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.

Background: Percutaneous nephrolithotomy (PCNL) is widely performed in the treatment of kidney stones in children. The main risk of this therapy is hemorrhage that requires blood transfusion associated with an increased risk of kidney loss. This study was undertaken to assess the safety and efficacy of PCNL using ureteroscope and pneumatic intracorporeal lithotripsy in the treatment of pediatric renal calculi. Methods: We studied 22 kidneys of 15 patients under 14 years who underwent PCNL in our hospital. The average age of these patients was 9.2 years (range 5-14 years). In 7 bilateral and 8 unilateral cases of 5 staghorn calculi, the average stone burden was 2.04 (0.9-4.5) cm. PCNL was performed with an X-ray-guided peripheral puncture. With a minimal dilatation of the urinary tract with ureteroscope and pneumatic intracorporeal lithotripsy, a staged approach was used for bilateral cases. Results: Complete stone clearance was achieved in 20 of the 22 kidneys, giving an overall clearance rate of 91%. Mild fever (<39oC, <2 days) was seen in 14 patients, whereas serious pyrexia was seen in 1. The decrease in the level of hemoglobin averaged 1.6 g/dl, but none of the patients required blood transfusion. Conclusions: PCNL is a better treatment of choice for pediatric stone disease refractory to extracorporeal shock wave lithotripsy. To treat pediatric urolithiasis with PCNL using ureteroscope and pneumatic intracorporeal lithotripsy is safe and effective.

Percutaneous nephrolithotomy using ureteroscope and pneumatic intracorporeal lithotripsy in the management of pediatric renal calculi

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

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Comparision of renal parenchymal injury after mini and standard percutaneous nephrolithotomy