Complex renal calculi remain to be a challenge for the treating urologist due to sheer bulk and the technicalities involved.Percutaneous nephrolithotomy(PCNL)remains the treatment modality of choice in dealing with th...Complex renal calculi remain to be a challenge for the treating urologist due to sheer bulk and the technicalities involved.Percutaneous nephrolithotomy(PCNL)remains the treatment modality of choice in dealing with these large and complex stones.The limiting factor in their treatment continues to be the need for using additional tracts or the use of flexible nephroscopy for complete stone clearance.This systematic review focuses on the need for multi-tract PCNL for complex renal calculi.The literature review was performed using PubMed database using the keywords“multiple tract PCNL”or“multiperc”.We identified original articles published on the usage of multiple tracts for stone clearance in renal calculi between January 2000 to October 2018,and the search was restricted to available literature in English language only.Ten studies with n>20 were included for the final analysis.We analyzed the technical efficacy with respect to the number of tracts and stages that were required for stone clearance,outcomes and complications,especially,procedural bleeding and post-procedure infective complications of multiple-tract PCNL for large burden renal stones.Multiperc is found to be safe,feasible and effective for the management of large burden complex renal calculi with respect to stone clearance and morbidity associated with the procedure.It is cost effective and complete stone clearance as a single procedure is higher in comparison to flexible ureteroscopy and shockwave lithotripsy.展开更多
Background There is limited published evidence regarding the incidence of intraoperative and postoperative events and the effect of percutaneous nephrolithotomy(PCNL)in supine and prone positions and laparoscopic pyel...Background There is limited published evidence regarding the incidence of intraoperative and postoperative events and the effect of percutaneous nephrolithotomy(PCNL)in supine and prone positions and laparoscopic pyelolithotomy on kidney function in patients with large and complex calculi.Materials and methods We evaluated the surgical outcomes of 97 patients with large and complex kidney stones.The patients were divided into 3 groups:those who underwent PCNL in the prone position,PCNL in the supine position,and pyelolithotomy by laparoscopy and retroperitoneoscopy.General surgical outcomes,size of residual stones,stone-free rate,glomerular filtration rate(GFR),and split GFR obtained from Tc-99m renal dynamic scintigrams were analyzed.Results Percutaneous nephrolithotomy in the prone position was correlated with improved function of the affected kidney.In the supine PCNL group,none of the analyzed indicators demonstrated a significant difference.Dynamic nephroscintigrams revealed negative changes in terms of accumulation and secretion of the affected kidney.A slight decrease in creatinine clearance was noted.However,positive dynamics in split GFR and secretory index were seen in this group.The laparoscopic group showed positive results in all analyzed parameters.However,full assessment of the function of the affected kidney in this group was limited due to restricted use of laparoscopic pyelolithotomy for complex stones.Conclusions Percutaneous nephrolithotomy in the prone position resulted in the most favorable renal functional outcomes for patients with high-grade renal calculi,whereas a laparoscopic approach may be preferred for patients with stones of lower grades.The most significant factors that adversely affected renal function were intraoperative bleeding volume,kidney stone size and density,and body mass index.展开更多
文摘Complex renal calculi remain to be a challenge for the treating urologist due to sheer bulk and the technicalities involved.Percutaneous nephrolithotomy(PCNL)remains the treatment modality of choice in dealing with these large and complex stones.The limiting factor in their treatment continues to be the need for using additional tracts or the use of flexible nephroscopy for complete stone clearance.This systematic review focuses on the need for multi-tract PCNL for complex renal calculi.The literature review was performed using PubMed database using the keywords“multiple tract PCNL”or“multiperc”.We identified original articles published on the usage of multiple tracts for stone clearance in renal calculi between January 2000 to October 2018,and the search was restricted to available literature in English language only.Ten studies with n>20 were included for the final analysis.We analyzed the technical efficacy with respect to the number of tracts and stages that were required for stone clearance,outcomes and complications,especially,procedural bleeding and post-procedure infective complications of multiple-tract PCNL for large burden renal stones.Multiperc is found to be safe,feasible and effective for the management of large burden complex renal calculi with respect to stone clearance and morbidity associated with the procedure.It is cost effective and complete stone clearance as a single procedure is higher in comparison to flexible ureteroscopy and shockwave lithotripsy.
基金We gratefully acknowledge the assistance of the statistical team of the CUC“City Multidisciplinary Hospital No.2,”RUDN,and the organizers of the“RUDN University Program 5-100.”。
文摘Background There is limited published evidence regarding the incidence of intraoperative and postoperative events and the effect of percutaneous nephrolithotomy(PCNL)in supine and prone positions and laparoscopic pyelolithotomy on kidney function in patients with large and complex calculi.Materials and methods We evaluated the surgical outcomes of 97 patients with large and complex kidney stones.The patients were divided into 3 groups:those who underwent PCNL in the prone position,PCNL in the supine position,and pyelolithotomy by laparoscopy and retroperitoneoscopy.General surgical outcomes,size of residual stones,stone-free rate,glomerular filtration rate(GFR),and split GFR obtained from Tc-99m renal dynamic scintigrams were analyzed.Results Percutaneous nephrolithotomy in the prone position was correlated with improved function of the affected kidney.In the supine PCNL group,none of the analyzed indicators demonstrated a significant difference.Dynamic nephroscintigrams revealed negative changes in terms of accumulation and secretion of the affected kidney.A slight decrease in creatinine clearance was noted.However,positive dynamics in split GFR and secretory index were seen in this group.The laparoscopic group showed positive results in all analyzed parameters.However,full assessment of the function of the affected kidney in this group was limited due to restricted use of laparoscopic pyelolithotomy for complex stones.Conclusions Percutaneous nephrolithotomy in the prone position resulted in the most favorable renal functional outcomes for patients with high-grade renal calculi,whereas a laparoscopic approach may be preferred for patients with stones of lower grades.The most significant factors that adversely affected renal function were intraoperative bleeding volume,kidney stone size and density,and body mass index.
