Percutaneous nephrolithotomy: technique

Knoll, Thomas; Daels, Francisco Pedro Juan; Desai, Janak; Hoznek, Andràs; Knudsen, Bodo E.; Montanari, Emanuele; Scoffone, Cesare Marco; Skolarikos, Andreas; Tozawa, Keiichi

doi:10.1007/s00345-017-2001-0

Cited by 80 publications

(53 citation statements)

References 61 publications

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“…PCNL has been one of the best choices of minimally invasive operation for the treatment of staghorn calculi and complex renal stones since its introduction more than 30 years ago. PCNL numbers were rising in recent years [23]. The most commonly used instruments for fragmentation in PCNLs are pneumatic and Ho:YAG laser lithotripters.…”

Section: Discussionmentioning

confidence: 99%

Pneumatic Lithotripsy versus Holmium Laser Lithotripsy in Percutaneous Nephrolithotomy for Patients with Guy’s Stone Score Grade IV Kidney Stone

Hong¹,

Lin²,

Yang³

et al. 2020

Urol Int

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Background and Objective: The aim of this study was to compare the efficacy and reliability of holmium (Ho:YAG) laser lithotripsy (HLL) and pneumatic lithotripsy (PL) in percutaneous nephrolithotomy (PCNL) in the treatment of patients with Grade IV kidney stones based on Guy’s Stone Score. Study Design/Materials and Methods: This retrospective study included 103 patients with Grade IV kidney stones out of 440 patients who underwent PCNL through HLL and PL in Second Affiliated Hospital of Shantou University Medical College, China, from January 2016 to December 2018. We analyzed preoperative, intraoperative, and postoperative variables of the patients to evaluate the efficacy and reliability of PCNL procedures. Results: Patients were categorized as Grade I, II, III, and IV, and the patients of each grade were 85 (19.32%), 39 (8.86%), 213 (48.41%), and 103 (23.41%), respectively. In Grade IV, the total operative time (min) for the PL and HLL groups was 137.7 ± 47.79 and 134.27 ± 53.38, respectively (p = 0.744). The variation in laboratory examination values including ΔHGB (g/L), ΔHCT, ΔPCT, and ΔCr (μmol/L) for PL and HLL groups was 19 ± 11.23/12 ± 15.42 (p = 0.012), 0.057 ± 0.034/0.038 ± 0.045 (0.009), 0.027 ± 0.034/0.026 ± 0.034 (0.702), and 3.07 ± 17.4/20.54 ± 65.93 (0.692), respectively. The postoperative hospitalization day was 8.94 ± 4.2 and 7.73 ± 2.75 (p = 0.015), respectively. As for the stone-free rate (SFR), the SFRs for PL and HLL were 48.15% (n = 39/81) and 59.09% (n = 13/22) (p = 0.363), respectively. Conclusions: HLL showed a comparable advantage of not only decreased postoperative hemoglobin and hematocrit but also fewer postoperative hospitalization days. Based on the results of our retrospective study, for those Grade IV kidney stone patients who have a risk of bleeding before PCNL operation, HLL can be a considerable treatment option. Besides, in consideration of reducing human care cost, HLL which showed fewer hospitalization days, would be more welcome by patients.

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Section: Discussionmentioning

confidence: 99%

Pneumatic Lithotripsy versus Holmium Laser Lithotripsy in Percutaneous Nephrolithotomy for Patients with Guy’s Stone Score Grade IV Kidney Stone

Hong¹,

Lin²,

Yang³

et al. 2020

Urol Int

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“…Satisfactory results mean that virtual navigation enabled us to select an accurate and safe needle access to the target stone. The mean procedure time was 63.6 minutes (sum of puncture, dilation and fragmentation time), which is reasonable compared with conventional PCNL procedures (40-180 min) (19,20). The stone-free rate (93.8%) is similar to that reported in the literature with US guidance (80%-96%) (19,20), which is reasonable because it only affects the needle pass, and the PCNL is essentially the same as the one performed with US guidance.…”

Section: Discussionmentioning

confidence: 70%

Percutaneous nephrolithotripsy: C-arm CT with 3D virtual navigation in non-dilated renal collecting systems

Jiao

Zhan-li²,

Sun

et al. 2018

Diagn Interv Radiol

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T he establishment of a percutaneous tract into the renal collecting system is important and requires imaging supervision during percutaneous nephrolithotomy (PCNL) (1, 2). Unlike percutaneous nephrostomy for patients with hydronephrosis, if percutaneous stone removal is planned, the puncture should be performed in a calyx with possible access to the stone. Montvilas et al. (3) demonstrated that ultrasonography (US)-guided techniques yield lower technical success in patients with non-dilated than in those with dilated collecting systems (82% vs. 98.2%). Furthermore, renal anomalies and scoliosis make needle access more challenging and necessitate puncture planning and control. The syngo iGuide navigation system (Siemens Healthcare) is a three-dimensional (3D) virtual needle tracking system which helps predict and observe the needle trajectory, facilitating real-time puncture to the target (4-7). We report our experience of percutaneous tract establishment for patients with non-dilated renal collecting systems after failed US-guided attempts. Methods Patient selectionThis retrospective study was approved by our Institutional Review Board and informed consent was waived. Between May 2014 and May 2015, of 442 patients with non-dilated renal collecting systems who required PCNL access in two urology surgery departments at our hospital, routine US-guided nephrostomy attempts failed in 33 patients. Those 33 patients (19 males, 14 females; mean age, 60.1±11.8 years) with non-dilated renal collecting systems underwent C-arm computed tomography (CT) with 3D virtual navigation system-guided establishment of PCNL access. A collecting system was identified as non-dilated if no calyceal dilatation was observed on US. All cases had previously failed under US-guidance. The mean body mass index (BMI) was 24.7±4.5 kg/m 2 (range, 17. I N T E R V E N T I O N A L R A D I O LO G Y O R I G I N A L A R T I C L E PURPOSEWe aimed to evaluate the clinical superiority of using C-arm computed tomography (CT) to establish percutaneous nephrolithotripsy (PCNL) access for patients with non-dilated renal collecting systems. METHODSFrom May 2014 to May 2015, 33 patients underwent C-arm CT-guided puncture to establish PCNL access after failed attempts of ultrasonography-guided nephrostomy. Technical success, procedure details, radiation exposure, complications, and stone-free rate were recorded. RESULTSThe technical success rate was 97% (32/33) with a mean puncture score of 4.5/5. Mean puncture, dilation, and fragmentation times were 17.9±6.0, 12.6±3.9, and 33.1±8.8 minutes, respectively. Mean radiation exposure was 4.8±2.1 mSv without serious complications. Stone-free rate was 93.8%. CONCLUSIONC-arm CT is a useful tool to establish PCNL access, particularly in cases of upper pole access or complicated anatomy.You may cite this article as: Jiao D, Zhang Z, Sun Z, Wang Y, Han X. Percutaneous nephrolithotripsy: C-arm CT with 3D virtual navigation in non-dilated renal collecting systems. Diagn Interv Radiol 2018; 24: 17-22.

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“…With laser and ultrasound lithotripsy tools, kidney stones can be quickly broken and removed, and the stone clearance is better than 2 cm [ 18 ]. PCNL, as a minimally invasive operation, can perform repeated lithotripsy because of its small trauma and rapid recovery, and has become an important type of kidney stone surgery [ 19 ]. Although PCNL has obvious advantages in the treatment of renal calculi, complications such as bleeding, infection, residual stones, and renal atrophy after PCNL cannot be ignored [ 17 – 20 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Assessment of Risk Factors for Renal Atrophy After Percutaneous Nephrolithotomy

et al. 2020

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Background This study explored the risk factors for renal atrophy after percutaneous nephrolithotomy (PCNL), and provides a reference for clinical prevention of renal atrophy after PCNL. Material/Methods According to the inclusion and exclusion criteria, the clinical data of 816 patients who underwent PCNL in our hospital from May 2013 to February 2018 were retrospectively collected. Depending on whether the patient had kidney atrophy, they were divided into a renal atrophy group and a non-renal atrophy group. We collected and analyzed data on patient sex, age, kidney location, duration of disease, stone size, hydronephrosis, renal calculus position (renal ureteral junction or multiple pyelonephritis-associated stones), operation time, intraoperative blood loss, perfusion pressure, and pyonephrosis. The indicators with statistically significant differences were selected and multivariate logistic regression analysis was carried out to determine the risk factors for renal atrophy. Results Among 816 patients, 49 had renal atrophy and the incidence rate was 6.01%. Univariate analysis and multivariate logistic regression analysis showed that independent risk factors for renal atrophy after PCNL were: duration of the disease longer than 12 months (OR=4.216, P=0.003, 95% CI: 1.714, 7.354), perfusion pressure >30 mmHg (OR=3.895, P=0.001, 95% CI: 1.685, 8.912), moderate and severe hydronephrosis (OR=5.122, P<0.001, 95% CI: 1.847, 9.863), stones located at the junction of the renal pelvis (OR=3.787, P=0.001, 95% CI: 1.462, 7.654), stones located in multiple calyces (OR=4.531, P=0.014, 95% CI: 1.764, 8.196), and pyonephrosis (OR=10.143, P<0.001, 95% CI: 2.214, 16.248). Conclusions The main risk factors for renal atrophy after PCNL are: course of disease more than 12 months, moderate and severe hydronephrosis, pyonephrosis, multiple calyceal stones, stones at the junction of the renal pelvis, and intraoperative high perfusion pressure.

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Percutaneous nephrolithotomy: technique

Cited by 80 publications

References 61 publications

Pneumatic Lithotripsy versus Holmium Laser Lithotripsy in Percutaneous Nephrolithotomy for Patients with Guy’s Stone Score Grade IV Kidney Stone

Pneumatic Lithotripsy versus Holmium Laser Lithotripsy in Percutaneous Nephrolithotomy for Patients with Guy’s Stone Score Grade IV Kidney Stone

Percutaneous nephrolithotripsy: C-arm CT with 3D virtual navigation in non-dilated renal collecting systems

Clinical Assessment of Risk Factors for Renal Atrophy After Percutaneous Nephrolithotomy

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