Routine Flexible Nephroscopy for Percutaneous Nephrolithotomy for Renal Stones with Low Density: A Prospective, Randomized Study

Gücük, Adnan; Kemahlı, Eray; Üyetürk, Uğur; Tuygun, Can; Yildiz, Mevlüt; Metin, Ahmet

doi:10.1016/j.juro.2013.01.009

Cited by 36 publications

(21 citation statements)

References 20 publications

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“…Though in such cases, flexible nephroscope could also be useful as it can reach locations which are in accessible with rigid nephroscope. Routine flexible nephroscopy in addition to PCNL with rigid nephroscope was associated with fewer relook procedures, less bleeding, and a higher stone-free rate, especially in patients with low HU density stones [13]. We do agree with above observation but flexible nephroscopes are unavailable at several centers in developing countries.…”

Section: Discussionsupporting

confidence: 77%

Prospective randomized comparison between superior calyceal access versus inferior calyceal access in PCNL for inferior calyceal stones with or without pelvic stones

et al. 2015

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The objective of this study is to assess the efficacy of superior calyceal access versus inferior calyceal access for inferior calyceal calculi with or without pelvic calculi. A total of 100 patients with inferior calyceal calculi or inferior calyceal calculi with pelvic calculi were included in this prospective randomized study. In 50 patients (Group 1), a fluoroscopy-assisted superior calyceal puncture was made, and in other 50 patients (Group 2), access was obtained through a fluoroscopy-assisted inferior calyceal puncture. The stone-free rates, hemoglobin drop, operative duration, requirement for additional tracts, complications, and auxiliary procedures in the two groups were compared. Stone clearance rates and hemoglobin drop values were better in group 1, though they were not statistically significant. The mean operative duration, number of tracts required, and the relook procedure rate were significantly in favor of Group 1. Only one patient (2%) in Group 1 developed hydropneumothorax related to supracostal puncture and required intercostal tube drainage. Superior calyceal puncture (supracostal or infracostal) provides favorable access to inferior calyceal stones, providing better and faster clearance with less requirement of secondary tracts and auxiliary procedures.

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Section: Discussionsupporting

confidence: 77%

Prospective randomized comparison between superior calyceal access versus inferior calyceal access in PCNL for inferior calyceal stones with or without pelvic stones

et al. 2015

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“…Six studies [9,10,11,12,13,14,15,16] in this review showed that RIRS with holmium laser was as efficient as PCNL in the treatment of selected cases with larger renal stones. In order to improve the stone clearance rate, we can combine PCNL and ﬂexible ureteroscopy for the treatment of large or complex renal stones [37,38]. Flexible nephrolithotomy with a stone basket can easy reach each calyx, thus improving the stone clearance rate.…”

Section: Discussionmentioning

confidence: 99%

Retrograde Intrarenal Surgery versus Percutaneous Nephrolithotomy for Treatment of Renal Stones >2 cm: A Meta-Analysis

et al. 2014

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Objective: To systematically review the efficacy and safety of retrograde intrarenal surgery (RIRS) versus percutaneous nephrolithotomy (PCNL) for the treatment of renal calculi >2 cm. Methods: We searched PubMed, Cochrane Library, Embase and the Chinese Biomedical Literature Database about RIRS and PCNL for the treatment of renal stones. The retrieval time ended in December 2013. All clinical trials were retrieved and their included references investigated. Two reviewers independently assessed the quality of all included studies, and the eligible studies were included and analyzed using the RevMan 5.2 software. Results: Two randomized controlled trials and six clinical controlled trials were included, involving a total of 590 patients. Our meta-analysis showed that there were not significant differences in stone-free rate (relative risk [RR] = 0.95, 95% confidence interval (CI) 0.88-1.02, p = 0.11) and fever (RR = 0.95, 95% CI 0.54-1.67, p = 0.85) between RIRS and PCNL. We found that hospital stay (weighted mean difference [WMD] = -2.10, 95% CI -3.08 to -1.11, p < 0.10) and bleeding (RR = 0.20, 95% CI 0.06-0.68, p = 0.01) were lower and operation time was longer (WMD = 19.11, 95% CI 7.83-30.39, p < 0.10) for RIRS. Conclusion: RIRS is a safe and effective procedure. It can successfully treat patients with stones >2 cm with a high stone-free rate and significantly reduce hospital stay without increasing complications. RIRS can be used as an alternative treatment to PCNL in selected cases with larger renal stones. However, further randomized trials are needed to confirm these findings.

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“…Our surgical PCNL technique was described previously [10]. Briefly, following administration of general anesthesia, a 6-F open-ended ureteral catheter was placed in the patient in the lithotomy position to view the anatomy of the collecting system.…”

Section: Methodsmentioning

confidence: 99%

Factors Influencing the Duration of Urine Leakage following Percutaneous Nephrolithotomy

Üyetürk

Gücük

Kemahlı

et al. 2014

Advances in Urology

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Purpose. The duration of urine leakage following the removal of the nephrostomy tube after percutaneous nephrolithotomy (PCNL) shows significant variations depending on the techniques used. We aimed to assess the factors likely to influence the duration of urine leakage. Material and Methods. In total, 103 patients who underwent PCNL were reviewed retrospectively. DUL was evaluated regarding patient characteristics, thickness of the access line, presence of hydronephrosis, and residual stones. Results. DUL was significantly prolonged in accordance with a decrease in the thickness of parenchyma tissue (R = −0.716, P < 0.001). DUL was prolonged as the degree of hydronephrosis (R = 0.526, P < 0.001) and the number of patients with residual stones (R = 0.273, P = 0.005) increased. Median DUL was significantly longer in patients with residual stones than those without residual stones (P = 0.002). In the receiving operating curve analysis, the optimum cut-off value of parenchymal thickness for hospitalization ≤12 h was 17.2 mm (sensitivity, 90.2%; specificity, 69.4%; P = 0.001). Conclusions. We found that parenchymal thickness of the access line, hydronephrosis, and residual stones were the most influential factors determining DUL following PCNL, respectively.

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Routine Flexible Nephroscopy for Percutaneous Nephrolithotomy for Renal Stones with Low Density: A Prospective, Randomized Study

Abstract: Routine flexible nephroscopy during percutaneous nephrolithotomy was associated with a higher stone-free rate, fewer interventions and less bleeding, especially in patients with low HU density stones.

Cited by 36 publications

References 20 publications

Prospective randomized comparison between superior calyceal access versus inferior calyceal access in PCNL for inferior calyceal stones with or without pelvic stones

Prospective randomized comparison between superior calyceal access versus inferior calyceal access in PCNL for inferior calyceal stones with or without pelvic stones

Retrograde Intrarenal Surgery versus Percutaneous Nephrolithotomy for Treatment of Renal Stones >2 cm: A Meta-Analysis

Factors Influencing the Duration of Urine Leakage following Percutaneous Nephrolithotomy

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