Percutaneous Approaches to the Upper Urinary Tract Collecting System

Wolf, J. Stuart

doi:10.1016/b978-1-4160-6911-9.00047-5

Cited by 28 publications

(28 citation statements)

References 286 publications

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“…The general scheme of the PNL is to place a needle through the skin into the renal collecting system, place a guidewire through the needle, and then over the guidewire place tract dilators until the desired lumen is reached for the procedure. Then, after placement of the access sheath over the dilator, stone fragmentation can commence, and finally, a nephrostomy tube can be inserted into the collecting system …”

Section: Discussionmentioning

confidence: 99%

Ultrasound‐guided micropercutaneous nephrolithotomy in pediatric patients with kidney stones

et al. 2015

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Objective: To present the outcomes of ultrasound-guided micropercutaneous nephrolithotomy for the treatment of renal stones in pediatric patients. Methods: Ultrasound-guided micropercutaneous nephrolithotomy was carried out on 25 pediatric patients from June 2012 to October 2014. Micropercutaneous nephrolithotomy surgery was completed without the use of fluoroscopy in 19 patients. Medical records were retrieved from our institutional database and retrospectively reviewed. Percutaneous puncture was carried out by an "all-seeing needle" in seven patients and by a 14-G intravenous cannula in 18 patients. After entering to the collecting system through an "all-seeing needle" or by Microsheath, the calculus was fragmented using a 273-micron holmium yttrium aluminium garnet laser. After the stone was fragmented to the smallest pieces possible, the operation was terminated. Results: Single access was obtained in all patients using ultrasound guidance. The average age of the patients was 4.12 ± 5.33 years. The mean stone size was 13.45 ± 3.11 mm. The mean operative time was 51.45 ± 30.69 min. The mean duration of hospitalization was 3.18 ± 1.77 days. Treatment success was 92%. Two patients had residual fragments after the procedure; these patients were followed conservatively. A total of three minor complications were observed and all of them were managed conservatively. Conclusions: To our knowledge, this is the first study of ultrasound-guided micropercutaneous nephrolithotomy in the pediatric population. Our findings suggest that micropercutaneous nephrolithotomy can be safely carried out with ultrasound guidance in children by experienced hands, allowing to minimize risks associated with radiation exposure in this patient population.

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Section: Discussionmentioning

confidence: 99%

Ultrasound‐guided micropercutaneous nephrolithotomy in pediatric patients with kidney stones

et al. 2015

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“…[9,10] The factors associated with bleeding include: multiple entries, supracostal entry, dilatation of the tract, tract dilatation with different procedures other than with balloon dilatation, prolonged operation time and renal pelvis perforation. [8] However, most bleeds are from the renal parenchyma, which are not imperative in many cases. In cases of increased stone burden, especially staghorn stones, increased bleeding is likely during PCNL.…”

Section: Discussionmentioning

confidence: 99%

“…The reported blood transfusion rate for percutaneous nephrostomy procedures is 0.5% -4%. [8] In addition, the need for blood transfusion can rise from 6% up to 20% when opening the percutaneous tract with wider calibrations and with intrarenal manipulations during PCNL. [9,10] The factors associated with bleeding include: multiple entries, supracostal entry, dilatation of the tract, tract dilatation with different procedures other than with balloon dilatation, prolonged operation time and renal pelvis perforation.…”

Section: Discussionmentioning

confidence: 99%

Effects of Previous Unsuccessful Extracorporeal Shockwave Lithotripsy Treatment on the Performance and Outcome of Percutaneous Nephrolithotomy

Garg¹,

Mishra²,

Bharti³

et al. 2017

jemds

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BACKGROUNDMajority of renal stones diagnosed today are below 2 cm, perhaps due to easy and early accessibility to x-ray and ultrasonography. The preferred treatment of < 1 cm stone is extracorporeal shockwave lithotripsy (ESWL), while standard of care for renal stone > 2 cm is percutaneous nephrolithotomy (PCNL). The procedure of choice for 1 -2 cm renal stones is still a subject of debate. Controversy exists with regard to optimum management of these stones by percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) with reference to stone clearance, hospital stay and complications. The primary goal while treating renal stones is to achieve complete clearance, while causing minimal morbidity to the patient. Treatment of renal stone depends on stone size and location plus patient related factors including anatomy of pelvicalyceal system. In our study, previous ESWL treatment had no influence on the PCNL stone-free rate, operation time, incidence of postoperative complications and LOS in patients with similar stone burdens. However, bleeding during PCNL was more prevalent in the ESWL-treated patients, so close attention should be paid to bleeding in patients who have been pretreated with ESWL.The objective of this study is to evaluate the effects of previous unsuccessful extracorporeal shockwave lithotripsy (ESWL) treatment on the performance and outcome of percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODSOf 115 PCNL procedures performed in our institute with similar stone burden and number of accesses was included in the present study. We categorised the study patients into two groups according to whether they underwent ESWL within 1 year prior to PCNL or not. Accordingly, Group 1 comprised of 42 (36.5%) ESWL-treated patients and Group 2 comprised of 73 (63.4%) non-ESWLtreated patients. RESULTSThere were no statistically significant differences between the groups for length of hospital stay (LOS), nephrostomy tube removal time and the presence of residual stones. When we evaluated the groups for both the preoperative and postoperative haemoglobin (Hb) drop and blood transfusion rate, manifest Hb declined and more transfusions were required in the ESWL-treated patients (both P= 0.01). CONCLUSIONMany patients who undergo PCNL have undergone ESWL treatment beforehand. The renal side-effects of ESWL are well known, the duration of which varies between studies. In the present study, we found that previous ESWL had an effect on bleeding during the PCNL procedure.

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“…Because of the anatomic relationship, the left colon can be injured two times more than the right one (1). Specific characteristics of kidney such as renal fusion anomaly (i.e.…”

Section: Colon Injury In Percutaneous Renal Surgerymentioning

confidence: 99%