Totally ultrasound versus fluoroscopically guided complete supine percutaneous nephrolithotripsy: a first report.

PURPOSE: As endourologists are highly exposed to X-ray irradiation during endourologic surgeries, the use of alternative methods for entrance into the collective system and dilatation of tract could be safe and less expensive. MATERIALS AND METHODS: Percutaneous access was created under ultrasonographic guidance in the complete supine position without flank elevation in 14 patients (group A) and under fluoroscopic guidance in the complete supine position without flank elevation in 14 patients (group B). We performed all steps of the complete supine percutaneous nephrolithotripsy (PCNL) with ultrasonographic guidance in group A. RESULTS: In group A, mean age of patients was 46.5 ± 15.54 years and in group B 45.21 ± 10.72 years. The mean stone burden was 51.07 and 41.92 mm in groups A and B, respectively (p = 0.54). Mean operative time in group A was 88.93 ± 33.29 minutes and in group B it was 79.29 ± 16.74 minutes (p = 0.34). Stone-free rate was 78.6% in group A and 71.4% in group B (p = 0.66). Hospital stay was 85.88 ± 17.25 and 80.20 ± 17.71 hours in groups A and B, respectively (p = 0.12). Transfusion was done in 1 (7.14%) patient in group A and in 3 (21.43%) patients in group B (p = 0.28). Fever was detected in 2 (14.28%) patients in group A and in 1 (7.14%) patient in group B (p = 0.54). In our study, there were no pleural effusion, postoperative hematoma, renal pelvis perforation, and visceral organ trauma in any groups. CONCLUSION: We showed that totally ultrasound-guided complete supine PCNL is safe and feasible even in reoperative patients. It has certain advantages such as elimination of X-ray exposure to the surgeon and staff of the operating room, avoidance of contrast material administration, identification of all the tissue between the skin and kidney, and the energy expenditure of the surgeon and other staff of the operating room is decreased as it is not necessary to wear a lead shield.

One-shot versus metal telescopic dilation technique for tract creation in percutaneous nephrolithotomy: comparison of safety and efficacy.

PURPOSE: The aim of this study was to assess the feasibility and morbidity of single-step acute dilation, named "one-shot" technique, including a single dilation of the nephrostomy tract with a 28F or 30F Amplatz dilator compared with metal telescopic dilation technique. PATIENTS AND METHODS: Two hundred fourteen patients who underwent percutaneous nephrolithotomy (PNL) for stone disease from September 2005 to October 2007 were included in the study, and they were randomly divided into two groups according to the type of tract dilation technique: in group 1 (112 patients), Alken telescopic dilators were used; in group 2 (102 patients), one-shot technique was used. Access tract dilation time, X-ray exposure time, success rate, and blood loss and other complications were evaluated. RESULTS: One-shot technique was compared using Alken telescopic dilators without an increase in morbidity and with significant reduction in X-ray exposure (p = 0.003). There was no significant difference in the procedural success rate between groups 1 and 2 (100% v 96.07%, respectively) (p = 0.765). There was no any significant difference in complications. Access time was similar in both groups (p = 0.14). CONCLUSION: One-shot dilation was proved to be safe and effective like metal telescopic dilation even in patients with a history of ipsilateral open renal surgery. In this procedure, X-ray exposure is lower.

Tubeless percutaneous nephrolithotomy for staghorn stones.

PURPOSE: To assess the outcome and safety of tubeless percutaneous nephrolithotomy (PCNL) to treat patients with staghorn stones. PATIENTS AND METHODS: Between March 2006 and March 2007, 75 patients underwent 82 PCNLs at our hospital. Of that total, 42 procedures were done without a nephrostomy tube (tubeless group) and 40 procedures were done with insertion of a nephrostomy tube at the end of the procedure (standard group). RESULTS: The mean age was 41.55 +/- 15.15 years and 50.29 +/- 9.42 years in the tubeless group and the standard group, respectively. Seven patients had bilateral stones. None of our patients had organ trauma or any other significant complication. The average operative time was shorter in the tubeless group than in the standard group (93.76 v 109.98 minutes, respectively; P = 0.03). The mean analgesic doses given postoperatively were 79.17 +/- 62.2 and 93.75 +/- 40.7 mg of meperidine in the tubeless group and the standard group, respectively, with no statistically significant difference. The mean postoperative hospital stay was 1.7 +/- 0.6 days in the tubeless group and 4 +/- 1.6 days in the standard group (P < 0.0001). The stone-free rate was 37 units (88.09%) and 35 units (87.5%) units in the tubeless and standard groups, respectively. CONCLUSIONS: Complications, operative time, and the length of hospitalization in selected patients undergoing tubeless PCNL were all lower than those seen in the standard group. Tubeless PCNL was thus found to be safe and effective, even in patients with staghorn stones.