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To compare the outcomes of using Ultrathin semirigid retrograde ureteroscopy and antegrade flexible ureteroscopy to treat proximal ureteric stones of sizes 1–2 cm. A prospective randomized multicenter study included patients who had proximal ureteric stones 1–2 cm, amenable for ureteroscopy and laser lithotripsy between August 2023 and February 2024. Two hundred thirty patients were divided evenly into two treatment groups. Group I included patients treated with antegrade flexible ureteroscopy and holmium laser stone fragmentation, and Group II included patients treated with retrograde ultrathin semirigid ureteroscopy. The study groups were compared in terms of patient demographics, stone access success, operation time, reoperation rates, peri-operative complications, and stone-free status. Group I included 114 patients, while Group II included 111. The mean age of the patients was 33.92 ± 10.37 years, and the size of the stones was 15.88 ± 3 mm. The study groups had comparable demographics and stone characteristics. The mean operative time was significantly longer in group I than in group II (102.55 ± 72.46 min vs. 60.98 ± 14.84 min, respectively, P < 0.001). Most reported complications were MCCS grades I and II, with no significant difference between the study groups. The stone-free rate after four weeks was 92.1% and 81.1% for groups I and II, respectively, which increased to 94.7% and 85.6% after eight weeks (P > 0.05). Antegrade flexible ureteroscopy is equivalent to retrograde ultrathin semirigid ureteroscopy in treating proximal ureteric stones regarding stone-free status and procedure-related morbidity. However, the antegrade approach has a longer operative time, greater fluoroscopy exposure, and longer hospital stays. [ABSTRACT FROM AUTHOR]

Objective: National guidelines recommend periprocedural antibiotics before percutaneous nephrolithotomy (PCNL), yet it is not clear which is superior. We conducted a randomized trial to compare two guideline-recommended antibiotics: ciprofloxacin (cipro) vs cefazolin, on PCNL outcomes, focusing on the development of systemic inflammatory response syndrome (SIRS) criteria. Methods: Adult patients who were not considered high risk for surgical or infectious complications and undergoing PCNL were randomized to receive either cipro or cefazolin perioperatively. All had negative preoperative urine cultures. Demographic and perioperative data were collected, including SIRS criteria, intraoperative urine culture, duration of hospitalization, and need for intensive care. SIRS is defined by ≥2 of the following: body temperature <96.8°F or >100.4°F, heart rate >90 bpm, respiratory rate >20 per minute, and white blood cell count <4000 or >12,000 cells/mm3. Results: One hundred forty-seven patients were enrolled and randomized (79 cefazolin and 68 cipro). All preoperative characteristics were similar (p > 0.05), except for mean age, which was higher in the cipro group (64 vs 57 years, p = 0.03). Intra- and postoperative findings were similar, with no difference between groups (p > 0.05), except a longer mean hospital stay in the cefazolin group (2 hours longer, p = 0.02). There was no difference between SIRS episodes in both univariate and multivariate analyses. Conclusions: Despite the relatively broader coverage for urinary tract pathogens with ciprofloxacin, this prospective randomized trial did not show superiority over cefazolin. Our findings therefore support two appropriate options for perioperative antibiotic prophylaxis in patients undergoing PCNL who are nonhigh risk for infectious complications. [ABSTRACT FROM AUTHOR]

Percutaneous access for treatment of renal pathologies is a minimally invasive modality, although it can present complications. Small bowel lesions are rare but correct diagnosis and management are essential to prevent major complications. A patient submitted to an uncomplicated percutaneous nephrolithotomy presented jejunal transfixing perforation with a stable clinical progression. It was first managed conservatively unsuccessfully. Therefore, a laparotomy with enterectomy was necessary, with a favorable outcome. In transfixing lesions of the small bowel, diagnosis may be difficult and delayed. This contributes to conservative management failures and the requirement of laparotomy with enterectomy in order to reduce further complications.

Purpose: Define factors for proper diagnosis and treatment of small intestinal injury during procedures with percutaneous renal access, thus optimizing favorable outcomes and avoiding complications and death during conservative or surgical approaches. Materials and methods: Bibliographic review of case reports available in the literature and presentation of data from an additional case have been carried out. Results: Percutaneous nephrolithotripsy was the procedure that most frequently caused injury of the small intestine. Time for diagnosis of the lesion took up to 5 days after the intraoperative phase. When occurring in the intraoperative phase, perforation was identified by direct endoscopic visualization; a catheter was then placed inside the intestinal lumen and a conservative approach to the derived fistula was adopted, which led to successful outcomes in all cases. Abdominal pain was the most common symptom in cases diagnosed during the postoperative phase (75%). In the presence of signs of peritonitis, surgical intervention was performed, with favorable evolution in all cases. Conclusions: Conservative management of small intestine injuries is possible when there is no peritoneal contamination. Its success factors include intraoperative diagnosis and non-transfixing lesions, which is more common in duodenal involvement. Laparotomy to clean the cavity associated with a corrective approach (enterorrhaphy or enterectomy with primary anastomosis) was successfully indicated in cases of late diagnosis with signs of peritonitis, a situation that is most commonly found in transfixing lesions of ileum and jejunum. [ABSTRACT FROM AUTHOR]

Purpose: A new minimally invasive approach for endopyelotomy for the treatment of ureteropelvic junction obstruction (UPJO) is described. The results are compared with those of other lines of treatment. Materials and Methods: A total of 39 patients with UPJO underwent percutaneous retropelvic endopyelotomy. Retrograde percutaneous renal access, using the Lawson catheter and deflecting guidewire, was done for creation of the nephrostomy tract. Using holmium laser through a 28-Fr nephroscope, a small window was made in the posterolateral surface of the renal pelvis. The nephroscope was advanced from the renal pelvis to the retropelvic space through that window. Crossing vessels were easily detected and were either coagulated or avoided. The window incision was extended distally, and the narrow ureteropelvic junction (UPJ) was incised using holmium laser. Results: The entire procedure was done in the supine position within 1 h. The presence of secondary stones, hugely dilated renal pelvis, high insertion of the UPJ, and whether UPJO was primary or secondary, did not alter the results. The only factor that affected the results was split function of the obstructed renal unit. The success rate was 100% when the split function exceeded 35%. When the split function was

Purpose: A new minimally invasive approach for endopyelotomy for the treatment of ureteropelvic junction obstruction (UPJO) is described. The results are compared with those of other lines of treatment. Materials and Methods: A total of 39 patients with UPJO underwent percutaneous retropelvic endopyelotomy. Retrograde percutaneous renal access, using the Lawson catheter and deflecting guidewire, was done for creation of the nephrostomy tract. Using holmium laser through a 28-Fr nephroscope, a small window was made in the posterolateral surface of the renal pelvis. The nephroscope was advanced from the renal pelvis to the retropelvic space through that window. Crossing vessels were easily detected and were either coagulated or avoided. The window incision was extended distally, and the narrow ureteropelvic junction (UPJ) was incised using holmium laser. Results: The entire procedure was done in the supine position within 1 h. The presence of secondary stones, hugely dilated renal pelvis, high insertion of the UPJ, and whether UPJO was primary or secondary, did not alter the results. The only factor that affected the results was split function of the obstructed renal unit. The success rate was 100% when the split function exceeded 35%. When the split function was <35%, the success rate dropped to 56%. Conclusion: Percutaneous retropelvic endopyelotomy is a promising approach for the treatment of UPJO that gave favorable results. The use of the nephroscope provided a wide visual field. The wide-field facilitated detection of crossing blood vessels with no incident of vascular injury. It also facilitated endopyelotomy with high precision. Ureteral injury was not a risk factor. [ABSTRACT FROM AUTHOR]

Introduction: Patients with ileal conduit urinary diversions are at an increased risk of long-term upper urinary tract (UUT) complications, including anastomotic strictures, infections, and urolithiasis. The reconstructed urinary system poses challenges for endoscopic manipulation. We present and describe our dual-center experience in performing retrograde ureteroscopy to treat or diagnose UUT abnormalities in patients with ileal conduit incontinent diversion. Patient and Methods: We performed a retrospective analysis of medical records for all patients with previous urinary diversion who underwent retrograde ureteroscopic procedures via the ileal loop in our institutions over a 9 year period (between June 2007 and August 2016). Results: Fifty-four procedures were performed in 36 patients. Mean age was 61 (28–90) years. Average time from diversion to ureteroscopic procedure was 13.0 (0.08–53) years. Stone disease was the most common indication for intervention in 35.2% (19/54) of cases, with a stone-free rate of 78.9% (15/19). Other indications included surveillance of transitional-cell carcinoma in 22.2% (12/54), diagnostic flexible ureteroscopy (fURS) in 20.4% (11/54), stricture management in 11.1% (6/54), removal of encrusted stent/nephrostomy in 7.4% (4/54), urine leak after diversion in 1.9% (1/54), and miscellaneous in 1.9% (1/54). Successful retrograde access was possible in 74% (40/54) of cases. A long and tortuous ileal segment, too difficult to negotiate, was the most common cause of failure to access the UUT. In 13 out of 54 (24.1%) cases, retrograde fURS was combined with simultaneous percutaneous antegrade access. Six patients (11.1%) developed postprocedural pyrexia requiring additional antibiotic therapy, and one (1.9%) patient required embolization of the renal artery for ongoing bleeding. Median length of stay was 1 day (0–55), with 13 (24%) being performed as day-case procedures. Conclusions: Retrograde ureteroscopy in patients with ileal conduits can be technically challenging due to distorted anatomy. This procedure can be safely performed in experienced hands with standard endourological equipment. An antegrade approach can be carried out simultaneously, which may be required in a small number of patients. [ABSTRACT FROM AUTHOR]

Surgical management of ureteropelvic junction obstruction (UPJO) has historically been performed with open pyeloplasty. With the advent of endourology, laparoscopy, and robotics, minimally-invasive techniques have been described and accepted as alternatives to open surgery. Each of these approaches has its own advantages and disadvantages, equipment needs, degree of invasiveness, and experience of the treating urologist. Advocates and critics have their own say as to their preferred technique. In this article, we review the chronological evolution of these techniques and discuss their current role in the management of UPJO. [ABSTRACT FROM AUTHOR]

Purpose of Review: This study aims to make the reader be aware of recent trends regarding the endoscopic management of upper tract urothelial carcinoma (UTUC) via review of the urologic literature over the past 5 years. Given the rare incidence of this disease, and the lack of level 1 evidence, systematic reviews and meta-analyses were also evaluated. Studies of importance are also considered and outlined in the annotated reference section. Recent Findings: The PubMed database was queried using the following medical subject headings (MeSH terms): 'carcinoma, transitional cell,' 'ureter,' 'ureteral neoplasms,' 'kidney pelvis,' 'endoscopy,' 'laser therapy,' 'ureteroscopy,' 'urologic surgical procedures,' and 'ureteroscopes.' MeSH terms were linked together in varying combinations and limited to human studies in English. Given the relatively rare nature of upper tract urothelial carcinoma (UTUC), level 1 evidence regarding the efficacy of endoscopic treatment does not exist, even after 30+ years of experience. Rather, the literature available mostly is in the form of single institutional retrospective series consisting of relatively small numbers of patients with short to intermediate follow-up. Only within the last 3 years have published series with larger numbers of patients and mean follow-up over 5 years been made available. Even with these more robust experiences, comparisons among series are difficult given variable treatment and follow-up approaches. Summary: Most endoscopically managed UTUC will locally recur, especially with longer follow-up. Renal preservation rate is high, however, approaching 80% with follow-up well over 3 years. Patients with high-grade disease often fare poorly regardless of treatment modality. As such, endoscopic management for high-grade urothelial carcinoma should only be used in exceptional circumstances (i.e., in those patients medically unfit for NU or those with solitary kidneys wishing to avoid the morbidity of dialysis). No level 1 evidence exists for the routine use of intraluminal adjuvant therapy for UTUC (i.e., BCG and Mitomycin C) and multiple retrospective observational series claim there is no overt benefit. The recent formation of multiple international groups with interest in UTUC may eventually lead to the production of level 1 studies regarding optimal treatment; however, uniformity in treatment approach will likely still offer challenges. [ABSTRACT FROM AUTHOR]

Percutaneous renal access is a common procedure in urologic practice. The main indications are drainage of an obstructed and hydronephrotic kidney and antegrade renal access prior to percutaneous renal surgeries such as percutaneous nephrolithotomy (PCNL) and percutaneous endopyelotomy (EP). The contraindications for this technique are patients with history of allergy to topical or local anesthesia and patients with coagulopathy. The creation of a percutaneous tract into the renal collecting system is one of the important steps for percutaneous renal access. This step usually requires imaging. The advantages and disadvantages of each modality of image guidance are controversial. We performed a structured review using the terms: Percutaneous nephrostomy, guidance, fluoroscopy, ultrasonography, computed tomography (CT) scan, and magnetic resonance imaging (MRI). The outcomes are discussed.

Introduction: Percutaneous nephrolithotomy (PCNL) is one of the greatest advances in the field of urology and has been considered the gold standard in the treatment of renal calculi of more than 2 cm in size. While both the supine and prone positions offer their unique advantages, it is still being debated which position offers the most in terms of surgical outcomes. We have evaluated the two approaches in terms of operative time, success rate, stone clearance rate, safety, and complications., Methods: This prospective cohort study was done in the urology department of a tertiary care center in South India between January 2018 and October 2020. A total of 166 patients, with 83 in supine and 83 in prone positions, were included in the study., Results: Both groups were matched in terms of age, body mass index, stone size and location, co-morbidities, medications taken, presence of diverticular stone, history of surgery, and baseline creatinine level. Mean operative time and pain scores were noted to be less in supine position as compared to prone. Ease of puncture was superior in supine position. Stone residue was noted to be higher in supine PCNL as well., Conclusion: Supine PCNLs are preferred in high-risk patients while the prone position is preferred in bilateral PCNLs, complex anatomy, or larger stone burden., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Kannan et al.)

Introduction: Traditional techniques for obtaining percutaneous renal access utilize continuous fluoroscopy. In an attempt to minimize radiation exposure, we describe a novel laser direct alignment radiation reduction technique (DARRT) for percutaneous access and test it in a bench-top model. Methods: In this randomized-controlled bench-top study, 20 medical personnel obtained renal accesses using both the conventional bullseye technique and the laser DARRT. The primary endpoint was total fluoroscopy time. Secondary endpoints included insertion time, puncture attempts, course corrections, and subjective procedural difficulty. In the laser DARRT, fluoroscopy was used with the C-arm positioned with the laser beam at a 30° angle. The access needle and hub were aligned with the laser beam. Effective caliceal puncture was confirmed with fluoroscopy and direct vision. The Paired samples Wilcoxon signed rank test was used for statistical analysis with significance at p < 0.05. Results: A total of 120 needle placements were recorded. Fluoroscopy time for needle access using the laser DARRT was significantly lower than the bullseye technique in all groups as follows: attendings (7.09 vs 18.51 seconds; p < 0.001), residents (6.55 vs 13.93 seconds; p = 0.001), and medical students (6.69 vs 20.22 seconds; p < 0.001). Students rated the laser DARRT easier to use (2.56 vs 4.89; p < 0.001). No difference was seen in total access time, puncture attempts, or course corrections between techniques. Conclusion: The laser DARRT reduced fluoroscopy time by 63%, compared with the conventional bullseye technique. The least experienced users found the laser DARRT significantly easier to learn. This novel technique is promising and merits additional testing in animal and human models. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of three-dimensional (3D) printed pelvicaliceal system models on residents' understanding of pelvicaliceal system anatomy before percutaneous nephrolithotripsy (PCNL). Materials and Methods: Patients with unilateral complex renal stones indicating PCNL were selected. Usable data of patients were obtained from CT-scans in Digital Imaging and Communications inMedicine (DICOM) format.Mimics software version 16.0 (Materialise, Belgium) was used for segmentation and extraction of pelvicaliceal systems (PCSs). All DICOM-formatted files were converted to the stereolithography file format. Finally, fused deposition modeling was used to create plasticine 3Dmodels of PCSs.Aquestionnaire was designed so that residents could assess the 3D models' effects on their understanding of the anatomy of the pelvicaliceal system before PCNL (Fig. 3). Results: Five patients' anatomically accurate models of the human renal collecting system were effectively generated (Figs. 1 and 2). After presentation of the 3D models, residents were 86% and 88% better at determining the number of anterior and posterior calices, respectively, 60% better at understanding stone location, and 64% better at determining optimal entry calix into the collecting system (Fig. 5). Conclusion: Generating kidney models of PCSs using 3D printing technology is feasible, and the models were accepted by residents as aids in surgical planning and understanding of pelvicaliceal system anatomy before PCNL. [ABSTRACT FROM AUTHOR]

ObjectiveThe aim of this study was to analyse the results regarding survival, recurrence and kidney preservation after endoscopic treatment for upper urinary tract urothelial carcinoma (UTUC) in a Norwegian hospital during the period from 2001 to 2012, and compare them with results reported in the literature. A further aim was to re-examine all initial histopathological specimens, and stratify primary results according to the World Health Organization/International Society of Urological Pathology grading system of urothelial carcinoma from 2004.Materials and methodsForty-three patients were treated endoscopically with curative intent for UTUC during 2001–2012. Of these, 28 patients were candidates for nephroureterectomy (CNU) with an elective indication, while 15 were non-candidates for nephroureterectomy (NCNU). Analyses were performed separately for the CNU and NCNU groups.ResultsIn the CNU group, the 5 year overall and disease-specific survival (OS and DSS) were 71% and 94%, respectively. In the NCNU group, the OS and DSS were 25% and 41%, respectively. Histopathological verification was available in 40 patients (93%), and re-examination showed 27 low-grade and 13 high-grade tumours. In patients with a low-grade tumour, the OS and DSS were 75% and 96%, respectively. In patients with a high-grade tumour, the OS and DSS were 23% and 39%, respectively. The 5 year kidney protection rate was 51% in the CNU group. The 5 year recurrence-free survival was 72%.ConclusionsThe endoscopic treatment of UTUC is feasible and safe in histopathologically verified low-grade tumours. The endoscopic treatment of high-grade tumours has poor results, and must be reserved for patients where nephroureterectomy is truly contraindicated. [ABSTRACT FROM AUTHOR]

Objective Few studies report long-term follow-up of renal cancer treated by radiofrequency ablation (RFA), thus limiting the comparison of this modality to well-established long-term follow-up series of surgically resected renal masses. Herein, we report long-term oncologic outcomes of renal cancer treated with RFA in a single institution. Methods and materials We retrospectively reviewed patients treated between November 2001 and October 2012 with laparoscopic-guided or computed tomography–guided RFA. All treatments were performed with real-time thermometry ensuring target ablation temperature (>60°C) was adequately reached. Only patients with biopsy-confirmed T1a-category cancer and a follow-up period>48 months were included in our analysis. Follow-up included office visits, laboratory work, and periodic contrast-enhanced imaging. Survival was calculated using the Kaplan-Meier analysis. Overall complications were reported using the Clavien-Dindo scale. Results Of 434 RFA cases, 53 treatments in 50 patients met the inclusion criteria. Of these, 29 were treated with computed tomography–guided RFA and 24 with laparoscopic-guided RFA. The mean follow-up interval was 65.6 months (48.5–120.2), and the mean renal mass size was 2.3 cm (0.3–4.0). There were 4 (7.5%) local recurrences and 1 case of distant metastases with no local recurrence. The 5-year overall survival was 98%, cancer-specific survival was 100%, and recurrence-free survival was 92.5%. The complication rate was 26.4%, which included 71% of Clavien-Dindo grade I and 29% of grade II. Mean estimated glomerular filtration rate preoperatively and at the most recent follow-up visit was 77 and 66 ml/min, respectively. Conclusions When performed on selected patients, while monitoring real-time temperatures to ensure adequate treatment end points, RFA offers favorable long-term oncologic outcomes approaching those reported for partial nephrectomy. [ABSTRACT FROM AUTHOR]

Objective: Supracostal superior calyceal access has been shown to be the most suitable approach for staghorn calculi, calculi in the upper ureter, and complex inferior calyceal calculi. It is a good choice for direct access for most of the intrarenal collecting system and upper ureter. The aim of this retrospective study was to evaluate a single center data regarding the safety and efficacy of this approach for percutaneous renal stone surgery. Materials and methods: A total of 597 renal units (597 cases) were treated with percutaneous nephrolithotomy from the March of 2000 to March of 2005. Supracostal approach was selected in 123 cases and infracostal approach in remaining 474 cases. The indications of supracostal approach in our cases were staghorn and complex inferior calyceal stones, and stones in the upper calyx or the upper ureter. All punctures were made by the urologist under C-arm fluoroscopic guidance in the prone position. The interspace between 11th and 12th rib was used in 116 patients (94%) and 10th-11th interspace in 7 cases (6%). The operative time, success rate, hospital stay, and complications were evaluated. Results: The complete and relative success rates were 89.4 and 10.6%, respectively. The total complication rate was 13%. The success rate in the 10th-11th rib access and 11th-12th interrib access was 77 and 90%, respectively. Complete success rate was 100% in stone sizes less than 2 cm in diameter of upper ureteral and renal pelvic areas, and 77.4% of staghorn calculi. The total complication rate was 13% (16 cases), in which the most common of it was perioperative bleeding (5.7%; 7 cases). Conclusion: The supracostal approach was found to be effective as well as safe, with acceptable complications. It gives high stone clearance rates with acceptable morbidity rates and should be attempted in selected cases. The rate of pulmonary complications is higher with the supracostal approach. If the supracostal approach is indicated, it should be used with caution. [ABSTRACT FROM AUTHOR]

Introduction: Changes in the management of minimally invasive oncologic renal surgery have introduced ablative therapies as the most recent advancement in minimally invasive technology. Methods: The current evidence-based medicine on the topic of laparoscopic (LCA) and percutaneous (PCA) renal cryoablation was gathered and outlined in this review. The mechanism and surgical approach to performing renal cryoablation as well a focus on the oncologic and renal functional outcomes after cryoablation will be discussed. Results: Although initially recommended only for patients who were at a high surgical risk, presence of a solitary kidney, or in elderly patients, renal cryoablation, has expanded to include the majority of patients being treated for a small (<3.5 cm) renal cortical neoplasm. Conclusion: Renal cryoablation has become a viable minimally invasive treatment option for the majority patients diagnosed with a small (≤ 3cm) renal cortical neoplasm. Cryoablation does not seem to impact post-ablative renal function regardless of surgical approach, pre-ablation renal function, or presence of a solitary kidney. [ABSTRACT FROM AUTHOR]

Presents guidelines for selecting the ideal nephrostomy tubes in urology. Selection of pitail catheters for routine drainage in urinary obstruction; Effect of nephrostomy tube size on comfort of the patient.

Introduction: Nephrostomy tract dilation is one of the important steps of percutaneous renal surgery. In this study, we present our initial experience with the balloon dilator in 95 patients and compare our results retrospectively with a group of 30 patients in whom Amplatz dilators were used. Patients and Methods: The medical records of 95 patients who underwent percutaneous renal operations, including percutaneous nephrolithotomy and antegrade endopyelotomy, between September 1999 and September 2002 were reviewed. All procedures were performed using balloon dilators. The operative technique is the same as the other dilation procedures. Thirty consecutive patients who had previously undergone percutaneous renal surgery using the Amplatz dilators were taken as the control group and their charts were reviewed retrospectively, and the results compared with the results of patients in whom balloon dilation was used. Results: There were no major perioperative complications or deaths in both groups. The mean operative time and tract formation times for the balloon dilation group and the Amplatz dilation group were 106.8 ± 41.4 and 11.2 ± 3.0, and 116.4 ± 23.7 and 16.3 ± 2.4 min, respectively. Thirteen (13.7%) patients had significant bleeding and required blood transfusion in the balloon dilation group, whereas 5 (16.6%) patients had significant bleeding in the Amplatz dilation group. Collecting system perforation due to too far advancement of the dilator occurred in 11 (11.6%) patients but there was no major parenchymal or vascular injury medially in the balloon dilation group. On the other hand, collecting system perforation occurred during sequential Amplatz dilation in 5 (16.6%) patients. Conclusion: We believe that the balloon system allows one-step dilation and shortens the dilation procedure. It may minimize bleeding which can occur during the stepwise fascial dilation. When using fascial dilators it is sometimes possible to go out of the collecting system by changing the size of the dilators. We think that balloon dilation may prevent these intraoperative and time-consuming situations.Copyright © 2003 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objectives: Renal access in percutaneous nephrolithotomy (PCNL) may be obtained via a pre-existing nephrostomy tube (NT) tract; however, emergent NTs are not always ideal for subsequent surgery. We sought to determine the rate of NT tract usability and assess factors related to the usability of emergently placed NTs., Methods: A retrospective review was performed of UC San Diego subjects undergoing percutaneous renal surgery between January 2016 and October 2018. Demographics and peri-operative variables were collected. The primary outcome was the usability of NT tract for dilation and instrumentation. "Usable" indicated a tract in which PCNL could be completed; "unusable" indicated lack of dilation and the requirement of additional tract(s) for PCNL., Results: 35 PCNL cases had previous emergently placed NT which were indwelling at time of percutaneous surgery. 51% of these NT tracts (18/35) were deemed usable and dilated for PCNL. No significant difference was seen between usable and unusable NT groups for number of dilated tracts during PCNL (p=0.13), or either the location of indwelling NT (p=0.96) or renal stones (p=0.95). In the usable NT tract cohort PCNL access was via the lower pole 56% of the time, where as when previous NT tracts were deemed unusable, a separate upper-pole access was obtained intra-operatively 53% of the time (p<0.01)., Conclusions: Pre-existing, emergent NTs served a ssufficient PCNL access tracts in over half of recorded cases. Contrary to recently published reports, the utility of pre-existing NTs appears to vary among health systems. Other variables, including the desired location of PCNL appear to directly influence the like lihood of NT tract usability.

Miniaturized percutaneous nephrolithotomy (PCNL) has gained increased popularity owing to efforts in recent years to lower peri-operative morbidity while maintaining a high stone-free rate (SFR). The outcomes of pediatric renal stones treated by mini-PCNL (MPCNL) versus standard PCNL (SPCNL) were retrospectively assessed. A retrospective data analysis of 134 consecutive patients younger than 17 years who underwent PCNL between January 2014 and July 2018 was performed. The patients were categorized into two treatment groups depending on the tract size and instruments used. Seventy-five patients were treated by SPCNL using adult instruments via a 22–26 Fr tract, and 59 patients were treated by MPCNL using pediatric instruments via a 16–20 Fr tract. A total of 134 children (SPCNL = 75; MPCNL = 59) underwent PCNL and subsequent evaluation. Patient demographics and stone characteristics were comparable between the two groups. The mean stone size ranged from 1.9 ± 1.162 cm in the MPCNL group to 2.2 ± 1.424 cm in the SPCNL group, and the overall SFR was 89.5% in the MPCNL group and 94.7% in the SPCNL group. When comparing the common characteristics, no significant difference was found between the two surgical access regarding the mean operative duration, SFR, incidence of peri-operative complications, and the rate of bleeding requiring a blood transfusion. Conversely, the mean postoperative hemoglobin decrease was significantly lower in the MPCNL group relative to the SPCNL group, at 0.354 ± 0.299 g versus 0.568 ± 0.332 g, respectively (P = 0.001). In addition, the mean duration of hospitalization was significantly lower in the MPCNL group than in the SPCNL group, at 1.91 ± 1.154 days compared with 2.41 ± 1.14 days, respectively (P = 0.014). Herein, the authors report the first systematic review of the first center in the locality treating this cross section of patients. This review reveals that the use of these smaller instruments can deliver a strong safety profile while achieving good stone clearance. As an alternative to decreasing the peri-operative morbidity associated with SPCNL, MPCNL can be conveniently used without affecting the outcomes of the procedure. It is a safe and feasible procedure for maximal clearance of stones and should comprise the treatment of choice—regardless of age—for experienced endourologists. MPCNL represents a valuable way of treating simple and complex renal stones in children, with an operative time, SFR, and overall complication rate comparable with those of SPCNL. Mini-PCNL resulted in shorter hospitalization and fewer hemoglobin drops. Table Operative and postoperative characteristics Table Variables MPCNL SPCNL P -value Hospital stay (days), mean (SD) 1.91±1.154 2.41±1.14 0.014 Operative and postoperative complication, n (%) 11 (18) 22 (29) Blood transfusion, n (%) 1 (1.69) 4 (5.3) 0.389 Postoperative fever, n (%) 9 (15.5) 14 (18.9) 0.609 Postoperative transient hematuria, n (%) 1 (1.69) 4 (5.3) 0.257 Mean postoperative Hg drop (g/l ±SD) 0.354 ± 0.299 0.568 ± 0.332 0.001 Stone clearance (PCNL single session), n (%) Complete clearance 51 (89.5) 71 (94.7) 0.513 Stone residual 6 (10.5) 4 (5.3.0) SPCNL: standard PCNL; MPCNL: mini-PCNL; PCNL: percutaneous nephrolithotomy; SD: standard deviation. [ABSTRACT FROM AUTHOR]

Background: Percutaneous nephrolithotomy (PNL) is a procedure that has traditionally been performed in an inpatient or hospital setting. Many surgical procedures have evolved over time from an inpatient/hospital setting to outpatient procedures performed in surgical centers. Outpatient PNL has become an accepted standard in select patients, but to date, the procedure has not been performed in an outpatient surgical center. Case Presentation: We describe our initial experience managing large renal stone burden with PNL performed completely outpatient in a freestanding ambulatory surgery center. The patient was carefully selected as a young, healthy, thin patient with straightforward renal stone burden and favorable anatomy per CT. Access was achieved with a combination of fluoroscopic and endoscopic needle guidance. The procedure was performed with several modifying factors to enable an effective outpatient discharge. Conclusion: Our experience reinforces the outpatient feasibility of PNL and incites the possibility of transitioning the procedure to an ambulatory surgical center in select patients to provide healthcare savings and an improved patient experience., Competing Interests: No competing financial interests exist.