Ultrasound‐guided percutaneous nephrolithotomy for upper urinary tract calculi in patients with spinal deformity: a decade's experience

Abstract

ObjectivesTo evaluate the efficacy and safety of ultrasound (US)-guided percutaneous nephrolithotomy (PCNL) in managing upper urinary tract calculi in patients with spinal deformity based on our experience over the last decade. Patients and MethodsA retrospective study was conducted on patients with spinal deformity who were admitted to Beijing Tsinghua Changgung Hospital and collaborative hospitals from August 2004 to August 2017. Patients diagnosed with urolithiasis and who underwent US-guided PCNL, performed by the same surgeon, were included. Patients' data were collected and the following variables were analysed: age; sex; plain abdominal radiograph of the kidneys, ureters and bladder (KUB); computed tomography (CT); stone burden; evaluation of spinal anatomy; respiratory function; operative time; and postoperative findings. The severity of surgical complications was determined according to the modified Clavien classification system (MCCS). ResultsA total of 72 patients (41 males and 31 females) were included, with a mean (range) age of 35 (21-69) years. The mean (range) stone diameter was 38 (19-68) mm. Seven patients had bilateral PCNL, completed in staged surgery with a 1-week interval. Five kidneys received staged PCNL because of either large residual stones or the potential risk of a long operation time. In all, 19 patients underwent the surgery in a prone position, 29 lateral, nine oblique supine, and the other 27 in unconventional positions (lateral prone, lateral supine, and lateral jackknife position). All procedures were successfully completed with no major complications during the operation. The mean (SD) tract building time was 8.5 (1.7) min. The mean (SD) stone disintegration time was 39.3 (14.6) min. The mean (range) temperature and postoperative haemoglobin (Hb) drop on the first postoperative day were 37.6 (36.7-39.2)°C and 1.5 (0.2-4.3) g/dL, respectively. Four patients needed blood transfusions and none of the patients had septic shock or severe renal bleeding requiring angiographic renal embolisation or nephrectomy. A stone-free status was achieved in 71 kidneys (89.87%). Eight patients with residual fragments ≥4 mm were either observed without treatment during follow-up or re-treated with shockwave lithotripsy (SWL) according to clinical significance. ConclusionPCNL in patients with spinal deformities is challenging but safe and effective. US-guided puncture and access establishment has its unique advantages when such patients are placed in unconventional positions.

Study on Clinical Application of Different Ultrasound-Guided Planar Techniques in Minimally Invasive Percutaneous Nephrolithotomy

“…The risk of damaging renal parenchymal blood vessels is therefore greatly reduced. 2 In this group of patients, 11.3% of patients with complications that are Clavien grade II or below. There was no visceral injury or death.…”

“…1 Establishing an ideal percutaneous channel accurately, fast, and safely is a critical step for the safety and effectiveness of percutaneous nephrolithotomy. 2 Compared with X-ray guidance, ultrasound-guided percutaneous nephrolithotomy has the following advantages: nonradioactive, simple and fast, sensitive to hydronephrosis, real-time monitoring of the depth and angle of needle insertion, and clear display of the perirenal organs. 3,4 Therefore, the ultrasoundguided percutaneous renal puncture method is adopted by more and more clinicians.…”

Efficacy and safety of ultrasound-guided percutaneous nephrolithotomy for kidney calculi patients with ankylosing spondylitis: a retrospective single center analysis

“…Compared with the widely utilization of fluoroscopy in western countries, Chinese urologists preferred to use ultrasound to guide renal puncture. Ultrasound has many advantages including reduction of radiation exposure, real-time imaging, improvement of visualization of adjacent viscera over fluoroscopy in PCNL (22). It can accurately present the renal structure and distinguish the relationship between kidney calculi and calyces, which can help urologists to choose the best puncture site to manage as many stones in different calyces as possible with minimal damage.…”

Percutaneous Nephrolithotomy With X-Ray Free Technique in Morbidlyobese Patients: Outcomes and Skills From A Large High-Volume Stone Management Center

“…El-Assmy et al 9 reported major complications in 6.4% of patients, including ve cases of colon injuries. Our center has been performing US-guided PNL for > 15 years, and tens of thousands of patients, including patients with spinal deformity, 15 patients with a solitary kidney, 16 and pediatric patients, 17 have been safely and e ciently treated by this technique. In a large-sample study, we found that the incidence of bleeding, embolization, or adjacent organ injury was signi cantly lower than that associated with uoroscopy.…”