Comparison of the results of pediatric percutaneous nephrolithotomy with different sized instruments.

We aim to compare the outcomes, including the morbidity and success rates in children undergoing percutaneous nephrolithotomy (PCNL) using different sized devices. According to the size of instruments used during surgery, three different groups (ultra-mini-PCNL, mini-PCNL and adult size PCNL) were composed and the outcomes were compared between the groups. PCNL was applied to 225 renal units of 220 children, including 5 patients with bilateral kidney stones. Percutaneous nephrolithotomy was performed using adult instruments (24 F) in 82 renal units, using pediatric instruments (18 F) in 89 and using minimal-size instruments (9.5 F) in 50. One-hundred and twenty-four girls and 96 boys with a mean age of 8.33 (<17) years were assessed. Stone-free rates were 78 % in group 1 (n = 39) using 9.5 F nephroscope, 75.8 % in group 2 (n = 69) using 18 F nephroscope and 71.4 % in group 3 (n = 60) using 24 F nephroscope. Time to access the collecting system, operative time, duration of nephrostomy and average postoperative hospital stay did not differ between the groups. However, mean hematocrit drop and stone burden were significantly lesser in ultra-mini-PCNL group. There was no significant difference in the complication rates between the groups, according to the modified Clavien classification system. As the important complication of PCNL, bleeding seems to be associated with diameter of dilatation, calibre of nephroscopes and stone burden. To reduce the certain complications, pediatric type of instruments is suitable but the use of adult instruments and techniques may achieve equal results.

A case of micro-percutaneous nephrolithotomy with macro complication.

Percutaneous nephrolithotomy is accepted as the standard management approach for kidney stones that are either refractory to extracorporeal shock wave lithotripsy or are >2 cm in diameter. The recently developed micro-percutaneous nephrolithotomy (microperc) technique provides intrarenal access under full vision using an optic instrument with a smaller calibration. A lesser amount of bleeding has been reported with the use of this method. Here we present a case of a bleeding complication on postoperative day 15 after a microperc procedure used to treat a left kidney stone. The complication led to retention of bloody urine in the bladder and required transfusion of 5 units of whole blood.

Urinary expression of acute kidney injury biomarkers in patients after RIRS: it is a prospective, controlled study.

OBJECTIVE: To evaluated the damage effects of retrograde intra-renal surgery (RIRS) on kidney tissue by measuring kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-ß-D-glucosaminidase (NAG), liver-type fatty acid binding protein (LFABP) expression. MATERIAL AND METHODS: We enrolled thirty consecutive patients (Group 1) who underwent RIRS that presented with renal calculi size < 2 cm. Forty-seven control patients (Group 2) with no signs or symptoms of urogenital disease were also enrolled for this study. Patients urine KIM-1, NGAL, NAG, and LFABP and creatinine levels were determined before the surgery, 2 hours after the surgery, and 24 hours after the surgery. RESULTS: Demographic data were established and found to be similar between the two groups. Two hours after the surgery KIM-1/Cr and NGAL/Cr levels had increased significantly in urine compared to levels before the surgery (P:0.04, P:0.02 respectively) and decreased 24 hours after the surgery. The NAG/Cr and LFABP/Cr levels did not change significantly after the surgery. CONCLUSION: According to acute kidney injury (AKI) markers, this study is suggests that RIRS is a safe method , KIM-1/Cr and NGAL/Cr levels were increased first 2 hours but returned to initial levels within 24 hours after the surgery.

Which treatment method should be used in pregnant patients with ureteral calculi? Two center comparative study.

OBJECTIVES: We aimed to compare ureterolithotripsy and inserting only ureteral-j stent in terms of efficiency, safety and patient comfort in treatment of ureteral calculi in pregnant patients. METHODS: Seventy patients who developed hydronephrosis due to ureteral calculi during pregnancy, and on whom endoscopic intervention was performed were included in the study. In a center, the stones were broken up by ureteroscopy, and then ureteral stents (JJ) were placed if needed. In the other center, nothing was performed on the stones, and only ureteral stents (JJ) was placed. For the statistical analysis, Pearson's chi squared test and the Mann-Whitney U tests were used and the significance level was determined as p < 0.05. RESULTS: The average age of the patients was 26.2 years (18-39) and the average gestational week was 23.4 weeks (8-36). While no significant difference was found between the two groups in terms of the frequency of complications (p=0.381) and post-operative pyelonephritis (p=0.2), the need for additional intervention in the group on whom ureteroscopy was performed was found to be less (9.7% vs. 31%; p=0.032). Moderate or severe LUTS or flank pain during the period between the procedure and the birth was found to be significantly less in the group in which ureterolithotripsy was performed (14% vs. 55%; p=0.036). CONCLUSIONS: Ureterolithotripsy is a safe and more comfortable procedure than only ureteral double-j insertion on pregnant patients with ureterolithiasis.

Ultra-mini-percutaneous nephrolithotomy in pediatric nephrolithiasis: both low pressure and high efficiency.

INTRODUCTION: The management of urolithiasis in children differs from adults because of anatomic and metabolic abnormalities. At present, various minimally invasive and invasive treatment strategies have been recommended to treat urinary tract Stones, including shock wave lithotripsy (SWL), standard percutaneous nephrolithotomy (PNL), mini-PNL, retrograde intrarenal surgery (RIRS), micro-PNL, and a new technique termed ultra-mini PNL (UMP). UMP is a new method for the treatment of kidney stones. The main difference between UMP and standard PNL or mini-PNL lies in the small access sheath and in its design. A 9.5F pediatric compact cystoscope was used (Figure). A major advantage of UMP is that it provides similar stone-free rates when compared with standard PNL, with lower intrarenal pressure than micro-PNL. OBJECTIVE: The aim of the study was to determine the applicability and safety of UMP in the treatment of pediatric kidney stones. PATIENTS AND METHODS: We retrospectively reviewed the files of 39 kidney stones in children who had undergone UMP between May 2011 and October 2014. The indications for UMP included stones resistant to SWL, stones requiring repeated sessions of SWL, and stones size larger than 20 mm. RESULTS: The study included 17 females and 22 males, with a mean age of 5.8 ± 4.6 years. The mean hemoglobin loss was 0.9 ± 0.6 mg/dL and none of the patients required a blood transfusion. The complication rate of the PNL procedure was 15.3% (n = 6). Complete clearance was achieved in 32 patients (82%) with UMP monotherapy, which increased to 34% (87.1%) 4 weeks after the operation. DISCUSSION: Management of urolithiasis necessitates a balance between stone clearance and morbidity related to the procedure. SWL often leads to persistent residual stones. The developing RIRS can minimize the risks associated with bleeding and visceral injury, but sometimes the abnormal pelvicaliceal anatomy and poor imaging of the flexible ureteroscopy may impact its success rate and applications. It has been reported that PNL can be performed safely and effectively to achieve a higher stone-free rate; however, it has serious complications such as bleeding that requires blood transfusion in 11-14% of the cases with increased risk of kidney loss. The recent development of smaller sheaths allows tract formation with minimal damage to the renal parenchyma, thereby reducing procedure-related morbidity without diminishing its therapeutic efficacy. CONCLUSION: The most important advantage of this surgical technique that has been developed is similar stone-free rates to standard PNL and lower intrarenal pressure than micro-PNL. Our experience supports that UMP is safe and effective for the management of renal stones in children.

Which treatment method should be used in pregnant patients with ureteral calculi? Two center comparative study / ¿Qué tratamiento debemos utilizar en embarazadas con cálculos ureterales? Estudio en dos centros

OBJECTIVES: We aimed to compare ureterolithotripsy and inserting only ureteral-j stent in terms of efficiency, safety and patient comfort in treatment of ureteral calculi in pregnant patients. Methocs: Seventy patients who developed hydronephrosis due to ureteral calculi during pregnancy, and on whom endoscopic intervention was performed were included in the study. In a center, the stones were broken up by ureteroscopy, and then ureteral stents (JJ) were placed if needed. In the other center, nothing was performed on the stones, and only ureteral stents (JJ) was placed. For the statistical analysis, Pearson's chisquared test and the Mann-Whitney U tests were used and the significance level was determined as p < 0.05. RESULTS: The average age of the patients was 26.2 years (18-39) and the average gestational week was 23.4 weeks (8-36). While no significant difference was found between the two groups in terms of the frequency of complications (p = 0.381) and post-operative pyelonephritis (p = 0.2), the need for additional intervention in the group on whom ureteroscopy was performed was found to be less (9.7% vs. 31%; p = 0.032). Moderate or severe LUTS or flank pain during the period between the procedure and the birth was found to be significantly less in the group in which ureterolithotripsy was performed (14% vs. 55%; p = 0.036). CONCLUSIONS: Ureterolithotripsy is a safe and more comfortable procedure than only ureteral double-j insertion on pregnant patients with ureterolithiasis

OBJETIVOS: El objetivo del estudio es comparar la ureteroscopia con litotricia in situ y la inserción aislada de catéter doble J en el tratamiento de la litiasis ureteral en pacientes embarazadas, en términos de eficiencia, seguridad y confort del paciente. MÉTODOS: Se incluyeron en el estudio 70 pacientes que desarrollaron hidronefrosis por cálculos ureterales durante el embarazo, en las que se realizó una intervención endoscópica. En un centro las piedras fueron rotas por ureteroscopia con inserción posterior de stents ureterales si era necesario. En el otro centro, no se hacía nada sobre la litiasis y sólo se colocaban Catéteres doble J. El análisis estadístico se realizó mediante los tests de Chi cuadrado de Pearson y U de Mann-Whitney con un nivel de significación estadística determinado como p < 0,05. RESULTADOS: La edad media de las pacientes era 26,2 años (18-39) y la media de semanas de gestación 23,4 (8-36). Aunque no se encontraron diferencias significativas entre los dos grupos en cuanto a la frecuencia de complicaciones (p = 0,381) y pielonefritis postoperatoria (p = 0,2), la necesidad de intervenciones adicionales fue menor en el grupo en el que se realizó ureteroscopia (9,7 vs. 31%; p = 0,032). Se vio que la presencia de síntomas del tracto urinario inferior moderados o severos, o dolor lumbar, durante el periodo entre el procedimiento y el parto fue significativamente menor en el grupo de ureteroscopia (14% vs 55%; p = 0,036). CONCLUSIONES: En pacientes embarazadas con litiasis ureteral la ureteroscopia con litotricia in situ es un procedimiento seguro y más confortable que la colocación de un doble J sólo