Renal access through the inferior calyx is associated with higher risk of severe bleeding after percutaneous nephrolithotomy

Tan, Juan; Chen, Binghai; He, Leye; Yin, Guangming; Jiang, Ziying; Yao, Kathy; Jiang, Xianzheng

doi:10.5114/aoms.2015.50966

Cited by 11 publications

(16 citation statements)

References 25 publications

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“…Several studies have identified prognostic factors for severe bleeding complications after PCNL [ 2 , 3 , 10 , 20 ]. However, due to the absence of standardized reporting classification systems, their results are difficult to interpret and compare.…”

Section: Discussionmentioning

confidence: 99%

“…Past analysis of prognostic factors showed that puncture correctness [ 2 ], blood transfusion [ 3 ], puncture via the inferior calyx, and multiple or isolated kidney stones [ 10 ] were previously reported to be independently associated with severe bleeding after PCNL. Severe postoperative bleeding complications are a challenge to urologists and patients.…”

Section: Introductionmentioning

confidence: 99%

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No staghorn calculi and none/mild hydronephrosis may be risk factors for severe bleeding complications after percutaneous nephrolithotomy

et al. 2021

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Background To explore the risk factors for severe bleeding complications after percutaneous nephrolithotomy (PCNL) according to the modified Clavien scoring system. Methods We retrospectively analysed 2981 patients who received percutaneous nephrolithotomies from January 2014 to December 2020. Study inclusion criteria were PCNL and postoperative mild or severe renal haemorrhage in accordance with the modified Clavien scoring system. Mild bleeding complications included Clavien 2, while severe bleeding complications were greater than Clavien 3a. It has a good prognosis and is more likely to be underestimated and ignored in retrospective studies in bleeding complications classified by Clavien 1, so no analysis about these was conducted in this study. Clinical features, medical comorbidities and perioperative characteristics were analysed. Chi-square, independent t tests, Pearson’s correlation, Fisher exact tests, Mann–Whitney and multivariate logistic regression were used as appropriate. Results Of the 2981 patients 70 (2.3%), met study inclusion criteria, consisting of 51 men and 19 women, 48 patients had severe bleeding complications. The remaining 22 patients had mild bleeding. Patients with postoperative severe bleeding complications were more likely to have no or slight degree of hydronephrosis and have no staghorn calculi on univariate analysis (p < 0.05). Staghorn calculi (OR, 95% CI, p value 0.218, 0.068–0.700, 0.010) and hydronephrosis (OR, 95% CI, p value 0.271, 0.083–0.887, 0.031) were independent predictors for severe bleeding via multivariate logistic regression analysis. Other factors, such as history of PCNL, multiple kidney stones, site of puncture calyx and mean corrected intraoperative haemoglobin drop were not related to postoperative severe bleedings. Conclusions The absence of staghorn calculi and a no or mild hydronephrosis were related to an increased risk of post-percutaneous nephrolithotomy severe bleeding complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

No staghorn calculi and none/mild hydronephrosis may be risk factors for severe bleeding complications after percutaneous nephrolithotomy

et al. 2021

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“…PCNL was considered to be the best way to tackle large renal stones, regardless of its success rate of operation or its higher SFR [19]- [21]. However, in a large number of recent studies, we have observed that severe complications following PCNL are being reported such as fever, sepsis, hemorrhage requiring blood transfusion and pneumothorax [22], [23] [24]. Lots of scholars reported that some patients are poor medical candidates for PCNL [25], [26].…”

Section: Discussionmentioning

confidence: 99%

The stone density does not affect the stone-free rate of kidney pelvic stones (2-3 cm) treated with flexible ureterorenoscopy

Bai

Dai

et al. 2020

Preprint

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Objectives To compare the efficacy of retrograde flexible ureterorenoscopy (FURS) in the treatment of low-density stone (LDS) and high-density stone (HDS).Patients and Methods From January 2017 to March 2019, 241 patients with 2–3 cm kidney pelvic stones were treated with retrograde flexible ureterorenoscopy. The relevant study parameter for all patients, including patients age, body mass index (BMI), gender, stone density values (Hounsfield units [HU]), stone size, stone location, operative time, hospitalization time, stone free rate (SFR), complications were evaluated. The results were assessed one month after the FURS and the follow-up time is 6 months.Results Effectively, 241 patients finish the whole process and are divided into two groups (LDS and HDS). The postoperative hemoglobin (Hb) was 13.31±1.06 vs. 13.21±1.14 g/dL (p=0.50). The mean total operating time was 83.91±13.7 vs. 130.65±19.8 min (p<0.01), respectively. The hospitalization time was 3.4±1.1 vs 3.2±1.1 days (p=0.33), respectively. The free stone rate was 91.5% vs. 93.5% (p=0.54) and the street stone rate was 12(10%) vs. 3(2.4%) (χ2=6.173 a , p=0.01) in the LDS and HDS groups.Conclusions We concluded that FURS is safe and effective for the treatment of large renal pelvic stones 2-3 cm. There is no difference in the SFR between LDS and HDS group after the FURS operation. Density (as measured by non-contrast CT) of the renal calculus can help predict the treatment outcome before FURS. For appropriate patients, FURS should be chosen as a common approach in the treatment of renal pelvic calculus.

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“…Lower calyceal access requires oblique and longer surgical approaches. To reach the renal pelvis, nephroscope should be adjusted frequently and this increases the risk of laceration of the renal parenchyma (17).…”

Section: Discussionmentioning

confidence: 99%

“…The study of Tan et al (17) reported that severe post-operative bleeding after PCNL wa associated with renal puncture via the lower calyx. multiple renal stones and solitary kidney stones.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Efficacy and Safety of Isolated Single Different Calyx Accesses in Percutaneous Nephrolithotomy

Deger¹,

İzol²,

Ok³

et al. 2019

jus

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What's known on the subject? and What does the study add? We investigated whether there was superiority in different calyceal accesses performed in percutaneous nephrolithotomy operation for renal stone treat. Amaç: Böbrek taşı tedavisinde uygulanan perkütan nefrolitotomi (PNL) operasyonunda izole ve tek giriş olarak yapılan üst, orta ve alt kaliks girişlerinin güvenlik ve etkinliklerini karşılaştırmayı amaçladık. Gereç ve Yöntem: Kliniğimizde Eylül 2007 ve Haziran 2018 tarihleri arasında böbrek taşı nedeniyle izole tek giriş ile PNL yapılan hastalar retrospektif olarak incelendi. Hastalar izole tek üst kaliks girişi (grup 1), izole tek orta kaliks girişi (grup 2) ve izole tek alt kaliks girişi (grup 3) olmak üzere üç gruba ayrıldı. Hastaların demografik özelikleri, taş boyutu ve lokalizasyonu, operasyona ait veriler, postoperatif sonuçlar ve komplikasyonlar açısından karşılaştırıldı. Öz Objective: We aimed to compare the safety and efficacy of upper, middle and lower calyx accesses obtained as isolated and single access in percutaneous nephrolithotomy (PCNL) operation which is performed for treating renal stones. Materials and Methods: The records of patients who had undergone PCNL via isolated single pole access due to renal stone between September 2007 and June 2018 were retrospectively evaluated. The patients were divided into three groups as isolated single upper calyceal access patients (group 1), isolated single middle calyceal access patients (group 2) and isolated single lower calyceal access patients (group 3). The patient groups were compared in terms of patient characteristics, stone size and location, operative data, postoperative outcomes and complications. Results: Fifty-seven (2.8%) patients who underwent isolated single calyceal access PCNL were included in group 1 (upper calyx), 542 (26.9%) in group 2 (middle calyx) and 1427 (70.4%) were included in group 3 (lower calyx). The mean age of the patients in groups 1, 2 and 3 was 43.09±15.00, 38.23±22.47 and 39.40±19.93, respectively. A thousand hundred and seventy-six (58%) patients were male and 850 (42%) were female. The mean stone burden was 367.19±266.48, 335.7±301.85 and 353.73±346.47 mm2 in groups 1, 2 and 3, respectively and there was no statistically significant difference between the groups (p=0.45, p=0.77, p=0.29, respectively). The mean operative time, mean fluoroscopy time, and mean nephrostomy time, and the mean length of hospitalization were statistically significantly longer in group 2 than in group 3. Stone-free rates in patients with clinically insignificant stones (SF + CIRF) were 89.5%, 89.6% and 91.6% in group 1, 2 and 3, respectively and there was no statistically significant difference between the groups (p=0.25, p=0.43 and p=0.6 respectively). There was no significant difference between the three groups in terms of postoperative fever, blood transfusion and overall complications. Conclusion: As a result, different isolated single calyceal accesses do not have superiority over each other in terms of stone-free rate and complica...

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Renal access through the inferior calyx is associated with higher risk of severe bleeding after percutaneous nephrolithotomy

Cited by 11 publications

References 25 publications

No staghorn calculi and none/mild hydronephrosis may be risk factors for severe bleeding complications after percutaneous nephrolithotomy

No staghorn calculi and none/mild hydronephrosis may be risk factors for severe bleeding complications after percutaneous nephrolithotomy

The stone density does not affect the stone-free rate of kidney pelvic stones (2-3 cm) treated with flexible ureterorenoscopy

Comparison of Efficacy and Safety of Isolated Single Different Calyx Accesses in Percutaneous Nephrolithotomy

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