A.Aminsharifi,A.Tadayyon,S.Shakeri,M.Z.Abbasi,M.Rastgar Shiraz,Jahrom and Bousher Universities of Medical Sciences,IRAN
Today PCNL is the modality of choice for treatment of large,complex nephrolithiasis,however such as open surgery has complication.We evaluated the result and complications in our training,referal center.
Materials and Methods
Between September 2002 to March 2012,7494 renal units of the 7236 adult patients,4121 men,3115 women,mean age 38.5 year(20-78) and mean stone size 32.6 mm(22-63) underwent PCNL by experienced,training urologist,and residents in two referal center.We recorded the results and complications of our patients.
Early stone-free rate was 88.5% and after 3 weeks with ancillary procedures(URS,SWL)94%.Intra and postoperative complications including access failure 87(1.1%), intraop hemorrhage 248(3.3%),Transfusion 219(2.9%),clot retention 31(0.4%),late hematuria in 2-3 weeks postoperative period 98( 1.3% )resulted to 4 nephrectomy and 23 angioembolization,pelvicalyceal perforation 142(1.8%),Conversion to open surgery 24(0.3%)resulted to 7 nephrectomy and 17 stone removal and kidney repair, suspicious to visceral injury 13( 0.1%),fever>38.3 C 223(2.9% ),infection 24(0.3%),perinephric collection needed drainage 21(0.26%),pneumo/hydro/hemothorax 39( 0.5%)8 needed chest tube insertion,hyponatremia(PCNL Sx.)16(0.2%),renal failure of normal functioning kidney 14(0.1%),scapular fracture 1,mortality 13(0.1%)including sepsis 3,Myocardial infarction 9,unknown 1),re-PCNL for large residual fragment or frist access failure 229(3%).Of course some late complications managed by referring physicians and may be did not refer/report to us.
Although PCNL seems the best treatment modality for large renal stones as a less invasive method,minor ana major complications should be in the mind of surgeon as in open procedure.
To evaluate theorientated function and advantages of methylene blue(MB) staining of renal cyst-wall with the help of percutaneous renal directly puncture guided by B ultrasound for parapelvic cyst within flexible ureteroscopy.
From February 2014 to March 2017, 19 patients who underwent minimally invasive surgery for parapelvic cyst at our center were included. According to the differences of operation method, The datas were divided into 2 groups: group MB-FUR-IDPC (flexible ureteroscopic holmium laser incision and drainage for parapelvic cyst with methylene blue staining) included 9 patients, group NMB-FUR-IDPC (flexible ureteroscopic holmium laser incision and drainage for parapelvic cyst with non-methylene blue staining) included 10 patients. Baseline clinical features, including sex, symptom and cyst size, were comparable between the two cohorts (P-values > 0.05). The time of preoperative Double-J ureteral stenting, the time of operation, the rate of successful orientation of cyst, the total length of hospital stay and the length of postoperative hospital stay between the two groups were analyzed and compared.
19 cases were operated successfully. Preoperative Double-J ureteral stenting time of NMB-FUR-IDPC and MB-FUR-IDPC were: 5.9±1.0 days and 3.9±2.6 days, respectively. 2 cases of MB-FUR-IDPC without using preoperative Double-J ureteral stenting, and the other 2 cases of MB-FUR-IDPC indwelled preoperative Double-J tube for only 3 days, with statistically significantly between the two groups (P-values < 0.05); the operation time and hospitalization time : 55.4±22.5min and 9.4±2.4 days for group NMB-FUR-IDPC and a statistically significantly more than group MB-FUR-IDPC (28.67±8.4min and 6.8±1.8 days); with intraoperative orientation of cyst failure under flexible ureteroscopy for 2 cases of NMB-FUR-IDPC, and then alterlative treatment approach of percutaneous renal holmium laser incision drainage were successfully performed. Postoperative hospitalization time were similarly 3.5±2.2 days for NMB-FUR-IDPC and 2.3±0.5days for MB-FUR-IDPC, respectively. Follow up for 1-36 months showed no recurrence. Conclusion Methylene blue staining of renal cyst-wall with the help of percutaneous renal directly puncture guided by B ultrasound can well locate parapelvic cyst under the condition of indwelling or shorter preoperatively indwelling Double-J tube time, with the advantages of improving the achievement ratio of one stage operation, shortening the operation time, and reducing hospitalization time.