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ABSTRACT: The Chinese minimally invasive percutaneous nephrolithotomy (MPCNL) was a modified version of standard PCNL which utilizes smaller tract and sheaths. The aim of this study was to present our experience on its efficacy and safety, and to grade its complications according to the modified Clavien classification. Between 1992 and 2011, 12,482 patients who underwent 13,984 MPCNL procedures entered this study. Data on stone size, access number, operative time, hospital length of stay, stone-free rate (SFR), and complications according to the modified clavien system were evaluated prospectively. Their mean age of patients was 47.6 years (range 0.6-93). The mean stone size was 3.2 ± 0.8 (1.4-7.4) cm. The mean operative time was 83 ± 38 min. Mean hemoglobin drop was 13.5 ± 11.3 g/L. Mean hospital stay was 10.3 ± 6.4 days (2-22 days). The initial SFR after first procedure was 78.6 %. In 14.7 % of cases with a second look, the SFR increase to 89.9 %. At 3 months after auxiliary procedures (re-PCNL, ureterorenoscopy, and shock wave lithotripsy), the overall SFR was achieved to 94.8 %. A total of 3,624 complications (25.92 %) were observed in 2,591 (18.53 %) procedures. There were 2,355 grade I (16.84 %), 706 grade II (5.05 %), 553 grade III (3.95 %), 7 grade IV (0.05 %), and three death of grade V (0.02 %) complications. This large-scale, contemporary analysis confirms MPCNL is still a safe and efficacious treatment option of kidney stones with a high stone-free rate and uncommon rate of high grade complications.
Urolithiasis. 04/2013;
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ABSTRACT: The purpose of this study is to summarize the results of percutaneous nephrolithotomy (PCNL) for renal stones following failed extracorporeal shockwave lithotripsy (SWL), and to investigate the effect of previous SWL on the performances and morbidities of subsequent PCNL. Sixty-two patients with a history of failed SWL who underwent PCNL on the same kidney (group 1) were compared to 273 patients who had received PCNL as first treatment choice (group 2). Patient demographics, stone characteristics, operative findings, and complications were documented and compared. Groups 1 and 2 had similar patient demographics and stone characteristics. Mean time to establish access was comparable in both groups (10.5 ± 4.2 vs. 9.6 ± 4.5 min, p = 0.894). Time required to remove stones and total operative time were longer in group 1 (71.5 ± 10.3 vs. 62.3 ± 8.6 min, p = 0.011 and 95.8 ± 12.0 vs. 80.6 ± 13.2 min., p = 0.018, respectively). Group 1 had lower clearance rate compared to group 2 (83.9 vs. 93.4 %, p = 0.021), while postoperative complications were similar in both groups. Scattered stone fragments buried within the tissues made the procedure more difficult for stone fragmenting and extracting, which lead to longer operative time and inferior stone free rate. However, the PCNL procedure was safe and effective in patients with failed SWL. The risk of complications was similar and clearance rate was encouraging.
Urolithiasis. 04/2013; 41(2):165-8.
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ABSTRACT: OBJECTIVE: To evaluate the role of the fascial dilators modified with scale marker in reducing fluoroscopy time during percutaneous nephrolithotomy (PCNL). METHOD: In a randomized clinical trial, eligible 100 consecutive patients anticipated to undergo single-tract PCNL were randomly assigned into two groups by the closed envelope method, to compare the efficacy and safety of the modified scale fascial dilator (group 1, n=50) and traditional non-scale fascial dilator (group 2, n=50) with respect to the x-ray exposure duration as well as the outcome of PCNL. RESULTS: There was no significant difference between group 1 and group 2 regarding to the initial successful access rate (100% vs. 96%), operative time (79.4 vs. 83.7 min), the initial stone free rate (82% vs. 81.3%), complications (24% vs. 20%), and bleeding required blood transfusion (4% vs. 6%) (all p >0.05). The mean operative duration and fluoroscopic time for tract dilation in group 1 and group 2 were 164.4±19 s vs. 168.3±14 s, and 3.2±0.9s vs. 22.2±4.6 s, (p =0.250 and p <0.001) respectively. CONCLUSIONS: Compared to the use of non-scaled dilators, using the scaled fascial dilators for a percutaneous access in PCNL was found to be associated with less radiation hazards along with similar stone free rate and complications .
Journal of endourology / Endourological Society 03/2013; · 1.75 Impact Factor
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ABSTRACT: To evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL) in infants (<3 years) with renal calculi.
From November 2005 to August 2010, 20 renal units with calculi in 19 infants (13 boys and 6 girls) were treated with PCNL at our institution. Mean age of infants was 20.6 months (range, 7-36 months), the mean stone size was 2.2 cm (range, 1.9-3.1 cm). All PCNL procedures were performed with 14 to 16F percutaneous access and 8/9.8F rigid ureteroscope. Stones were fragmented with a pneumatic lithotripter and evacuated.
Mean operative time was 77.5 minutes (range, 35-120 minutes). Stones were completely removed in 85% of kidneys (17 of 20 kidneys) after the first session and 95% (19 of 20 kidneys) after a second look PCNL procedure. No patients required a blood transfusion. Evaluation of the renal function before and after the PCNL procedure demonstrated the stabilization of corresponding glomerular filtration rate in the treated kidney (48.2 ± 3.7 vs 50.4 ± 5.2 mL/min; P = .22).
When performed by experienced endourologists, PCNL is a safe and effective procedure in infants for the removal of renal calculi.
Urology 06/2012; 80(2):408-11. · 2.43 Impact Factor
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ABSTRACT: The objective of the study is to compare the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) and mini-percutaneous nephrolithotomy (MPCNL) in treating renal stones sizing 15-25 mm in infants <3 years. Forty-six infants with renal stones sizing 15-30 mm were treated by either ESWL (22 renal units in 22 infants) using Dornier compact delta lithotripter or MPCNL (25 renal units in 24 infants) using 14F-18F renal access under general anesthesia. The operation time, stone-free rate, re-treatment rate, and complications between the two groups were compared with the χ(2), Mann-Whitney U, and Student's t tests. No significant differences in mean age and stone size were observed between the two groups. The 1- and 3-month postoperative stone-free rates were 84 and 96 % in MPCNL group and were 31.8 and 86.4 % in ESWL group. The re-treatment and complication rates were significantly higher in ESWL group than in MPCNL group (50 vs. 12 %, P = 0.004; 16.0 vs. 45.5 %, P = 0.028). The stone recurrence rate was similar between the two groups. No significant changes of serum creatinine (Cr) level and glomerular filtration rate were observed in both groups. In conclusion, MPCNL is an effective and feasible alternative monotherapy for large renal stones (15-25 mm) in infants, with a higher stone-free rate and a lower complication rate when compared with ESWL.
Urological Research 05/2012; 40(5):599-603. · 1.23 Impact Factor
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ABSTRACT: There has been continuing controversy regarding multiple tracts in a percutaneous nephrolithotomy (PCNL) session that may bring more complications, especially severe bleeding need for transfusion, even nephrectomy. Little tracts may bring less trauma to renal parenchyma than standard PCNL tracts. We carried minimally invasive PCNL (MPCNL) in treating staghorn calculi with multiple 16Fr percutaneous tracts in a single session, in an attempt to get high stone free with little trauma, and compared the morbidity of standard PCNL procedures in a prospective trial. A total of 54 consecutive patients with staghorn calculi were prospectively randomized for MPCNL (29) and PCNL (25). The size and location of stone, operative parameters, number of tracts, stone-free rate, operating time, hospital stay and complications were analyzed. In MPCNL group, a total of 67 percutaneous tracts were established in 29 renal units, while 28 tracts in 25 renal units in PCNL group. Compared to PCNL, MPCNL was associated with higher clearance rate (89.7 vs. 68%, p = 0.049), less chance need for adjunctive procedure of SWL or second-look PCNL (24.1 vs. 60%, p = 0.007), while a similar complication rate (37.9 vs. 52%, p = 0.300). In conclusion, with the development of instruments and increased experience, judiciously made multiple percutaneous tracts in a single session of MPCNL for treating staghorn calculi were safe, feasible and efficient with an acceptable morbidity.
Urological Research 04/2011; 39(2):117-22. · 1.23 Impact Factor
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ABSTRACT: Early prostate cancer antigen (EPCA), a nuclear matrix protein, has been recently suggested as a novel biomarker in malignant lesions of the prostate. This study was to determine whether preoperative serum EPCA levels predicted the presence of incidental prostate cancer (IPCa) in patients undergoing TURP for BPH.
Serum EPCA levels were measured by ELISA in 449 consecutive patients with symptomatic BPH treated with TURP and 112 healthy men. Predictive performance of serum EPCA levels for IPCa were evaluated.
With a cutoff of 10ng/ml, serum EPCA protein had a 100% specificity for the healthy men and a 98% specificity and a 100% sensitivity in separating men with IPCa from those without. Serum EPCA levels in patients with IPCa were significantly higher than in those without and in healthy controls (17.63±2.42ng/ml vs. 5.58±1.61 ng/ml and 4.95±1.43 ng/ml, all P<0.001), whereas an indwelling transurethral catheter presence and 5α-reductase inhibitor therapy had no effect on EPCA levels (P=0.144 and P=0.238, respectively). The area under ROC curves (AUC) showed that serum EPCA level had the best predictive accuracy of all IPCa (AUC: 0.952, 95% CI: 0.912-0.981, P<0.001). Univariate and multivariate Cox regression analyses further demonstrated the independently predictive performance by preoperative serum EPCA (Hazards Ratio: 4.23, 95% CI: 3.62-6.46, P<0.001).
This study firstly shows that EPCA might be used as a highly sensitive and specific serum biomarker to predict IPCa presence and to help reduce the unnecessary biopsies taken before TURP in patients with BPH.
The Prostate 12/2010; 70(16):1788-98. · 3.48 Impact Factor
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ABSTRACT: Plasmakinetic enucleation of the prostate (PKEP) has recently been proved a safe and technically feasible procedure for benign prostatic hyperplasia (BPH). However, its long-term safety, efficacy, and durability in comparison with the gold-standard transurethral resection of the prostate (TURP) have not yet been reported.
To report the 3-yr follow-up results of a prospective, randomised clinical trial comparing PKEP with standard TURP for symptomatic BPH.
A total of 204 patients with bladder outflow obstruction (BOO) secondary to BPH were prospectively randomised 1:1 into either the PKEP group or the TURP group.
The patients in each group underwent the procedure accordingly.
All patients were assessed perioperatively and followed at 1, 3, 6, 12, 18, 24, and 36 mo postoperatively. The preoperative and postoperative parameters included International Prostate Symptom Score (IPSS), quality of life (QoL) scores, the International Index of Erectile Function (IIEF) questionnaire, maximum urinary flow rates (Q(max)), transrectal ultrasound (TRUS)-assessed prostate volume, postvoid residual urine (PVRU) volume, and serum prostate-specific antigen (PSA) level. Patient baseline characteristics, perioperative data, and postoperative outcomes were compared. All complications were recorded.
PKEP was significantly superior to TURP in terms of the drop in haemoglobin (0.74±0.33 g/dl vs 1.88±1.06 g/dl; p<0.001), intraoperative irrigation volume (11.7±4.5 l vs 15.4±6.2 l; p<0.001), postoperative irrigation volume and time (18.5±7.6 l vs. 30.0±11.4 l and 16.6±5.2 h vs 25.3±8.5 h; all p<0.001), recovery room stay (67.3±11.1 min vs 82.0±16.4 min; p<0.001), catheterisation time (51.7±26.3 h vs 80.5±31.6 h; p<0.001), hospital stay (98.4±20.4 h vs 134.2±31.5 h; p<0.001), and resected tissue (56.4±12.8 g vs 43.8±15.5 g; p<0.001). There were no statistical differences in operation time and sexual function between the two groups. At 36 mo postoperatively, the PKEP group had a maintained and statistically significant improvement in IPSS (2.4±2.2 vs 4.3±2.9; p<0.001), QoL (0.6±0.5 vs 1.6±1.4; p<0.001), Q(max) (28.8±10.1 ml/s vs 25.1±8.0 ml/s; p=0.017), and TRUS volume (21.0±7.3 ml vs 26.4±6.8 ml; p<0.001), with urodynamically proven deobstruction (Schäfer grade 0.2±0.02 vs 0.8±0.1; p<0.001). More extensive clinical trials are required to validate these results.
PKEP is a safe and highly effective technique for relieving BOO. At 3-yr follow-up, the clinical efficacy of PKEP is durable and compares favourably with TURP.
European urology 11/2010; 58(5):752-8. · 7.67 Impact Factor
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ABSTRACT: To investigate the safety and feasibility of endoscopy in treating urinary tract calculi in preschool children.
From August 2004 to August 2008, 28 preschool children with urinary tract calculi were treated by endoscopy, 11 cases received ureterolithotripsy (URL) and 17 cases received minimally invasive percutaneous nephrolithotomy (MPCNL).
Of 11 cases with ureteric calculi, 5 cases were rendered stone free in the first session, the other 6 cases received passive dilation by indwelling of ureteric stents for 1 to 3 weeks and underwent successful ureteroscopy with a 8/9.8 Fr rigid ureteroscope. Seventeen cases with renal calculi received MPCNL and were rendered stone free.
Our study shows that endoscopy in treating urinary tract calculi is safe and feasible in preschool children.
Zhonghua wai ke za zhi [Chinese journal of surgery] 03/2009; 47(4):252-4.
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ABSTRACT: High renal pelvic pressure brings systemic absorption of irrigation fluid containing bacteria or endotoxins, which leads to postoperative fever. We inspected the renal pelvic pressure (RPP) in vivo during minimally invasive percutaneous nephrolithotomy (MPCNL) to investigate whether a 14- to 18-French percutaneous tract and perfusion would bring high RPP and postoperative fever.
Between July 2005 and December 2007, 80 patients were selected for RPP measurement during MPCNL. The RPP was measured by a baroceptor connected to the open-ended ureteric catheter, which was indwelling retrogradely in the renal pelvic. A computer recorded the RPP each second, and all the data were evaluated statistically with SPSS 12.0 software.
During MPCNL with 14-, 16-, 18-, and double-16-French percutaneous tracts, the mean RPP was 24.55, 16.49, 11.22, and 6.64 mm Hg, respectively. Logistical analysis suggested that postoperative fever did not correlate to gender (P = 0.195), age (P = 0.641), urinary tract infection (P = 0.663), white blood cell > or = 10 x 10(9)/L in routine postoperative blood examination (P = 0.751), or an occurrence of renal pelvic pressure > or = 30 mm Hg in the operation (P = 0.662), although infection calculi (P = 0.000), percutaneous tract (P = 0.029), mean RPP (P = 0.036), mean RPP > or = 20 mm Hg (P = 0.013), accumulated time of RPP > or = 30 mm Hg (P = 0.010), and RPP > or = 30 mm Hg longer than 50 s (P = 0.024) may contribute a postoperative fever.
Renal pelvic pressure generally remains lower than the backflow level (30 mm Hg) during MPCNL via a 14- to 18-French percutaneous tract. Any factors that brought about poor drainage would result in temporarily elevated RPP greater than 30 mm Hg, and many such occurrences of high pressure would have an accumulating effect, which means enough backflow to cause bacteremia and postoperative fever.
Journal of endourology / Endourological Society 09/2008; 22(9):2147-51. · 1.75 Impact Factor
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ABSTRACT: To report our experience with minimally invasive percutaneous nephrolithotomy (MPCNL) (14-18Fr percutaneous tract) to treat staghorn calculi via multiple percutaneous tracts in a single session procedure, and evaluate the feasibility and efficiency of this technique.
From March 2001 to November 2005, 100 patients with staghorn calculi were treated by MPCNL via multiple percutaneous tracts. The size and location of the stone, operative parameters, number of tracts, stone-free rate, operating time, hospital stay, and complications were analyzed retrospectively.
A total of 209 percutaneous tracts were established in 100 renal units during 128 operations including 28 second-look procedures. The mean operating time was 107 minutes (range 43 to 130 min) and the mean hospital stay was 9.4 days (range 6 to 13 d). The initial stone clearance rate of 72% after the first session was improved to 93% after a second-look procedure in 28 patients. The mean blood loss was 112 mL (range 64 to 483 mL), 3 patients required blood transfusion and 1 patient with branched renal arterial injury during puncture received a highly elective embolism. Seven patients had a postoperative fever of 38.5 degrees C or greater, whereas 4 patients had mild hydropneumothorax.
With the development of instrument and increased experience, judiciously made multiple percutaneous tracts in a single session MPCNL for treating staghorn calculi in selected cases is safe, feasible, and efficient with an acceptable morbidity.
Surgical laparoscopy, endoscopy & percutaneous techniques 05/2007; 17(2):124-8. · 1.23 Impact Factor
