Contemporary considerations in the management and treatment of lower pole stones

Abstract

The presence of lower pole stones poses a unique challenge due to the anatomical considerations involved in their management and treatment. Considerable research has been performed to determine the optimal strategy when faced with this highly relevant clinical scenario. Standard options for management include observation, shock wave lithotripsy, retrograde intrarenal surgery, or percutaneous nephrolithotomy. Indeed, each approach confers a distinct set of risks and benefi ts, which must be placed into the context of patient preference and expected outcomes. The current state of practice refl ects a combination of lessons learned from managing calculi not only in the lower pole, but also from other locations within the kidney as well.

Comparison of mini percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for renal stones >2cm: a systematic review and meta-analysis

“…In fact, the 24F PCNL is being favored by more and more urologists around the World, because it can greatly reduce the complications caused by the large tract. Encouragin-gly, mini-PCNL (<24F) is evolving rapidly to achieve improved efficacy while retaining the safety benefits of mini-PCNL (28,29). Smaller tract sizes, better efficacy, and lower complication rates will surely be achieved over time.…”

A novel nomogram and a simple scoring system for urinary leakage after percutaneous nephrolithotomy

“…Despite its high stone-free rates and efficacy, large-scale complications can occur after PCNL (3,4). The prolongation of urinary leakage from the nephrostomy tract after nephrostomy requires the insertion of a DJ catheter, which is classified as a grade 3 complication according to the Clavien scoring system (3).…”

“…The optimal cut--off value of the scoring system was 6.5, at which it had 76.1% sensitivity and specificity of 71.0% in predicting PUL. Based on novel scores, the patients were divided into the risk groups of low (3)(4)(5)(6), moderate (7)(8)(9), and high (10-11) (Figure -3), which were found to have the PUL rates of 3.6%, 19.4%, and 80%, respectively.…”

“…Despite the high efficacy of PCNL, complications of up to 20-83% are described in the literature. The most common of these complications are postoperative fever (4-32.1%), bleeding requiring transfusion (10.9-17.5%), and urine extravasation (7.2%) (3)(4)(5). However, when complications are classified according to the Clavien scoring system, the most common grade-3 complication is urine leakage persisting for >24 h (4%) treated by a double-J (DJ) ureteral stent (3).…”

Comparison of Mini Percutaneous Nephrolithotomy and Standard Percutaneous Nephrolithotomy in the Management of Renal Stones of more than 2CM

“…In fact, the 24F PCNL is becoming more and more popular among urologists worldwide since it may significantly lessen the difficulties brought on by the big tract. Mini-PCNL (24F) is fortunately improving quickly to attain increased efficacy while maintaining the advantages of mini-PCNL in terms of safety [23,24]. Over time, smaller tract diameters, greater effectiveness, and reduced complication rates will undoubtedly be attained.…”