Retrograde percutaneous nephrostomy: a case report

We performed retrograde percutaneous nephrostomy on a 79-year-old woman admitted to our hospital with recurrent right acute pyelonephritis. Computed tomographic scan showed mild hydronephrosis and some renal stones in the right kidney. Antegrade percutaneous nephrostomy was thought to be impossible because the patient could not be placed in a prone position. Urgent drainage by ureteral catheter placement in the right renal pelvis was performed in the lithotomy position. After pyelonephritis improved, retrograde percutaneous nephrostomy was performed, which provided precise percutaneous access to the desired renal calyx without complications. Renal stones in the right kidney were later removed by percutaneous nephrolithotomy. If a sufficient preoperative evaluation is performed, we consider retrograde percutaneous nephrostomy is a safe and useful method for percutaneous access to the kidney.     

Percutaneous transhepatic drainage and insertion of an endoprosthesis for obstructive jaundice

As a consequence of the good results with percutaneous transhepatic cholangiography using the Chiba needle, a similar technique was employed for percutaneous transhepatic drainage and insertion of a percutaneous transhepatic endoprostheses. Herein we have described the technique and results of percutaneous transhepatic cholangiography with the Chiba needle in 45 patients and of combined percutaneous transhepatic drainage and insertion of an endoprosthesis in a consecutive group of 69 patients with obstructive jaundice. In the latter group, 50 patients had a malignant lesion. Of these, 38 were subject to continuous drainage, 14 externally and 24 with an endoprosthesis. The percutaneous transhepatic drainage and insertion of an endoprosthesis procedure brings a new dimension to preoperative decompression of the bile ducts and palliative treatment of obstructive jaundice in high-risk patients.     

Techniques for fluoroscopic percutaneous renal access

PURPOSE: Percutaneous nephrolithotomy has undergone considerable evolution since its introduction in the 1970s, which has been driven by advances in access techniques, instrumentation and endoscopic technology. Recent reports suggest an increase in the number of percutaneous stone treatments being performed. However, despite the increasing use of percutaneous nephrolithotomy a minority of urologists obtain their own access. We reviewed the techniques for performing safe and effective percutaneous renal access. MATERIALS AND METHODS: A literature search using Entrez PubMed was performed. All relevant literature concerning techniques for fluoroscopic percutaneous renal access published within the last 20 years was reviewed. RESULTS: The success of percutaneous nephrolithotomy is critically dependent on achieving suitable percutaneous access. The ideal site of percutaneous puncture should be selected to maximize the use of rigid instruments, minimize the risk of complications and attain stone-free status. Familiarity with basic renal anatomy is essential to obtain access safely. Adherence to basic principles allows the establishment of percutaneous access in a straightforward and efficient manner. Certain clinical situations may require special access techniques. CONCLUSIONS: Percutaneous nephrolithotomy is the treatment of choice for complex stone disease. While the efficacy of percutaneous nephrolithotomy relies on the establishment of effective percutaneous access, there are considerable advantages for the urologist able to achieve access.     

Analysis of the transition to percutaneous placement of Greenfield filters

To establish whether a transition from surgical to percutaneous placement of Greenfield filters was justified, a review of the safety, efficacy, and cost-effectiveness of the two approaches was conducted. Between 1984 and 1989, 168 filters were placed in 169 patients, 48 surgically and 120 percutaneously. Placement was successful in 45 (94%) of the 48 surgical patients and 120 (99%) of the 121 percutaneous patients. Filter misplacement occurred in three (6%) surgical patients and no percutaneous patients. Clinically evident femoral vein thrombosis occurred in only four (5%) of the percutaneous patients, while inferior vena cava thrombosis occurred in three (3%) of the percutaneous patients. One pulmonary embolus occurred after percutaneous filter placement and resulted in death. The cost of percutaneous placement was 58% that of surgical placement. A retrospective review of the experience in our patient population indicates that safety, cost, and ease of insertion make the percutaneous approach the procedure of choice for Greenfield filter placement.     

Management of staghorn calculus: single puncture with judicious use of the flexible nephroscope

PURPOSE OF REVIEW: To focus on the technique and results of a single percutaneous puncture for the management of staghorn renal calculi. RECENT FINDINGS: The success rate for treating staghorn calculi with a single percutaneous puncture is over 90%. Animal and clinical studies seem to suggest that a single percutaneous access may be associated with reduced morbidity when compared with multiple percutaneous access punctures. SUMMARY: A single percutaneous access, whenever feasible, offers reduced morbidity without compromising excellent stone-free rates in the management of staghorn calculi.     

Pleural dissemination of cholangiocarcinoma caused by percutaneous transhepatic biliary drainage during the management of resectable cholangiocarcinoma

BackgroundOnly 3 case reports have addressed pleural dissemination in association with percutaneous transhepatic biliary drainage. The aim of this study was to investigate recurrence after resection of cholangiocarcinoma after percutaneous transhepatic biliary drainage and to clarify the incidence of and the factors responsible for pleural dissemination.MethodsBetween 2001 and 2015, we reviewed retrospectively all consecutive patients who underwent resection for perihilar or distal cholangiocarcinoma after percutaneous transhepatic biliary drainage for recurrence, including pleural dissemination.ResultsDuring the study period, all consecutive patients underwent resection of cholangiocarcinoma after management with percutaneous transhepatic biliary drainage. Of these, 100 patients (32.1%) underwent left-sided percutaneous transhepatic biliary drainage alone, and 212 (67.9%) underwent right-sided percutaneous transhepatic biliary drainage with or without left-sided percutaneous transhepatic biliary drainage. Pleural dissemination, which developed exclusively on the right side of the thoracic cavity after resection, was found in 12 patients (3.8%); these patients underwent right-sided percutaneous transhepatic biliary drainage; computed tomography demonstrated that the percutaneous transhepatic biliary drainage catheter passed through the thoracic cavity in all 12 patients. The diagnosis of pleural dissemination was made at a median of 381 days (range, 44 to 2,944 days) after operation. Survival was poor, with a median survival time of 516 days. Statistically, right-sided percutaneous transhepatic biliary drainage was identified as a risk factor for pleural dissemination.ConclusionPleural dissemination after right-sided percutaneous transhepatic biliary drainage is likely a procedure-related iatrogenic complication because of the “special route” by which the percutaneous transhepatic biliary drainage catheter must be passed through the right thoracic cavity.     

Percutaneous kidney surgery. Puncture and dilatation in the hands of the surgeon

The technique of puncture and dilatation "in the hands of one" is described in detail based on over 800 percutaneous operations on the kidney. All of the steps of the operation were carried out by the urologist himself. The advantages are presented and two new percutaneous instruments are introduced: a percutaneous working sheath and the lumbotome, a wire-guided, double blade knife for cutting the percutaneous tract.     

Long-term results of percutaneous and open surgery for trigger fingers and thumbs

Trigger digits can be treated surgically using a percutaneous or an open technique. The aim of this study was to evaluate the long-term results of the percutaneous and open surgery for trigger digits. The long-term results of 266 percutaneously released trigger digits and 70 open released trigger digits were evaluated. Recurrence of triggering occurred in 1% of patients after percutaneous release and 2% of patients after open release. After a mean follow-up period of 2.5 years, 17% of patients still had mild residual pain and 16% still had stiffness of the treated finger after percutaneous surgery. The open surgery group had a follow-up period of 5.5 years. Mild residual pain and stiffness persisted in 8% and 16%, respectively. After percutaneous surgery 3 (1%) patients suffered sensory loss on the radial side of the thumb. Compared to open surgery, percutaneous surgery resulted in significantly less scar formation. Ninety-six percent and 98% of patients were either satisfied or very satisfied with the result after percutaneous and open surgery, respectively. Both percutaneous and open surgery for the treatment of trigger digits have similar excellent long-term results.     

Percutaneous techniques in the thoracic and lumbar spine

Techniques of percutaneous spinal instrumentation have in the meantime become standard methods in many hospitals. While several indications have been established that are excellently suited to this technique, uncertainty prevails for other indications. This contribution intends to clarify the technical prerequisites for performing percutaneous instrumentation in the region of the thoracic and lumbar spine in addition to describing customary indications and various techniques of percutaneous instrumentation. This is combined with a critical assessment of what intrinsically cannot or cannot yet be achieved with a percutaneous approach to illustrate that the percutaneous procedure can by no means be considered a mere evolution of the previous classic open techniques.     

The potential impact of percutaneous pulmonary valve stent implantation on right ventricular outflow tract re-intervention.

OBJECTIVE: To assess the impact of a percutaneous technique for pulmonary valve implantation on the conventional surgical valve/conduit approach to right ventricular outflow tract re-intervention. METHODS: We have retrospectively reviewed our results following surgical or percutaneous re-intervention to the right ventricular outflow tract in both paediatric and adult groups. Between November 1998 and March 2004, 94 patients underwent surgical re-intervention to the right ventricular outflow tract. Percutaneous pulmonary valve implantation was introduced in October 2002 and 35 procedures were performed to March 2004. The median age was 26 years (6-65 years) in the surgical group and 16 years (9-39 years) in the percutaneous group. Tetralogy of Fallot was the commonest original diagnosis (64.9 and 62.9%, respectively). The predominant indication for re-intervention in the surgical group was pulmonary regurgitation (64.9%) compared to the percutaneous group in which it was homograft/conduit stenosis or a mixed lesion (68.6%). RESULTS: There has been one (1.1%) early death reported in the surgical series and none in the percutaneous group. In the surgical group 9 (9.6%) experienced a procedural complication whilst 3 (8.5%) of those undergoing a percutaneous valve experienced a significant procedural event necessitating urgent surgery. Important early morbidity was 8 (8.5%) in the surgical group and 2 (5.7%) in the percutaneous group. Freedom from re-operation at 1 year was 100% in the surgical group and 86.1% in the percutaneous group due to late restenosis. Median hospital stay in the surgical group was 7 (4-114) days and 2 (2-22) days in the percutaneous group. CONCLUSIONS: Preliminary data suggests that percutaneous pulmonary valve implantation provides a promising additional and complementary approach to a successful surgical programme. Both approaches are safe with acceptable levels of morbidity and low mortality. With current technology the aneurysmal outflow tract remains a problem for the percutaneous approach. Follow-up remains too short, at present, to prove longevity of the percutaneous conduit.     

Percutaneous litholapaxy

The technique of puncture and dilatation 'in the hands of one' is described in detail based on almost 800 percutaneous operations on the kidney. All of the steps of the operation were carried out by the urologist himself. The advantages are presented and two new percutaneous instruments are introduced: a percutaneous working sheath and the lumbotome, a wire-guided, double-blade knife for cutting the percutaneous tract. The principle of percutaneous stone operation is explained as well as special complications which can occur. Finally, statistic results are discussed which clearly show a remarkable decrease of the residual and recurrent stone rate in comparison to conventional kidney stone surgery.     

The roles of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy in the management of pyelocaliceal diverticula

Various combinations of extracorporeal shock wave lithotripsy (ESWL*) and percutaneous nephrostolithotomy were used in the treatment of 40 stone-containing caliceal diverticula in 39 patients (16 men and 23 women). Only 1 of 26 patients (4%) treated with ESWL as a single modality became stone-free, although 9 (36%) became asymptomatic. Ten patients undergoing ESWL primarily eventually required percutaneous nephrostolithotomy due to persistence of symptoms and all became stone-free. A total of 14 patients underwent a percutaneous approach as a single modality, and the diverticula in 13 of these patients became stone-free, although 2 patients did have residual parenchymal fragments. Therefore, 21 of 24 patients (87.5%) became completely free of stones using the percutaneous approach. All patients managed with percutaneous nephrostolithotomy became free of symptoms. The complex nature of access during percutaneous nephrostolithotomy favors a 1-stage approach with direct puncture into the stone-containing diverticulum. Simultaneous fulguration of the diverticulum at percutaneous nephrostolithotomy is favored, since all 17 patients in whom this technique was used had complete obliteration of the diverticulum on followup contrast studies. These data suggest that caliceal diverticula should be managed with percutaneous nephrostolithotomy, since ESWL monotherapy is unlikely to produce a stone-free or symptom-free status.     

Percutaneous nucleotomy in the current treatment concept of lumbar ischialgia]

As a minimal invasive alternative to open disc surgery percutaneous nucleotomy has remarkably development for the treatment of contained lumbar herniation. In our experience since 1979, today available percutaneous concepts have to be clearly individualized in their range of indication following their specific technical limits. So a direct correlation of operative results remain restricted on overlapping ranges of indications. Progress in the technical field, in correlation with discoscopy, introduced since 1982, brought percutaneous interbody fusion in 1988, alloplastic percutaneous implants are in development. This facts let us foresee a remarkable evolution of percutaneous spine surgery comparable to arthroscopic knee surgery in the near future.     

Therapeutic strategy of perioperative use of percutaneous cardiopulmonary bypass support (PCPS) for adult cardiac surgery

Subject and method: Percutaneous cardiopulmonary bypass support is beneficial for patients with circulatory collapse. However, therapeutic strategies of percutaneous cardiopulmonary bypass support for post-cardiotomy LOS have not been determined. We reviewed 9 patients undergoing cardiac surgery and treated with percutaneous cardiopulmonary bypass support to determine an adequate strategy for perioperative use of percutaneous cardiopulmonary bypass support. Patients included 8 males and 1 female with a mean age of 56.4 ± 3.9 years. Six patients with IHD underwent CABG for 5 and CABG + MVR for 1 patient and 3 patients with valvular disease underwent AVR, AVR + MVR, and Ross operation respectively. Indication for percutaneous cardiopulmonary bypass support was post-cardiotomy LOS in 7 and preoperative cardiogenic shock in 2 patients. All patients underwent IABP associated with percutaneous cardiopulmonary bypass support. Systemic blood pressure was regulated to 100–120 mmHg by percutaneous cardiopulmonary bypass support flow and with minimum inotropic supports.Results: Six of 9 patients (66.7%) were weaned from percutaneous cardiopulmonary bypass support and 5 patients were discharged. Five of 6 patients (83.3%) with IHD were weaned from percutaneous cardiopulmonary bypass support compared to 1 of 3 patients (33.3%) (p=0.134) with valvular disease. Hemodynamic conditions in patients weaned from percutaneous cardiopulmonary bypass support were markedly improved within 40 hours of the introduction of percutaneous cardiopulmonary bypass support (mean percutaneous cardiopulmonary bypass support running time: 23.9 ± 5.5 hrs). In contrast, those unable to be weaned from percutaneous cardiopulmonary bypass support (mean percutaneous cardiopulmonary bypass support running time: 84.3 ± 6.3 hrs) showed no improvement and developed major complications such as cerebral damage or multiorgan failure.Conclusions: Perioperative use of percutaneous cardiopulmonary bypass support may be more effective for patients undergoing coronary artery surgery. Limited use of percutaneous cardiopulmonary bypass support within 48 hours may be applicable for post-cardiotomy patients.     

The significance of atypical lobular hyperplasia at percutaneous breast biopsy

Atypical lobular hyperplasia (ALH) is occasionally found in specimens obtained by percutaneous stereotactic vacuum-assisted breast biopsy for microcalcifications. Since malignancy is often found at surgical excision when atypical ductal hyperplasia is found at percutaneous biopsy, we reviewed our pathologic findings from surgery for ALH at percutaneous biopsy. This was a retrospective review of all percutaneous breast biopsy specimens for mammographic microcalcifications obtained from a single institution over a 30-month period. The pathologic findings from percutaneous biopsy were correlated with the radiologic appearance and the pathology from surgical excision. ALH was found in 13 of 766 (1.7%) stereotactic vacuum-assisted core needle biopsies performed for mammographic microcalcifications. Subsequent surgery in six patients revealed ductal carcinoma in situ (DCIS) in two patients and one case of invasive ductal carcinoma. Surgical excision is indicated for areas with ALH discovered by percutaneous biopsy for mammographic microcalcifications.     

Repair of the achilles tendon rupture: a functional comparison of three surgical techniques.

A retrospective comparison of three surgical procedures for the acute treatment of closed ruptures of the Achilles tendon is presented: 1) open repair, 2) a percutaneous technique, and 3) a combined mini-open and percutaneous technique. The authors compared the results of 52 tendon ruptures, including 15 open repairs, 15 percutaneous repairs, and 22 combined repairs, with minimal follow-up of 12 months. The authors evaluated the parameters of strength, performance, use of shoes, time of returning to work, range of ankle motion, calf circumference, pain, ability to perform 20 toe-raises on each side, and MRI findings. In comparison to the uninjured leg, the strength of the involved extremity was 74% in the patients with an open repair, 88% in patients with a percutaneous repair, and 92% in the combined mini-open and percutaneous procedure. The combined mini-open and percutaneous repair gave significantly better results than the other surgical procedures. On MRI, the area of the posterior calf of the injured leg, in comparison to the contralateral uninjured leg was 82% in open repair, 81% in the percutaneous procedure, and 91% in combined mini-open and percutaneous procedure. These differences were found to be statistically significant (p < .01). On the basis of their results, the authors prefer to perform the combined percutaneous and mini-open repair of Kakiuchi for the repair of acute Achilles tendon ruptures.     

Prospective randomized comparison of intravesical with percutaneous bacillus Calmette-Guerin versus intravesical bacillus Calmette-Guerin in superficial bladder cancer

Conflicting reports of the necessity for percutaneous bacillus Calmette-Guerin (BCG) administration with intravesical BCG prompted us to evaluate its benefit in a randomized prospective comparison of intravesical versus intravesical with percutaneous BCG therapy. Intravesical Tice BCG was given in a dose of 50 mg. with or without percutaneous BCG weekly for 6 weeks, at 8, 10 and 12 weeks, at 6 months and every 6 months thereafter. Tumor recurrence was documented in 13 of 30 patients (43%) receiving only intravesical BCG and in 15 of 36 patients (42%) receiving intravesical plus percutaneous BCG. The addition of percutaneous BCG to intravesical therapy did not increase treatment efficacy in this study.     

Cephalad renal movement during percutaneous nephrostolithotomy

The change in the position of the kidney during percutaneous nephrostomy is a major concern to urologists who participate in percutaneous stone removal. We report that the majority of kidneys ascend an average of 2.2 cm. when the patient turns from a supine to a prone position. This change in position is more marked on the right side and is more common in male patients. Knowledge of this anatomical variation is important to determine which patients are suitable candidates for percutaneous nephrostolithotomy and to plan a percutaneous approach to a renal or ureteral calculus.     

经皮肾微造瘘联合二期经皮肾镜碎石术治疗上尿路结石并感染性休克12例报告

目的：探讨经皮肾微造瘘联合二期经皮肾镜碎石术治疗上尿路结石并感染性休克的临床疗效。方法：对12例上尿路石并感染性休克患者在积极抗感染及抗休克治疗的同时行经皮肾微造瘘术,并于术后1～4周行二期经皮肾镜碎石术。结果：12例患者。肾造瘘术均顺利完成,感染及休克症状得到控制。二期手术均顺利完成,结石基本完全清除。结论：对于上尿路结石并感染性休克患者,早期行经皮肾脏微造瘘能有效控制感染及休克症状,联合二期经皮肾镜碎石术能完整清除结石,临床效果满意。     

A comparison of coronary artery bypass grafting and percutaneous transluminal coronary angioplasty in patients on hemodialysis

The hospital records of 22 patients on hemodialysis undergoing coronary artery bypass grafting, and 19 others undergoing percutaneous transluminal coronary angioplasty were reviewed to compare the outcomes of these procedures in this population. Evidence of previous myocardial infarction or triple vessel or left main coronary artery disease was more common in patients undergoing coronary artery bypass graft than those undergoing percutaneous transluminal coronary angioplasty. Perioperative mortality and complication rates following coronary artery bypass graft (4.5% and 41%, respectively) were similar to those following percutaneous transluminal coronary angioplasty (5.3% and 42%). Cardiac event-free rates at 18 months by life-table analysis following coronary artery bypass graft and percutaneous transluminal coronary angioplasty were 87±16% and 40±14%, respectively. Survival at 18 months were 67±17% following coronary artery bypass graft and 69±14% following percutaneous transluminal coronary angioplasty. Cardiac events were observed to occur in three patients undergoing coronary artery bypass graft at a median of 10 months, and in nine patients following percutaneous transluminal coronary angioplasty at a median of 6 months. One patient required percutaneous transluminal coronary angioplasty after the initial coronary artery bypass graft. Seven patients required repeat percutaneous transluminal coronary angioplasty, and two patients underwent coronary artery bypass graft after initial percutaneous transluminal coronary angioplasty. Although these conclusions are limited by the retrospective nature of the study, it is concluded that coronary artery bypass graft can be performed with morbidity and mortality equivalent to percutaneous transluminal coronary angioplasty, and provides better cardiac event-free rates than percutaneous transluminal coronary angioplasty in patients on hemodialysis. Percutaneous transluminal angioplasty does not appear to be justified in this population because of its unacceptably high restenosis and cardiac event rates.