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
Anatomical renal anomalies are one of the most commonly occurring renal anomalies. Most of these anomalies require series of investigations for the proper diagnosis. We tried to compare the results of conventional rad...Anatomical renal anomalies are one of the most commonly occurring renal anomalies. Most of these anomalies require series of investigations for the proper diagnosis. We tried to compare the results of conventional radiological investigations with magnetic resonance urography in the diagnosis of complex renal anomalies. Materials and methods: This was a prospective study done over a period of five years from 2006 to 2011. All the patients with suspected or diagnosed presence of renal anomalies were investigated by ultrasound (USG), Intravenous urography (IVU), micturating cystourethrogram (MCU), magnetic resonance urography (MRU), retrograde urethrography, cystogenitoscopy, renal scans as per the indication in the case. Results: Total sixty three patients were studied over the period. The most common complex renal anomaly diagnosed was duplex system and conventional radiological investigations were useful in the diagnosis of less than 50% patients. Female patients outnumbered male patients in having complex renal anomalies. MRU was diagnostic in most of the patients with such anomalies and excellent mode of investigation for functional and anatomical details. Conclusion: MRU is better than conventional radiological investigations in the diagnosis of complex renal anomalies.展开更多
Background:The goal of this study was to determine the safety and efficacy of endoscopic combined intrarenal surgery(ECIRS)performed in the prone split-leg position for the treatment of complex renal stones.Materials ...Background:The goal of this study was to determine the safety and efficacy of endoscopic combined intrarenal surgery(ECIRS)performed in the prone split-leg position for the treatment of complex renal stones.Materials and methods:A mature ECIRS protocol was designed.Retrospective analysis was conducted of medical records between January 2020 and December 2021 of patients with complex renal stones at one center who underwent ECIRS by 2 skilled surgeons using retrograde flexible ureteroscopy and mini-percutaneous nephrolithotomy in the prone split-leg position.Results:A total of 44 patients were included in this study.Mean stone size was 26.1±12.7 mm,and the number of calyces involved was 4.36±2.09.Mean operative time was 71.1±21.8 minutes.Postoperative decline in hemoglobin was 15.8±9.8 g/L.Seventy-five percent of patients achieved stone-free status.The mean number of residual stones was 2.8±2.3,and the mean residual stone size was 10.30±4.76 mm.Six patients(13.6%)developed postoperative complications,including 4 with fever during the first 2 days postoperatively and 2 patients with transient postoperative pain.No patients developed severe complications.Conclusions:Endoscopic combined intrarenal surgery in the prone split-leg position can be performed safely by experienced surgeons using retrograde flexible ureteroscopy in conjunction with mini-percutaneous nephrolithotomy as a successful technique for the treatment of complex renal stones.展开更多
Objective To explore the diagnosis and treatment features of tuberous sclerosis complex associated renal cell carcinoma. Methods A 22-year-old boy with a childhood history of epilepsy and mental retardation pres-
Objective:Robot-assisted partial nephrectomy(RAPN)has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses.The aim of this systematic review was to analyze ...Objective:Robot-assisted partial nephrectomy(RAPN)has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses.The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses,large tumors(cT2-T3),renal cell carcinoma in solitary kidney,recurrent tumors,completely endophytic and hilar masses,and simultaneous and multiple tumors.Methods:A comprehensive search in the PubMed,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers.The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered.The secondary endpoint was to evaluate the surgical and functional outcomes.Results:After screening 1250 records,43 full-text manuscripts were selected,comprising over 8500 patients.Twelve and thirteen studies reported data for endophytic and hilar renal masses,respectively.Five and three studies reported outcomes for cT2-T3 and solitary kidney patients,respectively.Four studies focused on redo-RAPN for recurrent tumors.Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney.Conclusion:Over the past decade,evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown.Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes,the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result.Certainly,a higher likelihood of complication might be expected when facing extremely challenging cases.However,none of these indications should be considered per se an exclusion criterion for performing RAPN.Ultimately,a risk-adapted approach should be employed.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.
文摘Anatomical renal anomalies are one of the most commonly occurring renal anomalies. Most of these anomalies require series of investigations for the proper diagnosis. We tried to compare the results of conventional radiological investigations with magnetic resonance urography in the diagnosis of complex renal anomalies. Materials and methods: This was a prospective study done over a period of five years from 2006 to 2011. All the patients with suspected or diagnosed presence of renal anomalies were investigated by ultrasound (USG), Intravenous urography (IVU), micturating cystourethrogram (MCU), magnetic resonance urography (MRU), retrograde urethrography, cystogenitoscopy, renal scans as per the indication in the case. Results: Total sixty three patients were studied over the period. The most common complex renal anomaly diagnosed was duplex system and conventional radiological investigations were useful in the diagnosis of less than 50% patients. Female patients outnumbered male patients in having complex renal anomalies. MRU was diagnostic in most of the patients with such anomalies and excellent mode of investigation for functional and anatomical details. Conclusion: MRU is better than conventional radiological investigations in the diagnosis of complex renal anomalies.
文摘Background:The goal of this study was to determine the safety and efficacy of endoscopic combined intrarenal surgery(ECIRS)performed in the prone split-leg position for the treatment of complex renal stones.Materials and methods:A mature ECIRS protocol was designed.Retrospective analysis was conducted of medical records between January 2020 and December 2021 of patients with complex renal stones at one center who underwent ECIRS by 2 skilled surgeons using retrograde flexible ureteroscopy and mini-percutaneous nephrolithotomy in the prone split-leg position.Results:A total of 44 patients were included in this study.Mean stone size was 26.1±12.7 mm,and the number of calyces involved was 4.36±2.09.Mean operative time was 71.1±21.8 minutes.Postoperative decline in hemoglobin was 15.8±9.8 g/L.Seventy-five percent of patients achieved stone-free status.The mean number of residual stones was 2.8±2.3,and the mean residual stone size was 10.30±4.76 mm.Six patients(13.6%)developed postoperative complications,including 4 with fever during the first 2 days postoperatively and 2 patients with transient postoperative pain.No patients developed severe complications.Conclusions:Endoscopic combined intrarenal surgery in the prone split-leg position can be performed safely by experienced surgeons using retrograde flexible ureteroscopy in conjunction with mini-percutaneous nephrolithotomy as a successful technique for the treatment of complex renal stones.
文摘Objective To explore the diagnosis and treatment features of tuberous sclerosis complex associated renal cell carcinoma. Methods A 22-year-old boy with a childhood history of epilepsy and mental retardation pres-
文摘Objective:Robot-assisted partial nephrectomy(RAPN)has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses.The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses,large tumors(cT2-T3),renal cell carcinoma in solitary kidney,recurrent tumors,completely endophytic and hilar masses,and simultaneous and multiple tumors.Methods:A comprehensive search in the PubMed,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers.The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered.The secondary endpoint was to evaluate the surgical and functional outcomes.Results:After screening 1250 records,43 full-text manuscripts were selected,comprising over 8500 patients.Twelve and thirteen studies reported data for endophytic and hilar renal masses,respectively.Five and three studies reported outcomes for cT2-T3 and solitary kidney patients,respectively.Four studies focused on redo-RAPN for recurrent tumors.Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney.Conclusion:Over the past decade,evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown.Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes,the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result.Certainly,a higher likelihood of complication might be expected when facing extremely challenging cases.However,none of these indications should be considered per se an exclusion criterion for performing RAPN.Ultimately,a risk-adapted approach should be employed.
