Search

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...

To identify early predictive factors for urosepsis secondary to mini-percutaneous nephrolithotomy (MPCNL) in patients with negative preoperative urine culture (UC).A total of 786 patients with baseline negative UC who underwent MPCNL between January 2017 and June 2019 were retrospectively analyzed. Urosepsis was defined according to the Sepsis-3 definition. Subsequently, perioperative potential risk factors were compared between non-urosepsis and urosepsis groups.Despite negative UC in all patients, the rate of positive stone culture (SC) was 16.0%; the rate of pelvic urine culture (PUC) was 7.5%; 23 cases (2.9%) developed urosepsis after MPCNL. Univariate analysis showed that urosepsis was associated with the female gender, BMI, stone burden, diabetes mellitus and preoperative urine test. Multivariate logistic regression analysis suggested that urine test with positive nitrite and white blood cells and leukocyte esterase (N+WBC+LE+) (OR 17.51, 95% CI 6.75-45.38, P 0.001) and operative time 120 min (OR 3.53, 95% CI 1.41-8.85, P = 0.007) were independent risk factors for urosepsis. Additionally, receiver operating characteristic curve analysis of N+WBC+LE+ showed that the area under the curve was 0.785 for predicting the occurrence of urosepsis. Further analysis showed that N+WBC+LE+ provided an efficient prediction of SC+/PUC+ (SC+ or PUC+) with 61.7% sensitivity and 97.3% specificity.In spite of the baseline negative preoperative UC, 2.9% of patients developed urosepsis after MPCNL. N+WBC+LE + was determined to be an early and efficient prediction of intraoperative bacterial status and urosepsis following MPCNL. Nevertheless, further studies are needed to confirm the results.

Staghorn calculi remain a treatment challenge for urologists. The aim of the study was to compare the treatment outcomes of suctioning minimally invasive percutaneous nephrolithotomy (MPCNL) and traditional MPCNL for renal staghorn stones.Between April 2018 and June 2019, we included patients suffering from renal staghorn stones who were treated with modified MPCNL with a suctioning system. The outcomes of these patients were compared with those of a cohort of patients undergoing traditional MPCNL (between January 2017 and March 2018) using a 1:1 scenario matched-pair analysis. Cases were matched sequentially according to stone burden, stone branches, and stone hardness as well as age and sex.A total of 512 patients were included in this study (256 patients in each group). The baseline characteristics were equally distributed between the two groups. The suctioning MPCNL group achieved a significantly higher stone-free rate (SFR) (78.5% vs 69.1%; P = 0.016) after a single procedure and had a significantly shorter operative time (106.2 ± 18.4 vs. 132.1 ± 22.2 min; P 0.001) than the traditional MPCNL group. The traditional MPCNL group experienced a significantly higher rate of overall complications than the suctioning MPCNL group (27.3% vs. 16.8%; P = 0.004). Regarding individual complications, a significantly higher rate of fever (13.7% vs. 7.4%; P = 0.021) and urosepsis requiring only additional antibiotics (8.2% vs. 3.5%; P = 0.024) was observed in the traditional MPCNL group than in the suctioning MPCNL group; there was a trend that the suctioning MPCNL group conferred a decreased risk of urosepsis shock (1.2% vs. 2.3%), but this trend failed to achieve statistical significance (P = 0.313). There was no significant difference between the two groups regarding the incidence of severe hemorrhage, the mean number of tracts used during a single procedure and the postoperative hospital stay.The use of suctioning MPCNL for staghorn calculi had advantages over the use of traditional MPCNL in terms of a higher SFR after a single procedure and fewer postoperative infectious complications. Further well-designed studies are needed to confirm the results.

To assess the safety, feasibility, and efficacy of a modified process we developed in order to perform decortication surgeries for simple renal cysts through a percutaneous approach, 18 patients with simple renal cysts larger than 5 cm were treated with our new technique, from November 2016 to January 2019. All of the cysts were evaluated with ultrasonography and contrast-enhanced computed tomography. The Surgical procedure: as the standard mini-Percutaneous Nephrostomy procedure, a puncture was made directly into the cyst through the cyst roof under ultrasound guidance. After the inner cyst wall examination, the sheath was then retracted to just outside the cyst roof. The sheath together with the scope was used to detach the roof from the perirenal fat, after which the cyst roof was resected using a laser. A drain tube was left in the retroperitoneal space for 1-2 days. Subsequently, all patients were discharged 1 to 2 days post-surgery. Skin incision was less than 1 cm. No major complication was observed. The follow-up time ranges from 14 to 37 months. One case had an incompletely resected cyst with the cyst volume being decreased by more than 60%. This patient didn't receive any additional treatments during his follow-up. For all the other patients, the cysts had completely disappeared and no relapse had occurred. In conclusion, in the selected patients with a simple posterior renal cyst, our new technique is a safe and an effective option. It is also considered the least invasive decortication surgery for posterior renal cyst.

BACKGROUND: To evaluate to what degree preoperative urine white blood cell (WBC) and urine nitrite (NIT) values are predictive of postoperative infections following percutaneous nephrolithotomy (PCNL). METHODS: A systematic literature search was performed of the PubMed, Embase, Cochrane Library, Wanfang Data, National Knowledge Infrastructure (CNKI), and China Science and Technology Journal Database (CSTJ or VIP) online databases to identify relevant studies that examined the predictive value of urine WBC or NIT as risk factors for post-PCNL infection, and the search was finished on February 28, 2020. Two independent reviewers screened the relevant studies, extracted necessary data from the eligible case-control studies (CCS), and assessed the quality of included studies through the Newcastle-Ottawa scale (NOS). RevMan 5.3 software and the Stata 16.0 software were used to complete the statistical analysis of data. Results are expressed as odds ratio (OR) with 95% confidence intervals (CIs). RESULTS: According to the statistical analysis of 12 eligible studies involving 6113 patients, positive urine WBC (WBC+: OR =3.86, 95% CI: 3.03–4.91, P

To determine the incidence and risk factors of the venous thromboembolism (VTE) in patients undergoing percutaneous nephrolithotomy (PCNL). We retrospectively reviewed the records of 896 consecutive cases receiving PCNL between July 2018 and August 2020 in our institution. Univariate analysis was performed to identify the risk factors of VTE, and multivariate logistic regression analysis was further performed to determine the independent risk factors. Furthermore, the corresponding nomogram was conducted to establish a predicted model for VTE. The overall incidence of VTE was 2.8%. The multivariate logistic regression analysis showed that discontinued anticoagulant or antiplatelet therapies (OR 4.505, 95% CI 1.410–14.401), increased postoperative 12-h d-dimer (OR 11.162, 95% CI 2.370–52.574), hydronephrosis (OR 3.303, 95% CI 1.303–8.375), higher Caprini risk assessment model (RAM) score (OR 3.233, 95% CI 1.207–8.659) and postoperative sepsis or septic shock (OR 3.784, 95% CI 1.163–12.306) were independent risk factors of VTE following PCNL. Moreover, the area under the curve of postoperative 12-h d-dimer, hydronephrosis and Caprini RAM score was 0.826, 0.621 and 0.660, respectively. Based on the identified independent risk factors, the well-calibrated nomogram showed a moderate discriminative ability with concordance index 0.731. 2.8% of patients developed VTE following PCNL. Regarding those patients who have independent risk factors in this study, due attention should be paid to the effective thromboprophylaxis and the early detection of VTE.

Objective: The purpose of this meta-analysis was to systematically assess the influence of three-dimensional (3D) printing technology in laparoscopic partial nephrectomy (LPN) of complex renal tumors. Methods: A systematic literature review was performed in June 2020 using the Web of Science, PubMed, Embase, the Cochrane library, the China National Knowledge Infrastructure (CNKI), and the Wanfang Databases to identify relevant studies. The data relative to operation time, warm ischemic time, intraoperative blood loss, positive surgical margin, reduction in estimated glomerular filtration rate (eGFR), and complications (including artery embolization, hematoma, urinary fistula, transfusion, hematuria, intraoperative bleeding, and fever) were extracted. Two reviewers independently assessed the quality of all included studies, and the eligible studies were included and analyzed using the Stata 12.1 software. A subgroup analysis was performed stratifying patients according to the complexity of the tumor and surgery type or to the nephrometry score. Results: One randomized controlled trial (RCT), two prospective controlled studies (PCS), and seven retrospective comparative studies (RCS) were analyzed, involving a total of 647 patients. Our meta-analysis showed that there were significant differences in operation time, warm ischemic time, intraoperative blood loss, reduction in eGFR and complications between the LPN with 3D-preoperative assessment (LPN-3DPA) versus LPN with conventional 2D preoperative assessment (LPN-C2DPA) groups. Positive surgical margin did not differ significantly. Conclusion: The LPN-3DPA group showed shorter operation time and warm ischemic time, as well as less intraoperative blood loss, reduction in eGFR, fewer complications for patients with complex renal tumor. Therefore, LPN assisted by three-dimensional printing technology should be a preferable treatment of complex renal tumor when compared with conventional LPN. However, further large-scale RCTs are needed in the future to confirm these findings.

Day care percutaneous nephrolithotomy is being performed rapidly. This meta-analysis aimed to assess the safety and efficacy of PCNL as a day care surgical procedure compared to conventional inpatient PCNL.Randomized controlled trials and clinical controlled trials involving day care percutaneous nephrolithotomy were included by searching PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE up to Jan 2020. We completed a meta-analysis to assess the two surgical procedures.Four retrospective case-controlled trials, one prospective cohort study and one randomized controlled trial were included in the meta-analysis. The meta-analysis revealed that there was no significant difference between the day care PCNL and inpatient PCNL groups in the stone-free rate (OR = 1.49; 95% CI, 0.83 to 2.67; P = 0.18). The mean overall complication rates were 13.6% and 24.4% in the day care and inpatient PCNL groups, respectively (OR = 0.47; 95% CI, 0.30 to 0.72; P 0.001). The two groups had similar readmission rates (OR = 1.73, 95% CI, 0.67 to 4.50, P = 0.26). In addition, day care PCNL was associated with a shorter operative time (WMD = -11.89 min; 95% CI, -20.37 to -3.42; P = 0.006) and shorter hospital stay (WMD = -61.01 h; 95% CI, -107.54 to -12.48; P = 0.01).Our meta-analysis demonstrated that PCNL can be performed safely and efficiently in selected patients as a day care surgical procedure.