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Simultaneous combined use of flexible ureteroscopy and percutaneous nephrolithotomy to reduce the number of access tracts in the management of complex renal calculi.
BJU Int. 2005 Nov; 96(7):1097-100.BI

Abstract

OBJECTIVE

To present early experience in managing complex renal calculi using a combined ureteroscopic and percutaneous approach, as complex and branched renal calculi often require multiple access tracts during percutaneous nephrolithotomy (PNL), and the combined use of flexible ureteroscopy and PNL has the potential to reduce the inherent morbidity of several tracts.

PATIENTS AND METHODS

The study included seven patients (mean age 54 years) with multiple, branched, large-volume renal calculi suitable for management with PNL. Preoperative data, including patient demographics, stone location and stone surface area, were recorded. After informed consent, the patients underwent combined PNL and ureteroscopy in one session. Intraoperative data, including the location of PNL puncture sites, operative duration and complications, were analysed. Stone-free rates were determined by follow-up imaging at 3 months.

RESULTS

All patients had either two or more stones in separate locations in the collecting system, or staghorn stones involving multiple calyces. The mean stone burden was 666 mm(2). All patients had only one percutaneous access tract. The mean operative duration was 142 min and the mean blood loss 79 mL. Two patients had small residual stones (< 3 mm), that required ureteroscopic intervention as they failed to pass spontaneously by 3 months after the initial combined procedure. The convalescence was similar to that in our current PNL practice; imaging showed that five of the patients were stone-free.

CONCLUSIONS

Combined PNL and ureteroscopic management can effectively reduce the number of percutaneous access tracts which would otherwise be required for managing complex and branched renal calculi, as stones in an unfavourable location relative to the access tract can be relocated and fragmented within easy reach of the single nephrostomy tract. This manoeuvre reduces potential patient morbidity and blood loss but with no significant effect on stone-free rates and operative durations.

Authors+Show Affiliations

Department of Urology, Duke University Medical Center, Durham, NC 27710, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16225535

Citation

Marguet, Charles G., et al. "Simultaneous Combined Use of Flexible Ureteroscopy and Percutaneous Nephrolithotomy to Reduce the Number of Access Tracts in the Management of Complex Renal Calculi." BJU International, vol. 96, no. 7, 2005, pp. 1097-100.
Marguet CG, Springhart WP, Tan YH, et al. Simultaneous combined use of flexible ureteroscopy and percutaneous nephrolithotomy to reduce the number of access tracts in the management of complex renal calculi. BJU Int. 2005;96(7):1097-100.
Marguet, C. G., Springhart, W. P., Tan, Y. H., Patel, A., Undre, S., Albala, D. M., & Preminger, G. M. (2005). Simultaneous combined use of flexible ureteroscopy and percutaneous nephrolithotomy to reduce the number of access tracts in the management of complex renal calculi. BJU International, 96(7), 1097-100.
Marguet CG, et al. Simultaneous Combined Use of Flexible Ureteroscopy and Percutaneous Nephrolithotomy to Reduce the Number of Access Tracts in the Management of Complex Renal Calculi. BJU Int. 2005;96(7):1097-100. PubMed PMID: 16225535.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Simultaneous combined use of flexible ureteroscopy and percutaneous nephrolithotomy to reduce the number of access tracts in the management of complex renal calculi. AU - Marguet,Charles G, AU - Springhart,W Patrick, AU - Tan,Yeh H, AU - Patel,Anup, AU - Undre,Shabnam, AU - Albala,David M, AU - Preminger,Glenn M, PY - 2005/10/18/pubmed PY - 2005/11/16/medline PY - 2005/10/18/entrez SP - 1097 EP - 100 JF - BJU international JO - BJU Int VL - 96 IS - 7 N2 - OBJECTIVE: To present early experience in managing complex renal calculi using a combined ureteroscopic and percutaneous approach, as complex and branched renal calculi often require multiple access tracts during percutaneous nephrolithotomy (PNL), and the combined use of flexible ureteroscopy and PNL has the potential to reduce the inherent morbidity of several tracts. PATIENTS AND METHODS: The study included seven patients (mean age 54 years) with multiple, branched, large-volume renal calculi suitable for management with PNL. Preoperative data, including patient demographics, stone location and stone surface area, were recorded. After informed consent, the patients underwent combined PNL and ureteroscopy in one session. Intraoperative data, including the location of PNL puncture sites, operative duration and complications, were analysed. Stone-free rates were determined by follow-up imaging at 3 months. RESULTS: All patients had either two or more stones in separate locations in the collecting system, or staghorn stones involving multiple calyces. The mean stone burden was 666 mm(2). All patients had only one percutaneous access tract. The mean operative duration was 142 min and the mean blood loss 79 mL. Two patients had small residual stones (< 3 mm), that required ureteroscopic intervention as they failed to pass spontaneously by 3 months after the initial combined procedure. The convalescence was similar to that in our current PNL practice; imaging showed that five of the patients were stone-free. CONCLUSIONS: Combined PNL and ureteroscopic management can effectively reduce the number of percutaneous access tracts which would otherwise be required for managing complex and branched renal calculi, as stones in an unfavourable location relative to the access tract can be relocated and fragmented within easy reach of the single nephrostomy tract. This manoeuvre reduces potential patient morbidity and blood loss but with no significant effect on stone-free rates and operative durations. SN - 1464-4096 UR - https://www.unboundmedicine.com/medline/citation/16225535/Simultaneous_combined_use_of_flexible_ureteroscopy_and_percutaneous_nephrolithotomy_to_reduce_the_number_of_access_tracts_in_the_management_of_complex_renal_calculi_ L2 - https://doi.org/10.1111/j.1464-410X.2005.05808.x DB - PRIME DP - Unbound Medicine ER -