Non papillary mini-percutaneous nephrolithotomy: early experience

Kallidonis, Panagiotis; Vagionis, Athanasios; Vrettos, Theofanis; Adamou, K; Pagonis, Konstantinos; Ntasiotis, Panteleeimon; Callas, G.A.; Tanaseskou, L; Aown, A.M.A. Al; Liatsikos, Evangelos

doi:10.1007/s00345-020-03267-z

Cited by 22 publications

(7 citation statements)

References 17 publications

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“…Currently, some researchers believe that non-papillary puncture is as safe as papillary puncture, illustrating that the bleeding rate of the two puncture pathways did not differ statistically, and that the bleeding rate of non-papillary puncture was close to that reported in the literature for papillary puncture (23)(24)(25). Based on our preliminary autopsy of cadavers, we found that the prevalence of FRP in human kidneys is not low (13).…”

Section: Discussionsupporting

confidence: 70%

Presence of a Novel Anatomical Structure May Cause Bleeding When Using the Calyx Access in Mini-Percutaneous Nephrolithotomy

Lin

Rao

et al. 2022

Front. Surg.

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BackgroundFused renal pyramid (FRP) is a kidney anatomical structure which was first identified by us. The vascular anatomy of FRP exhibits different from that of the normal renal pyramid (NRP), manifested by the distribution of the ectopic interlobar arteries in FRP. In this study, we analyzed the effect of FRPs on bleeding when using calyx access in mini-percutaneous nephrolithotomy (PCNL).Patients and MethodsOverall, 633 patients who underwent ultrasound-guided single-tract mini-PCNL were divided into two groups according to the puncture method used: in group A, puncture was performed through the axial direction of the renal calyx, the line from the apex of the fornix to the center of the neck plane under B-mode ultrasound guidance; and in group B, Doppler ultrasound-guided axillary puncture through calyces corresponding to NRPs when the plane of renal column blood vessels on both sides was selected or calyx puncture through the hypovascular area of the FRPs. Relevant demographic and clinical data were retrospectively analyzed.ResultsThe two groups exhibited similar baseline characteristics. No significant differences were found in hemoglobin reduction, puncture site, tract size, postoperative creatinine level, or stone-free rate between the two groups (P > 0.05). Blood transfusion and embolization rates in group B were significantly lower than those in group A (P = 0.03 and 0.045, respectively). No differences were found between the two groups in terms of persistent pain, hydrothorax, fever, subcapsular hematoma, and urosepsis (P > 0.05). The overall complication rate was not significantly different between the two groups (P = 0.505).ConclusionsFRP is a non-negligible anatomical structure that may cause hemorrhage when using calyx access. Doppler ultrasound can identify ectopic blood vessels in FRPs to reduce bleeding during calyx access in mini-PCNL procedures.

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Section: Discussionsupporting

confidence: 70%

Presence of a Novel Anatomical Structure May Cause Bleeding When Using the Calyx Access in Mini-Percutaneous Nephrolithotomy

Lin

Rao

et al. 2022

Front. Surg.

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“…Our data showed the CEUS-guided PCNL achieved more precise puncture in patients with no or mild hydronephrosis, with a rate of puncture via calyceal fornix up to 86.1%. Recently, studies have showed that nonpapillary or infundibular puncture was not associated with higher blood loss or transfusion rate compared to calyceal puncture [22,23]. However, these reports are from single center and have not been recognized worldwide.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of contrast-enhanced ultrasound and flank position during percutaneous nephrolithotomy in patients with no apparent hydronephrosis: a randomized controlled trial

et al. 2022

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Purpose To investigate the puncture accuracy and feasibility of contrast-enhanced ultrasound (CEUS) guided percutaneous nephrolithotomy (PCNL) in flank position for patients with no apparent hydronephrosis. Methods Between May 2018 and June 2020, 72 kidney stone patients with no or mild hydronephrosis were randomized into two groups: a CEUS-guided PCNL group and a conventional ultrasound (US)-guided group. Patients’ demographics and perioperative outcomes were compared, including the success rate of puncture via calyceal fornix, the success rate of a single-needle puncture, puncture time, operative time, postoperative hemoglobin loss, stone-free rate, incidence of complications and postoperative stay. Results The success rate of puncture via calyceal fornix for CEUS-guided group was significantly higher than that for conventional US-guided group (86.1 vs. 47.2%, p = 0.002). Patients performed with CEUS-guided PCNL required shorter renal puncture time than those guided with conventional US (36.5 s vs. 61.0 s, p < 0.001). The median postoperative hemoglobin loss in the CEUS-guided group was significantly lower than that in conventional US-guided group (2.5 vs. 14.5 g/L, p < 0.01). There was no statistically significant difference in the success rate of a single-needle puncture, operative time, stone-free rate, incidence of complications and postoperative stay between the two groups. Conclusion CEUS guidance facilitates identification of the renal calyx fornix, and benefits more precise renal puncture and less hemoglobin loss in PCNL. CEUS-guided PCNL in flank position is a feasible approach to the treatment of kidney stone patients with no apparent hydronephrosis. Trial registration number: ChiCTR1800015417.

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“…The feasibility and safety of the non-papillary approach were also investigated for mini-PCNL using 18 Fr nephroscope with a maximal outer sheath diameter of 22 Fr. 7 The mean haemoglobin drop in the cohort was 1.23±0.88 gr/dL and none of their patients developed severe bleeding requiring transfusion and additional intervention.…”

Section: Authorsmentioning

confidence: 85%

Non-papillary Percutaneous Puncture: A Safe Approach to Consider

2021

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Percutaneous nephrolithotomy (PCNL) is the ‘gold standard’ treatment modality for renal stones larger than 2 cm. It can be also applied to manage smaller renal stones and large, impacted stones located in the proximal ureter. Nevertheless, even in experienced hands, the PCNL procedure is associated with the development of several complications. Despite the existing extensive research in this field, studies evaluating the effect of puncture site on perioperative bleeding are very few. In part, this can be explained by the dogma that the safest way to perform kidney puncture is through the renal papilla. In this paper, the authors summarise their experience of non-papillary PCNL and demonstrate this puncture technique for PCNL tract establishment.

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Non papillary mini-percutaneous nephrolithotomy: early experience

Cited by 22 publications

References 17 publications

Presence of a Novel Anatomical Structure May Cause Bleeding When Using the Calyx Access in Mini-Percutaneous Nephrolithotomy

Presence of a Novel Anatomical Structure May Cause Bleeding When Using the Calyx Access in Mini-Percutaneous Nephrolithotomy

Feasibility of contrast-enhanced ultrasound and flank position during percutaneous nephrolithotomy in patients with no apparent hydronephrosis: a randomized controlled trial

Non-papillary Percutaneous Puncture: A Safe Approach to Consider

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