[Puncture access with a new atraumatic needle MG for mini-percutaneous nephrolithotomy].

INTRODUCTION: An important aspect of the prevention of complications in percutaneous nephrolithotomy (PCNL) is to reduce the likelihood of injury to the adjacent structures and perirenal tissues. AIM: To determine the efficiency and safety of renal puncture during mini-PCNL with a new atraumatic needle MG. MATERIALS AND METHODS: A total of 67 patients who underwent mini-percutaneous nephrolithotomy at the Institute of Urology and Human Reproductive Health of Sechenov University were included in the prospective study. For the purpose of homogeneity of the groups, those with staghorn nephrolithiasis, nephrostomy, a history of prior kidney surgery (including PCNL), renal and collecting system anomalies, acute pyelonephritis, and blood clotting disorders were not included. The main group consisted of 34 (50.7%) patients who underwent atraumatic kidney puncture with a new needle MG (MIT, Russia), while in the control group there were 33 (49.3%) patients, who underwent standard puncture with Chiba or Troakar needles (Coloplast A/S, Denmark). The outer diameter of all needles was 18 G. RESULTS: In patients with a standard access, a hemoglobin decrease in the early postoperative period was more pronounced (p=0.024). The incidence of complications according to the Clavien-Dindo classification did not differ significantly (p=0.351), however, a JJ stent was placed in two patients from the control group due to impaired urine flow and the development of urinoma. CONCLUSION: Together with a similar stone-free rate, atraumatic needle allows to reduce a hemoglobin drop, as well as less development of severe complications.

[Calico-venous fistulae: an intrarenal complication of percutaneous nephrolithotomy].

Bleeding is a serious complication of percutaneous nephrolithotomy (PCNL). A rare cause of gross hematuria is a calico-venous fistula. A clinical case of successful intraoperative diagnosis and treatment of calico-venous fistula during PCNL is presented in the article. Description of a clinical case. A patient J., 53 years old, underwent examination and treatment at the Institute of Urology and Reproductive Health, FGAOU VO I.M. Sechenov First Moscow State Medical University with a diagnosis of staghorn stone of the right kidney, a stone of the left kidney, chronic right-side pyelonephritis. On June 15, 2021, mini-PCNL was performed for the staghorn stone of the right kidney. The procedure seemed to be unremarkable, but during intraoperative antegrade pyelography, the inflow of contrast agent from the lower calyxes into the posterior segmental vein of the right kidney was detected, which was managed by creating sufficient traction of the nephrostomy drainage. Communication of the collecting and venous systems of the kidney is associated with a risk of both severe gross hematuria and urine flow into the venous bed. The urine flow into the bloodstream may result in hemodynamic disturbances, up to collapse followed by cardiac arrest. In order to prevent complications of PCNL it is necessary to analyze the kidney anatomy based on three-dimensional modeling of contrast- enhanced computed tomography. A calicovenous fistula can be a source of risk of bleeding and severe complications. To minimize intraoperative damage to parenchymal structures, an analysis of three-dimensional modeling of a kidney in patients with staghorn calculus based on computed tomography is required, which allows rational planning of surgical tactics.

[A novel atraumatic puncture needle MG. Results of a comparative morphological study].

INTRODUCTION: Despite the low invasiveness of percutaneous nephrolithotripsy, this surgery is not without complications. One of the most important stages of the operation, on which depends not only the success of the patient completely getting rid of calculus, but the likelihood of complications, is the puncture of the pelvic-pelvic system. PURPOSE: Determination of the effectiveness and security of the new less-traumatic puncture needle MG under experimental conditions. MATERIALS AND METHODS: A series of pork kidney punctures with a new less-traumatic needle MG and standard Chiba and Troakar needles (Coloplast A/S, Denmark) were performed under experimental conditions, followed by a comparative morphological assessment. The staining of the slides was performed with hematoxylin and eosin. For the purpose of additional assessment of the structures of the kidney punctured with a low-traumatic MG needle, a morphological assessment of the parenchyma stained with picrofuchsin according to Van Gieson was performed. RESULTS: On parenchymal slides with punctures with Chiba and Trocar needles, the passage places with multiple large fragments of desquamated (damaged) epithelium are visualized. On preparations of the parenchyma punctured with a less-traumatic needle MG, the place of passage of the needle is presented with clear contours. The damaged epithelium in the lumen of the formed defect is practically absent. With additional staining according to Van Gieson (magnification x200), the integrity of the full-blooded vessel adjacent to the limited focus of the needle MG was visualized. Output. The new less-traumatic puncture needle MG is an innovative development in urology. The design of the needle with an atraumatic mandrel-bulb atraumatic mandrel-bulb on a spring basis made it possible to significantly reduce the trauma to the structures of the kidney and perirenal tissues due to the bougienage effect.