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.     

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.     

Tubeless percutaneous neprolithotomy: the new gold standard

PURPOSE: We present our experience with tubeless percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: Between July 2004 and December 2006, 121 patients (82 males and 39 females) with 18-70 mm (mean 31.19 mm) renal stones underwent tubeless PCNL leaving only a 6 Fr externalized ureteric catheter. Their ages ranged between 4 and 80 years (mean 37.27). Two patients had bilateral disease, so a total of 123 renal units are included. The procedure was performed under general anesthesia in the prone (110 units) or supine position (13 units). A total of 133 punctures were performed. The punctures were single (114 units), double (8 units), or triple (1 unit). The approach was subcostal through the lower calyx (n = 110) or middle calyx (n = 10), or supracostal through the middle calyx (n = 8) or upper calyx (n = 5). RESULTS: Mean operative time was 46.30 min (range 15-100). Mean reduction in hemoglobin level was 1.57 g (range 0.3-4) with blood transfusion rate 4.13%. Complication rate was 9.9% in the form of perirenal collection (five patients), urinary leakage (two patients), fever (four patients), and hydrothorax (one patient). The ureteric catheter was left for 7-72 h (mean 45.67). Postoperative analgesia was required in 22 patients (18.2%) with mean 22.9 mg diclofenac sodium per patient. Mean hospital stay was 50.69 h (range 12-96) with 106 units (86.18%) rendered stone free, 13 (10.57%) with insignificant residuals, and four units (3.25%) were left with significant residual stones. CONCLUSIONS: Tubeless PCNL is a good option in non-complicated PCNL with the advantages of reduced hospital stay, low postoperative pain, and little need for postoperative analgesia.     

Percutaneous nephrolithotomy in children before school age: experience of a Pakistani centre

OBJECTIVE: To review our experience of percutaneous nephrolithotomy (PCNL) in children before school age, and determine its efficacy and safety in this age group. PATIENTS AND METHODS: The records of children aged < or = 5 years undergoing PCNL were reviewed. Variables assessed included stone number, size, location and type. The PCNL puncture site and number were also recorded. We reviewed stone clearance with PCNL, ancillary procedures used, complication rates and follow-up status of the children. RESULTS: There were 30 renal units in 29 children (median age 3.8 years, range 1.4-5). Because of poor growth the mean (SD) body weight of the children was only 12.2 (2.8) kg, which is near the 50th percentile for children of mean age 3.5 years. The median (range) stone burden was 2.35 (1.3-6) cm; 60% of the patients had single stones while 28% had more than five. There were five staghorn stones. All PCNL was primary and with one puncture, using a 17 F angled nephroscope; stones were fragmented using a pneumatic lithoclast. After PCNL stones were completely cleared in 60% of the renal units, which increased to 100% after combining it with extracorporeal shockwave lithotripsy. The median (range) follow-up was 24.9 (4-51) months; the overall complication rate was 6%. In the long follow-up hypertension was not detected in any child and isotopic renograms in 17 kidneys detected no new scarring or loss of renal function. CONCLUSION: PCNL is a safe and effective for treating renal stones in very young children.     

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.     

Need for ancillary procedures among patients undergoing tubeless percutaneous renal surgery for nephrolithiasis

PURPOSE: We routinely perform percutaneous nephrolithotomy (PCNL) without the use of nephrostomy tubes. We examined the need for secondary surgery for the treatment of residual stones in patients who underwent both tubeless surgery and PCNL with tube placement. PATIENTS AND METHODS: We retrospectively reviewed the charts of 180 patients who underwent 186 percutaneous nephrolithotomies. Among them, 125 patients had tubeless surgery, and 61 had nephrostomy tubes. We compared the need for ancillary surgical procedures for residual stone disease in the two groups. RESULTS: A total of 99 patients (79%) without tubes and 25 (41%) of those with tubes were stone free after surgery. A total of 45 ancillary procedures were performed for residual stone disease, with 15% of the tubeless and 43% of the patients with tubes requiring a second procedure. Extracorporeal shockwave lithotripsy (SWL) was the most common ancillary procedure. CONCLUSIONS: Patients who are eligible for tubeless PCNL are unlikely to need a secondary procedure, and residual stones can most often be treated with SWL. Patients who required nephrostomy tubes had more complicated disease and a greater need for subsequent surgery.     

Single upper-pole percutaneous access for treatment of > or = 5-cm complex branched staghorn calculi: is shockwave lithotripsy necessary?

BACKGROUND AND PURPOSE: Percutaneous nephrolithotomy for staghorn calculi is reported to have a residual stone rate of 28%, while shockwave lithotripsy alone results in residual stones in approximately 50% of cases. Combination therapy, sandwich therapy, and multiple percutaneous accesses have also been advocated for staghorn stones. We believe these stones can often be removed with a staged procedure via a single upper-pole percutaneous access using flexible nephroscopy and the holmium:YAG laser. Our experience is reviewed. PATIENTS AND METHODS: The hospital records of patients having a cumulative stone burden > or =5 cm who underwent percutaneous nephrolithotripsy (PCNL) for a single complex staghorn calculus were reviewed. There were 15 male and 34 female patients having 45 complete and 7 partial staghorn calculi constituting a mean stone burden of 6.7 cm (range 5.0-10.0 cm). A calix was punctured that would provide access to the majority of the involved calices. Thirty-five renal units were approached through a single upper-pole percutaneous access, and four and six renal units were accessed through single middle or lower-pole calices, respectively. The remaining seven renal units were treated with multiple percutaneous accesses. RESULTS: In the renal units having only a single access, a mean of 1.6 (range 1-3) procedures were required to achieve stone-free status. The mean operating room time was 2.9 hours (range 2.0-3.5 hours). For the second PCNL, the mean operating room time was 63 minutes (range 30-90 minutes). Two patients (two renal units) had residual stones <1 cm in diameter. One refused additional surgery, and the other is awaiting further treatment. The mean estimated blood loss was 238 mL (range 50-800 mL), with only one procedure (2.2%) necessitating a blood transfusion. One (2.8%) hydrothorax developed among the 35 upper-pole puncture cases. Six patients had transient oral temperature readings >101 degrees F with negative blood cultures. Other early complications included single cases of leg cellulitis, atrial fibrillation, and noncardiac chest pain. There were no delayed surgical complications. Patients were discharged from the hospital a mean 2 days (range 1-10 days) after the first PCNL. CONCLUSION: Use of flexible nephroscopy with holmium:YAG laser lithotripsy and Nitinol basket stone extraction has allowed us to render staghorn-containing renal units stone free in a mean of 1.6 procedures. Of the 45 renal units treated through a single percutaneous access, 43 (95%) were rendered stone free. The holmium:YAG laser appears to be a safe lithotrite for the kidney, as no complications occurred from its use.     

Totally tubeless percutaneous nephrolithotomy in selected patients

PURPOSE: Significant early postoperative discomfort after percutaneous procedures is usually secondary to nephrostomy tubes and externalized ureteral catheters. We describe our modification of the traditional percutaneous nephrolithotomy (PCNL) approach that we name "totally tubeless PCNL." PATIENTS AND METHODS: Between June 2000 and May 2001, 60 consecutive PCNLs were performed at our centers. At the end of the surgery, we omitted the nephrostomy tube and removed the externalized catheter in selected patients: no solitary kidney, stone size <3 cm, and without any obstructions or arterial bleeding. A total of 30 patients underwent totally tubeless PCNL (group 1). We compared their results with those of a control group of 30 patients who underwent standard PCNL (group 2). The incidence of complications, analgesic requirements, length of hospitalization, and time to return to normal activities were compared in the two groups. RESULTS: In both groups, PCNL was performed successfully without any significant complications. A 90% stone-free rate was achieved in both groups, and in the remaining patients, small residual stones (<4 mm) were detected. No urinoma was demonstrated by postoperative ultrasound scanning in group 1. The average length of hospitalization was 1.5 days for group 1 and 3 days for group 2. The average analgesic requirements were 30 mg of pentazosin in group 1 and 90 mg in group 2. No transfusion was needed. There were three complications: 2 patients (6.6%) had urinary tract infection in group 1 and 1 (3.3%) in group 2. All were managed medically. CONCLUSIONS: Omitting the percutaneous nephrostomy tube and removing ureteral catheter at the end of surgery in selected patients were safe and accompanied by significantly reduced postoperative discomfort, length of hospitalization, and analgesic requirements. Further studies are needed to determine the role of this technique.     

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.     

Tubeless percutaneous nephrolithotomy: Experience of 1000 cases at a single institute

ObjectiveTo access the safety and efficacy of tubeless percutaneous nephrolithotomy (PCNL).Materials and methodsSince January 2001, 1000 consecutive tubeless PCNLs performed at our hospital were enrolled into this retrospective chart review. The average age of the patients (659 males and 341 females) was 54.4 ± 12.6 years, and 55 patients were 75 years old or older. The stone characteristics were 490 non-complete staghorn kidney stones, 218 ureteral stones, 119 kidney + ureteral stones and 173 complete staghorn stones. The mean stone size was 3.5 ± 2.0 cm, and 200 patients had stone size ≥5.0 cm. The average operative time was 78.0 ± 29.4 minutes. The stone free rates were 78.8%, 100%, 84.9% and 45.0% for kidney, ureter, kidney + ureter and complete staghorn stones, respectively, with an overall stone free rate of 78.3%. The average postoperative hospital stay was 3.6 ± 2.1 days, and the blood transfusion rate was 2.4%. Postoperative fever was noted in 104 patients, and urosepsis was noted in 13 patients. Pulmonary complication included hydrothorax in 5 patients, hemothorax in 2 patients, pneumothorax in 2 patients and acute pulmonary edema in 1 patient. Cadiovascular complications included congestive heart failure in 1 patient and pneumomediastinum in 1 patient.ConclusionOur study demonstrated that sith adequate hemotasis, tubeless modification is a safe modality for PCNL.     

侧卧位B超引导经皮肾镜取石术治疗复杂性肾结石

目的 评价侧卧位B超引导下经皮肾镜取石术(PCNL)治疗复杂性肾结石的疗效及安全性. 方法 复杂性肾结石患者650例.男512例,女138例.平均年龄38(11～78)岁.结石位于左肾366例,右肾284例.单发121例,多发42例,部分鹿角形结石392例,全鹿角形结石95例.肾结石平均长径31(20～58)mm.均行侧卧位B超引导下PCNL治疗. 结果 650例手术顺利.B超引导下穿刺均成功,Ⅰ期微通道气压弹道碎石术493例,标准通道气压弹道和(或)超声联合碎石清石术157例.Ⅰ期结石取净563例(86.6 0%),Ⅱ期取净65例(10.0%),Ⅲ期取净6例,有残余结石者16例联合使用ESWL治疗.Ⅰ期PCNL平均手术时间72(35～145)min.未发生气胸、结肠损伤、肾盂穿孔、水中毒、肾周感染等合并症.平均住院时间18(9～32)d. 结论 侧卧位B超引导下PCNL治疗复杂性肾结石安全有效,患者耐受性好,便于麻醉管理,医护人员和患者避免x线辐射损伤,是一种值得推荐的微创治疗方法.     

Supra-costal tubeless percutaneous nephrolithotomy is not associated with increased complication rate: a prospective study of safety and efficacy of supra-costal versus sub-costal access

Background

To assess the morbidities of tubeless percutaneous nephrolithotomy (PCNL) using supra-costal access and re-evaluate traditional concept of increased complications with supra-costal access.

Methods

From January 2010 to December 2014, a single surgeon performed 118 consecutive one-stage fluoroscopic guided PCNL’s for complex renal and upper ureteral stone. Our definition for complex renal stone is defined as partial or complete staghorn stone, multiple renal stones in more than 2 calyxes, obstructive uretero-pelvic stone >?2?cm, and a renal stone in single functional kidney. Inclusion criteria include: staghorn stones, renal calculi >?2?cm in diameter, upper ureteral stone >?1.5?cm in diameter. Exclusion criteria for tubeless PCNL include: significant bleeding or perforation of the collecting system, large residue stone, multiple PCNL tract and obstructive renal anatomy. Morbidity, operation time, analgesia requirement, length of hospital stay, stone- free rate, were analyzed.

Results

Of the 118 consecutive PCNL, eighty-six patients underwent tubeless PCNL (56 supra-costal and 30 sub-costal) and included in our prospective follow-up period. The mean age, operation side, stone locations were similar. The male to female ratio is higher in supra-costal than sub-costal. Large renal stones and staghorn stones makes up for most patients (supra-costal: 75%, sub-costal: 80%). The stone–free rate of supra-costal group was 59% (33/56) and in sub-costal group was 50% (15/30). The operative times, length of stay, post-op analgesic use, hematocrit change was similar in both groups. The overall complication rate is 6% [supra-costal (1/56), sub-costal (4/30)] with the majority being infectious complications.

Conclusions

Supra-costal access above 12th rib during tubeless PCNL is safe and effective procedure and is not associated with higher incidence of post-op complications in experience hands.

     

Outpatient tubeless percutaneous nephrolithotomy: the initial case series

Introduction:

Percutaneous nephrolithotomy (PCNL) has traditionally been performed on an inpatient basis. To the best of our knowledge, this is the first report of tubeless PCNL on a completely outpatient basis. The purposes of this study were to assess the safety and efficacy of outpatient PCNL.

Methods:

We reviewed the initial consecutive outpatient tubeless PCNLs performed at our institution by a single surgeon. Patients were discharged home the day of surgery only after meeting strict discharge criteria. Preoperative, intraoperative and postoperative data were collected prospectively.

Results:

Outpatient tubeless PCNL was performed in 3 patients. The mean maximum stone diameter was 14 mm. The average hospital stay was 175 minutes. All 3 patients were discharged home in stable condition after meeting all of the inclusion criteria. There were no emergency room visits or hospital readmissions postoperatively. The mean follow-up period was 47 days. All stones were calcium oxalate and the stone free rate was 100%. There were no minor or major complications.

Conclusion:

In properly selected patients, outpatient tubeless PCNL is safe and effective. Our initial experience with outpatient PCNL has been favourable and warrants further investigation in a larger patient population.     

微创经皮肾镜治疗肾结石术中留置肾造瘘与无管化的比较

目的探讨无管化微创经皮肾镜碎石取石术(MPCNL)治疗肾结石的临床应用。方法回顾性分析我院2015年5月至2018年1月的肾结石患者资料,无管组58例结石大小(3.1±1.6)(2.2~4.8)cm。建立16 F经皮肾通道,8/9.8 F输尿管镜下碎石,清理结石无残留后,留置安全导丝至输尿管,退鞘无明显活动性出血,拔除撕开鞘,完成无管化微创MPCNL。留管组50例结石大小(3.2±1.5)(2.1~5.0)cm,手术方法与无管组相同,术后留置肾盂造瘘管。结果两组资料术前比较差异无统计学意义。两组结石患者均成功接受PCNL,手术时间无管组(72±21)(40~98)min,留管组(74±21)(46~100)min。术后次日复查血常规,两组患者均无需输血。结石清除率为98.3%(57/58)和98%(49/50),术后住院时间无管组(2.2±0.2)d,留管组(4.3±0.8)d。并发症中无管组21例患者患者术后出现38.5℃以上发热,其中6例(10.3%)退热治疗改善,15例(25.9%)抗生素治疗后改善;1例患者术后因尿外渗引起腹胀。留管组中出现18例患者38.5℃以上发热,其中5例(10%)退热治疗改善,13例(26%)抗生素治疗后改善;其余患者无其他严重并发症发生。结论无管化MPCNL治疗肾结石安全有效,并缩短住院时间。     

Tubeless percutaneous nephrolithotomy: what about replacing the Double-J stent with a ureteral catheter?

PURPOSE: To evaluate the feasibility and safety of replacing the Double-J stent with a ureteral catheter in tubeless percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: From August 1998 to February 2007, 33 patients underwent tubeless PCNL for renal calculi by the same surgeon. A retrograde 7F ureteral catheter was placed at the beginning of the surgery in all patients. A nephrostomy tube was not used in any patient. At the end of the procedure, the working tract was electrocauterized using a 26F resectoscope with a rollerball electrode; no hemostatic sealant was used. The ureteral catheter was the sole means of drainage left in place. The incidence and type of complications, the operative time, the length of hospitalization, the rate of transfusion, and the degree of pain were obtained by chart review. RESULTS: In this group of patients, the mean stone burden was 17.25 mm. The mean operative time was 71.5 min. The mean length of hospitalization was 1.9 day (range 1 to 7 days). The mean hemoglobin decrease was 0.8 g/dL. No blood transfusions were needed. The mean visual analog pain intensity scale was 1.87. Complications developed in five (15%) patients, of whom one needed a Double-J stent placement. The complications were pyelonephritis, urinary extravasation, sustained hematuria, and renal colic. The ureteral catheter was removed by postoperative day 1 in 91% of patients. CONCLUSIONS: Replacing the Double-J stent with a ureteral catheter in tubeless PCNL is an effective procedure and can be performed in patients with a moderate stone burden. The electrocauterization of the bleeding points at the end of percutaneous renal surgery with a rollerball resectoscope is safe.     

Paediatric percutaneous nephrolithotomy: setting new frontiers

OBJECTIVE: To assess the safety and outcome of paediatric percutaneous nephrolithotomy (PCNL) for atypical cases and compare the results with 'standard' unilateral paediatric PCNL. PATIENTS AND METHODS: We retrospectively reviewed children who had had a PCNL between December 1997 and December 2004. Patients were grouped as follows: group 1, aged >5-16 years with normal anatomy and normal renal function undergoing unilateral PCNL or staged bilateral PCNL; group 2, < or = 5 years with normal anatomy and renal function undergoing unilateral PCNL; group 3, undergoing bilateral simultaneous PCNL; group 4, impaired renal function in addition to renal stone disease; group 5, renal anatomical abnormality with calculi in the same kidney. Demographics, stone profile, procedure and outcome indicators were analysed for each group. RESULTS: In all, 188 consecutive PCNLs in 169 children were included (mean age 3.3-10.3 years, mean stone burden 19.1-33.3 mm in the five groups). The mean duration of PCNL was 69-115 min. Stone clearance was satisfactory with single tract access in 90-100% of patients. Transient postoperative fever was the commonest complication (12.5-51%) followed by hyponatraemia and hypokalaemia. Blood transfusion was required in 0-7.7%. The mean stone clearance rates were 47-90% in the five groups; additional extracorporeal shockwave lithotripsy increased the cumulative clearance rates to 90-100%. CONCLUSION: PCNL is safe for treating renal stones, with excellent results and minimal complications. Comparable results are achieved in the very young child, children with anatomically abnormal kidneys, children with impaired renal function and children with bilateral renal stones undergoing simultaneous bilateral PCNL. Hence none of these factors should be considered as relative contraindications.     

Management of bladder stones with pneumatic lithotripsy using a ureteroscope in children

PURPOSE: To evaluate the effectiveness and safety of pneumatic lithotripsy by using a ureteroscope to treat bladder stones in children. PATIENTS AND METHODS: Twenty-seven boys presenting with bladder stones underwent transurethral cystolithotripsy. The indication for transurethral cystolithotripsy was stone size 相似文献   

Evaluation of a synchronous twin-pulse technique for shock wave lithotripsy: the first prospective clinical study

OBJECTIVE: To present the results of the first clinical study of a synchronous twin-pulse technique for extracorporeal shock-wave lithotripsy (ESWL), which is effective for in vitro stone fragmentation and safe when assessed in vivo on animal tissue. PATIENTS AND METHODS: Fifty patients with urinary stones (35 men and 15 women) were enrolled and treated with the TWINHEADS lithotripter. The entry criteria were: age > or = 18 years, with a radio-opaque single stone in the kidney or upper ureter, a normal laboratory profile (serum creatinine, liver function, blood, bleeding and clotting times, and prothrombin concentration). The exclusion criteria included lower ureteric stones, patients with urinary tract infection, obstructed urinary tract distal to the stones, or congenital abnormalities. All patients received one session and were evaluated by ultrasonography (US), urinary tract plain X-ray, and complete laboratory investigations before and immediately after treatment, and after 2, 14 and 30 days. Patients requiring re-treatment at the 14-day visit received a second session and were re-evaluated after 7 and 14 days. RESULTS: The mean (sd, range) stone size (longest diameter) was 12.3 (2.6, 9-18) mm. Intravenous sedation was used in 30 patients. There was mild haematuria in 25 patients on the day of treatment. During the follow-up there was no evidence of haematoma, gross renal injury, upper urinary tract obstruction or significant changes in the laboratory investigations. After 14 days, 17 patients (34%) were free of stones, with residual stones of < or = 5 mm in 20 (40%); they were free of stones at the 1-month follow-up. Thirteen patients (26%) had residual stones of 6-9 mm, but the stones were half or less of the original size. Patients with residual stones of > 5 mm had another ESWL session and were free of stones within 14 days. Thus all patients were rendered stone-free within 1 month. CONCLUSIONS: Synchronous twin-pulse ESWL is promising, seems safe and effective for treating patients with renal and upper ureteric lithiasis.     

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。     

Safety and efficacy of supracostal access in tubeless percutaneous nephrolithotomy

PURPOSE: To evaluate the feasibility and safety of supracostal access in tubeless percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: From September 2004 to November 2005, tubeless PCNL using supracostal access was done for 72 patients at our institute. Patients requiring more than two percutaneous tracts or with significant intraoperative bleeding or residual stone burden were excluded from the study. The outcome of these patients was compared with that of a historic cohort of similar patients having supracostal access with routine placement of a nephrostomy tube. The two groups had comparable demographic data. RESULTS: The differences in the mean drop in hemoglobin concentration, transfusion requirement, and complication rate in the two groups were not statistically significant, with three patients in the study group and four patients in the control group requiring blood transfusion. Patients undergoing tubeless PCNL required less analgesia (P = 0.000) and were discharged a mean of 19 hours earlier (P = 0.000) than those in the control group. Complete stone clearance was achieved in 90.27% of the renal units in the study group and 86.11% of the renal units in the control group. Two patients in the study group and three patients in the control group had postoperative hydrothorax, all of whom, except for one in the control group, were managed conservatively. CONCLUSION: Supracostal access in tubeless PCNL appears to be feasible, safe, and effective, offering the advantages of a lower analgesic requirement and shorter hospital stay without increasing thoracic complications. Studies with larger numbers of patients are needed to confirm these initial findings.