3-dimensional ultrasound-guided percutaneous nephrolithotomy: total free versus partial fluoroscopy

Ding, Xiaobo; Hao, Yun; Jia, Yatao; Hou, Yuchuan; Chun-xi, Wang; Wang, Yanbo

doi:10.1007/s00345-019-03007-y

Cited by 9 publications

(4 citation statements)

References 26 publications

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“…15 Examination is susceptible to the effects of catheters, instruments, gas into the pelvis, and blood clots. 16 Some scholars have switched to color Doppler-guided puncture, which can identify renal cortex blood flow, avoid large blood vessel damage, and reduce perioperative blood loss, 17 which is worthy of clinical recommendation.…”

Section: Discussionmentioning

confidence: 99%

Study on Clinical Application of Different Ultrasound-Guided Planar Techniques in Minimally Invasive Percutaneous Nephrolithotomy

Fan

Song

et al. 2021

Surg Innov

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Objective. The objective is to explore the clinical application value of ultrasound long- and short-axis planar technology in real-time guided puncture in minimally invasive percutaneous nephrology. Methods. The clinical data of 80 patients undergoing real-time ultrasound-guided minimally invasive percutaneous nephrolithotomy from September 2018 to October 2019 were analyzed. The patients were randomly divided into 2 groups with different ultrasound-guided puncture techniques, long-axis in-plane technique and short-axis out-of-plane technique. Results. Minimally invasive percutaneous nephrolithotomies under real-time ultrasound guidance were successfully completed in both groups of patients. The success rate of the first puncture in the short-axis out-of-plane group was significantly higher than that in the long-axis in-plane group, and the differences were statistically significant ( P <.05); the total puncture time in the short-axis out-of-plane group was significantly less than the long-axis in-plane group, and the differences were statistical significance ( P <.05); there was no significant difference in the single-stage stone removal rate, total percutaneous renal channels, total hospital stay, and rate of complications by the Clavien classification between the 2 groups ( P > .05). Conclusion. Ultrasound long-axis and short-axis planar technologies can achieve good clinical application results in real-time guided puncture to establish percutaneous renal channels during minimally invasive percutaneous nephrolithotomy. Compared with the long-axis in-plane technique, the short-axis out-of-plane technique can shorten the puncture time and improve the success rate of the first puncture.

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Section: Discussionmentioning

confidence: 99%

Study on Clinical Application of Different Ultrasound-Guided Planar Techniques in Minimally Invasive Percutaneous Nephrolithotomy

Fan

Song

et al. 2021

Surg Innov

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“…Percutaneous nephrolithotomy (PCNL) is considered the first choice of treatment for large (≥2 cm) and complex renal calculi ( 1 , 2 ). However, it remains a challenge to predict whether PCNL can completely remove stones before surgery.…”

Section: Introductionmentioning

confidence: 99%

Correlation analysis between renal anatomical factors and residual stones after an ultrasound-guided PCNL

Zhu¹,

Fan

Hu³

et al. 2023

Front. Surg.

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IntroductionTo predict the factors of residual stones after percutaneous nephrolithotomy (PCNL) by analyzing the characteristics of the renal anatomical structure in intravenous urography, so as to make a reasonable operation plan, reduce the risk of residual stones in PCNL, and improve the stone-free rate (SFR).MethodsA retrospective study was performed between January 2019 and September 2020 for patients treated with PCNL. According to the results of a kidney ureter bladder review after PCNL, 245 patients were divided into a residual stone group (71 patients, stone size >4 mm) and a stone-free group (174 patients, stone size ≤4 mm). An independent sample t-test was used to analyze the age, the length and width of channel calices, the angle between the channel calices and the involved calices, and the length and width of the involved calices. The gender, the channel types, the number of channels, the degree of hydronephrosis, and the number of involved calices were analyzed by using the chi-square test. A score of p < 0.05 was considered statistically significant. At the same time, logistic regression analysis was carried out to explore the independent influencing factors of the SFR after PCNL.ResultsA total of 71 patients developed residual stones after surgery. The overall residual rate was 29.0%. The width of the channel calices (p = 0.003), the angle between the channel calices and the involved calices (p = 0.007), the width of the involved calices (p < 0.001), the channel types (p = 0.008), and the number of involved calices (p < 0.001) were all significantly correlated with residual stones after PCNL. Logistic regression analysis showed that the width of the channel calices (p = 0.003), the angle between the channel calices and the involved calices (p = 0.012), the width of the involved calices (p < 0.001), the channel types (p = 0.008), and the number of involved calyces (p < 0.001) were all independent influencing factors of the SFR after PCNL.ConclusionA larger caliceal neck width and angle can reduce the risk of residual stones. The more calyces that are involved, the higher the risk of residual stones. There was no difference between F16 and F18, but F16 had a higher SFR than F24.

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“…However, urologists' concerns about severe bleeding complications hinder the application and popularisation of PCNL, especially in medical institutions without a digital subtraction angiography (DSA) device. Regarding ways to reduce the risk of bleeding in PCNL, the current areas of focus are mainly on how to reduce the number and size of access tracts to make the surgery as minimally invasive as possible [3][4][5] and the use of various technical means to improve the success rate of the centre of renal papillae access puncture [6][7][8]. Although the current technology and equipment have enabled considerable progress, approximately 1-1.3% of patients still experience blood transfusion [3,9], and approximately 1% of patients require arterial embolization due to severe bleeding [3].…”

Section: Introductionmentioning

confidence: 99%

Renal puncture access using a blunt needle: proposal of the blunt puncture concept

et al. 2022

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Purpose Severe haemorrhage in percutaneous nephrolithotomy (PCNL) is an alarming event, and preventing injury to renal major vessels is a challenge. We evaluated the efficiency of a blunt needle in renal puncture procedures. Methods We first retrospectively reviewed the embolization images of post-PCNL patients to analyse the types of arteries injured, which were considered target arteries. Then, either a blunt needle or a conventional needle was used to directly puncture target arteries in ex vivo porcine kidneys and to establish renal access ex vivo and in vivo. The primary outcome was the incidence of target artery injuries, which were observed by digital subtraction angiography, nephroscopy and 3-dimensional endocasts. The secondary outcome was the rate of excreted fluid per access. Results The segmental and interlobar arteries were the most common types of injured arteries that needed to be embolized after PCNL. When these arteries were punctured directly, blunt needles reduced injury (1/20 vs. 16/20; OR 4.750; 95% CI 1.966–11.478; P < .001) by 76% compared to injuries induced by conventional needles. Moreover, the blunt needle group also had a significantly lower incidence of these arteries’ injuries ex vivo due to renal puncture and yielded a lower rate of excreted fluid in ex vivo and in vivo renal puncture procedures. Conclusion A blunt needle for renal puncture can be effective in reducing injury to renal major arteries and the accompanying haemorrhage. We propose the concept of blunt puncture, which may be a promising method for achieving safe renal access in PCNL.

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3-dimensional ultrasound-guided percutaneous nephrolithotomy: total free versus partial fluoroscopy

Cited by 9 publications

References 26 publications

Study on Clinical Application of Different Ultrasound-Guided Planar Techniques in Minimally Invasive Percutaneous Nephrolithotomy

Study on Clinical Application of Different Ultrasound-Guided Planar Techniques in Minimally Invasive Percutaneous Nephrolithotomy

Correlation analysis between renal anatomical factors and residual stones after an ultrasound-guided PCNL

Renal puncture access using a blunt needle: proposal of the blunt puncture concept

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