Current trends in percutaneous nephrolithotomy: an internet-based survey

Ahmad, Abd Alrahman; Alhunaidi, Omar; Aziz, Mohamed Mostafa; Omar, Mohamed; Al-Kandari, Ahmed M.; El-Nahas, Ahmed R.; El-Shazly, Medhat K.

doi:10.1177/1756287217724726

Cited by 32 publications

(17 citation statements)

References 29 publications

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“…According to Ahmad et al, the use of retrograde intrarenal surgery (RIRS) in the Galdakao-modified supine Valdivia position has an increasing role in combination with PCNL in the contemporary management of staghorn stones. 34 , 35 In this survey, 24.5% preferred combined flexible ureteroscopy with PCNL (endoscopic combined intrarenal surgery, ECIRS) for complex staghorn stones. This trend is also reflected by 17.8% laparoscopic lithotomy for an impacted upper ureteric stone of ˃1.5cm.…”

Section: Discussionmentioning

confidence: 90%

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Current Trends in Percutaneous Nephrolithotomy in China: A Spot Survey

Jiang¹,

Zhang²,

Kang³

et al. 2021

RMHP

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Objective To describe trends in the procedure of percutaneous nephrolithotomy (PCNL) in China to identify training needs. Methods A spot survey with 36 questions, which revealed demographic data, patterns of PCNL practice, and opinions regarding specific clinical cases, was administered to Chinese urologists during the 17 th National Urological Urolithiasis Symposium held in Dandong in 2018. Results Out of 400 participants, 221 responses to the survey were received. PCNL was performed by 80.5% of the participants, and 70.2% of them were senior clinicians. It was found that 91% used the prone decubitus in training programs and 27.6% the modified supine, and 46.6% were apprenticeship trained for PCNL, while 5.6% trained during their residency. The prone position was the preferred decubitus, even for obese patients. All of the urologists established their own access, 93.7% used ultrasonography guidance alone, 70.7% used ultrasonic and/or pneumatic lithotripters, and 29.2% used laser. When exiting the kidney, 73.8% placed a nephrostomy tube whereas 26.2% used the tubeless technique. For postoperative follow-up, 51.3% used computed tomography (CT) or ultrasonography plus kidney–ureter–bladder (KUB) to monitor the results of procedures, while 45% used KUB alone. Colonic injury was reported by 8.9%. Average hospital stays of >3 days were reported for 81.2% of procedures. Conclusion Chinese urologists obtain their own access during PCNL, with ultrasonic guidance in most cases, and almost a half of them are apprenticeship trained. They prefer the prone position, use fascial dilators, and place a nephrostomy tube when exiting the kidney. Most urologists follow the official management guidelines in special cases. Skilled use of urological ultrasound examination, flexible nephroscopy, postoperative CT, tubeless procedures in selected patients, and urology residency training are recommended for PCNL practice.

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Section: Discussionmentioning

confidence: 90%

“…In our survey average hospital stays of >3 days were reported by 130 (81.2%) of the PCNL practitioners, which contrasts with Ahmad’s study, in which 1–3 day average hospital stays were reported by 95.9% of PCNL practitioners. 34 …”

Section: Discussionmentioning

confidence: 99%

Current Trends in Percutaneous Nephrolithotomy in China: A Spot Survey

Jiang¹,

Zhang²,

Kang³

et al. 2021

RMHP

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“…Minimally invasive percutaneous nephrolithotomy (PCNL) has been widely used in the treatment of renal and upper ureteral calculi (1). Nephrostomy and double-J tubes are routinely placed after PCNL surgery, but the nephrostomy tube is associated with adverse events such as pain, channel infection, postoperative bleeding, and longer hospital stay.…”

Section: Introductionmentioning

confidence: 99%

Case selection and implementation of tubeless percutaneous nephrolithotomy

Mao¹,

Huang²,

Li³

et al. 2021

Transl Androl Urol

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Background: The tubeless percutaneous nephrolithotomy (PCNL) was proposed to eliminate the side effects of the nephrostomy tube in recent years, such as pain, channel infection, postoperative bleeding, and longer hospital stay. But there is neither clinical guidelines nor consensus about tubeless PCNL in clinical practice. The study is aimed to how to implement the tubeless PCNL step by step, including case selection preoperatively, improving the technique of the surgeon, making the correct decisions at the end of the procedure, which had not been previously examined.Methods: From January 2017 to March 2018, 364 consecutive patients requiring PCNL were comprehensively analyzed preoperatively and patients were selected for scheduled tubeless PCNL based on four aspects. The selected patients were divided into two groups according to whether the nephrostomy tube was finally placed. The mean operative time, intraoperative blood loss, stone clearance rate, visual pain score, postoperative hospitalization days and perioperative complications were all evaluated.Results: Based on the preoperative evaluation, 42 patients were selected for tubeless PCNL, among which there were finally 37 cases of completed tubeless PCNL. Compared with patients undergoing conventional PCNL, there were not statistical differences in the mean operative time (P=0.207) or intraoperative blood loss (P=0.450) in the tubeless group. Stone clearance rate was 100% in both groups. The visual pain scores in the tubeless PCNL group were lower on operation day (P=0.029), first postoperative day (P<0.001) and the day of discharge (P=0.025). The postoperative hospitalization for the tubeless PCNL group was shorter than that of the control group (P<0.001). No significant difference in grade 1 complications was seen (P=0.424), and no grade 2 or higher complications were observed in either group. Conclusions:Postoperative pain was significantly relieved and postoperative hospitalization was significantly shortened in the tubeless PCNL group. Tubeless PCNL is safe if patients are carefully selected using four criteria before operation, attention is paid to four key points and five confirmations are made during operation.

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“…However, a second-stage PCNL is commonly required for several reasons. Derived from an internet-based survey receiving 300 responses from Endourological Society members representing 47 countries, 14.3% of urologists preferred a second-stage PCNL to manage ≤1 cm stone residual following initial PCNL [ 1 ]. At many centers, second-look PCNL is routinely undertaken following initial, large stone burden PCNL to assure a complete stone clearance [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

A novel spherical-headed fascial dilator is feasible for second-stage ultrasound guided percutaneous nephrolithotomy: A pilot study

Wang

Gao

et al. 2021

Asian Journal of Urology

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Objective In second-stage percutaneous nephrolithotomy (PCNL), because the hydronephrosis has been decompressed, the dilated renal pelvis has resolved and the space is small. Consequently, introduction of the tip of the Amplatz dilator can cause injury to the opposite side of the renal-pelvic mucosa. In this study, we report the experimental and initial clinical performance of a spherical-headed fascial dilator developed specifically for second-stage PCNL. Methods The novel spherical-headed dilator was compared with existing tapered-headed dilators in configuration and in puncture resistance utilizing a static puncture test. Subsequently, a pilot clinical study was conducted during which patients scheduled to undergo second-stage PCNL from June 2019 to October 2019 in our center were enrolled. A typical ultrasound guided PCNL procedure was performed with the exception that the new spherical-headed fascial dilator was substituted for a tapered-headed one. Results Experimentally, stab resistance against polyethylene film was significantly increased using the novel spherical-headed dilator compared to the traditional tapered-headed dilators ( p <0.005). In the clinical study, the novel dilators were successfully introduced into the renal pelvis and passed down the collecting system in all eight second-stage PCNL cases. There were no cases of renal pelvic perforation or brisk hemorrhage nor need for transfusion. Conclusion The design of the novel spherical-headed fascial dilator avoided the concentration of pressure at the tapered tip of the current Amplatz dilator by increasing the contact area and uniformly distributing and diffusing the pressure. Therefore, it is feasible to use the spherical-headed fascial dilator for second-stage PCNL.

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Current trends in percutaneous nephrolithotomy: an internet-based survey

Cited by 32 publications

References 29 publications

Current Trends in Percutaneous Nephrolithotomy in China: A Spot Survey

Current Trends in Percutaneous Nephrolithotomy in China: A Spot Survey

Case selection and implementation of tubeless percutaneous nephrolithotomy

A novel spherical-headed fascial dilator is feasible for second-stage ultrasound guided percutaneous nephrolithotomy: A pilot study

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