Alternative management of complex renal stones

Pevzner, Millie; Stisser, Brian C.; Luskin, Jordan; Yeamans, Jeffrey C.; Cheng-Lucey, Marina; Pahira, John J.

doi:10.1007/s11255-010-9880-y

Cited by 20 publications

(12 citation statements)

References 22 publications

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“…Staghorn calculi are branched stones that fill the renal pelvis and branch into several or all of the calices [7,8]. Despite the widespread appeal of PCNL in the management of large-volume renal stones, its application in patients with staghorn calculi is one of the more challenging endourologic procedures.…”

Section: Discussionmentioning

confidence: 99%

Standard-Tract Combined with Mini-Tract in Percutaneous Nephrolithotomy for Renal Staghorn Calculi

et al. 2014

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Purpose: To compare the safety and efficacy of standard-tract combined with mini-tract to single standard-tract in percutaneous nephrolithotomy (PCNL) for renal staghorn calculi. Methods: The records of 216 patients with staghorn calculi (110 (50.9%) had complete and 106 (49.1%) had partial) who received PCNL were reviewed retrospectively. 58 patients received standard-tract combined with mini-tract PCNL (group A) and 158 patients underwent single standard-tract PCNL (group B). Both groups had comparable demographic data. Operation time, stone-free rate, blood transfusion rate, hospital stay and complications were analyzed. Results: Postoperative Clavien score in the two groups was similar. The rate of blood transfusion and perioperative bleeding requiring superselective embolization were not statistically significant between the groups (p = 0.557, 0.463, respectively). The mean operation time was comparable between groups in the standard-tract combined with mini-tract group. The stone-free rate was significantly higher (89.7 vs. 78.5%, p = 0.044) in group A than in group B. The rate of second PCNL was higher in group B. Conclusion: The standard-tract combined with mini-tract results had higher success rates with no increase in the incidence of complications, and should be the first option for renal staghorn calculi.

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Section: Discussionmentioning

confidence: 99%

Standard-Tract Combined with Mini-Tract in Percutaneous Nephrolithotomy for Renal Staghorn Calculi

et al. 2014

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“…It was observed that as the size of the stone increases, and as the complexity of the situation increases, the stone-free rate decreases. 35,36 Residual stone of varying size was seen in 15 (14.1%) cases. Re-PCNL was required in 1 patient, while 1 patient required URSL in whom the stone had descended into the ureter, and ESWL was given to 13 (12.1%) patients.…”

Section: Discussionmentioning

confidence: 99%

Prospective Study of Percutaneous Nephrolithotomy in the Management of Renal Calculi

Raut¹,

Tiwari²,

Singhania³

et al. 2017

MGM Journal of Medical Sciences

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“…19,37,39,42,44,45 This decreased to 25%-75% when stones greater than 4 cm were treated. 20,38,39,41,47,48 Ricchiuti et al's study of 23 patients' SFR dropped from 88% to 60% to 40% for stone sizes 2-3 cm, 3-4 cm, and above 4 cm, respectively. 47 Mariani did report an overall SFR of 95% for stones ranging from 2 to 10 cm, but required an average of 1.7 procedures per patient.…”

Section: Effects Of Obesity On Outcomesmentioning

confidence: 92%

“…25,37 Recent studies have reported the successful treatment of stones greater than 2 cm with flexible URS. 19,20,[37][38][39][40][41][42][43][44][45][46][47][48][49] One limitation of the current literature related to stone treatment is the lack of a standardized definition of stone-free. The definition of less than 4 mm on imaging not requiring a second procedure was used here as a standardized comparison between studies.…”

Section: Effects Of Obesity On Outcomesmentioning

confidence: 99%

Flexible ureteroscopy versus percutaneous nephrolithotomy as primary treatment for renal stones 2 cm or greater

Akar¹,

Knudsen

2013

RMI

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The purpose of this review, based on the current evidence in the literature, is whether ureteroscopy (URS) is a comparable primary treatment option to the current gold standard of percutaneous nephrolithotomy (PCNL) for the treatment of large kidney stones 2 cm or greater. The lack of prospective randomized trials directly comparing URS and PCNL makes comparison challenging. The numerous studies are not standardized in terms of their definition of stone-free or how stone size is reported. In order to standardize comparison of results, we used a stonefree definition of ,4 mm after one procedure per imaging of the author's choice, since how each patient was imaged postoperatively was not reported. The results from the literature show that moderately large stones from 2 to 3 cm treated ureteroscopically have similar outcomes to PCNL. Stone-free rates with URS decrease when stone size is above 3 cm. Our interpretation of the literature suggests that a current limitation of URS is that multiple procedures for URS would be required to achieve comparable stone-free rates to PCNL, particularly for stones greater than 4 cm.

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Alternative management of complex renal stones

Abstract: This series demonstrates that ureterorenoscopy and Holmium laser lithotripsy is an effective and safe primary treatment modality for the treatment of large complex kidney stones. It is an attractive alternative to PCNL, particularly in those with comorbid conditions.

Cited by 20 publications

References 22 publications

Standard-Tract Combined with Mini-Tract in Percutaneous Nephrolithotomy for Renal Staghorn Calculi

Standard-Tract Combined with Mini-Tract in Percutaneous Nephrolithotomy for Renal Staghorn Calculi

Prospective Study of Percutaneous Nephrolithotomy in the Management of Renal Calculi

Flexible ureteroscopy versus percutaneous nephrolithotomy as primary treatment for renal stones 2 cm or greater

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