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Purpose: Upper urinary tract stones are a common condition in urology clinics. Percutaneous nephrolithotomy (PCNL) is an effective procedure frequently used for the treatment of stones larger than 2 cm. MAP scoring is used to predict oncological outcomes and intraoperative complications after partial nephrectomy by using the thickness and adhesion of perinephric adipose tissue. We examined the relationship between MAP score and clinical and demographic findings of the patients, especially postoperative Hgb drop and postoperative complications. Material-Method: Patients were divided into 2 groups: Those with MAP score < 3 and ≥ 3. The impact of the MAP score on the demographic, clinical, and surgical parameters of the groups was assessed and analyzed. The relationship between MAP score and complications based on Clavien Dindo classification was also examined. The study investigated factors affecting the development of complications, the amount of bleeding, and the influence of MAP scores on these outcomes. Results: The Hgb drop was 2.56 ± 1.00 in the group with a MAP score ≥ 3 which was statistically significantly higher than the group with a MAP score < 3 (1.43 ± 1.21) (p < 0.001). The stone-free rate was 81.7% in the group with a MAP score < 3, which was statistically significantly higher than the group with a MAP score ≥ 3 (59.6%) (p = 0.012). Conclusion: As the MAP score of patients scheduled for standard PNL operation increased, there was a corresponding rise in Hgb drop, a decline in stone-free rates and an uptick in postoperative urinary complications of postoperative urinary infections. [ABSTRACT FROM AUTHOR]

To assess outcomes of supracostal ultrasound guided approach percutaneous nephrolithotomy (SUGA-PNL) and retrograde intrarenal surgery (RIRS) in isolated large volume upper calyceal stones (UCS). This was a prospective randomized study including patients with isolated UCS > 20mm. The patients were randomized into two groups: group (P) (SUGA-PNL) and group (R) (RIRS). Patients' demographics, stones characteristics, operative, and postoperative outcomes essentially the stone free rate (SFR) and complications rate were documented. The stone clearance was defined as no fragments or residual fragments less than 2mm in the one month non contrast CT scan follow up. Eighty-nine patients opted to undergo the procedure according to the preoperative randomization. Four patients, 2 patients from each group, lost to follow up and other 2 patients were excluded from group (R) due to a tight ureter. Both groups were comparable as regards the preoperative demographics and stone characteristics. There were statistically significant differences regarding total operative time, the change in hemoglobin level, and postoperative pain score (P: 0.024, 0.010 and 0.032 respectively). The SFR was 88.1% in group (P) compared to 73.2% in group (R) (P: 0.019). Moreover, it did not differ significantly between both groups regarding the intraoperative and postoperative complications. No visceral and thoracic injuries were documented in group (P). On other side, 6 patients (14.6%) from group (R) had different grades of ureteral injury during access sheath placement. SUGA-PNL is a safe and effective treatment modality for UCS > 20mm with a higher SFR than RIRS. [ABSTRACT FROM AUTHOR]

Purpose: To compare the Comprehensive Complication Index (CCI) to the Clavien–Dindo classification (CDC) in an elderly population who underwent percutaneous nephrolithotomy (PCNL) and to identify predictors of postoperative complications in this population. Methods: We conducted a retrospective cohort study involving patients 60 years and older who underwent PCNL at our Institution between 2009 and 2020. Postoperative complications were considered up to 30 days after surgery. Both CDC and CCI were calculated to assess patient outcomes. Length of stay (LOS) and admission to the emergency room (ER) were used as surrogates of postoperative complications. Results: We included 244 patients with a median age of 65 [63–69] years. 15.6% presented postoperative complications, and 2.5% multiple complications. LOS had a correlation coefficient of 0.29 (p < 0.001) and ER admissions had a coefficient of 0.27 (p < 0.001) with both CDC and CCI. Cost of hospitalization based on CDC underestimated CCI-based cost of hospitalization in 0.8% (p = 0.049). Higher American Society of Anesthesiology (ASA) physical status (p = 0.02), Charlson Comorbidity Index (p = 0.008), Guy's classification (p = 0.005), and history of urinary tract infection (UTI, p = 0.047) exhibited significant correlations with postoperative complications. Conclusion: Both CDC and CCI equally correlate with LOS and ER admissions following PCNL in elderly patients. However, CDC underestimates cost of hospitalization in comparison to CCI. We found higher ASA physical status, Charlson Comorbidity Index, Guy's classification, and history of UTI as predictors of postoperative complications after this procedure in this population. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects of intrarenal pelvic pressure (IPP) on pyelo-tubular backflow and renal cortical blood perfusion during mini-percutaneous nephrolithotomy (MPCNL). Methods: Dynamic changes in pyelo-tubular backflow and renal cortical blood perfusion were studied in six patients undergoing MPCNL using dynamic contrast-enhanced ultrasonography (CEUS) and IPP monitoring. Results: CEUS of intrarenal pelvic perfusion revealed that renal tubules began to exhibit contrast agent reflux when IPP exceeded 34 mmHg during the MPCNL procedure. There was a positive correlation between renal tubule contrast agent reflux and IPP (P < 0.05). Intravenous CEUS of renal cortical blood flow demonstrated that both intrarenal pelvic perfusion time and IPP during MPCNL significantly affected renal cortical blood perfusion. Intrarenal pelvic perfusion time and pressure were negatively correlated with contrast agent peak intensity (PI) and area under the curve (AUC) (P < 0.05). Longer intrarenal pelvic perfusion times and higher pressures resulted in decreased renal cortical blood perfusion. Conclusion: This study directly confirmed through dynamic CEUS and real-time IPP monitoring that an increase in IPP above the threshold of approximately 34 mmHg during MPCNL in patients leads to reflux through the renal tubules and a significant decrease in renal cortical blood perfusion. The safe upper limit for intrarenal pelvic perfusion pressure during MPCNL is approximately 34 mmHg. [ABSTRACT FROM AUTHOR]

Objectives Patients and Methods Results Conclusion To define the natural distensibility of the human ureter and evaluate the impact of other possibly favourable factors on ureteric distensibility.A total of 101 patients undergoing ureteroscopic stone removal or percutaneous nephrolithotomy underwent ureteric sizing using sequential passage of 37‐cm urethral dilators in 2‐F increments while attached to a unique force sensor. Insertion forces were limited to 6 N. After 6 N was attained, an appropriately sized ureteric access sheath was passed. At the conclusion of each procedure, Post‐Ureteroscopic Lesion Scale score was determined.Urethral dilators were passed in 61% of patients at ≤14 F; 39% of patients accepted urethral dilators of ≥16 F. The mean dilator size was 14 F. Multivariate logistic regression analysis revealed that preprocedural ureteric stenting and antibiotic use favoured passage of 16‐F dilators (odds ratio [OR] 5.16, 95% confidence interval [CI] 1.70–15.62 [P = 0.004] and OR 5.15, 95% CI 1.743–15.243 [P = 0.003], respectively). Neither tamsulosin nor prior urinary tract infection had an impact on ureteric size (OR 0.765, 95% CI 0.281–2.084 [P = 0.601], OR 1.049, 95% CI 0.269–4.089 [P = 0.945], respectively).Using continuous insertion force monitoring and a 6‐N threshold, the majority of unstented adult human ureters within our patient population safely accommodated a 14‐F dilator. Safe passage of a 16‐F dilator at the 6‐N threshold was more likely among patients with a preexisting indwelling ureteric stent or patients who were treated with antibiotics within a week of the procedure. [ABSTRACT FROM AUTHOR]

Over the past three decades, there has been increasing interest in miniaturized percutaneous nephrolithotomy (mPCNL) techniques featuring smaller tracts as they offer potential solutions to mitigate complications associated with standard PCNL (sPCNL). However, despite this growing acceptance and recognition of its benefits, unresolved controversies and acknowledged limitations continue to impede widespread adoption due to a lack of consensus on optimal perioperative management strategies and procedural tips and tricks. In response to these challenges, an international panel comprising experts from the International Alliance of Urolithiasis (IAU) took on the task of compiling an expert consensus document on mPCNL procedures aimed at providing urologists with a comprehensive clinical framework for practice. This endeavor involved conducting a systematic literature review to identify research gaps (RGs), which formed the foundation for developing a structured questionnaire survey. Subsequently, a two-round modified Delphi survey was implemented, culminating in a group meeting to generate final evidence-based comments. All 64 experts completed the second-round survey, resulting in a response rate of 100.0%. Fifty-eight key questions were raised focusing on mPCNLs within 4 main domains, including general information (13 questions), preoperative work-up (13 questions), procedural tips and tricks (19 questions), and postoperative evaluation and follow-up (13 questions). Additionally, 9 questions evaluated the experts' experience with PCNLs. Consensus was reached on 30 questions after the second-round survey, while professional statements for the remaining 28 key questions were provided after discussion in an online panel meeting. mPCNL, characterized by a tract smaller than 18 Fr and an innovative lithotripsy technique, has firmly established itself as a viable and effective approach for managing upper urinary tract stones in both adults and pediatrics. It offers several advantages over sPCNL including reduced bleeding, fewer requirements for nephrostomy tubes, decreased pain, and shorter hospital stays. The series of detailed techniques presented here serve as a comprehensive guide for urologists, aiming to improve their procedural understanding and optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Percutaneous nephrolithotomy (PNL) is the preferred surgical procedure for treating renal stones larger than 2 cm. Patients may experience significant pain in the postoperative period due to factors such as the catheter entry site and tension in the renal capsule. Erector Spinae Plane (ESP) block provides perioperative muscle relaxation and reduces analgesic use. In this study, we investigated the effect of ESP block on postoperative pain scale and quality of recovery in patients undergoing PNL. The study was conducted with a total of 96 patients, with 45 patients receiving the ESP block and 51 patients not receiving the ESP block. Following the surgery, the visual pain scale (VAS) was completed at 0, 2, 6, 12, and 24 h, and the Quality of Recovery-15 (QoR-15) scale along with the willingness scale were completed at the 24-hour mark. The normal distribution of data was evaluated with the Kolmogorov-Smirnov test, histogram, and skewness-kurtosis coefficients. For comparing paired groups, the Student's T-test was used for normally distributed variables, while the Mann-Whitney U test was used for parameters that did not have a normal distribution. The comparison of postoperative pain, as measured by VAS scores between the groups, revealed statistically significantly lower scores in the ESP block group at 0, 2, 6, 12, and 24 h (p < 0.001, p < 0.001, p < 0.001, p = 0.008, p = 0.010, respectively). Our study results indicated that patients who received the ESP block experienced reduced pain levels and had higher QoR-15 scores compared to those who did not receive the ESP block. [ABSTRACT FROM AUTHOR]

Objective Patients and Methods Results Conclusions To compare the safety and efficacy of flexible ureteroscopy (f‐URS) and ambulatory tubeless mini‐percutaneous nephrolithotomy (mini‐PCNL) in the treatment of 1–2 cm lower calyceal renal stones.Patients who underwent f‐URS and mini‐PCNL for the treatment of 1–2 cm lower calyceal renal stones between October 2020 and November 2023 were evaluated in a randomised controlled trial. A total of 72 patients were included in the study. All patients underwent a computed tomography renal colic scan preoperatively, on postoperative Day 1 (POD 1), and at 3 months follow‐up. We compared perioperative outcomes, including operative time and hospital stay. Additionally, we evaluated follow‐up outcomes, such as the stone‐free rate (SFR) and complications. All patients were discharged home on the same operative day.There were no significant differences in preoperative baseline data between the two surgical groups. A significantly longer median operative time was reported in the mini‐PCNL group (P = 0.04). The median hospital stay was 5 h and 4 h in the mini‐PCNL and f‐URS groups, respectively (P = 0.14). On POD 1, the SFR, defined as the absence of residual fragments measuring 0 cm, was 50% for mini‐PCNL vs 11.1% for f‐URS (P < 0.001). When a total cut‐off of <4 cm was utilised, the SFR was 75% in the mini‐PCNL group vs 22.2% in the f‐URS cohort (P < 0.001). At 3 months follow‐up, the SFR remained favourable for mini‐PCNL at 72.2% vs 37.1% for f‐URS (P = 0.003), with a cut‐off of 0 cm, and it increased to 86.1% for mini‐PCNL vs 65.7% for f‐URS (P = 0.04) when a total cut‐off of <4 cm was applied. There was no significant difference in postoperative complications between the two groups. Two patients (5.7%) in the f‐URS group required re‐treatment.Ambulatory tubeless mini‐PCNL and f‐URS are effective treatment options for 1–2 cm lower calyceal renal stones. Both techniques have a comparable hospital stay and complication rates, with a significantly better SFR with mini‐PCNL. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to investigate the clinical value of a navigation system based on deep learning and mixed reality for the treatment of kidney stones with percutaneous nephrolithotomy (PNL), and to improve its theoretical basis for the treatment of kidney stones. Methods: The data of 136 patients with kidney stones from October 2021 to December 2023 were retrospectively analyzed. All patients underwent PNL, and were categorized into a control group (Group 1) and a surgical navigation group (Group 2) according to puncture positioning method. Preoperative computed tomography (CT) was performed in both groups. In group 1, procedures were performed under standard ultrasound guidance. PNL was performed with navigation system fused with ultrasound to guide percutaneous puncture in group 2. The baseline information and procedural characteristics of both groups were compared. Results: PNL was successfully performed in both groups. No significant difference was found in the baseline date between the two groups. In group 2, real-time ultrasound images could be accurately matched with CT images with the aid of navigation system. The success rate of single puncture, puncture time, and decrease in hemoglobin were significantly improved in group 2 compared to group 1. (p < 0.05). Conclusions: The application of navigation system based on deep learning and mixed reality in PNL for kidney stones allows for real-time intraoperative navigation, with acceptable accuracy and safety. Most importantly, this technique is easily mastered, particularly by novice surgeons in the field of PNL. [ABSTRACT FROM AUTHOR]

To evaluate the predictive factors affecting the stone-free rate (SFR) and complications of percutaneous nephrolithotomy (PCN) in the treatment of proximal impacted ureteral stones (PIUS) based on a new scoring standard. The data of 90 patients with PIUS were collected in this retrospective study between January 2015 and June 2023. Univariate and multivariate logistic regression analyses were used to determine factors affecting treatment outcome in terms of SFR and complications. The scoring standard for patients with PIUS was developed based on the univariate logistic regression analyses. In the univariate analysis, stone density (P = 0.015), and stone diameter (P = 0.032) significantly were associated with lower SFR. And degree of hydronephrosis (P = 0.014), Preoperative infection (P = 0.002), and history of lithotripsy (P = 0.045) were associated with occurrence of complications. Multivariate analysis indicated that stone density (P = 0.020), and stone diameter (P < 0.001) were associated with lower SFR; independent risk factors for development of complications were history of lithotripsy (P = 0.024), and preoperative infection (P < 0.001). Additionally, score ≥ 3 was the independent risk factor for both SFR (P < 0.001) and complication rate (P < 0.001). Subgroup analysis shown that there were statistically significant differences between the two groups in terms of stone-free rate (P = 0.032) and complications (P = 0.015). According to the findings of this study, the stone score ≥ 3 was determined as a critical predictive factor of SFR and complications in PIUS patients undergoing PCN based on a new scoring standard. Additionally, PCN has high initial SFR and low complications when dealing with score < 3 PIUS. [ABSTRACT FROM AUTHOR]

To assess the use of miniaturized percutaneous nephrolithotomy (mini-PCNL) for renal stones in children, as well as its safety and efficacy. Seventy-seven patients with more than 15 mm renal stones whose age was less than 15 years were enrolled in this prospective case-controlled study at Al-Ramadi Teaching Hospital, Ar Razi Private Hospital, and Ghazi Al-Hariri Hospital for Surgical Specialties, Anbar and Baghdad, Iraq. The study was conducted from January 2020 to January 2024. The group mentioned above served as group A, and it was compared to the control group (group B), which consisted of 70 adult patients aged 18–60 years. Patients in both groups underwent mini-PCNL. Gender, stone size and location, time of operation, stone-free rate, hemoglobin drop, need for blood transfusion, postoperative fever, associated visceral injury, and need for further interventions such as extracorporeal shock wave lithotripsy or flexible ureteroscopy (ESWL or FURS) were compared in both groups. The age of patients in group A ranged from 8 months to 15 years with a mean (4.30 ± 3.16), while in group B ranged from 18 to 60 years with a mean (36.3 ± 12.0), p-value 0.001. There were no statistically significant differences regarding gender distribution, stone size, and location, p-value > 0.05. The stone-free rate was 87.01% for group A and 88.57% for group B, with no statistical difference, p-value 0.773. Hemoglobin drop was 1.096 ± 0.412 for group A and 1.195 ± 0.110 for group B, p-value 0.046. Blood transfusion was needed in one case in each group with no statistical difference, p-value 0.946. The need for ESWL was 3 cases in group A, and 2 cases in group B, with no statistical difference between the two groups, p-value 0.729. The need for FURS was 4 cases in group A and 3 cases in group B, p-value 0.796. Operative time was 30 to 125 min in group A and 34 to 129 min in group B, p-value 0.941. Postoperative fever was seen in 23 cases in group A and 21 cases in group B, p-value 0.986. Minor liver injury was seen was seen in one case in each group. The use of mini-PCNL for treating renal stones in children is safe and effective as it is associated with a relatively low rate of significant complications and achieves a high stone-free rate. [ABSTRACT FROM AUTHOR]

Background: Bilateral duplicated kidney and ureter is a rare condition in urology, and it is even rarer for patients to have multiple stones simultaneously. We delineate the diagnostic and therapeutic trajectory of a patient presenting with bilateral duplex kidneys and ureters, characterized by the presence of multiple stones. Notably, the left kidney is a complete duplication, whereas the right kidney exhibits an incomplete duplication. Case presentation: A 47-year-old male patient was diagnosed with bilateral duplex kidney and ureter combined with multiple stones. Ureteral flexible lithotripsy and percutaneous nephrolithotomy were performed successively in our hospital. On the postoperative five day, he was discharged from the hospital without apparent discomfort.The double J tube was pulled out one month later, and no stone recurrence was found after 3 months of follow-up. Conclusions: Bilateral duplicated renal ureteral malformations combined with multiple stones are very rare. Stones can be removed by ureteroscopic lithotripsy or percutaneous nephrolithotripsy and sometimes multiple procedures are required, which should be chosen according to the patient's relevant condition. [ABSTRACT FROM AUTHOR]

The correlation between novel negative pressure ureteroscopic lithotripsy (NP-URL) combined with flexible ureteroscopy (FU) and percutaneous nephrolithotomy (PCNL) on stone-free rates (SFR) remains unclear. There is a lack of evidence from Chinese populations regarding the relationship between SFR and NP-URL combined with FU (NP-URL-FU) versus PCNL. We aimed to assess the association between NP-URL-FU and PCNL on SFR. We conducted a cohort study involving 166 participants with 2–4 cm kidney stones. Data on SFR (7 days and 2 months) were collected from all participants. Logistic regression analysis was used to substantiate the research objectives. NP-URL-FU versus PCNL showed an 86% decrease in the 7-day SFR (OR = 0.14, 95% CI 0.07–0.29). The results remained stable even after adjusting for potential confounders. However, no statistically significant association was found between the surgical method and the 2-month SFR. Further exploratory subgroup analyses showed no significant interactions, with all P values > 0.05. Among patients with 2–4 cm kidney stones, NP-URL-FU was associated with a lower risk of incident 7-day SFR than PCNL. However, no statistically significant difference was found in the long-term stone removal rate. Therefore, NP-URL-FU may be a viable alternative surgical option for patients seeking minimally invasive procedures. [ABSTRACT FROM AUTHOR]

Background: It is controversial whether double-J (DJ) stent insertion is necessary in tubeless percutaneous nephrolithotomy (PCNL) for patients with staghorn stones. We compared the outcomes of using ureteral catheters and double-J stents in tubeless complete supine PCNL (csPCNL) of staghorn stones. Methods: In this analytical cross-sectional study, from May 2008 to August 2022, 123 patients who underwent tubeless csPCNL were assessed. Patients were divided into two groups by either tubeless csPCNL with DJ stent (Group I; n = 23) or totally tubeless just with perioperative ureteral stent (Group II; n = 100). Demographic characteristics, stone-related factors, perioperative and postoperative parameters were compared in groups. Results: Baseline characteristics were comparable in groups. The operative time in group I was significantly longer than group II (68.26 vs. 55.25 min, P = 0.05). However, the duration of hospitalization in Group I was shorter than the other group (1.81 vs. 2.37 days, P = 0.03). Stone free rate was notably higher in Group I (90.5% vs. 79.8.0%) with no statistically significant difference. No significant differences were found in major complications. Patients in Group II had a significantly shorter time to return to normal life (6.48 vs. 7.91 day; P = 0.043). Multivariable linear regression showed the preoperative creatinine level and stone size can affect the operative time (P = 0.02). In addition, stone number and underlying disease can affect the length of hospital stay (P = 0.007 & 0.030, respectively). Conclusion: Although not inserting a double J stent after csPCNL has acceptable results, because of higher residual rate in staghorn stone which cause more incidence of renal colic, longer time of hospital stay and return to normal life, inserting DJ stent is recommended. [ABSTRACT FROM AUTHOR]

Introduction: Standard PCNL, where a nephrostomy tube is placed at the end of the surgery, is the predominant modality in the treatment of renal stones at present. With the advancement of techniques however, a new method has developed where tube placement is omitted. More and more studies are being done to evaluate the benefits of tubeless PCNL over the standard PCNL. Objectives: To compare the perioperative characterstics, analgesics requirement(according to VAS score), duration of hospital stay, post surgical complication, to know the which one is more beneficial to patient Methods: The study was done in Muzaffarnagar Medical College and Hospital, Muzaffarnagar, U.P. on indoor patients of the General Surgery department by following inclusion and exclusion criteria, clinical examinations, and interpretation of laboratory results. Results: Tubeless PCNL is better than the standard pcnl in terms of analgesics requirement, duration of hospital stay and complication. Conclusion: Standard PCNL has a longer operating time, that leads to more bleeding and drop in haemoglobin. Tubeless pcnl has a lesser analgesic requirement, lower rates of complications and shorter duration of hospital stay, as well as more cost effectiveness. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy and postoperative infection rate of super mini percutaneous nephrolithotomy (SMP) and flexible ureteroscopic lithotripsy (FURL) in patients with diabetic nephrolithiasis and to explore the risk factors associated with postoperative infection following these two procedures. Methods: The medical history and surgery details of 252 patients with diabetic nephrolithiasis who underwent lithotripsy in our hospital between January 2018 and May 2023, including 144 SMP and 108 FURL, were reviewed and compared. Perioperative outcomes were compared between the two groups. Logistic regression was performed to identify the significant risk factors for infection after each procedure. Results: SMP achieved a higher stone-free rate (SFR) on postoperative day 1 and postoperative day 30 compared with FURL (p < 0.05). The mean operative time was shorter in SMP (p < 0.01). FURL was associated with less hemoglobin drop (p < 0.01) and shorter length of stay (p < 0.01). The incident rate of systemic inflammatory response syndrome (SIRS) was higher after SMP (p = 0.019), while the incident rate of urinary tract infection (UTI) was higher after FURL (p = 0.021). Overall postoperative infection and sepsis rates were similar between the two procedures. Logistic regression analysis revealed that gender odds ratio [OR]: 0.225, 95% confidence interval [CI]: 0.079–0.639), HbA1c (OR: 3.516, 95% CI: 1.841–6.716), and operation time (OR: 1.037, 95% CI: 1.008–1.066) were independent risk factors for infection after FURL, while operation time (OR: 1.063, 95% CI: 1.022–1.106) and HbA1c (OR: 7.443, 95% CI: 2.956–18.742) significantly predicted SMP-associated infections. Conclusion: In diabetic patients, SMP demonstrated higher SFR and shorter operation time, whereas FURL was associated with less bleeding and shorter hospitalization. SMP had a higher incident rate of SIRS and FURL had a higher incident rate of UTI. Elevated HbA1c and prolonged operative duration increased infection risk after both procedures, while female gender was an additional risk factor for FURL-related infections. [ABSTRACT FROM AUTHOR]

Background: Preoperative identification of the bowel on imaging is essential in planning renal access during percutaneous nephrolithotomy (PCNL) and avoiding colonic injury. We aimed this study to assess which noncontrast computed tomography (NCCT) window setting provides the optimal colonic identification for PCNL preoperative planning. Methods: Ten urologic surgeons (four seniors, six residents) reviewed 22 images of NCCT scans in both abdomen and lung window settings in a randomized blinded order. Colonic area delineation in each image was performed using a dedicated, commercially available area calculator software. A comparison of the marked colonic area between the abdomen and lung window settings was performed. Results: Overall, the mean marked colonic area was greater in the lung window compared with the abdomen window (8.82 cm2 vs 7.4 cm2, respectively, p < 0.001). Switching the CT window from abdomen to lung increased the identified colonic area in 50 cases (50%). Intraclass correlation showed good agreement between the senior readers and among all readers (0.92 and 0.87, respectively). Similar measurements of the colonic area in both abdomen and lung windows were observed in 26/44 (60%) of the seniors cases and in 7/66 (10%) of the resident cases (p = 0.002). Conclusion: Lung window solely or in combination with abdomen window appears to provide the most accurate colonic identification for preoperative planning of PCNL access and potentially reduce the risk of colonic injury. This pattern is more evident among young urologists, and we propose to introduce it as a standard sequence in PCNL preplanning. [ABSTRACT FROM AUTHOR]

Objective • To analyze the potential value of paraspinal nerve block (PVB) in percutaneous nephrolithotomy (PCNL) and to compare it with general anesthesia and epidural anesthesia. Methods • 120 patients undergoing PCNL surgery in Shanghai Jiao Tong University Affiliated Sixth People’s Hospital from January 2021 to June 2022 were selected and divided into PVB anesthesia group, general anesthesia group, and epidural anesthesia group according to different anesthesia methods, with 40 cases in each group. The anesthesia index (anesthesia operation time, anesthetic effect time, anesthesia time), the vital signs (heart rate, mean arterial pressure), postoperative pain [visual analog scale (VAS)], stress response index (cortisol and noradrenaline), the incidence of adverse reactions (nausea and vomiting, lethargy, dizziness, skin itching, bradycardia) were compared among the three groups. Results • The operation time of the anesthesia in the PVB anesthesia group was 5.72±1.25, which was significantly lower than that in the the general (7.95±1.15) and epidural anesthesia groups(8.23±1.43), and the differences were statistically significant (P = .000). The time of onset of anesthesia in the PVB anesthesia group was 6.63±1.87, which was significantly lower than that in the the general (9.84±2.41) and epidural anesthesia groups(10.14±2.89), and the differences were statistically significant (P = .000). The heart rate during percutaneous puncture and intraoperative lithotripsy in the PVB anesthesia group was statistically lower than in the general and epidural anesthesia groups (P < .05). The mean arterial pressure 20 minutes after anesthesia and at the end of operation in the PVB anesthesia group was higher than that in the general anesthesia group, and the mean arterial pressure during percutaneous puncture and intraoperative lithotomy was lower than that in the general anesthesia group (P < .05). The VAS scores of the PVB anesthesia group at 2, 6, 12, 24, and 48 hours after the operation were lower than those of general and epidural anesthesia groups (P < .05). The incidence of adverse reactions was 5.00% (2/40) in the PVB anesthesia group and 35.00% (14/40) in the general anesthesia group, which was lower than that of 27.50% (11/40) in the epidural anesthesia group. (P < .05). Conclusion • The potential value of PVB in PCNL is high is better than that of general anesthesia and epidural anesthesia, anesthesia can shorten operation time and work time, extend the time of anesthesia to maintain, and be helpful to the intraoperative vital signs in patients with stable, mild postoperative pain and stress, low incidence of adverse reactions, efficacy and safety are good, can be introduced. [ABSTRACT FROM AUTHOR]

Background: Supracostal puncture could be the most effective method for accessing the upper pole posterior calyx, which is considered the ideal route for staghorn and large complex renal stones. We aimed at this work to assess the efficacy, safety as well as the outcome of supine supracostal Percutaneous Nephrolithotomy (PCNL) in managing the renal calculi. Methods:We carried out this prospective cohort study on 25 patients with renal stones larger than 2 cm who underwent percutaneous nephrolithotripsy as indicated and attended the Urology Outpatient clinic, they underwent PCNL through supra costal puncture in supine position. Postoperative chest X-ray, Kidney, ureter as well as bladder (KUB) x-ray, in addition to pelvi-abdominal ultrasonography were done for all patients. Results: The incidence of postoperative complications was as follows: Out of 25 patients, 3 patients (12%) developed hydrothorax. Significant intraoperative bleeding occurred in 12% of cases, one of which required blood transfusion. The success rate was 76 % at 24 hours and raised to 84% at four weeks as 2 cases passed the stone spontaneously, two cases 8.0% had 2nd look PNL, and two cases 8.0% needed Extracorporeal Shock Wave Lithotripsy (ESWL). We found no significant injuries to adjacent organs, attributed to the use of preoperative helical CT and careful puncture techniques. Conclusions: The supracostal approach in PCNL in modified supine position is a safe procedure and effective in case of upper calyceal and staghorn stones. It demonstrates accepted stone-free rates, with considerable complication rates, so the approach must be put in consideration. [ABSTRACT FROM AUTHOR]

To evaluate the relationship between patient complexity, practice setting, and surgeon reimbursement for ureteroscopy and percutaneous nephrolithotomy (PCNL). The "2021 Medicare Physician and Other Provider" file was used to collect Rural-Urban Commuting Area (RUCA) codes and hierarchical condition category (HCC) scores of urologists. Higher HCC score corresponds to higher medical complexity and higher RUCA code corresponds to a more rural area. Medicare reimbursement for ureteroscopy and PCNL were collected. Linear regressions were performed to predict change in reimbursement based on RUCA and HCC scores. In 2021, 52,816 procedures under Current Procedural Terminology (CPT) code 52356 (ureteroscopy) and 1649 procedures under 50080 or 50081 (PCNL) were billed to Medicare. Mean reimbursement was $338.24 for ureteroscopy and $957.89 for PCNL. For ureteroscopy, higher HCC score predicted lower reimbursement (P <.001). Higher HCC score predicted higher reimbursement for PCNL (P <.01). Average RUCA for ureteroscopy was higher than for PCNL (P =.02). Rural location predicted lower reimbursement for ureteroscopy (P <.001), however, there was no association for PCNL. For ureteroscopy, higher-risk patients are associated with lower reimbursement while the opposite holds true for PCNL. Rural practices were associated with lower reimbursement for ureteroscopy, but there was no association between location and PCNL reimbursement. Together, these findings suggest practice pattern variation between ureteroscopy and PCNL and highlight gaps in reimbursement policy. Risk-adjusted reimbursement should be considered to incentivize urologists to treat complex patients within their practice scope. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Percutaneous nephrolithotomy (PCNL) is the recommended treatment for stones >2 cm in size. The majority of PCNL are still conducted with larger telescopes using tracts up to 30F in size. We have conducted a randomized pilot study comparing mini PCNL with our standard 22F PCNL for renal stones between 10 and 25 mm in diameter.Patients were randomized to either PCNL (24F Amplatz sheath/22F nephrosocope) or mini PCNL (18F Amplatz sheath/11F nephroscope). All operations were performed in the modified supine position. Patients were reviewed with imaging to assess stone clearance and complications.Eighteen well matched patients were randomized. All procedures were completed as planned and all were tubeless with no complications. There were no differences in operative time, analgesia requirements or length of stay. Seven of nine (77.75%) standard PCNL were completely stone free at CT review with a 2 mm and a 5 mm fragments in the other patients. Four (44.4%) of the mini PCNL group were stone free, with stone fragments 4–10 mm remaining in the others. 40 patients/arm would be required for an adequately powered study.There was no advantage in using mini PCNL compared to our standard 24F PCNL in this pilot study. There may be benefits in using mini PCNL compared to the more widely used 30F PCNL and it may be a more cost‐effective alternative to laser pyeloscopic stone procedures. [ABSTRACT FROM AUTHOR]

This article discusses a case report of a patient with a partial staghorn renal stone who underwent endoscopic combined intrarenal surgery (ECIRS) at Cottolengo Hospital in Torino, Italy. ECIRS is a procedure that combines antegrade and retrograde endourological treatments for urolithiasis. The surgery was successful in removing the stone and the patient had an uneventful postoperative course. The article highlights the advantages of ECIRS, such as high stone-free rates and low complication rates, and emphasizes the importance of thorough preoperative planning and the use of appropriate endoscopes and devices. The authors disclose their potential conflicts of interest and express gratitude to the patient for allowing the publication of her case. [Extracted from the article]

Percutaneous nephrolithotomy (PCNL) is the treatment of choice for pediatric nephrolithiasis more than 20 mm. Prone position was the preferred position for decades. Recently, supine position has gained more interest. This meta-analysis aims to evaluate the safety and efficacy of PCNL in supine versus prone position in pediatric population. A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library was performed till 28 February 2024. The study included comparative studies comparing both positions in children that were written in English. A total of three randomized studies and three retrospective studies were included with a total number of 290 patients. Cochrane risk-of-bias tool for randomized trials was used for quality assessment, while Newcastle–Ottawa scale was used for non-randomized controlled trials. The meta-analysis was conducted using Review Manager software. Numerical data were analyzed using standardized mean difference (SMD), while the risk ratio was used for analysis of categorical data. Fixed or random effects models were used according to heterogeneity. There were statistically insignificant differences between both groups for stone-free rate (RR 1.08, 95% CI [0.98–1.18], p = 0.11) and overall complications (RR 0.93, 95% CI [0.59–1.47], p = 0.76). Operation time was significantly shorter in supine group (SMD −0.99, 95% CI [−1.67 to −0.30], p = 0.005). Therefore, comparable efficacy and safety outcomes were proved between both supine and prone positions for PCNL in pediatrics. [ABSTRACT FROM AUTHOR]

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Purpose: The aim of this study is to investigate the results and safety of retrograde intrarenal surgery (RIRS) in patients who have previously undergone percutaneous nephrolithotomy (PCNL). Methods: A retrospective analysis included patients who underwent RIRS for kidney stones between August 2018 and April 2023. Group 1 comprised 396 patients who underwent primary RIRS, while Group 2 included 231 individuals who had RIRS after previous PCNL. Evaluation parameters included preoperative characteristics, stone attributes, operative details, treatment outcomes, stone-free status, and complications. Statistical analysis utilized Student's t test, Mann–Whitney U test, and Pearson Chi-square test (p < 0.05). Results: The mean age, body mass index, stone number, mean stone burden, and SFS were not statistically different between the groups. Lower pole stones were identified in 144 patients in Group 1 and 88 patients in Group 2 (p = 0.315). In Group 1 and Group 2, the mean operation time and fluoroscopy time were 65.23 ± 18.1 min, 81.32 ± 14.3 min, 26.34 ± 8.31 s, 46.61 ± 7.6 s, respectively, showing statistically significant differences between the groups (p = 0.013, p < 0.001, respectively). Infundibulum stenosis was identified and treated with a laser in 12% of Group 2 cases. Complications occurred in 12 patients in Group 1 and 14 patients in Group 2 (p = 0.136). Conclusion: A history of PCNL may contribute to extended operation times and increased fluoroscopy exposure in subsequent RIRS without significantly affecting postoperative SFS or complication rates. [ABSTRACT FROM AUTHOR]

Purpose: The Comprehensive Complication Index (CCI) was introduced in 2013 to overcome the limitations of the Clavien–Dindo Classification (CDC) in grading postoperative complications. The objective of this study to assess the predictive value of the CDC and the CCI for postoperative course in patients undergoing standard adult percutaneous nephrolithotomy (PCNL). Methods: A retrospective analysis of 320 renal units that underwent standard PCNL between July 2021 - April 2023 was conducted. The CDC and CCI systems assessed complications occurring within the first 30 days after surgery. A second CCI score was calculated only on the highest CDC grade, and this score was referred to as the noncumulative CCI. A comparative analysis was conducted to determine the predictive efficacy of both evaluation methods regarding the postoperative course. Results: The postoperative complication rate was 23.1% (74/320). Eight patients (2.5%) experienced multiple complications, resulting in a higher total CCI score than the noncumulative CCI (p = 0.010). Correlation analysis revealed that the CCI correlated with the length of hospital stay (LOS) more precisely than the noncumulative CCI (CCI: r = 0.335; p = 0.004 vs. noncumulative CCI: r = 0.325; p = 0.005). Compared with patients with a single complication, those with multiple complications had similar demographics, preoperative stone characteristics, and intraoperative features. Conclusion: Cumulative CCI proves to be a more effective predictor of LOS and complication burden in standard PCNL than CDC. Hence, using CCI to evaluate complications after PCNL may be a more appropriate approach. [ABSTRACT FROM AUTHOR]

Introduction: The safety and effectiveness of percutaneous nephroscopic surgery without artificial hydronephrosis remain controversial, and there are few relevant studies. This retrospective study aimed to compare the efficacy of two different methods of eliminating and creating artificial hydronephrosis in percutaneous nephrolithotomy (PCNL) in the oblique supine position. Methods: This is a retrospective study. A total of 162 patients who underwent PCNL in an oblique supine position at our hospital were divided into two groups according to the surgical method: the free artificial hydronephrosis group (group A) and the artificial hydronephrosis group (group B). Group A was directly treated with PCNL under ultrasound guidance, and group B was treated with artificial hydronephrosis before PCNL. Several outcomes were measured, including procedure time, stone clearance rate, and incidence of complications. Results: The procedure time in group A lower than that in group B, and the incidence of sepsis was significantly lower in group A than in group B (p < 0.05). There was no statistical difference in stone clearance rate, success rate of primary establishment of puncture channel, unilateral change in perioperative red blood cell count, change in perioperative renal function, and perioperative complications (except sepsis) between the two groups (p > 0.05). Conclusion: For experienced physicians, PCNL without artificial hydronephrosis in an oblique supine position can be attempted to reduce the number of surgical steps without affecting the stone clearance rate and increasing the occurrence of complications. [ABSTRACT FROM AUTHOR]

Background: The study aimed to compare the pain-relieving effectiveness of anterior quadratus lumborum block (QLB3) and erector spinae plane block (ESPB), both of which have been documented to provide relief during abdominal surgery. Methods: This prospective observational study, conducted between February and July 2023, included 96 patients who had undergone percutaneous nephrolithotomy (PCNL). Patients were divided into three groups: QLB3, ESPB, and control (no block) and received the corresponding nerve block in the preanesthetic room for regional block. Cumulative morphine consumption during the initial 24 h after PCNL, numerical rating scale resting/movement scores, intraoperative remifentanil usage, rescue analgesic requirements, time when the first analgesic was requested, and postoperative nausea and vomiting scores were documented and compared between the groups. Results: Total median morphine consumption in the first 24 h postoperatively was similar in the QLB3 and ESPB groups but higher in the control group (QLB3, 7 mg [(Q1-Q3) 7–8.5]; ESPB, 8 mg [6.5–9]; control, 12.5 [10–17]; P < 0.001). Similarly, median intraoperative remifentanil consumption did not differ between the block groups but was higher in the control group (QLB3, 1082 µg [IQR 805.5–1292.7]; ESPB, 1278 µg [940.2–1297.5]; control, 1561 µg [1315–2068]; P < 0.001). The number of patients receiving rescue analgesic medication was similar in the block groups but higher in the control group (QLB3, n = 9 [30%]; ESPB, n = 14 [46.7%]; control, n = 21 [70%]; P = 0.008). Conclusions: QLB3 and ESPB were adequate and comparable in providing postoperative analgesia as part of multimodal analgesia after PCNL. Trial registration: The study was registered on ClinicalTrials.gov (Identifier: NCT05822492). [ABSTRACT FROM AUTHOR]

Objective To analyzed the safety and efficacy of percutaneous nephrolithotomy (PCNL) in lateral decubitus position and prone position for upper ureteral calculi. Methods Databases including PubMed, Springer, ScienceDirect, Wiley Online Library, CNKI, CSPD and VIP were searched for clinical controlled studies involved with lateral decubitus position and prone position PCNL from their establishment to November 2023.Studies were enrolled according to inclusion and exclusion criteria. the dates were compared by Review Manager 5.4 software. Results seven studies were eligible, including 807 cases. The Meta-analysis showed that, blood loss and perioperative complication rate of lateral decubitus position PCNL group were significantly different from those of the prone position PCNL group (P < 0.05). There was no significant difference between the two groups regarding hospital time, operative time, channel establishment time and stone-free rate (P>0.05).Conclusions The lateral decubitus position can reduce blood loss and perioperative complication rate. The lateral decubitus position PCNL is safe and effective for upper ureteral calculi which was deserved clinical popularizing use. [ABSTRACT FROM AUTHOR]

Introduction: This article attempts to provide a comprehensive review of the learning objectives and importance of the supine percutaneous nephrolithotomy (PCNL) technique. Material method: We retrospectively reviewed the cases of Supine PCNL between January 2018 and January 2024. We divided the groups into 3: residents between 2 and 3 years (Group 1), residents between 4 and 5 years (Group 2), and endourologist (Group 3). The 2–3-year resident started to perform PCNL for the first time, while the 4–5-year resident started to perform Supine PCNL for the first time while previously performing prone PCNL. Results: Access, fluoroscopy, and operation time were higher in Group 1, shorter in Group 2, and shortest in Group 3 (p < 0.001). Postoperative length of stay and the need for additional treatment were found to be shorter (p < 0.001), and the stone-free rate (SFR) increased (p < 0.001) from Group 1 to Group 3. The highest complication rates were observed in Group 1 (p = 0.002). SFR rate increased as the number of cases increased in Group 1 patients. Success was stable after 46–60 cases in terms of SFR. In Group 2, the SFR rate was stable after 31–45. cases. The most complications were observed in Group 1 and the least in Group 3. Conclusion: In 2-3-year residents, access time and fluoroscopy time decrease with experience. In 4-5-year residents, due to their expertise in prone PCNL, the operation time and fluoroscopy time decrease with the number of cases performed. SFR is higher after 46–60 cases for 2-3-year residents and 31–45 cases for 4-5-year residents. [ABSTRACT FROM AUTHOR]

Objective: To analyze the risk factors for complications in patients with struvite stones following percutaneous nephrolithotomy (PCNL) or flexible ureteroscopy (fURS), and to establish a nomogram for postoperative complications in patients following PCNL. Methods: A retrospective analysis was conducted on patients with struvite stones after PCNL and fURS at the Department of Urology, Peking University People's Hospital, from January 2012 to March 2022. The common pathogens and antimicrobial susceptibilities in preoperative midstream urine culture were analyzed. Logistic regression analyses were used to evaluate the risk factors. Receiver-operating characteristic (ROC) curve, calibration plots, and decision curve analysis (DCA) were used to assess the discrimination, accuracy, and practicability of the nomogram. Results: 332 patients with struvite stones received one-stage PCNL or fURS, including 243 cases of PCNL and 89 cases of fURS. 72 patients (21.69%) developed postoperative complications. The most common pathogens in preoperative urine cultures were Escherichia coli, Proteus mirabilis, and Enterococcus faecalis. Multivariate logistic regression analysis showed that preoperative hemoglobin (OR = 0.981, P = 0.042), staghorn stone (OR = 4.226, P = 0.037), and positive preoperative midstream urine culture (OR = 2.000, P = 0.043) were independent risk factors for postoperative complications in patients following PCNL. The nomogram showed good performance in discrimination, accuracy, and applicability. Conclusion: Preoperative hemoglobin, staghorn stone, and positive preoperative midstream urine culture were independent risk factors for postoperative complications in patients with struvite stones following PCNL. A nomogram was developed to predict the probability of postoperative complications. [ABSTRACT FROM AUTHOR]

BACKGROUND: Urology is one of the most rapidly evolving and technologically advanced surgical specialties. However, training programs in Sub-Saharan Africa (SSA) face unique challenges. This study aimed to assess the current status of urology training in SSA and identify areas for improvement, providing crucial insights into the strengths and limitations of these programs. METHODS: A 24-discrete items online survey was developed with “Google Forms” in English and French. The questionnaire was composed of two parts. The first part assessed general information about the urology training, and the second part evaluated the consultant's or department head's ability to perform and teach endourology procedures. RESULT: A total of 25 responses were received from 18 countries. The oldest training center is the University of Cape Town, South Africa; the program started in 1950. The number of consultants in the department ranges from 1 to 12, with an average of 4.79. Twenty of the training sites have a compulsory general surgery clinical attachment in their program. Fourteen of the training sites stated that research is mandatory in their curriculum. Fourteen of the centers reported providing laparoscopic urology surgery. Cystoscopy is the most mastered procedure and percutaneous nephrolithotomy (PCNL) is the most difficult procedure to gain any experience with by residents. CONCLUSION: Urology training in sub-Saharan Africa started late but is increasing in number through time. Urology training in Africa faces multiple challenges, including inadequate number of experts, limited availability of advanced equipment and simulation-based training sites. Training institutions should be encouraged to facilitate research and basic urological skills training. [ABSTRACT FROM AUTHOR]

Background: Percutaneous nephrolithotomy (PCNL) is associated with a wide range of complications. This review aims to explore how recent technological advancements and personalized medicine can help prevent or predict these complications. Methods: A scoping review was conducted according to the PRISMA-SCR guidelines and registered on the Open Science Framework in April 2024. A literature search was performed on PUBMED, Web of Science, and Scopus databases. This review focused on predictive AI models, 3D surgical models, intrasurgical image guidance, and biomarkers. Articles meeting the following criteria were included: publication between 2019 and 2024, written in English, involving human participants, and discussing technological advancements or personalized medicine in the context of complications in PCNL. Results: Of the 11,098 articles searched, 35 new studies were included. We identified a few articles on predictive AI models. Several studies demonstrated that 3D presurgical models and virtual models could enhance surgical planning and reduce complications. New intrasurgical image and guidance systems showed the potential in reducing bleeding and radiation exposure. Finally, several biomarkers were identified as predictors of sepsis and other complications. Conclusion: This scoping review highlights the potential of emerging technologies in reducing and predicting PCNL complications. However, larger prospective studies are required for validation. [ABSTRACT FROM AUTHOR]

Introduction: Next-generation sequencing (NGS) is a new molecular technique for identifying microorganisms. Treating bacteriuria in patients undergoing stone removal procedures is important for preventing postoperative urinary tract infection (UTI). The objective of this study is to assess the usefulness of preoperative urine NGS testing by comparing NGS with standard urine culture in predicting postoperative UTI after ureteroscopic lithotripsy (URSL) and percutaneous nephrolithotomy (PCNL). Materials and Methods: This prospective study was conducted from February 16, 2022, to January 11, 2024. Sixty subjects who underwent URSL or PCNL were included. Preoperative voided urine samples were collected for urine culture and tested by MicroGenDX for urine polymerase chain reaction (PCR) and urine NGS. Stone specimens obtained intraoperatively were also sent for stone culture and MicrogenDx. Patients were monitored for 4 weeks post-operation for recording clinical outcomes related to infections and complications. Results: Twenty-six (43.3%) male and 34 (56.7%) female participants were included. Twenty-six (43.3%) patients underwent PCNL (15 standard PCNL and 11 mini PCNL), and 34 (56.7%) underwent URSL. Standard urine culture identified positive results in 26 cases (43.3%), PCR for 17 cases (28.3%), and NGS for 31 cases (51.7%). The overall postoperative UTI rate was 6 (10%). Standard urine culture demonstrated a sensitivity of 50%, specificity of 57.4%, and accuracy of 56.7%. Positive predictive value (PPV) was notably poor at 11.5%. Urine NGS showed a higher sensitivity of 83.3%, specificity of 53.7%, accuracy of 55%, and PPV of 16.7%. Conclusion: Urine NGS significantly improves the sensitivity of detecting microorganisms in preoperative urine compared with standard urine culture. Despite its high sensitivity and capability to identify nonculturable bacteria, using NGS alongside standard urine culture is recommended. This parallel approach harnesses the strengths of both methods. Integrating NGS into standard practice could elevate the quality of care, especially for patients at high risk of UTIs, such as those undergoing invasive stone removal procedures. [ABSTRACT FROM AUTHOR]

Introduction and Objective: In early 2020, as the SARS-Cov-2 (COVID-19) pandemic progressed, many institutions limited nonurgent surgical care. This coincided with a decade-long trend of increasing percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS) and decreasing shock wave lithotripsy (SWL) for surgical management of urolithiasis. Herein, we evaluate temporal stone surgery rates and surgeon volumes in the Medicare population and suggest how COVID-19 contributed to them. Methods: Retrospective analysis was conducted using the "Medicare Physician & Other Practitioners" database containing data from January 2013 to December 2021. Adult patients who underwent stone surgery were included. We evaluated surgeon characteristics and changes in case volumes over time adjusted for population. Results: In 2013, urologists performed 68,910 stone surgeries: SWL 42,903 (62%); URS 25,321 (37%); PCNL 686 (1%). Over the next 8 years, there was an average annual increase in URS (+13%) and PCNL (+13%) and decrease in SWL (−2%). In 2020, there was a 14% reduction in all stone cases: SWL (−25%); URS (−6%); PCNL (−8%). By 2021, case volumes recovered to pre-2020 levels, though SWL remained low: SWL 33,974 (34%); URS 64,541 (64%); PCNL 1764 (2%). From 2013 to 2021, the number of urologists performing SWL decreased (1718 to 1361) while URS and PCNL providers doubled (1,347 to 2,914 and 28 to 76, respectively). Conclusions: From 2013 to 2021, there was an increase in URS and PCNL and a decrease in SWL in the US Medicare population. The COVID-19 pandemic was associated with a decline in stone surgeries, particularly SWL. By 2021, PCNL and URS case numbers increased significantly with a smaller increase in SWL. [ABSTRACT FROM AUTHOR]

Introduction: Percutaneous nephrolithotomy (PCNL) remains the gold standard treatment for patients with complete staghorn stones, for which multiple access tracts may be required. In this study, we describe a series of patients undergoing PCNL with a minimum of five dilated access tracts. Materials and Methods: We performed a multi-institutional retrospective review of 10 patients with complete staghorn stones who underwent PCNL requiring five or more access tracts. We recorded patient demographics, stone characteristics postoperative complications, and stone-free rates (SFRs). The primary endpoint was any postoperative complication. Secondary endpoints included SFR, operative time, and length of stay. SFR was defined as absence of stones or residual fragments <4 mm. Results: A total of 10 patients from two institutions were included. Access tract number ranged from 5 to 11, and median stone volume was 233,042 mm3. Seven patients (70%) experienced postoperative complications, ranging from Clavien II to IVa. Three patients (30%) required blood transfusions. Median operative time was 312 minutes ranging from 180 to 560 minutes. Five patients (50%) were stone-free after the initial procedure. Of those with residual fragments, 4 (40%) required reoperation to be rendered stone-free. Median length of stay was 2.5 days, with a range of 1–6 days. Conclusion: To our knowledge, this is the largest series of patients undergoing PCNL with five or more access tracts reported to date. This study confirms that PCNL with five or more tracts is feasible and relatively safe, albeit with a high rate of complications in the immediate postoperative period. [ABSTRACT FROM AUTHOR]

Background and Objective: Percutaneous Nephrolithotomy (PCNL) is recommended for large Kidney Stones. It is mostly done in prone position. However, PCNL in Supine position is another safe option. Only few centers in country are doing it and so it is challenging task to adopt supine PCNL approach in an institution initially. In this study our purpose was to assess initial experience of Supine PCNL in our center. Methods: It is a preliminary retrospective study of our first fifty-one supine PCNL procedures, performed by a single Surgeon, over Twelve months period, from April 2021 to April 2022. We managed a retrospective review of patients’ records. Analysis was completed by utilizing SPSS version 20. Implementation of Mean along with standard deviation values was utilized for continuous variables. While frequency/percentages represented categorical factors. Results: Patients mean age was 39 years, comprising of 62.74% male and 37.25% female patients. Thirty patients had their stones treated on the left side. Mean Stone burden was 3.2 cm. Most of the stones were GUYs score one and two (complexity wise). The mean procedure time 147minutes. Mean hospital stay of 2.17 days was observed in this study. Forty patients were stone free. Only seven patients (14%) had level I-II complications (Clavien-Dindo classification). Conclusion: Supine PCNL can be adopted safely in an institute if careful selection of patients is done before surgery. In our center it had acceptable success rates and few complications. [ABSTRACT FROM AUTHOR]

Extraosseous bone formation of the upper urothelial tract is an unusual phenomenon with limited documentation in the uropathology literature, reported in only 2 clinical series of patients undergoing percutaneous nephrolithotomy for the management of renal stones. While speculations regarding the pathogenesis of this occurrence have been published, heterotopic ossification is still poorly understood. We report the finding of extraosseous bone formation in the renal pelvis of a 30-year-old male patient with a history of kidney stones. Histologic sections of the ureter and renal pelvis showed submucosal nodules of woven bone. Ancillary fluorescence in-situ hybridization studies were negative for MDM2 amplification and USP6 rearrangement. [ABSTRACT FROM AUTHOR]

Intravenous misplacement of the nephrostomy catheter following percutaneous nephrolithotomy (PCNL) is severe and extremely rare, and little information is available about this complication. Because the patient's prognosis may be poor, sufficient attention should be paid to early identification and treatment of this complication. We report a case with intravenous misplacement of nephrostomy catheter and severe bleeding from the catheter after PCNL was transferred to our hospital. The patient was successfully managed using a two-step intervention. First, the patient underwent embolization of the pseudoaneurysms in renal parenchyma, then underwent catheter withdrawal under digital subtraction angiography (DSA) and control bleeding by pushing the absorbable hemostatic material (Surgicel) into the tunneled renal drainage. There were no severe complications. Withdrawal could be performed by open surgery or under the supervision of imaging modalities. Some reports showed that minimally invasive management was safer and less invasive than open surgery.

Abstract Background The aim of this study was to identify the factors that impact the post- percutaneous nephrolithotomy (PCNL) urine leak (UL) following nephrostomy tube removal and to assess if the calyx of entry made any difference. Materials and methods In this retrospective study, from April 2016 to May 2019, all the patients undergoing conventional percutaneous nephrolithotomy by a single 24 Fr access with complete stone clearance were evaluated. Patients with urine leak for > 4 h after nephrostomy tube removal were included in the urine leak group (n = 18), while the non-urine leak group (n = 60) comprised patients with urine leak for

Abstract Percutaneous nephrolithotomy (PNL) is the preferred surgical procedure for treating renal stones larger than 2 cm. Patients may experience significant pain in the postoperative period due to factors such as the catheter entry site and tension in the renal capsule. Erector Spinae Plane (ESP) block provides perioperative muscle relaxation and reduces analgesic use. In this study, we investigated the effect of ESP block on postoperative pain scale and quality of recovery in patients undergoing PNL. The study was conducted with a total of 96 patients, with 45 patients receiving the ESP block and 51 patients not receiving the ESP block. Following the surgery, the visual pain scale (VAS) was completed at 0, 2, 6, 12, and 24 h, and the Quality of Recovery-15 (QoR-15) scale along with the willingness scale were completed at the 24-hour mark. The normal distribution of data was evaluated with the Kolmogorov-Smirnov test, histogram, and skewness-kurtosis coefficients. For comparing paired groups, the Student’s T-test was used for normally distributed variables, while the Mann-Whitney U test was used for parameters that did not have a normal distribution. The comparison of postoperative pain, as measured by VAS scores between the groups, revealed statistically significantly lower scores in the ESP block group at 0, 2, 6, 12, and 24 h (p

Abstract Background This study was conducted to investigate the clinical value of a navigation system based on deep learning and mixed reality for the treatment of kidney stones with percutaneous nephrolithotomy (PNL), and to improve its theoretical basis for the treatment of kidney stones. Methods The data of 136 patients with kidney stones from October 2021 to December 2023 were retrospectively analyzed. All patients underwent PNL, and were categorized into a control group (Group 1) and a surgical navigation group (Group 2) according to puncture positioning method. Preoperative computed tomography (CT) was performed in both groups. In group 1, procedures were performed under standard ultrasound guidance. PNL was performed with navigation system fused with ultrasound to guide percutaneous puncture in group 2. The baseline information and procedural characteristics of both groups were compared. Results PNL was successfully performed in both groups. No significant difference was found in the baseline date between the two groups. In group 2, real-time ultrasound images could be accurately matched with CT images with the aid of navigation system. The success rate of single puncture, puncture time, and decrease in hemoglobin were significantly improved in group 2 compared to group 1. (p

Chao Yang,1 Haitao Xiao,1 Qizhi Yang,1 Zhendong Zhao,1 Yifan Liu1,2 1Department of Urology, 302 Hospital of China Guizhou Aviation Industry Group, Anshun City, Guizhou Province, 561400, People’s Republic of China; 2Department of Urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou City, Guangdong Province, 510000, People’s Republic of ChinaCorrespondence: Yifan Liu, Department of Urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou City, Guangdong Province, 510000, People’s Republic of China, Email doctorhorse2008@foxmail.comObjective: This study aimed to assess the association between preoperative neutrophil–lymphocyte ratio (NLR) and febrile urinary tract infection (fUTI) in patients who underwent percutaneous nephrolithotomy (PCNL).Patients and Methods: The clinical data of patients who underwent PCNL at our hospital between March 2020 and May 2023 were retrospectively analyzed. According to whether fUTI occurs after operation, collected data were divided to the patients into fUTI and non-fUTI. Univariate analysis, relative operating characteristic (ROC) curves and multivariate logistic regression analysis were performed on the data.Results: A total of 405 patients were enrolled in the study. The procedure was successfully performed in all patients, and the incidence of fUTI was 8.4% (34/405). Eight patients eventually developed sepsis, and the incidence of sepsis in fUTI patients was 23.5%. The result shows a significant correlation between NLR and fUTI (95% confidence interval [CI],1.21– 1.83, Odds ratio [OR]=1.49, p< 0.001). The predictive ability of NLR on the occurrence of fUTI was assessed by plotting relative operating characteristic (ROC) curves. The area under the curve (AUC) in the ROC curve for NLR was 0.718 according to the Youden index, and the best cut-off value of NLR was 2.71. Furthermore, logistic multiple regression model adjustment was carried out to further confirm the robustness of the relationship between NLR and fUTI. The results indicated robustness regardless of whether NLR was a continuous variable or a categorical variable.Conclusion: NLR can be used as a simple and effective preoperative indicator for the prediction of fUTI in patients undergoing PCNL.Keywords: percutaneous nephrolithotomy, febrile urinary tract infection, neutrophil–lymphocyte ratio

Abstract Background The study aimed to compare the pain-relieving effectiveness of anterior quadratus lumborum block (QLB3) and erector spinae plane block (ESPB), both of which have been documented to provide relief during abdominal surgery. Methods This prospective observational study, conducted between February and July 2023, included 96 patients who had undergone percutaneous nephrolithotomy (PCNL). Patients were divided into three groups: QLB3, ESPB, and control (no block) and received the corresponding nerve block in the preanesthetic room for regional block. Cumulative morphine consumption during the initial 24 h after PCNL, numerical rating scale resting/movement scores, intraoperative remifentanil usage, rescue analgesic requirements, time when the first analgesic was requested, and postoperative nausea and vomiting scores were documented and compared between the groups. Results Total median morphine consumption in the first 24 h postoperatively was similar in the QLB3 and ESPB groups but higher in the control group (QLB3, 7 mg [(Q1-Q3) 7–8.5]; ESPB, 8 mg [6.5–9]; control, 12.5 [10–17]; P

Abstract Objective To analyzed the safety and efficacy of percutaneous nephrolithotomy (PCNL) in lateral decubitus position and prone position for upper ureteral calculi. Methods Databases including PubMed, Springer, ScienceDirect, Wiley Online Library, CNKI, CSPD and VIP were searched for clinical controlled studies involved with lateral decubitus position and prone position PCNL from their establishment to November 2023.Studies were enrolled according to inclusion and exclusion criteria. the dates were compared by Review Manager 5.4 software. Results seven studies were eligible, including 807 cases. The Meta-analysis showed that, blood loss and perioperative complication rate of lateral decubitus position PCNL group were significantly different from those of the prone position PCNL group (P 0.05).Conclusions The lateral decubitus position can reduce blood loss and perioperative complication rate. The lateral decubitus position PCNL is safe and effective for upper ureteral calculi which was deserved clinical popularizing use.

Abstract Background At present, the guidelines for urology recommend percutaneous nephrolithotomy (PCNL) as the preferred treatment for staghorn renal calculi (SRC). However, for complete SRC, it has been questioned by clinicians and patients due to high residual stone rate, complications, repeated hospitalizations and high treatment cost. Anatrophic nephrolithotomy (ANL) is a traditional and classic method for the treatment of SRC. Due to its high trauma and high technical requirements, it is difficult to carry out in primary hospitals, and gradually replaced by PCNL. The purpose of this study is to compare the efficacy of PCNL and ANL in the treatment of complete SRC. Methods Overall, 238 patients with complete SRC were divided into mini-PCNL in lateral supine position group, (n = 190) and ANL group (n = 94) according to treatment for a retrospective cohort study. The calculi parameters, renal function index, comorbidities of calculi, surgical complications, length and frequency of hospitalization, treatment costs, results of postoperative satisfaction survey were compared between the two groups. Results The risk of the residual stone rate after mini-PCNL in lateral supine position was 239 times (OR = 238.667, P

Background: Percutaneous nephrolithotomy (PCNL) is a routine endourologic procedure in patients with renal calculi. Although it is less painful than open surgery, pain around the nephrostomy tube is a clinical problem; therefore, good post-operative analgesia is required to alleviate pain. Peritubal infiltration can be one of the choices to alleviate pain around the nephrostomy tube. Aims and Objectives: The aim of this study was to evaluate the efficacy of peritubal infiltration of local anesthetics for post-operative pain following PCNL. Materials and Methods: A total of 60 patients with American Society of Anesthesiologists Grade I/II scheduled for elective PCNL surgeries were randomly allocated into two groups. Group L received levobupivacaine 0.25% (30 mL) and Group B received bupivacaine 0.25% (30 mL). The duration of rescue analgesia, total dose of tramadol consumption in 24 h, hemodynamic parameters, and adverse events during the post-operative period were noted. Results: The mean duration of rescue analgesia in Group L was 274.50±24.89 min and in Group B was 275.33±23.04 min which was not significant (P>0.05). Conclusion: Peritubal infiltration of 0.25% levobupivacaine and 0.25% bupivacaine is efficient in alleviating post-operative pain after PCNL. Both drugs can be used for infiltration around nephrostomy tubes in PCNL surgeries safely and are associated with minimal side effects.

Percutaneous nephrolithotomy (PCNL) is the procedure of choice for large kidney stones, but serious complications such as bowel perforation may occur. We discuss the diagnosis and management of colonic and small-bowel perforations due to PCNL and suggest principles for care and prevention. We emphasize the significance of imaging tools to direct percutaneous access, the importance of early diagnosis, and the relatively high success rate for conservative management. Patient summary: Large kidney stones are usually treated with a keyhole surgery procedure called percutaneous nephrolithotomy (PCNL). A rare but serious complication of this procedure is puncture of the bowel. We discuss how to prevent, diagnose, and treat this complication in patients undergoing PCNL.

Abstract Background This systematic review and meta-analysis aimed to evaluate the efficiency and safety of percutaneous nephrolithotomy (PCNL) between flank position and prone position for the treatment of renal stones. Methods PubMed, Embase, OVID, and Cochrane Library were comprehensively searched from their inception to Jul 2024. Randomized and nonrandomized trials evaluating renal calculi patients who underwent PCNL via flank position or prone position were included. Data extraction and quality assessment were conducted by two independent reviewers. The outcomes and complications of both groups were compared in this meta-analysis. Results This review involved five articles (554 patients). Specifically, four articles were randomized controlled trials, and the remaining publication was prospective cohort study. No significant difference was found in stone-free rate between the flank group and prone group after the PCNL procedure. Similarly, the percutaneous access time, operative time, and hospital stay of flank position had no significant difference compared with the prone group. There was no significant difference in the comparison of complication rates between the flank group and the prone group. Although further analysis indicated that patients in the prone position suffered more hemoglobin drop than the flank group, no significant difference was found in the hemorrhage and blood transfusion rates. Conclusions Both surgical positions were appropriate for most PCNL procedures and had shown similar efficacy and safety. In practice, the optimal choice should be made according to the patients’ conditions and urologists’ acquaintance.

Abstract Background Renal calculi are one of the most frequent diseases in urology, and percutaneous nephrolithotomy (PCNL) being the gold standard for treating renal calculi larger than 2 cm. However, traditional rigid nephroscope cannot bend, presents significant limitations during PCNL. This study aims to develop a novel digital flexible nephroscope for PCNL and verify its safety and efficacy using 3D printed models and ex vivo porcine kidney models, providing new equipment for PCNL. Methods Based on the determined technical parameters, the novel digital flexible nephroscope was manufactured. First, 3D-printed model and ex vivo porcine kidney models were utilized to simulate the PCNL procedures. Then, the traditional rigid nephroscope and the novel digital flexible nephroscope were utilized to simulate the PCNL procedures on 10 ex vivo porcine kidneys for comparison. We observed and recorded the renal calyces visualized and accessed by both the traditional rigid nephroscope and the novel digital flexible nephroscope. Results In both the 3D printing and ex vivo porcine kidney models, the novel percutaneous digital flexible nephroscope smoothly entered the renal collecting system through the percutaneous renal tract. It freely changed angles to reach most target calyces, demonstrating significant advantages over the traditional rigid nephroscope. Conclusion The successful development of the novel percutaneous digital flexible nephroscope allows it to be used either independently or as an adjunct in complex stone cases, providing more effective and safer surgical equipment for percutaneous nephrolithotomy.