Title: Application of a stone-breaking and suction system combined with ultrasonography in the mPCNL of staghorn renal calculi
Abstract: Objective To determine the efficacy and practicability of a stone-breaking and suction system combined with ultrasonography in treating staghorn renal calculi by using minimally invasive percutaneous nephrolithotomy (mPCNL).Methods From August 2008 to April 2011,we retrospectively review our outcome when using mPCNL to treat staghorn renal calculi in 302 patients with the aid of a stone-breaking and suction system combined with ultrasonography.There were 158 males and 144 females.Their age ranged from 3.5 to 65.0 years with a mean age of 41.0.There were 216 cases complicated by hydronephrosis,37 cases complicated by pyonephrosis and 34 cases having a history of open surgery to remove the stones.During the surgery,the patient was placed in a flat prone position without boosting the abdomen to prevent the fixation of the kidneys.The mPCNL was performed after establishing a percutaneous tract under the guidance of ultrasonography.With the aid of the stone-breaking and suction system including a rigid sheath with high flexibility in movement,the lithotripsy was performed using a 100 Watt holmium laser under continuous large volume saline irrigation.Ultrasonography was also used intraoperatively to guide lithotripsy and stone clearance.Results Percutaneous tracts were established successfully in all 302 cases.There were 291 cases that had lithotripsy on the first surgery and 11 cases that underwent a second-stage lithotripsy due to complicated pyonephrosis.There were 280 cases in which a single percutaneous tract was used,17cases in which double percutaneous tracts were used,and 5 cases in which 3 percutaneous tracts were used.Three hundred and twenty two of 329 percutaneous tracts were established using a 12th rib infracostal approach,the remaining 7 percutaneous tracts were established using a 1 1th or 12th rib supracostal approach.The average time in establishing a percutaneous tract was 3.2 min.The average stone clearance time was 55.4 min.Stone clearance rate by one surgery using one percutaneous tract was 252/280.Stone clearance rate after supplemental therapies such as ESWL or percutaneous nephrolithotomy (Ⅱ) was 296/302.The percentage of blood transfusion was 11/302.The percentage of interventional embolization was 4/302.The percentage of postoperative fever was 25/302.There was neither injury to surrounding organs nor death during or after the surgery.Conclusions There are several advantages of mPCNL with the aid of the stonebreaking and suction system combined with ultrasonography.First,It is simple,convenient,and safe procedure which had a high successful rate.Second,it can help in designing a more reasonable percutaneous tract.Third,the stone clearance rate was increased by using B ultrasound guidanc e intraoperatively and the rigid sheath with high flexibility in movement.
Key words:
Percutaneous nephrolithotomy; Minimally invasive percutaneous tract; Suction; Ultrasonography; Staghorn renal calculi
Publication Year: 2013
Publication Date: 2013-04-15
Language: en
Type: article
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