¿Cómo afecta la técnica de punción al riesgo de sangrado intraoperatorio durante la nefrolitotomía percutánea? Ensayo aleatorizado prospectivo / How does puncture modality affect the risk of intraoperative bleeding during percutaneous nephrolithotomy? A prospective randomized trial

Introducción y objetivos: Evaluar los posibles efectos de dos técnicas diferentes de punción renal (guiada por ecografía [GE] o guiada por fluoroscopia [GF]) sobre el riesgo de hemorragia intraoperatoria durante la nefrolitotomía percutánea (NLPC).Material y métodosUn total de 130 pacientes con puntuaciones de la escala de Guy de 1-2 fueron asignados prospectivamente a los grupos de punción GE y punción GF mediante aleatorización simple. Se excluyeron del estudio los pacientes que sufrieron rotura pielocalicial durante la cirugía y los que necesitaron múltiples accesos. Aparte de los pasos relacionados con la punción, todos los demás pasos del procedimiento de NLPC fueron realizados con técnicas similares por un único cirujano. Se compararon las características de los pacientes, los datos quirúrgicos y los resultados postoperatorios.ResultadosUn total de 10 pacientes fueron excluidos del estudio debido a una complicación intraoperatoria tras la punción. Los datos demográficos de los pacientes y las características de los cálculos fueron similares entre los dos grupos (p>0,05). La media del descenso de hemoglobina fue significativamente mayor en el grupo GF (1,7g/dl) en comparación con el grupo GE (1,3g/dl) (p<0,01). La duración media de la exposición a la radiación fue significativamente mayor en el grupo GF (p<0,001). El tiempo quirúrgico total, el número de intentos para una punción exitosa, la duración de la estancia hospitalaria y la tasa libre de cálculos fueron similares entre los grupos (p>0,05). Asimismo, las demás complicaciones clasificadas según la escala modificada de Clavien-Dindo fueron similares entre los grupos (p>0,05).ConclusiónLa punción guiada por ecografía (GE) proporciona niveles significativamente menores de descenso de hemoglobina y tiempo de exposición a la radiación en comparación con el procedimiento guiado por fluoroscopia (GF). (AU)

Introduction and objectives: To evaluate the possible effects of two different renal puncture techniques (ultrasound-assisted [US-assisted], fluoroscopic-guided [FG]) on the intraoperative hemorrhage risk during percutaneous nephrolithotomy (PCNL).Material and methodsA total of 130 patients with Guy stone scores of 1-2 were prospectively allocated to US-assisted and FG puncture groups by simple randomization. Patients with intraoperative pelvicalyceal rupture and the ones requiring multiple accesses were excluded from the study. Apart from the puncture steps, all other steps of the PCNL procedure were performed with similar techniques by a single surgeon. Patient characteristics, operative data, and postoperative outcomes were compared.ResultsA total of 10 patients were excluded from the study due to intraoperative complications after puncture. Patient demographics and stone characteristics were similar between the two groups (P>.05). Mean hemoglobin drop was meaningfully greater in the FG group (1.7g/dL) when compared with US-assisted group (1.3g/dL) (P<.01). The mean duration of radiation exposure was significantly higher for the FG (P<.001). Total operative time, number of attempts for a successful puncture, length of hospital stay, and stone free rates were similar between the groups (P>.05). In addition, the remaining complications classified according to the modified Clavien-Dindo grading system were similar between groups (P>.05).ConclusionUS-assisted puncture provides significantly decreased level of hemoglobin drop and radiation exposure time when compared with FG. (AU)

How does puncture modality affect the risk of intraoperative bleeding during percutaneous nephrolithotomy? A prospective randomized trial.

INTRODUCTION AND OBJECTIVES: To evaluate the possible effects of two different renal puncture techniques (ultrasound-assisted [US-assisted], fluoroscopic-guided [FG]) on the intraoperative hemorrhage risk during percutaneous nephrolithotomy (PCNL). MATERIAL AND METHODS: A total of 130 patients with Guy stone scores of 1-2 were prospectively allocated to US-assisted and FG puncture groups by simple randomization. Patients with intraoperative pelvicalyceal rupture and the ones requiring multiple accesses were excluded from the study. Apart from the puncture steps, all other steps of the PCNL procedure were performed with similar techniques by a single surgeon. Patient characteristics, operative data, and postoperative outcomes were compared. RESULTS: A total of 10 patients were excluded from the study due to intraoperative complications after puncture. Patient demographics and stone characteristics were similar between the two groups (p > 0.05). Mean hemoglobin drop was meaningfully greater in the FG group (1.7 g/dL) when compared with US-assisted group (1.3 g/dL) (p < 0.01). The mean duration of radiation exposure was significantly higher for the FG (p < 0.001). Total operative time, number of attempts for a successful puncture, length of hospital stay, and stone free rates were similar between the groups (p > 0.05). In addition, the remaining complications classified according to the modified Clavien-Dindo grading system were similar between groups (p > 0.05). CONCLUSION: US-assisted puncture provides significantly decreased level of hemoglobin drop and radiation exposure time when compared with FG.

Resultados de LEOCH con o sin catéter para el tratamiento de cálculos en la pelvis renal: un estudio aleatorizado / Effect of JJ stent on outcomes of extracorporeal shock wave lithotripsy treatment of moderate sized renal pelvic stones: A randomized prospective study

Objetivo: Evaluar el efecto de la colocación del catéter doble J en el tratamiento con LEOCH de los cálculos en la pelvis renal de tamaño moderado (15-25 mm). Materiales y métodos: Entre enero de 2016 y diciembre de 2017, se incluyó en el estudio a un total de 152 pacientes adultos que serían tratados con LEOCH por un solo cálculo radiopaco localizado en la pelvis renal. Se excluyeron los pacientes con riñón solitario, anomalía congénita, anomalía del sistema esquelético, cirugía previa del tracto urinario, hidronefrosis (grado 2 o superior), infección del tracto urinario sin tratar, trastorno hemorrágico y sospecha de embarazo. Los 114 pacientes restantes se dividieron aleatoriamente en 2 grupos: cateterizados y no cateterizados. Veintidós pacientes cuyo cálculo no pudo fragmentarse después de 3 sesiones consecutivas también fueron excluidos del estudio. Un total de 92 pacientes (54 no cateterizados y 38 cateterizados) se incluyeron en el análisis final. Resultados: No hubo diferencias significativas entre los grupos respecto a edad, sexo, índice de masa corporal, grosor parenquimal renal, hidronefrosis, distancia piel-cálculo, unidades Hounsfield y tamaño del cálculo. El éxito fue significativamente mayor en el grupo cateterizado que en el grupo no cateterizado (71 vs. 39%; p = 0,002). En pacientes libres de cálculos, el número de visitas al servicio de urgencias y el consumo de analgésicos fue significativamente menor en el grupo cateterizados que en el grupo no cateterizados (p < 0,001 y p < 0,001, respectivamente). En pacientes no libres de cálculos, el consumo de analgésicos fue significativamente menor en el grupo cateterizados que en el grupo no cateterizados (p = 0,004). Conclusiones: La colocación de catéter antes del tratamiento con LEOCH para cálculos en la pelvis renal de tamaño moderado tiene algunas ventajas en términos de éxito, visitas al servicio de urgencias y consumo de analgésicos

Purpose: To evaluate the effect of JJ stents on SWL treatment of moderate (15-25mm) renal pelvic stones. Materials and methods: Between January 2016 and December 2017, a total of 152 adult patients who were planned to undergo SWL for a single radiopaque renal pelvic stone were included in the study. Patients with solitary kidney, congenital abnormality, skeletal tract abnormalities, previous urinary system surgery, hydronephrosis (grade 2 or more), untreated urinary tract infection, bleeding disorder, and suspected pregnancy were excluded. The remaining 114 patients were randomly divided into two groups; non-stented and stented. Twenty-two patients whose stone could not be fragmented despite 3 consecutive sessions were also excluded from the study. A total of 92 patients (54 non-stented and 38 stented) were included in the final analysis. Results: There was no significant difference in terms of age, sex, body mass index, renal parancyhimal thickness, hydronephrosis, skin-to-stone distance, Hounsfield units, and stone size between the groups. Success was significantly higher in the stented group than in the non-stented group (71% vs. 39%, P = .002). In stone-free patients, the number of emergency department visits and analgesic tablet consumption was significantly lower in the stented group than in the non-stented group (P < .001 and P < .001, respectively). In non- stone-free patients, analgesic tablet consumption was significantly lower in the stented group than in the non-stented group (P = .004). Conclusions: Pre-stenting before SWL treatment of moderate sized renal pelvic stones has some advantages in terms of success, emergency service visits, and analgesic tablet consumption

Effect of JJ stent on outcomes of extracorporeal shock wave lithotripsy treatment of moderate sized renal pelvic stones: A randomized prospective study. / Resultados de LEOCH con o sin catéter para el tratamiento de cálculos en la pelvis renal: un estudio aleatorizado.

PURPOSE: To evaluate the effect of JJ stents on SWL treatment of moderate (15-25mm) renal pelvic stones. MATERIALS AND METHODS: Between January 2016 and December 2017, a total of 152 adult patients who were planned to undergo SWL for a single radiopaque renal pelvic stone were included in the study. Patients with solitary kidney, congenital abnormality, skeletal tract abnormalities, previous urinary system surgery, hydronephrosis (grade 2 or more), untreated urinary tract infection, bleeding disorder, and suspected pregnancy were excluded. The remaining 114 patients were randomly divided into two groups; non-stented and stented. Twenty-two patients whose stone could not be fragmented despite 3 consecutive sessions were also excluded from the study. A total of 92 patients (54 non-stented and 38 stented) were included in the final analysis. RESULTS: There was no significant difference in terms of age, sex, body mass index, renal parancyhimal thickness, hydronephrosis, skin-to-stone distance, Hounsfield units, and stone size between the groups. Success was significantly higher in the stented group than in the non-stented group (71% vs. 39%, P=.002). In stone-free patients, the number of emergency department visits and analgesic tablet consumption was significantly lower in the stented group than in the non-stented group (P<.001 and P<.001, respectively). In non- stone-free patients, analgesic tablet consumption was significantly lower in the stented group than in the non-stented group (P=.004). CONCLUSIONS: Pre-stenting before SWL treatment of moderate sized renal pelvic stones has some advantages in terms of success, emergency service visits, and analgesic tablet consumption.