Percutaneous Nephrolithotomy: An Innovative Extraction Technique

Karamcheti, Anand; O'Donnell, Walter F.

doi:10.1016/s0022-5347(17)58148-3

Cited by 34 publications

(4 citation statements)

References 6 publications

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“…It is traditionally guided by fluoroscopy and may pose a risk of radiation to patient and staff especially in a high workload center [ 1 2 ]. The use of ultrasonography in PCNL was first described as early as the 1970s [ 3 ]. In the recent years, its popularity has grown with multiple case series being published, demonstrating its feasibility, safety and efficacy [ 4 5 6 7 ].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided percutaneous nephrolithotomy: Advantages and limitations

Yam

Benjamin

et al. 2017

Investig Clin Urol

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PurposeThe use of ultrasound in percutaneous nephrolithotomy (PCNL) has not been shown to translate to better clinical and stone outcomes. To compare the operative outcomes, postoperative outcomes and complication rates of ultrasound-guided access PCNL (USGA-PCNL) versus fluoroscopy-guided access PCNL (FGA-PCNL).Materials and MethodsA total of 184 consecutive patients who underwent PCNL from July 2008 to September 2014 were identified from our PCNL database. Seventy-two patients underwent USGA-PCNL and 112 FGA-PCNL.ResultsThe patients were similar in age, sex, race, American Society of Anesthesiologists physical status classification, mean largest stone diameters, side of PCNL, number of stones and the degree of hydronephrosis between both groups. There were higher rates of upper pole (5.6% vs. 3.6%), mid pole (8.3% vs. 2.7%) and multiple pole punctures (4.2% vs. 0%) in USGA-PCNL compared to FGA-PCNL (p=0.027). There was no difference in the stone free rates of both groups in univariate analysis. Those who had FGA-PCNL were 2.26 (95% confidence interval, 1.09–4.75; p=0.029) times more likely to require a second-look procedure compared to USGA-PCNL on univariate analysis but not on multivariate analysis. There were no differences in Clavien-Dindo complications. No patient in the USGA-PCNL group experienced organ injuries during puncture compared to 1 patient in the FGA-PCNL group who had pneumothorax requiring urgent chest tube insertion.ConclusionsThe use of ultrasonography to guide access puncture during PCNL eliminates the risk of inadvertent organ injuries. Similar operative and stone outcomes show that the learning curve for USGA is minimal compared to conventional FGA.

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Section: Introductionmentioning

confidence: 99%

Ultrasound-guided percutaneous nephrolithotomy: Advantages and limitations

Yam

Benjamin

et al. 2017

Investig Clin Urol

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“…3 Case reports and small series were subsequently reported until the technique gained popularity in the 1980s. 4,5 The evolution of endourological equipment and the adaptation of the angioplasty balloon for PNL tract dilation were instrumental to the widespread use of PNL. 6 From 1988 to 2002 the annual use of PNL in the United States more than doubled from 1.2/ 100,000 to 2.5/100,000 residents.…”

Section: Discussionmentioning

confidence: 99%

Renal Calyceal Anatomy Characterization with 3-Dimensional In Vivo Computerized Tomography Imaging

et al. 2013

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Abbreviations and Acronyms 3DPurpose: Calyceal selection for percutaneous renal access is critical for safe, effective performance of percutaneous nephrolithotomy. Available anatomical evidence is contradictory and incomplete. We present detailed renal calyceal anatomy obtained from in vivo 3-dimentional computerized tomography renderings. Materials and Methods: A total of 60 computerized tomography urograms were randomly selected. The renal collecting system was isolated and 3-dimensional renderings were constructed. The primary plane of each calyceal group of 100 kidneys was determined. A coronal maximum intensity projection was used for simulated percutaneous access. The most inferior calyx was designated calyx 1. Moving superiorly, the subsequent calyces were designated calyx 2 and, when present, calyx 3. The surface rendering was rotated to assess the primary plane of the calyceal group and the orientation of the select calyx. Results: The primary plane of the upper pole calyceal group was mediolateral in 95% of kidneys and the primary plane of the lower pole calyceal group was anteroposterior in 95%. Calyx 2 was chosen in 90 of 97 simulations and it was appropriate in 92%. Calyx 3 was chosen in 7 simulations but it was appropriate in only 57%. Calyx 1 was not selected in any simulation and it was anteriorly oriented in 75% of kidneys. Conclusions: Appropriate lower pole calyceal access can be reliably accomplished with an understanding of the anatomical relationship between individual calyceal orientation and the primary plane of the calyceal group. Calyx 2 is most often appropriate for accessing the anteroposterior primary plane of the lower pole. Calyx 1 is most commonly oriented anterior.

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“…Although fluoroscopy has been the main tool to establish access in PCNL, its excessive use leads to an increase in the risk of radiation to patients and staff (11). The use of ultrasound-guided puncture in PCNL was first reported in the 1970s (12) and has gained increased recognition as an alternative to fluoroscopy because of its feasibility, safety, and efficacy. Ultrasound guidance not only has the advantage of low radiation exposure, it can also monitor the image of lithiasis and collecting systems in three-dimensional (3D) orientation during surgical procedures (13).…”

Section: A C D Bmentioning

confidence: 99%

The safety and efficacy of mini-percutaneous nephrolithotomy vs. retrograde intrarenal surgery for treatment of renal lithiasis in pelvic ectopic kidney: an exploratory pilot study

Shen

2021

Transl Androl Urol

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Percutaneous Nephrolithotomy: An Innovative Extraction Technique

Cited by 34 publications

References 6 publications

Ultrasound-guided percutaneous nephrolithotomy: Advantages and limitations

Ultrasound-guided percutaneous nephrolithotomy: Advantages and limitations

Renal Calyceal Anatomy Characterization with 3-Dimensional In Vivo Computerized Tomography Imaging

The safety and efficacy of mini-percutaneous nephrolithotomy vs. retrograde intrarenal surgery for treatment of renal lithiasis in pelvic ectopic kidney: an exploratory pilot study

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