Does previous standard percutaneous nephrolithotomy impair retrograde intrarenal surgery outcomes?

Abstract

Purpose: The objective of this study is to evaluate the impact of a previous standard percutaneous nephrolithotomy (PCNL) on the outcomes of retrograde intrarenal surgery (RIRS). Materials and Methods: Outcomes of RIRS performed from January 2017 to January 2020 in adult patients with residual stone fragments ≤20mm after a standard PCNL (Post-PCNL) and symptomatic adult patients with kidney stones ≤20mm (Control) were prospectively studied. Stone-free rate (SFR) was evaluated on a postoperative day 90 non-contrast computed tomography. Surgical complications based on Clavien-Dindo classification during the 90 days of follow-up were recorded. Results: Outcomes of 55 patients and 57 renal units of the post-PCNL group were compared to 92 patients and 115 renal units of the control group. SFR was lower in post-PCNL group than in control (28/57, 49.1% vs. 86/115, 74.8%, p <0.001). Overall complications were more frequent in post-PCNL group (p=0.004). Infundibula strictures were identified and incised with laser in 15/57 (26.3%) renal units of the post-PCNL group. Thirteen renal units had infundibulum stricture at the site of previous percutaneous tract (13/15; 86.7%, p=0.004) and one renal unit had three infundibula strictures. Postoperative complications were not affected by the treatment of infundibula strictures (p=0.198). Conclusions: Previous standard PCNL significantly impairs the outcomes of RIRS. Infundibula strictures can be found in 26.3% of the patients with residual stone fragments after standard PCNL for large burden kidney stones. The main site of infundibulum stricture after standard PCNL is the infundibulum of the entry ca lyx .

Postoperative antibiotic prophylaxis for percutaneous nephrolithotomy and risk of infection: a systematic review and meta-analysis

“…In contrast, studies focusing exclusively on the preoperative scenario have indicated that seven days of oral antibiotics before PCNL can reduce the incidence of SIRS/sepsis, as well as the positivity of intraoperative urine culture and stone culture (26). It's important to note that many, but not all, of the patients included in these studies had some infectious risk factors, such as larger stone size, positive preoperative urine culture, dilated pelvicalyceal system, or the presence of an indwelling ureteral stent or nephrostomy tube (26).…”

Comparing Balloon Dilation to Non-Balloon Dilation for Access in Ultrasound-Guided Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

“…Zhou et al concluded that ultrasound-guided balloon dilation simplifies the access creation process, reduces the potential trauma associated with continuous operation of the Amplatz dilator, and results in fewer bleeding complications ( 15 ). Danilovic et al reveals infundibula strictures can be found in 26.3% of the patients with residual stone fragments after standard PCNL for large burden kidney stones ( 31 ). This meta-analysis revealed a slightly lower complication rate in the balloon group (12.56%) compared to the non-balloon group (13.86%), although the difference was not statistically significant.…”

Nomogram to predict the risk of adverse outcomes in patients with residual stones following percutaneous nephrolithotomy

“…In the past 30 years, the incidence of upper urinary tract calculi has been increasing continuously ( 16 ). The harm of upper urinary tract calculi to the human body is significant ( 17 , 18 ). Although PCNL is one of the primary methods for the treatment of upper urinary tract calculi, PCNL cannot completely eliminate stone fragment residues.…”