RESUMO
Staghorn calculi are branched stones which occupy a majority portion of the pelvicaliceal system. An untreated staghorn calculus over time can damage the kidney and deteriorate its function and/or cause life threatening sepsis. Total stone clearance is an important goal in order to eradicate any infective focus, relieve obstruction, prevent recurrence and preserve the kidney function. Percutaneous nephrolithotomy (PCNL) is currently the accepted first-line treatment option for staghorn calculi. The options available are single-tract PCNL with an auxiliary procedure like shockwave lithotripsy, single-tract PCNL with flexible nephroscopy, or multitract PCNL. Each has its own pros and cons. But the ultimate goal of treatment for any patient with staghorn calculi should be safety, cost-effectiveness, and to achieve total stone clearance. With this article, we review the management of staghorn calculi with multiple percutaneous ("multitract") access, its advantages and disadvantages and its current position by studying the various published materials across the globe.
RESUMO
OBJECTIVE: To describe our experience and results of using the MicroPerc™ micropercutaneous nephrolithotomy armamentarium (PolyDiagnost, Germany) for unusual indications unexplored using this modality. PATIENTS AND METHODS: We used the MicroPerc™ system for stone clearance in three ureteric calculi, two bladder calculi, one case of urethral calculus, for antegrade biopsy in a case of upper tract urothelial carcinoma, for Deflux® (dextranomer/hyaluronic copolymer, Salix Pharmaceuticals, Uppsala, Sweden) injection in three cases of vesico-ureteric reflux (VUR), and three cases of posterior urethral valve (PUV) fulgurations. A 4.85-F 'All-Seeing Needle®' (PolyDiagnost) was used in most of the cases. An 8-F mini-micro sheath was used where stability was deemed necessary. Clinical data were collected in a dedicated database. Intraoperative variables, postoperative complications, and outcomes were assessed. RESULTS: All patients were successfully treated with complete stone clearance at 1 month with no residual fragments. The antegrade biopsy confirmed a high-grade papillary neoplasm. There were no technical difficulties with injection of Deflux or PUV fulgurations. Follow-up at 1 year revealed no stone recurrence, resolved reflux in all three cases, and all the children that had had PUVs were voiding well. The small sample and retrospective nature of the analysis are the limitations of this study. CONCLUSION: MicroPerc™, besides its usual use for minimally invasive percutaneous nephrolithotomy, can also be feasibly used for ureteric, bladder and urethral stones, and for treating non-calculus diseases such as PUVs and VUR. True to its name, it may be an 'All-Seeing Needle' in reality with much more to offer and harvest from.
RESUMO
Transitional-cell carcinoma (TCC) of the upper tract in a case of circumcaval ureter (CCU) is a rare entity. Laparoscopic transperitoneal nephroureterectomy in such case represents a unique challenge in the era of minimally invasive surgery. We report a case of complete transperitoneal laparoscopic nephroureterectomy with bladder cuff excision done for TCC in a case of CCU. This case report describes the first point of technique of the procedure done for this rare entity. A 38-year-old male patient underwent the procedure for high-grade TCC of right lower calix. The essential tenets of the procedure included performance of the technique in a manner contrary to the conventional nephroureterectomy. The case report describes the procedure in the following steps: management of lower ureter and bladder cuff followed upper tract procedure after transposition of bladder cuff posterior to inferior vena cava. The procedure was accomplished utilizing four ports and a 6 cm Pfannenstiel incision with operative time of 220 minutes and blood loss of 50 mL.
