"Pass the Ball!" Simultaneous Flexible Nephroscopy and Retrograde Intrarenal Surgery for Large Residual Upper-Pole Staghorn Stone

Undre, Shabnam; Olsen, Sisse; Mustafa, N; Patel, Anup

doi:10.1089/end.2004.18.844

Cited by 37 publications

(16 citation statements)

References 9 publications

(8 reference statements)

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“…[29][30][31] Another treatment option for complex cases is a simultaneous combined PCNL and flexible ureteroscopy, because it reduces the number of access tracts and the morbidity of the percutaneous approach. [18][19][20]32 In our series, one patient had an incomplete PCNL because of major bleeding and underwent flexible ureteroscopy as a second procedure, which yielded complete clearance of a 1-cm residual stone. A second patient had a PCNL in which the percutaneous tract was inadequate for stone removal, although we used a flexible nephroscope.…”

Section: Indications and Outcomesmentioning

confidence: 88%

“…2,29 Nevertheless, there are several reports from various authors that flexible ureteroscopy with holmium laser lithotripsy is a minimally invasive treatment modality that can be used to manage large intrarenal calculi (stone dimensions larger than 2 cm or even 4 cm) with the potential to decrease morbidity, while maintaining a high level of efficacy. [30][31][32] One of the main indications for RIRS is an abnormal body habitus, as with morbid obesity or musculoskeletal deformities. A disadvantage of ureteroscopy is that multiple procedures may be necessary to clear a large stone, and a stent is usually placed postoperatively.…”

Section: Indications and Outcomesmentioning

confidence: 99%

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Percutaneous Nephrolithotomy in Patients with Spinal Deformities

Goumas-Kartalas

Montanari

2010

Journal of Endourology

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PCNL in patients with spinal deformities is challenging. Accurate preoperative evaluation of the anatomy and respiratory function and a precise preoperative planning are mandatory. US-guided puncture of the collecting system permits avoiding visceral injury. Supine PCNL offers advantages in terms of patient comfort, protection of cardiorespiratory function, and the ability to perform a simultaneous combined ureteroscopic approach, although the prone position, if feasible with the patient's body habitus, may offer a wider space for percutaneous access. Combination therapy with either SWL or RIRS after PCNL improves stone-free rates.

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Section: Indications and Outcomesmentioning

confidence: 88%

Section: Indications and Outcomesmentioning

confidence: 99%

Percutaneous Nephrolithotomy in Patients with Spinal Deformities

Goumas-Kartalas

Montanari

2010

Journal of Endourology

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“…Combination of flexible ureteroscopy and PCNL reduced the need for multiple tracts in the management of complex renal calculi and also decreased the potential morbidities and blood loss [7,8,11]. With the help of RIRS to manage the residual stones in parallel calyx, fewer tracts were needed in the combined PCNL and RIRS group than in the monotherapy group (1.09 vs. 2.34 tracts/patient, p < 0.001) in the present study.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous-Based Management of Staghorn Calculi in Solitary Kidney: Combined Mini Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery

Zhong¹,

Zhao²,

Wang

et al. 2014

Urol Int

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Introduction: Mini percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) are well-established techniques with little morbidity. The combined use of standard PCNL and the mini-PCNL or the RIRS technique was evaluated and compared to investigate their own role in the management of staghorn calculi in solitary kidney. Materials and Methods: 23 patients received combined standard PCNL and mini-PCNL (group 1), and 22 patients received combined standard PCNL and RIRS (group 2). The treatment results and complications were evaluated and compared. Results: The mean operation time was 128.8 ± 9.1 min in group 1 and 109.8 ± 10.7 min in group 2 (p < 0.001). The decrease in hemoglobin level in group 1 was significantly higher than that in group 2 (3.5 ± 0.6 vs. 2.1 ± 0.5 g/dl, p < 0.001). The final stone-free rate was significantly higher (p = 0.038) in group 2 (90.9%) than in group 1 (65.2%). Conclusions: Combined standard PCNL and RIRS technique can extract the majority of staghorn calculi quickly by PCNL with EMS Lithoclast, and RIRS used simultaneously can reduce the need for multiple tracts and therefore reduce blood loss and potential morbidity related to multiple tracts, shorten the operation time and achieve a high stone-free rate.

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“…Several authors have described the use of flexible nephroscopy/ureteroscopy with single-tract PCNL [13,14,15]. Regarding the limitation of flexible instruments in removal of large stone fragments, their results showed suboptimal stone-free rates [3,16].…”

Section: Discussionmentioning

confidence: 99%

Number of Tracts or Stone Size: Which Influences Outcome of Percutaneous Nephrolithotomy for Staghorn Renal Stones?

et al. 2012

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Introduction: Percutaneous nephrolithotomy (PCNL) is the recommended first-line treatment for staghorn stones. To achieve complete stone clearance, PCNL may require using multiple tracts. Objective: To evaluate outcome of PCNL in patients with staghorn calculi and its correlation with the number of tracts and stone features. Materials and Methods: One hundred consecutive patients with staghorn renal stone who underwent PCNL were included in the study. Perioperative and postoperative features were recorded. Correlation of the variables with number of tracts and stone size was assessed. Results: Mean age (±SD) was 49.6 ± 14.7 years. Our patients were ASA class I. The mean cumulative stone burden was 365.9 ± 156.5 mm². The mean number of tracts was 2.4 (range: 1–7), and stone-free rate was 83%. The stone-free rate (p = 0.026) and hospital stay (p = 0.005) correlated with stone size, but not with number of tracts. Postoperative fever correlated with stone size (p = 0.017) and number of tracts (p = 0.037). Conclusion: PCNL using multiple tracts seem to be effective and safe in treatment of staghorn calculi. Most outcome measures correlated with stone size rather than number of tracts.

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"Pass the Ball!" Simultaneous Flexible Nephroscopy and Retrograde Intrarenal Surgery for Large Residual Upper-Pole Staghorn Stone

Cited by 37 publications

References 9 publications

Percutaneous Nephrolithotomy in Patients with Spinal Deformities

Percutaneous Nephrolithotomy in Patients with Spinal Deformities

Percutaneous-Based Management of Staghorn Calculi in Solitary Kidney: Combined Mini Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery

Number of Tracts or Stone Size: Which Influences Outcome of Percutaneous Nephrolithotomy for Staghorn Renal Stones?

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