Nephrostomy tube misplacement in the inferior vena cava following percutaneous nephrostomy

Percutaneous renal interventions are characterized by bleeding and infectious complications, as well as trauma to organs located near the kidney, renal or inferior vena cava (IVC). The article presents a clinical observation of a rare complication of percutaneous nephrostomy (PCN), i.e. migration of the distal end of the nephrostomy tube into the IVC. Its timely removal followed by re-nephrostomy made it possible to avoid bleeding and restore drainage of the pyelocalyceal system. Along with this, the article presents a literature review on this condition in the eLibrary, Springer, MedLine, Embase, UpToDate databases from 2000 to 2021. The indications for PCN, the frequency and risk factors of IVC damage during percutaneous renal interventions, as well as treatment tactics were studied. After the initial evaluation of the literature, ten articles were selected for further analysis. The main risk factors associated with IVC perforation after PCN include the surgeon's lack of experience in instrumental imaging, misjudgment of the length of the nephrostomy tube, and its insertion depth, resulting in its inadequate placement. Removal of the nephrostomy tube from the IVC under radiological and ultrasound guidance or open surgery are the main methods to correct for this complication

Retrograde endoscopic-assisted percutaneous treatment of transplanted kidney calyceal fistula

Introduction. Calyceal fistula is a rare complication of a renal transplantation. This complication can lead to postoperative graft failure. The treatment approaches range from a partial nephrectomy to a routine nephrostomy.Objective. To present the successful application of the retrograde endoscopic-assisted percutaneous treatment of transplanted kidney calyceal fistula.Clinical case. A patient after kidney allotransplantation is under our care. Control postoperative ultrasound examination revealed a pararenal fluid mass in the left iliac region. Its percutaneous drainage was performed. Biochemical analysis revealed high levels of creatinine and urea in the drainage discharge. Despite ureteral stent and urethral catheter drainage, about 500 to 600 ml of urine per day was excreted by the drainage. Percutaneous puncture nephrostomy could not be performed due to the absence of dilatation of the renal cavity system. In the lithotomic position, the damaged calyx was identified by performing flexible ureteropyeloscopy. Then we percutaneously targeted the injured calyx and the distal end of the ureteroscope inserted transurethrally, so that the needle tip appeared in the paranephral cavity opposite the injured calyx. Under the control of a flexible ureteroscope the needle was inserted into the kidney pelvis, a nephrostomy tube 12 Ch was placed along the string. The discharge through the drain stopped within a week and it was removed. Follow-up examination nine weeks after surgery revealed that the patient had no complaints and renal ultrasound showed no features, so the nephrostomy tube was removed.Conclusion. The described method is the minimally invasive, affordable, and efficient method for the treatment of transplanted kidney calyceal fistula

The three-dimensional reconstruction of the dilated renal pelvicalyceal system by non-enhanced computed tomography

Introduction. The three-dimensional reconstruction of the renal pelvicalyceal system (PCS) is possible when performing enhanced computed tomography (CT). However, the use of a contrast agent has its limitations associated with the presence of allergy and chronic kidney disease.Purpose of the study. To describe the method of semi-autonomous three-dimensional (3D) reconstruction of the PCS based on non-enhanced CT images of patients with upper urinary tract obstruction.Materials and methods. Five patients diagnosed with renal colic were recruited from April-May 2021. All patients underwent CT-urography after informed consent. Medical Imaging Interaction Toolkit program (MITK) expanded with explainable update were used for 3D-reconstruction of PCS via excretory and native phases. To assess the accuracy of the latter, both contrast and non-contrast models were compared regarding their surface area. Also, the PCS of one patient was used to reconstruct virtual endoscopic views based on enhanced and non-enhanced models. Five urologists estimated their similarity and potential use of non-enhanced models for the interventional planning via a Likert scale questionnaire. The resulting models were also analyzed by programmer-engineers to test their suitability for 3D-printing.Results. The average surface area of enhanced and non-enhanced models was 3291 mm2 and 2879 mm2, respectively. Obtained models were suitable for their intraluminal reconstruction and potential 3D-printing. Analyzed properties of non-enhanced models were estimated at 4.5 out of 5.0.Conclusion. The described semi-autonomous reconstruction of the renal PCS based on non-enhanced CT images allows for a short time to reconstruct its 3D-view in patients with the upper urinary tract obstruction

The non-biological simulator with the ability to regulate the position of the kidney and bone landmarks: use for training puncture access in percutaneous nephrolithotripsy

Introduction. The non-biological simulators presented in the literature are far from the real human anatomy and are primarily aimed at developing the skill of the pyelocalyceal system (PCS) puncture without the possibility of imitating various intraoperative scenarios.Purpose of the study. To describe the manufacturing and initial testing of the ultrasound-guided PCS puncture simulator with arbitrary placement of bone landmarks and a kidney model, along with the use of a retrograde view during PCS puncture.Materials and methods. This study included training for 5 resident and 2 urologists. Each participant performed the puncture 5 times using an 18-gauge ultrasound-guided needle. A comparison was made between the number of attempts to form access, the duration of the puncture and its correctness (puncture into the small calyx through the papilla), as well as the correctness of determining the target calyx. The trajectory of the needle was retrogradely assessed using a semi-rigid ureteroscope, and the anatomical identification of the selected calyx was assessed using our mobile application.Results. The total number of attempts was 49 and 14 among residents and urologists, respectively. The average duration of the puncture step was 25.2 and 12.0 seconds. In 9/25 cases, residents were able to correctly analyze visual ultrasound information to determine the target calyx. When a contrast agent was injected into the PCS after 63 punctures, no contrast leakage was found.Conclusion. The proposed PCS puncture simulator allows to develop to develop all the necessary skills for cost-effective training of young urologists in the technique of percutaneous access

Virtual reality simulator for developing spatial skills during retrograde intrarenal pyeloscopy

Introduction. Currently, several virtual reality (VR) simulators have been described for the upper urinary tract stone surgery skill development, including retrograde or antegrade nephroscopy. However, their high cost and the lack of a detailed reconstruction of the intraluminal pelvicalyceal system (PCS) appearance limit their implementation into educational process and clinical practice.Objectives. To develop the approach for VR-reconstruction of the intraluminal appearance of the PCS via head mounted device (HMD), as well as estimate its usefulness for novices to improve spatial orientation during retrograde flexible nephroscopy.Materials & methods. Five residents without experience in self-performing retrograde flexible nephroscopy participated in a 7-day training course on the VR simulator developed, during which each novice studied six variants of the PCS. For the procedure simulation, a silicone kidney model was created with the stone placed in the calyx which was selected randomly in each case. Before and after VR-course, each resident assisted the experienced urologist during simulated retrograde nephroscopy to find the stone placed according to random selection. The nephroscopy time and the number of errors in stone-finding during retrograde flexible nephroscopy were analysed.Results. There was a statistically significant decrease in nephroscopy time (on avg by 17.6 minutes, p = 0.043) and errors to find targeted calyx, which was observed once after the training one resident only.Conclusion. The described VR simulator does not require significant time, technical and financial costs, and is available for wide implementation in the training of young specialists

Comparative analysis of the results of standard and minipercutaneous nephrolithotripsy for staghorn stones

Introduction. There are conflicting data in the literature on the results of mini-percutaneous nephrolithotripsy (PCNL) in staghorn stones.Objective. To compare the results of standard and mini-PCNL.Materials and methods. The results of PCNL in 90 patients with staghorn stones were analyzed, which were divided into two groups. In the I group, 58 (64.4%) patients underwent standard PNL with a nephroscope 24 Fr, in the II group, 32 (35.6%) patients underwent mini-PCNL with an endoscope 15 Fr. The operative time and the number of postoperative complications were compared. To assess the effectiveness of PCNL, an overview radiography or native computed tomography was performed. The operation was considered successful with residual fragments less than 3 mm.Results. Operative time, number of complications and blood transfusions, the effectiveness of PCNL in groups I and II were 80.0 ± 20.6 and 96.5 ± 25.0 min, 24.1% and 15.6%, 10.3% and 3.1%, 86.2% and 84.4%. Additional interventions were resorted to in 7 (12.1%) patients in I group, and in 4 (12.5%) patients in II group. Complications in I and II groups were observed in 14 (24.1%) and 5 (15.6%) cases. The frequency of blood transfusions was significantly higher after standard PCNL (10.3% / 3.1%, p < 0.05). Complications of grade III with mini-PCNL, replacement of an incorrectly installed stent was included in 2 patients, and with standard PCNL, ureteral stenting with urine leakage through the nephrostomic tract in 2 patients, drainage of the pleural cavity in one case.Conclusion. Standard PCNL is an effective method in staghorn stones, but the number of complications after it remains higher. In selected patients with staghorn stones, the results of mini-PCNL are comparable to those of standard PCNL

Diagnostics and correction of metabolic disorders in patients with recurrent urolithiasis after endoscopic removal of stones

The article is devoted to the problem of kidney stones. The authors provide the results of a study of 107 men aged 48 to 76 years, were divided into three groups – primary and two control groups. The main and the first control group consisted of 40 patients with recurrent urolithiasis without urinary tract obstruction after endoscopic stone removal and partial androgen deficiency. The second control group consisted of 27 healthy men aged 48 to 70 years. Patients for one year he was promoted endoscopic removal of urinary stones: transurethral nephrolithotripsy – 55 patients, and percutaneous nephrolithotripsy – 25. After discharge from hospital all patients had a diagnosis and correction of metabolic disorders using physical-chemical and biochemical indicators of urine and blood. To study the mineral composition and structural-textural features of urinary stones and their fragments after surgical interventions were performed: x-ray diffraction, infrared spectroscopy, polarization and electron microscopy. Was carried out following the relapse of urolithiasis: patients of the main group received pathogenetic androgen therapy as monotherapy, and patients in the control group conventional treatment (antibiotics, spasmolytic, herbal remedies). The results of therapy and follow-up care for 6 years showed a low recurrence of stone formation in patients of the main group and highest in the control. Age-related decline in androgen levels in men may be an additional factor in stone formation. Pathogenic androgen replacement therapy leads to normalization of the content of lithogenic substances in the blood and urine, as well as physico-chemical properties of urine, thereby reducing the process of stone formation