Renal angiomyolipomas (AMLs), formerly known as PEComas (tumors showing perivascular epithelioid cell differentiation) are common benign renal masses composed of a varying ratio of fat, blood vessels, and smooth muscles. They are largely asymptomatic and diagnosed incidentally on imaging.The adipose tissue content is the factor that gives AMLs their characteristic appearance on imaging and makes them easily identifiable. However, the fat-poor or fat-invisible varieties, which are difficult to differentiate radiologically from renal cell carcinomas (RCCs), present a diagnostic challenge. It is thus essential to establish the diagnosis and identify the atypical and hereditary cases as they require more intense surveillance and management due to their potential for malignant transformation.Multiple management options are available, ranging from conservative approach to embolization and to the more radical option of nephrectomy. While the indications for intervention are relatively clear and aimed at a rather small cohort, the protocol for follow-up of the remainder of the cohort forming the majority of cases is not well established. The surveillance and discharge policies therefore vary between institutions and even between individual practitioners. We have reviewed the literature to establish an optimum management pathway focusing on the typical AMLs.
Percutaneous nephrolithotomy (PCNL) is a well-established treatment for staghorn stones. Given the im-provement in technology and techniques of flexible ureterorenoscopic lasertripsy (FURS), we retrospectively compared its treatment outcome against PCNL for staghorn stones at our institution. Materials and MethodsAll patients with partial and complete staghorn stones treated by FURS or PCNL between December 2014 and December 2017 were included. Outcome measures included the duration of the procedure, length of stay, retreatment rate, auxiliary rate, complications, and clinical success rates (stone or dust-free status). ResultsOut of 22 staghorns, 10 (1 complete, 9 partial) had FURS and 12 (2 complete and 10 partial) had PCNL. Comparatively, the FURS group were older (mean 70.1 vs. 57.1 years, U-test p<0.001) with higher mean ASA scores (mean 2.3 vs. 1.5, U-test, p=0.04), with a similar body-mass index (mean 29.1 vs. 27.3), maximum stone size (29.7 vs. 34.6mm) and Hounsfield unit (836 vs. 891HU). FURS was quicker to clinical success (102.4min vs. 159.5min, U-test p<0.001) and had shorter hospital stay (1.1d vs. 3.5d, U-test p<0.001). Higher primary procedure success [80% vs. 36%, 95% CI = (-3.0%, 74.5%)], higher overall success [90% vs. 73%, 95% CI = (-22%, 51%)], similar retreatment rate (10%), and higher auxiliary treatment rate (100% vs. 18%) were observed. 1 patient from FURS had a small intrapa-renchymal aspect of staghorn inaccessible to a laser. There were no complications in the FURS group. In the PCNL group, one developed a pseudoaneurysm requiring embolization, and 1 had failed PCNL access (excluded from the statistical calculation). ConclusionOur preliminary data suggest that FURS is efficacious and safe for staghorn stones treatment, and comparable to PCNL. In this context, we highlight FURS potential role as first-line management of staghorn stones.
Introduction: Nephrostomy insertion is a vital part of modern-day urology used to manage obstructedrenal tract or gain percutaneous renal access.Method: We carried out a PubMed literature search on the history of the development of nephrostomies. Results: The first percutaneous nephrostomy was performed in 1864 on a child who died in 5 years. Nephroscopy was then described and performed in 1941 during an open surgery with subsequent advancement to percutaneous nephrolithotomy in 1976 and antegrade stent insertion in 1978.Conclusion: Clinical need and innovation have led to percutaneous renal access and subsequent stone treatment modality.
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