Mini Versus Standard Percutaneous Nephrolithotomy: The Impact of Sheath Size on Intrarenal Pelvic Pressure and Infectious Complications in a Porcine Model

Loftus, Christopher; Hinck, Bryan; Makovey, Iryna; Sivalingam, Sri; Monga, Manoj

doi:10.1089/end.2017.0602

Cited by 54 publications

(31 citation statements)

References 19 publications

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“…High intrarenal pressures have also been associated with infectious complications. In a study comparing mini-PCNL to regular PCNL, mini-PCNL procedures demonstrated higher intra-renal pressures and had higher rates of end-organ seeding with bacteria which originated in the kidney (15). Furthermore, sustained time at high intra-renal pressures have been associated with post-operative fever (8).…”

Section: Discussionmentioning

confidence: 99%

High pressure endoscopic irrigation: impact on renal histology

Loftus

Byrne²,

Monga

2021

Int. braz j urol.

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Purpose: High intra-renal pressures during flexible ureteroscopy have been associated with adverse renal tissue changes as well as pyelovenous backflow. Our objective was to investigate the effect of various intra-renal pressures on histologic changes and fluid extravasation during simulated ureteroscopy. Materials and Methods: Twenty-four juvenile pig kidneys with intact ureters were cannulated with an Olympus flexible ureteroscope with and without a ureteral access sheath and subjected to India ink-infused saline irrigation for 30 minutes at constant pressures ranging from sphygmomanometer settings of 50mm, 100mm and 200mmHg. Renal tissue samples were collected, processed and stained, and were evaluated by a blinded pathologist for depth of ink penetration into renal parenchyma as a percentage of total parenchymal thickness from urothelium to renal capsule. Results: The mean percentage of tissue penetration for kidneys with ink present in the cortical tubules at sphygmomanometer pressure settings of 50, 100, and 200mm Hg without a ureteral access sheath was 33.1, 31.0 and 99.3%, respectively and with ureteral access sheath was 0, 0 and 18.8%, respectively. Overall, kidneys with an access sheath demonstrated a smaller mean tissue penetration among all pressure compared to kidneys without a sheath (6.3% vs. 54.5%, p=0.0354). Of kidneys with sheath placement, 11% demonstrated any ink compared to 56% of kidneys without sheath placement. Conclusions: Pressurized endoscopic irrigation leads to significant extravasation of fluid into the renal parenchyma. Higher intra-renal pressures were associated with increased penetration of irrigant during ureteroscopy in an ex-vivo porcine model.

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Section: Discussionmentioning

confidence: 99%

High pressure endoscopic irrigation: impact on renal histology

Loftus

Byrne²,

Monga

2021

Int. braz j urol.

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“…Chu et al focused specifically on the differences between standard and mini PCNL and found comparatively higher intrarenal pressures for mini PCNL, and also noted that mini PCNL procedures were more likely to be associated with postoperative sepsis [36]. In a porcine model, mini PCNL was associated with higher intrarenal pressures and higher risk of organ bacterial seeding in the setting of an infected collecting system, suggesting a higher potential for infectious complications [37]. Suction through the sheath or other intrarenal pressureregulating systems (e.g., new designs of the sheath) may overcome the concerns regarding pressure in mini PCNL, and suction through the sheath during miniaturized PCNL definitely deserves attention with respect to both efficacy and safety [38][39][40].…”

Section: Safety Aspects Of Lithotripsy During Miniaturized Pcnlmentioning

confidence: 99%

Consultation on kidney stones, Copenhagen 2019: lithotripsy in percutaneous nephrolithotomy

Axelsson

Cracco²,

Desai

et al. 2020

World J Urol

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Purpose To evaluate the balance between existing evidence and expert opinions on the safety and efficacy of new technological improvements in lithotripsy techniques for percutaneous nephrolithotomy (PCNL). Methods A scoping review approach was applied to search literature in Pubmed, Embase, and Web of Science. Consensus by key opinion leaders was reached at a 2-day meeting entitled "Consultation on Kidney Stones: Aspects of Intracorporeal Lithotripsy" held in Copenhagen, Denmark, in September 2019. Results New-generation dual-mode single-probe lithotripsy devices have shown favourable results compared with use of ballistic or ultrasonic lithotripters only. However, ballistic and ultrasonic lithotripters are also highly effective and safe and have been the backbone of PCNL for many years. Compared with standard PCNL, it seems that mini PCNL is associated with fewer bleeding complications and shorter hospital admissions, but also with longer operating room (OR) time and higher intrarenal pressure. Use of laser lithotripsy combined with suction in mini PCNL is a promising alternative that may improve such PCNL by shortening OR times. Furthermore, supine PCNL is a good alternative, especially in cases with complex renal stones and large proximal ureteric stones; in addition, it facilitates endoscopic combined intrarenal surgery (ECIRS). Conclusion Recent technological improvements in PCNL techniques are promising, but there is a lack of high-level evidence on safety and efficacy. Different techniques suit different types of stones and patients. The evolution of diverse methods has given urologists the possibility of a personalized stone approach, in other words, the right approach for the right patient.

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“…The development of surgical techniques and instruments continues to play a major role in the popularization of PCNL and RIRS [48,50]. mPCNL is de ned as PCNL performed using Amplantz sheaths with a diameter of 14-20 Fr [3,51]. mPCNL has the advantage of reducing complications that may arise from larger instruments and sheaths [4].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the stone-free rates of mini-percutaneous nephrolithotomy, standard percutaneous nephrolithotomy, and retrograde intrarenal surgery for renal stones: A systematic review and network meta-analysis

Kang¹,

Chung

Jeong

et al. 2020

Preprint

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Background: Retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are performed to treat renal stones. PCNL is effective for kidney stones >2 cm but is invasive compared with RIRS. Miniature PCNL (mPCNL) has been used as an alternative treatment for conventional PCNL, and employs a miniature endoscope of 11–18 Fr. We conducted a systematic review of published studies regarding the RIRS, PCNL, and mPCNL treatment modalities, and performed a network meta-analysis of the success or stone-free rates.Methods: The data collected up to January 2016 were searched using PubMed and EMBASE, and references were searched electronically. Two researchers used data extraction formats to extract data on the stone-free or success rates, study design, number of subjects and characteristics, and treatments for renal stones (i.e., RIRS, PCNL, and mPCNL). To evaluate the quality of the studies, the Downs and Black checklist, which is an observational research quality evaluation tool, was used and analyzed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Results: Twenty-five studies were used to compare the stone-free or success rates of RIRS, PCNL, and mPCNL for renal stones. Six comparisons of PCNL and mPCNL, seven of mPCNL and RIRS, and 12 of RIRS and PCNL were analyzed. No difference in the stone-free rate was found between PCNL and mPCNL (OR: 0.95; 95% CI: 0.51–1.9) in network mata-analysis. Between RIRS and mPCNL, the stone-free rate of RIRS was lower than mPCNL (OR: 0.41; 95% CI: 0.021–0.82). Comparison of RIRS and PCNL revealed that RIRS was also lower than PCNL in terms of stone-free rate (OR: 0.43; 95% CI: 0.22–0.82). In the ranking analysis, rankogram showed that mPCNL was ranked as No. 1 and PCNL was ranked as No. 2. The P-score was 0.820 for mPCNL, 0.680 for PCNL and 0 for RIRS.Conclusions: PCNL and mPCNL showed higher success or stone-free rates than RIRS for the treatment of renal stones. However, PCNL and mPCNL showed no difference in the treatment outcome.

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Mini Versus Standard Percutaneous Nephrolithotomy: The Impact of Sheath Size on Intrarenal Pelvic Pressure and Infectious Complications in a Porcine Model

Abstract: Mini-PCNL was associated with higher intrarenal pressures and higher risk of end organ bacterial seeding in the setting of an infected collecting system. This suggests a higher potential for infectious complications in a clinical setting.

Cited by 54 publications

References 19 publications

High pressure endoscopic irrigation: impact on renal histology

High pressure endoscopic irrigation: impact on renal histology

Consultation on kidney stones, Copenhagen 2019: lithotripsy in percutaneous nephrolithotomy

Comparison of the stone-free rates of mini-percutaneous nephrolithotomy, standard percutaneous nephrolithotomy, and retrograde intrarenal surgery for renal stones: A systematic review and network meta-analysis

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