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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]

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]

To evaluate whether different positions are advantageous for hemodynamics and respiratory balance in patients undergoing percutaneous nephrolithotomy (PCNL) procedures. Pre- and postoperative arterial blood gas data obtained during spontaneous breathing for 67 prone (Group 1) and 56 supine (Group 2) patients undergoing PCNL were analyzed. Additionally data on all patients' gender, age, body mass index, stone size, access and surgical duration, volume of irrigation fluid, length of hospital stay, requirement for blood transfusion, and residual stones were recorded: There were no differences between the groups in terms of age, stone size, operation time, access time, radiation exposure, transfusion requirements, stone-free rate, and length of hospitalization. A statistically significant pH decrease was observed in both groups in the postoperative period (p = 0.001 and p = 0.001, respectively). There was a statistically significant increase in pCO2 values in both groups in the postoperative period (p = 0.001 and p = 0.024, respectively), and that increase did not differ significantly between the groups (p = 0.624). A statistically significant decrease in pO2 and SpO2 values was observed in both groups in the postoperative period compared to the preoperative period. Again, no statistical difference was observed between the groups for these values. There was a statistically significant decrease in bicarbonate in both groups period (p < 0.001 and p = 0.001, respectively). Hemodynamics and the respiratory balance of the patient are impaired in both prone and supine positions. Neither position is superior to the other in this respect. [ABSTRACT FROM AUTHOR]

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 < 0.0001), the number of residual stone 1.3 times (OR = 1.326, P < 0.0001), the amount of residual stone 2.2 times (OR = 2.224, P < 0.0001) that of ANL. The risk of the cost of initial treatment after mini-PCNL in lateral supine position was 3.3 times (OR = 3.273, P < 0.0001), the total cost of treatment 4 times (OR = 4.051, P < 0.0001), the total length of hospital stays 1.4 times (OR = 1.44, P < 0.0001) that of ANL, the incidence of postoperative renal atrophy was 2.2 times (OR = 2.171, P = 0.008) higher in the ANL than in the mini-PCNL in lateral supine position. Glomerular filtration rate (GFR) reduction after ANL was 1.4 times (OR = 1.381, P = 0.037) greater than that after mini-PCNL in lateral supine position at 24-month follow-up. The risk of the overall satisfaction of ANL was 58 times (OR = 57.857, P < 0.0001) higher than that of mini-PCNL in lateral supine position, the number of branches of staghorn greater than 8 is a high risk factor for the occurrence of residual stone after mini-PCNL in lateral supine position (OR = 353.137, P < 0.0001). Conclusion: Although the risk of renal atrophy and decreased GFR after ANL is higher than that of mini-PCNL in lateral supine position, the efficacy of traditional ANL in the treatment of complete SRC was generally superior to that of mini-PCNL in lateral supine position. Moreover, number of branches of staghorn greater than 8 are the preferred ANL for complete SRC. Trial registration: ChiCTR2100047462. The trial was registered in the Chinese Clinical Trial Registry; registration date: 19/06/2021. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: Compare the surgical outcomes, safety, stone free rate, hospital stay, and complication of prone and supine PCNL in case of complex renal stone. Materials and methods: This is an observational study conducted in our institute, it consist of 120 patients over the period of 2 years from July 2021 to June 2023, all the patients were divided into two groups: 60 patients underwent modified supine percutaneous nephrolithotomy (PCNL) and remaining 60 patients underwent standard prone PCNL. The measured data included operative time, number of punctures, blood loss, stone-free rate, length of hospital stays, and rate of complications. Results: The two groups were comparable in mean age, male to female ratio, number of punctures, number of tract, size of tract, residual calculi in follow up period, blood transfusion, re-do surgery, chest complication, hospital stay, and postoperative fever and pain. The mean operating time was 1.59 h in supine PCNL and 2.49 h in prone PCNL. The p value was significant (p = 0.001). Conclusions: By this study we observed that the supine PCNL is associated with statistically significant reduced operating time as compared to conventional prone PCNL with advantages of not putting the patient in prone position. The postoperative complications such as pain and fever were not significant when compared in both groups. We conclude our study and found that, the supine PCNL is an equally effective in treating complex renal stone as compared to prone PCNL. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of hydronephrosis on operation success and the development of complications in supine percutaneous nephrolithotomy (PCNL). Methods: A total 259 patients were included in the study who underwent supine PCNL in our clinic between September 2019 and November 2023. The patients were divided into four groups: normal, mild, moderate and severe, according to their preoperative hydronephrosis degrees. Demographic data, kidney stone characteristics, clinical aspects, surgical findings, and postoperative complications were compared across groups. Results: In terms of American Society of Anesthesiologists score, stone-free rate, operation time, fluoroscopy time, and Clavien–Dindo classification grades, a statistically significant difference was found between the hydronephrosis groups. The stone-free rate in the normal, mild, moderate, and severe groups was 86.6, 82.5, 76.0, and 61.5, respectively. The severe hydronephrosis group varied statistically substantially from the other hydronephrosis groups in terms of stone-free rate, according to the post-hoc analysis. In terms of Clavien–Dindo classification grades, the severe hydronephrosis group varied statistically significantly from the normal and mild hydronephrosis groups (p values 0.04, 0.02, respectively). In terms of Clavien–Dindo classification grades, no statistically significant difference was seen between the severe and moderate hydronephrosis groups (p = 0.085). Conclusion: The findings of this study demonstrated that the existence of hydronephrosis was a predictive factor for the occurrence of complications and decreased the success rate of supine PCNL. Furthermore, univariate and multivariate analyses showed that the presence of hydronephrosis was a predictive factor for PCNL success and the development of complications. [ABSTRACT FROM AUTHOR]

Background and Objectives: Percutaneous nephrolithotomy (PCNL) is a current treatment method with high success rates and low complication rates in treating large kidney stones. It can be conducted in different positions, especially supine and prone positions. PCNL in the supine position is becoming increasingly common due to its advantages, such as simultaneous retrograde intervention and better anesthesia management. This study aimed to assess how the choice of position impacts the PCNL learning curve. Materials and Methods: The results of the first 50 consecutive PCNL cases performed by two separate chief residents as primary surgeons in supine and prone positions in a reference center for stone treatment between August 2021 and January 2023 were evaluated. The two groups' demographic and clinical data, stone-free rates, operation times, and fluoroscopy times were compared. Results: While the mean operation time was 94.6 ± 9.8 min in the supine PCNL group, it was 129.9 ± 20.3 min in the prone PCNL group (p < 0.001). Median fluoroscopy times in the supine PCNL and prone PCNL groups were 31 (10–89) seconds and 48 (23–156) seconds, respectively (p = 0.001). During the operation, the plateau was reached after the 10th case in the supine PCNL group, while it was reached after the 40th case in the prone PCNL group. Conclusions: For surgeons who are novices in performing PCNL, supine PCNL may offer both better results and a faster learning curve. Prospective and randomized studies can provide more robust conclusions on this subject. [ABSTRACT FROM AUTHOR]

Impacted proximal ureteral stones (IPUS) present challenging clinical scenarios due to their persistent nature and associated complications. While ureterorenoscopy (URS) lithotripsy is recommended as the primary treatment, controversies exist regarding the optimal management of such stones. In this retrospective analysis, we compared the operative outcomes and long-term results of transperitoneal laparoscopic ureterolithotomy (LU) and percutaneous nephrolithotomy (PCNL) for IPUS larger than 15 mm. Propensity score matching (PSM) was employed to mitigate potential selection biases. Following PSM, 83 patients in each cohort exhibited comparable baseline characteristics. LU demonstrated a superior surgical success rate (100% vs. 96.4%, p = 0.244) and significantly lower perioperative hemoglobin decline (0.6 ± 0.4 g/dL vs. 1.5 ± 0.7 g/dL, p = 0.036) compared to PCNL. Additionally, LU exhibited a higher stone-free rate after 2 months (100% vs. 91.6%, p = 0.043), but a longer duration of catheterization (7.4 ± 1.2 days vs. 3.5 ± 2.2 days vs., p = 0.011). Conversely, PCNL was associated with a higher incidence of total complications (21.7% vs. 9.6%, p = 0.033) and stone recurrence during a mean period of 40-month follow-up (20.5% vs. 8.4%, p = 0.027). Transperitoneal LU and PCNL represent effective interventions for managing IPUS exceeding 15 mm. Notably, LU emerges as a preferable option over PCNL, offering superior stone clearance rates, reduced perioperative complications, and lower recurrence rates. [ABSTRACT FROM AUTHOR]

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 FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

To assess the safety and effectiveness of tubed versus tubeless percutaneous nephrolithotomy (PCNL) after tract inspection and bipolar cauterization of the significant bleeders. Patients who were scheduled for PCNL were screened for enrollment in this prospective randomized controlled trial. The patients were randomly assigned to one of two groups; Group 1 received tubeless PCNL with endoscopic inspection of the access tract using bipolar cauterization of the significant bleeders only, while Group 2 had a nephrostomy tube was inserted without tract inspection. We excluded patients with multiple tracts, stone clearance failure, and significant collecting system perforation. We recorded blood loss, hemoglobin drop after 6 h, postoperative analgesia requirements, hospital stay, and the need for angioembolization. A total of 110 patients completed the study. There were no significant differences between the two groups in in terms of demographic characteristics. Likewise, there was no significant difference in the mean decrease in hemoglobin after 6 h and the frequency of blood transfusion. However, the incidence of hematuria within the first 6 h (p = 0.008), postoperative pain scale (p = 0.0001), the rate of analgesia requirement (p = 0.0001) and prolonged hospital stay (p = 0.0001) were significantly higher in Group 2. Only 9 cases of tract screened patients (16% of group 1) required cauterization. Tubeless PCNL with tract inspection and cauterization of bleeders can provide a safer tubeless PCNL with less postoperative pain, analgesia requirement, and same-day discharge. [ABSTRACT FROM AUTHOR]

This review addresses the management of urolithiasis in renal transplant recipients, a notably vulnerable group due to the unique anatomical and physiological alterations of the transplanted organ. The prevalence of nephrolithiasis in these patients varies between 0.1% and 6.3%, with a significant impact on graft longevity and function. Surgical access complications due to the renal graft's position on the iliac vessels and the variety of urinary anastomoses complicate the treatment approaches. This study evaluates the effectiveness and outcomes of percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS), two primary minimally invasive strategies for managing graft stones. Through a narrative review using the PubMed and EMBASE databases, it was found that PCNL offers high stone-free rates especially beneficial for large stones, whereas URS provides a less invasive option with a lower risk of complications for small stones. Both techniques require tailored approaches based on stone composition—mostly calcium oxalate—and specific patient anatomical factors. This review underscores the importance of early diagnosis, appropriate treatment selection, and continuous post-treatment monitoring to mitigate risks and promote long-term renal function in transplant recipients. [ABSTRACT FROM AUTHOR]

Purpose: We assessed the impact of the one-year endourological society fellowship program (ESFP) on the achievement of optimal surgical outcomes (OSO) in stone patients treated with ureteroscopy (URS). Materials and Methods: We identified 303 stone patients treated with URS from January 2018 to June 2022 by five experienced surgeons (ES). Of those, two attended ESFP. OSO was defined as the presence of residual fragments ≤ 4 mm at 1-month post-operative imaging (Ultrasound + X – Ray or CT scan). Descriptive statistics explored patients' characteristics and the rate of OSO according to the attendance of ESFP. Uni- and multivariate logistic regression analyses (UVA and MVA) tested the impact of stone characteristics, surgical data, ESFP, and imaging technique on the rate of OSO. The LOWESS curve explored the graphical association between stone size and the multivariable-adjusted probability of OSO in the two groups of surgeons. Results: Of 303 patients, 208 (69%) were treated by the two surgeons who attended ESFP. OSO was achieved in 66% and 52% of patients treated by ES with and without ESFP, respectively (p = 0.01). At UVA, ESFP (OR = 1.78; 95% CI = 1.09–2.90), stone diameter (OR = 0.92; 95% CI = 0.88–0.96), stone location (kidney vs. ureter; OR = 0.34; 95% CI = 0.21–0.58), imaging technique (CT scan vs. Ultrasound + X-Ray; OR = 0.28; 95% CI = 0.16–0.47) predicted OSO achievement (all p < 0.05). At MVA analyses, ESFP was associated with OSO (OR = 2.24; 95% CI = 1.29–3.88; p < 0.05), along with the other aforementioned variables. The LOWESS curve showed that the greater the stone size, the greater the difference in OSO in the two groups of surgeons. Conclusions: ESFP positively affects OSO achievement after URS, especially in patients with a high stone burden. [ABSTRACT FROM AUTHOR]

Background: To evaluate the incidence of metabolic syndrome (MetS) in patients with unilateral and bilateral staghorn calculi (SC) and evaluate the impact on the outcome of percutaneous nephrolithotomy (PCNL). Methods: The clinical data of patients who underwent PCNL for the treatment of SC between 2019 and 2022 were retrospectively reviewed. SC was divided into unilateral and bilateral. The incidence of MetS was compared between the patients with unilateral SC and the patients with bilateral SC, and the impact on the outcome of PCNL was assessed. Results: A total of 1778 patients underwent PCNL between 2019 and 2022. After screening computed tomography, 379 patients were confirmed to have SC, finally, leaving 310 patients with follow-up and complete data to be included in the study. Eighty-four had bilateral SC and 226 had unilateral SC. The patients with bilateral SC had a significantly higher body mass index and higher rates of complete staghorn stones and metabolic syndrome. Higher body mass index, hypertension, diabetes mellitus, hyperlipidaemia, and MetS were present in 62.58%, 44.84%, 21.94%, 60.65% and 27.42% of all patients, respectively. The number of MetS components remained significantly associated with bilateral SC. Specifically, when the number of MetS components increases from 0 to 3–4, the likelihood of developing bilateral staghorn calculi increases by 21.967 times. Eighty-five patients with MetS(+) had a higher rate of overall complications (number (N)(%), 29 (34.12) vs.33 (14.46), P < 0.001) and a comparable stone-free rate to 225 MetS(-) patients. Multivariable analysis confirmed that hyperlipidaemia (P = 0.044, odds ratio [OR] = 1.991, 95% confidence interval [CI] 1.020–3.888) and MetS (P = 0.005, OR = 2.427, 95% CI 1.316–4.477) were independent risk factors for overall complications. Conclusions: MetS is correlated with the formation of bilateral SC and is the main predictor for complications of PCNL especially for low-grade complications (I-II). [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to develop and evaluate the performance of machine learning models for predicting the possibility of systemic inflammatory response syndrome (SIRS) following percutaneous nephrolithotomy (PCNL). Methods: We retrospectively reviewed the clinical data of 337 patients who received PCNL between May 2020 and June 2022. In our study, 80% of the data were used as the training set, and the remaining data were used as the testing set. Separate prediction models based on the six machine learning algorithms were created using the training set. The predictive performance of each machine learning model was determined by the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity and specificity using the testing set. We used coefficients to interpret the contribution of each variable to the predictive performance. Results: Among the six machine learning algorithms, the support vector machine (SVM) delivered the best performance with accuracy of 0.868, AUC of 0.942 (95% CI 0.890–0.994) in the testing set. Further analysis using the SVM model showed that prealbumin contributed the most to the prediction of the outcome, followed by preoperative urine culture, systemic immune-inflammation (SII), neutrophil to lymphocyte ratio (NLR), staghorn stones, fibrinogen, operation time, preoperative urine white blood cell (WBC), preoperative urea nitrogen, hydronephrosis, stone burden, sex and preoperative lymphocyte count. Conclusion: Machine learning-based prediction models can accurately predict the possibility of SIRS after PCNL in advance by learning patient clinical data, and should be used to guide surgeons in clinical decision-making. [ABSTRACT FROM AUTHOR]

Objective • Kidney stones (renal calculi) are a prevalent medical condition, causing significant pain and discomfort to patients. The existing treatment options for kidney stones include extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and flexible ureteroscopy. It is crucial to evaluate the effectiveness of different treatment modalities, including flexible ureteroscopy, to ensure optimal patient outcomes. This study aims to assess the effectiveness of flexible ureteroscopy in treating renal calculi and determine its value in managing this condition. Methods • The study involved a total of 106 patients with kidney stones admitted to the hospital. The patients were divided into an experimental group and a control group. In the control group, percutaneous nephrolithotomy was performed on the patients. The procedure involved placing the patient in the lithotomy position, making an opening at the urethra, inserting a ureteral catheter retrograde to the affected side, and performing puncture under ultrasound guidance. Postoperative anti-infection treatment was given and the results were evaluated through imaging.In the experimental group, ureteral lithotripsy was performed with the patient under general anesthesia. The procedure included dilating the patient’s ureter, exploring the location of the kidney stone, using a laser lithotripter to crush the stone, and clearing the fragments. A double J tube was placed at the end of the procedure, and the patient received appropriate antibiotics. Treatment and care continued until the patients were discharged. Clinical efficacy, clinical indicators, renal function, coagulation function, complications, and other factors were observed and recorded. Results • The experimental group showed higher rates of treatment effectiveness (98.11%) and significance (79.25%) compared to the control group, while the treatment failure rate (1.89%) was lower in the experimental group (P < .05). In terms of surgical outcomes, the experimental group had lower intraoperative bleeding volume, catheter removal time, hospitalization time, and postoperative activity time compared to the control group. The time to get out of bed after surgery and drainage tube removal time were also lower in the experimental group. However, the operation time was longer in the experimental group (P < .05). Regarding postoperative indicators, the experimental group exhibited lower levels of KIM-1, Cys-c, and NGAL compared to the control group (P < .05). The experimental group also had lower MA and α values, but higher R and K values during the postoperative period compared to the control group (P < .05). Overall, the experimental group had a significantly lower complication rate (11.32%) compared to the control group (28.30%) (P < .05). Conclusion • The use of ureteroscopic lithotripsy in the treatment of kidney stones can effectively improve the efficiency of patient treatment, with better intraoperative conditions and better prognosis, and less impact on the patient’s renal function and coagulation function, as well as reducing the occurrence of postoperative complications in patients, which is worthy of wide application and promotion in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To determine whether preoperative use of JJ stents in patients undergoing shockwave lithotripsy (SWL) impacts on stone clearance and the rate of postoperative complications. Patients and Methods: We screened multiple databases from inception to January 2021, using the relevant search terms for SWL in patients with a preoperative stent. Inclusion criteria were randomised controlled trials of ≥20 patients aged >18 years who had had SWL with a JJ stent. This review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42023443195). Statistical analysis was performed using 'meta' in R. Results: There were seven eligible studies (403 patients receiving JJ stents and 394 controls). There was no significant difference in the stone‐free rate (SFR) following SWL with a JJ stent compared to SWL alone. When considering the complication rates, there was a significantly reduced risk of steinstrasse in patients with a JJ stent. However, there was no significant difference in the risk of other complications including pain, fever, and haematuria, and no significant difference in the likelihood of requiring auxiliary procedures or re‐treatment. Conclusions: There was a reduced risk of steinstrasse in patients undergoing SWL with a JJ stent compared to SWL alone. However, there was no significant difference in the risk of other postoperative complications. Use of a JJ stent had no effect on the efficacy of SWL, with no significant difference in the SFR. [ABSTRACT FROM AUTHOR]

From September 2016 to September 2019, this study was carried out at the Urology and Nephrology University Hospital at Assiut University in Assiut, Egypt. On sixty individuals were divided into two therapy groups, each comprising thirty patients. The first group underwent a traditional percutaneous nephrolithotomy (PCNL), while the second group underwent a tubeless procedure. The average blood loss before and after the procedure, changes in hemoglobin, and creatinine levels did not differ statistically significantly between the two groups, according to the results. These findings demonstrates that the tubeless group had a longer surgical length, a difference that was statistically significant (P-value = 0.034*). However, there were no significant differences between the two groups with respect to the number of tracts or methods of access. Following the procedure, the patient was randomly assigned to have either a nephrostomy tube or have the tract closed without the need for a tube. The patient was randomly assigned to get either a nephrostomy tube or have the tract closed without the need for a tube. [ABSTRACT FROM AUTHOR]

Background: The treatment of lower calyceal calculi with a size <1.5 cm remains a subject of debate. Mini-percutaneous nephrolithotomy (Mini PCNL) and retrograde intrarenal surgery (RIRS) are both effective options, but there is a need for comparative analysis to determine the optimal approach. Mini-perc has the advantage of direct visualization and efficient fragmentation and clearance, while RIRS is a minimally invasive technique with excellent visualization and minimal morbidity. Aims and Objectives: This study aims to evaluate and compare the efficacy, safety, and outcomes of mini-perc PCNL and RIRS in the management of lower calyceal calculi. Materials and Methods: This retrospective comparative cohort study included a total of 72 patients with lower calyceal calculi <1.5 cm. Thirty-six patients underwent mini-perc, and 36 patients underwent RIRS. Results: No significant differences were observed in patient demographic characteristics, stone size, or stone location between the mini-perc and RIRS groups. The mini-perc group had a significantly higher stone-free rate (SFR) (94.4%) compared to the RIRS group (86.1%) (P<0.05). The mini-perc technique had a higher success rate in first-session stone clearance (88.9%) compared to RIRS (77.8%) (P<0.05). The mini-perc group had a longer operative time, higher estimated blood loss, and a longer post-operative hospital stay compared to the RIRS group (P<0.05). Conclusion: Both mini-perc and RIRS techniques are effective for managing lower calyceal calculi <1.5 cm. Mini-perc offers a SFR and a better success rate in first-session stone clearance compared to RIRS. However, mini-perc procedures are associated with longer operative time, higher estimated blood loss, and a longer post-operative hospital stay. [ABSTRACT FROM AUTHOR]

Background: Complex renal calculi, characterized by their size, location, and composition, pose a significant challenge to urologists due to the potential for complications and the difficulty in achieving complete stone clearance. Conventional percutaneous nephrolithotomy (PCNL) and endoscopic combined intrarenal surgery (ECIRS) are two established techniques for managing these complex renal calculi. Aims and Objectives: The aims and objectives are to compare the effectiveness, safety, and outcomes of PCNL versus ECIRS in managing complex renal calculi in a cohort of 60 cases treated at GMKMCH-Salem. Materials and Methods: A retrospective analysis was conducted on 60 patients with complex renal calculi who underwent either conventional PCNL or ECIRS during a specified period at GMKMCH-Salem. Patient demographics, stone characteristics, procedural details, intraoperative and post-operative parameters, and complications were analyzed and compared between the two treatment groups. Results: The study found that both PCNL and ECIRS techniques were effective in treating complex renal calculi. However, significant differences were observed between the two groups in terms of outcomes. The ECIRS technique exhibited superior outcomes with higher stone clearance rates (P<0.001), shorter operative times (P<0.05), and reduced hospital stays (P<0.05) compared to conventional PCNL. Conclusion: This study demonstrates that ECIRS is a promising alternative to conventional PCNL in the management of complex renal calculi. The ECIRS technique yielded higher stone clearance rates, shorter operative times, and reduced hospital stays, potentially improving patient outcomes and reducing health-care costs. Although our findings show favorable results for ECIRS, the decision between conventional PCNL and ECIRS should be based on individual patient characteristics, surgeon expertise, and resource availability. [ABSTRACT FROM AUTHOR]

Copyright of Osmangazi Journal of Medicine / Osmangazi Tip Dergisi is the property of Eskisehir Osmangazi University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Minimally invasive percutaneous nephrolithotomy (mini-PCNL) maintains a stone clearance rate similar to standard PCNL while reducing blood loss. Bleeding is a complex and serious complication that can arise after PCNL surgery. Pseudoaneurysm (PA) is an uncommon type of delayed bleeding problem, which affects less than 1% of patients after PCNL. The most effective treatment for severe post-PCNL hemorrhage is super-selective renal angiographic embolization (SRAE), but it can fail in some patients and require additional surgical intervention. This report details the case of a male patient, 55 years old, who experienced severe bleeding four times and had three SRAE procedures and one laparoscopic procedure after PCNL. The presence of a renal artery pseudoaneurysm was not initially identified during the first two attempts of angiography due to arterial spasm and a small, undeveloped lesion. This case report is intended to enhance awareness of tiny pseudoaneurysms, emphasizing the importance of avoiding oversight to improve the success rate of embolization. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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.

Abstract Objective The objective of this study was to develop and evaluate the performance of machine learning models for predicting the possibility of systemic inflammatory response syndrome (SIRS) following percutaneous nephrolithotomy (PCNL). Methods We retrospectively reviewed the clinical data of 337 patients who received PCNL between May 2020 and June 2022. In our study, 80% of the data were used as the training set, and the remaining data were used as the testing set. Separate prediction models based on the six machine learning algorithms were created using the training set. The predictive performance of each machine learning model was determined by the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity and specificity using the testing set. We used coefficients to interpret the contribution of each variable to the predictive performance. Results Among the six machine learning algorithms, the support vector machine (SVM) delivered the best performance with accuracy of 0.868, AUC of 0.942 (95% CI 0.890–0.994) in the testing set. Further analysis using the SVM model showed that prealbumin contributed the most to the prediction of the outcome, followed by preoperative urine culture, systemic immune-inflammation (SII), neutrophil to lymphocyte ratio (NLR), staghorn stones, fibrinogen, operation time, preoperative urine white blood cell (WBC), preoperative urea nitrogen, hydronephrosis, stone burden, sex and preoperative lymphocyte count. Conclusion Machine learning-based prediction models can accurately predict the possibility of SIRS after PCNL in advance by learning patient clinical data, and should be used to guide surgeons in clinical decision-making.

Abstract Background To evaluate the incidence of metabolic syndrome (MetS) in patients with unilateral and bilateral staghorn calculi (SC) and evaluate the impact on the outcome of percutaneous nephrolithotomy (PCNL). Methods The clinical data of patients who underwent PCNL for the treatment of SC between 2019 and 2022 were retrospectively reviewed. SC was divided into unilateral and bilateral. The incidence of MetS was compared between the patients with unilateral SC and the patients with bilateral SC, and the impact on the outcome of PCNL was assessed. Results A total of 1778 patients underwent PCNL between 2019 and 2022. After screening computed tomography, 379 patients were confirmed to have SC, finally, leaving 310 patients with follow-up and complete data to be included in the study. Eighty-four had bilateral SC and 226 had unilateral SC. The patients with bilateral SC had a significantly higher body mass index and higher rates of complete staghorn stones and metabolic syndrome. Higher body mass index, hypertension, diabetes mellitus, hyperlipidaemia, and MetS were present in 62.58%, 44.84%, 21.94%, 60.65% and 27.42% of all patients, respectively. The number of MetS components remained significantly associated with bilateral SC. Specifically, when the number of MetS components increases from 0 to 3–4, the likelihood of developing bilateral staghorn calculi increases by 21.967 times. Eighty-five patients with MetS( +) had a higher rate of overall complications (number (N)(%), 29 (34.12) vs.33 (14.46), P

Double-j stents are commonly used in many urological procedures to facilitate the drainage of renal systems postoperatively. Their usage has revolutionized the world of urological interventions but if left forgotten present serious complications. We report a case of an old man who was diagnosed with bilaterally fragmented DJ stents in situ in our urology department following his sessions of extracorporeal shock wave lithotripsy for chronic encrustations. These stents were placed after complete breakdown of bilateral ureteral stones through ureterorenoscopy and laser lithotripsy.

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.

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]

Abstract Background There are numerous methods available for predicting sepsis following Percutaneous Nephrolithotomy. This study aims to compare the predictive value of Quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SISR), National Early Warning Score (NEWS), interleukin-6 (IL-6), and procalcitonin (PCT) for septicemia. Methods Patients who underwent percutaneous nephrolithotomy were included in the study and divided into a control group and a septic shock group. The effectiveness of qSOFA, SIRS, NEWS, Interleukin-6, and Procalcitonin was assessed, with Receiver Operating Characteristic curves and Area Under the Curve used to compare the predictive accuracy of these four indicators. Results Among the 401 patients, 16 cases (3.99%) developed septic shock. Females, elderly individuals, and patients with positive urine culture and positive nitrite in urine were found to be more susceptible to septic shock. PCT, IL-6, SIRS, NEWS, qSOFA, and surgical time were identified as independent risk factors for septic shock. The cutoff values are as follows: qSOFA score > 0.50, SIRS score > 2.50, NEWS score > 2.50, and IL-6 > 264.00 pg/ml. Among the 29 patients identified by IL-6 as having sepsis, 16 were confirmed to have developed sepsis. The qSOFA identified 63 septicemia cases, with 16 confirmed to have developed septicemia; NEWS identified 122 septicemia cases, of which 14 cases actually developed septicemia; SIRS identified 128 septicemia patients, with 16 confirmed to have developed septicemia. In terms of predictive ability, IL-6 (AUC 0.993, 95% CI 0.985 ~ 1) demonstrated a higher predictive accuracy compared to qSOFA (AUC 0.952, 95% CI 0.928 ~ 0.977), NEWS (AUC 0.824, 95% CI 0.720 ~ 0.929) and SIRS (AUC 0.928, 95% CI 0.888 ~ 0.969). Conclusions IL-6 has higher accuracy in predicting septic shock after PCNL compared to qSOFA, SIRS, and NEWS.

To date, the literature presents a wide data regarding the effectiveness, safety, and technical features of percutaneous nephrolithotomy. A significant proportion of studies are presented in the format of systematic literature reviews and meta-analyses. This article presents an analysis of the accumulated data was carried out in the form of a systematic review of meta-analyses.