Efficacy of Percutaneous Nephrostomy Tube During Ureteroscopy for Upper Ureter Stone Management

Kwon, Se Yun; Choi, Jae Young; Kim, Bum Soo; Kim, Hyun Tae; Yoo, Eun Sang; Park, Yoon Kyu

doi:10.1089/end.2013.0347

Cited by 5 publications

(8 citation statements)

References 24 publications

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“…Kwon et al . reported that draining the retrograde irrigation fluid through the PCN catheter can help decompress the renal pelvis and straighten the ureter portion above the stone, thereby reducing the risk of urinary tract infection, preventing stone migration, and providing a better view . Indeed, we maintained a clear view of the operative field throughout the entire procedure, and the patient did not experience postoperative fever.…”

Section: Discussionmentioning

confidence: 79%

Two‐year‐old girl with impacted ureteral stone successfully treated with a single session of combined percutaneous nephrostomy and ureteroscopy

Hamamoto

Unno

et al. 2017

Int J of Urology

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Impacted stones frequently cause changes in the ureter, including edema of the ureteral wall, stone embedding in the ureteral mucosa or ureteral bending, which often preclude spontaneous passing of the stone and increase the risk of complications during surgery. When stone impaction is suspected preoperatively, management should be adapted accordingly. However, surgical treatment strategies remain controversial in pediatric patients because of the scarcity of cases reported. We describe the case of a 2-year-old girl with a right impacted ureteral stone who presented with gross hematuria and pyuria, but no metabolic risk factors or hematological abnormalities. Ureteroscopy was carried out in the presence of a percutaneous nephrostomy catheter. At the 7-month follow up, hydronephrosis had improved from grade 3 to grade 1, and the ureter was free from residual or recurrent stones. No complications were noted. We believe that percutaneous nephrostomy before the lithotripsy facilitates treatment for impacted stones in pediatric patients.

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Section: Discussionmentioning

confidence: 79%

Two‐year‐old girl with impacted ureteral stone successfully treated with a single session of combined percutaneous nephrostomy and ureteroscopy

Hamamoto

Unno

et al. 2017

Int J of Urology

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“…In our study, to compare the outcomes between the antegrade and retrograde irrigation groups, patients who had to undergo PCN insertion because of ureter stone with suspected infection were excluded. A previous study used antegrade irrigation during retrograde ureteroscopy, which is a method similar to ours; 42 patients had PCN and antegrade irrigation was applied in 21 patients [14]. They found that, with antegrade irrigation method during retrograde ureteroscopy, fragmented stones could be more easily shifted from the proximal to the distal ureter.…”

Section: Discussionmentioning

confidence: 84%

“…Therefore, if percutaneous nephrostomy (PCN) has been performed before URS, the antegrade irrigation via PCN may increase stone-free rate and reduce the ancillary procedures, such as flexible ureteroscopy or percutaneous antegrade ureteroscopy. Nevertheless, to the best of our knowledge, only one clinical research where PCN was utilized during retrograde semirigid ureteroscopy (the irrigation fluid flowed via the PCN tube and not via the ureteroscope) was conducted [14]. It may be due to the facts that (1) PCN cases in the upper ureter stones are not common because PCN is generally considered in patients with intractable pain, suspicious infection, or deteriorating renal function; (2) surgeons may be concerned that the antegrade irrigation via PCN during URS may increase the infection rate.…”

Section: Introductionmentioning

confidence: 99%

The Role of Antegrade Irrigation via Percutaneous Nephrostomy on Surgical Outcomes in Semirigid Ureteroscopy among Patients with Upper Ureteral Stones

Jung

Byun

Lee

2019

BioMed Research International

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Objective. We aimed to investigate the role of antegrade irrigation via percutaneous nephrostomy on surgical outcomes in retrograde ureteroscopy in patients with upper ureter stones. Materials and Methods. In this retrospective study, we analyzed 134 patients who underwent retrograde semirigid ureteroscopy for upper ureter stones between August 2012 and December 2017. Patients were divided into two groups: retrograde irrigation group (conventional URS) and antegrade irrigation group (using percutaneous nephrostomy). Operation time, postoperative hospital stay, complications, and stone-free rate were measured for each patient after ureteroscopy. Results. The mean age in the retrograde irrigation and antegrade irrigation groups was 53.3 and 60.7 years, respectively (p=0.007). The operation time was 60.8 min vs. 43.0 min (p=0.002), and stone-free rate was 82.0 % vs. 95.5 % (p=0.033). Stone size, laterality, the proportion of male patients, and urinary tract infection prevalence were comparable between the groups. In the subgroup analysis of stone size >10 mm, the antegrade irrigation group had a shorter operation time and a higher stone-free rate. For stone size of 5–10 mm, operation time in the antegrade irrigation group was shorter and the stone-free rate between the two groups was comparable. Conclusion. Antegrade irrigation via percutaneous nephrostomy during ureteroscopy has a higher stone-free rate with a shorter operation time without an increased urinary tract infection risk. Therefore, if percutaneous nephrostomy is necessary before ureteroscopy, antegrade irrigation of external fluid via percutaneous nephrostomy is strongly recommended.

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“…During this period, at total of 1,519 patients were registered in our database. Inclusion criteria for the current study were as follows: i) upper ureter stones measuring 4 to 20 mm, ii) radiopaque calculi located within the ureter on simple X-ray within one month of treatment with no evidence of stone migration, and iii) the upper ureter is defined as the segment between the ureteropelvic junction and the superior margin of the sacroiliac joint, and the upper ureter stone is defined as the calculi in the upper ureter [ 12 ]. Patients without NCCT scans were excluded.…”

Section: Methodsmentioning

confidence: 99%

Optimal Skin-to-Stone Distance Is a Positive Predictor for Successful Outcomes in Upper Ureter Calculi following Extracorporeal Shock Wave Lithotripsy: A Bayesian Model Averaging Approach

Jung¹,

Ham

Chung

et al. 2015

PLoS ONE

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ObjectivesTo investigate whether skin-to-stone distance (SSD), which remains controversial in patients with ureter stones, can be a predicting factor for one session success following extracorporeal shock wave lithotripsy (ESWL) in patients with upper ureter stones.Patients and MethodsWe retrospectively reviewed the medical records of 1,519 patients who underwent their first ESWL between January 2005 and December 2013. Among these patients, 492 had upper ureter stones that measured 4–20 mm and were eligible for our analyses. Maximal stone length, mean stone density (HU), and SSD were determined on pretreatment non-contrast computed tomography (NCCT). For subgroup analyses, patients were divided into four groups. Group 1 consisted of patients with SSD<25th percentile, group 2 consisted of patients with SSD in the 25th to 50th percentile, group 3 patients had SSD in the 50th to 75th percentile, and group 4 patients had SSD≥75th percentile.ResultsIn analyses of group 2 patients versus others, there were no statistical differences in mean age, stone length and density. However, the one session success rate in group 2 was higher than other groups (77.9% vs. 67.0%; P = 0.032). The multivariate logistic regression model revealed that shorter stone length, lower stone density, and the group 2 SSD were positive predictors for successful outcomes in ESWL. Using the Bayesian model-averaging approach, longer stone length, lower stone density, and group 2 SSD can be also positive predictors for successful outcomes following ESWL.ConclusionsOur data indicate that a group 2 SSD of approximately 10 cm is a positive predictor for success following ESWL.

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Efficacy of Percutaneous Nephrostomy Tube During Ureteroscopy for Upper Ureter Stone Management

Cited by 5 publications

References 24 publications

Two‐year‐old girl with impacted ureteral stone successfully treated with a single session of combined percutaneous nephrostomy and ureteroscopy

Two‐year‐old girl with impacted ureteral stone successfully treated with a single session of combined percutaneous nephrostomy and ureteroscopy

The Role of Antegrade Irrigation via Percutaneous Nephrostomy on Surgical Outcomes in Semirigid Ureteroscopy among Patients with Upper Ureteral Stones

Optimal Skin-to-Stone Distance Is a Positive Predictor for Successful Outcomes in Upper Ureter Calculi following Extracorporeal Shock Wave Lithotripsy: A Bayesian Model Averaging Approach

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