Fluoroscopy guided percutaneous renal access in prone position

Sharma, Gyanendra

doi:10.12998/wjcc.v3.i3.245

Cited by 26 publications

(17 citation statements)

References 102 publications

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“…It was noted that a high proportion of these patients, 5 of 7 (71.4%), had a renal pelvis stone with extension into the upper ureter that was approached by the lower pole calyx. When selecting a pole for puncture, it is recommended that the pole that provides the most straight line along the stone axis be selected [20]. If this principle is not kept, the angle between the tract and the stone axis may become too acute, leading to excessive torque or a change in the direction of the tract, which can cause injury to the adjacent parenchyma with its vascular supply (Fig.…”

Section: Discussionmentioning

confidence: 99%

Critical causes in severe bleeding requiring angioembolization after percutaneous nephrolithotomy

Kim

Lee

2020

BMC Urol

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Background: To identify the risk factors for severe bleeding requiring angioembolization among patients who received transfusions after PCNL, particularly those who underwent anatomically incorrect renal puncture. Methods: A total of 53 patients, who received transfusions after PCNL and simultaneously had a postoperative CT scan performed between November 2009 and May 2019 at two teaching hospitals, were retrospectively reviewed. The patients were divided into two groups: those who underwent angioembolization and those who did not. Patient, stone and procedural factors were compared between the two groups. Puncture correctness was evaluated using postoperative CT scans. Puncture was defined as being a correct puncture if the fornix or papilla of the posterior calyx was punctured and the trajectory of the tract was within 20 degrees posterior to the frontal plane of the kidney (i.e., within Brödel's line). Results: 21 patients underwent angioembolization after PCNL. Incorrect puncture was seen in 14/21 (66.7%) patients who underwent angioembolization after PCNL, whereas it was seen in 11/32 (34.4%) patients who did not undergo angioembolization (p = 0.021). On multivariable regression analysis, puncture correctness was found to be the only significant factor, with an OR of 3.818, 95% CI of 1.192-12.231 and p value of 0.024. Conclusions: Incorrect renal puncture was related to severe bleeding requiring angioembolization after PCNL. Our results emphasize the importance of the basic principle of renal puncture for PCNL.

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Section: Discussionmentioning

confidence: 99%

Critical causes in severe bleeding requiring angioembolization after percutaneous nephrolithotomy

Kim

Lee

2020

BMC Urol

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“…2 It provides a clear mapping of the collecting system, 15 but is associated with a relatively long learning curve driven by difficulty identifying posterior calices and collecting system depth. 16 Moreover, the ionizing radiation exposures required by fluoroscopy, although individually relatively small, have been shown to be cumulative and affect both patients and intraoperative personnel, with potential adverse health effects including cataracts or even secondary malignancies. 3,17 …”

Section: Discussionmentioning

confidence: 99%

X-ray–free Ultrasound-guided Percutaneous Nephrolithotomy: How to Select the Right Patient?

Usawachintachit

Tzou

et al. 2017

Urology

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OBJECTIVE To identify factors associated with successful ultrasound guidance for each surgical step of ultrasound-guided percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS Consecutive patients undergoing PCNL between March 2015 and June 2016 were prospectively enrolled. An attempt was made to use ultrasound guidance in renal access, tract dilation, and nephrostomy tube placement for each patient. For steps during which ultrasound guidance was unsuccessful, fluoroscopic screening was applied. Regression analysis identified patient characteristics associated with successful use of ultrasound guidance. RESULTS A total of 96 patients composed this cohort, with a mean body mass index of 28.7 kg/m2. Mean stone size was 33.1 ± 18.9 mm, and no hydronephrosis was found in 63.5% of cases. Fluoroscopic screening was required for renal access in 27 cases (28.1%), tract dilation in 38 (39.6%), and nephrostomy tube placement in 80 (83.3%). Multivariate analysis demonstrated that successful ultrasound guidance was significantly associated with the presence of hydronephrosis for renal access and the absence of staghorn calculi for tract dilation. Ultrasound-guided nephrostomy tube placement appeared linked to surgeon experience. CONCLUSION To achieve completely x-ray–free ultrasound-guided PCNL, the ideal patient should have a hydronephrotic collecting system with no staghorn stone present. For practitioners looking to adopt ultrasound guidance into their PCNL practice, these represent the most appropriate patients to safely initiate a surgical experience.

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“…[15] Complete staghorn calculi are staged by protocol to two or rarely three sessions. At the end of 1 month, patients are assessed for any residual calculi by means of X-ray (in case of radiodense calculi) and/or USG (in case of radiolucent calculi).…”

Section: Methodsmentioning

confidence: 99%

Stepwise case selection using Guy's stone score reduces complications during percutaneous nephrolithotomy training

et al. 2017

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Introduction:Traditional percutaneous nephrolithotomy (PCNL) training involved subjective award of cases to the trainee. We restructured this according to the Guy's stone score (GSS) such that each trainee stepwise completed 25 cases of each grade before progressing. This study compares the outcomes of training with traditional versus stepwise approach.Methods:Four hundred consecutive cases equally distributed for two trainees in each group were compared in terms of complications (Clavien-Dindo), stone free rate (SFR), operative and fluoroscopy time. External comparison was also done against a benchmark surgeon. Multivariable regression model was created to compare SFR and complications while adjusting for comorbidity, Amplatz size, access tract location, number of punctures, body mass index, stone complexity, and training approach.Results:The distribution of cases in terms of calculus complexity was similar. Overall, in comparison to traditional training, stepwise training had significantly shorter median operative time (100 vs. 120 min, P < 0.05), fluoroscopy time (136 vs. 150 min, P < 0.05) and fewer overall (29.5% vs. 43.5%, P < 0.005) as well as major complications (3% vs. 8.5%, P - 0.029), though initial SFR was higher but not statistically significant (77% vs. 71.5%). On multivariable analyses, stepwise training was independently associated with lower complications (odds ratio 0.46 [0.20–0.74], P - 0.0013) along with GSS grade, number of punctures, and Amplatz size. Stepwise training had similar fluoroscopy time, major complications and final clearance rate compared to expert surgeon.Conclusions:PCNL has a learning curve specific for each grade of calculus complexity and stepwise training protocol improves outcomes.

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Fluoroscopy guided percutaneous renal access in prone position

Cited by 26 publications

References 102 publications

Critical causes in severe bleeding requiring angioembolization after percutaneous nephrolithotomy

Critical causes in severe bleeding requiring angioembolization after percutaneous nephrolithotomy

X-ray–free Ultrasound-guided Percutaneous Nephrolithotomy: How to Select the Right Patient?

Stepwise case selection using Guy's stone score reduces complications during percutaneous nephrolithotomy training

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