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.

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

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

There are still disagreements on which is a better approach to choose to establish percutaneous tract for percutaneous nephrolitotomy (PCNL), between supracostal and infracostal approaches. The aim of this study is to investigate the safety, efficacy and practicability of minimally invasive PCNL (MPCNL) with the aid of a patented system either through supracostal or through infracostal access. A retrospective study was carried out for 83 patients with renal or upper ureteral stones. Under the guidance of B ultrasound or C-arm, these patients were treated by MPCNL through either 12th rib infracostal (Group 1, 43 cases) or supracostal (Group 2, 40 cases) access approach. These 2 groups were compared for total number of percutaneous tracts, average time in establishing a given percutaneous tract, the number of percutaneous tract used for each case, the average stone clearance time, the clearance rate of all stones by one surgery, and the amount of bleeding using a single percutaneous tract. There was a significantly smaller total number of percutaneous tracts needed, a smaller number of cases that needed two percutaneous tracts to clear stones completely, a shorter average time in establishing a percutaneous tract, and a smaller average amount of bleeding in infracostal access group. At the same time, there were a significantly larger number of cases in which stones were cleared completely using a single percutaneous tract and a higher renal stone clearance rate by one surgery. There were several advantages of infracostal access. These included accuracy in establishing a percutaneous tract, safety, quickness, convenience and flexibility in moving the patented sheath, and higher renal and upper ureteral stone clearance rate by one surgery.

/pdf/a-comparison-of-supracostal-and-infracostal-access-19ta7rb11i.pdf

A comparison of supracostal and infracostal access approaches in treating renal and upper ureteral stones using MPCNL with the aid of a patented system.

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

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Factors affecting blood loss during minimally invasive percutaneous nephrolithotomy