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138 KIDNEY DISPLACEMENT IN COMPLETE SUPINE PERCUTANEOUS NEPHROLITHOTRIPSY IS LOWER THAN PRONE PCNL (THE FIRST RANDOMIZED CLINICAL TRIAL)
Stone location Right side (%) Left side (%)
21 (52.5) 19 (47.5)
24 (60) 16 (40)
0.65
Hydronephrosis Mild (%) Moderate (%) Severe (%)
6 (15) 15 (37.5) 19 (47.5)
5 (12.5) 12 (30) 23 (57.5)
0.67
Stone diameter
13.5(10-28)
14.2(10-25)
0.56
Results: A hundred-percent success was achieved in both groups. The duration of the operations were 54.35(50-82) minutes, and 82.15(73-180) minutes (P >0.0001); and the average hospital stay days were 2.6(2-5) and 3.5(3-8) days (p=0.011) in groups PNL and LUL, accordingly. The mean Hb decrease in PNL group was 0.9mg/dl and in LUL group was 0.4mg/dl (p=0.001). No statistically significant differences in terms of blood transfusion, fever, the need for ICU admission, and prolonged urinary leakage were detected in both groups. Conclusions: LUL is a more expensive procedure that needs special equipment with longer operation time and prolonged hospital admission. Ultrasonographyguided PNL is a rapid, safe and effective option for large upper ureteral calculi especially in cases of moderate to severe hydronephrosis.
137
Tubeless percutaneous nephrolithotomy with double-J stent compared with external ureteral catheter to decrease post operative complications
Telha K., Alba'adani T., Alkohlany K., Al-Adimy A., Alnono I. Medical College, Sana'a University, Dept. of Urology, Sana'a, Yemen Introduction & Objectives: The percutaneous application of endoscopic techniques with leaving of a percutaneous nephrostomy tube (PCN) in the tract at the end of procedure fear of complication. Tubeless (percutaneous nephrolithotomy) PNL with j-j catheter or external ureteral catheter can be performed with one or multiple puncture with complications. The objective of this study was to decrease post tubeless PNL complications, by using of J- J (double-j) stent or with external ureteral catheter. Materials & Methods: A prospective randomized comparative study, between first January 2008 and first January 2010, table no.1, 148 cases with kidney stones deferent in size & locations, were operated by either tube less PNL with j-j stent( group1) or tubeless with ureteric catheter ( group2). Group 1 consists of 72 cases, 54 male and 18 female. Group 2 consists of 76 patients, 56 male and 20 female. Both groups compared from the point of post PNL complications, without using tissue sealants or tract cauterization. Table (1) Demographic data of patients and stone characteristics &hospitality. Character
PNL with j- j-catheter
PNL with ureteral catheter
Male Female
54 18
56 20
Total
72
76
23 67 31
20 63 29
Right Left
43 29
36 40
total
72
76
Minimum Maximum Mean
2,5 6,0 4,9
2,2 5,3 4,3
Hospital stay
36-48hours
48-72hour
Gender
Age(year) Minimum Maximum Mean Renal units
Urine leak post PCNL
4
5,6%
13
17.1%
Perinephric collection
0
0
8
10,5%
Postoperative hematuria 48hours ا
6
8,3%
9
11,8%
0,48
Postoperative fever
2
2,8%
5
6,6%
0و28
Bowel injury
0
0
1
1,3%
Mortality
0
0
0
0
Total 12 16,6% 36 47,3% Conclusions: Post PNL complications are reported everywhere with different incidence. To decrease these complications leakage of urine, perirenal collection, discomfort of external ureteral catheter, tubeless PNL with J- J stent the best method to decrease the complications and less hospital stay.
138
complication
TUBE LESS PCNL WITH J-J
TUB LEES PCNL WITH URETRAL CATHETER
Introduction & Objectives: To compare the amount of kidney displacement in complete supine Percutaneous Nephrolithotripsy (Cs PCNL) to prone PCNL during getting renal access. Materials & Methods: From April 2009 to September 2009, thirty-three patients were prospectively enrolled and divided into two groups by blocked randomization method. The patients in group A (18 patients, mean age 49.9) were placed in Cs PCNL and the patients in group B (15 patients, mean age 47.06) in prone position. Amounts of kidney displacement in 3 stages and data including age, gender, BMI, stone burden, operative time, stone free rate, hospital stay and complications were analyzed by SPSS.16 and Mann-Whitney test (we considered p<0.05 as significant). Linear regression test was done to measure the controlled β coefficient for predictors (we considered p<0.01 as significant). Results: The two groups were comparable in age, BMI, male to female ratio and stone burden. There was no significant difference between the groups in terms of stone free rate (group A, 77.8% vas group B, 80%), mean hospital stay (group A, 2.7d vs. group B, 3.1d), transfusion rate (group A, 5.6% vs. group B, 6.7%), fever rate (group A, 5.6% vs. group B, 20%) and other complications. The mean amount of kidney displacement in complete supine PCNL was 10.1±7.9mm in stage 1, 10.7±8.28 mm in stage 2 and 12.2±10.4mm in stage 3. The mean amount of kidney displacement in prone PCNL was 16.6±5.8mm in stage 1, 16.2±6.3mm in stage 2 and 17.6±6.7mm in stage 3. In stages 1 and 2 a significant difference between the two groups derived from the mean amount of kidney displacement, but the difference was not statistically significant in stage3. In the evaluation of controlled coefficient (age, gender, BMI, stone burden and position of PCNL) for predictors, prone position was a predictor caused significantly more displacement in all three stages. Among other predictors ,only BMI had a significant effect on the amount of kidney displacement (in stages 2 and 3). Conclusions: Performing PCNL in complete supine position is safe and effective and lead to less kidney displacement during getting renal access and therefore, it maybe considered in most patients requiring PCNL.
139
No
No
Eur Urol Suppl 2011;10(2):68
%
%
Pv Chi² test
Kidney displacement in complete supine percutaneous nephrolithotripsy is lower than prone PCNL (the first randomized clinical trial)
Falahatkar S., Asgari Ghalehbin S.A., Naseh H., Jafari Farshami F., Allahkhah A., Shakiba M., Esmaeili S. Urology Research Center, Guilan University of Medical Sciences, Dept. of Urology, Rasht, Iran
Stone size
Results: Tubeless PNL was done in both groups, we achieved stone free rate in 96 patients (64, 8%) and residual stone in 52 patients (35,1%) required ESWL. Post PNL complications table no. 2 (group1) with j-j stent leakage of urine 4 cases (5,6%), hematuria more than 48 hours in 6 cases (8,3%), no fluid collections around the kidneys, 2 cases (2,8%) with fever & hospital stay was 36-48 hours. As regard more in (group 2) with external ureteral catheter leakage of urine in 13 patients (17,1%), hematuria more than 48 hours in 9 patients (11,8%), 5 cases (6,6%) with fever, colonic injury in 1 case, fluid collections around the kidneys in 8 patients(10,5%), so statistic study shows Pv 0,028 is significant urinary leakage more with external ureteral catheter after removal of it & hospital stay was 48-72 hours.Table (2) Post operative complications.
0.028
Flank free modified supine versus prone position in percutaneous nephrolithotomy: A prospective randomized study
Desoky E.A.E., Zaied A.E.M., Youssef M.K., Alayman A.A., Shahin A.M.S., Kamel H.M. Faculty of Medicine, Zagazig University, Dept. of Urology, Zagazig, Egypt Introduction & Objectives: To compare the technical aspects, operative time, safety, and efficacy of percutaneous nephrolithotomy (PNL) in the flank free modified supine position versus the standard prone position. Materials & Methods: The present study was conducted at urology department Zagazig University hospitals, from October 2008 to June 2010. Seventy seven patients (47 men, 30 women) with renal stones were enrolled in the study and systematically randomized into 2 groups: group A, 39 patients, flank free modified supine position and group B, 38 patients, prone position .Inclusion criteria were patients with indication for PNL and have no contraindication to perform the procedure in prone position. Procedures; for group A, patients were placed in flank free modified supine position by putting a suitable cushion (3L water bag or less) under the ipsilateral shoulder, fixing ipsilateral arm over the thorax, and crossing the extended patient ipsilateral leg over the contralateral leg. For group B, patients were turned to the standard prone position. Procedure was considered successful
21 (52.5) 19 (47.5)
24 (60) 16 (40)
0.65
Hydronephrosis Mild (%) Moderate (%) Severe (%)
6 (15) 15 (37.5) 19 (47.5)
5 (12.5) 12 (30) 23 (57.5)
0.67
Stone diameter
13.5(10-28)
14.2(10-25)
0.56
Results: A hundred-percent success was achieved in both groups. The duration of the operations were 54.35(50-82) minutes, and 82.15(73-180) minutes (P >0.0001); and the average hospital stay days were 2.6(2-5) and 3.5(3-8) days (p=0.011) in groups PNL and LUL, accordingly. The mean Hb decrease in PNL group was 0.9mg/dl and in LUL group was 0.4mg/dl (p=0.001). No statistically significant differences in terms of blood transfusion, fever, the need for ICU admission, and prolonged urinary leakage were detected in both groups. Conclusions: LUL is a more expensive procedure that needs special equipment with longer operation time and prolonged hospital admission. Ultrasonographyguided PNL is a rapid, safe and effective option for large upper ureteral calculi especially in cases of moderate to severe hydronephrosis.
137
Tubeless percutaneous nephrolithotomy with double-J stent compared with external ureteral catheter to decrease post operative complications
Telha K., Alba'adani T., Alkohlany K., Al-Adimy A., Alnono I. Medical College, Sana'a University, Dept. of Urology, Sana'a, Yemen Introduction & Objectives: The percutaneous application of endoscopic techniques with leaving of a percutaneous nephrostomy tube (PCN) in the tract at the end of procedure fear of complication. Tubeless (percutaneous nephrolithotomy) PNL with j-j catheter or external ureteral catheter can be performed with one or multiple puncture with complications. The objective of this study was to decrease post tubeless PNL complications, by using of J- J (double-j) stent or with external ureteral catheter. Materials & Methods: A prospective randomized comparative study, between first January 2008 and first January 2010, table no.1, 148 cases with kidney stones deferent in size & locations, were operated by either tube less PNL with j-j stent( group1) or tubeless with ureteric catheter ( group2). Group 1 consists of 72 cases, 54 male and 18 female. Group 2 consists of 76 patients, 56 male and 20 female. Both groups compared from the point of post PNL complications, without using tissue sealants or tract cauterization. Table (1) Demographic data of patients and stone characteristics &hospitality. Character
PNL with j- j-catheter
PNL with ureteral catheter
Male Female
54 18
56 20
Total
72
76
23 67 31
20 63 29
Right Left
43 29
36 40
total
72
76
Minimum Maximum Mean
2,5 6,0 4,9
2,2 5,3 4,3
Hospital stay
36-48hours
48-72hour
Gender
Age(year) Minimum Maximum Mean Renal units
Urine leak post PCNL
4
5,6%
13
17.1%
Perinephric collection
0
0
8
10,5%
Postoperative hematuria 48hours ا
6
8,3%
9
11,8%
0,48
Postoperative fever
2
2,8%
5
6,6%
0و28
Bowel injury
0
0
1
1,3%
Mortality
0
0
0
0
Total 12 16,6% 36 47,3% Conclusions: Post PNL complications are reported everywhere with different incidence. To decrease these complications leakage of urine, perirenal collection, discomfort of external ureteral catheter, tubeless PNL with J- J stent the best method to decrease the complications and less hospital stay.
138
complication
TUBE LESS PCNL WITH J-J
TUB LEES PCNL WITH URETRAL CATHETER
Introduction & Objectives: To compare the amount of kidney displacement in complete supine Percutaneous Nephrolithotripsy (Cs PCNL) to prone PCNL during getting renal access. Materials & Methods: From April 2009 to September 2009, thirty-three patients were prospectively enrolled and divided into two groups by blocked randomization method. The patients in group A (18 patients, mean age 49.9) were placed in Cs PCNL and the patients in group B (15 patients, mean age 47.06) in prone position. Amounts of kidney displacement in 3 stages and data including age, gender, BMI, stone burden, operative time, stone free rate, hospital stay and complications were analyzed by SPSS.16 and Mann-Whitney test (we considered p<0.05 as significant). Linear regression test was done to measure the controlled β coefficient for predictors (we considered p<0.01 as significant). Results: The two groups were comparable in age, BMI, male to female ratio and stone burden. There was no significant difference between the groups in terms of stone free rate (group A, 77.8% vas group B, 80%), mean hospital stay (group A, 2.7d vs. group B, 3.1d), transfusion rate (group A, 5.6% vs. group B, 6.7%), fever rate (group A, 5.6% vs. group B, 20%) and other complications. The mean amount of kidney displacement in complete supine PCNL was 10.1±7.9mm in stage 1, 10.7±8.28 mm in stage 2 and 12.2±10.4mm in stage 3. The mean amount of kidney displacement in prone PCNL was 16.6±5.8mm in stage 1, 16.2±6.3mm in stage 2 and 17.6±6.7mm in stage 3. In stages 1 and 2 a significant difference between the two groups derived from the mean amount of kidney displacement, but the difference was not statistically significant in stage3. In the evaluation of controlled coefficient (age, gender, BMI, stone burden and position of PCNL) for predictors, prone position was a predictor caused significantly more displacement in all three stages. Among other predictors ,only BMI had a significant effect on the amount of kidney displacement (in stages 2 and 3). Conclusions: Performing PCNL in complete supine position is safe and effective and lead to less kidney displacement during getting renal access and therefore, it maybe considered in most patients requiring PCNL.
139
No
No
Eur Urol Suppl 2011;10(2):68
%
%
Pv Chi² test
Kidney displacement in complete supine percutaneous nephrolithotripsy is lower than prone PCNL (the first randomized clinical trial)
Falahatkar S., Asgari Ghalehbin S.A., Naseh H., Jafari Farshami F., Allahkhah A., Shakiba M., Esmaeili S. Urology Research Center, Guilan University of Medical Sciences, Dept. of Urology, Rasht, Iran
Stone size
Results: Tubeless PNL was done in both groups, we achieved stone free rate in 96 patients (64, 8%) and residual stone in 52 patients (35,1%) required ESWL. Post PNL complications table no. 2 (group1) with j-j stent leakage of urine 4 cases (5,6%), hematuria more than 48 hours in 6 cases (8,3%), no fluid collections around the kidneys, 2 cases (2,8%) with fever & hospital stay was 36-48 hours. As regard more in (group 2) with external ureteral catheter leakage of urine in 13 patients (17,1%), hematuria more than 48 hours in 9 patients (11,8%), 5 cases (6,6%) with fever, colonic injury in 1 case, fluid collections around the kidneys in 8 patients(10,5%), so statistic study shows Pv 0,028 is significant urinary leakage more with external ureteral catheter after removal of it & hospital stay was 48-72 hours.Table (2) Post operative complications.
0.028
Flank free modified supine versus prone position in percutaneous nephrolithotomy: A prospective randomized study
Desoky E.A.E., Zaied A.E.M., Youssef M.K., Alayman A.A., Shahin A.M.S., Kamel H.M. Faculty of Medicine, Zagazig University, Dept. of Urology, Zagazig, Egypt Introduction & Objectives: To compare the technical aspects, operative time, safety, and efficacy of percutaneous nephrolithotomy (PNL) in the flank free modified supine position versus the standard prone position. Materials & Methods: The present study was conducted at urology department Zagazig University hospitals, from October 2008 to June 2010. Seventy seven patients (47 men, 30 women) with renal stones were enrolled in the study and systematically randomized into 2 groups: group A, 39 patients, flank free modified supine position and group B, 38 patients, prone position .Inclusion criteria were patients with indication for PNL and have no contraindication to perform the procedure in prone position. Procedures; for group A, patients were placed in flank free modified supine position by putting a suitable cushion (3L water bag or less) under the ipsilateral shoulder, fixing ipsilateral arm over the thorax, and crossing the extended patient ipsilateral leg over the contralateral leg. For group B, patients were turned to the standard prone position. Procedure was considered successful