A Series Clinical Study Of Minimally Invasive Percutaneous Nephrolithotomy And Flexible Ureteroscopy In The Treatment Of Complicacy Kidney Stone

Chapter1:Single-tract minimally invasive percutaneous nephrolithotomy and staged flexible ureteroscopy in the treatment of complicacy kidney stoneObjective:To evaluate the efficacy and safety of staged single-tract minimally invasive percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopy in the treatment ofcomplicacy kidney stone.Methods:From Jan2011ureteroscopy by a single surgeon. Twenty five patients were staghorn (31.6%), and the others were multiple kidney stone (68.4%). All patients underwent single-tract MPCNL througha20F tract and had most of the intrarenal calculi removed at the first stage. The second stage of retrograde flexible ureteroscopy was performed three to five days later after the drainage was cleared. The preoperative patient, characteristics, stone size, operative time and postoperative outcomes were then evaluated.ResuIt:All operationwere successful and no major complications were noted in all patients. Theaverage operation time was(85±16) minutes at first stage and (46±21) minutes at second stage. The overall stone-free rate was92.4%after the second-stage procedures and only six patients had significant residue.Conclusion:Staged single-tract MPCNL and flexible ureteroscopy are safe and effective for the management of complicacy kidney stone. Chapter2:Combined minimally invasive percutaneous nephrolithotomy and retrograde flexible ureteroscopy in the treatment of complicacy kidney stoneObjective:To evaluate the efficacy and safety ofcombined minimally invasive percutaneous nephrolithotomy (MPCNL) andretrograde flexible ureteroscopy in the treatment of complicacy kidney stone.Methods:From Jan2012to Nov2012, a total of62patients withcomplicacy kidney stone, including17complete staghorn calculi,31partial staghorn calculiand14multiple calculi, were treated with minimally invasive percutaneous nephrolithotomy and retrograde flexibleureteroscopy. All patients underwent MPCNL and removedmost of the intrarenal calculi. Mutip-MPCNL was performed when the the residual stones large than20mm in diameter. After the residual stones less than20mm in diameter, retrograde flexible ureteroscopy was performed. The preoperative patient, characteristics, stone size, operative time and postoperative outcomes were then evaluated.Result:All operationwere successful and no major complications were noted in all patients. Only3patients can’t search the residual stones, the other59patients can search the residual stonesand were performed retrograde flexible ureteroscopy in on session.Theaverage operation time was(125±18) minutes.Theoverall stone-free rate was72.6%after the operation and91.9%at1month later.Conclusion:Combined minimally invasive percutaneous nephrolithotomy and retrograde flexible ureteroscopy are safe and effective for the management of staghorn calculi in one session. Chapter3:Staged single-tract minimally invasive percutaneousnephrolithotomy and flexible ureteroscopy in the treatmentof staghorn stone in patients with solitary kidneyObjective:The aim of this study was to evaluate the outcome of staged single-tract minimally invasive percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopyas a minimally invasive option in the treatment of staghornstone in patients with a solitary kidney.Methods:A total of24patients with staghorn stone in a solitary kidney weretreated with single-tract MPCNL and flexible ureteroscopyby a single surgeon. All the patients underwent single-tractMPCNL through a20F tract and had most of the intrarenalcalculi removed at the first stage. The second stage ofretrograde flexible ureteroscopy was performed3-5dayslater, after the drainage was cleared. The preoperativepatient, characteristics, stone size, operative time, renalfunctional status and postoperative outcomes were thenevaluated.Result:Sixteen patients were partial staghorn (66.7%),and other eight were complete staghorn (33.3%). Theoverall stone-free rate was83.3%after the second-stageprocedures, and only four patients had significant residue.The hemoglobin drop ranged from1.1to3.7g/dl, and threepatients required blood transfusion. The mean serum creatinine value was1.7±0.8mg/dl before surgery and1.3±0.4mg/dl at the end of the follow-up period withstatistical significance (P<0.05). None of the patients hadincreased serum creatinine, and needed dialysis at the endof the follow-up period. Conclusion:Staged single-tract MPCNL and flexible ureteroscopy are safe and effective for the management of staghorn stone in patients with a solitary kidneyand even in patients with impaired renal functions. Chapter4:Clinical application of three-dimensional CT reconstruction for flexible ureteroscopy in the treatment of residual renal calculi after percutaneons nephrolithotomyObjective:To evaluate the clinic effect of three-dimensional CT reconstruction for flexible ureteroscopy in the treatment of residual renal calculi after percutaneons nephrolithotomy.Methods:From Jan2012to Aug2012, a total of42patients with renal calculi, including17single calculi and25mutiple calculi which residual after single tract minimally invasive percutaneous nephrolithotomy, were performed upper urinary tract non-enhanced CT scanning and three dimensional reconstruction. Flexible ureteroscopy was performed for the treatment of residual renal calculi by the directionof three-dimensional CT reconstruction. Stone size, operative time and postoperative outcomes were then evaluated.Result:All operationwere successful and no major complications were noted in all patients. By the directionof three-dimensional CT reconstruction, flexible ureteroscopywas performed by retrograde in34cases and through the nephrostomy in14cases. Theaverage operation time was(52±11) minutes and the stone-free rate was95.2%.Conclusion:Three-dimensional CT reconstruction provided a good map of the pelvicalyceal system and the accurately located of renal calculi, which was benefit for searching kidney calculi by flexible ureteroscopy, reducing operation time, improving stone-free rate and ensuring operation safety. Chapter5:Comparative study on efficacy of multi-tract minimally invasive percutaneous nephrolithotomy and single-tract percutaneous nephrolithotomy with flexible ureteroscope in the treatment of complex renal calculiObjective:To comparatively analyze the clinical efficacy of multi-tract percutaneous nephrolithotomy lithotomy (multi-tract MPCNL) and single-tract percutaneous nephrolithotomy lithotomy with flexible ureteroscope for the treatment of complex renal calculi.Method:Select the patients which treated with single-tract MPCNLand residual multiple renal stones. Limited the diameter of single residual stones≤2cm. March2012to December2012,32patients were enrolled in this group, including19males and16females, mean age45.6±10.5years (range21-69years). According to the size of stones,32patients were divided into Group A and Group B. Group A was treated with multi-tractMPCNL. Group B was treated with single-tractMPCNLand flexible ureteroscope.After the first stage single-tractMPCNL, the second stage of operations were performed3-5dayslater when the drainage was cleared. Operative data, hospitalization periods, blood loss, serum creatinine changes and complications of the treated patients were recorded.Results:All operations were successful and not serious complications occur. An average of1.4tract was created in group A. The average operative time was59.6±22.5min and63±24.8min in group A and group B (P>0.05). The average hemoglobin concentration decreased was0.83±0.76g/dl ingroup A and0.35±0.47g/dl in group B (P<0.01),1patients need blood transfusion therapy in Group A and none in Group B. Stone clear rate was100%in group A and87.5%in group B. The hospitalization periodswas longer in group A(5.8days:1.9days). In group A, the mean serum creatinine value was1.13±0.8mg/dL after the operation, which is higher than the preoperative,0.92±0.21mg/dL (P<0.01). In group B, the mean serum creatinine value were0.96±0.22mg/dL and0.95±0.13mg/dLbefore and after surgery (P>0.05). However, both group A and group B, compared with preoperative, the mean serum creatinine value were on significantly1month later.Conclusion:Both multi-tractMPCNLand single-tractMPCNLwith flexible ureteroscope are safe and effective for treatment of complex renal calculi. Compare to single-tractMPCNLwith flexible ureteroscope, the single-tractMPCNLwith flexible ureteroscope has certain advantages in reducing operative bleeding and hospitalization time.