Objectives. To describe our novel modified technique of ultra-mini-percutaneous nephrolithotomy (UMP) using of a novel 6 Fr mininephroscope through an 11–13 Fr metal sheath to perform holmium: YAG laser lithotripsy. Methods. The medical records of 36 patients with moderate-sized (<20 mm) kidney stones treated with UMP from April to July 2012 were retrospectively reviewed. Patients were assessed at the 1st day and 1st month postoperatively by KUB and US to assess stone-free status. Results. The mean stone size was 14.9 ± 4.1 mm (rang: 6–20). The average operative time was 59.8 ± 15.9 (30–90) min. The stone-free rate at postoperative 1st day and 1st month was 88.9% and 97.2%. The mean hospital stay was 3.0 ± 0.9 (2–5) days. Complications were noted in 6 (16.7%) cases according to the Clavien classification, including sepsis in 2 (5.6%) cases (grade II), urinary extravasations in 1 (2.8%) case (grade IIIa), and fever in 3 (8.3%) cases (grade II). No patients needed blood transfusion. Conclusions. UMP is technically feasible, safe, and efficacious for moderate-sized renal stones with an advantage of high stone-free rates and low complication rates. However, due to the limits of its current unexplored indications, UMP is therefore a supplement to, not a substitute for, the standard mini-PCNL technology.

Objective To present a novel miniature endoscopic system designed to improve the safety and efficacy of percutaneous nephrolithotomy, named the ‘super‐mini percutaneous nephrolithotomy’ (SMP). Patients and Methods The endoscopic system consists of a 7‐F nephroscope with enhanced irrigation and a modified 10–14 F access sheath with a suction‐evacuation function. This system was tested in patients with renal stones of <2.5 cm, in a multicentre prospective non‐randomised clinical trial. In all, 146 patients were accrued in 14 centres. Nephrostomy tract dilatation was carried out to 10–14 F. The lithotripsy was performed using either a Holmium laser or pneumatic lithotripter. A nephrostomy tube or JJ stent was placed only if clinically indicated. Results SMP was completed successfully in 141 of 146 patients. Five patients required conversion to larger nephrostomy tracts. The mean (sd) stone size was 2.2 (0.6) cm and the mean operative duration was 45.6 min. The initial stone‐free rate (SFR) was 90.1%. The SFR at the 3‐month follow‐up was 95.8%. Three patients required auxiliary procedures for residual stones. Complications occurred in 12.8% of the patients, all of which were Clavien grade ≤II and no transfusions were needed. In all, 72.3% of the patients did not require any kind of catheter, while 19.8% had JJ stents and 5.7% had nephrostomy tubes placed. The mean hospital stay was 2.1 days. Conclusions SMP is a safe and effective treatment for renal stones of <2.5 cm. SMP may be particularly suitable for patients with lower pole stones and stones that ae not amenable to retrograde intrarenal surgery.

No abstract

Renal pelvic pressure generally remains lower than the backflow level (30 mm Hg) during MPCNL via a 14- to 18-French percutaneous tract. Any factors that brought about poor drainage would result in temporarily elevated RPP greater than 30 mm Hg, and many such occurrences of high pressure would have an accumulating effect, which means enough backflow to cause bacteremia and postoperative fever.

This study proposed and validated an extension of the unified model of electronic government adoption (UMEGA). The data analysis was conducted with a structural equation modeling technique using Smart PLS 3.0. The results have demonstrated contrary to expectations that performance expectancy, effort expectancy, and social influence do not predict the attitude toward the use of e-government services. Facilitating conditions, however, were found to significantly determine both the behavioral intention to use and effort expectancy of e-government services. Also, perceived service quality and trust in government were found to positively predict, respectively, the intention to use and recommend the adoption of e-government services. The implications of these and other result findings of this study are thoroughly interrogated.