The supracostal approach was found to be effective as well as safe, with acceptable complications. It gives high stone clearance rates with acceptable morbidity rates and should be attempted in selected cases. The rate of pulmonary complications is higher with the supracostal approach. If the supracostal approach is indicated, it should be used with caution.
The purpose of this study was to evaluate how the upper calyx-lower calyx infundibular (ULI) angle influences intrarenal stone migration during percutaneous nephrolithotomy (PCNL) in patients with a solitary renal pelvis stone and significant hydronephrosis. 50 adult patients with a solitary renal pelvis stone larger than 20 mm were considered for PCNL with a pneumatic lithotriptor for stone fragmentation. Inclusion criteria were moderate to severe hydronephrosis and upper calyx infundibular width >10 mm, and access point was the lower calyx in all cases. The ULI angle as well as stone fragment migration from the renal pelvis toward the upper calyx was noted during the operation. To determine the "critical" angle above which the probability of stone migration would be increased significantly, receiver operating characteristic curve was used. Mean stone size was 33.8 ± 13.2 mm. In 23 patients (46 %) the stone migrated toward the upper calyx during stone fragmentation. Mean ULI angle was significantly wider in patients whose stone migrated (120.2 ± 20.5 versus 102.2 ± 21.4, P = 0.004, 99 % CI = 6.04-29.9). A ULI angle of 117.5° was the critical angle, above which the rate of stone migration rose significantly (P < 0.008). One-session stone-free rate was significantly higher in patients without stone migration (P = 0.03). In patients with a solitary renal pelvis stone and significant hydronephrosis, a wider ULI angle was associated with a greater likelihood of stone scattering which could potentially affect the outcome of PCNL with pneumatic lithotriptor. A cut-off angle of 117.5° was the critical angle, above which access via a calyx other than the lower calyx (example: middle or upper calyx) seems advisable.
ObjectivesTo determine the long-term preventive effects of intraperitoneal propofol on testicular ischemia–reperfusion injury in a rat model.Materials and methodsForty adult male albino Wistar rats were divided randomly into the following four groups according to the planned treatment (n=10 per group): group I, control; group II, sham-operated; group III, torsion/detorsion (T/D); and group IV, T/D plus propofol. Testicular ischemia was achieved by twisting the left testis 720° clockwise (ie, applying torsion) for 1 h. In the T/D plus propofol group (group IV), 50 mg/kg propofol was administered intraperitoneally 30 minutes before detorsion. Ipsilateral orchiectomy was performed under general anesthesia to determine the mean testicular weight and to enable histopathological examination of the testes using Johnsen’s mean testicular biopsy score 30 days after the surgical procedure in all groups.ResultsThe testicular weights in groups I, II, III, and IV were 1.65±0.32, 1.59±0.33, 1.11±0.56, and 1.08±0.50 g (mean ± SD), respectively. Testicular weight was significantly lower in the T/D groups (III and IV) than in both the control and sham-operated groups (I and II), but there was no improvement in testicular weight as a result of propofol administration. Similarly, Johnsen’s mean testicular biopsy score was lower in groups III and IV than in groups I and II, but no positive effect was conferred by the administration of propofol in group IV.ConclusionThe use of propofol in the treatment of testicular ischemia–reperfusion injury caused by testis torsion has no significant long-term therapeutic potential.
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