The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: Nephrolithotomy in 189 Patients with Solitary Kidneys

Abstract Background and Purpose: The study compared characteristics and outcomes in patients with solitary and bilateral kidneys who were treated with percutaneous nephrolithotomy (PCNL) in the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study. Patients and Methods: Data from consecutively treated patients from 96 centers worldwide were collated after a 1-year period. The following variables in patients undergoing PCNL with solitary or bilateral kidneys were compared: Prevalence, patient characteristics, intraoperative differences and outcomes, including bleeding and transfusion rates, renal function, and stone-free rates. Results: Data from 5803 patients were collated; 189 (3.3%) with solitary and 5556 (96.7%) with bilateral kidneys. Patient characteristics were well matched generally with the exception of cardiovascular disease and American Society of Anesthesiologists (ASA) risk scores, which were significantly greater in patients with solitary than with bilateral kidneys (P<0.0001 and P=0.004, respectively). Patients with solitary kidneys had also undergone significantly more procedures to remove calculi before this survey than bilateral patients (P= 00.049 ?<0.0001). Levels of renal impairment were significantly greater (P<0.0001) and stone-free rates were significantly lower (P=0.001) post-PCNL in solitary than bilateral kidney patients. Although bleeding rates were the same in both groups, transfusion rates were significantly greater in solitary kidney patients (P=0.014). Conclusions: Patients with a solitary kidney had a higher cardiovascular risk and ASA score. Outcomes related to morbidity and stone-free rate were less favorable for solitary kidneys.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98444/1/end%2E2011%2E0169.pd

Bipolar vaporization of the prostate: is it ready for the primetime?

Although transurethral resection of the prostate is still the ‘gold standard’ in the surgical management of benign prostatic hyperplasia, it is associated with significant morbidity. This review presents one of its most successful alternatives, bipolar transurethral vaporization of the prostate, a procedure that has emerged during the last decade. The technical principles are presented, together with the trials that compare it with the standard resection technique. The review concludes that bipolar vaporization of the prostate is safe and effective, providing very good hemostasis control and low complication rates, at a significantly reduced cost per procedure. Improved vision and hemostasis make it suitable for patients with cardiac pacemakers, bleeding disorders, or those under anticoagulant therapy. However, long-term follow-up and more randomized trials are still needed, to validate the value of bipolar vaporization