Percutaneous stone surgery in the obese: outcome stratified according to body mass index

OBJECTIVE: To report our experience of percutaneous surgery for treating renal pelvicalyceal stones over 6 years, to show that this approach is feasible and safe in obese and morbidly obese patients, as the prevalence of obesity and stone disease has risen in the last 20 years. PATIENTS AND METHODS: We retrospectively reviewed the results of 223 percutaneous nephrolithotomies (PCNLs) by one urologist between 1995 and 2001. Patients were stratified into four groups according to the World Health Organization classification of body mass index (BMI), i.e. <25, 25-29.9 (overweight), 30-39.9 (obese) and > 40 kg/m(2) (morbidly obese). The outcomes of surgery in these four groups were compared. RESULTS: There were no statistically significant differences in operative duration, decrease in haemoglobin concentration, postoperative analgesic use, hospital stay and stone-free rates; nor was there a higher complication rate in patients who were obese. CONCLUSION: The outcome of PCNL is independent of the patients' BMI and results can be favourable in most patients. We therefore advocate treating obese patients with symptomatic stone disease based on individual status, using percutaneous surgery where appropriate.     

Tubeless percutaneous nephrolithotomy: call of the day

PURPOSE: We challenge the routine placement of nephrostomy tube after percutaneous nephrolithotomy (PCNL) without taking into consideration the size, burden, and multiplicity of the stones; the degree of obstruction of the pelvicaliceal system, or any anatomic variations of the kidney in shape or position. PATIENTS AND METHODS: Between January 2005 to March 2006, 110 patients underwent PCNL, 77% of whom had multiple stones. The mean size of the single stones was 4.3 cm (range 2.8-6.5 cm), and the mean single-stone burden was 7.2 cm2 (range 5.6-14.3 cm2). The mean burden of multiple stones was 11.4 cm2 (range 8-23 cm2). Among the patients, 18 had had previous renal surgery, 12 had renal insufficiency, and 7 had a solitary functioning kidney. One patient each had horseshoe kidney and malrotated kidney. In 106 patients, no nephrostomy drain was placed, only an externalized 5F ureteral catheter for 16 to 20 hours. Two patients had simultaneous bilateral tubeless PCNL. The outcome was evaluated prospectively. The frequency of complications, length of hospital stay, and stone-free status were assessed. RESULTS: A stone-free rate of 80% was achieved using PCNL as monotherapy. The mean postoperative hospital stay was 16 to 20 hours. Three patients required placement of a nephrostomy tube because of significant bleeding and one because of purulent renal discharge. In four patients, a ureteral catheter was replaced by a stent because of significant residual stone burdens. The initial 18 patients underwent ultrasound examination on the first postoperative day, and none demonstrated any extrarenal collection, so routine ultrasound examination was omitted in succeeding patients. One patient required exploration because of a retroperitoneal hematoma. CONCLUSION: Omission of a nephrostomy tube after PCNL while retaining an externalized ureteral catheter for 16 to 20 hours is sufficient and safe irrespective of the stone characteristics. Shape, position, and function of the kidneys are also irrelevant with regard to tubeless PCNL.     

Outcome of percutaneous nephrolithotomy: effect of body mass index

OBJECTIVE: The surgical management of renal and upper ureteral calculi presents unique challenges in obese patients. We reviewed our recent experience with percutaneous nephrolithotomy (PNL) in obese patients to determine the safety and outcome of this procedure in such group of patients. PATIENTS AND METHODS: The surgical records of 1121 patients treated with PNL between 2000 and 2004 were reviewed. Patients were stratified into four groups according to the World Health Organization classification of body mass index (BMI): <25 (average), 25-29.9 (overweight), 30-39.9 (obese), and >40 kg/m(2) (morbidly obese). The outcomes of PNL in these four groups were compared. RESULTS: A total of 1287 procedures were performed on 1155 renal units (1.1 procedures per renal unit). The overall stone-free rate was 85.1% and the mean hospital stay was 3.3+/-2.6 d. Major complications were seen in 72 patients (6.4%). No statistically significant differences were found in decrease in haemoglobin concentration, hospital stay, and complication rate among the four study groups. The need for auxiliary procedures and stone-free rates were comparable. CONCLUSIONS: PNL in obese and morbidly obese patients yields a stone-free rate that is comparable to that achieved in nonobese patients. The complication rate and length of hospital stay are also similar.     

Percutaneous nephrolithotomy in patients aged 60 years or older

PURPOSE: To assess the safety and efficacy of percutaneous nephrolithotomy in patients more than 60 years old. PATIENTS AND METHODS: We retrospectively evaluated and compared the data of 28 percutaneous nephrolithotomies (PCNL) performed on 27 patients aged 60 years and older (mean 65.8) with the data of the remaining 178 PCNL procedures on 166 patients performed in our clinic between December 1997 and December 1999. RESULTS: Although staghorn stones seemed to be more common in the elderly group (25% v 22%), no statistical significance was demonstrated (P = 0.715), and the stone burden was similar for the two groups (P = 0.112). The only interesting finding in terms of patient characteristics was a significantly higher incidence of solitary kidney in patients aged 60 years or older (29% v 7%; P = 0.003). The success rates (stone-free patients and patients with residual stones <4 mm) were similar, being 89% for the elderly group and 92% for the younger patients (P = 0.718). Transfusion rates were also similar (21.4% in the elderly v 18% in the younger group; P = 0.662). No significant complication was observed in this elderly group, and no renal deterioration has been detected even in the follow-up of patients with a solitary kidney. CONCLUSIONS: Despite the somewhat higher stone burden in the elderly patients (1077.92 mm2 v 920.85 mm2), the stone-free rate was similar to that obtained in the younger patients, without any higher rates of complications or blood transfusions or longer hospital stay. Percutaneous nephrolithotomy is a safe and effective method of stone treatment in the elderly, even if they have a solitary kidney or complex calculi.     

超重/肥胖患者肾输尿管结石治疗的结果和分析

目的 分析肥胖是否会影响肾结石治疗的效果及增加并发症的发生率。方法 回顾性分析2018年3月至2022年4月间在我院接受外科治疗的肾或输尿管结石患者的临床数据,根据BMI水平将患者分为超重/肥胖组（≥24.0 kg/m²）和正常体重组,分别有98和212例入组。根据治疗的方法选择,比较超重/肥胖患者与正常体重患者接受体外冲击波碎石术（ESWL）、经皮肾镜取石术（PCNL）及输尿管软镜（FURS）碎石术下的临床结果和并发症。结果 超重/肥胖组患者的BMI为27.6±1.9 kg/m²,其中,BMI≥28 kg/m²者29例,最高值为30.8 kg/m²。超重/肥胖患者应用ESWL显示较低的碎石成功率（68.5%）,和正常体重患者（72.7%）比较,两组的差异有统计学意义（P=0.0046）;由于超重/肥胖患者结石-皮肤距离（SSD）高于正常体重者（P<0.001）,在碎石过程中X线曝光时间也较正常体重明显延长（P=0.005）。PCNL的结石清除率在两组相当,差异没有统计学意义（P=0.118）,但超重/肥胖中PCNL的手术时间较正常体重患者明显延长（P=0.038）,前者Hb下降值也略高于后者,但差异没有统计学意义（P=0.069）。采用FURS的两组患者中,超重/肥胖组患者在结石残留、术后住院时间及并发症方面与正常体重组患者相当。结论 本组病例中,肾输尿管结石肥胖患者可同正常体重患者一样选择各种清除结石的治疗方法,两组临床效果相当,但ESWL的成功率略低,肥胖患者选择ESWL应建立在更加综合分析的基础上。另外,超重/肥胖组可能伴随治疗费用以及并发症增加的风险。     

How do increasing stone surface area and stone configuration affect overall outcome of percutaneous nephrolithotomy?

BACKGROUND AND PURPOSE: Studies reporting the outcome of percutaneous nephrolithotomy (PCNL) in relation to stone burden and configuration are limited. We analyzed our stone-free and complication rates of PCNL with regard to stone surface area and configuration. PATIENTS AND METHODS: Data of 234 patients who underwent PCNL were analyzed retrospectively. Patients were stratified into six groups according to stone burden and into four groups in relation to stone configuration. Groups were compared with respect to the number of tracts, success of therapy, complications, requirement for secondary procedures, drop in hematocrit, and blood transfusion requirement. RESULTS: The overall stone-free rate was 78.6% with a complication rate of 34.6%. Stone-free rates decreased with increasing stone size (P = 0.001) and with increasing caliceal component in complex stones (P = 0.01). The total number of complications rose with increasing stone surface area (P = 0.0001); however, stone distribution within the kidney did not affect the complication rate (P = 0.2). The mean operative time rose with increasing stone burden (P < 0.05) and increasing caliceal involvement by complex stones (P < 0.01). The need for multiple tracts also rose with increasing stone burden (P < 0.05). CONCLUSION: There is a decrease in the overall stone-free rate, as well as an increase in the complication rate, the secondary procedure rate, the mean operative time, and the need for multiple tracts, with increasing stone surface area with PCNL. With regard to stone configuration, there is a decrease in the stone-free rate, as well as an increase in the operative time, with increasing caliceal component in complex renal stones.     

Pre- and perioperative predictors of short-term clinical outcomes in patients undergoing percutaneous nephrolitholapaxy

Percutaneous nephrolitholapaxy (PCNL) with modern stone disintegration technologies is the treatment of choice for patients with extensive stone burden or stones refractory to extracorporeal shock wave lithotripsy. However, little is known about factors predicting unfavourable outcome in terms of perioperative complications, residual stone burden or prolonged hospitalization. The aim of this study was to evaluate preoperative, patient- and stone-related parameters that might influence the perioperative course and short-term clinical outcomes. In a prospective study, age, sex, body mass index (BMI), bidimensional size, side, pre-existent urinary tract infection, pre-existent hydronephrosis and previous kidney surgery were used as independent variables in both univariate and multiple regression models in 109 PCNL patients in order to predict the partition of patients rendered stone free at hospital discharge, duration of surgery, length of inpatient hospital stay and the occurrence of major complications. Univariate and multiple regression analysis revealed that stone size was the only factor influencing duration of surgery (P < 0.001) and hospitalization (P = 0.02), but had no predictive potential for major complications. Univariate analysis showed a trend towards longer inpatient hospital stay and clinically relevant residuals in patients with lower BMI (P = 0.05 and 0.06); however, after controlling for the other confounding variables, this was only reproducible for residual stone burden. The other patient- and stone-related factors did not adversely affect the outcome measures. In our patient sample treated with PCNL by LithoClast Master/Ultra we found evidence that large stone burden is a prognostic factor predicting longer surgery and prolonged hospitalization. In addition, patients with lower BMIs might be at higher risk of not being stone free at hospital discharge accompanied by prolonged inpatient treatment.     

经皮肾镜碎石术治疗上尿路结石750例临床分析

目的探讨经皮肾镜碎石术（PCND治疗上尿路结石的疗效。方法对我院2002年5月至2010年5月收治的750例上尿路结石患者的临床资料进行回顾性分析,其中男410例,女340例;年龄6～74岁,平均年龄40~13岁。肾结石620例,输尿管上段结石130例。结果750例PCNL手术均成功,手术时间80～130rain,平均90±25min,术中出血量为50～800ml,平均出血量110ml,输血10例。术后平均住院时间为6．5d,肾造瘘管留置时间为4—8d。I期结石清除率为86％（645／750）,Ⅱ期结石清除率为91．8％（689,750）。术中术后明显出血16例,2例出现保守治疗难以控制大出血,l例切除患。肾,另1例行介入栓塞治疗,必经保守治疗后痊愈。结论PCNL是治疗上尿路结石的一种有效方法,创伤小、恢复快。     

PCNL在融合肾、异位肾、旋转不良、萎缩肾、肾盂肾盏畸形等异常肾结石中的应用

目的:探讨经皮肾镜取石术(PCNL)治疗融合肾、异位肾、旋转不良、萎缩肾和肾盂肾盏畸形等异常肾脏中的复杂结石的临床效果。方法:回顾性分析2015年至2019年在汉川市人民医院行PCNL治疗的48例肾结石患者的临床资料。其中,14例存在肾脏旋转不良,12例有重复肾盂伴有完全或不完全性重复输尿管,10例为马蹄肾,8例单侧肾...     

Does previous open nephrolithotomy affect the outcome of percutaneous nephrolithotomy?

PURPOSE: To determine the effects of previous open nephrolithotomy on the results and morbidity of subsequent percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: Between March 2005 and January 2006, 89 patients underwent PCNL at our institution. We compared the patients who had had previous open surgery on the same kidney (group 1; n = 27) with those who had had no previous surgery (group 2; n = 62). The two groups did not differ significantly in age (45.4 v 44 years), stone burden (361.3 mm(2) v 482.4 mm(2) ), stone number, or laterality. Operative time, hospital stay, success rate, visual analog pain scores 8 hours after surgery, analgesic doses (diclofenac sodium), and intraoperative and postoperative complications were compared. RESULTS: There were no differences in operating time, postoperative analgesic doses, pain scores, intraoperative and postoperative complications, the number of accesses, or the stone-free rate. CONCLUSIONS: The morbidity and efficacy of PCNL are similar in patients who have had previous open nephrolithotomy and those having no previous surgery. Previous open surgery does not affect the success of PCNL.     

Obesity and prostate cancer clinical risk factors at presentation: data from CaPSURE

PURPOSE: We investigated the association of obesity with prostate cancer case demographics and clinical disease features at presentation. MATERIALS AND METHODS: Data were abstracted from CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor), a disease registry of 10,018 men with prostate cancer. A total of 2,952 men were included who were treated between 1989 and 2002, and had complete body mass index (BMI) information. BMI classes were defined as normal (less than 25 kg/m), overweight (25 to 29.9 kg/m), obese (30 to 34.9 kg/m) or very obese (35 kg/m or greater). Patients were categorized as having low, intermediate or high risk disease based on the D'Amico classification. Associations among BMI, risk and demographics were analyzed using univariate and multivariate models. RESULTS: Of the patients 29% had a normal BMI, 51% were overweight, 16% were obese and 5% were very obese. Patients who were overweight or obese were more likely to be young, have hypertension and diabetes, and have a lower education level. The overweight group had a lower serum prostate specific antigen (p = 0.010) and lower stage disease (p = 0.030) at diagnosis, but there was no association between Gleason score and obesity (p = 0.57). However, among men with a BMI of 25 kg/m or greater there was a positive correlation between increasing BMI and risk of being in a worse prognostic group at diagnosis (p = 0.018). CONCLUSIONS: Overweight and obese patients are more likely to be young at diagnosis and have multiple comorbidities. Men in the overweight and obese groups presented with lower risk prostate cancer at diagnosis. This may be due to earlier disease detection secondary to more frequent interaction with the medical community. Among overweight and obese patients increased obesity is associated with a slightly increased chance of having high risk prostate cancer at diagnosis.     

Third prize: contemporary percutaneous nephrolithotripsy: 1585 procedures in 1338 consecutive patients

BACKGROUND AND PURPOSE: The approach to urinary-stone disease has changed dramatically over the last three decades with a transition from open surgery to minimally invasive procedures. Percutaneous nephrolithotripsy (PCNL) is a cornerstone of the treatment of kidney and selected upper-ureteral stones and continues to evolve with advances in techniques and instrumentation. The purpose of this study was to assess outcomes and trends prospectively in a large contemporary group of patients undergoing PCNL. PATIENTS AND METHODS: Between July 1990 and December 2005, all 1338 patients at a single center scheduled for PCNL (N = 1585 procedures) were enrolled. Their mean age was 53 years (range 4-89 years). Data including comorbidities, stone burden, stone location, surgical time, hospital length of stay, rate of secondary procedures, and adverse events were collected prospectively. The primary outcome measures were stone-free rate and complications. RESULTS: There was a substantial incidence of comorbid medical conditions (48.8%) and anatomic renal abnormalities (25.3%), demonstrating the diverse and challenging patient population in this contemporary series. The overall stone-free rate at 3 to 6 months of follow-up was 94.8%. CONCLUSIONS: Percutaneous nephrolithotripsy is a highly effective procedure and may be performed in a diverse group of patients with comorbid conditions and renal abnormalities. Improved intracorporeal lithotripters, balloon dilation of the tract, use of flexible instruments, and liberal use of secondary nephroscopy result in excellent stone-free rates with low morbidity.     

标准通道与微通道经皮肾镜碎石取石术治疗肾结石的疗效分析(附视频)

目的 探讨标准通道经皮肾镜取石术(PCNL)与微通道经皮肾镜取石术(MPCNL)治疗肾结石的临床疗效及其优缺点.方法 回顾性分析323例肾结石患者,其中178例采用MPCNL,145例采用标准通道PCNL,对两组手术时间、一期手术成功率、结石清除率、手术并发症、肾功能、输血率、住院时间等指标进行比较分析.结果 两组患者分别成功建立了18 F和24 F肾穿刺通道并一期行碎石术.MPCNL组手术时间较PCNL组延长(P＜0.05),但肾盏多发性结石患者结石清除率高于标准通道PCNL组(P＜0.05),而单纯肾盂结石患者结石清除率则低于标准通道PCNL组(P＜0.05).两组鹿角型结石患者一期结石清除率比较无统计学意义(P＞0.05).两组术后手术并发症、肾功能、输血率、住院时间等均无显著性差异(P＞0.05).结论 MPCNL与标准通道PCNL均具有术中损伤小、住院时间短、结石清除率高、并发症低、对肾功能无明显影响等优点.标准通道PCNL较适合处理较大的肾盂结石,MPCNL较适合治疗肾盏多发结石,两者联合应用可提高鹿角型结石的治疗疗效.     

Percutaneous nephrolithotomy in patients who previously underwent open nephrolithotomy

BACKGROUND AND PURPOSE: Open stone surgery nowdays is rare. However, some patients who are treated today have in the past undergone open nephrolithotomy. The aim of this study was to determine the possible impact of open nephrolithotomy on the efficacy and morbidity of subsequent percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: We reviewed the files of all 167 patients undergoing PCNL at our institution between December 2000 and December 2003. The same surgeon performed all of the procedures. We compared 21 patients undergoing PCNL after open nephrolithotomy to the same kidney with all other patients undergoing PCNL. The groups did not differ in terms of age or stone burden (mean size, number of stones, percentage with staghorn calculi). The outcomes measured were operating time, necessity for secondary procedures, stonefree rate, and intraoperative and postoperative complications. RESULTS: The operating time (203+/-92 v 177+/-52 minutes) and percentage of secondary procedures (29% v 12%) were significantly higher in patients who had previously undergone open stone surgery. However, the stone-free rate (95% v 93%), intraoperative complication rate (10% v 9%), and postoperative complication rate (10% v 11%) did not differ significantly. CONCLUSIONS: A PCNL in a patient with a history of open nephrolithotomy may take longer and lead to a higher percentage of auxiliary procedures, probably because of scar tissue and anatomic changes in the kidney. However, the morbidity and efficacy of PCNL appear to remain the same in these patients.     

Growth of a nation part I: impact of organ donor obesity on whole-organ pancreas transplantation

Obesity has reached epidemic proportions in the USA. Consequently, there are an increasing number of potential organ donors that are obese, but would otherwise be appropriate donors for pancreas transplantation (PTx). This is a retrospective study of all PTx performed at Indiana University between 2003 and 2009 (n = 308) comparing donors with body mass index (BMI) <25, 25-29.9, and ≥30 kg/m(2) . Data included recipient and donor demographics, seven and 90-d graft loss, one-yr pancreas, kidney (for simultaneous pancreas and kidney transplant only) and patient survival, causes of graft loss and death, peak amylase and lipase, length of stay, readmissions, complications, HbA1C, and c-peptide. Of the 308 donors, 84 (27%) were overweight and 43 (14%) were obese. The overweight donors were significantly older, and the obese donors had hypertension significantly more frequently than the other two groups. There were no significant differences in recipient transplant demographics. There was no significant difference in length of stay or 90-d readmissions, seven or 90-d pancreas graft loss, one-yr graft or patient survival, peak serum amylase or lipase, HbA1C, or c-peptide. The incidence of post-transplant technical, immunological, and infectious complications were similar. Although technically challenging, PTx of allografts from obese donors can be accomplished with similar results compared to normal BMI donors.     

经皮肾镜取石术在高危肾结石患者中的安全性研究

目的探讨经皮肾镜取石术(PCNL)治疗高危肾结石患者的安全性和有效性。方法根据术前美国麻醉医师协会(ASA)评分,将226例行经皮肾镜取石术肾结石患者分为高危组(ASA～Ⅲ或Ⅳ)(61例)和低危组(ASA～Ⅱ或Ⅰ)(165例),所有患者均行标准通道(22F)PCNL钬激光碎石术。记录并比较两组手术时间、麻醉时间、术后住院时间、术中出血量、结石取净率、结石成分及手术并发症。结果两组患者在平均年龄(53.4±14.7岁vs51.6±16.3岁,P0.05)和体重指数(29.1±5.2vs29.9±4.7,P0.05)方面无显著统计学差异。高危组和低危组分别接受73次和184次PCNL手术。高危组和低危组在平均合并疾病数量之间有显著统计学差异(4.9±1.8vs1.6±0.7,P0.05)。两组在结石总体积之间无显著性差异(3.16±1.21cm3vs3.25±1.34cm3,P0.05)。高危组和低危组在平均麻醉时间(128±34minvs96±25min,P0.05)和平均术后住院天数(8.3±3.5dvs6.1±2.7d,P0.05)有显著性差异,但在平均失血量(146±28mlvs137±33ml,P0.05),并发症率(19.7%vs17%,P0.05)和手术时间(73±26minvs69±28min,P0.05)无显著性差异。高危组和低危组结石清除率分别为78.2%和93.8%,具有显著统计学差异(P0.05)。结论经皮肾镜取石术可以同样安全有效地治疗高危肾结石患者。     

Tubeless percutaneous nephrolithotomy in patients with previous ipsilateral open renal surgery: a feasibility study with review of literature

PURPOSE: To present our initial experience of tubeless percutaneous nephrolithotomy (PCNL) in patients with previous ipsilateral open renal surgery. PATIENTS AND METHODS: Twenty-five patients with previous ipsilateral open renal surgery underwent tubeless PCNL at our institute. Patients with large renal and/or upper ureteral calculi, irrespective of the number and size of the stones, amount of hydronephrosis, or the renal parameters, were selected for the procedure. Exclusion criteria were patients needing more than two percutaneous tracts, significant bleeding, and a significant residual stone burden that would necessitate a staged PCNL. The perioperative outcome of these patients (study group) was retrospectively compared with an historic cohort of the same number of patients with a history of open surgery for renal calculi who underwent ipsilateral PCNL with routine placement of a nephrostomy tube (control group). RESULTS: The two groups had comparable demographic data. Patients in the study group needed less postoperative analgesia (P = 0.000). They were discharged a mean of 10 hours earlier (P = 0.000). Two patients in both groups required blood transfusion. No urinoma or urinary leak from the nephrostomy site occurred in the study group. The incidence of other postoperative complications was comparable in both groups. Complete stone clearance was achieved in 88% of patients in the study group and 84% patients in the control group. CONCLUSION: The tubeless approach in patients with a history of open renal surgery is associated with decreased analgesia requirement and hospital stay without compromising stone-free rates or increasing the complications.     

折叠式结石拦截器在经皮肾镜取石术中的应用

目的 探讨折叠式结石拦截器在经皮肾镜取石术(PCNL)治疗肾结石中的有效性和安全性.方法 回顾分析108例行PCNL肾结石患者临床资料.术中应用折叠式结石拦截器56例,未应用52例.2组患者性别、年龄、结石大小比较差异均无统计学意义(P＞0.05).比较2组在结石清除率、手术时间、术中出血量、住院天数和并发症等差异. 结果 2组结石清除率分别为94.6%(53/56)和82.7%(43/52),手术时间分别为112、142 min,出血量为205、245 ml,差异均有统计学意义(P＜0.05).2组住院时间分别为2.8、3.0 d,并发症发生率分别为16.1%(9/56)和15.4%(8/52),2组比较差异无统计学意义(P＞0.05). 结论折叠式结石拦截器使用简单、方便、安全,PCNL术中能有效阻止结石碎片下滑进入输尿管,提高结石清除率、缩短手术时间、减少手术出血量、不增加手术并发症.

Abstract：

Objective To evaluate the efficacy and safety of percutaneous nephrolitholomy with a PercSys accordion stone management device in the treatment of renal calculi. Methods The data of 108 patients with renal calculi who underwent PCNL were retrospectively analyzed. Outcomes of 56 patients who underwent PCNL with the PercSys accordion device (group A) were compared with the outcomes of 52 patients who underwent PCNL without the accordion device (group B). Clinical data including stone-free rate, operative time, estimated blood loss, length of hospital stay and complications were compared. Results The stone-free rates of group A and group B were 94. 6% and 82.7%, operative time was 112 min and 142 min, the mean blood loss was 205 ml and 245 ml, respectively. The differences between the 2 groups were significant(P＜0. 05). The length of hospital stay was 2.8 d and 3.0 d, the complication rates were 16.1 % and 15.4%. There was no significant difference between the 2 groups for these 2 aspects(P＞0. 05). Conclusions The PercSys accordion device can be easily inserted and deployed during PCNL. It successfully prevents antegrade stone fragment migration, increases the stone-free rate and reduces the operative time and blood loss.     

Treatment of staghorn calculi. Strategies and results of the combined use of new technics

From January 1984 to June 1986, 270 patients with staghorn calculi were treated by ESWL, PCNL, or a combination of both. The indications were determined according to stone burden, distribution of stone load, architecture of the renal collecting system, radiopacity, and chemical composition of the calculi. Another group (83 patients) treated from January 1982 to October 1983 exclusively with open surgery was also examined. In a retrospective study, the treatment and follow-up data of the two groups were evaluated and compared. At discharge, 78 (29%) of the patients treated by the new techniques were free of stones, while 192 (71%) still had residual fragments in the kidney or in the ureter. Among the group treated by open surgery, 54 (65.1%) were free of stones at discharge, 17 (20.4%) still had residual fragments, and 12 (14.5%) had to undergo nephrectomy. The follow-up data (18 months n = 186) for the ESWL-PCNL-group revealed a stone-free rate of 54.8%. Residual fragments were observed in 40.3% and recurrent stone formation occurred in only 4.9%. Follow-up examination of group treated by open surgery (42 months, n = 61) revealed a stone-free rate of 72.1%, while residual stones persisted in 8.2% and recurrent stone formation occurred in 19.7%. The incidence of urinary tract infection was only 11.3% after ESWL/PCNL, as against 30% after open surgery. It is remarkable that 80% of the patients with residual fragments after ESWL-PCNL did not have any such symptoms as infection or colic.     

Growth of a nation part II: impact of recipient obesity on whole-organ pancreas transplantation

Obesity has reached epidemic proportions in the USA. Consequently, there is an increasing number of obese diabetic patients who would otherwise be appropriate candidates for pancreas transplantation (PTx). This is a retrospective study of all PTx performed at Indiana University between 2003 and 2009 (n = 308) comparing recipients with body mass index (BMI) < 25, 25-29.9, and ≥30 kg/m(2) Data included recipient and donor demographics, seven and 90-d graft loss, one-yr pancreas, kidney (for SPK only) and patient survival, causes of graft loss and death, peak amylase and lipase, length of stay, readmissions, complications, HbA1C, and c-peptide. Of the 308 PTx, 100 (32%) were overweight and 42 (14%) were obese. Obese recipients were older and more likely to be men. Donor demographics were similar. There was no difference in seven-d or 90-d graft loss, one-yr pancreas, kidney or patient survival, cause of graft loss or death, 30-d peak amylase or lipase, HbA1C, or C-peptide. The incidence of post-transplant technical, immunological and infectious complications was similar except for an increased incidence of cytomegalovirus infection in the obese group. Two recipients returned to insulin therapy despite normal C-peptide levels. Although technically challenging, PTx can be successful in select obese recipients with similar results compared to normal BMI recipients.