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Acute kidney injury (AKI) is a common postoperative outcome in urology patients undergoing surgery for nephrolithiasis. The objective of this study was to determine the prevalence of postoperative AKI and its degrees of severity, identify risk factors, and understand the resultant outcomes of AKI in patients with nephrolithiasis undergoing percutaneous nephrolithotomy (PCNL). A cohort of patients admitted between 2012 and 2019 to a single tertiary-care institution who had undergone PCNL was retrospectively analyzed. Among 417 (n = 326 patients) encounters, 24.9% (n = 104) had AKI. Approximately one-quarter of AKI patients (n = 18) progressed to Stage 2 or higher AKI. Hypertension, peripheral vascular disease, chronic kidney disease, and chronic anemia were significant risk factors of post-PCNL AKI. Corticosteroids and antifungals were associated with increased odds of AKI. Cardiovascular, neurologic complications, sepsis, and prolonged intensive care unit (ICU) stay percentages were higher in AKI patients. Hospital and ICU length of stay was greater in the AKI group. Provided the limited literature regarding postoperative AKI following PCNL, and the detriment that AKI can have on clinical outcomes, it is important to continue studying this topic to better understand how to optimize patient care to address patient- and procedure-specific risk factors.

Background The purpose is to compare the efficacy and safety of mini percutaneous nephrolithotomy (mini-PCNL) versus standard percutaneous nephrolithotomy (standard-PCNL) in patients with renal stones >2cm. Materials and Methods A systematic literature search was conducted in PubMed, Web of Science, Scopus, and the Cochrane Library databases to identify relevant studies before March 8, 2021. Stone-free rate (SFR), operation time, fever rate, hemoglobin drop, blood transfusion rate, and hospitalization time were used as outcomes to compare mini-PCNL and standard-PCNL. The meta-analysis was performed using the Review Manager version 5.4. Results Seven randomized controlled trials were included in our meta-analysis, involving 1407 mini-PCNL cases and 1436 standard-PCNL cases. Our results reveal that, for renal stones >2cm, mini-PCNL has a similar SFR (risk ratio (RR)=1.01, 95% confidence interval (CI): 0.98 to 1.04, p=0.57) and fever rate (RR=1.22, 95% CI: 0.97-1.51, p=0.08). Standard-PCNL was associated with a significantly shorter operating time (weighted mean difference (WMD)=8.23, 95% CI: 3.44 to 13.01, p 2cm renal stones, mini-PCNL should be considered an effective and reliable alternative to standard-PCNL (30F). It achieves a comparable SFR to standard-PCNL, but with less blood loss, lower transfusion rate, and shorter hospitalization. However, the mini-PCNL does not show a significant advantage over the 24F standard-PCNL. On the contrary, this procedure takes a longer operation time. Trial registration This meta-analysis was reported consistent with the PRISMA statement and was registered on PROSPERO, with registration number 2021CRD42021234893.

Purpose To evaluate the current practice of percutaneous nephrolithotomy (PCNL), conducting a worldwide survey among urologists with a special interest in endo-urology. Methods A 22-question survey was specifically developed by the European Association of Urology (EAU) young academic urologists (YAU) and uro-technology (ESUT) groups and globally distributed via SurveyMonkey to almost 2000 members of Endourology Society. The questionnaire included questions dedicated to the demographics and general practice of the participating urologists. Results In total, 441 responses (male/female ratio - 418/23) were received. A comparatively higher percentage of specialists (56.2%) practiced in academic institutions and had specific endo-urological fellowship training (56.7%). The classical prone PCNL remained the most practiced approach among the surveyed specialists, 47.7% stated to always do prone PCNLs, while 51.8% of respondents used multiple positioning options as required. The PCNL tract was mostly performed by urologists (84.3%) and fluoroscopic guidance was still predominantly used by 74.5% of respondents. The most practiced tract dilation method was balloon dilator used by 42% of respondents. Most of the surveyed urologists had ultrasonic, pneumatic or laser lithotripsy devices in their armamentarium. The use of some form of post-procedural drainage was reported in 85.1% of respondents, whereas tubeless PCNL remained a fairly uncommon practice. Conclusion The majority of urologists still use prone positioning, get their own access under fluoroscopy guidance and use a balloon for tract dilation. However, we also identified that when necessary, urologists will deviate from routine practice and change strategy, adopting other approaches for PCNL.

Background Demographic changes are leading to an increase in geriatric urolithiasis patients aged ≥70 yr. Published data regarding their management remain sparse. In particular, for the subgroup of patients aged ≥80 yr there is a lack of evidence supporting the hypothesis that stone-removing treatment is effective, safe, and beneficial. Objective To examine the efficiency and safety of stone-removing treatment in geriatric urolithiasis patients aged ≥80 yr compared to their younger geriatric counterparts aged 70–79 yr against the background of their respective life expectancy. Design, setting, and participants Data for the study cohort were extracted from an institutional review board–approved retrospective database with 325 patients aged ≥70 yr (70–79 yr: n = 241; ≥80 yr: n = 84) consecutively admitted to hospital because of symptomatic urolithiasis from 2013 to 2018. Outcome measurements and statistical analysis Baseline characteristics, outcome and follow-up data, and survival were compared using Wilcoxon-Mann-Whitney U tests, χ2 tests, Kaplan-Meier estimation, log-rank tests, and Cox regression. Results and limitations At baseline, the incidence of infected hydronephrosis was greater among patients aged ≥80 yr (p 0.05). Survival analysis for the two groups demonstrated a 2-yr overall survival (OS) rate of 0.91 (95% confidence interval [CI] 0.75–1) for patients aged ≥80 yr and 0.97 (95% CI 0.88–1), for those aged 70–79 yr (p Conclusions Stone-removing treatment for patients aged ≥80 yr proved to be as effective and safe as for patients in their seventies. Although characterized by shorter remaining life expectancy, excellent 2-yr OS for patients aged ≥80 yr supports the hypothesis of equal benefit from stone-removing treatment when compared to septuagenarians. Patient summary There is a lack of evidence supporting the benefit of urinary stone-removing treatment for patients older than 80 yr. Our study included geriatric patients older than 70 yr with symptomatic urinary stone disease for which urinary drainage or stone removal is indicated. We compared treatment outcomes and survival between two age groups: patients aged 70–79 yr and those aged 80 yr or older. We found equivalent outcomes for the two groups and excellent 2-yr overall survival of 91% for those older than 80 yr. The study strengthens the evidence that active stone-removing therapy is safe and beneficial for these patients.

PURPOSE OF REVIEW: The aim of this study was to discuss current trends and recent developments in the surgical management of paediatric urolithiasis. RECENT FINDINGS: Medical expulsive therapy (MET) is considered as an option for the treatment of children with ureter stones. Extracorporeal shockwave lithotripsy (SWL) remains as a first option for majority of kidney stones and upper ureter stones. Advances in endourology have led to increased adoption of retrograde intrarenal surgeries (RIRS) and percutaneous nephrolithotomy (PCNL/mini-PCNL/ultra-mini-PCNL/micro-PCNL). SUMMARY: Management of paediatric stone disease has developed significantly in the past decade. However, the evidence in the literature remains disproportional to these advances. Well designed multicentric studies are still needed to compare effectiveness and safety of these procedures.

SUMMARY OBJECTIVE: The aim of this study was to evaluate the predictive factors for success following percutaneous nephrolithotomy in the supine position. METHODS: Patients who underwent percutaneous nephrolithotomy in the supine position from June 2011 to October 2018 were evaluated. Age, sex, body mass index, the American Society of Anesthesiologists physical status classification, hemoglobin level, number of previous surgeries, stone size, and the Guy’s Stone Score were analyzed. Success was considered if no fragments were observed on the computed tomography scan on the first postoperative day. Univariate and multivariate analyses were performed to determine significant parameters. RESULTS: We evaluated 961 patients; of them, 483 (50.2%) underwent previous stone-related surgery, and 499 (51.9%) had Guy’s Stone Score 3 or 4. The overall success rate in a single procedure was 40.7%, and complication rate was 13.7%. The univariate analysis showed that the maximum diameter of the stone (25.10±10 mm; p

Background: Successful percutaneous nephrolithotomy (PCNL) relies on a technically challenging, precise needle puncture of the renal collecting system. We aimed to compare, in an ex vivo model, the use of a real time image guidance system (the SabreSource™) and a mechanical stabilising device with conventional manual techniques for the accuracy of needle placement. Methods: The SabreSource™ system (Minrad International Inc.; New York, USA) is a real time image guidance system. The system platform is mounted on a C-arm fluoroscope. It employs targeting cross hairs on the fluoroscopic image that can be easily positioned to target the desired renal calyx. The system directs a visible laser beam onto the patient which is precisely aligned with the cross hairs on the fluoroscopic image. This provides the correct “bull’s-eye” angle of approach to the calyx, even after the x-ray source is turned off. The locator then stabilises the needle in the “bull’s-eye” position so that only screening for depth is required. Objective assessment using a simulated PCNL puncture was performed by 7 urologic trainees on a kidney phantom with and without using the SabreSource™. Fluoroscopy screening time (FST) and amount of radiation (mGy) used to achieve successful puncture were compared. Results: Simulated PCNL puncture was quicker and resulted in reduced radiation exposure when the apparatus was used. The mean FST for traditional “bull’s-eye” vs SabreSource™ puncture was 17 vs 5 seconds (p = 0.01), and the mean radiation exposure to puncture was 0.7 vs 0.2 mGy (p = 0.03), respectively. Conclusion: The SabreSource™ is a novel assistant to achieving successful PCNL puncture. In combination with “the locator” the preliminary in vitro testing suggests that the device reduces fluoroscopy exposure and is quicker. The device warrants further evaluation in the clinical setting.&nbsp

Background: percutaneous nephrolithotomy (PCNL) is a minimally invasive surgery to treat renal stones. Post-operative pain is distressing to the patient due to the injury to the capsule. Efficacy of ultrasound-guided thoracic paravertebral block at multiple level (T9–T10, T10–T11, T11–T12) was evaluated to manage postoperative analgesia in percutaneous nephrolithotomy surgeries.Methodology: a prospective randomized double-blind study of 60 cases of the American Society of Anesthesiologists I–II patients who underwent percutaneous nephrolithotomy were allocated into group P (test) and group N (control). Immediately after surgery, group P were given ultrasound-guided paravertebral block at T9–T10, T10–T11, T11–T12 on operated side using 5 ml of 0.25 % Levobupivacine at each level, while group N did not receive paravertebral block. The patients were assessed for visual analogue scale (VAS), time for first rescue analgesic, number of rescue analgesics in first 24 hrs postoperatively.Results: VAS pain scale shows significant difference between group P (4.2 + 0.8) and group N (5.3 + 1.1) (p < 0.05) at 30 mins, 2, 4, 8 hrs postoperatively. Total opioid consumption at postoperative 2, 6, and 24 hrs was less in group P than group N (P < 0.05). Number of rescue analgesics in first 24 hrs post-surgery in group P was 3.0 ± 0.4, and 4.0 ± 1.1 in group N with statistical significant difference (p = 0.0001). Total dose of opioid consumption (mg) in group P was 110 ± 40.45, and 155 ± 64.87 mg in group N with statistical significant difference (p = 0.002). The group N cases used more opioid than group P, with lower scores for satisfaction (p < 0.05). Analgesic consumption in postoperative 24 hrs of group P was less than that of group N (P = 0.001). Patient satisfaction score was significantly higher in group P than group N (P = 0.0001) in 24 hrs. No nausea and/or vomiting were noted in both groups.Conclusion: ultrasound-guided thoracic paravertebral block had more analgesic, and reduce the requirement of opioids and maintains stable hemodynamics., Довідкова інформація: Черезшкірна нефролітотомія (PCNL) є малоінвазивною операцією для лікування каменів у нирках. Післяопераційний біль турбує пацієнта через пошкодження капсули. Ефективність торакальної паравертебральної блокади під ультразвуковим контролем на кількох рівнях (T9–T10, T10–T11, T11–T12) була оцінена для лікування післяопераційної аналгезії під час операцій черезшкірної нефролітотомії.Методологія: проспективне рандомізоване подвійне сліпе дослідження 60 випадків пацієнтів Американського товариства анестезіологів I–II, які перенесли черезшкірну нефролітотомію, були розподілені на групу P (тест) і групу N (контроль). Відразу після операції групі P була проведена паравертебральна блокада під ультразвуковим контролем на T9–T10, T10–T11, T11–T12 на боці операції з використанням 5 мл 0,25 % левобупівацину на кожному рівні, тоді як групі N не проводили паравертебральну блокаду. Пацієнтів оцінювали за візуально-аналоговою оцінкою (VAS), час для першого невідкладного анальгетика, кількість невідкладних анальгетиків у перші 24 години після операції.Результати: Оцінка болю за VAS показує суттєву різницю між групою P (4,2 + 0,8) і групою N (5,3 + 1,1) (p < 0,05) через 30 хвилин, 2, 4, 8 годин після операції. Загальне споживання опіоїдів на 2-гу, 6-ту і 24-ту години після операції було меншим у групі P, ніж у групі N (P

Context: Paediatric stone disease is an important clinically entity and management is often challenging. Although it is known that the condition is endemic in some geographic regions of the world, the global incidence is also increasing. Patient age and sex; the number, size, location, and composition of the stone; and the anatomy of the urinary tract are factors that need to be taken into consideration when choosing a treatment modality.Objective: To provide a general insight into the evaluation and management of urolithiasis in the paediatric population in the era of minimally invasive surgery.Evidence acquisition: A nonsystematic review of the literature on management of paediatric urolithiasis was conducted with the aim of presenting the most suitable treatment modality for different scenarios.Evidence synthesis: Because of high recurrence rates, open surgical intervention is not the first option for paediatric stone disease, except for very young patients with very large stones in association with congenital abnormalities. Minimally invasive surgeries have become the first option with the availability of appropriately sized instruments and accumulating experience. Extracorporeal shockwave lithotripsy (SWL) is noninvasive and can be carried out as an outpatient procedure under sedation, and is the initial choice for management of smaller stones. However, for larger stones, SWL has lower stone-free rates and higher retreatment rates, so minimally invasive endourology procedures such as percutaneous nephrolithotomy and retrograde intrarenal surgery are preferred treatment options.Conclusions: Contemporary surgical treatment for paediatric urolithiasis typically uses minimally invasive modalities. Open surgery is very rarely indicated. Patient summary: Cases of urinary stones in children are increasing. Minimally invasive surgery can achieve high stone-free rates with low complication rates. After stone removal, metabolic evaluation is strongly recommended so that medical treatment for any underlying metabolic abnormality can be given. Regular follow-up with imaging such as ultrasound is required because of the high recurrence rates.

OBJECTIVE Using anticoagulants and antiplatelet drugs in patients with cardiovascular and medical comorbidities is prevalent. Because of hyper vascular nature of kidney, physicians tend to stop using aspirin before percutaneous nephrolithotomy (PCNL). We have shown the effects of remaining on low dose aspirin in complete supine PCNL (csPCNL). MATERIAL AND METHODS The records of 643 patients who underwent csPCNL between 2012 and 2018 were analyzed. Surgical outcomes and complications of patients who were on aspirin therapy and continued it daily (group A) were compared with those not taking aspirin (group B). RESULTS Of the 643 csPCNLs, 40 (6%) were performed in patients of group A and the rest of 603 (94%) cases were in group B. The differences between the mean age of groups were statistically significant (60.08±9.45, group A and 48.66±12.32, group B) (P

Context Paediatric stone disease is an important clinically entity and management is often challenging. Although it is known that the condition is endemic in some geographic regions of the world, the global incidence is also increasing. Patient age and sex; the number, size, location, and composition of the stone; and the anatomy of the urinary tract are factors that need to be taken into consideration when choosing a treatment modality. Objective To provide a general insight into the evaluation and management of urolithiasis in the paediatric population in the era of minimally invasive surgery. Evidence acquisition A nonsystematic review of the literature on management of paediatric urolithiasis was conducted with the aim of presenting the most suitable treatment modality for different scenarios. Evidence synthesis Because of high recurrence rates, open surgical intervention is not the first option for paediatric stone disease, except for very young patients with very large stones in association with congenital abnormalities. Minimally invasive surgeries have become the first option with the availability of appropriately sized instruments and accumulating experience. Extracorporeal shockwave lithotripsy (SWL) is noninvasive and can be carried out as an outpatient procedure under sedation, and is the initial choice for management of smaller stones. However, for larger stones, SWL has lower stone-free rates and higher retreatment rates, so minimally invasive endourology procedures such as percutaneous nephrolithotomy and retrograde intrarenal surgery are preferred treatment options. Conclusions Contemporary surgical treatment for paediatric urolithiasis typically uses minimally invasive modalities. Open surgery is very rarely indicated. Patient summary Cases of urinary stones in children are increasing. Minimally invasive surgery can achieve high stone-free rates with low complication rates. After stone removal, metabolic evaluation is strongly recommended so that medical treatment for any underlying metabolic abnormality can be given. Regular follow-up with imaging such as ultrasound is required because of the high recurrence rates.

Background: Renal stone disease is a common disorder in urology practice. Kidney stone has various treatment methods such as extracorporeal shock wave lithotripsy, retrograde intrarenal surgery, an...

INTRODUCTION The burden of kidney stone disease (KSD) has risen, and several treatment options now exist. We wanted to evaluate the preference and treatment choices based on the information provided for management of hypothetical 8mm and 15mm renal stone, and factors that influenced their decision. METHODS An online questionnaire to investigate trends in decision-making for two hypothesized scenarios of asymptomatic kidney stones (8mm and 15mm) was formatted online in Microsoft Forms and posted on social media (Facebook) in Europe. The ethical approval was obtained from the university ethics committee and data was collected from general public between Sept-Nov 2020. RESULTS A total of 476 participants of different age and background answered the survey with a male:female ratio of 1:2.7. The age groups were categorised as 18-25 years (n=149), 26-49 years (n=192) and 50+ years (n=135). In the 8mm scenario, 107 of the 476 participants (22.5%) chose observation (OBS), 249 (52.3%) chose shockwave lithotripsy (SWL) and 120 (25.2%) opted for ureteroscopy (URS). In the 15mm scenario, 194 participants chose SWL treatment (40.8%), 216 (45.4%) URS, and 66 (13.9%) preferred percutaneous nephrolithotomy (PCNL). The influencing factors were success rate, complication risk and invasiveness of the procedure. On comparison to 8mm stone, while stent avoidance and activity limitation were considered less important with 15mm stone (p

PURPOSE High-quality evidence comparing supine to prone percutaneous nephrolithotomy (PCNL) for the treatment of complex stones is lacking. This study aimed to compare the outcomes of supine position (SUP) and prone position (PRO) PCNL. MATERIALS AND METHODS A noninferior randomized controlled trial was performed according to the CONSORT (Consolidated Standards for Reporting Trials) criteria. The inclusion criteria were patients over 18 years of age with complex stones. SUP was performed in the Barts flank-free modified position. Except for positioning, all the surgical parameters were identical. The primary outcome was the difference in the success rate on the first postoperative day (POD1) between groups. The secondary outcome was the difference in the stone-free rate (SFR) on the 90th postoperative day (final SFR). A noninferiority margin of 15% was used. Demographic, operative, and safety variables were compared between the groups. Statistical significance was set at p

OBJECTIVES Compare color Doppler (Color) ultrasound-guided puncture to common type-B (Type-B) ultrasound-guided puncture in reducing the incidence of hemorrhagic complications of percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS A total of 348 patients who received PCNL from September 2017 to December 2018 were divided into Color (231 cases) and Type-B groups (117 cases). The avascular area of the target fornix was pinpointed in the Color group while the middle of the target fornix was the default puncture point in the Type-B group. Tract bleeding, nephrostomy tract creation time, operation time, postoperative hemoglobin (Hb) values and serum creatinine (Scr) concentrations, and stone-free rates were analyzed. RESULTS Color Doppler imaging revealed that 35.1% of the cases in the Color group (81/231) had variable artery positioning in the target fornix. Tract bleeding and postoperative Hb reduction in the Color group were significantly lower than the Type-B group (10.8% vs 24.8%, P=0.0007, and 4.87±8.58 vs 7.70±8.90 g/L, P=0.0044, respectively). The postoperative hospitalization of the Color group was also shortened (8.3±5.9 vs 9.7±3.0 d, P

Context Although percutaneous nephrolithotomy (PCNL) has been performed for decades and has gone through many refinements, there are still concerns regarding its more widespread utilization because of the long learning curve and the potential risk of severe complications. Many technical details are not included in the guidelines because of their nature and research protocol. Objective To achieve an expert consensus viewpoint on PCNL indications, preoperative patient preparation, surgical strategy, management and prevention of severe complications, postoperative management, and follow-up. Evidence acquisition An international panel of experts from the Urolithiasis Section of the European Association of Urology, International Alliance of Urolithiasis, and other urology associations was enrolled, and a prospectively conducted study, incorporating literature review, discussion on research gaps (RGs), and questionnaires and following data analysis, was performed to reach a consensus on PCNL. Evidence synthesis The expert panel consisted of 36 specialists in PCNL from 20 countries all around the world. A consensus on PCNL was developed. The expert panel was not as large as expected, and the discussion on RGs did not bring in more supportive evidence in the present consensus. Conclusions Adequate preoperative preparation, especially elimination of urinary tract infection prior to PCNL, accurate puncture with guidance of fluoroscopy and/or ultrasonography or a combination, keeping a low intrarenal pressure, and shortening of operation time during PCNL are important technical requirements to ensure safety and efficiency in PCNL. Patient summary Percutaneous nephrolithotomy (PCNL) has been a well-established procedure for the management of upper urinary tract stones. However, according to an expert panel consensus, core technical aspects, as well as the urologist’s experience, are critical to the safety and effectiveness of PCNL.

Although percutaneous nephrolithotomy (PCNL) is less morbid than open surgery, it still carries risks of significant complications as well as injury to the renal parenchyma. Flexible ureteroscopic stone removal, although causes no appreciable damage to the renal parenchyma, has limitations, most notably, a lower stone-free rate than PCNL. Advances in our knowledge regarding ureteral physiology combined with technical developments applied to ureteral access sheath deployment and size may well propel retrograde intrarenal surgery to the forefront of kidney stone removal, regardless of stone size or location.

Percutaneous nephrolithotomy (PCNL) remains the treatment of choice for large and complex renal stones. The technological advances over the past several decades gave birth to different varieties of minimally invasive PCNLs, including the mini-PCNL, ultra-mini PCNL, super mini-PCNL, and micro-PCNL, with indications being extended to stones even larger than 20 mm. This article provides an update of all these available techniques of miniaturized PCNL along with its anatomic and physiologic impact. This should assist urologists in providing a personalized approach to the patient based on various patient- and stone-related factors to provide the best of all available technology for treatment.

Background Systemic inflammatory response syndrome (SIRS) is a dangerous complication after percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). We aimed to review the diag...

Context Although miniaturized percutaneous nephrolithotomy (mPCNL) and retrograde intrarenal surgery (RIRS) are both options for treating >1 cm kidney stones, controversies exist on whether one is more effective and safer than the other. Objective To systematically appraise randomized trials comparing the effectiveness and safety of mPCNL and RIRS for treating >1 cm kidney stones. Evidence acquisition A systematic search on PubMed/Medline, Web of Science, Embase, and ClinicalTrials.gov was conducted in August 2020 following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA). Randomized trials comparing mPCNL and RIRS for >1 cm kidney stones, and reporting stone-free rate (SFR), hemoglobin drop, transfusion rate, length of hospital stay (LOS), and/or complications, were included. Evidence synthesis Eight studies compared mPCNL and RIRS, but one was not included due to its high risk of bias. SFR was higher for mPCNL (RR: 1.06 [95% coefficient interval {CI}, 1.01–1.10], p = 0.008). Hemoglobin drop was higher for mPCNL (mean difference [MD]: 0.35 [95% CI, 0.05–0.65] g/dl, p = 0.02); however, transfusion rates were similar (p = 0.44). Complication rate was similar between mPCNL and RIRS (p = 0.39), and the LOS was higher for mPCNL (MD: 1.11 [95% CI, 0.06–2.16] d, p = 0.04). A subgroup analysis of lower pole stones showed that SFR was higher for mPCNL (RR: 1.09 [95% CI, 1.00–1.19], p = 0.05). Conclusions Both approaches are effective and safe. Among these approaches, mPCNL has a higher SFR than RIRS for overall >1 cm renal and lower pole stones, but longer LOS, and a higher hemoglobin drop that does not translate into higher transfusion rates. Complications are comparable. Patient summary Randomized trials have evaluated whether miniaturized percutaneous nephrolithotomy (mPCNL) or retrograde intrarenal surgery is more effective and safer for treating >1 cm stones. After comparing the stone-free rate, hemoglobin drop, transfusion rate, length of hospital stay, and complications between both the approaches, mPCNL was found to be slightly more effective, but both were equally safe.

Objective To evaluate whether there would be a difference in outcome when the smaller ultra mini 12 Fr sheath was used instead of the mini 16 Fr sheath for percutaneous nephrolithotomy (PCNL) in paediatric patients for stones less than 25 mm. Methods This was a prospective cohort study of patients who underwent PCNL in our hospital in a 2 year period from 2016 to 2018 by a single surgeon. PCNL was performed in a prone position and tract was dilated to the respective size using single step dilatation. Laser was used to fragment the stone. Stone-free outcome was defined as absence of stone fragment at 3 months on kidney, ureter, and bladder (KUB) X-ray. Results There were 40 patients in each group. Mean stone size was comparable between the two groups, (14.5 mm vs. 15.0 mm). The procedure was completed faster in the 16 Fr group compared to 12 Fr group, (24.5 min vs. 34.6 min). Stone clearance was highly successful in both groups (97.5% vs. 95%). There was no difference in complications between the two groups. The decrease in hemoglobin was minimal in both groups (0.2 g/dL vs. 0.3 g/dL). Conclusions We found that the success rates were similar in both mini PCNL and the smaller ultra-mini PCNL groups. No significant difference in bleeding was noted in our pilot study, however, operative time was longer in the ultra-mini group as compared to the mini sheath group.

Objectives: The study aimed to evaluate quality of nephrolithometric nomograms to predict stone-free rates (SFRs) and complication rates (CRs) in case of minimally invasive percutaneous nephrolithotomy (PNL). In the last decade, nomograms have been introduced to estimate the SFRs and CRs of PNL. However, no data are available regarding their reliability in case of utilization of miniaturized devices. Herein we present a prospective multicentric study to evaluate reliability of Guy's stone score (GSS), the stone size, tract length, obstruction, number of involved calyces, and essence of stone (S.T.O.N.E.) nephrolithometry score and Clinical Research Office of the Endourological Society (CROES) score in patients treated with minimally invasive PNL. Methods: We evaluated SFRs and CRs of 222 adult patients treated with miniaturized PNL. Patients were considered stone-free if no residual fragments of any size at post-operative unenhanced computed tomography scan. Patients demographics, SFRs, and CRs were reported and analysed. Performances of nomograms were evaluated with the area under the curve (AUC). Results: We included 222 patients, the AUCs of GSS, CROES score and S.T.O.N.E. nephrolithometry score were 0.69 (95% confidence interval [CI] 0.61–0.78), 0.64 (95% CI 0.56–0.73), and 0.62 (95% CI 0.52–0.71), respectively. Regarding SFRs, at multivariate binomial logistic regression, only the GSS had significance with an odds ratio (OR) of 0.53 (95% CI 0.31–0.95, p=0.04). We did not find significant correlation with complications, with only a trend for GSS. Conclusion: This is the first study evaluating nomograms in miniaturized PNL. They still show good reliability; however, our data showed lower performances compared to standard PNL. We emphasize the need of further studies to confirm this trend. A dedicated nomogram for minimally invasive PNL may be necessary.

SUMMARY OBJECTIVE: The aim of this study was to identify predictive factors for complications after percutaneous nephrolithotomy. METHODS: We prospectively analyzed patients who underwent percutaneous nephrolithotomy from June 2011 to October 2018. The association of preoperative and intraoperative factors with the presence of complications was assessed using univariate and multivariate analyses. The significance level was set at p

Objective: Pediatric urolithiasis has been more common over the past 20 years, and urologists have unique challenges in managing it surgically because this particular demographic is recognized as one of the high-risk categories for stone recurrence. Given this reality, care focuses on maintaining renal function, achieving total stone-free status, and most importantly avoiding stone recurrences. In this presented article, we aimed to make a comprehensive review of the current minimally invasive treatment of pediatric kidney stone disease. Methods: We evaluated the results of 74 studies following a comprehensive PubMed search till February 2023. This article was written by making use of current urology guidelines. Results: Considering the reported occurrence of metabolic issues in up to 50% of cases in addition to the anatomic anomalies (about 30% of cases), the treatment of pediatric urolithiasis necessitates a full metabolic and urological examination on an individual basis. Timely management of metabolic imbalances and obstructive diseases is necessary. In addition to encouraging proper fluid consumption, it is advisable to improve urine volume and consider using medical therapeutics to raise urinary citrate levels. The location, content, and size of the stone(s), the morphology of the collecting system, the presence of urinary tract infection, as well as the presence of any obstruction, should all be taken into consideration while deciding on the best surgical procedure. Conclusion: All modern endourological methods are now used in the safe and efficient care of pediatric urolithiasis as a consequence of the obvious advancements in instrument technology and expanding expertise derived from adult patients. Other minimally invasive procedures, such as ureterorenoscopy and percutaneous nephrolithotomy, require more expertise and can be successfully applied with careful management for an excellent stone-free rate with minimal morbidity. Of these procedures, shock wave lithotripsy is still the first choice in the majority of cases with upper tract calculi. Open surgery will still be the therapy of choice for pediatric patients with complicated and big stones as well as anatomical anomalies.

Εισαγωγήː Δεν υπάρχουν μελέτες παρατήρησης σχετικά με τη συσχέτιση των ενδοουρολογικών επεμβάσεων με τη βλάβη του νεφρικού παρεγχύματος. Αυτή η τυχαιοποιημένη δοκιμή εξέτασε την επίδραση της τυπικής διαδερμικής νεφρολιθοτομής (sPCNL) σε σύγκριση με τη μικρογραφία PCNL (mini-PCNL) και την ανιούδσ ενδονεφρική χειρουργική (RIRS) για τη θεραπεία νεφρολιθίασης σε νέους βιοδείκτες νεφρικής βλάβης. Μέθοδοιː Εβδομήντα πέντε ασθενείς τυχαιοποιήθηκαν σε αναλογία 1:1:1 για να λάβουν sPCNL, mini-PCNL και RIRS για νεφρολιθίαση. Οι αναλογίες λιποκαλίνης σχετιζόμενης με ουδετερόφιλο-ζελατινάση (NGAL), μορίου νεφρικής βλάβης-1 (KIM-1) και ιντερλευκίνης-18 (IL-18) που κανονικοποιήθηκαν για την κρεατινίνη ούρων (Cr) υπολογίστηκαν από δείγματα ούρων που συλλέχθηκαν κατά την έναρξη ( 2 ώρες-προεγχειρητικά) και στις 2, 6, 24 και 48 ώρες μετεγχειρητικά. Χρησιμοποιήθηκε αμφίδρομη μικτή ANOVA για επαναλαμβανόμενες μετρήσεις για την αξιολόγηση των επιδράσεων του τύπου της διαδικασίας και του χρόνου στους βιοδείκτες που μελετήθηκαν. Αποτελέσματαː Μεταξύ της βασικής εκτίμησης και των 2 ωρών μετεγχειρητικά, δεν παρατηρήθηκαν σημαντικές διαφορές στις αλλαγές NGAL/Cr μεταξύ sPCNL [9,46 (4,82-14,9)], mini-PCNL [12,78 (1,69-25,24)] και RIRS [6.42 (2.61-23.90)] (p=0.902). Ομοίως, δεν παρατηρήθηκαν διαφορές μεταξύ των ομάδων του KIM-1/Cr (p=0,853) και του IL-18 (p=0,980) στις 2 ώρες, και όλων των βιοδεικτών σε οποιοδήποτε χρονικό σημείο μετεγχειρητικά. Εντός των ομάδων, σημειώθηκαν σημαντικές αυξήσεις από την αρχική τιμή για το NGAL/Cr (sPCNL p, Backgroundː Observational studies on the association of endourological procedures with renal parenchymal damage are lacking. This randomized trial examined the effect of standard-percutaneous-nephrolithotomy (sPCNL) in comparison to miniaturized-PCNL (mini-PCNL) and retrograde-intrarenal-surgery (RIRS) for nephrolithiasis treatment on novel biomarkers of renal injury. Methodsː Seventy-five patients were randomized in 1:1:1 ratio to receive sPCNL, mini-PCNL and RIRS for nephrolithiasis. The ratios of neutrophil-gelatinase-associated-lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and interleukin-18 (IL-18) normalized for urinary creatinine (Cr) were calculated from urine samples collected at baseline (2-hours-preoperatively) and at 2, 6, 24 and 48-hours postoperatively. Two-way mixed ANOVA for repeated measurements was used to evaluate the effects of type of procedure and time on studied biomarkers. Resultsː Between baseline and 2-hours postoperatively, no significant differences were observed in NGAL/Cr changes between sPCNL[9.46 (4.82-14.9)], mini-PCNL[12.78 (1.69-25.24)] and RIRS[6.42 (2.61-23.90)] (p=0.902). Similarly, no between-group differences were observed of KIM-1/Cr (p=0.853) and IL-18 (p=0.980) at 2-hours, and all biomarkers at any time-point postoperatively. Within-groups, significant increases from baseline were noted for NGAL/Cr (sPCNL p

Patients with chronic spinal cord injury suffer from a number of pathophysiological alterations that can lead to im-portant morbidity and mortality in the perioperative period. The diaphragmatic pacemaker is a device that enables pulmonary ventilation in patients with high cervical cord injuries and provides them with a better quality of life when compared to mechanical ventilation. We present here the clinical case of a patient with chronic spinal cord injury who used a diaphragmatic pacemaker, and who was scheduled for percutaneous nephrolithotomy and double-J stent implantation. The anesthesiologist should know the pathophysiological situation of these patients in order to provide a safe perioperatory care.

BACKGROUND Lingual nerve injury (LNI) is a rare complication following the use of laryngeal mask airway (LMA). The occurrence of this unexpected complication causes uncomfortable symptoms in patients and worsens their quality of life. We present an unusual case of LNI caused by the use of an LMA in percutaneous nephrolithotomy (PCNL). CASE SUMMARY A 49-year-old man presented to our hospital with a 3-year history of intermittent left lower back pain. Abdominal computed tomography showed a 25 mm × 20 mm stone in the left renal pelvis. PCNL surgery using LMA was performed to remove the renal stone. The patient reported numbness on the tip of his tongue after the operation, but there were no signs of swelling or trauma. The patient was diagnosed with LNI after other possible causes were ruled out. The symptom of numbness eventually improved after conservative medical therapy for 1 wk. The patient completely recovered 3 wk after surgery. CONCLUSION This is the first case report describing LNI with the use of LMA in PCNL. In our case, an inappropriate LMA size, intraoperative movement, and a specific surgical position might be potential causes of this rare complication.

Introduction: Urinary tract infection (UTI) should be treated before percutaneous nephrolithotomy (PCNL). However, the most appropriate treatment strategy in patients with negative urine culture bu...

Purpose: Bleeding is the most dreadful and distressing complication of percutaneous nephrolithotomy, which can cause significant morbidity. Intravenous use of tranexamic acid to reduce bleeding complication is widely established. Our aim is to compare the result between the two groups using tranexamic acid intravenous and in irrigation solution. Materials and methods: A total of 160 patients were enrolled in this study. Patients were randomly allocated to two groups. Group 1 received 0.1% tranexamic acid solution (1000 mg in 1 L of irrigation solution (normal saline)). Group 2 received 1 g tranexamic acid intravenously in intraoperative period. Results: The mean estimated fall in haematocrit, mean estimated total blood loss and mean operative time in tranexamic acid irrigation group is significantly less compared to intravenous tranexamic acid group. No significant difference was found with regards to stone clearance. Conclusion: We found that tranexamic acid irrigation was safe and associated with reduced blood loss as compared to intravenous tranexamic acid.

Purpose: The objective of this study is to evaluate the impact of a previous standard percutaneous nephrolithotomy (PCNL) on the outcomes of retrograde intrarenal surgery (RIRS). Materials and Methods: Outcomes of RIRS performed from January 2017 to January 2020 in adult patients with residual stone fragments ≤20mm after a standard PCNL (Post-PCNL) and symptomatic adult patients with kidney stones ≤20mm (Control) were prospectively studied. Stone-free rate (SFR) was evaluated on a postoperative day 90 non-contrast computed tomography. Surgical complications based on Clavien-Dindo classification during the 90 days of follow-up were recorded. Results: Outcomes of 55 patients and 57 renal units of the post-PCNL group were compared to 92 patients and 115 renal units of the control group. SFR was lower in post-PCNL group than in control (28/57, 49.1% vs. 86/115, 74.8%, p

Objective:To prospectively compare the feasibility and safety of tubeless percutaneous nephrolithotomy (PCNL) Vs standard PCNL. Patients and methods:220 patients undergoing PCNL were randomized to two groups: Group A (tubeless PCNL) with antegrade placement of a Double-J stent without nephrostomy and group B (standard PCNL) with nephrostomy tube placement postoperatively with 110 patients in each group.Inclusion criteria were stone size more than 2 cm, single tract puncture with complete clearance, less than three stones with a diameter Results:There was no significant difference between the two groups for patient demographics and stone characteristics. There was no statistically significant difference between the two groups for the complications, stone clearance, need for ancillary procedure, mean postoperative drop in haemoglobin, need for blood transfusion. The mean postoperative ana;gesic requirement, operative time and hospital stay was statistically significantly higher in the tubeless PCNL group compared with the standard PCNL group with p values of 0.000, 0.040, 0.001 respectively. Conclusion:Tubeless PCNL is considered a safe and efficient technique in any tract location (upper, middle, lower), in patients with bilateral disease and effective procedure if done in a selected group of patients.

Urolithiasis is one of the most common urological conditions (30–45 %), peaking in the 4th–6th decades of life. About 50 % of patients have one recurrent episode of nephrolithiasis during their lifetime, and among the operated patients, more than 10–15 % of individuals report recurrences with the need for repeated surgical treatment. Increasing the incidence of nephrolithiasis in the world requires the development of new and improvement of existing methods of surgical treatment, which would be characterized by a high level of efficiency and low invasiveness with minimal complications and postoperative rehabilitation. The use of a combination of percutaneous nephrolithotripsy and flexible ureteronephrolithotripsy, especially in complex cases of urolithiasis, can increase the safety and improve the treatment of nephrolithiasis by combining the positive qualities of both methods. Aim. To summarize the data of the world scientific literature on the treatment of nephrolithiasis by studying a combination of percutaneous nephrolithotripsy and retrograde or antegrade flexible intrarenal surgery based on the evaluation of their effectiveness and safety. Materials and methods. The literature review was conducted using the databases PubMed, Google Scholar, Web of Science and Scopus for the period 2015–2022. The following keywords were used for the search: surgical treatment of nephrolithiasis, endoscopic combined intrarenal surgery (ECIRS), percutaneous nephrolithotomy, retrograde intrarenal surgery, simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotomy, simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotripsy. Conclusions. The use of ECIRS increases the effectiveness of one-stage treatment of nephrolithiasis with minimal complications and reduces the number of re-operations required. Treatment of complex forms of nephrolithiasis may be a priority for ECIRS. The main disadvantages of ECIRS are the need for simultaneous operation of two operating surgeons and the availability of two sets of endoscopic equipment, which make this procedure expensive., Сечокам’яна хвороба (СКХ) – один із найпоширеніших урологічних патологічних станів (30–45 %), пік якого припадає на четверте – шосте десятиліття життя. Майже 50 % пацієнтів надалі мають один повторний епізод нефролітіазу, а серед прооперованих хворих понад 10–15 % визначають часті рецидиви з необхідністю повторних оперативних лікувань. Збільшення рівня захворюваності на нефролітіаз у світі зумовлює необхідність розроблення нових і вдосконалення наявних методів хірургічного лікування, що будуть характеризуватися високим рівнем ефективності, малоінвазивністю при мінімальних ускладненнях і терміні післяопераційної реабілітації. Використання комбінації перкутанної нефролітотрипсії та гнучкої уретеронефролітотрипсії, особливо при складних випадках сечокам’яної хвороби, може підвищити безпечність і покращити результати лікування нефролітіазу шляхом поєднання позитивних якостей обох методик. Мета роботи – узагальнити відомості світової наукової літератури, що присвячена лікуванню нефролітіазу, шляхом вивчення комбінації перкутанної нефролітотрипсії та ретроградної або антеградної гнучкої інтраренальної хірургії на основі оцінювання їхньої ефективності та безпечності. Матеріали та методи. Огляд літератури здійснили, використавши бази даних PubMed, Google Scholar, Web of Scienсe та Scopus за період 2015–2022 рр. Для пошуку застосовували ключові слова: surgical treatment of nephrolithiasis (хірургічне лікування нефролітіазу), endoscopic combined intrarenal surgery (ендоскопічна комбінована інтраренальна хірургія, ЕКІРХ), percutaneous nephrolithotomy (перкутанна нефролітотрипсія), flexible uretero-renoscopy (гнучка уретерореноскопія), retrograde intrarenal surgery (ретроградна інтраренальна хірургія), simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotomy (симультанне використання гнучкої уретерореноскопії та перкутанної нефролітотрипсії). Висновки. Використання ЕКІРХ підвищує ефективність одноетапного лікування нефролітіазу при мінімальному рівні ускладнень, зменшує кількість необхідних повторних операцій. Пріоритетним напрямом використання ЕКІРХ може бути лікування складних форм нефролітіазу. Основні недоліки ЕКІРХ полягають у необхідності одночасної роботи двох оперуючих хірургів і необхідності двох комплектів ендоскопічного обладнання, що роблять цю процедуру доволі дорогою.

This study aimed at investigating the efficacy and safety of retrograde intrarenal surgery (RIRS) in treatment of renal pelvic stone larger than 2 cm against the percutaneous nephrolithotomy (PCNL). Between March 2018 and December 2020, 121 patients were randomized to undergo PCNL (60 patients), or RIRS (61 patients). Both groups were compared in terms of operative time, intraoperative complications. Postoperative complications were assessed based on Clavien-Dindo grading system. Stone-free rates were evaluated by CT scan 6 weeks after surgery. No significant difference were observed between both groups in perioperative criteria. The main operative time was slightly longer in PCNL group (105 vs 95 min, p = 0.49). Stone clearance was higher in PCNL, yet the difference was not significant. (53 patients in PCNL group had either complete clearance or residual fragments

AIM To determine the possibility of performing minimally invasive percutaneous nephrolithotomy (PCNL) under ultrasound guidance with the use of X-ray during the access tract formation. MATERIALS AND METHODS The results of 102 mini-PNL procedures, performed by a single surgeon during the period 2018-2019, were analyzed retrospectively. In the beginning, ureteral catheter Ch5 was put into an ipsilateral ureter. Further, a puncture of the collecting system was performed with an advancement of the guidewire. At the next stage, a dilation of tract was done using X-ray guidance for the safe formation of the working channel, followed by holmium lithotripsy. At the end a nephrostomy or JJ-stent was left. RESULTS The mean age of the patients was 53.13+/-12.9, while average BMI was 29.3+/-6.5. In total, there were 44.1% of women. The average stone size was 20.7+/-10.9 mm; 45.1% of stones were left-sided. Staghorn stones accounted for 15.7% of cases and hydronephrosis was found in 18.6% of patients. The time for creating renal access, dilation of the nephrostomy tract, total operative time and fluoroscopy time were: 19.6+/-13.1, 7.7+/-4.2, 107.7+/-49.9, 57.1+/-41.2 minutes, respectively. In the Group I there were 32 (31.4%) patients undergoing to PCNL under X-ray guidance, while in Group II (n=70, 68.6%) combined US+/-X-ray control was used. The patients age (52.2+/-12.6 vs 53.6+/-13.2, p

In the past two decades, endourological procedures such as ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) have become the mainstay of managing kidney stone disease (KSD), with URS also used for investigating upper urinary tract lesions. Post-endourological infections affect between 1% and 6% of cases. Numerous risk factors have been identified, including longer operative times and indwelling ureteric stents, but the literature is largely heterogeneous. Identification of risk factors preoperatively include the use of pre-operative urine culture, minimizing stent dwell time and targeted antibiotic use. Intraoperatively, efforts need to be made in minimizing operative times and intra-renal pressures. Although rare, urinary tract infections following endourological procedures remain a risk, with a smaller minority developing potentially deadly urosepsis. Clinical decisions on prevention and treatment of severe sepsis have to be individualized based on the risk factors. Machine learning techniques are currently being utilized to build these tools and might provide an answer in the future.

Introduction: Percutaneous nephrolithotomy (PNL) is widely used for kidney stones. One of the complications of PNL is Systemic inflammatory response syndrome (SIRS), which is of great importance. Here we wanted to estimate the effectiveness of neutrophil to lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting SIRS following PNL. Methods: This study is prospective observational work done in 2018-2019 in Isfahan, Iran, on patients diagnosed with kidney stones that were candidates of PNL. We collected patient demographic data, including gender, age, and size of kidney stones. Information about the operation duration, procedures, and laboratory data were collected before and after the procedures. All data were compared between patients with or without SIRS after PNL. Results: In the present study, 152 candidates for PNL entered the research. The average age of the patients was 52.1± 13.4 years. In this study, 95 patients (62.5%) were male, and 57 (37.5%) were female. The average stone size was 29.4± 5.3 mm. Based on our data; 26 patients (17.1%) had sepsis after the procedure. There was only a significant difference between groups of patients regarding primary stone composition in the way that 92.3% of cases with sepsis had two stone compositions while 44.4% of other patients had two stone compositions and 50% had one stone composition (P-value

Urolithiasis is rare in renal transplant patients (

Objective: To compare grade I complication as per Clavien-Dindo classification in patients undergoing standard (with tube) verses tubeless percutaneous nephrolithotomy. Study design: Hospital based randomized control study. Place and Duration of Study: Urology Clinic, Sindh Institute of Urology & Transplantation Karachi from 3rd June 2016 to 2nd December 2016. Methodology: Seventy four patients (37patients) in each group were enrolled. In group 1 patients, a 20 F nephrostomy tube were placed in the kidney over the guide wire, which was removed later. Group II patients had antegrade placement of a Double-J stent without nephrostomy and the wound compressed for 5min. The demographic like age, gender and complications grade I complications according to Clavian-Dindo classification were noted. Results: The mean age was 49.42±7.06 years. There were 46 (62.16%) males and 28 (37.84%) females. There was no significant difference in stone clearance rate between the groups; 91.9% in standard percutaneous nephrolithotomyg roup and 94.6% in tubeless percutaneous nephrolithotomy group. Need for analgesics for pain control was high in standard percutaneous nephrolithotomy group 86.5% versus 64.9% in tubeless percutaneous nephrolithotomy group (p=0.03). Frequency of urine leakage was 18.9% in standard percutaneous nephrolithotomy group and only 2.7% in tubeless percutaneous nephrolithotomy group (p=0.02). Conclusion: Tubeless percutaneous nephrolithotomy procedure has fewer complications as per Clavien-Dindo classification regarding need for analgesics and urine leakage. In suitable cases, the tubeless procedure can be safely used as the standard for percutaneous nephrolithotomy. Keywords: Percutaneous nephrolithotomy (PCNL), Clavien-Dindo classification, Complication

Objective: The prone position for percutaneous nephrolithomy (PCNL) has been widely practiced. There has been a shift from prone position to supine position which showed numerous benefits. The aim of our study is to describe the 5 year experience from the perspective of a tertiary care center using a modified Galdakao supine Valdivia position for total tubeless ultra mini supine PCNL, total tubeless supine PCNL, tubeless supine PCNL, and standard supine PCNL. Material and methods: We retrospectively reviewed the data of 90 patients who underwent supine PCNL at the tertiary care center during the period of 5 years from January 2017 to January 2021. The data collection was done from patients’ medical records. Pre operatively, complete examination of the patients with laboratory investigations were done. The modified Clavien classification system was used to classify the perioperative complications of PCNL. Results: Operative time was lowest for ultra mini supine PCNL (50 ± 10.4 min) compared to standard supine PCNL (58 ± 11.2 min). Stones were single in 54 patients and multiple in 40 patients with 4 patients with staghorn stones. The size of the stones in the largest dimension ranged from 1.2 to 5.5 cm.Complete clearance was achieved in 84 (89.7%) patients. Seven patients (7.2%) developed mild fever and four patients (4.5%) required blood transfusion. Conclusion: We found supine PCNL to be an immensely convenient, time-saving practice, and with higher stone free rate compared to prone PCNL. The different techniques of supine PCNL were also useful in patients with horseshoe kidney and calyceal diverticulum which resulted in good outcomes in these patients.

Purpose: To investigate the influence of bimanual compression of abdomen-flank to control bleeding after completion of percutaneous nephrolithotomy (PCNL) including tubeless PCNL. Materials and methods: This study is a parallel-group randomized clinical trial with 1:1:1 randomization. Ninety patients who were candidates for PCNL during July to October 2019 were enrolled. After completion of PCNL operation, patients were randomized into three groups to receive bimanual abdomen-flank compression for 0, 3, and 7 min by the operating surgeon with the opening of sealed envelopes (groups 0, 3, and 7 min afterwards). Preoperative, 24, and 48 h postoperative hemoglobin (Hb) and electrolytes were collected. The primary endpoint of interest was the comparison of 48-h blood loss across study groups. Secondary endpoints included the percent drop in 24- and 48-h Hb, transfusion rates, and operation complications. This trial is registered at www.irct.ir with the following number: IRCT20190618043925N1 on 18 July 2019. Results: There was no statistically significant difference in study groups regarding stone mass, stone location, access location, and patients’ age (all p > 0.05). The medians (IQR) of 48-h blood loss were 490 mL (105–916), 338 mL (160–933), and 413 mL (71–650) in groups of 0, 3, and 7 min. The percent drop in 24-h postoperative Hb relative to preoperative Hb were 11.5 ± 8.6% versus 9.2 ± 7.3% versus 9.3 ± 6.8% ( p = 0.44) and relative values for the percent drop in 48-h Hb relative to preoperative Hb were 8.6 ± 8.7% versus 9.5 ± 9.9% versus 7.2 ± 9.6% ( p = 0.63) in groups of 0, 3, and 7 min respectively. Transfusion was needed in four patients in group 0 min, five patients in group 3 min, and three patients in group 7 min. Conclusions: The results of this study reveal that postoperative bimanual compression of abdomen-flank has no statistically significant influence on the control of bleeding after PCNL operations.

Objective. To investigate the efficacy and safety of the oblique supine lithotomy during percutaneous nephrolithotomy (PCNL) to treat upper urinary calculi. Methods. Clinical data were retrospectively analyzed for 371 patients with upper urinary calculi who underwent PCNL at The First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2017 to October 2020. Based on different positions, patients were divided into the observation group (oblique supine lithotomy position, 155 cases, Group 1) or control group (prone position, 216 cases, Group 2). Groups were compared for effectiveness, complications, bleeding, surgical time, clinical indicators, and hospitalization time. Results. There were no significant differences in the clinical baseline data between the two groups ( p > .05). However, the stone-free rate for patients was significantly higher in the observation than in the control group ( p < .05). Both operation time and hospital stay time were significantly lower in the observation versus the control groups ( p < .05). No significant differences were observed for complications or amount of blood loss ( p > .05). Conclusion. In patients with upper urinary calculi, percutaneous nephrolithotomy in the oblique supine lithotomy position has a higher stone-free rate than the prone position. This approach can shorten the operation and provide better comfort and quicker recovery to the patients. A further advantage is that there is no difference in safety and blood loss between the prone position and the oblique lithotomy position.

Objective: In this study, we aimed to compare the success and complication rates of percutaneous nephrolithotomy (PCNL) in obese patients with staghorn renal stones. Material and Methods: Between January 2012 and December 2017, 183 patients who had single access PCNL for staghorn renal calculi were evaluated retrospectively. Patients were divided into two groups according to body mass index (BMI). The patients with BMI < 30 kg/mm2 and >30 kg/mm2 were defined group-1 and group-2, respectively. Among the groups, we compared demographic characteristics, perioperative and postoperative datas. Postoperatively, >4 mm stone was identified as residual fragment. Complications were classified according to the Clavien scoring system. Results: In our study, there were 127 and 56 patients with staghorn renal calculi in the Group-1 and Group-2, respectively. The mean BMI were 24.5±2.7 kg/mm2 and 32.3±2.2 kg/ mm2 in the Group-1 and Group-2, respectively ( p=0.001). The number of patients with metabolic syndrome was also statistically significant higher in group-2 ( p=0.001). The mean stone size were 848±302 mm2 and 1020±197 mm2 in the Group-1 and Group-2, respectively ( p=0.535). Operation, nephroscopy and fluoroscopy times were similar between the groups (p=0.800, p=0.123, p=0.107 respectively). When we evaluated the postoperative results, stone-free rates were 55.6% and 62.5% in group-1 and group-2, respectively (p=0.381). Total complication rates were 38.9% and 33.9% in group-1 and group-2, respectively (p = 0.523). Investigating the subgroups of complications according to the Clavien scoring system, the rate of minor complications were 27.6% and 25.0% in the group-1 and group-2, respectively and this difference was not statistically significant (p = 0.697). Major complication rates were 11.0% and 8.9% in the group-1 and group-2, respectively (p=0.657). Conclusion: PCNL is an effective and safe treatment method for staghorn stones in obese patients. Keywords: Percutaneous nephrolithotomy, Staghorn renal calculi, Clavien scoring system, obesity, body mass index.

Hounsfield units (HU) are a measure of radiodensity, related to the density of a tissue and the composition of kidney stones. Hounsfield density is what is related to the composition of kidney stones. In the standard acquisition method, these measures are arbitrary and dependent on the operator. This study describes the implementation of a technique based on the HU and Hounsfield density to predict the stone compositions of patients with nephrolithiasis. By conventional percutaneous nephrolithotomy, thirty kidney stone samples corresponding to the cortex, middle, and nucleus were obtained. The HU were obtained by CT scanning with a systematic grid. Hounsfield density was calculated as the HU value divided by the stone’s greatest diameter (HU/mm). With that method and after analyzing the samples by IR-spectroscopy, anhydrous uric acid and ammonium magnesium phosphate were identified as the compounds of kidney stones. Additionally, anhydrous uric acid, magnesium ammonium phosphate, and calcium oxalate monohydrate were identified via Hounsfield density calculation. The study identified HU ranges for stone compounds using a systematic technique that avoids bias in its analysis. In addition, this work could contribute to the timely diagnosis and development of personalized therapies for patients with this pathology.

Introduction: Pain is important morbidity following percutaneous nephrolithotomy (PNL). Various adjunctive procedures such as intercostals nerve block (ICNB) have been described to reduce post-operative pain. The aim of this review was to determine the analgesic efficacy of ICNB in PNL patients. Materials and Methods: Systematic literature search was conducted to identify relevant publications. We followed preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines while conducting this review. Results: In this review, five randomized studies with 319 patients were included. The analgesic requirement was statistically similar in ICNB and control group (Standard mean difference (SMD) -0.48 confidence interval (CI)[-1.4, 0.44] p=0.31) whereas analgesic requirement was lower for peritubal infiltration group (PTI) as compared to ICNB (SMD 0.85 CI[0.25,1.44] p=0.005). Also, time to first analgesic requirement was similar between ICNB and PTI (SMD 0.86 CI[-9.3,11.0]), p=0.87). Pain according to VAS (visual analog scale) and Dynamic VAS (DVAS) at 24 hours was lower in ICNB group as compared to the control group; however, only DVAS at 24 hours was statistically significant. DVAS and VAS at 24 hours were similar for both ICNB and PTI. Conclusions: Intercostal nerve block in terms of analgesic requirement appears to be inferior to peritubal block and no better than control group. Also, mean pain scores for ICNB were similar to control group and peritubal block. Keywords: Percutaneous nephrolithotomy, Intercostal nerve block, Peritubal block, PNL, PCNL.

The presence of lower pole stones poses a unique challenge due to the anatomical considerations involved in their management and treatment. Considerable research has been performed to determine the optimal strategy when faced with this highly relevant clinical scenario. Standard options for management include observation, shock wave lithotripsy, retrograde intrarenal surgery, or percutaneous nephrolithotomy. Indeed, each approach confers a distinct set of risks and benefits, which must be placed into the context of patient preference and expected outcomes. The current state of practice reflects a combination of lessons learned from managing calculi not only in the lower pole, but also from other locations within the kidney as well.

Background Percutaneous nephrolithotomy (PCNL) is a complex surgery and has a flat learning curve. Due to this and the ethical issues, trainees do not get enough hands on exposure. Virtual simulator is very expensive and bulky. Animal model requires legal clearance. This inexpensive portable homemade PERC Mentor (IPHOM) teaches all the major aspects of PCNL surgery. This article has shown the way to make this model and its validation study. Methods IPHOM can be made at home with carton box, ball bearings, LED torch and some hospital wastes. After a short demonstration of IPHOM, 14 residents and 4 urologists were given 8 tasks to perform on it followed by 15-min supervised practice exercise on day 0 and day 1. Their performance was reassessed on day 2 and 3. Response to 17 feedback points was recorded on a seven-point Likert scale. Results There was significant difference between the performance of expert and novice on day 0. Expert completed all the tasks in less time and no. of attempts. The time for tract dilatation and duration of radiation exposure were significantly less in the expert group. The performance of both expert and novice improved on day 2 and 3, but the improvement was significantly more in novice. Response to the feedback points showed no difference between expert and novice (p > .05). Conclusions We have found that training on IPHOM has improved the concept and skills of PCNL in residents. The simplicity and low cost of the model make it constructible at home.

Percutaneous Nephrolithotomy (PCNL) is the leading intervention for removing large or irregularly shaped kidney stones. It involves gaining access to the kidney through a small incision in the patient's back, through which a nephroscope is steered towards the stones. Despite decades of clinical prevalence, PCNL remains a complex procedure to learn and perform, sometimes requiring several attempts to gain kidney access, leading to a variety of complications. This letter proposes to use robotic assistance to steer a flexible nephroscope during PCNL to concurrently improve accuracy and reduce the risk of tissue damage. The nephroscope is modelled as a cantilever beam fixed to the robot's end-effector. Under the assumption that an optimal tooltip path exists, Non-dominated Sorting Genetic Algorithm-II is implemented to determine the end-effector position and orientation so that the tooltip follows the path while minimizing four objective functions, i.e., tissue compression, variations in the tool's strain energy, changes in end-effector position, and tooltip error. Data collected through experiments performed on ex-vivo porcine tissue show that the path tracking error was on average 2.03 mm. The results confirm the accuracy of the model in 2 dimensions and suggest that the multiobjective optimizer returned adequate solutions that minimized 4 different cost functions, altogether allowing the robot to effectively follow the predefined path.

Purpose: To compare preoperative midstream urine cultures (PMUC) and renal pelvic urine culture (RPUC) or stone culture (SC) in predicting systemic inflammatory response syndrome (SIRS) and uroseps...

Background and Aims: Percutaneous nephrolithotomy (PCNL) is the procedure of choice for managing large renal calculi. Although minimally invasive, it is associated with pain due to dilatation of renal capsule, parenchymal tract, and nephrostomy tube placement. Gender differences in pain perception and analgesic requirement have not been studied in PCNL surgeries. This study was done to evaluate the influence of gender on pain. Material and Methods: It was a prospective observational study including 60 ASA physical status I and II patients. The number of males and females were 29 and 31, respectively. Analgesic requirement and postoperative pain score were assessed by visual and dynamic visual analog scales (VAS, DVAS) score fourth hourly for first 24 h. Rescue analgesia was IV paracetamol 1 g when pain score exceeded four. VAS scores were assessed using Mann–Whitney test. Rescue analgesia was calculated as frequency and proportions. A P value of