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Fahmy A, Mahfouz W, Elbadry M, Moussa A. Single step track dilatation for percutaneous nephrolithotomy in children. Int Urol Nephrol 2022; 54:2789-2795. [PMID: 35941301 PMCID: PMC9534808 DOI: 10.1007/s11255-022-03314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022]
Abstract
Introduction and objectives Data on the use of single step dilatation technique during pediatric percutaneous nephrolithotomy (PCNL) in the literature is sparse. In this prospective randomized study, we aimed to compare the safety, efficacy, and perioperative complications of single step versus serial tract dilatation using Alken metal telescopic dilators during pediatric PCNL. Methods Patients undergoing PCNL were randomized into two groups according to the dilatation technique used. In group A, Alken telescopic serial metal dilatation was utilized, and in group B, single step dilatation was performed. Inclusion criteria included children < 18 years with stone burden from 2 to 4 cm, located in the renal pelvis ± one calyx, who were candidates for PCNL. The primary outcomes were access time and complications’ rate. The secondary outcomes were dilatation fluoroscopy time, operative duration, stone free rate, postoperative hospital stay, hemoglobin deficit, and need for blood transfusion. Both outcomes were evaluated and compared between both treatment groups. Results A total of 70 patients were randomized into group A (35 patients) and group B (35 patients). Access was successfully obtained in all procedures. All the procedures were performed through a single tract. Access time and dilatation fluoroscopy time were shorter in group B (statistically significant). Patients in group A had higher rate of complications (statistically significant). Intraoperative bleeding requiring blood transfusion was less in single track dilatation than serial metal track dilatation. Conclusions Compared to serial metal track dilatation, single step dilatation showed comparable operative time and stone free rate, with significantly reduced access time and dilatation fluoroscopy time.
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Affiliation(s)
- Ahmed Fahmy
- Urology Department, Alexandria University, Alexandria, Egypt
| | - Wally Mahfouz
- Urology Department, Alexandria University, Alexandria, Egypt
| | | | - Ahmed Moussa
- Urology Department, Alexandria University, Alexandria, Egypt
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Ketsuwan C, Pimpanit N, Phengsalae Y, Leenanupunth C, Kongchareonsombat W, Sangkum P. Peri-Operative Factors Affecting Blood Transfusion Requirements During PCNL: A Retrospective Non-Randomized Study. Res Rep Urol 2020; 12:279-285. [PMID: 32802804 PMCID: PMC7383108 DOI: 10.2147/rru.s261888] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/13/2020] [Indexed: 11/23/2022] Open
Abstract
Background Percutaneous nephrolithotomy (PCNL) is accepted as the gold standard of care for the treatment of large renal calculi. Kidney hemorrhage, which requires blood transfusion, is one of the most common complications after percutaneous kidney stone surgery. Objective To evaluate perioperative factors associated with transfusion requirements during PCNL. Materials and Methods A total of 226 patients with kidney calculi undergoing PCNL between January 2011 and December 2019 were reviewed retrospectively. We analyzed the impact of perioperative clinical factors on the necessity of blood transfusion during PCNL. Results The overall blood transfusion rate was 9.29%. Multiple perioperative determinants were significantly correlated with the application of packed red blood cells (PRCs), including larger stone size (p = 0.006), multiple tract punctures (p = 0.029), presence of staghorn calculi (p = 0.026), and long operative time (OT; p = 0.017). Multivariate analysis demonstrated that only multiple tract punctures independently affected blood transfusion requirements during PCNL (p = 0.038). Conclusion In accordance with the present study, only the multiple tract punctures were associated with blood transfusion requirements in PCNL.
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Affiliation(s)
- Chinnakhet Ketsuwan
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Narutsama Pimpanit
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yada Phengsalae
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Charoen Leenanupunth
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wisoot Kongchareonsombat
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Premsant Sangkum
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Peng PX, Lai SC, Seery S, He YH, Zhao H, Wang XM, Zhang G. Balloon versus Amplatz for tract dilation in fluoroscopically guided percutaneous nephrolithotomy: a systematic review and meta-analysis. BMJ Open 2020; 10:e035943. [PMID: 32660949 PMCID: PMC7359382 DOI: 10.1136/bmjopen-2019-035943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To compare the safety and efficacy of balloon and Amplatz for tract dilation in fluoroscopically guided percutaneous nephrolithotomy (PCNL). METHOD EMBASE, PUBMED, MEDLINE and the Cochrane Central Register of Controlled Trials were searched for pertinent studies up until 30 October 2019. Pooled effects were calculated as ORs with 95% CIs or mean differences (MD) with 95% CIs. Endpoints included postoperative decrease in haemoglobin, transfusion rate, complication rate, successful dilation rate, stone-free rate, fluoroscopy time, access time, total operation time and length of postoperative hospitalisation (LPH). Bonferroni's correction was intercalated to reduce the likelihood of making a meta-analytical false positive. RESULTS One randomised controlled trial and five controlled clinical trials were included, which involved 1317 patients in total. We found a lower drop in postoperative haemoglobin for patients receiving balloon dilation compared with those in the Amplatz group (MD=-0.21, 95% CI -0.33 to 0.09, p=0.0005; Bonferroni correction a=0.005). Access time in the balloon group was also, on average, 2.61 min shorter than the Amplatz group (MD=-2.61, 95% CI -4.20 to 1.01, p=0.001; Bonferroni correction a=0.005). No significant differences were identified between the two dilation methods in terms of transfusion rate, complication rate, successful dilation rate, stone-free rate, fluoroscopy time, total operation time and LPH. CONCLUSION Balloon dilation is a safe and effective tract dilation technique for access creation during fluoroscopically guided PCNL. Both of methods have similar success rates although balloon dilation is associated with significantly less postoperative haemoglobin decline and shorter access time. Therefore, balloon dilation appears to be the superior tract dilation technique, but further confirmatory research is required to confirm these findings.
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Affiliation(s)
- Pan-Xin Peng
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
- School of Clinical Medicine, China-Japan Friendship Hospital, Peking University, Beijing, China
| | - Shi-Cong Lai
- Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking, Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Samuel Seery
- School of Humanities and Social Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu-Hui He
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
- School of Clinical Medicine, China-Japan Friendship Hospital, Peking University, Beijing, China
| | - Hang Zhao
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
- School of Clinical Medicine, China-Japan Friendship Hospital, Peking University, Beijing, China
| | - Xu-Ming Wang
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
- School of Clinical Medicine, China-Japan Friendship Hospital, Peking University, Beijing, China
| | - Guan Zhang
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
- School of Clinical Medicine, China-Japan Friendship Hospital, Peking University, Beijing, China
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Chiancone F, Meccariello C, Fedelini M, Giannella R, Fedelini P. Four dilation techniques in percutaneous nephrolithotomy: a single-institute comparative analysis. Minerva Urol Nephrol 2020; 73:253-259. [PMID: 32638574 DOI: 10.23736/s2724-6051.20.03836-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study was to compare four renal access techniques in percutaneous nephrolithotomy (PCNL). METHODS A total of 437 patients who underwent PCNL at our center from January 2015 to December 2019 were included in the analysis. Telescopic metallic coaxial dilation (TMD) was used in 146 patients, single step balloon dilation (BD) in 98 patients, one-shot dilation with 30F Amplatz (OS 30F) in 106 patients, and one-shot dilation with 16F Amplatz (OS 16F) in 87 patients. Primary endpoints were perioperative outcomes and complications of the procedures. RESULTS Similar baseline characteristics were observed in the four groups. Fluoroscopy time was significantly shorter in OS 30F and OS 16F groups (P<0.0001). The drop in hemoglobin level was not significantly different between TMD and BD groups, but it was significantly lower in OS 16F group versus the OS 30F group and lower in OS 30F group versus the BD Group (P<0.0001). Despite this, the rate of blood transfusion was similar across groups (P=0.837). Moreover, a smaller tract was associated with reduced postoperative morbidity including time to nephrostomy removal (P=0.001), hospital stay (P<0.0001), VAS scale (P<0.0001). There were no significant differences in postoperative complications (P=0.683), and Clavien-Dindo grade ≥3 complication rates (P=0.486) among the groups. Stone-free rates and number of auxiliary procedures required to achieve stone-free status were also similar among all groups (P=0.964 and 0.988, respectively). Multinomial logistic regression analysis showed that BMI (P=0.002), stone size (P=0.002) and previous PCNL (P=0.038) were predictive factors associated with the choice of OS 16 approach. CONCLUSIONS Different dilation methods are equally effective and safe to use in a PCNL procedure for kidney stone treatment, allowing similar stone free rates and risk of complications. The OS dilation techniques seem to allow a shorter X-ray exposure time, which might be beneficial for both patients and operators. The use of a 16 F dilator can reduce the postoperative morbidity. Risk of sepsis should be always kept in mind.
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Affiliation(s)
| | | | | | | | - Paolo Fedelini
- Department of Urology, A.O.R.N. Antonio Cardarelli, Naples, Italy
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Petrovsky B, Berent AC, Weisse CW, Branter E, Bagley DH, Lamb KE. Endoscopic nephrolithotomy for the removal of complicated nephroliths in dogs and cats: 16 kidneys in 12 patients (2005-2017). J Am Vet Med Assoc 2020; 255:352-365. [PMID: 31298636 DOI: 10.2460/javma.255.3.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe techniques and outcomes for dogs and cats undergoing endoscopic nephrolithotomy (ENL) for the removal of complicated nephroliths. ANIMALS 11 dogs and 1 cat (n = 16 renal units) with complicated nephroliths that underwent ENL via a surgically assisted ENL approach (12 renal units) or a percutaneous nephrolithotomy approach (4 renal units) between December 2005 and June 2017. PROCEDURES Data were obtained from the medical records regarding preoperative, operative, and postoperative findings. Follow-up information on complications and outcomes was also collected. RESULTS Indications for nephrolith removal included massive calculi displacing parenchyma (n = 7), recurrent urinary tract infections (5), and ureteral outflow obstruction (4). Median nephrolith diameter was 2.5 cm (range, 0.5 to 5.7 cm). Nephrolith composition differed among patients; calcium oxalate was the most common type (n = 7 [including 2 mixed nephroliths containing ≥ 60% calcium oxalate]). Following ENL (median duration, 180 minutes), 15 of 16 renal units were completely nephrolith free. Procedure-related complications included renal puncture-associated hemorrhage requiring a blood transfusion (n = 1), renal capsule tear (1), and ureteral puncture (1); all were managed without adverse consequence. Five of 12 patients remained alive at the final follow-up (median, 557 days after ENL), and none died from the procedure. CONCLUSIONS AND CLINICAL RELEVANCE ENL as performed was safe and effective in removing complicated nephroliths in a renal-sparing manner for the patients in this study. This procedure requires technical training and could be considered for the treatment of complicated nephrolithiasis in dogs and possibly cats.
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Wu Y, Xun Y, Lu Y, Hu H, Qin B, Wang S. Effectiveness and safety of four tract dilation methods of percutaneous nephrolithotomy: A meta-analysis. Exp Ther Med 2020; 19:2661-2671. [PMID: 32256747 PMCID: PMC7086190 DOI: 10.3892/etm.2020.8486] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/06/2020] [Indexed: 11/06/2022] Open
Abstract
Percutaneous nephrolithotomy (PCNL) has become a routine surgical procedure for treating patients with large kidney stones; the fundamental step in this process is the creation of the nephrostomy tract. In the present study, a meta-analysis was performed to compare the effectiveness and safety of different tract dilation techniques for PCNL. Databases were searched from inception to 1 April 2019 to identify relevant randomized controlled trials. The X-ray exposure time, hemoglobin decrease, stone-free rate, transfusion rate, hospital stay and the complication rate associated with the various techniques were analyzed. A total of 11 studies comprising 1,415 cases were enrolled in the meta-analysis. Significant differences in X-ray exposure time [weighted mean difference (WMD), 30.67; 95% confidence interval (CI), 20.08-41.26; P<0.001] and hemoglobin decrease (WMD, 0.19; 95%CI, 0.15-0.23; P<0.001) were identified between metal telescopic dilation (MTD) and one-shot dilation (OSD). A significantly lower hemoglobin decrease was observed in the balloon dilation (BD) vs. fascial Amplatz dilation (AD) group [WMD, -0.65; 95%CI, -(0.77-0.52); P<0.001]. The transfusion rate was similar between these techniques. The MTD had an obviously higher successful dilation rate compared with that of the OSD, but no significant differences in stone-free rate and transfusion rate were obtained. The present study determined that, compared with other methods, OSD was safer in almost every adult patient, including those that had previously undergone renal surgery; though it is recommended that this should be performed by experienced surgeons. BD was reported to be effective and safer in patients without a history of renal surgery compared to other methods. The present study proposed AD and MTD as safer methods of dilation for patients who have previously undergone kidney surgery.
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Affiliation(s)
- Yue Wu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Yang Xun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Yuchao Lu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Henglong Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Baolong Qin
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
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Can single-step dilatation technique in pediatric percutaneous nephrolithotomy be an effective alternative to stepwise dilatation? JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.606488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bansal A, Arora A. A double-blind, placebo-controlled randomized clinical trial to evaluate the efficacy of tranexamic acid in irrigant solution on blood loss during percutaneous nephrolithotomy: a pilot study from tertiary care center of North India. World J Urol 2016; 35:1233-1240. [PMID: 27995302 DOI: 10.1007/s00345-016-1980-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/29/2016] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of 0.1% tranexamic acid in irrigant fluid in reducing blood loss during PCNL. MATERIALS AND METHODS The study involved 400 patients who were planned for PCNL and were prospectively randomized into two equal groups. In tranexamic group, 0.1% tranexamic acid was given in irrigant fluid, while in placebo group, distilled water was added to irrigant fluid during surgery. Operative data were recorded which included fall in hemoglobin, total blood loss, operative time, irrigation fluid, length of stay in hospital, requirement of blood transfusion, complications related to PCNL and adverse events of tranexamic acid. RESULTS Baseline parameters were comparable between two groups. The fall in hemoglobin and total blood loss in the tranexamic group was significantly lower than placebo group (1.71 vs. 2.67 gm/dL, 154.55 vs. 212.61 mL, respectively, p < 0.0001). Operative time, amount of irrigation fluid used and hospital stay of tranexamic group were significantly less compared to placebo (p < 0.05). Complete stone clearance rate was 88% in tranexamic group versus 82% in placebo (p = 0.12). The blood transfusion requirement was significantly lower in the tranexamic group versus placebo (5 vs. 12.5%, p = 0.012), as was the complication rate (19 vs. 28%, p = 0.044). The requirement of angioembolization in the tranexamic group was significantly less as compared to placebo (0.5 vs. 4%, p = 0.03). No adverse events related to administration of tranexamic acid were noted. CONCLUSIONS 0.1% tranexamic acid in irrigant fluid is safe and significantly reduces perioperative blood loss and requirement of blood transfusion during percutaneous nephrolithotomy. It is associated with lower perioperative complication rates.
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Affiliation(s)
| | - Aditi Arora
- Janak Surgicare Centre, Patiala, Punjab, India
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Ultrasonography-guided percutaneous nephrolithotomy with Chinese one-shot tract dilation technique based on stimulated diuresis: A report of 67 cases. ACTA ACUST UNITED AC 2016; 36:881-886. [PMID: 27924508 DOI: 10.1007/s11596-016-1679-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/02/2016] [Indexed: 10/18/2022]
Abstract
The safety and effectiveness of a novel Chinese one-shot dilation technique based on stimulated diuresis for percutaneous nephrolithotomy (PCNL) were investigated. After the feasibility of the Chinese one-shot dilation based on stimulated diuresis was verified by an animal study, this technique was applied in the clinical practice. A total of 67 patients in our department underwent the modified PCNL from July 2014 to June 2015. After the renal infundibulum was distended by stimulated diuresis, the kidney was punctured under the ultrasonographic guidance via the fornix of the target calyx. The working channel was dilated using a special designed pencil-shaped fascial dilator. The successful access rate, nephrostomy tract creation time, pre- and postoperative hemoglobin values and serum creatinine concentrations, stone-free rate and complications were recorded and analyzed. The renal infundibulum was successfully distended in all of the patients by the diuresis treatment. Under the ultrasonographic guidance, the successful access rate was 100% and the mean tract creation time was 2.0 min (range: 1.5-5.0 min). The stone-free rate right after surgery was 91.0%. Although the postoperative hemoglobin was significantly reduced (P<0.01), transfusion was not clinically necessary. There was no significant difference in serum creatinine concentrations before and after operation (P>0.05). No severe complication occurred during or after the PCNL. It was suggested that this Chinese one-shot dilation technique based on stimulated diuresis is an efficient and safe innovation for PCNL, and is even helpful for those patients with non-dilated pelvicaliceal systems.
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Srivastava A, Singh S, Dhayal IR, Rai P. A prospective randomized study comparing the four tract dilation methods of percutaneous nephrolithotomy. World J Urol 2016; 35:803-807. [PMID: 27614706 DOI: 10.1007/s00345-016-1929-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/29/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Alok Srivastava
- Department of Urology and Renal Transplant, Dr.RMLIMS, Vibhuti Khand, Gomti Nagar, Lucknow, 226010, India.
| | - Sanjeet Singh
- Department of Urology and Renal Transplant, Dr.RMLIMS, Vibhuti Khand, Gomti Nagar, Lucknow, 226010, India
| | - Ishwar Ram Dhayal
- Department of Urology and Renal Transplant, Dr.RMLIMS, Vibhuti Khand, Gomti Nagar, Lucknow, 226010, India
| | - Priyanka Rai
- Department of Surgery, B.R.D. Medical College, Gorakhpur, India
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Nalbant I, Karakoyunlu AN, Yesil S, Ekici M, Zengin K, Ozturk U, Imamoğlu MA. Comparison of Dilation Methods in Percutaneous Nephrolithotomy: Which One Is More Successful? J Laparoendosc Adv Surg Tech A 2016; 26:478-82. [PMID: 27027932 DOI: 10.1089/lap.2015.0618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ismail Nalbant
- Clinics of Urology, Diskapi Training and Research Hospital, Ankara, Turkey
| | | | - Suleyman Yesil
- Clinics of Urology, Medical Faculty, Gazi University, Ankara, Turkey
| | - Musa Ekici
- Clinics of Urology, Medical Faculty, Hitit University, Corum, Turkey
| | - Kursad Zengin
- Clinics of Urology, Medical Faculty, Bozok University, Yozgat, Turkey
| | - Ufuk Ozturk
- Clinics of Urology, Diskapi Training and Research Hospital, Ankara, Turkey
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Sharma GR, Maheshwari PN, Sharma AG, Maheshwari RP, Heda RS, Maheshwari SP. Fluoroscopy guided percutaneous renal access in prone position. World J Clin Cases 2015; 3:245-264. [PMID: 25789297 PMCID: PMC4360496 DOI: 10.12998/wjcc.v3.i3.245] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 09/24/2014] [Accepted: 12/01/2014] [Indexed: 02/05/2023] Open
Abstract
Percutaneous nephrolithotomy is a very commonly done procedure for management of renal calculus disease. Establishing a good access is the first and probably the most crucial step of this procedure. A proper access is the gateway to success. However, this crucial step has the steepest learning curve for, in a fluoroscopy guided access, it involves visualizing a three dimensional anatomy on a two dimensional fluoroscopy screen. This review describes the anatomical basis of the renal access. It provides a literature review of all aspects of percutaneous renal access along with the advances that have taken place in this field over the years. The article describes a technique to determine the site of skin puncture, the angle and depth of puncture using a simple mathematical principle. It also reviews the common problems faced during the process of puncture and dilatation and describes the ways to overcome them. The aim of this article is to provide the reader a step by step guide for percutaneous renal access.
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Tsai YS, Jou YC, Shen CH, Lin CT, Chen PC, Cheng MC. Antegrade ureteroscopic assistance during percutaneous nephrolithotomy for complete renal staghorn stone: Technique and outcomes. UROLOGICAL SCIENCE 2015. [DOI: 10.1016/j.urols.2014.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Hartman C, Gupta N, Leavitt D, Hoenig D, Okeke Z, Smith A. Advances in percutaneous stone surgery. Asian J Urol 2015; 2:26-32. [PMID: 29264116 PMCID: PMC5730686 DOI: 10.1016/j.ajur.2015.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/11/2014] [Accepted: 08/18/2014] [Indexed: 11/21/2022] Open
Abstract
Treatment of large renal stones has changed considerably in recent years. The increasing prevalence of nephrolithiasis has mandated that urologists perform more surgeries for large renal calculi than before, and this has been met with improvements in percutaneous stone surgery. In this review paper, we examine recent developments in percutaneous stone surgery, including advances in diagnosis and preoperative planning, renal access, patient position, tract dilation, nephroscopes, lithotripsy, exit strategies, and post-operative antibiotic prophylaxis.
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Hartman C, Gupta N, Leavitt D, Hoenig D, Okeke Z, Smith A. WITHDRWAN: Advances in percutaneous stone surgery. Asian J Urol 2014. [DOI: 10.1016/j.ajur.2014.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Ordon M, Urbach D, Mamdani M, Saskin R, D'A Honey RJ, Pace KT. The surgical management of kidney stone disease: a population based time series analysis. J Urol 2014; 192:1450-6. [PMID: 24866599 DOI: 10.1016/j.juro.2014.05.095] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE We evaluate population based trends in the use of extracorporeal shock wave lithotripsy, ureteroscopy and percutaneous nephrolithotomy during the last 20 years, as well as assess the re-treatment rate and morbidity from treatment over time. MATERIALS AND METHODS Using administrative databases in the province of Ontario, Canada, a population based cross-sectional time series analysis was performed between July 1, 1991 and December 31, 2010. All extracorporeal shock wave lithotripsy, ureteroscopy and percutaneous nephrolithotomy procedures were identified, along with all hospital readmissions and emergency department visits within 7 days of treatment. The primary outcome was treatment use, and secondary outcomes were the need for ancillary treatment and hospital readmission or emergency department visit after treatment. Exponential smoothing and autoregressive integrated moving average (ARIMA) models were used to assess trends over time. RESULTS We identified 194,781 kidney stone treatments performed during the study period. Time series modeling revealed a significant increase in the use of ureteroscopy over time (25% to 59% of all procedures, p <0.0001) and a reciprocal decrease in the use of extracorporeal shock wave lithotripsy (69% to 34% of all procedures, p <0.0001). A corresponding significant decrease in the need for ancillary treatment over time (23% to 15%, p <0.0001) and increase in the need for hospital readmission (7% to 11%, p <0.0001) or emergency department visit (7% to 11%, p=0.0024) after treatment were also demonstrated. CONCLUSIONS Our population based study demonstrates a shift in the treatment paradigm with increased use of ureteroscopy over time and a reciprocal decrease in the use of extracorporeal shock wave lithotripsy. We also observed a corresponding decrease in ancillary treatment and increase in posttreatment morbidity over time.
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Affiliation(s)
- Michael Ordon
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - David Urbach
- Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Muhammad Mamdani
- Applied Health and Research Department, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Refik Saskin
- Programming & Biostatistics, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
| | - R John D'A Honey
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth T Pace
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Özçift B, Bal K, Dinçel Ç. A comparison of balloon and amplatz dilators in percutaneous nephrolithotomy: a retrospective evaluation. Turk J Urol 2013; 39:226-31. [PMID: 26328115 DOI: 10.5152/tud.2013.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 05/17/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In this study, we compared our experience using balloon and amplatz dilatation in percutaneous nephrolithotomy (PCNL). We also evaluated peri- and postoperative variables, including success rates. MATERIAL AND METHODS Two hundred renal stone patients (123 men/77 women) underwent PCNL at the Urology Clinic of İzmir Atatürk Training and Research Hospital from September 2005 to May 2011. The nephrostomy tract was dilated using a balloon (128 patients) or amplatz (72 patients) dilator. The groups were compared by age, total operating time, treatment success rate, retreatment rate, pre- and postoperative hematocrit values, mean decrease in hematocrit values, blood transfusion rate, stone burden, tract dilatation failure, hospital stay and nephrostomy removal times, stone localization, previous stone operation and the cost of the dilatation system. RESULTS There was no statistically significant difference in the operative time (97.9±45.3 minutes in balloon group vs. 98.5±43.4 minutes in the amplatz group; p=0.43), preoperative hematocrit value (39.04±4.21 vs. 38.94±4.49; p=0.87), postoperative hematocrit value (32.74±4.86 vs. 32.48±5.43; p=0.73), decrease in hematocrit values (6.30±2.60 vs. 6.45±2.64; p=0.68), blood transfusion rate (15.6% vs. 16.7%; p=0.84) or treatment success rate (78.9% vs. 79.2%; p=0.96) between balloon and amplatz groups. Differences in other variables were also not observed between the two groups. CONCLUSION The balloon or amplatz dilatation methods have similar results with regard to efficacy, speed, and safety. However, the cost of the balloon dilator is higher than that of the amplatz dilator.
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Affiliation(s)
- Burak Özçift
- Department of Urology, Hakkari State Hospital, Hakkari, Turkey
| | - Kaan Bal
- Department of Urology, İzmir Atatürk Training and Research Hospital, İzmir, Turkey
| | - Çetin Dinçel
- Department of Urology, Faculty of Medicine, İzmir Katip Çelebi University, İzmir, Turkey
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Ramón de Fata F, Pérez D, Resel-Folkersma L, Galán J, Serrano A, Servera A, Arrabal M, Álvarez-Ossorio J, Ballestero R, Cao E, Arzoz M, Navarro P, Rigabert M, Sánchez-Zalabardo J, Lista F, Angulo J, Amón-Sesmero J. Analysis of the factors affecting blood loss in percutaneous nephrolithotomy: a registry of the Spanish Association of Urology in the supine position. Actas Urol Esp 2013; 37:527-32. [PMID: 23850392 DOI: 10.1016/j.acuro.2013.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 05/03/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Percutaneous nephrolithotomy (PCNL) is the minimally invasive procedure of choice for removing renal stones larger than 2 cm. This study has aimed to identify the different variables that might influence decrease of hemoglobin during the surgery performed in supine position. MATERIAL AND METHODS A prospective, multicenter, observational study of supine PCNL, based on the Spanish Association of Urology database, was analyzed. The different preoperative and postoperative factors that might affect the decrease of hemoglobin were assessed: demographics and anthropometric data, comorbidities, size and location of the stones, anatomical variants and technical aspects of the procedure. RESULTS From September 2008 to December 2012, 397 supine PCNL procedures performed in 15 Spanish centers were registered. Mean hemoglobin decrease was 2.3±1.5 g/dl and overall blood transfusion rate was 5.5%. No statistically significant differences were found between genders, body mass index (BMI) and age in terms of blood loss. There were also no differences between patients with cardiovascular, hypertensive, diabetic and anticoagulant treatment background. Blood loss was not significantly influenced by stone size and location. Technical aspects of the procedure as operative time (> 120 min ≤), access to the pelvi-caliceal system (ultrasound, fluoroscopy), percutaneous tract dilation technique (Alken, balloon or Amplatz) or placement of nephrostomy (tube versus tubeless) were not associated with differences in pre-op/post-op hemoglobin. Only multiple percutaneous tracts (≥2) and middle calix access were statistically significantly (P=.03 and P=.01) related with less blood loss. CONCLUSIONS PCNL in supine position is a minimally invasive procedure for removal of large (≥2 cm) and multiple renal stones, with a low incidence of blood loss and minimal transfusion rate. Multiple percutaneous tracts and middle calix puncture were the only statistically significant variables associated with decrease in hemoglobin levels.
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20
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Analysis of the factors affecting blood loss in percutaneous nephrolithotomy: A registry of the Spanish Association of Urology in the supine position. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.acuroe.2013.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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A comparison among four tract dilation methods of percutaneous nephrolithotomy: a systematic review and meta-analysis. Urolithiasis 2013; 41:523-30. [PMID: 23975408 DOI: 10.1007/s00240-013-0598-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 08/05/2013] [Indexed: 02/05/2023]
Abstract
The purpose of this study was to evaluate the efficacy and safety of the Amplatz dilation (AD), metal telescopic dilation (MTD), balloon dilation (BD), and one-shot dilation (OSD) methods for tract dilation during percutaneous nephrolithotomy (PCNL). Relevant eligible studies were identified using three electronic databases (Medline, EMBASE, and Cochrane CENTRAL). Database acquisition and quality evaluation were independently performed by two reviewers. Efficacy (stone-free rate, surgical duration, and tract dilatation fluoroscopy time) and safety (transfusion rate and hemoglobin decrease) were evaluated using Review Manager 5.2. Four randomized controlled trials and eight clinical controlled trials involving 6,820 patients met the inclusion criteria. The pooled result from a meta-analysis showed statistically significant differences in tract dilatation fluoroscopy time and hemoglobin decrease between the OSD and MTD groups, which showed comparable stone-free and transfusion rates. Significant differences in transfusion rate were found between the BD and MTD groups. Among patients without previous open renal surgery, those who underwent BD exhibited a lower blood transfusion rate and a shorter surgical duration compared with those who underwent AD. The OSD technique is safer and more efficient than the MTD technique for tract dilation during PCNL, particularly in patients with previous open renal surgery, resulting in a shorter tract dilatation fluoroscopy time and a lesser decrease in hemoglobin. The efficacy and safety of BD are better than AD in patients without previous open renal surgery. The OSD technique should be considered for most patients who undergo PCNL therapy.
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22
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Zeng G, Zhao Z, Zhong W, Wu K, Chen W, Wu W, Xiao C, Liu Y. Evaluation of a novel fascial dilator modified with scale marker in percutaneous nephrolithotomy for reducing the X-ray exposure: a randomized clinical study. J Endourol 2013; 27:1335-40. [PMID: 23527890 DOI: 10.1089/end.2012.0671] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate the role of the fascial dilators modified with a scale marker in reducing fluoroscopy time during percutaneous nephrolithotomy (PCNL). METHOD In a randomized clinical trial, eligible 100 consecutive patients anticipated to undergo single-tract PCNL were randomly assigned into two groups by the closed envelope method, to compare the efficacy and safety of the modified scale fascial dilator (group 1, n=50) and traditional nonscale fascial dilator (group 2, n=50) with respect to the X-ray exposure duration as well as the outcome of PCNL. RESULTS There was no significant difference between group 1 and group 2 regarding to the initial successful access rate (100% v 96%), operative time (79.4 v 83.7 minutes), the initial stone-free rate (82% v 81.3%), complications (24% v 20%), and bleeding required blood transfusion (4% v 6%) (all p>0.05). The mean operative duration and fluoroscopic time for tract dilation in group 1 and group 2 were 164.4 ± 19 seconds v 168.3 ± 14 seconds, and 3.2 ± 0.9 seconds v 22.2 ± 4.6 seconds, (p=0.250 and p<0.001), respectively. CONCLUSIONS Compared to the use of nonscaled dilators, using the scaled fascial dilators for a percutaneous access in PCNL was found to be associated with less radiation hazards along with similar stone-free rate and complications.
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Affiliation(s)
- Guohua Zeng
- 1 Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University , Guangzhou, China
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23
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Lee JK, Kim BS, Park YK. Predictive factors for bleeding during percutaneous nephrolithotomy. Korean J Urol 2013; 54:448-53. [PMID: 23878687 PMCID: PMC3715708 DOI: 10.4111/kju.2013.54.7.448] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 05/13/2013] [Indexed: 12/01/2022] Open
Abstract
Purpose Although percutaneous nephrolithotomy (PCNL) has been accepted as a standard method for the management of large renal stones, the incidence of renal hemorrhage is relatively high. This study investigated the variables that affect bleeding during PCNL. Materials and Methods The medical records of 370 patients who underwent PCNL by a single surgeon from January 2005 to December 2010 were reviewed retrospectively. All patients were divided into two groups according to median blood loss (lesser bleeding group and higher bleeding group). Various clinical and perioperative factors including age, sex, stone size and position, degree of hydronephrosis, operative time, underlying disease, history of anticoagulant medication, presence of previous nephrostomy catheter, stone composition, and thickness of the renal cortex were assessed. For statistical assessment, univariate and multivariate logistic regression analyses were used. Results The mean patient age was 48.8 years (range, 22 to 75 years). Forty-three patients (11.6%) received a transfusion and 9 patients (2.4%) underwent angioembolization after surgery. The mean blood loss was 511.8±341.3 mL. Body mass index (BMI), stone size, stone position, operation time, and degree of preoperative hydronephrosis were predictive factors for severe bleeding during PCNL. Conclusions On the basis of the results achieved by a single surgeon, staghorn stones, high BMI, large stones, prolonged operation time, and absence of hydronephrosis were significantly associated with the risk of severe bleeding during PCNL.
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Affiliation(s)
- Jeong Kuk Lee
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
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Shah AK, Xu K, Liu H, Lin T, Xie K, Huang H, Han J, Fan X, Chen J, Huang J. The "visual dilator system": initial experimental evaluation of an optical tract dilation technique in percutaneous nephrolithotomy. J Endourol 2013; 27:908-13. [PMID: 23461420 DOI: 10.1089/end.2012.0710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Ascertaining the optimal depth of dilator progression is a crucial factor during tract dilation in percutaneous nephrolithotomy. Dilation is generally guided under fluoroscopy, ultrasonography, or combination of both techniques, and it is still difficult to prevent overdilation causing perforation and vascular injury or underdilation causing difficulty in establishment of access. Thus, improvements in dilation technique bears clinical significance. Our aim was to evaluate the feasibility in an animal model of using the "visual dilator system" for optimal percutaneous tract dilation under real-time visual guidance. MATERIALS AND METHODS The visual dilator system consisted of a transparent hollow dilator made of polyvinyl chloride and a rigid ureteroscope inserted within its lumen. The ureteroscope was connected to a standard endoscopic camera system. The dilator system backloaded with an access sheath was passed over a guidewire to dilate the tract and position the access sheath under visual guidance. Saline was used as irrigation to maintain clarity during dilation. The dilation technique was implemented to establish percutaneous access tract in six PCNL simulator models made from fresh porcine kidney placed inside an eviscerated chicken carcass and four female swine (eight kidneys) to experimentally evaluate its feasibility and efficacy. RESULTS All tracts were successfully established with dilation through the intervening tissue layers, approach into the target calix, as well as access sheath placement being visually monitored through the dilator wall to confirm accuracy. All procedures were free of dilation-related complications such as collecting system perforation, excessive bleeding (in-vivo model), or loss of access. The limited number of animal models and lack of randomized comparative study with other dilator modalities were major drawbacks of the study. CONCLUSIONS The study demonstrates feasibility of percutaneous access tract dilation using a Visual dilator system. This technique can provide visual confirmation of accuracy in dilation to improve safety and efficacy of the procedure.
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Affiliation(s)
- Arvind K Shah
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Tepeler A, Binbay M, Akman T, Erbin A, Kezer C, Silay MS, Yuruk E, Kardas S, Akçay M, Armagan A, Muslumanoglu AY. Parenchymal thickness: does it have an impact on outcomes of percutaneous nephrolithotomy? Urol Int 2013; 90:405-10. [PMID: 23391606 DOI: 10.1159/000346336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 12/03/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate whether renal parenchymal thickness (RPT) has an effect on the outcomes of percutaneous nephrolithotomy (PNL). METHODS We performed a retrospective analysis of 144 patients with lower pole and/or renal pelvic stones who underwent PNL. The relationship between RPT and peri- and postoperative measures was evaluated. RESULTS The average age was 45.94 ± 14.47 (15-76) years. The mean BMI was calculated as 27.47 ± 4.73 (16.9-44.9) kg/m(2). The mean stone burden was 293 ± 126 (150-800 mm(2)). The mean RPT was measured as 17.33 ± 5.32 (6-35) mm. No correlation was detected between the RPT and the operation or fluoroscopy times or the duration of hospitalization (p = 0.63, 0.52, 0.08, respectively). The mean drop in hemoglobin level was 1.45 ± 1.25 (0-9) g/dl. A negative correlation was detected between hemoglobin drop and RPT (p = 0.01, r = -0.23). However, the RPT was similar in patients who did or did not require a blood transfusion (p = 0.09). The RPT was found to have no impact on success rate (p = 0.4). CONCLUSION The postoperative hemoglobin drop increases in parallel with the increase in RPT. However, no relationship was detected between the RPT and blood transfusion, overall success rate or any other perioperative parameters.
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Affiliation(s)
- Abdulkadir Tepeler
- Department of Urology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
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Abstract
Percutaneous nephrolithotomy (PCNL) is the most morbid of the minimally invasive surgeical procedures for stone removal. Over the last 2 decades, refinements in technique and new technology have improved the efficacy and the efficiency of the procedure. Although PCNL has long been the procedure of choice for large and complex stones, it is increasingly being used for moderate stone burdens because of its high stone-free rates and because of the limitations of shock wave lithotripsy and ureteroscopy. The article reviews advances in the technique and technology applied to percutaneous access, tract dilation, stone visualization, stone fragmentation, stone clearance, and postoperative management.
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27
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Philip J. Randomized and prospective trial comparing tract creation using plasma vaporization with balloon dilatation in percutaneous nephrolithotomy. BJU Int 2012; 112:3. [PMID: 23035848 DOI: 10.1111/j.1464-410x.2012.11520.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ozok HU, Sagnak L, Senturk AB, Karakoyunlu N, Topaloglu H, Ersoy H. A comparison of metal telescopic dilators and Amplatz dilators for nephrostomy tract dilation in percutaneous nephrolithotomy. J Endourol 2011; 26:630-4. [PMID: 21999400 DOI: 10.1089/end.2011.0291] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Nephrostomy tract dilation is one of the important steps in percutaneous renal surgery. We present our experiences with using Amplatz and metal telescopic dilators (Alken) to create a percutaneous tract and compare the advantages and risk factors of both procedures. PATIENTS AND METHODS We retrospectively reviewed the medical records of 173 patients who had undergone 188 percutaneous nephrolithotomy procedures between April 2007 and December 2010. The nephrostomy tracts had been created by using Amplatz (67 cases) or Alken dilators (121 cases). Total operative time, scope time, tract formation time, decrease in hemoglobin concentrations, blood transfusion rates, tract dilation failures, and the cost of both systems were compared between the groups. RESULTS There were no statistically significant differences in total operative time (103.3 ± 46.5 vs 99.1 ± 44.4 min, P=0.583), scope time (5.23 ± 3.06 vs 5.28 ± 2.52 min, P=0.732), decrease in hemoglobin concentration (-1.5 ± 1.2 vs-1.3 ± 1.1 mg/dL, P=0.230), blood transfusion rates (13.4% vs 11.6%, P=0.709), and tract dilation failure rates (6.0% vs 1.7%, P=0.107) for Amplatz and Alken dilation groups, respectively. A shorter tract formation time (6.56 ± 3.04 vs 5.42 ± 3.07 min, P<0.001) was observed in the Alken dilation group. The approximate costs per each case were $220 and $7.25 for Amplatz and Alken dilation groups, respectively. CONCLUSIONS The Alken dilation technique produces similar results to the Amplatz dilators in terms of efficiency, safety, and total operative time. Notwithstanding, it is more cost-effective in comparison.
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Affiliation(s)
- Hakki Ugur Ozok
- Diskapı Yildirim Beyazit Training and Research Hospital, 3rd Urology Clinic, Ministry of Health, Ankara, Turkey.
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Seitz C, Desai M, Häcker A, Hakenberg OW, Liatsikos E, Nagele U, Tolley D. Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy. Eur Urol 2011; 61:146-58. [PMID: 21978422 DOI: 10.1016/j.eururo.2011.09.016] [Citation(s) in RCA: 280] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 09/15/2011] [Indexed: 11/29/2022]
Abstract
CONTEXT Incidence, prevention, and management of complications of percutaneous nephrolitholapaxy (PNL) still lack consensus. OBJECTIVE To review the epidemiology of complications and their prevention and management. EVIDENCE ACQUISITION A literature review was performed using the PubMed database between 2001 and May 1, 2011, restricted to human species, adults, and the English language. The Medline search used a strategy including medical subject headings (MeSH) and free-text protocols with the keywords percutaneous, nephrolithotomy, PCNL, PNL, urolithiasis, complications, and Clavien, and the MeSH terms nephrostomy, percutaneous/adverse effects, and intraoperative complications or postoperative complications. EVIDENCE SYNTHESIS Assessing the epidemiology of complications is difficult because definitions of complications and their management still lack consensus. For a reproducible quality assessment, data should be obtained in a standardized manner, allowing for comparison. An approach is the validated Dindo-modified Clavien system, which was originally reported by seven studies. No deviation from the normal postoperative course (Clavien 0) was observed in 76.7% of PNL procedures. Including deviations from the normal postoperative course without the need for pharmacologic treatment or interventions (Clavien 1) would add up to 88.1%. Clavien 2 complications including blood transfusion and parenteral nutrition occurred in 7%; Clavien 3 complications requiring intervention in 4.1.%; Clavien 4, life-threatening complications, in 0.6%; and Clavien 5, mortality, in 0.04%. High-quality data on complication management of rare but potentially debilitating complications are scarce and consist mainly of case reports. CONCLUSIONS Complications after PNL can be kept to a minimum in experienced hands with the development of new techniques and improved technology. A modified procedure-specific Clavien classification should be established that would need to be validated in prospective trials.
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Affiliation(s)
- Christian Seitz
- Department of Urology, St. John of God Hospital, Teaching Hospital of the Medical University of Vienna, Austria.
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Honey J. Treating lower pole renal stones: in defence of shock wave lithotripsy. Can Urol Assoc J 2011; 2:625-7. [PMID: 19066683 DOI: 10.5489/cuaj.981] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- John Honey
- Head, Division of Urology, St. Michael's Hospital, Toronto, Ont.; Director of Endourology, University of Toronto, Toronto, Ont
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Yamaguchi A, Skolarikos A, Buchholz NPN, Chomón GB, Grasso M, Saba P, Nakada S, de la Rosette J. Operating times and bleeding complications in percutaneous nephrolithotomy: a comparison of tract dilation methods in 5,537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study. J Endourol 2011; 25:933-9. [PMID: 21568697 DOI: 10.1089/end.2010.0606] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The study investigated factors that affect operating times and bleeding complications associated with percutaneous nephrolithotomy (PCNL) in the PCNL Global Study. PATIENTS AND METHODS All patients who underwent PCNL for primary or secondary treatment of kidney stone indications during the study period (November 2007-December 2009) were eligible for inclusion. PCNL procedures were performed according to local clinical guidelines and practices. Nephrostomy tract dilation was performed using balloon dilation, metal telescopic dilation, or Amplatz serial dilation. Hematologic complications assessed included bleeding rates, transfusion rates, and preoperative and postoperative hematocrit values. RESULTS The median operating time with balloon dilation (n=2277) was significantly longer than with telescopic/serial dilation (n=3260) at 94.0 vs 60.0 minutes, respectively (P<0.0001). In the balloon dilation group, there was significantly more bleeding (9.4% vs 6.7%, respectively; P<0.0001) and more transfusions (7.0% vs 4.9%, respectively; P=0.001) compared with the telescopic/serial dilator group. Univariate analysis showed that the probability of bleeding complications was higher with balloon vs telescopic/serial dilation (odds ratio [OR] 1.75; P=0.0001) and larger sheath size (OR 1.42; P=0.0001). By multivariate analysis, sheath size but not dilation method was predictive of bleeding complications. Other significant predictive factors included operating time, stone load, and caseload. CONCLUSION This study shows that in PCNL, factors that are associated with bleeding/transfusion include sheath size, operating time, stone load, and caseload.
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Affiliation(s)
- Akito Yamaguchi
- Department of Urology, Harasanshin General Hospital, Fukuoka, Japan
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Lopes T, Sangam K, Alken P, Barroilhet BS, Saussine C, Shi L, de la Rosette, on behalf of the Cli J. The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: Tract Dilation Comparisons in 5537 Patients. J Endourol 2011; 25:755-62. [PMID: 21388242 DOI: 10.1089/end.2010.0488] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Kandasami Sangam
- Vedanayagam Hospital and Postgraduate Institute, Tamilnadu, India
| | - Peter Alken
- Mannheim University Hospital, Mannheim, Germany
| | | | | | - Lei Shi
- Yantai Yu Huang Ding Hospital, Yantai, China
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Wezel F, Mamoulakis C, Rioja J, Michel MS, de la Rosette J, Alken P. Two contemporary series of percutaneous tract dilation for percutaneous nephrolithotomy. J Endourol 2009; 23:1655-61. [PMID: 19558265 DOI: 10.1089/end.2009.0213] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Dilation of the tract for percutaneous nephrolithotomy can be performed with three different basic techniques. A retrospective outcome analysis of two techniques-metal telescoping dilation and balloon dilation-in a contemporary series of two European departments shows no significant difference in morbidity related to the dilation procedure. A literature survey that concentrates on publications with a focus on tract dilation shows that balloon dilation is the most frequently performed, but the morbidity reported for the different techniques appears identical. The three standard techniques have been developed more than 20 years ago. Very few new techniques have been added.
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Affiliation(s)
- Felix Wezel
- Department of Urology, Mannheim University Hospital , Mannheim, Germany
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34
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Kwon T, Bang JK, Kim SC, Shim M, Ha SH, Hong B, Park HK. Percutaneous Nephrolithotomy: A Single Center Experience of 610 Cases. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.7.669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Taekmin Kwon
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Kyoon Bang
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Chul Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myungsun Shim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong-Heon Ha
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung Keun Park
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kumar V, Keeley FX. Percutaneous nephrolithotomy: why do we use rigid dilators? J Endourol 2008; 22:1877-9; discussion 1885, 1889. [PMID: 18811476 DOI: 10.1089/end.2008.9785] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Vivekanandan Kumar
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, England.
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36
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Williams SK, Bird VG, Maurici G, Leveillee RJ. Borrowing From Interventional Radiology: Novel Technique to Dilate Scarred Nephrostomy Tract. Urology 2008; 72:1156-8. [DOI: 10.1016/j.urology.2008.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Revised: 05/22/2008] [Accepted: 06/02/2008] [Indexed: 10/21/2022]
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Chichakli R, Krause R, Voelzke B, Turk T. Incidence of perinephric hematoma after percutaneous nephrolithotomy. J Endourol 2008; 22:1227-32. [PMID: 18578654 DOI: 10.1089/end.2008.0002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To identify the incidence of, risk factors for, and subsequent complications of perinephric hematomas after percutaneous nephrolithotomy. MATERIALS AND METHODS We retrospectively analyzed patients who had undergone CT within 5 days of surgery for evidence of perinephric hematomas. Hematoma severity was graded on a 4-point system in which 0 = no blood, 1 = subcapsular blood, 2 = perinephric blood that does not or minimally displaces the kidney, 3 = blood that displaces the kidney > 2 cm, and 4 = blood that extends into the retroperitoneum. Univariate analysis was performed to identify significant preoperative, intraoperative, or postoperative risk factors. RESULTS A total of 202 patients underwent percutaneous nephrolithotomy and were imaged with CT within 5 days of surgery. Of these, 140 (69%) were grade 0, 55 (27.2%) had localized bleeding (grades 1 or 2), and 7 (3.5%) had extensive bleeding (grades 3 or 4). Complications developed postoperatively in 13 of the patients in groups 1 to 4, including persistent fever longer than 12 hours after surgery in 8 patients, ileus in 2 patients, transfusion of packed red blood cells in 2 patients, and hydrothorax necessitating a chest tube in 1 patient. No patient had surgical or percutaneous intervention. At 3-month follow-up, no patients had symptoms or needed further imaging. Placement of a ureteral stent at the conclusion of the procedure occurred in a significantly higher number of patients in groups 1 to 4 (P = 0.009). The remaining factors were not significantly different. Subset analysis revealed a significantly greater hemoglobin decline in patients with extensive hematomas, groups 3 and 4, compared with groups 0 to 2 (P = 0.001). CONCLUSIONS Perinephric hematomas occur in nearly one-third of patients undergoing percutaneous nephrolithotomies but are extensive only 11% of the time. Hematomas are not associated with an increased incidence of clinically relevant complications. There does not appear to be any indication for serial imaging during hospitalization or at 3-month follow-up.
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Affiliation(s)
- Ramsey Chichakli
- Department of Urology, Sharp Community Medical Group, La Jolla, California 92037, USA.
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Hendlin K, Monga M. Radial dilation of nephrostomy balloons: a comparative analysis. Int Braz J Urol 2008; 34:546-52; discussion 552-4. [DOI: 10.1590/s1677-55382008000500002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2008] [Indexed: 01/18/2023] Open
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Kumar V, Keeley, Jr. FX. Rebuttal. J Endourol 2008. [DOI: 10.1089/end.2008.9785a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vivekanandan Kumar
- Bristol Urological Institute, North Bristol NHS Trust, Westbury-on-Trym, Bristol, BS10 5NG, England E-mail:
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Benway BM, Nakada SY. Rebuttal. J Endourol 2008. [DOI: 10.1089/end.2008.9786a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Stephen Y. Nakada
- Department of Medicine (Nephrology), University of Wisconsin School of Medicine and Public Health, G5/339 CSC, 600 Highland Avenue, Madison, WI 53792 E-mail:
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Benway BM, Nakada SY. Balloon Dilation of Nephrostomy Tracts. J Endourol 2008; 22:1875-6; discussion 1887, 1889. [DOI: 10.1089/end.2008.9786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Brian M. Benway
- Department of Urology, Department of Medicine (Nephrology), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Stephen Y. Nakada
- Department of Urology, Department of Medicine (Nephrology), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Department of Radiology, Department of Medicine (Nephrology), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Gönen M, Istanbulluoglu OM, Cicek T, Ozturk B, Ozkardes H. Balloon dilatation versus Amplatz dilatation for nephrostomy tract dilatation. J Endourol 2008; 22:901-4. [PMID: 18429681 DOI: 10.1089/end.2007.0167] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE In this study, we present our experience using balloon and Amplatz dilatation to establish a percutaneous tract. We also discuss advantages and risk factors of both techniques. MATERIALS AND METHODS We retrospectively reviewed medical records of 229 patients who had undergone 235 percutaneous nephrolithotomy procedures. The nephrostomy tract had been dilated using a balloon (42 patients) or Amplatz (187 patients) dilator. Total operating time, preoperative and postoperative hemoglobin concentrations, number of tracts required, stone burden, blood transfusion rates, tract dilatation failures, and the cost of the dilatation system were compared between the groups. RESULTS There were no statistically significant differences in operative time (85.7+/-43.2 v 86.3+/-41.2 minutes; P=0.42), preoperative hemoglobin concentration (14.1+/-1.1 v 13.8+/-1.4 mg/dL; P= .153), postoperative hemoglobin concentration (11.6+/-1.7 v 11.2+/-1.5 mg/dL; P= .601), or blood transfusion rate (18.6% v 21.3%; P= .687) between the two groups. Also, there were no differences in failure rates between the two groups. CONCLUSIONS The Amplatz dilator is comparable with the balloon dilator with regard to efficacy, speed, and safety. The Amplatz dilator is more cost-effective than the balloon dilator. However, kidney hypermobility may be a significant problem during Amplatz dilatation.
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Affiliation(s)
- Murat Gönen
- Department of Urology, Baskent University Medical Research and Teaching Center, Konya, Turkey.
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Srirangam SJ, Darling R, Stopford M, Neilson D. Contemporary practice of percutaneous nephrolithotomy: review of practice in a single region of the UK. Ann R Coll Surg Engl 2008; 90:40-4. [PMID: 18201499 DOI: 10.1308/003588408x242240] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Most series of percutaneous nephrolithotomy (PCNL) from single specialised centres represent optimum results achievable and may not reflect outcomes of everyday practice. We analysed the practice in our region. PATIENTS AND METHODS Medical records of 178 patients undergoing PCNL in 2002 in 12 participating hospital trusts were retrospectively analysed. RESULTS Even outside the tertiary referral centres, there was a 6-fold difference between trusts in the frequency of PCNL. In 28% of cases, another stone-removing modality had been tried first. Failed renal puncture was a major cause of abandoning surgery (9%). An indication of the difficulty in obtaining complete stone clearance is that only 107 (60%) operation notes recorded complete clearance, while 75 (42%) patients required a subsequent procedure (13% a secondary PCNL). Use of supra 12th rib punctures was small (6%) as was the rate of 'tube-less' PCNL (4%). Some 22% had simultaneous ureteric stent insertion. Approximately 8% of cases required a blood transfusion. Thirty-eight patients (23%) had a proven infection (UTI) pre-operatively (> 10(4) organisms; > 10 white blood cells) with almost all patients receiving antibiotics at anaesthesia induction. Postoperative sepsis rates (temperature > 38.5 degrees C) were similar in those with and without a pre-operative UTI (18.4% versus 14.3%) and pre-operative antibiotics appeared to have little extra protective effect. Severe sepsis was rare with no patient requiring intensive care admission for this reason. Median length of stay postoperatively was 5 days. CONCLUSIONS These results present important figures to quote when counselling patients pre-operatively, albeit that the degree of difficulty (and hence the likelihood of problems) is identifiable from stone and anatomical configurations. In addition, the present data are a more accurate reflection of urinary stone surgery in non-tertiary, general urological practice.
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Ziaee SAM, Karami H, Aminsharifi A, Mehrabi S, Zand S, Javaherforooshzadeh A. One-Stage Tract Dilation for Percutaneous Nephrolithotomy: Is It Justified? J Endourol 2007; 21:1415-20. [DOI: 10.1089/end.2006.0454] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Seyed Amir Mohsen Ziaee
- Department of Urology, Shaheed labbafinezhad Hospital, Shaheed Beheshti Medical University, Tehran, Iran
- Urology Nephrology Research Center, Shaheed Beheshti Medical University, Tehran, Iran
| | - Hossein Karami
- Department of Urology, Shaheed labbafinezhad Hospital, Shaheed Beheshti Medical University, Tehran, Iran
| | - Alireza Aminsharifi
- Department of Urology, Shaheed labbafinezhad Hospital, Shaheed Beheshti Medical University, Tehran, Iran
| | - Sadrollah Mehrabi
- Department of Urology, Shaheed labbafinezhad Hospital, Shaheed Beheshti Medical University, Tehran, Iran
| | - Saeed Zand
- Department of Urology, Shaheed labbafinezhad Hospital, Shaheed Beheshti Medical University, Tehran, Iran
| | - Ahmad Javaherforooshzadeh
- Department of Urology, Shaheed labbafinezhad Hospital, Shaheed Beheshti Medical University, Tehran, Iran
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Shen CH, Cheng MC, Lin CT, Jou YC, Chen PC. Innovative Metal Dilators for Percutaneous Nephrostomy Tract: Report on 546 Cases. Urology 2007; 70:418-21; discussion 421-2. [PMID: 17905087 DOI: 10.1016/j.urology.2007.03.083] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Revised: 02/15/2007] [Accepted: 03/12/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVES A retrospective study was conducted to evaluate the efficacy and safety of creating a percutaneous nephrostomy tract for stone removal with innovative metal dilators. METHODS A total of 546 percutaneous nephrolithotomies was performed at Chiayi Christian Hospital from January 2001 to December 2005. Innovative metal dilators were used to create 546 percutaneous nephrostomy tracts in 520 patients. Several patients had multiple percutaneous nephrostomy tracts. Patient age, stone burden, operative time, stone-free rate, postoperative hospital day, postoperative urinary tract infection rate, and blood transfusion rate were recorded using retrospective chart review. RESULTS The dilation time was less than 15 minutes. The average patient age was 53.7 +/- 13.1 years, and the average stone size was 3.5 +/- 2.0 cm. The average operative time was 100 +/- 45 minutes. The average postoperative hospital stay was 4.4 +/- 2.6 days. The overall stone-free rate was 84.4% (461 of 546). The stone-free rate was 99% (142 of 143) for upper ureteral stones, 87% (268 of 305) for renal stones, and 52% (51 of 98) for complete staghorn stones. The blood transfusion rate was 2.5% (14 of 546). The postoperative urinary tract infection rate was 8.6% (47 of 546). Of the 520 patients, 6 had pleural effusion and 1 had pneumothorax. CONCLUSIONS Our innovative metal dilators saved time, resulted in less bleeding, and successfully provided one-stage tract creation in 520 patients. The dilation system also allowed the use of a ureteroscope to check the entrance tract to reduce complications.
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Affiliation(s)
- Cheng-Huang Shen
- Department of Urology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
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Abstract
PURPOSE OF REVIEW As urologists will continue to rely on percutaneous nephrolithotomy, a clear understanding of its associated bleeding risks and management is mandatory. RECENT FINDINGS Despite advances in lithotripsy technology, bleeding continues to be a cause of patient morbidity in percutaneous nephrolithotomy. Although most patients can be managed conservatively, a subset of patients will require endovascular embolization for vascular control. Investigators have identified risk factors and described management options. The use of different dilators and tract size continues to be examined. Additionally, novel applications of proclotting agents as well as direct renal and tract electrocauterization immediately postpercutaneous nephrolithotomy have been reported to decrease transfusions. Finally, initial access obtained by the urologist is associated with less bleeding and higher stone-free rates. SUMMARY Optimal renal access is the most critical factor influencing surgical success and minimizing overall blood loss. Although real-time ultrasonography may add to the safety of the initial access, surgeon experience is the key factor. As such, the urologist must be actively involved in tract placement. Clinically significant bleeding can be treated conservatively in a majority of cases with tamponade nephrostomy tubes with or without transfusions. Arterial hemorrhage, pseudoaneurysms, and arterial-venous fistulas, however, require prompt intervention with angiographic embolization.
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Affiliation(s)
- Keith L Lee
- Department of Urology, University of California San Francisco, San Francisco, California 94143-0738, USA
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Abstract
The term “fascia” is a very frequently used notion, particularly in an anatomical, surgical, and radiological context. A closer look at the underlying concepts, however, reveals that the denomination is all but a consistent one. It is this use of one and the same term for very different entities that is one of the sources for controversial opinions on fascial structures and their applications in surgical practice. This article summarizes and illustrates examples of structures called fasciae. Considering the impossibility to give a simple, universal definition, we conclude that a precise description and iconographic documentation of the structure under consideration remain mandatory. They should replace the presumably unequivocal, but in fact often nebulous, notion “fascia” in surgical, radiological, and anatomical articles.
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Affiliation(s)
- Jean H.D. Fasel
- Clinical Anatomy Research Group, Department of Cellular Physiology and Metabolism, University Medical Center, Geneva, Switzerland and the
- Department of Surgery, University Hospitals, Geneva, Switzerland
| | - Jean-Claude DembÉ
- Clinical Anatomy Research Group, Department of Cellular Physiology and Metabolism, University Medical Center, Geneva, Switzerland and the
| | - Pietro E. Majno
- Department of Surgery, University Hospitals, Geneva, Switzerland
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Baldwin DD, Maynes LJ, Desai PJ, Jellison FC, Tsai CK, Barker GR. A Novel Single Step Percutaneous Access Sheath: The Initial Human Experience. J Urol 2006; 175:156-61. [PMID: 16406896 DOI: 10.1016/s0022-5347(05)00020-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2004] [Indexed: 11/17/2022]
Abstract
PURPOSE A novel 1-step percutaneous access sheath NS has been developed that allows the insertion of a dilating balloon and renal access sheath in a single step. We present the initial human experience with this sheath. MATERIALS AND METHODS We performed a retrospective chart and database review of the initial 30 consecutive patients undergoing percutaneous nephrostolithotomy using the NS. Data collected included patient demographics, operative and recovery parameters, and complications. RESULTS Mean patient age was 50.4 years (range 11 to 81), mean body mass index was 31.63 kg/m(2) (range 17.1 to 65) and mean preoperative stone area was 6.23 cm(2) (range 1 to 14.6). Six and 3 patients had full and partial staghorn calculi, respectively. Access was achieved via the upper pole in 16 patients, middle pole in 7 and lower pole in 7. Mean operative time was 114.8 minutes (range 61 to 237). Mean estimated blood loss was 145.5 cc (range 10 to 500) and mean postoperative hospital stay was 4.89 days (range 2 to 14). A total of 23 patients (76.7%) had no residual calculi on postoperative computerized tomography, 5 (16.7%) had residual fragments 4 mm or less and 2 (6.7%) had residual stone fragments greater than 4 mm. There were no complications related to the NS. CONCLUSIONS The NS is safe, easy to use and has potential advantages compared to currently available renal access sheaths.
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Affiliation(s)
- D Duane Baldwin
- Division of Urology, Loma Linda University Medical Center, Loma Linda, California, USA
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A Novel Single Step Percutaneous Access Sheath. J Urol 2006. [DOI: 10.1097/00005392-200601000-00044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Joel AB, Rubenstein JN, Hsieh MH, Chi T, Meng MV, Stoller ML. Failed percutaneous balloon dilation for renal access: Incidence and risk factors. Urology 2005; 66:29-32. [PMID: 15992884 DOI: 10.1016/j.urology.2005.02.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2004] [Revised: 01/27/2005] [Accepted: 02/18/2005] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To present our experience using balloon dilation and discuss secondary techniques to establish a percutaneous tract when balloon dilation fails. Balloon dilation is a safe and effective method to achieve percutaneous renal access, but it is not uniformly successful. Also, the failure rate and risk factors have not been well documented. METHODS We retrospectively reviewed our last 99 consecutive percutaneous renal procedures using a balloon system as our initial dilation modality. In all cases, the urologist achieved needle access. We determined the balloon failure rate, relationship to prior renal surgery and other patient-related factors, and success rate using secondary techniques of tract dilation. RESULTS The balloon did not adequately dilate a tract in 17 (17% failure rate) of 99 cases. The risk factors for failure included a history of prior ipsilateral renal surgery (25% failure rate versus 8% without surgery) and subcostal compared with supracostal puncture (18% versus 9% failure rate). The failure rate was not increased when stratified by laterality, stone composition, stone size and location, or history of ipsilateral renal infection. Amplatz dilators were used in 16 refractory cases and were successful in 15. Metal Alken dilators were successfully used in 2 patients. CONCLUSIONS The balloon dilation system is commonly used as the primary modality to establish percutaneous renal access. Although safe and effective (83%), the success rate drops dramatically in patients with prior ipsilateral renal surgery. Knowledge and skill with alternative dilation systems, such as Amplatz or metal Alken dilators, are necessary to successfully gain entry into all renal collecting systems.
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Affiliation(s)
- Andrew B Joel
- Department of Urology, University of California, School of Medicine, San Francisco, California 94143, USA
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