The majority of complications after PCNL are minor. Longer operative time and higher ASA scores are associated with the risk of more severe postoperative complications in PCNL.
Objective: To assess perioperative outcomes of percutaneous nephrolithotomy (PCNL) using ultrasound or fluoroscopic guidance for percutaneous access. Methods: A prospectively collected international Clinical Research Office of the Endourological Society (CROES) database containing 5806 patients treated with PCNL was used for the study. Patients were divided into two groups based on the methods of percutaneous access: ultrasound versus fluoroscopy. Patient characteristics, operative data, and postoperative outcomes were compared.
A robot-assisted NOTES nephrectomy was accomplished in a porcine model using the daVinci S robot. Additional testing on survival animals is necessary to further explore this approach.
Though it has been extensively studied, the exact cause of stent-related symptoms remains unknown but is likely related to irritation of the bladder by the distal curl of the stent and reflux of urine through the stent up to the renal pelvis and transmission of high pressures associated with this. Recent research has focused on trying to modify stents including the creation of drug eluting stents as well as preventing symptoms with intravesical instillation of medications in the operative room at the time of placement. Some of these approaches show promise, but anticholinergic and alpha-blocking medications remain the only treatments for stent-related symptoms with reasonable evidence to support them. Current evidence suggests that a multimodal approach to stent-related symptoms and pain with alpha-blockers, anticholinergic medications, and anti-inflammatory and narcotic pain medications is likely the most effective. Further research is needed to better investigate many novel techniques for decreasing stent-related symptoms. This continues to be an important area of research given the need for ureteral stents in urology and the high prevalence of patient discomfort related to stent placement.
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