C臂数字减影X线引导在建立经皮肾通道的应用

目的:探讨C臂数字减影X线引导在经皮肾镜取石术(PCNL)建立经皮肾通道的应用效果.方法:在C臂数字减影X线机透视下对320例上尿路结石患者一期建立经皮肾通道.结果:320例患者穿刺成功率100%,其中双侧肾穿刺19例,单侧双通道34例.建立经皮肾通道时间10～90 min,平均30 min.无一例发生大出血、肾盂穿孔、脏器损伤等严重并发症.结论:C臂数字减影X线机下在PCNL中建立经皮肾通道穿刺成功率高,并发症少,具有重要的应用价值.     

Simultaneous bilateral percutaneous nephrolithotomy in children

In the paediatric section, two papers relating to the upper urinary tract are presented. The first, from Hungary, describes simultaneous bilateral percutaneous nephrolithotomy in 13 patients, where it was deemed feasible; this is the first such report. Authors from London report on unilateral nephrectomy in patients with nephrogenic hypertension, and found that it was successful in normalising blood pressure in patients with renal hypertension with a normal contralateral kidney. OBJECTIVE: To evaluate the efficacy of removing bilateral kidney stones simultaneously from children, in one session. PATIENTS AND METHODS: Thirteen patients (three girls and 10 boys, 26 kidneys; mean age 8 years, range 3-14) underwent simultaneous bilateral percutaneous nephrolithotomy (PCNL) in the same session, under general anaesthesia, starting with ureteric catheter insertion into both kidneys and using a 26 F adult nephroscope. The mean (range) stone diameter was 2 (1-3.5) cm. Three patients had staghorn stones in one of their kidneys. Ultrasonic disintegration was used; two patients had bilateral and two others unilateral endopylotomy, and one patient had percutaneous suprapubic cystolithotomy in the same session. The mean (range) operative duration was 65 (55-90) min. RESULTS: All patients were rendered stone-free; there was no severe bleeding or any other complication. On one side in one of the patients, a second session was needed because of residual stone. The nephrostomy tubes were removed 3 and 4 days after PCNL and the hospital stay was 6 (1-11) days. CONCLUSION: The advantages of simultaneous bilateral PCNL are reduced psychological stress, one cystoscopy and anaesthesia, less medication and a shorter hospital stay and convalescence, with considerable savings in cost. In experienced hands this method can be used not only in adults but also in children. To our knowledge this is the only report of this technique in children.     

无管化标准通道经皮肾镜取石术治疗上尿路结石67例

目的探讨无管化标准通道经皮肾镜取石术在治疗上尿路结石方面的疗效及安全性。方法回顾性分析2008年1月至2013年7月采用无管化标准通道经皮肾镜取石术治疗67例上尿路结石患者的临床资料。其中单发肾结石24例,多发肾结石13例,不完全性鹿角形结石8例,连接部及输尿管上段结石22例,结石最大直径0．9～3．0cm。我们对于非复杂型上尿路结石,肾皮质厚度≥1cm、无严重尿路感染、无活动性出血、无集合系统穿透性损伤及满意的清石病例,术后仅留置双J管而不放置肾造瘘管。结果所有患者均一期手术成功。平均手术时间36．7±2．3min;术后第l天疼痛评分为2．9±1．5mm,术后平均住院时间（4．1±0．8）d;术前、后平均血红蛋白下降值为（1．0±0．5）μ/L;结石清除率100％。无输血病例及选择性肾动脉栓塞病例;无感染性休克和肾周积液发生。结论在经过严格筛选病例基础上,无管化标准通道经皮肾镜取石术治疗上尿路结石是安全可行的。     

Percutaneous nephrolithotomy: keeping the bridge for one night

This study was conducted to compare nephrostomy-free percutaneous nephrolithotomy (PCNL) with early nephrostomy tube removal (after 1 day). A prospective study started from January 2008 through December 2009 and included patients who underwent non-complicated PCNL through a single tract without intra-operative residual stones. Nephrostomy-free technique was performed during 2008 (nephrostomy-free group). During 2009, a nephrostomy tube was placed for 1 day (1-day nephrostomy group). Both groups were compared for post-operative events, dose of analgesia, hemoglobin deficit and hospital stay. The study included 55 patients (27 in nephrostomy-free group and 28 in 1-day nephrostomy group). There were no statistically significant differences between patients, renal and stone characteristics of both groups. Post-operative events were significantly more in nephrostomy-free group (26 vs. 14.3%, p = 0.039). They include hematuria in three (11.1%) of nephrostomy-free patients and one (3.6%) of 1-day nephrostomy patient, severe renal colic in four patients of nephrostomy-free group (14.8%), and temporary urinary leakage via the nephrostomy site in three patients of 1-day nephrostomy group (10.7%). Mean dose of post-operative analgesia, mean hemoglobin deficit and hospital days were comparable for both groups (p = 0.946, 0.541, 0.807, respectively). A second look PCNL was performed through the already present tract to retrieve residual stones in two patients with nephrostomy. In conclusion, 1-day nephrostomy technique after PCNL showed significantly better post-operative course. It was comparable to nephrostomy-free technique in analgesic requirements and hospital stay. The nephrostomy tube provided a bridge for second look nephroscopy.     

Cauterization of access tract for nephrostomy tube-free percutaneous nephrolithotomy

BACKGROUND AND PURPOSE: Percutaneous nephrolithotomy (PCNL) is now a popular method for removal of renal and ureteral stones. Placement of a nephrostomy tube after the completion of PCNL has been considered a standard procedure by most urologists, but some authors have recently challenged this practice. Bleeding is one of the most prevalent problems after nephrostomy tube-free percutaneous renal surgery. To diminish the possibility of postoperative bleeding, we cauterized the PCNL tract to make it bloodless. The efficacy and safety of this procedure were reviewed in this study. PATIENTS AND METHODS: From March 2001 to March 2003, 51 patients underwent PCNL with a one-stage procedure and a single access tract. The stone size ranged from 1.0 to 7.0 cm (mean 2.7 +/- 1.4 cm). A holmium:YAG laser and pneumatic lithotripter were used. After stone extraction, a 6F double-J catheter was inserted antegrade. The access tract was checked, and the bleeding points were cauterized. No nephrostomy tube was inserted, but a Penrose drain was left overnight. Perforation of the collecting system was not a contraindication to tubeless PCNL. RESULTS: The stone-free rate was 80.4%, including five patients with complete staghorn stones. Twenty-one patients required postoperative analgesics. Only one patient had urine leakage for longer than 24 hours. Transient low fever was noted in five patients, but no patient experienced severe urinary tract infection. Delayed hemorrhage (1 week after the operation) secondary to irritation by the double-J ureteral stent was noted in one patient. The average postoperative hospital stay was 2.2 days (range 1-3 days). No patient required a blood transfusion. No urinoma was noted on the postoperative ultrasound follow-up. CONCLUSION: Nephrostomy tube-free percutaneous renal surgery is a safe and effective procedure for selected patients with minimal hemorrhage after PCNL. Cauterization of tract bleeding points may make this modification a more secure procedure and make it suitable for more patients.     

局部浸润麻醉超声引导下经皮肾镜取石术

目的探讨局部浸润麻醉下超声引导经皮肾穿刺取石术（PCNL）治疗肾结石或输尿管上段结石的方法及效果。方法该组42例肾结石或输尿管上段结石均采用超声引导，局部浸润麻醉下行经皮肾穿刺取石术。结果42例均一期穿刺造瘘成功，39例一期成功PCNL，3例患者因脓肾改行二期PCNL，一期手术结石清除率为83．8％。手术时间为15～80min，平均55min，无严重并发症。结论局麻下超声引导PCNL治疗多发性肾结石或输尿管上段结石具有操作简单、创伤小、并发症少、恢复快、结石清除率高等优点，可作为部分简单肾结石或输尿管上段结石的治疗方法。     

Percutaneous nephrolithotomy requiring multiple tracts: comparison of morbidity with single-tract procedures

PURPOSE: To compare the morbidity of percutaneous nephrolithotomy (PCNL) requiring multiple percutaneous tracts with that of procedures requiring a single tract for calculus clearance. PATIENTS AND METHODS: Data from 20 patients undergoing PCNL through two or more percutaneous renal tracts over a 1-year period were compared with a contemporary cohort of 20 patients undergoing PCNL requiring a single tract. The mean stone size was 2157 mm(2) v 423 mm(2) (P < 0.0001), the baseline serum creatinine concentration was 1.67 mg/dL v 1.13 mg/dL (P < 0.05), and the baseline hemoglobin concentration was 11.8 g/dL v 13.4 g/dL (P < 0.05) in the multiple- and single-tract groups, respectively. RESULTS: All single-tract and 95% of multiple-tract patients were rendered stone free. The mean drop in hemoglobin was similar in the two groups (2.3 g/dL for single tract v 2.1 g/dL for multiple tracts; P = 0.55). Complications occurred in two patients in each group. Four multiple-tract patients required blood transfusion. The need for transfusion correlated with lower preoperative hemoglobin and higher preoperative serum creatinine. There was a significant rise in serum creatinine (1.67 mg/dL to 1.91 mg/dL; P < 0.05) and drop in creatinine clearance (76.9 mL/min to 67.2 mL/min; P < 0.05) in the multiple-tract group; this was more pronounced in patients with existing renal insufficiency. No significant change in renal function was seen in the single-tract group. CONCLUSIONS: Monotherapy with PCNL utilizing multiple percutaneous tracts is highly effective in the treatment of staghorn and other large-volume renal calculi. Blood loss and complication rates with such an aggressive approach are comparable to those of PCNL incorporating a single percutaneous tract for more straightforward calculi.     

Tubeless percutaneous nephrolithotomy: a prospective feasibility study and review of previous reports

OBJECTIVE: To evaluate the status of tubeless percutaneous nephrolithotomy (PCNL) in managing renal and upper ureteric calculi, from initial experience and a review of previous reports. PATIENTS AND METHODS: From September 2004 to December 2004, 46 patients were scheduled for tubeless PCNL in a prospective study. Patients with solitary kidney, or undergoing bilateral simultaneous PCNL or requiring a supracostal access were also enrolled. Patients needing more than three percutaneous access tracts, or with significant bleeding or a significant residual stone burden necessitating a staged second-look nephroscopy were excluded. At the end of the procedure, a JJ ureteric stent was placed antegradely and a nephrostomy tube avoided. The patients' demographic data, the outcomes during and after surgery, complications, success rate, and stent-related morbidity were analysed. Previous reports were reviewed to evaluate the current status of tubeless PCNL. RESULTS: Of the 46 patients initially considered only 40 (45 renal units) were assessed. The mean stone size in these patients was 33 mm and 23 patients had multiple stones. Three patients had a serum creatinine level of >2 mg/dL (>177 micromol/L). Five patients had successful bilateral simultaneous tubeless PCNL. In all, 51 tracts were required in 45 renal units, 30 of which were supracostal. The mean decrease in haemoglobin was 1.2 g/dL and two patients required a blood transfusion after PCNL. There was no urine leakage or formation of urinoma after surgery, and no major chest complications in patients requiring a supracostal access tract, except for one with hydrothorax, managed conservatively. The mean hospital stay was 26 h and analgesic requirement 40.6 mg of diclofenac. Stones were completely cleared in 87% of renal units and 9% had residual fragments of < 5 mm. Two patients required extracorporeal lithotripsy for residual calculi. In all, 30% of patients had bothersome stent-related symptoms and 60% needed analgesics and/or antispasmodics to treat them. CONCLUSION: Tubeless PCNL was safe and effective even in patients with a solitary kidney, or with three renal access tracts or supracostal access, or with deranged renal values and in those requiring bilateral simultaneous PCNL. The literature review suggested a need for prospective, randomized studies to evaluate the role of fibrin sealant and/or cauterization of the nephrostomy tract in tubeless PCNL.     

Nephrostomy tube after percutaneous nephrolithotomy: large-bore or pigtail catheter?

BACKGROUND AND PURPOSE: A nephrostomy tube is an integral part of any percutaneous renal surgery. Commonly, a nephrostomy tube that is 2F to 3F smaller than the percutaneous tract is used after percutaneous nephrolithotomy (PCNL). In our experience, quite a few patients have pain at the nephrostomy tube site, and many patients complain of a prolonged urinary leak after tube removal when a large nephrostomy tube is used. This prospective study was planned to document whether these symptoms could be attributed to the size of the nephrostomy tube and whether a small pigtail catheter could reduce these problems without increasing complications. PATIENTS AND METHODS: Forty well-matched patients in whom a one-stage PCNL was done for calculus disease were studied prospectively. Alternate patients had a 28F nephrostomy tube or a 9F pigtail catheter placed at the end of the procedure. Patients were observed for the duration of hematuria, number of analgesic injections needed, and the duration of urinary leak after tube removal. RESULTS: The groups were comparable in the amount and duration of hematuria after PCNL. There was a statistically significant difference in the analgesic need and the duration of urinary leak after tube removal, both of which were less in patients having a pigtail catheter. CONCLUSIONS: A pigtail catheter nephrostomy tube after PCNL reduces the hospital stay by reducing the duration of the urinary leak. The postoperative course is smooth, as patient has less pain and needs less analgesic support. There is no statistically significant increase in the postoperative bleeding secondary to use of a pigtail catheter. Second-look nephroscopy was easy in the one patient with a pigtail nephrostomy catheter who needed the procedure.     

The effect of local anesthetic infiltration around nephrostomy tract on postoperative pain control after percutaneous nephrolithotomy

The objective of the study was to investigate the effect of a long acting local anesthetic infiltration around nephrostomy tract on pain control after percutaneous nephrolithotomy. Forty-six patients with kidney stones of >2 cm undergoing single access subcostal percutaneous nephrolithotomy (PCNL) were enrolled in the study. Patients were randomized to levobupivacaine (Group I) and saline (Group II) infiltration groups. Group I patients (n = 23) had 75 mg/30 cc levobupivacaine infiltration around the access site after placement of nephrostomy catheter. Group II patients had 30 cc saline infiltration. Postoperatively the patients were given narcotics on demand. Pain scores were collected using a visual analog scale (VAS) at 2, 4, 6, 8, 12 and 24 h postoperatively. The VAS scores, time to analgesic demand, ambulation, and duration of nephrostomy tube were compared between two groups. The mean age was 44 and 45 years in group I and II patients. There were no significant differences between the two groups with regard to demographics, surgery or stone characteristics. Comparison of pain scores at all postoperative time points was not statistically significant between the two groups. Time to first analgesic demand and total narcotic analgesic dose per patient were 1.2 ± 1.05 and 4.04 ± 1.57 h; and 96 and 112 mg for group I and II patients (p = 0.009 and p = 0.41, respectively). Ambulation time and duration of nephrostomy tube were also similar. Infiltration of nephrostomy tract site with levobupivacaine does not have a superior effect compared to saline on postoperative pain control in patients undergoing PCNL.To prolong analgesia, the effect of intermittent tract injections or continuous infusion of local anesthetics for the postoperative maintenance of the local anesthetic effect seems worth to investigate in future studies.     

Endourological renal salvage in patients with calculus nephropathy and advanced uraemia.

OBJECTIVE: To document our experience with percutaneous nephrolithotripsy (PCNL) for the treatment of calculus nephropathy and advanced renal failure. PATIENTS AND METHODS: Between October 1989 and April 1996, 78 patients with calculus nephropathy (51 males and 27 females, mean age 42 years, range 16-67; mean serum creatinine level 663.8 micromol/L, range 282.8-1449.7) were treated in our department. Forty-six of the patients had bilateral upper urinary calculi, while the remaining 32 had a solitary functioning kidney obstructed by stone. Thirty-two patients had a normal urine output, 26 were oliguric and 20 presented with anuria. A preliminary percutaneous nephrostomy (PCN) was performed under local anaesthesia in 64 patients, and stone retrieved subsequently through the same nephrostomy track after improvement in their uraemic status. In the remaining 14 patients, the stones were removed at the first session. Of the 46 patients with bilateral stones, 21 underwent stone retrieval by PCNL on the contralateral side after an interval of 2-3 weeks, while 25 patients underwent simultaneous JJ stenting on the contralateral side, followed, after improvement in uraemic status, by delayed PCNL or extracorporeal shock wave lithotripsy on that side. RESULTS: There were three deaths, caused by overwhelming sepsis; 64 of the remaining 75 patients recovered well from uraemia, while 11 showed no improvement, suggesting irreversible renal damage. Complications included five patients with nonfatal sepsis and five with secondary haemorrhage. At the last follow-up 2.5-9 years after presentation, the mean serum creatinine level (271.3 micromol/L) was significantly better than the mean preoperative level. Six patients are on maintenance haemodialysis. CONCLUSIONS: It is not uncommon in developing countries for patients with urolithiasis to present with advanced uraemia caused by long-standing obstruction, almost invariably complicated by infection. A percutaneous endourological approach offers the best hope for these patients, and in our experience a significant percentage of these cases can be salvaged.     

Impact of percutaneous nephrolithotomy on estimated glomerular filtration rate in patients with chronic kidney disease

BACKGROUND AND PURPOSE: We investigated the impact of percutaneous renal procedures on estimated glomerular filtration rate (GFR) of patients with chronic kidney disease (CKD). PATIENTS AND METHODS: The GFRs of adult patients were calculated using the Modification of Diet in Renal Disease formula, and the patients were staged according to the Kidney Disease Outcome Quality Initiative CKD classification system. The study included 185 patients with preoperative GFR values less than 60 mL/min/1.73 m(2). The impact of percutaneous nephrolithotomy (PCNL) on GFR was analyzed by comparing the preoperative GFR with the GFR before discharge and at postoperative month 3. RESULTS: Patients with CKD had a significant increase in the GFR after the procedure. In postoperative month 3, the mean GFR was more than 60 mL/min/1.73 m(2) in 25% of the patients with CKD and less than 60 mL/min/1.73 m(2) in 75%. While all patients with stage 5 CKD improved to better stages, some other patients' conditions declined to stage 5 from better stages at the end of postoperative month 3. No patient needed dialysis. The presence of urinary tract infections tended to affect GFR negatively. CONCLUSION: Estimated GFR, as a better indicator of renal function, is significantly affected by the PCNL procedure. While significant improvement was observed in late-stage patients with CKD, unexpected deterioration could occur in patients at earlier stages.     

A prospective randomized comparison of type of nephrostomy drainage following percutaneous nephrostolithotomy: large bore versus small bore versus tubeless

PURPOSE: We compared postoperative outcomes among tubeless, conventional large bore nephrostomy drainage and small bore nephrostomy drainage following percutaneous nephrostolithotomy (PCNL) in a prospective randomized fashion. MATERIALS AND METHODS: Between January and June 2001, 30 patients undergoing PCNL were randomized to receive conventional large bore (20Fr) nephrostomy drainage (group 1, 10 patients), small bore (9Fr) nephrostomy drainage (group 2, 10 patients) or no nephrostomy drainage (group 3, 10 patients). Inclusion criteria included a single subcostal tract, uncomplicated procedure, normal preoperative renal function and complete stone clearance. Factors compared among the 3 groups were postoperative analgesia requirement, urinary extravasation, duration of hematuria, duration of urinary leak, decrease in hematocrit and hospital stay. RESULTS: The postoperative analgesic requirement was significantly higher in group 1 (217 mg) compared to groups 2 (140 mg, p <0.05) and 3 (87.5 mg, p <0.0001). Patients in group 3 had a significantly shorter duration (4.8 hours) of urinary leak through the percutaneous renal tract compared to patients in groups 1 (21.4 hours, p <0.05) and 2 (13.2 hours, p <0.05). Hospital stay was significantly shorter in group 3 (3.4 days) compared to groups 1 (4.4 days, p <0.05) and 2 (4.3 days, p <0.05). All 3 groups were similar in terms of operative time, duration of hematuria and decrease in hematocrit. Postoperative ultrasound did not reveal significant urinary extravasation in any case. CONCLUSIONS: Tubeless PCNL is associated with the least postoperative pain, urinary leakage and hospital stay. Small bore nephrostomy drainage may be a reasonable option in patients in whom the incidence of stent dysuria is likely to be higher.     

腹腔镜辅助经皮肾镜与输尿管软镜治疗盆腔异位肾结石的临床研究

目的探讨经腹途径腹腔镜辅助经皮肾镜碎石取石术（PCNL）和输尿管软镜碎石术（RIRS）治疗盆腔异位肾结石的临床疗效。 方法回顾性分析从2016年1月至2017年10月采用经腹途径腹腔镜辅助PCNL或RIRS手术方法治疗的6例盆腔异位肾结石病例。对患者术前的基本信息（包括年龄、性别、异位肾位置、结石大小、结石数量、结石位置、特殊病史）和术中、术后的基本情况（包括通道大小、手术时间、曲卡、肾造瘘管、腹腔引流管、双J管、结石清除率和住院时间）进行分析和总结。 结果腹腔镜辅助PCNL和RIRS的平均手术时间分别为92 min和85 min,其平均结石最大径分别为19 mm和12 mm。RIRS术后的平均住院时间（3 d）短于腹腔镜辅助PCNL（5 d）,其手术成功率分别为60%（3/5）和100%（3/3）。两种方法都没有严重并发症发生,术后复查均没有结石残留。 结论两种手术方法治疗盆腔异位肾结石均具有较高的安全性。RIRS在微创和住院时间方面具有优势,腹腔镜辅助PCNL则能够应对更大的结石负荷和更复杂的肾脏结构,其手术成功率亦相对较高。     

Advances in Tubeless Percutaneous Nephrolithotomy and Patient Selection: An Update

Percutaneous nephrolithotomy (PCNL) is the gold standard for the treatment of large renal calculi. Recently, modifications to the standard PCNL with nephrostomy tube placement have evolved, most notably the introduction of tubeless PCNL. Tubeless PCNL appears to decrease postoperative discomfort and shorten hospital stays, without increasing complication rates in the appropriately selected patient population. Urologists have attempted to expand the role of tubeless PCNL in more complex clinical scenarios, including pediatric and geriatric patients, and in stones complicated by multiple access tracts, renal anomalies or previous renal surgery. In an attempt to further improve outcomes following tubeless PCNL, adjunct interventions such as the use of hemostatic agents along the percutaneous access tract and local tract anesthetic have also been evaluated. We report the most recent published data over the past year, reviewing the employment and efficacy of tubeless PCNL, and discuss the selection of appropriate patients for this modified procedure.     

B超引导联合CT三维重建辅助穿刺定位结石性脓肾经皮肾镜取石术

目的 探讨B超引导联合螺旋CT三维重建技术辅助结石性脓肾经皮肾取石术中穿刺定位可行性及临床效果.方法 实验组24例脓肾结石,先Ⅰ期B超引导下经皮肾穿刺造瘘脓肿引流术,再行Ⅱ期CT三维重建辅助定位经皮肾镜取石术(PCNL).对照组21例脓性结石行静脉泌尿系造影(IVU)定位经皮肾镜取石术.结果 与对照组相比,实验组所有病...     

经皮肾镜取石术后不留置肾盂造瘘管的疗效评价

目的 评价经皮肾镜取石术(PCNL)后不放置肾盂造瘘管的疗效.方法 输尿管上段或肾结石行PCNL患者240例.男147例,女93例.年龄19～64岁,平均(48.5～9.4)岁.结石直径1.2～5.6 cm,平均(2.8±1.2)cm.患者入选标准:术前无尿路感染病史、单通道、碎石术中无明显出血、无需行二次经皮肾操作者.随机分2组:A组(n=120)术后不放置肾盂造瘘管,B组(n=120)术后放置14 F肾盂造瘘管.比较2组患者术后疼痛程度、需应用镇痛药例数、术后住院时间及漏尿发生率.结果240例患者均一期手术成功.A组术后6 h、第1天、第2天的疼痛评分分别为4.2±1.5、2.1±1.6和1.2±1.0,均显著低于B组的5.5±2.4、3.9士1.5和2.5±1.5,P值均<0.01;A组需使用镇痛药者18例,B组为32例(15.0%与26.7%,P<0.05),A组术后发生尿漏3例,B组28例(2.5%与23.3%,P<0.01),术后住院时间A组(1.7±0.6)d,B组(3.1±1.1)d,P<0.01.结论对于无尿路感染、一期手术、单通道、术中无明显出血的患者,PCNL术后不放置肾盂造瘘管可减轻患者痛苦和经济负担、缩短患者恢复时间,是安全可行的治疗方法.     

A randomized comparison of tubeless and standard percutaneous nephrolithotomy

PURPOSE: We present a randomized study of tubeless or nephrostomy-free percutaneous nephrolithotomy (PCNL), a modification of the standard technique, compared with standard PCNL to evaluate the role of tubeless PCNL in minimizing postoperative discomfort and reducing duration of hospital stay. PATIENTS AND METHODS: Two hundred and two patients undergoing PCNL were randomized to two groups: Group A (standard PCNL) with nephrostomy tube placement postoperatively, and group B (tubeless PCNL) with antegrade placement of a Double-J stent without nephrostomy. Inclusion criteria were: normal renal functions, single tract procedure with complete clearance, and minimal bleeding at completion. The two groups were comparable in age and sex and in metabolic and anatomic features. Factors evaluated included postoperative pain, analgesia requirement, blood loss, postoperative morbidity, hospital stay, and time to recovery. RESULTS: All patients had an uneventful postoperative recovery. The average visual analogue scale pain score on postoperative day 1 for group A patients was 59 +/- 5.1 compared with 31 +/- 4.8 in group B (P < 0.01). The mean analgesia requirement for group A (meperidine 126.5 +/- 33.3 mg) was significantly more compared with group B (meperidine 81.7 +/- 24.5 mg) (P < 0.01). The difference in average blood loss and urinary infection for the two groups was not statistically significant. The incidence of urinary leakage from the nephrostomy site was significantly less for the tubeless group (0/101), compared with the standard PNL group (7/101). The average hospital stay in the tubeless group (21.8 +/- 3.9 hours) was significantly shorter than that of the standard PCNL group (54.2 +/- 5 hours) (P < 0.01). Tubeless group patients took 5 to 7 days for complete convalescence whereas standard PCNL patients recovered in 8 to 10 days. No long-term sequelae were noticed in the median follow-up period of 18 months in any patient. CONCLUSION: Nephrostomy-free or tubeless PCNL reduces postoperative urinary leakage and local pain related to the drainage tube. It also minimizes hospital stay; the majority of patients were discharged from the hospital in fewer than 24 hours.     

经皮肾镜联合不同软镜治疗鹿角形肾结石的研究

目的：评价单通道经皮肾镜联合不同软镜下钬激光碎石治疗鹿角形肾结石的手术效果。方法：B超引导穿刺,单通道经皮肾镜联合膀胱软镜和输尿管软镜,行钬激光碎石治疗鹿角形。肾结石93例。结石直径2．6～5．4cm。结果：93例均采用单通道经皮。肾镜联合软镜下钬激光碎石,一期手术平均手术时间为108min,完全清除率为83．9％（78／93）,二期手术平均手术时间为43min,结石完全清除率87．5％（7／8）。全部病例均无肾盂穿孔、气胸、腹腔内脏器官损伤等严重并发症发生。结论：单通道经皮。肾镜联合不同软镜下钬激光碎石治疗鹿角形肾结石具有碎石成功率和结石排净率高、创伤小、手术时间短、并发症少、周围脏器损伤风险小等优点,是一种治疗鹿角状肾结石的理想方法。     

The influence of minimally invasive percutaneous nephrolithotomy on renal pelvic pressure in vivo

OBJECTIVE: To inspect the renal pelvic pressure during minimally invasive percutaneous nephrolithotomy (MPCNL) and to investigate whether the use of the 14 to 18-Fr percutaneous tract, 8/9.8-Fr rigid ureteroscope, and a perfusion with high pressure furnished for MPCNL results in high renal pelvic pressure. PATIENTS AND METHODS: Between July 2005 and February 2006, 76 patients were selected for renal pelvic pressure measurement during MPCNL. The renal pelvic pressure was measured by a baroceptor of the invasive blood pressure channel in a MAIDRAY PM9000 monitor, which was connected to the open-ended ureteric catheter indwelled in the renal pelvis retrogradely. The computer collected the renal pelvic pressure data each second and all the data were evaluated statistically with SPSS 12.0 software. RESULTS: During MPCNL within the 14, 16, 18, and double-16-Fr percutaneous tracts, the average renal pelvic pressures were 24.85, 16.23, 11.68, and 5.8 mm Hg, respectively. The average lasting times of renal pelvic pressure >/=30 mm Hg were 283, 96, 44, and 10 seconds, respectively. A postoperative fever >/=38 degrees C was recorded in 2 (2/12), 3 (3/30), 2 (2/21), and 1 case (1/13), respectively. CONCLUSIONS: Renal pelvic pressure generally remains lower than the level required for a backflow (30 mm Hg), during MPCNL via 14 to 18-Fr percutaneous tract. Any factor, which causes bad drainage, will result in a temporarily elevated renal pelvic pressure greater than 30 mm Hg; and multiple temporary high-pressure episodes can have a cumulative effect, which means that there will be enough backflow to cause a bacteremia.