Mini percutaneous nephrolithotomy: its role in the management of renal stone and our tertiary care centre experience

Background: Miniaturized percutaneous nephrolithotomy (PCNL) procedures for urolithiasis have gained increased popularity in recent years. To decrease the complications of conventional PCNL by  reduced tract size led to the development of Mini PCNL, which makes the use of 15-18F sheaths in place of 24-30F of conventional PCNL. It has developed rapidly and become a popular technique of renal stone management with reduced morbidity and excellent outcome. Authors report our experience with Mini PCNL for the treatment of renal stone.Methods: In between his August 2015 and January 2018, sixty patients with the diagnosis of unilateral single medium size (8-20mm) renal stone were identified. Patient’s demographical, clinical, diagnostic and procedural data were recorded.  All patients were evaluated by history taking, physical examination and laboratory investigations. Radiological evaluation was done with X ray kidney, ureter and bladder region (KUB) and also with renal ultrasonography followed by computed tomography (CT). All patients underwent Mini PCNL using 12F nephroscope and 16.5/17.5F sheath. Holmium: YAG laser was used for stone fragmentation. No nephrostomy tube was used routinely. Treatment outcome was assessed in terms of operative time, haemoglobin drop, hospital stay and stone free rate.Results: Complete stone fragmentation was achieved in 41 out of 60 patients using Mini PCNL, so initial stone free rate was 68.3%. After 4 weeks of surgery total 53 patients were stone free (88.3%), 5 patients required some auxiliary procedure for complete clearance of stone and other 2 were managed conservatively. The mean operative time was 48.28 min, mean haemoglobin drop was 0.74gm/l and mean postoperative hospital stay was 54.22 hours. After 12 weeks postoperatively all patients were stone free. There were no significant postoperative complications, and all had good quality of life.Conclusion: Mini PCNL technique appears to be safe and effective alternative to conventional PCNL for moderate size renal calculi. It is usually related to less blood loss and shorter hospital stay than the standard method. It can achieve good stone-free rates with minimal complications and low morbidity. Mini PCNL can also be considered as a good alternative to retrograde intrarenal surgery and shockwave lithotripsy in selected cases. However, further high quality studies with larger sample size are required in future

Retroperitoneal laparoscopic adrenalectomy: its role in the management of adrenal tumour and tertiary care centre experience

Background: Laparoscopic adrenalectomy for adrenal tumour has gained increased popularity worldwide. To decrease the complications of commonly used transperitoneal approach, by not entering into peritoneal cavity the retroperitoneal laparoscopic adrenalectomy (RLA) has developed. It has several advantages over the transperitoneal approach and associated with reduced morbidity and excellent outcome. The objective of this study was to report our experience with RLA for treatment of adrenal tumour.Methods: The study was done from August 2014 and December 2017, data of 44 patients who underwent RLA for adrenal tumour in the institute were retrospectively reviewed. Patient’s demographical, clinical, diagnostic and procedural data were recorded. All patients were assessed by history, physical examinations, laboratory values with biochemical marker test and imaging by computed tomography/magnetic resonance imaging. Treatment outcome was assessed in terms of operative time, haemoglobin drop, conversion rate, hospital stay and complications.Results: In 44 adrenalectomy, 24 men and 20 women, with a mean age of 47.0±8.9 years were enrolled. Mean body mass index was 23.5±2.2 kg/m2. Right adrenal tumour was seen in 26 cases and left in 18 cases. Mean adrenal mass size was 2.6±0.85 cm. Mean operative time was 109.1±21.16 minutes, mean haemoglobin drop was 0.47±0.26 gram/L. Conversion to open surgery was necessary in 2 patients. Mean postoperative hospital stay was 4.0±0.91 days. Recovery time mean value was 12.18±1.7 days postoperatively. In final histopathology result adenoma was most prevalent (25 cases) and myelolipoma was least (1 case).  Conclusions: RLA appears to be safe and effective alternative to transperitoneal adrenalectomy for moderate size adrenal tumour in particular less than 6 cm. It is associated with less blood loss, shorter hospitalization, low conversion rate, fewer complications and early recovery. RLA offers an alternative method for treating adrenal tumour with improved surgical outcomes

Feasibility of urolithiasis management after studer neobladder urinary diversion: A multicenter center study

Background: Stones formation is a common complication after cystectomy including stones of the upper urinary tract and reservoir or conduit. Advances in instrumentation and techniques have expanded treatment options, while minimizing morbidity. Aims and Objectives: Feasibility of urolithiasis management after urinary diversion surgery. Materials and Methods: Eleven patients of diversion with stone were observed from January 01, 2015, to July 30, 2022. Operative procedures were decided on basis on stone locations and size. Perioperative parameters were observed and compared with similar studies. Percutaneous nephrolithotomy, percutaneous-based antegrade ureteroscopy with semi-rigid or flexible ureteroscope, transurethral reservoir lithotripsy, percutaneous pouch lithotripsy, and open operation were performed. The operative finding and complications were retrospectively collected and analyzed. Results: The mean age of the patients was 53.2±8.1 years and mean pre-operative stone diameter was 3.1±3.5 cm. Three patients suprapubic cystolithotomy, two patients percutaneous cystolithotripsy, two patients percutaneous nephrolithitomy, two patients extracorporeal shock wave lithotripsy, one patient per urethral cystolithotripsy/cystolitholapexy, and one patient ureteroscopy/flexible ureteroscopy were done. The male-to-female ratio was 9/2. Stone-free rate was 100% after single session of treatment. In the post-operative period, fever was observed in two patients, and urinary leakage through wound site in one patient. Conclusion: Stone surgery after urinary diversion is challenging, success of treatment depends on experience of surgical team, pre-operative preparation, and correct instrumentations

Does size of semi-rigid ureteroscope make any difference in the management of ureteric stones in adult patients?

Background:Ureteroscopic lithotripsy is the standard of treatment for ureteric stones. Varying size of ureteroscopes provide their own advantages and drawbacks. We explored this issue further in our study by comparing outcomes of two different sized ureteroscopes.Methods: Forty adult patients of ureteric stones of Indian origin were taken. They were divided into two groups. Group A utilized 6.4/7.8Fr ureteroscope; while group B used 8.6/9.8Fr ureteroscope. Baseline demographic, clinical and stone parameters were compared. Outcome was assessed in form of stone free rate (SFR), operative time, hospital stay and occurrence of perioperative complications. Student-T and Chi-square tests were used in analysis.Results:Mean age and BMI were 42.1±13.9 years and 28.6±4.3. Both groups were comparable in age (p=.446), gender (p=.592), BMI (p=.453), stone size (p=.512), side (p=.393) and location (p=.387). Operation time was high in group A (38.8 ± 13.0 v/s 33.8 ± 6.8), while hospital stay was similar among groups (p=.878). Replacement of ureteroscope was more in group B (8/21 v/s 4/19). SFR in group A and B without ureteroscope exchange was 73.7% and 57.1%; while replacement improved SFR to 84.2% and 90.5% respectively (p=.000). SATAVA intraoperative complications were modestly high in group B. Occurrence of Clavien-Dindo postoperative complications were also similar (p=.672).Conclusion:Small ureteroscope was better in a narrow or proximal ureter, while large size offered better vision with quick stone clearance. Though complications were slightly high with large caliber ureteroscope, most were of low grades. Replacement to other size in difficult situations ensures best SFR

Comparison of One Shot Tract Dilatation to Metal Telescopic Dilatation in Percutaneous Nephrolithotomy and their Effect on Various Outcomes

Background: Tract dilatation during percutaneous nephrolithotomy (PCNL) is a crucial step. Many methods to achieve it have been advocated; however superiority of anyone is not established. We have compared two popularly used methods namely metal telescopic dilatation (MTD) and one shot dilatation (OSD) in our study. Methods: Retrospective observational study included 40 adult patients of renal or upper ureteric stone, underwent PCNL. Group A utilized MTD, while OSD was used in group B. Demographic features, stone parameters, access establishment time, fluoroscopy time, stone free rate and complications were compared. Chi-square and Student T-test was used for analysis.Results: Group A and B had 21 and 19 cases respectively. Age, BMI, stone size, stone location, past surgery status, presence of hydronephrosis was similar in both groups. Tract dilatation fluoroscopy time was significantly shorter in group B (OSD) than A (MTD) (35.1±7.6 sec v/s 53.8±13.2 sec, p=.000). Access establishment time was also reduced in group B than A (289.7±89.7 sec v/s 405.1±133.3 sec, p=.003). Operation time, blood transfusion rate, hemoglobin drop and stone free rate was not significantly different among groups. Incidences of intraoperative and postoperative complications were also similar in both groups.Conclusion: Both methods are safe and effective for tract dilatation. OSD however is associated with lower radiation exposure and short access establishment time