of complex renal staghorn calculi . Methods From May 2009 to September 2012, 35 patients with complex renal staghorn calculi were treated by F 16 single-tract MPCNL combined with flexible ureteroscopy in this hospital .All the patients underwent MPCNL at the first-stage, and 5-7 days afterwards a second-stage operation was performed by using flexible ureteroscopy .The fragments of stones were removed from the MPCNL tract .For patients diagnosed as having residual stones , a third-stage reoperation of MPCNL combined with flexible ureteroscopy was given . Results Twenty-one patients were stone-free after the second-stage operation , 12 patients were stone-free after the third-stage operation , and the remaining 2 patients with residual stones were given drug administration for stone removal and were clarified as stone -free within 1 month of follow-up.No serious intraoperative or postoperative complications such as hemorrhage or infectious shock occurred .Follow-up reviews for 3 -6 months in the 35 patients found no residual stones or recurrence . Conclusion F16 single-tract MPCNL combined with flexible ureteroscopy is an effect and safe procedure for complex renal staghorn calculi .
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Background & objectives: With the ethical concern about the dose of CT scan and wide use of CT in protocol of suspected renal colic, more attention has been paid to low dose CT. The aim of the present study was to make a comparison of unenhanced low-dose spiral CT localization with unenhanced standard-dose spiral CT in patients with upper urinary tract calculi for minimally invasive percutaneous nephrolithotomy (MPCNL) treatment. Methods: Twenty eight patients with ureter and renal calculus, preparing to take MPCNL, underwent both abdominal low-dose CT (25 mAs) and standard-dose CT (100 mAs). Low-dose CT and standard-dose CT were independently evaluated for the characterization of renal/ureteral calculi, perirenal adjacent organs, blood vessels, indirect signs of renal or ureteral calculus (renal enlargement, pyeloureteral dilatation), and the indices of localization (percutaneous puncture angulation and depth) used in the MPCNL procedure. Results: In all 28 patients, low-dose CT was 100 per cent coincidence 100 per cent sensitive and 100 per cent specific for depicting the location of the renal and ureteral calculus, renal enlargement, pyeloureteral dilatation, adjacent organs, and the presumptive puncture point and a 96.3 per cent coincidence 96 per cent sensitivity and 93 per cent specificity for blood vessel signs within the renal sinus, and with an obvious lower radiation exposure for patients when compared to standard-dose CT (P<0.05). The indices of puncture depth, puncture angulation, and maximum calculus transverse diameter on the axial surface showed no significant difference between the two doses of CT scans, with a significant variation in calculus visualization slice numbers (P<0.05). Interpretation & conclusions: Our findings show that unenhanced low-dose CT achieves a sensitivity and accuracy similar to that of standard-dose CT in assessing the localization of renal ureteral calculus and adjacent organs conditions and identifying the maximum calculus transverse diameter on the axial surface, percutaneous puncture depth, and angulation in patients, with a significant lower radiation exposure, who are to be treated by MPCNL, and can be used as an alternative localization method.
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Objective To evaluate the occurrence and management of complications following mini- mally invasive percutaneous nephrostolithotomy (MPCNL).Methods The data of 436 cases of MPCNL from December 2001 to March 2005 were reviewed,including 249 male cases and 187 female cases.Their age ranged from 14 to 71 years with a mean of 41.6 years.Of the 436 cases,314 cases had simple nephrolith- iasis,79 had nephrolithiasis combined with upper ureterolithiasis,27 had unilateral upper ureterolithiasis,and 16 had bilateral upper ureterolithiasis.Results Among the 436 cases of MPCNL,complications occurred in 27 cases (6.2%).Of the 27 cases,5 had massive hemorrhage,which was cured by closing meatus of nephric fistula,cleaning out the blood clot within the bladder with instrument and transfusing blood;2 cases had pleural effusion,11 cases had hydroperitoneum,8 eases had renal perforating injury,and they were cured by puncture and drainage;1 case had pyocalix,which was cured by using effective antibiotics,re-punc- turing kidney and postponing pulling out the fistula catheter.Conclusions MPCNL is a minimally inva- sire operation.However,it has obvious risk if the surgeon's skill is not proficient.The improvement in the pre- vention and management of complications can promote the application of this procedure.
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Objective To evaluate the surgical method and curative effect of minimally invasive percutaneous nephrolithotomy(MPCNL) in treatment of impacted proximal ureteric calculi.Methods 45 cases of proximal ureteric calculi treated with MPCNL were studied retrospectively.Percutaneous nephrostomy was established under the guide of X-ray,B-ultrasound and naked eye,and the nephropathy was extended to F16 through invasive percutaneous.Stones were taken out by ureteropyeloscopic pneumatic lithotripsy with help of hydraulic perfusion pump.Results The surgical time was 15～110 min with the average of 42 min after percutaneous nephrostomy.The average blood loss volume was 30 mL;no severe complications were occurred in the intra-or post-operative time.The rate of complete clearance of stones was 100% in first attempt.The mean hospital stay was 9 d,and the mean postoperative hospital stay was 3.5 d.Conclusion MPCNL used to treat the impacted proximal urethral calculi have satisfied effects and a lot of merits.