Therapeutic effects of visual standard channel combined with F4.8 visual puncture super-mini percutaneous nephrolithotomy on multiple renal calculi

Abstract

Objective:To evaluate the therapeutic effects of visual standard channel combined with F4.8 visual puncture super-mini percutaneous nephrolithotomy (SMP) on multiple renal calculi.Methods:The clinical data of 46 patients with multiple renal calculi treated in Affiliated Hospital of Hebei University from October 2015 to September 2016 were retrospectively analyzed. There were 28 males and 18 females aged from 25 to 65 years old, with an average of 42.6. The stone diameters were 3.0-5.2 cm, (4.3 ± 0.8) cm on average. F4.8 visual puncture-assisted balloon expansion was used to establish a standard channel. After visible stones were removed through nephroscopy combined with ultrasound lithotripsy, the stones of other parts were treated through F4.8 visual puncture SMP with holmium laser. Indices such as the total time of channel establishment, surgical time, decreased value of hemoglobin, phase-I stone clearance rate and surgical complications were summarized.Results:Single standard channel was successfully established in all cases with the assistance of F4.8 visual puncture, of whom 24 were combined with a single microchannel, 16 were combined with double microchannels, and six were combined with three microchannels. All patients were placed with nephrostomy tube which was not placed in the microchannels. Both F5 double J tubes were placed after surgery. The time for establishing a standard channel through F4.8 visual puncture was (6.8 ± 1.8) min, and that for establishing a single F4.8 visual puncture microchannel was (4.5 ± 0.9) min. The surgical time was (92 ± 15) min. The phase-I stone clearance rate was 91.3% (42/46), and the decreased value of hemoglobin was (12.21 ± 2.5) g/L. There were 8 cases of postoperative fever which was relieved after anti-inflammatory treatment. Four cases had 0.5-0.8 cm of stone residue in the lower calyx, and all stones were discharged one month after surgery by in vitro shock wave lithotripsy combined with position nephrolithotomy, without stone streets, delayed bleeding, peripheral organ damage or urethral injury.Conclusion:Combining visual standard channel with F4.8 visual puncture SMP for the treatment of multiple renal calculi had the advantages of reducing the number of large channels, high rate of stone clearance, safety and reliability and mild complications. The established F4.8 visual puncture channel was safer and more accurate.

Application of Micro-Percutaneous Nephrolithotomy (Micro-PCNL) combined with FURL in 1-2 cm symptomatic, refractory lower calyceal stones

“…In this way, it can effectively avoid blood vessels and important tissues so as to reduce the impact of the invasiveness of PCNL, which can be a disadvantage during Microperc. 13 Wicaksono F et al have concluded that micro-PCNL is superior to FURL in managing pediatric kidney stones, 10-20 mm in size based on their comparable SFR and fewer requirements of additional stenting procedures. 14 …”

“…In this way, it can effectively avoid blood vessels and important tissues so as to reduce the impact of the invasiveness of PCNL, which can be a disadvantage during Microperc. 13 Wicaksono F et al have concluded that micro-PCNL is superior to FURL in managing pediatric kidney stones, 10-20 mm in size based on their comparable SFR and fewer requirements of additional stenting procedures. 14 Through this study,we summarizes the advantages of this surgery: (1) Visual puncture ultra-micro channel nephroscopy can use different guidance methods at different anatomical levels, making the display of puncture paths clearer and more accurate, reducing channel related complications and bleeding 15 ; (2) The combination of dual mirrors reduces the dead angle of the renal calyx field of view and increases the stone clearance rate; (3) Visual puncture technology has a short Learning curve and is easy to master; (4) The simple operation space of the lower renal calyx is small, and a single retrograde soft mirror surgery or a single percutaneous nephroscopy surgery can easily lead to high pressure inside the calyx.…”

The clinical research of 1,470 nm laser in percutaneous nephrolithotomy

“…To reduce the risk of bleeding and improve operation efficiency, the author improved some instruments in PNCL. (I) Selection of skin and kidney channel: instead of the previous standard channel, i.e., the metal nested 24F working channel, the 20F skinning sheath is used, which has the advantage of elasticity and shape variability and the tearing rate of the calyceal neck when nephroscope swings during operation are significantly lower than the standard channel metal sheath (20). Also, it is more convenient to take out stones by using foreign body forceps under nephroscope, and even if the shape of stones is irregular, stones can be taken out by changing the shape of the skinning sheath, which significantly improves the efficiency of stone cleaning.…”