PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Nephrolithotomy, Percutaneous”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources
PubMed2002

Renal intrapelvic pressure during percutaneous nephrolithotomy and its correlation with the development of postoperative fever.

PURPOSE: Systemic absorption of irrigation fluid containing bacteria or endotoxin may lead to fever and urosepsis after percutaneous nephrolithotomy. Although to our knowledge the exact method of absorption is undefined, intrapelvic pressure greater than 30 mm. Hg has been shown to result in pyelovenous-lymphatic backflow. We measured intrapelvic pressure during percutaneous nephrolithotomy and correlated pressure with postoperative fever and operative technique. MATERIALS AND METHODS: Intrarenal pressure was measured with a transurethral 7Fr ureteral occlusion balloon catheter and a urodynamic system during percutaneous renal access, rigid and flexible nephroscopy, and intracorporeal lithotripsy. Postoperative fever was correlated with elevated intrarenal pressure, stone type and surgical technique. RESULTS: Enrolled in this study were 18 women and 13 men. Pressure greater than 30 mm. Hg was recorded in 8 patients (26%). Elevated pressure occurred under 2 conditions, namely incomplete positioning of the nephroscopy sheath within the collecting system and endoscopy through a narrow infundibulum. In 13 cases (42%) a fever of 38C or greater developed postoperatively. Elevated pressure did not correlate with fever. However, of those undergoing percutaneous nephrolithotomy for the removal of infection versus noninfection stones 64% and 24%, respectively, had fever postoperatively. CONCLUSIONS: Renal intrapelvic pressure generally remains low during percutaneous nephrolithotomy. Elevated pressure was associated with incomplete nephroscopy sheath positioning within the collecting system and endoscopy through an infundibular narrowing. There was no association of renal pressure greater than 30 mm. Hg with fever but postoperative fever and percutaneous nephrolithotomy done for infection related stones correlated significantly.

Adult↗
PubMed1998

Holmium:YAG percutaneous nephrolithotomy: the laser incident angle matters.

PURPOSE: Laser physics dictate that maximal radiant exposure occurs when the laser strikes the target at a normal incidence. Since the renal collecting system often limits nephroscope movements during percutaneous nephrolithotomy, the laser-calculus incidence angle may vary. We have observed during holmium:YAG percutaneous nephrolithotomy that the side firing fiber more easily approaches a normal incidence compared to the end firing fiber. We test the hypothesis that holmium:YAG percutaneous nephrolithotomy is faster with a side firing fiber compared to an end firing fiber. MATERIALS AND METHODS: Consecutive holmium:YAG percutaneous nephrolithotomy cases were studied retrospectively. The calculus size and composition, surgical time, fragmentation speed (size/time) and stone-free rates were compared between 11 patients treated with end and 8 treated with side firing fibers. RESULTS: When the end and side firing groups were compared, calculus sizes (mean plus or minus standard deviation) were 22 +/- 13 versus 48 +/- 17 mm. (p = 0.004), calcium oxalate monohydrate incidence was 55 versus 75% (p = 0.3), surgical times were 168 +/- 87 versus 124 +/- 51 minutes, computed fragmentation speeds were 0.15 +/- 0.09 versus 0.43 +/- 0.15 mm. per minute (p = 0.0009) and stone-free rates were 73 versus 88% (p = 0.4), respectively. CONCLUSIONS: The side firing fiber is faster than the end firing fiber for holmium:YAG percutaneous nephrolithotomy. These results are consistent with principles of laser physics.

Aluminum↗
PubMed2006

Colonic perforation during percutaneous nephrolithotomy: study of risk factors.

OBJECTIVES: To identify the risk factors implicated in colonic perforation during percutaneous nephrolithotomy. METHODS: From 1985 to 2004, 5039 percutaneous nephrolithotomy procedures were performed in our center. Colonic perforation complicated 15 procedures (0.3%). The patient files were retrospectively reviewed for detection of preoperative risk factors as shown by multivariate statistical analysis. The operative details and postoperative course were also studied to determine the time and mode of diagnosis of colonic injury and treatment strategies and outcome. RESULTS: All injuries were retroperitoneal. The mean patient age was 57 +/- 8.4 years. Of the 15 patients, 11 were men and 4 were women. The left side was affected in 10 patients (66.6%). The right side was injured only in those with horseshoe kidneys or with recurrent disease. Colonic perforation complicated lower caliceal puncture in 12 procedures (80%) and complicated upper caliceal punctures in those with horseshoe kidneys or chronic colonic distension. Significant independent risk factors were advanced patient age and the presence of a horseshoe kidney. The diagnosis was established intraoperatively in 5 patients and postoperatively in 10, 5 of whom presented with colocutaneous fistula. The diagnosis was confirmed with abdominal computed tomography or opacification of the colon during antegrade or retrograde pyelography. Conservative treatment was successful in all but 2 patients who required colostomy. CONCLUSIONS: Significant independent risk factors for colonic perforation during percutaneous nephrolithotomy were advanced patient age and the presence of a horseshoe kidney. Early diagnosis and proper treatment represent the key to minimizing patient morbidity and avoiding serious complications.

Adult↗
PubMed2003

Use of fibrin glue in percutaneous nephrolithotomy.

OBJECTIVES: To report our experience with the use of fibrin glue during tubeless percutaneous nephrolithotomy. We addressed the safety of this approach and evaluated its use for any clinical benefit with respect to length of hospital stay, bleeding, analgesic usage, and urinary extravasation. METHODS: This was a retrospective review of 43 patients who underwent tubeless percutaneous nephrolithotomy. In 20 consecutive patients (one bilateral), percutaneous tracts were injected with 2 to 3 mL of Tissel Vapor Heated sealant at the conclusion of the procedure. The fibrin glue was instilled during simultaneous removal of the percutaneous sheath. These 20 patients were compared with a control group (23 consecutive patients) in which fibrin glue was not used. The length of hospitalization, hematocrit drop, analgesic use, stone burden, operative times, postoperative complications, and any noted computed tomography scan findings were compared. RESULTS: Postoperatively, the average length of hospital stay was less in the experimental than in the control group by 0.71 day (P <0.05). Differences in hematocrit drop between the experimental (6.8%) and control (5.6%) groups were not statistically significant. The total analgesic use was less in the experimental group, but the difference was not statistically significant. No statistical difference was found between the operative times for both groups. Postoperative fevers and wound seroma were noted in the experimental group. No abscesses or any significant changes along the percutaneous tracts were seen on postoperative computed tomography scans. In the control group, no procedure-related complications were noted. CONCLUSIONS: The use of fibrin glue is safe in percutaneous nephrolithotomy procedures and additional prospective randomized studies are needed to evaluate for any clinical benefit.

Adolescent↗
PubMed1994

Hypothermia associated with percutaneous nephrolithotomy.

OBJECTIVES: To characterize the perioperative fall in core body temperature associated with percutaneous nephrolithotomy, and to identify patients at greater risk of hypothermia. METHODS: A retrospective review was undertaken of core body temperatures in 77 patients who underwent 95 percutaneous nephrolithotomy (PNL) procedures using room temperature irrigants over a 3 year period. Intraoperative temperature measurements were obtained via an esophageal thermistor probe. RESULTS: Mean core body temperature fell from 36.7 degrees C preoperatively to 35.8 degrees C after retrograde manipulations and subsequent patient positioning before commencing the renal puncture. The mean core temperature fell an additional mean 1.0 degrees C during the percutaneous nephrolithotomy. This additional temperature drop was proportional to the length of the procedure. Female patients had a significantly greater decline in intraoperative core body temperature than male patients (p < 0.01). Obese patients preserved their preoperative temperature more efficiently. Blood loss and advanced age had no impact on the occurrence of hypothermia. Mean preoperative temperature was regained on average within 3 hours postoperatively. CONCLUSIONS: Hypothermia occurs in the majority of patients undergoing PNL. Nearly an equivalent fall in temperature is seen during presurgical preparation, induction of anesthesia, and patient positioning as is seen during the surgical procedure itself. Efforts to preserve core body temperature both before and during the percutaneous procedure may reduce the degree of hypothermia and its potential complications.

Body Temperature↗
PubMed1991

Percutaneous nephrolithotomy for calculi in horseshoe kidneys.

Between 1983 and 1988, 15 patients (18 kidneys) underwent percutaneous nephrolithotomy at this unit for calculi in horseshoe kidneys. A standard 1-stage percutaneous access technique with minor modifications was used. In situ disintegration with ultrasound or electrohydraulic lithotripsy was necessary in 15 moieties (83.3%) and nephrostomy drainage was required in 12 (66.7%). Percutaneous access was not a problem and there were minimal perioperative problems. Blood transfusion was required postoperatively in 2 patients. A total of 14 kidneys (77.8%) were rendered free of stone with percutaneous nephrolithotomy alone and 2 kidneys were left with asymptomatic stone fragments of 2 mm. or less. Another 2 kidneys became free of stone after extracorporeal shock wave lithotripsy, thus giving an over-all stone clearance rate of 88.8%. We conclude that percutaneous nephrolithotomy is an acceptable treatment for stones in horseshoe kidneys and it is the treatment of choice for patients in whom imaging is difficult or impossible.

Adult↗
PubMedDate not supplied

Percutaneous nephrolithotomy.

Our initial experience with percutaneous nephrolithotomy in 46 randomly selected patients included 16 who had undergone previous surgery for calculi. A urologist and radiologist cooperated closely in carrying out the procedure, which was performed in one or two stages (16 and 30 cases respectively). Calculi were successfully removed from 80.4% of the patients with the use of grasping forceps or ultrasonic lithotripsy. Operating time ranged from 30 to 180 min and the average hospital stay was 8 days. Complications were few and of a transient nature. Further experience and patient selection is necessary in order to reduce the time and cost of this procedure.

Adolescent↗
PubMed1998

The "mini-perc" technique: a less invasive alternative to percutaneous nephrolithotomy.

The disadvantages of standard percutaneous nephrolithotomy (PCNL) as compared with ureteroscopy or extracorporeal shock-wave lithotripsy include increased blood loss, greater pain, and longer hospital stay. A 13-Fr "mini-perc" technique using a ureteroscopy sheath for PCNL was developed in an attempt to address these drawbacks. Nine "mini-percs" have been performed in patients aged 40-73 years with stone burdens of < or = 2 cm2. On average, patients had 1.4 stones with a cross-sectional area of 1.5 cm2. The mean total procedure time, estimated blood loss, and hematocrit decrease were 176 min, 83 ml, and 6.6%, respectively. On average, patients used 14 mg of parenteral morphine and stayed 1.7 days in the hospital. There was no procedure-related complication or transfusion. Eight of nine kidneys (89%) were stone-free on early follow-up at a mean of 3.8 weeks. As compared with standard PCNL, the "mini-perc" technique has similar early success rates in selected patients and may offer advantages with respect to hemorrhage, postoperative pain, and shortened hospital stays.

Adult↗
PubMed1996

Percutaneous nephrolithotomy--results and clinical experience.

Percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) have largely replaced open surgical intervention for the management of upper urinary tract calculi. ESWL is the preferred treatment modality for calculi less than or equal to 2 cm in diameter as morbidity is lower than PCNL and success rates are comparable. However, the morbidity of ESWL rises substantially for stones greater than 2 cm in diameter while stone-free rate is less when compared to PCNL, suggesting that PCNL is the preferred treatment modality for most larger stones. PCNL was performed on 86 patients with 87 renal calculi. The indication for this approach was either high stone burden as in 72 patients (83%) or failed previous ESWL as in 15 patients (17%). The success rate was 74.7% and this was associated with minimal morbidity which included; symptomatic urinary tract infection (9.2%), pleural effusion (2.3%) and the formation of a pseudo-aneurysm (2.3%). Blood transfusion was required in one patient (1.1%) and we had one postoperative death due to massive pulmonary embolism (1.1%). PCNL is the preferred approach to patient with difficult renal calculi at our institution.

Adult↗
PubMed2001

Percutaneous nephrolithotomy in patients aged 60 years or older.

PURPOSE: To assess the safety and efficacy of percutaneous nephrolithotomy in patients more than 60 years old. PATIENTS AND METHODS: We retrospectively evaluated and compared the data of 28 percutaneous nephrolithotomies (PCNL) performed on 27 patients aged 60 years and older (mean 65.8) with the data of the remaining 178 PCNL procedures on 166 patients performed in our clinic between December 1997 and December 1999. RESULTS: Although staghorn stones seemed to be more common in the elderly group (25% v 22%), no statistical significance was demonstrated (P = 0.715), and the stone burden was similar for the two groups (P = 0.112). The only interesting finding in terms of patient characteristics was a significantly higher incidence of solitary kidney in patients aged 60 years or older (29% v 7%; P = 0.003). The success rates (stone-free patients and patients with residual stones <4 mm) were similar, being 89% for the elderly group and 92% for the younger patients (P = 0.718). Transfusion rates were also similar (21.4% in the elderly v 18% in the younger group; P = 0.662). No significant complication was observed in this elderly group, and no renal deterioration has been detected even in the follow-up of patients with a solitary kidney. CONCLUSIONS: Despite the somewhat higher stone burden in the elderly patients (1077.92 mm2 v 920.85 mm2), the stone-free rate was similar to that obtained in the younger patients, without any higher rates of complications or blood transfusions or longer hospital stay. Percutaneous nephrolithotomy is a safe and effective method of stone treatment in the elderly, even if they have a solitary kidney or complex calculi.

Aged↗
PubMed1988

Comparison between percutaneous nephrolithotomy and open stone procedures.

A total of 205 patients have undergone stone extraction surgery. Three groups were studied: in 70 patients the stones were removed by flank incision, in 20 patients by posterior incision and 80 patients were treated by percutaneous nephrolithotomy. Patients submitted to percutaneous nephrolithotomy had a shorter hospitalization, operative time and a significantly reduced period of recuperation, allowing earlier return to work and decreased disability. Narcotic drugs were demanded in a lower amount in the percutaneous nephrolithotomy group.

Adolescent↗
PubMed1986

Monitoring radiation exposure to medical personnel during percutaneous nephrolithotomy.

To ascertain radiation exposure to medical personnel during percutaneous nephrolithotomy, lithium fluoride thermoluminescent dosimeters (TLDs) were utilized for the radiographic monitoring of 7 consecutive patients. Average fluoroscopy time per procedure was 27.8 minutes of which 15.1 minutes were for nephrostomy tube insertion and 12.7 minutes were for calculi extraction. The 2 radiologists received 4.5 and 5.1 mrad per procedure, while the 2 urologists received 2.5 and 3.7 mrad. All other ancillary personnel received less than 2.1 mrad per procedure except the anesthesiologists whose mean exposure was 4.7 mrad. By taking appropriate precautions and using the proper equipment, percutaneous nephrolithotomy can be performed with a low level of radiation exposure for all involved physicians and personnel.

Adult↗
PubMed1986

Combined treatment of branched calculi by percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy.

Eighty-seven patients with branched renal calculi were treated by a combination of percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy. Stone debulking was achieved by percutaneous nephrolithotomy and residual stone fragments were destroyed by shock wave lithotripsy. Of the patients 70 (80 per cent) required 2 to 3 treatments, 12 (14 per cent) required 4 treatments and 5 (6 per cent) required 5 to 6 treatments. Results after 3 months indicated that 58 patients were free of stones, 3 had recurrent stones and 12 had disintegrated stone particles (less than 3 mm.) in the collecting system, while 13 were lost to followup. One patient had undergone nephrectomy. This treatment plan minimized the disadvantages of either technique when used alone and made open operative intervention unnecessary. Procedural and fluoroscopy times were reduced drastically compared to reported data on percutaneous nephrolithotomy only. We believe that more than 90 per cent of all branched calculi can be treated with this combined technique.

Adolescent↗
PubMed2007

Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors.

PURPOSE: We identified risk factors predicting severe bleeding due to percutaneous nephrolithotomy. MATERIALS AND METHODS: Computerized data on 2,909 patients who underwent a total of 3,878 percutaneous nephrolithotomy procedures between January 1995 and December 2005 were retrospectively reviewed. Data on patients who experienced severe bleeding requiring angiographic renal embolization were compared with those on other patients using univariate and multivariate analyses. We tested the characteristics of patients, kidneys and stones together with details of the operative procedure and surgeon experience. RESULTS: Severe bleeding complicated a total of 39 procedures (1%) in 25 males and 14 females with a mean age of 50.7 +/- 12.6 years. Associated morbidity included shock in 6 patients and perirenal hematoma in 4. Renal angiography revealed pseudoaneurysm in 20 patients, arteriovenous fistula in 9, the 2 lesions in 8 and arterial laceration in 2. Bleeding could be controlled with superselective embolization in 36 patients (92.3%). Followup was available on 33 patients (mean 21 +/- 15 months). Renal function was stable in all patients except 3 who had a post-embolization increase in serum creatinine, of whom all had a solitary kidney and none required renal replacement therapy. Significant risk factors for severe bleeding were upper caliceal puncture, solitary kidney, staghorn stone, multiple punctures and inexperienced surgeon. CONCLUSIONS: Percutaneous nephrolithotomy should be performed by an experienced endourologist in patients at risk for severe bleeding, such as those with a solitary kidney or staghorn stones.

Adult↗
PubMed2004

Percutaneous nephrolithotomy in children: experience with 138 cases in a developing country.

Our aim was to evaluate our experience with percutaneous nephrolithotomy (PCNL) in children in the Republic of Yemen. Between January 1993 and December 1998, 135 children underwent 138 percutaneous nephrolithotomies in Yemen. The patient's age ranged between 8 months and 14 years (average 8.9 years). There were 117 boys and 18 girls (male:female ratio 6.5:1). The stone size ranged between 124 and 624 mm2 (average 507 mm2). A 26 F adult nephroscope was used. The stone free rate was 98.5% (136 out of the 138 cases). Two patients had clinically insignificant fragments. A second session had to be performed because of residual stone in one patient. No severe intra- or postoperative complications were observed. We conclude that percutaneous nephrolithotomy is a safe and effective method for the treatment of kidney stones in children. It reduces morbidity and hospital stay and thus the cost of treatment. To our knowledge, this is the largest reported series.

Adolescent↗
PubMed1989

Critical evaluation of treatment of staghorn calculi by percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy.

The combined use of percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy in patients with staghorn calculi has become an established treatment regimen. We evaluated the results of 90 staghorn calculi-bearing kidneys treated with such combination therapy after a mean follow-up of approximately 2 years. A total of 69 kidneys (76.7 per cent) became free of stones at some point after treatment. However, due to stone recurrence this number decreased to 55 kidneys (61.1 per cent) at the end of follow-up. Patients who had undergone a previous open operation on the stone-bearing kidney showed less favorable results than the over-all group. When our results were compared to reported data on open surgery or percutaneous nephrolithotomy alone even better results may have been obtained by such treatment modalities. However, our data indicate that percutaneous stone debulking combined with further destruction of residual stone fragments by shock wave lithotripsy certainly is less invasive than an open operation and provides an alternative to percutaneous treatment alone, which can yield comparable results.

Adult↗