Comparative study of percutaneous access for staghorn calculi

Netto, Nelson Rodrígues; Ikonomidis, Jean; Ikari, Osamu; Claro, Joaquim Francisco de Almeida

doi:10.1016/j.urology.2004.10.081

Cited by 105 publications

(76 citation statements)

References 14 publications

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“…But Netto and colleagues reported higher complication rates for multiple accesses versus upper pole and lower/middle calices accesses in staghorn stones. 45 In our experience, multiple tracts predicted higher complications in MCC. Many of our complications were related to vascular events, bleeding, and transfusion.…”

Section: Discussionmentioning

confidence: 57%

Factors affecting complications according to the modified Clavien classification in complete supine percutaneous nephrolithotomy

Falahatkar¹,

Moghaddam

Kazemnezhad³

et al. 2015

CUAJ

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Cite as: Can Urol Assoc J 2015;9(1-2):e83-92. http://dx.doi.org/10.5489/cuaj.2248 Published online February 9, 2015. AbstractIntroduction: An increase in percutaneous nephrolithotomy (PCNL) has been accompanied by an increase in complications. We identified the parameters affecting the severity of complications using the modified Clavien classification (MCC). Methods: From 2008 to 2013, 330 patients underwent complete supine PCNL using subcostal access, one-shot dilation, rigid nephroscopy, and pneumatic lithotripsy. We assessed the impact of the following factors on complication severity based on the MCC: age, gender, body mass index, hypertension, diabetes, previous stone surgery and extracorporeal shock wave lithotripsy, preoperative hemoglobin, renal dysfunction (creatinine >1.4 mg/dL), preoperative urinary tract infection, anatomic upper urinary tract abnormality (AUUTA), significant (moderate-severe) hydronephrosis, stonerelated parameters (opacity, number, burden, location, staghorn, complex stones), anesthesia type, kidney side, imaging and calyx for access, tract number, tubeless approach, operative time, postoperative hemoglobin, and hemoglobin drop and stone-free results. Results: The complication rate was 19.7% (MCC: 0=80.3%, I=6.4%, II=11.2%, ≥III=2.1%). On univariate analyses, only the following factors affected MCC: gender, preoperative hemoglobin, AUUTA, significant hydronephrosis, imaging for access, calyx for access, tract number, postoperative hemoglobin, hemoglobin drop and stone-free result. Renal dysfunction was accompanied by higher complications, yet the results were not statistically significant. Multivariate logistic regression analysis demonstrated renal dysfunction, absence of significant hydronephrosis, AUUTA, multiple tracts, lower postoperative hemoglobin, and higher postoperative hemoglobin drop as the significant parameters which affected MCC and predicted higher grades. The paper's limitations include a low number of cases in the higher Clavien grades and some subgroups of variables, and not applying some techniques due to surgeon preference. Interpretation: Many of the complete supine PCNL complications were in the lower Clavien grades and major complications were uncommon. Renal dysfunction, AUUTA, significant hydronephrosis, tract number, postoperative hemoglobin, and hemoglobin drop were the only factors affecting MCC. IntroductionPresently, percutaneous nephrolithotomy (PCNL) is preferred as a safe and effective way to remove large or multiple upper urinary tract calculi. [1][2][3][4][5][6][7] An increase in PCNL has been accompanied by variations in positions, techniques, and instruments, and these may have led to increased complications.1,2,4,5 Following PCNL, 79.5% of patients may experience an uncomplicated postoperative period, 5,8 although there are reports of an early complication rate of 50.8%. 4PCNL complications may occur during puncturing, access, or stone removal. 4 A standardized classification allow us to compare complications among different instruments, te...

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Section: Discussionmentioning

confidence: 57%

Factors affecting complications according to the modified Clavien classification in complete supine percutaneous nephrolithotomy

Falahatkar¹,

Moghaddam

Kazemnezhad³

et al. 2015

CUAJ

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“…Contemporary studies demonstrate improved stone-free rates with a low incidence of pleural injuries with upper pole access. 20,28 As such, we feel that the risk of pleural injury should not impede selection of upper calyceal access if deemed appropriate to maximize stone clearance. Although a multiple-access approach is advocated by some to avoid a supracostal puncture, its use has been found to be associated with an increase in bleeding complications.…”

Section: Preventing Splenic Injurymentioning

confidence: 99%

“…Although a multiple-access approach is advocated by some to avoid a supracostal puncture, its use has been found to be associated with an increase in bleeding complications. [28][29][30][31] 1 Transsplenic catheter Nephrostomy tube drainage (2 weeks) None Santiago et al 24 …”

Section: Preventing Splenic Injurymentioning

confidence: 99%

“…28 A synchronous bidirectional approach that combines the use of flexible instruments in a retrograde fashion as well as through the nephrostomy tract to avoid multiple percutaneous punctures has also been described. 32 We prefer to use a single-access approach, utilizing the upper pole when necessary, with the liberal use of flexible nephroscopy and retrograde intrarenal surgery to achieve optimal stone-free rates.…”

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confidence: 99%

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Splenic Injury During Percutaneous Nephrolithotomy: A Case Report with Novel Management Technique

Desai

Jain

Benway

et al. 2010

Journal of Endourology

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We describe a case of a splenic injury caused by a transsplenic percutaneous nephrostomy tract. The case was completed without incident and the nephrostomy tube was noted to traverse the spleen on routine postoperative imaging. This rare complication was managed by deposition of Gelfoam Ò pledgets along the transsplenic nephrostomy tract and placement of a ureteral stent. This novel management technique has not been previously described in the literature and was successful in the conservative treatment of the uncommon complication of splenic injury during percutaneous nephrolithotomy.

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“…Access to the collecting system is performed via upper, middle and lower calices. [11][12][13][14][15] Upper calyx access provides a perfect reach to the collecting system and many upper tract stones. However, this access may incur intrathoracic complications.…”

Section: Introductionmentioning

confidence: 99%

Middle calyx access in complete supine percutaneous nephrolithotomy

Falahatkar

Kazemnezhad

Moghaddam

et al. 2013

CUAJ

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Background: Middle calyx access has been underused in percutaneous nephrolithotomy (PCNL), especially in the supine position. We compared the safety and efficacy outcomes between middle calyx and lower calyx accesses in the complete supine PCNL in a non-randomized single-surgeon clinical study. Methods: Between February 2008 and October 2011, 170 patients underwent posterior subcostal single tract complete supine PCNL with one-shot dilation and middle calyx (n = 48) and lower calyx (n = 122) accesses. Stone location and surgeon decision determined target calyx for access. Inclusion criteria were pelvis stones, staghorn stones and multiple location stones. Exclusion criteria were renal anomalies, only upper calyx stones, only middle calyx stones and only lower calyx stones. Important parameters were compared between the two groups. A p value of <0.05 was considered significant. Results: Two groups were similar in important patient-and stonerelated parameters. Mean operative time (60.7 minutes), mean postoperative hospital stay (1.84 days) and mean hemoglobin drop (0.67 g/dL) in the middle calyx group were significantly lesser than in the lower calyx group (80.1 minutes, 2.19 days, 1.36 g/dL). The middle calyx group (89.6%; 79.6%) had a higher stone-free rate (p = 0.054) and efficiency quotient than the lower calyx group (76.2%; 61.6%). In the middle calyx group (10.4%; 2.1%), complication and transfusion rates were lesser (p > 0.05) than lower calyx group (14.8%; 7.4%). No significant difference (p = 0.40) was seen between two groups using the modified Clavien classification of complications. Interpretation: Middle calyx can be an optimal access in PCNL with the complete supine position for many of upper urinary tract stones due to its superior outcomes.

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Comparative study of percutaneous access for staghorn calculi

Cited by 105 publications

References 14 publications

Factors affecting complications according to the modified Clavien classification in complete supine percutaneous nephrolithotomy

Factors affecting complications according to the modified Clavien classification in complete supine percutaneous nephrolithotomy

Splenic Injury During Percutaneous Nephrolithotomy: A Case Report with Novel Management Technique

Middle calyx access in complete supine percutaneous nephrolithotomy

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