Purpose: To investigate the clinical effect of minimally invasive percutaneous nephrolithotomy (MPCNL) using a patented irrigation and clearance system. Patients and Methods: From August 2008 to August 2009, 60 patients with renal stones ≥2.0 cm were randomly assigned to two groups. Group 1 included 30 patients who were treated by MPCNL through a patented 16F sheath with the aid of a patented irrigation and clearance system combined with a high power holmium laser. Group 2 included 30 patients who were treated by a third generation EMS ultrasound/ballistic trajectory lithotripsy and clearance system through a standard 24F sheath. The differences in (1) average time needed for stone clearance; (2) percentage of cases in which one surgery resulted in freedom from stones; (3) mean renal pelvic pressure; and (4) mean amount of intraoperative bleeding were compared. Results: Compared with the EMS ballistic trajectory/ultrasound lithotripsy and clearance system, the MPCNL irrigation and clearance syste...

The application of a patented system to minimally invasive percutaneous nephrolithotomy.

OBJECTIVE To report our experience with minimally invasive percutaneous nephrolithotomy (mPCNL) for upper urinary tract (UUT) calculi in transplanted kidneys. PATIENTS AND METHODS Between August 2002 and June 2006, seven patients (mean age 40.7 years) with UUT stones in transplanted kidneys (including one staghorn, two pelvic and four ureteric stones) were treated by mPCNL. A 16 F peel-away sheath was placed as the percutaneous access port and a 8.5/11.5 F nephroscope or a 8/9.8 F ureteroscope was used for manipulation. Every 2-3 months during the follow-up, patients had their serum urea, creatinine and uric acid measured, with urine culture and ultrasonography. RESULTS All patients were rendered stone-free at one mPCNL procedure, with no complications during or after surgery. The mean (range) operative duration was 53 (20-100) min and the mean haemoglobin decrease was 0.55 (0.2-1.2) g/dL. At a mean (range) follow-up of 23 (3-48) months renal allograft function was stable in all patients and no recurrence of stone was detected. CONCLUSIONS mPCNL is safe and effective for managing calculi in transplanted kidneys, and it can be the initial therapy for most cases of UUT stones in transplanted kidneys, except for simple and small stones in the middle or lower calyx.

Minimally invasive percutaneous nephrolithotomy for upper urinary tract calculi in transplanted kidneys.

Comparative study of outcome in treating upper ureteral impacted stones using minimally invasive percutaneous nephrolithotomy with aid of patented system or transurethral ureteroscopy.

OBJECTIVE To report our experience of endoscopic incision for obstruction of vesico-ureteric anastomosis (VUA) in transplanted kidneys. PATIENTS AND METHODS Between February 2001 and March 2006, six men and two women (mean age 38 years, range 27-57) with VUA obstruction in their transplanted kidneys were treated by percutaneous nephrostomy and endoscopic incision. After the anastomosis was completely cut, two JJ stents were placed in the ureter for 4-6 weeks. During the follow-up, serum urea, creatinine and uric acid levels were measured, and urine culture, ultrasound examination and washout renal scintigraphy were performed every month for the first 6 months, then every 3 months. RESULTS In all, 12 procedures of endoureterotomy were performed and all procedures resulted in successful incision of the obstruction. There were no complications during or after the procedures. The retrograde and antegrade endoureterotomies were performed with four procedures in two patients and eight procedures in six patients, respectively. At a mean (range) follow-up of 16 (4-45) months, five of the eight patients had ureteric patency and stable renal function. In three patients there was a recurrence of obstructive uropathy, immediately after JJ stent removal, which finally required open surgical correction. CONCLUSIONS Percutaneous nephrostomy and endoscopic incision is safe and effective for obstruction of VUA in transplanted kidney, and it can be the initial therapy for ureteric obstruction in transplanted kidneys; however, open surgical reconstruction should be considered if the initial endoscopic incision procedure fails.

Endoscopic incision for obstruction of vesico-ureteric anastomosis in transplanted kidneys

Purpose: To determine the impact of staghorn calculi branch number on outcomes of percutaneous nephrolithotomy (PNL). Materials and Methods: Retrospectively, we evaluated 371 patients (386 renal units) who underwent PNL for staghorn calculi. All calculi were showed with CT three-dimensional reconstruction (3DR) imaging preoperatively. From 3DR images, the number of stone branching into minor renal calices was recorded. According to the number, patients were divided into four groups. Group 1: the branch number 2–4; Group 2: the branch number 5–7; Group 3: the branch number 8–10; Group 4: the branch number >10. The number of percutaneous tract, operative time, staged PNL, intraoperative blood loss, postoperative hospital stay, complications, main stone composition, and stone clearance rate were compared. Results: A significantly higher ratio of multitract (p<0.001) and staged PNL (p<0.001), a longer operative time (p<0.001) and postoperative hospital stay (p=0.043), and a lower rate of stone cleara...

Impact of Stone Branch Number on Outcomes of Percutaneous Nephrolithotomy for Treatment of Staghorn Calculi

目的 寻找微创经皮肾镜取石术(MPCNL)术中出血量的影响因素.方法 2006年4月至8月,应用MPCNL治疗肾结石患者178例(219次手术).以可能影响术中出血量的患者因素(年龄、体重指数、高血压、糖尿病、肝功能不全、肾功能不全、泌尿系感染、肾脏既往手术史、肾实质厚度、肾积水程度及结石表面积)和手术相关因素(肾盏入路、总穿刺次数、穿刺针流出液体是否血性液、扩张通道大小、通道数目、手术时间、术中操作因素引起的并发症、分期手术)为自变量,应用多因素逐步回归分析各因素与失血量之间的关系,找出影响术中出血量的主要因素. 结果 178例(219次手术)患者手术均成功.采用单通道取石177例次,多通道取石42例次,双侧手术13例.手术平均出血量(201.7±145.2)ml,单通道手术平均出血量(191.8±139.6)ml,多通道(244.9±162.2)ml.多因素回归逐步回归分析结果显示,术中操作并发症(P=0.000)、肾实质厚度(P=0.000)、分期手术(P=0.000)、通道数目(P=0.001)、手术时间(P=0.019)、肾积水程度(P=0.033)及结石表面积(P=0.044)对失血量有明显影响.结论 术中出现操作并发症、肾实质肥厚、多通道取石、手术时间过长及结石体积较大都能显著增加失血量,分期手术可减少失血量.避免术中操作并发症发生、减少手术时间、对大体积结石或出现操作并发症的患者选择分期手术十分重要。

Factors affecting blood loss during minimally invasive percutaneous nephrolithotomy

目的 比较微创经皮肾取石术和传统经皮肾取石术对肾皮质的损伤.方法 6只平均体重22 kg的小猪行经皮肾穿刺造瘘术,左侧扩张到16 F,右侧扩张到32 F,扩张后分别留置一16 F和28 F的肾造瘘管于穿刺道,1周后拔除.5周后处死小猪,肉眼观察肾周有无血肿及尿性囊肿.将造瘘道瘢痕切片,数字图像分析技术测量瘢痕面积,分别用圆柱体的和椭圆体的体积公式算出造瘘道瘢痕体积和肾脏体积,并比较二种通道的瘢痕所占肾皮质体积的比率.结果总有11个造瘘道成功施行,处死小猪时均未见肾周血肿和尿性囊肿形成.16 F和32 F的造瘘道的瘢痕体积为(0.42±0.18) mm3和(0.63±0.24) mm3,其占整个肾皮质的体积的比率分别为(0.07±0.03)%和(0.10±0.04)%,二者比较差异无统计学意义(P>0.05).结论微创经皮肾取石术和传统经皮肾取石术对肾皮质损伤都很小,16 F的扩张通道在减少术后肾皮质的损伤方面较32 F并无优势,但大的扩张通道更可能损伤通道旁的血管从而增加术后肾皮质的损伤。

Comparision of renal parenchymal injury after mini and standard percutaneous nephrolithotomy

目的 探讨腔内治疗移植肾尿路结石的效果和策略.方法采用腔内技术治疗13例移植肾尿路结石,其中肾结石3例,金属支架结石1例,输尿管结石9例,合并输尿管口狭窄2例.结石最大直径8～48 mm,接受肾移植的时间1个月～8年.结果3例肾结石和1例金属支架结石行经皮微造瘘输尿管镜取石术成功取石.4例输尿管结石行逆行输尿管镜取石治疗;3例行经皮顺行输尿管镜取石成功,其中1例合并移植输尿管口狭窄者同时行内切开取石;1例移植输尿管口狭窄合并下端结石者,改行开放手术;1例输尿管结石直接行体外冲击波碎石术2次后排净结石.术后随访l～8年,人肾存活均良好,12例患者肾功能恢复正常,无结石复发.结论移植肾尿路结石处理应选择创伤小、效果好的腔内微创治疗,尽可能保护肾功能。

Endoscopic treatment of urinary calculi in allograft kidneys

目的 探讨微创经皮肾穿刺造瘘术(PCN)治疗上尿路疾病的可行性.方法肾结石906例,输尿管上段结石132例,肾盂-输尿管连接处(UPJ)狭窄87例,移植肾结石2例,马蹄肾结石7例,放疗后双侧输尿管狭窄19例,孤立肾结石28例,肾结石合并肾囊肿2例,肾脓肿41例,利用微创PCN技术治疗. 结果肾结石取净率93%(842/906);输尿管上段结石一期1次取净率100%(132/132);UPJ狭窄平均随诊7个月,成功率89%(77/87);2例移植肾结石和7例马蹄肾结石均一次取净;放疗后输尿管狭窄治疗成功率89%(17/19);孤立肾肾结石1次取净率86%(24/28);治疗肾结石合并肾囊肿2例,术后随访6个月囊肿无复发;治疗肾脓肿成功率90%(37/41).结论微创PCN具有创伤小、出血少的优点,扩大了PCN治疗泌尿系疾病的范围,疗效良好。

Minimally invasive percutaneous nephrostomy for treatment of upper urinary diseases

目的 总结微创经皮肾镜取石术(MPCNL)术后迟发出血的原因及介入栓塞治疗的经验.方法回顾性分析1998年2月至2004年7月3812例MPCNL患者的临床资料,共发生术后迟发出血12例,男11例,女1例,平均年龄45岁.对出血原因及治疗结果进行分析.结果MPCNL术后迟发出血发生率为0.31%(12/3812),迟发出血平均时间为术后10 d,肾动脉造影显示7例为肾穿刺扩张通道小动脉损伤(动脉瘤形成),5例为动静脉瘘.12例患者经超选择性肾动脉栓塞治疗后,血尿消失,随访肾功能恢复良好.结论MPCNL术后迟发出血发生率明显低于传统PCNL,出血原因大部分为穿刺通道的小动脉损伤,超选择性肾动脉栓塞是控制出血的有效方法。

Analysis of the cause of hemorrhage after MPCNL and its interventional treatment

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