Confident Intraoperative Decision Making During Percutaneous Nephrolithotomy: Does This Patient Need a Second Look?

Portis, Andrew J.; Laliberte, Mark A.; Holtz, Cindy; Ma, Wenjun; Rosenberg, Michael S.; Bretzke, Carl A.

doi:10.1016/j.urology.2007.08.063

Cited by 48 publications

(21 citation statements)

References 15 publications

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“…The absence of residual stones > 4mm in size was confirmed using a complete inspection of the collecting system endoscopically (flexible nephroscopy and antegrade flexible ureteroscopy in all patients) in conjunction with high magnification rotational fluoroscopy (11).…”

Section: Surgical Techniquementioning

confidence: 83%

Tubeless percutaneous nephrolithotomy: outcomes with expanded indications

et al. 2014

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ARTICLE INFO ______________________________________________________________ ______________________Introduction: Tubeless PCNL has been utilized to shorten hospital stay and improve patient postoperative pain control. Prior studies have excluded those patients with significant bleeding or other complications. Our objective was to evaluate the utility of tubeless PCNL in all patients irrespective of intraoperative outcome. Materials and Methods:A retrospective review of the charts of patients who underwent PCNL at our institute was performed. Patients were assigned to one endourologist who routinely performed tubeless PCNL and to a second endourologist who routinely left a small-bore pigtail nephrostomy. Preoperative demographics operative and postoperative outcomes were compared. Results: Out of 159 patients included, 83 patients had tubeless PCNL while 76 patients had standard PCNL. There was no difference between groups regarding age, gender, ASA score, number, maximum diameter of stones, number of calyces involved, stone density (HU), laterality and use of preoperative narcotics. While staghorn stones were more common in patients who underwent standard PCNL (p = 0.008). Tubeless patients had less number of access tracts (p ≤ 0.001), shorter hospital stay (1.7 vs. 3.0 days, p = 0.001) when compared to standard PCNL group. Multivariable analysis controlling for confounding factors including staghorn calculi and number of accesses confirmed that tubeless PCNL was associated with shorter hospital stay and less postoperative pain. There was no significant difference in complication rates between the two groups. Conclusion: Our report confirms the previous reports of shorter hospital stay, less pain and analgesia as compared to standard PCNL, and establishes its safety irrespective of bleeding, perforation, extravasation or other intraoperative issues that have previously been utilized as exclusionary criteria for this approach.

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Section: Surgical Techniquementioning

confidence: 83%

Tubeless percutaneous nephrolithotomy: outcomes with expanded indications

et al. 2014

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“…Além disso, a fluoroscopia no final da intervenção poderá também não identificar fragmentos de menores dimensões. 15 Tendo em conta estes resultados, a perceção do cirurgião deve ser valorizada com reserva. A taxa de sucesso global mostrou-se inferior ao frequentemente publicado.…”

Section: Discussionunclassified

Tratamento da Litíase Renal com Ureterorrenoscopia: Experiência de um centro

Cerqueira¹,

Cerqueira²,

Dinis³

2017

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ResumoIntrodução: No presente estudo, analisámos os resultados iniciais desta técnica no nosso centro, com o objetivo de avaliar a eficácia e segurança da cirurgia intra-renal retrógrada no tratamento de cálculos renais e fatores preditores do seu sucesso. Material e Métodos: Após a recolha dos dados dos processos clínicos e exames de imagem dos doentes submetidos a cirurgia intra-renal retrógrada para tratamento de cálculos renais em 2014 e 2015 no Centro Hospitalar de São João, e aplicação dos critérios de exclusão, analisámos os dados relativos a 138 doentes (total de 179 cirurgia intra-renal retrógrada). Os nossos desfechos primários foram a taxa de sucesso imediata, avaliada pela perceção do cirurgião, e a taxa de sucesso pós-operatória, avaliada pela imagiologia de controlo, considerando como litíase residual significativa cálculos > 3 mm. Resultados: A taxa de sucesso global foi de 67,0% tendo em conta a perceção do cirurgião. Considerando o controlo imagiológico, a taxa de sucesso foi de 66,7% nos cálculos < 150 mm 2 fora do grupo calicial inferior, mas menor nas restantes localizações ou carga litiásica maior. Na análise univariada, a carga litiásica, o número de cálculos e a localização foram estatisticamente significativos como preditores do sucesso da cirurgia intra-renal retrógrada. Não foram registadas complicações major. Conclusão: A localização no grupo calicial inferior foi considerada um preditor do insucesso da cirurgia intra-renal retrógrada, sendo que neste grupo calicial a eficácia foi maior nos cálculos com <150 mm 2 ; esta diferença não se verificou nos cálculos fora desta localização. É uma intervenção segura, permitindo a sua utilização seriada.

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“…Therefore imaging 1 month after PCNL seems optimal. Imaging after a month may have advantages over more immediate imaging, since the residual stones may be obscured by ureteral stents and nephrostomy tubes (22). However, if PCNL is being performed with active extraction, imaging can be done immediately if there are no tubes blurring the assessment.…”

Section: Diagnosis Of Residual Fragmentsmentioning

confidence: 99%