Is There Still a Place for Percutaneous Nephrolithotomy in Current Times?

Lorenzis, E. De; Zanetti, S.P.; Boeri, Luca; Montanari, Emanuele

doi:10.3390/jcm11175157

Cited by 15 publications

(17 citation statements)

References 95 publications

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“…PCNL was first introduced in 1976 ( 9 ). Nowadays, PCNL is the first-line treatment for large and complex renal stones ( 1 , 10 ). However, some patients have residual stones, accounting for 24%–44% of postoperative patients ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

Correlation analysis between renal anatomical factors and residual stones after an ultrasound-guided PCNL

Zhu¹,

Fan

Hu³

et al. 2023

Front. Surg.

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IntroductionTo predict the factors of residual stones after percutaneous nephrolithotomy (PCNL) by analyzing the characteristics of the renal anatomical structure in intravenous urography, so as to make a reasonable operation plan, reduce the risk of residual stones in PCNL, and improve the stone-free rate (SFR).MethodsA retrospective study was performed between January 2019 and September 2020 for patients treated with PCNL. According to the results of a kidney ureter bladder review after PCNL, 245 patients were divided into a residual stone group (71 patients, stone size >4 mm) and a stone-free group (174 patients, stone size ≤4 mm). An independent sample t-test was used to analyze the age, the length and width of channel calices, the angle between the channel calices and the involved calices, and the length and width of the involved calices. The gender, the channel types, the number of channels, the degree of hydronephrosis, and the number of involved calices were analyzed by using the chi-square test. A score of p < 0.05 was considered statistically significant. At the same time, logistic regression analysis was carried out to explore the independent influencing factors of the SFR after PCNL.ResultsA total of 71 patients developed residual stones after surgery. The overall residual rate was 29.0%. The width of the channel calices (p = 0.003), the angle between the channel calices and the involved calices (p = 0.007), the width of the involved calices (p < 0.001), the channel types (p = 0.008), and the number of involved calices (p < 0.001) were all significantly correlated with residual stones after PCNL. Logistic regression analysis showed that the width of the channel calices (p = 0.003), the angle between the channel calices and the involved calices (p = 0.012), the width of the involved calices (p < 0.001), the channel types (p = 0.008), and the number of involved calyces (p < 0.001) were all independent influencing factors of the SFR after PCNL.ConclusionA larger caliceal neck width and angle can reduce the risk of residual stones. The more calyces that are involved, the higher the risk of residual stones. There was no difference between F16 and F18, but F16 had a higher SFR than F24.

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Section: Discussionmentioning

confidence: 99%

Correlation analysis between renal anatomical factors and residual stones after an ultrasound-guided PCNL

Zhu¹,

Fan

Hu³

et al. 2023

Front. Surg.

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“…Indeed, RIRS has demonstrated promising results and a review by Breda et al summoned the studies reporting results of RIRS for renal stones >2.5 cm and concluded that an SFR of 89.3% was feasible with an average of 1.6 procedures per case and low complication rate (6). However, comparable results of RIRS to PNL are achievable frequently through staged procedures in high-volume centers, which suggests that RIRS is not yet equivalent to PNL (7). Moreover, technological developments are also contributing to the optimization of PNL procedures, with the miniaturization of the respective scopes and access sheaths, which makes PNL less invasive and safer in terms of complication rate (7).…”

Section: Introductionmentioning

confidence: 99%

“…However, comparable results of RIRS to PNL are achievable frequently through staged procedures in high-volume centers, which suggests that RIRS is not yet equivalent to PNL (7). Moreover, technological developments are also contributing to the optimization of PNL procedures, with the miniaturization of the respective scopes and access sheaths, which makes PNL less invasive and safer in terms of complication rate (7).…”

Section: Introductionmentioning

confidence: 99%

Comparison of retrograde intrarenal surgery and percutaneous nephrolithotomy results for 20-30 mm kidney stones: A matched-pair analysis

et al. 2023

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Objective: To compare the results of retrograde intrarenal surgery and percutaneous nephrolithotomy for 20-30 mm kidney stones.Material and Methods: The demographic, radiologic, clinic and surgery related data of 324 patients who underwent retrograde intrarenal surgery and percutaneous nephrolithotomy for 20-30 mm kidney stones between January 2013 and July 2022 were retrospectively analyzed. All patients were divided into two roups as retrograde intrarenal surgery group and percutaneous nephrolithotomy group according to the surgery performed. After matching two groups in terms of age, number of stones, location of stones, stone size and stone density, 122 patients were included in the study (61 patients in retrograde intrarenal group and 61 patients in percutaneous nephrolithotomy group as 1:1).Results: The success rate of retrograde intrarenal surgery group (78.7%) and percutaneous nephrolithotomy group (80.2%) were similar (p=0.823). There was no difference between two groups in terms of infective and non-infective complications (respectively, p=0.752 and p=0.61). There were statistically significant difference between the two groups in duration of operation and hospitalization. The median operation time was 70 (30-100) minutes and the median hospital stay was 1 (1-28) days in the RIRS group, while the median operation time was 90 (50-160) minutes and the median hospital stay was 4 (2-10) days in the PNL group (p<0.001).Conclusion: Retrograde intrarenal surgery is a good alternative in the surgical treatment of 20-30 mm kidney stones with similar success and complication rates and also shorter operation time and hospitalization time.

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“…1,2 However, minimally invasive approaches might not be appropriate for urolithiasis with anatomical abnormalities and/or a high stone burden because they are technically challenging and have a low stone-free rate. 3 Laparoscopic surgery was one option that some considered. 4 Robotic surgery, however, might be a preferred option due to its superior visualisation and manoeuverability.…”

Section: Introductionmentioning

confidence: 99%

Case report: Crossed fused renal ectopia with stones: A surgical challenge overcome by robotic surgery

Chai

2023

Robotics Computer Surgery

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BackgroundCrossed fused renal ectopia (CFRE) is an extremely rare congenital anomaly of the urinary tract that is prone to stone formation. The surgical treatment of CFRE with stones is challenging due to anatomical abnormalities.Materials and MethodsRight kidney stones were treated by flexible ureteroscopic lithotripsy (FURSL) and left kidney stones were treated by robotic surgery.ResultsThe authors present an unreported case of bilateral renal stones in a patient with CFRE, which was successfully treated by robotic pyelolithotomy combined with FURSL. The procedure was manoeuverable, and the stone‐free rate was satisfactory.ConclusionsCFRE with stones (S‐shaped kidney) present a surgical challenge due to anatomical abnormalities and a high stone burden. The authors recommend robotic pyelolithotomy with or without FURSL as a viable treatment option for stones with similar anatomical abnormalities.

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Is There Still a Place for Percutaneous Nephrolithotomy in Current Times?

Cited by 15 publications

References 95 publications

Correlation analysis between renal anatomical factors and residual stones after an ultrasound-guided PCNL

Correlation analysis between renal anatomical factors and residual stones after an ultrasound-guided PCNL

Comparison of retrograde intrarenal surgery and percutaneous nephrolithotomy results for 20-30 mm kidney stones: A matched-pair analysis

Case report: Crossed fused renal ectopia with stones: A surgical challenge overcome by robotic surgery

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