A prospective comparative study of haemodynamic, electrolyte, and metabolic changes during percutaneous nephrolithotomy and minimally invasive percutaneous nephrolithotomy

Xu, Shuxiong; Shi, Hua; Zhu, Jianguo; Wang, Yuanlin; Cao, Ying; Li, Kai; Wang, Yandong; Sun, Zhaoqing; Xia, Shujie

doi:10.1007/s00345-013-1204-2

Cited by 31 publications

(23 citation statements)

References 16 publications

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“…Patients treated with SMP had single stones in 88.7% of the cases and a mean diameter of 2.2 cm [14]. We recorded a median OT of 90 min, lower than the safety limit of 120 min described in the Literature [16], and a median LT of 28 min. As in the SMP series [14], we observed lower post-operative fever (7.4%) and transfusion (0.8%) rates than reported in the Literature for PCNL (10.8% and 7%, respectively) [2].…”

Section: Discussionmentioning

confidence: 65%

Vacuum-assisted mini-percutaneous nephrolithotomy: a new perspective in fragments clearance and intrarenal pressure control

et al. 2020

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Purpose To describe the vacuum-assisted mini-percutaneous nephrolithotomy (vmPCNL) technique performed via the 16Ch ClearPetra sheath, to evaluate its outcomes and to analyze intrarenal pressure (IRP) fluctuations during surgery. Methods Data from all consecutive vmPCNL procedures from September 2017 to October 2019 were prospectively collected. Data included patients' and stones characteristics, intra and peri-operative items, post-operative complications and stone clearance. Patients undergoing vmPCNL from March to October 2019 were submitted to IRP measurement during surgery. Results A total of 122 vmPCNL procedures were performed. Median stone volume was 1.92 cm 3. Median operative time was 90 min and median lithotripsy and lapaxy time was 28 min. Stone clearance rate was 71.3%. Thirty-one (25.2%) patients experienced post-operative complications, seven of which were Clavien 3. Postoperative fever occurred in nine (7.4%) patients and one (0.8%) needed a transfusion. No sepsis were observed. IRPs were measured in 22 procedures. Mean IRP was 15.3 cmH 2 O and median accumulative time with IRP > 40.78 cmH 2 O (pyelovenous backflow threshold) was 28.52 sec. Maximum IRP peaks were reached during the surgical steps when aspiration is closed (mainly pyelograms), whereas during lithotripsy and suction-mediated lapaxy, the threshold of 40.78 cmH 2 O was overcome in three procedures. Conclusions vmPCNL is a safe procedure with satisfactory stone clearance rates. Mean IRP was always lower than the threshold of pyelo-venous backflow and the accumulative time with IRP over this limit was short in most of the procedures. During lithotripsy and vacuum-mediated lapaxy, IRP rarely raised over the threshold.

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Section: Discussionmentioning

confidence: 65%

Vacuum-assisted mini-percutaneous nephrolithotomy: a new perspective in fragments clearance and intrarenal pressure control

et al. 2020

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“…Hemodynamic, electrolyte and metabolic changes were assessed and compared prospectively between mini-PCNL and standard PCNL. [ 54 ] Electrolyte levels and arterial blood gas analysis during and after both procedures were evaluated. Heart rate and arterial blood pressure were also monitored.…”

Section: Complicationsmentioning

confidence: 99%

“…A trend toward metabolic acidosis was observed as the irrigation time went by during mini-PCNL compared to the standard method. [ 54 ] Liu et al . retrospectively analyzed the data from 834 patients who underwent mini-PCNL, in order to explore the risk factors, prevention and management of the septic shock following the procedure.…”

Section: Complicationsmentioning

confidence: 99%

Mini percutaneous nephrolithotomy in the treatment of renal and upper ureteral stones: Lessons learned from a review of the literature

Ferakis

Stavropoulos

2015

Urol Ann

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The aim of this review is to present the most recent data regarding the indications of mini percutaneous nephrolithotomy (PCNL), the results and the complications of the method. Medline was searched from 1997 to January 2014, restricted to English language. The Medline search used a strategy including medical subject headings and free-text protocols. PCNL is a well-established treatment option for patients with large and complex renal calculi. In order to decrease morbidity associated with larger instruments like blood loss, postoperative pain and potential renal damage, a modification of the technique of standard PCNL has been developed. This is performed with a miniature endoscope via a small percutaneous tract (11–20 F) and was named as minimally invasive or mini-PCNL. This method was initially described as an alternative percutaneous approach to large renal stones in a pediatric patient population. Furthermore, it has become a treatment option for adults as well, and it is used as a treatment for calculi of various sizes and locations. However, the terminology has not been standardized yet, and the procedure lacks a clear definition. Nevertheless, mini-PCNL can achieve comparable stone-free rates to the conventional method, even for large stones. It is a safe procedure, and no major complications are reported. Although less invasiveness has not been clearly demonstrated so far, mini-PCNL is usually related to less blood loss and shorter hospital stay than the standard method.

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“…Whether MPCNL is equally effective as and safer than PCNL remains unsettled and the debate rages on. Numerous studies on this issue had been conducted but results had been conflicting [3][4][5][6][7][8][9][10][11]. We performed this meta-analysis based on current evidence Abstract The aim of the study was to objectively analyze the outcomes for minimally invasive percutaneous nephrolithotomy (MPCNL) vs standard percutaneous nephrolithotomy (PCNL) by systematic review and meta-analysis of published data.…”

Section: Introductionmentioning

confidence: 98%

Minimally invasive versus standard percutaneous nephrolithotomy: a meta-analysis

et al. 2015

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The aim of the study was to objectively analyze the outcomes for minimally invasive percutaneous nephrolithotomy (MPCNL) vs standard percutaneous nephrolithotomy (PCNL) by systematic review and meta-analysis of published data. A systematic literature review was performed in November 2014 using the PUBMED, EMBASE and Cochrane Library databases to identify relevant studies. Only comparative studies investigating MPCNL vs PCNL were included. Effect sizes were estimated by pooled odds ratio (ORs) and mean differences (MDs). The analyzed outcomes were stone-free rate (SFR), blood loss, pain assessment, operative time, hospital stay and complications. We identified 8 trials with a total 749 patients. 353 patients were treated with MPCNL and 396 with PCNL. Meta-analysis of the data showed that there was no difference in SFR between MPCNL and PCNL (OR 1.06, 95% CI 0.71-1.58). Patients in the MPCNL group experienced less drop in hemoglobin (MD: -4.67 g/L, 95% CI -7.29 to -2.04), a lower incidence of blood transfusion (OR 0.18, 95% CI 0.06-0.54), less pain (visual analog score) (MD: -0.53, 95% CI -0.94 to -0.13) and shorter hospitalization (MD: -1.32 days, 95% CI -2.15 to -0.50). Operative time was longer in the MPCNL group (MD: 15.54 min, 95% CI 4.25-26.83). Postoperative fever and pyelocalyceal perforation did not differ between the groups (p = 0.38 and 0.44, respectively). Current evidence suggested that MPCNL was a safe and effective procedure with an SFR comparable to that of PCNL. MPCNL resulted in less bleeding, fewer transfusion, less pain and shorter hospitalization. Well-designed multicentric/international randomized, controlled trials are still needed.

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A prospective comparative study of haemodynamic, electrolyte, and metabolic changes during percutaneous nephrolithotomy and minimally invasive percutaneous nephrolithotomy

Abstract: Although haemodynamic and electrolyte changes remains stable, a trend towards metabolic acidosis is obvious as the irrigation time goes by during MPCNL compared with PCNL. Therefore, arterial blood gases should be monitored during and after MPCNL in patients with prolonged irrigation time.

Cited by 31 publications

References 16 publications

Vacuum-assisted mini-percutaneous nephrolithotomy: a new perspective in fragments clearance and intrarenal pressure control

Vacuum-assisted mini-percutaneous nephrolithotomy: a new perspective in fragments clearance and intrarenal pressure control

Mini percutaneous nephrolithotomy in the treatment of renal and upper ureteral stones: Lessons learned from a review of the literature

Minimally invasive versus standard percutaneous nephrolithotomy: a meta-analysis

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