[Complications of minimally-invasive percutaneous nephrolithotomy].

OBJECTIVE: To evaluate the occurrence and management of complications following minimally invasive percutaneous nephrolithotomy (MPCNL). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

[Treating renal carcinoma with ablation or ablation combined with 125I seed implantation: a report of eleven cases].

BACKGROUND & OBJECTIVE: Recently, multi-needles radiofrequency ablation and brachyradiotherapy have been used to treat some solid tumors, such as liver cancer and prostate cancer. This study was to explore the feasibility and efficacy of radiofrequency ablation or ablation combined with 125I seed implantation on treating renal carcinoma. METHODS: From Jun. 2000 to Feb. 2004, 11 patients with a total of 13 renal carcinoma lesions were treated with ablation or ablation combined with (125)I seed implantation, including 6 cases of renal carcinoma of solitary kidney, 2 cases of renal carcinoma combined with contralateral renal atrophy resulted from ureteric stone, 1 case of bilateral tumor, and 2 cases with general conditions contraindicated to surgery. Of the 13 lesions, 1 was resected by open operation, 6 were treated with multi-needles radiofrequency ablation, and 6 were treated with ablation and simultaneous (125)I seed implantation around tumor margin. RESULTS: The patients were followed-up for 6-46 months (mean 27 months). One patient died of cardiac muscle infarction 4 months after operation. Of the 10 alive patients, 2 with recurrent tumors 7 months and 13 months after operation were treated with ablation again, 1 with postoperative uremia was treated with intermittent peritoneal dialysis, the rest 7 had normal renal function. CONCLUSION: Multi-needles radiofrequency ablation or ablation combined with (125)I seed implantation would be an option in the treatment for patients with renal carcinoma of solitary kidney or bilateral kidney lesions, or for patients can't suffer from surgery.

[Effects of ureteral stents on rabbit upper urinary tract urodynamics].

OBJECTIVE: To explore the effects of ureteral stent placement on ureteral peristalsis and the time course of renal pelvic pressure changes. METHOD: Forty rabbits were randomized equally into 8 groups, including a control group without placement of ureteral stents. The other 7 groups received ureteral stent placement, which were retained for 0, 1, 2, 3, 4, 7, and 12 weeks respectively. When the rabbits were bred for the specified time periods, ureteral peristalsis was observed and renal pelvic pressure measured. RESULT: The renal pelvic pressure was initially increased after the stent placement, but then followed by gradual decreases. Ureteral peristalsis was not observed after the stent placement. CONCLUSION: Ureteral stent is a factor for causing obstruction in normal ureter.

[Treatment of upper urinary calculi with the PCNL technique (Experience of 20 years)].

OBJECTIVE: To sum up experience of 20 years for treating upper urinary calculi with percutaneous nephrolithotomy (PCNL) at our institute and assess the safety, feasibility and superiority of the technique. METHODS: We retrospectively investigated 4,014 patients suffering from upper urinary calculi, who were treated with PCNL of 4,014 cases, traditional PCNL was performed in 358, two stage "mini perc" technique in 520 and minimally invasive PCNL in 3,136. RESULTS: The success rates were 90%, 95% and 98%, the stone free rates were 82%, 86% and 91%. Major complications rates were 5.3%, 1.2% and 0.5%, respectively,with single tract in 3,027 cases and multiple tracts in 987 cases. A total of 5,571 PCNLs were performed in 4,014 patients. CONCLUSION: By improvement and innovation of this technique, percutaneous nephrolithotomy can reach the high success rate and stone free rate, with less morbidity and wide clinical indications.

[Endoscopic management of bilateral ureteral obstruction after radiotherapy].

BACKGROUND & OBJECTIVE: It is difficult to stent the obstructed ureters cystoscopically in patients with renal failure caused by radiotherapy for abdominal or pelvic tumors. Commonly draining the kidney with nephrostomy is the only method for the patients. However, external nephrostomy impacts on life quality of the patients. We reported our experience in stenting the obstructed ureters using minimally invasive percutaneous nephrostomy combined with ureteroscopy, and investigated viability of endoscopic treatment for bilateral ureteral strictures following radiotherapy. METHODS: Indwelling double pigtail stents in ureter by minimally invasive percutaneous nephrostomy combined with ureteroscopy was carried out in 19 patients with bilateral ureteral strictures following radiotherapy. The clinical outcomes including ureteral drainage and renal function were reviewed. RESULTS: Bilateral retrograde placement of double pigtail stent was performed in 2 cases. Indwelling different size double pigtail stents in unilateral ureters were carried out in 17 cases. The patients were followed-up for 1-24 months. Renal function was improved excellently in 17 cases, with serum creatinine level of 45 micromol/L to 113 micromol/L. Two patients had poor renal function improvement after ureteral stenting and were converted to percutaneous nephrostomy for draining the kidney. CONCLUSION: Indwelling different size double pigtail stents simultaneously in unilateral ureter by minimally invasive percutaneous nephrostomy is safe, simple, and effective in treating bilateral ureteral obstruction following radiotherapy.