Percutaneous extraction of upper urinary tract calculi

Renal calculi less than 8–9 mm in diameter and ureteral calculi of various sizes can be removed intact using fluoroscopic guidance without the need for endoscopy. Advantages of percutaneous stone extraction include a shorter hospital stay, decreased cost, and avoidance of general anesthesia. When compared with fragmentation techniques. percutaneous extraction appears to be the treatment of choice for urinary tract calculi amenable to this technique.     

Percutaneous nephrolithotomy through an intercostal approach

During a 5-year period percutaneous nephrolithotripsy through an intercostal space was performed in 56 of 231 procedures. Minimal thoracic complications were seen in 3 of 53 patients with 11th intercostal space tracts into a lower, middle, or upper pole calyx. A working sheath and a pyelostomy drainage catheter were used in all these cases. Hydro- and pneumothorax requiring treatment occurred in 2 of 3 patients with a 10th intercostal space approach into an upper pole calyx combined with improper use of the working sheath and/or the pyelostomy catheter. Review of the literature also indicates that an intercostal approach appears safe when performed via the 11th intercostal space into a lower or middle pole calyx. Thoracic complications occurred when punctures were made towards an upper pole calyx or above the 11th rib. The complications may be limited by identifying the posterior inferior lung border by fluoroscopy during puncture, and performing it under general anesthesia with controlled breath-holding. The use of a working sheath to seal the pleural opening during the procedure and an efficient pyelostomy drainage catheter to allow free drainage of urine and to tamponade the tract postoperatively are also recommended.     

Percutaneous removal of renal caliceal calculi: An alternative approach

An alternative method is presented for the removal of caliceal calculi refractory to standard techniques. The involved calyx is punctured directly and dilatation performed to the stone without negotiating a wire into the renal pelvis. The stone is then removed under direct vision. This technique has been successfully used in 3 patients without complication.     

Fluoroscopically guided percutaneous extraction of upper urinary tract calculi

Recent developments in instrumentation have revolutionized the management of renal and ureteral calculi, so that over 90 per cent of all upper urinary tract calculi can presently be treated by means of percutaneous manipulations. Approximately two thirds of these stones can be extracted under either fluoroscopic or nephroscopic control, with the remainder disintegrated under nephroscopic control with ultrasonic or electrohydraulic energies. The authors describe techniques and equipment for fluoroscopically guided percutaneous extraction of renal and ureteral calculi.     

经皮肾微造瘘输尿管镜术治疗复杂性上尿路结石

目的探讨经皮肾微造瘘输尿管镜术治疗复杂性上尿路结石的效果。方法回顾性分析我院于2003年3月～2007年5月，采用经皮’肾微造瘘输尿管镜术治疗复杂性上尿路结石143例患者的临床资料。结果结石总排净率为87．4％（125／143），输尿管结石排净率为89．0％（73／82）。手术时间30～190min，平均80min。6例中转开放手术。手术未出现肾盂穿孔、邻近脏器损伤、持续的泌尿系感染、大出血等严重并发症。结论该手术安全、有效，适宜于复杂性上尿路结石的治疗。     

Nephrolithotony: Percutaneous removal of renal calculi

The development of percutaneous nephrostomy has laid the foundation for a major advance in the treatment of urolithiasis: the percutaneous removal of renal and ureteral calculi (i.e., nephrolithotony). With the use of a variety of instruments, calculi can be either removed intact or, if too large, fragmentedin situ and then extracted. The method has wide applicability; more than 90% of all upper urinary tract calculi can be successfully treated. Length of hospitalization and costs are comparable to or less than those for open surgery; however, the period of convalescence is only 2–7 days. Continued advances in fluoroscopic technology and endoscopic instrumentation will enable the urologic surgeon to treat the majority of urinary tract conditions using endourologic techniques.     

Percutaneous nephrostolithotomy: application to staghorn calculi

Twenty-five renal staghorn stones measuring at least 5 cm in diameter were removed percutaneously from 24 patients. Twelve patients required multiple access tracts for complete stone removal. Estimated blood loss more than 1000 ml occurred in 16 patients and temperature greater than 38.5 degrees C in 19 patients. All stones were successfully removed, with only two patients having definite residual fragments. Percutaneous nephrostolithotomy may be successfully applied to large staghorn stones. The relative roles of percutaneous therapy and extracorporeal lithotripsy remain to be determined.     

Percutaneous removal of renal calculi

Percutaneous removal of symptomatic renal and ureteral calculi evolved in the early 1980s, replacing standard surgical stone removal operations because of reduced patient morbidity and shortened hospitalizations. A wide variety of instruments designed to work through the percutaneous track are available to remove or fragment nearly all renal calculi. Success rates of this modality are excellent, and major complications are few. Despite the wide applications of extracorporeal shock-wave lithotripsy, percutaneous stone removal methods will continue to be needed in some patients.     

Percutaneous chemolysis of renal calculi

Certain types of pyeloureteral calculi can be treated by chemolytic drug irrigation through a percutaneous nephrostomy catheter. Struvite, apatite, and carbonate stones can be dissolved with an acidic solution (hemacidrin, Suby solution G). An alkaline agent (Tham-E®, acetylcysteine) will dissolve cystine calculi. While most uric acid stones are managed by oral alkalinization with sodium bicarbonate or potassium citrate, there are occasions (cardiac, metabolic conditions) where treatment via percutaneous nephrostomy is preferable. Successful nonoperative management of symptomatic calculi has been obtained in 85% of cases with chemolysis of more than 150 stones.     

Percutaneous lithotripsy of renal calculi

Percutaneous nephrostomy and stone removal was performed 240 times in 84 patients during a five-year period. Surgery was necessary in only two cases; hemorrhage requiring blood transfusion occurred in four. Perforation of the renal pelvis in five patients healed without sequelae. Final control of the nephrostomy was achieved in almost all cases. Indications and technical points regarding percutaneous lithotripsy are discussed.     

Percutaneous lithotripsy of staghorn calculi

Eleven cases of staghorn calculi managed by percutaneous lithotripsy were reviewed. Ten of 11 cases were successful, and 70% of the successfully treated patients were discharged free of any renal stones. The percentage of patients discharged with residual stone fragments was higher than those with either percutaneously managed nondendritic calculi or surgically treated staghorn calculi. The complication rate was higher than for nonbranched stones managed percutaneously and was comparable to that for surgically removed dendritic calculi. Hospital stay averaged 18 days, equal to that for staghorn calculi treated by conventional surgical approach, but considerably longer than for nonbranched stones. Overall results more closely approximated those for surgical removal of staghorn calculi than those for percutaneous removal of nonbranched calculi. However, the principal advantage of percutaneous lithotripsy of staghorn calculi over surgical management is the significant reduction in convalescence after discharge from the hospital.     

Percutaneous removal of small ureteral calculi

Percutaneous renal and ureteral stone removal procedures are widely practiced. A new technique is described for removal of small symptomatic ureteral calculi using small (less than or equal to 14 French) tearable sheaths and standard stone retrieval baskets placed through acute percutaneous nephrostomy tracks. This fluoroscopically-guided technique was successful in 60 of 64 patients, who ranged from 16 to 88 years old. Subsequent endoscopic percutaneous calculus removal was successful in the four failures. The use of these small sheaths over previously described large tracks has produced no major complications, short hospital stays, and minimal patient disability.     

Percutaneous removal of renal staghorn calculi

Using a percutaneous approach, 18 of 20 staghorn calculi were completely removed from the upper urinary tract. The initial nephrostomy was performed in the radiology department with local anesthesia. Tract dilatation and stone removal ensued on the next day in the operating room under general anesthesia. Minor complications, including postoperative temperature spikes and pyelonephritis, occurred in seven patients. Two major complications, urosepsis and hemorrhage requiring transfusion, were encountered.     

Percutaneous removal of ureteral calculi: clinical and experimental results

Between May 1983 and October 1984, 51 patients who had 68 ureteral stones underwent treatment at the University of Minnesota. All 68 stones were removed successfully using percutaneous techniques. The 100% success rate is a great improvement over previous results at our institution. The primary factors appear to be the development of the retrograde-flush technique, familiarity with and access to a wider range of methods, and the increasing use of the retrograde ureterorenoscope to see stones in the lower ureter. The average patient was a 45-year-old man who had no other medical problems. The average hospital stay was 6.8 days. Experimental studies with dogs indicate that injection rates of up to 30 ml/sec of contrast material through a retrograde catheter in the ureter are safe if a vent is present in the upper collecting system.     

Upper ureteral calculi: extraction via percutaneous nephrostomy

Symptomatic calculi in the upper ureter are usually removed using surgical and endoscopic techniques. Extraction via percutaneous nephrostomy was successful in 35 of 37 patients using sequentially the techniques of retrograde catheter push, basket sheath exchange, and steerable loop-snare. In 12 patients, the calculus was dislodged into the renal pelvis by the retrograde ureteral catheter; extraction was then easily done. Stone basket retrieval was used for an additional 17 patients. A steerable loop-snare was necessary in six other patients when basket retrieval failed.     

Treatment of urinary calculi in the combat zone

Renal colic is a common condition among deployed soldiers in the Middle East. Eight percent of all admissions to the jump package of the 21st Combat Support Hospital in Mosul, Iraq, during Operation Iraqi Freedom involved patients with renal colic and urinary stones. The majority of patients were treated successfully with primary care measures. Fourteen percent of patients required urologic interventions; however, many of these soldiers were treated with ureteral stents and returned to duty. Aggressive management of urolithiasis resulted in 92% of soldiers remaining in the combat zone, preserving the fighting strength of supported units.     

Computed tomographic analysis of urinary calculi

Excised urinary calculi were subjected to computed tomographic (CT) scanning in an attempt to determine whether CT attenuation values would allow accurate analysis of stone composition. The mean, maximum, and modal pixel densities of the calculi were recorded and compared; the resulting values reflected considerable heterogeneity in stone density. Although uric acid and cystine calculi could be identified by their discrete ranges on one or more of these criteria, calcium-containing stones of various compositions, including struvite, could not be distinguished reliably. CT analysis of stone density is not likely to be more accurate than standard radiography in characterizing stone composition in vivo.     

Medullary sponge kidney and urinary calculi: aeromedical concerns

Medullary sponge kidney (MSK) is a benign disorder associated with a lifetime risk of renal stones in 60% of patients. Patients frequently have episodic painless hematuria, but are often otherwise asymptomatic unless renal calculi or infections complicate the disease. Nephrolithiasis is a relative, but frequently enforced, contraindication to space or other high-performance flight. Two case reports of asymptomatic NASA flight crew with MSK and three cases of United States Air Force (USAF) military aviators diagnosed with MSK are reviewed. All cases resulted in waiver and return to flight status after treatment and a vigorous followup and prophylaxis protocol. MSK in aviation and spaceflight necessitates case-by-case evaluation and treatment to rule out other potential confounding factors that might also contribute to stone formation and in order to requalify the aviator for flight duties.