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Year : 2015  |  Volume : 7  |  Issue : 5  |  Page : 38-44  

Endo – Urology Abstracts

Date of Web Publication20-Mar-2015

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How to cite this article:
. Endo – Urology Abstracts. Urol Ann 2015;7, Suppl S1:38-44

How to cite this URL:
. Endo – Urology Abstracts. Urol Ann [serial online] 2015 [cited 2022 Jan 24];7, Suppl S1:38-44. Available from: https://www.urologyannals.com/text.asp?2015/7/5/38/153733

Staged versus synchronous percutaneous nephrolithotomy: A comparative study in patients with bilateral renal calculi

Mousa Tawhary

King Saud University, Riyadh, Saudi Arabia

Background and Purpose: Treatment of patients with large bilateral stones still poses a urologic challenge. We wanted to evaluate in a comparative manner synchronous and staged bilateral percutaneous nephrolithotomy (PCNL).

Patients and Methods: A retrospective review of all patient who with bilateral renal calculi requiring PCNL were reviewed between January 2005 and December 2014. A total of 20 patients were identified. 13 patient underwent staged bilateral PCNL (Group 1) and seven patient undergone synchronous bilateral PCNL (Group 2). Variables of operative time, transfusion rates, length of hospital stay, complication and stone free rates was evaluated per operation and per renal unit.

Results: The average operative time was 178 min and 106 min for group 1 and group 2 respectively. 65 percent of the patients in Group 1 were stone free compared with 92% of the patients in Group 2. Complication in group1 was one patient with bleeding and required blood transfusion, one patient complicated by renal pelvis perforation and one by pleural effusion ,in group 2 one patient complicated by minor chin pressure injury because of prolonged procedure (420 monuits) hospital stay was nearly doubled for group 1 compared to group 2 respectively 8 day and 4.2 days. Transfusion rates of (7.6%) and (0%) for group 1and group 2 respectively.

Conclusions: Synchronous PCNL reduced total operative time, hospital stay, along with the requirement for only one anesthesia. Synchronous bilateral PCNL is an acceptable option for select individuals with bilateral renal calculi.

Retrograde endoscopic injection of fibrin sealant for upper urinary tract unexplained hematuria (temporary effect): Case report

Saeed Al-Qahtani

King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz National Guard Hospital, Saudi Arabia

Background and Purpose: Upper urinary tract (UUT) hematuria represents unique clinical challenges that often necessitate upper tract endoscopic exploration as well as renal embolization in certain pathologies. Huge advances in retrograde instrumentation have enabled endourologists to perform more minimally invasive approaches for UUT diseases. We present our experience with endoscopic exploration and injection of fibrin sealant (TISSEEL) BAXTER; for the UUT unexplained hematuria.

Patients and Methods: We performed a flexible ureterorenoscopy and retrograde endoscopic injection of TISSEEL for 33-year-old female who presented with recurrent severe unexplained hematuria. Renal angiograph was performed and did not show any vascular abnormalities. We have described treatment technique, method/duration of follow-up, complications, and success, which was defined as temporary resolution of this dilemma.

Results: Hematuria resolved immediately for at least 3-month post a single injection of TISSEEL. There were no complications. Failure was apparent at 3 months.

Conclusion: Retrograde endoscopic injection of fibrin sealant (TISSEEL) demonstrates a new alternative approach as a temporary effect of UUT hematuria. Although renal angiography and Flexible flexible Ureterorenoscopy ureterorenoscopy remain the gold standard to diagnose and treat most of UUT pathologies, retrograde endoscopic injection of fibrin sealant offers a safe minimally invasive technique that may avoid

the morbidity of further invasive ones in such challenging patients.

Endoscopic diagnosis and management of calyceal diverticular calculi

Abdulrahman Al-Aown, Hassan Assiri, Sead Malawi

Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, KSA

Introduction and Objectives: Calyceal diverticula are uncommon urine-containing cavities within the renal parenchyma that communicate with the collecting system through a narrow channel. Diverticula that are located deep within renal parenchyma can be difficult to manage due to challenges in identifying the patent communication of the diverticulum to the collecting system and the potential blurring of the endoscopic vision due to significant hemorrhage from surrounding parenchyma. This report aims to demonstrate an endoscopic approach for the diagnosis and management of calyceal diverticular calculi.

Methods: The video demonstrates the aforementioned approach in a 45-year-old female who initially presented with left flank pain and recurrent urinary tract infections. CT urography revealed an 8 mm left intra-parenchymal lower renal calyceal diverticulum stone. She had a previous history of unsuccessful ESWL. A ureteral catheter was placed cystoscopically to allow contrast injection (retrograde pyelography) for the localization of the diverticular opening to the renal collecting system. During the procedure, a flexible digital ureteroscope was inserted over a guide wire. Inspection of the pelvicalyceal system revealed no stone and the calyceal diverticulum was suspected. A second injection of double contrast took place and diverticular opening has been located. A guide wire was inserted through the diverticular opening followed by flexible ureteroscopic dilatation and the stone could be eventually visualized. Laser litrotripsy was performed to fragment the stone.

Operative time was 70 min. There were no intraoperative or post-operative complications. Intraoperative blood loss was insignificant. The patient was discharged on the same day. The symptoms of flank pain and recurrent urinary tract infections were resolved during the follow-up period of 18 months. Follow-up CT urography at 6 months showed no residual stones in the diverticulum.

Conclusions: In the current video, we demonstrate a safe and reproducible way for the management of a symptomatic calyceal diverticular stone. Essential technical tricks during the presented endoscopic approach include the placement of a ureteral catheter, performance of multiple retrograde pyelographies and the good visualization of the pelvicalyceal system with the use of new generation of digital flexible ureteroscopes. Careful preoperative imaging and high degree of suspicion are also essential.

The role of microbiological evaluation in prediction and management of post inflammatory response syndrome post percutaneous nephrolithotomy: A prospective clinical study

Mohammed Elawdy

Ministry of Health, Oman

Urinary tract infection (UTI) and its consequences are common post percutaneous nephrolithotomy (PCNL). The role of mid-stream urine (MSU), renal pelvis (RP) or stone cultures are not fully understood. We aimed to study the role of microbiological evaluation in prediction of post inflammatory response syndrome (SIRS) events post PCNL.

Patients and Methods: Between June 2012 and April 2013, 84 consecutive patients were recruited for PCNL for renal stones. Pre-operative MSU, RP, and retrieved stone fragments were cultured and antibiotic sensitivity tests were performed. All patients were monitored for any SIRS criteria during their inpatient stay. The data was collected using SPSS version 16; .

Results: One or more SIRS criteria were recorded in 42 patients (50%). In univariate analysis, positive pre-operative MSU (P = 0.005), positive stone culture (P = 0.049) and higher mean pre-operative WBCs count (P = 0.006) were significantly associated with development of the SIRS criteria. Only positive preoperative MSU culture (P = 0.02) and preoperative WBC count (P = 0.01) predict SIRS in multivariate analysis. Clavien GI-II perioperative complications occurred in 19 and GIII occurred in 6. No postoperative clinical significant sepsis necessitating ICU admission was reported (Clavien IV).

Conclusion: Although occurrence of one of more of SIRS events is common post PCNL, it doesn't always accompanied by significant UTI that respond well to conservative management. Positive MSU culture and high WBC count are predictors of SIRS events, however neither positive RP nor retrieved stone cultures could help in prediction of SIRS events post PCNL.

Factors predicting spontaneous passage of a ureteral calculus ≤10 mm

Abul-fotouh Ahmed 1,2 , Ahmed H. Gabr 2,3 ,

Abdel-Aziz Emara 1 , Mahmoud Ali 1 ,

Al-Sayed Abdel-Aziz 1 and Saad Alshahrani 2

1 Department of Urology, Al-Azhar University, Cairo, 3 Department of Urology, Minia University, Minia, Egypt, 2 Department of Urology, Salman Bin Abdul-Aziz University, Al-Kharj, 4 Department of Urology, King Khalid Hospital, Tabouk, KSA

Purpose: To evaluate the outcome of expectant management of ureteric stones and to determine factors predictive of spontaneous stone passage.

Methods: We retrospectively reviewed the medical records of patients who had ureteric stones ≤10 mm and treated conservatively at our institutions during the period from 2008 to 2013. The stone passage rate and time and different clinical, laboratory and radiological variables were analyzed.

One hundred sixty three patients with ureteric stones were enrolled in the study. Out of them, 127 (77.9%) passed their stones spontaneously with a mean passage time of 24.06 ΁ 8.09 days. The cumulative stone passage rate was 1.6%, 15%, 41.7%, 72.4%, 89.8% and 98.4% at 7, 14, 21, 28, 35 and 42 days, from the first presentation, respectively. Patients with high pain scale score, stone ≤5 mm, lower ureteric stone, high WBCs count and those with absent computed tomography (CT) findings of perinephric fat stranding (PFS) and tissue-rim sign (TRS) have a higher likelihood for spontaneous stone passage. Patients with stone ≤5 mm, stone in lower ureter and those with absent PFS have a shorter spontaneous passage time. In multivariate analysis, the absence of PFS and TRS were the only significant predictors for spontaneous stone passage (P < 0.001 and 0.002, respectively).

Spontaneous ureteral stone passage rate and time varies with different factors. Absence of CT findings, PFS and TRS, are significant predictors for stone passage and should be considered when choosing the expectant management.

Contemporary management of staghorn stones, King Saud University experience

Mousa Tawhary

King Saud University, Riyadh, Saudi Arabia

Background and Purpose: Percutaneous nephrolithotripsy (PCNL) is an important technique in the management of staghorn renal calculi. In this study, we present our experience with PCNL for management of staghorn renal calculi.

Patients and Methods: A retrospective analysis of patients with staghorn renal calculi who were treated with PCNL between october2005 to Dec December 2014.

Results: A total of 138 renal units in 121 patients underwent PCNL. The mean age of the patients was 40 years range from 18 months to 86 years. 71 (51%) patients with complete staghorn calculi and 68 (49%) with partial staghorn calculi. The mean stone size was 45mm range between 30 and 90 mm. Stone-free rate was achieved in 111 (80.4%). The mean procedure times, and hospitalization times were (171) min and (4.9) days, respectively. Transfusion rate was (5%). puncture site was most common through subcostal access in (58%) and (19.5%) supracostal access, and (22.5%) accessed by both. our access done by the surgeon in 131 (95%) renal unite. Postoperative complications were observed in (23) (16.6%) patients. Bleeding in 9 patient three of them required angioempolization, urosepsis in 2 patients, one renal pelvis perforation, 3 hydrothorax and 3 atelectasis 4 pleural effusion leakage after removal of nephrostomy tube in 2 patient.

PCNL is an effective and a safe for the treatment of staghorn stones, and has advantages such as acceptable surgical duration, fewer complications, rapid recovery, short hospital stay, effective stone free rate.

Endoscopic exscion of solitary metastasis of renal cell carcinoma to the proximal part of the contralateral ureter

Ahmed Al Hady

Armed Forces Hospital Southern Region, Saudi Arabia

Purpose: Isolated metachronus metastasis of renal cell carcinoma to the contralateral ureter is extremely rare. To date only 6 cases occur at the contralateral ureter. We report a rare case of metastatic renal cell carcinoma in the contrlateral ureter 18 months after radical laparoscopic nephrectomy.

Methods: A 39-year-old man presented with gross painless hematuria for 2 weeks duration. Computed tomography scan confirmed that a 1cm by 0.5 cm mass with mild enhancement occurred in the contralateral proximal ureter with proximal mild back pressure.

Results: The reappearance of hematuria after radical nephrectomy is the most common presentation of the metastasis to the ureter. The mechanism of metastasis is not clear. In pathology, cytokeratin might help to differentiate between metastatic clear cell renal cell carcinoma and clear cell transitional cell carcinoma.

Conclusion: Metastasis of renal cell carcinoma to the contralateral ureter is extremely rare. Early recognition is extremely important in protecting the remaining renal function to prolong life-expectancy for post-nephrectomy patients. Complete endoscopic excision and laser ablation have been shown feasible approach of managment as minimal invasive surgery with its advantges regarding oncology control and patient safety.

Hand-assisted laparoscopic nephrectomy for large renal mass

Ahmed Alzahrani

Prince Sultan Military Medical City, Riyadh, Saudi Arabia

Introduction: Hand-assisted laparoscopy (HAL) allows surgeons direct hand contact with the operative field, maximizing tactile feedback and minimizing surgical injury to the patient. Indications for HAL include radical, donor, and partial nephrectomies, nephroureterectomy, and, most recently, dismembered pyeloplasties.

Materials and Methods: Video demostrating a procedure for a 60-year-old patient, incidental right renal mass 16 cm Χ 10 cm, enhancing involving mid and lower pole of the right kidney. Hand-assisted laparoscopic nephrectomy done,gel port from applied medical used,hemolock and endo gia used for vascular pedicle control.

Operative time was 160 min, blood loss was 300 mL, histopathology renal cell carcinoma clear cell type furhman grade II, hospital stay 72 h postoperative, analgesia comparable to conventional laparoscopy.

Conclusion: Compared with standard laparoscopy hand assisted laparoscopy decreases operative time without significantly altering short-term parameters of convalescence, it is feasible approach for large renal masses.

Laparoscopic experience in prince sultan military medical city in the past 2 years

S. AlRasheedi, A. Binjohar, H. Al Akrash,

A. Al Zahrani

PSMMC, Riyadh, KSA

Introduction: The minimal invasive intervention in urology is rapidly evolving. Laparoscopic experience in our institution started long time ago and kept progressing in a good manner.

Materials and Methods: In retrospective fashion by using the OR records and patients files between January 2012 to December 2014, a total of 52 cases were done. Nephrectomies predominate in about 36 cases (69.2%), 8 pyeloplasties (15.5%), 2 pyelolithotomies (3.8%) and 6 other procedures (11.5%) (orchidopexy, orchiectomy, sacrocolpopexy, diagnostic laparoscopy, laparoscopy + retroperitoneal mass biopsy and gossiboma, one case for each).

Results: Almost all of the cases completed laparoscopically except 5 cases with conversion rate of 9.6%, operative times ranging from 45 min to 6 h with mean OR time of 3.1 h and the hospital stay post operatively ranging from 1-day to 20 days with mean hospital stay of 6.5 days. One major complication happened as missed descending colon injury required Hartman's procedure.

Conclusion: The laparoscopic surgery in our department is progressing well and more sophisticated procedures with good results are being done.

Spontaneous resolution of staghorn calculi: Two case reports and review of literature

Irfan S. Khan, Al Oraifi Ibrahim, Aldossary Nader

Department of Urology, King Fahad Specialist Hospital, Dammam, Dammam, Eastern Province, Saudi Arabia

Introduction: Disappearance of Staghorn calculi without any prior surgical or medical interventions is a rare occurrence. We are hereby reporting two cases.

Materials and Methods: Two cases of disappearance of previously documented staghorn calculi were identified. Their medical records were reviewed with regards to presentations, imaging, treatment received and outcome. A review of previous similar English literature was conducted.

Results: The first case was a 40-year-old male patient who was rendered quadriplegic following a cervical spine injury due to RTA. He was found to have bilateral staghorn calculi on CT after presenting with UTI. He had a split renal function of 68% on the left and 32% on the right. He was initially treated with Ciprofloxacin for 5 days. Thereafter he was kept on Nitrofurantoin prophylaxis while awaiting PCNL, which was done after 1-month. Intra-operatively, nephroscopy including all the calyceal system showed no evidence of calculi. This was confirmed on subsequent CT scan. The second case was a 55-year-old male patient who was otherwise fit and well. He was diagnosed with a left sided complete stag horn calculus. His urine culture showed recurrent Proteus Mirabilis growth which was treated according to sensitivity until a negative culture was obtained. Following that, he underwent left PCNL. Similarly, intra-operatively, the stone size was significantly smaller (reduced by around 80%). Moreover, the remaining part was soft and friable and easily sucked.

Conclusion: Resolution of staghorn calculi without intervention or complete reversal of lithogenic factors such as immobility or urine chemistry is an unusual phenomenon that is yet to be explored. This, however, should not discourage active intervention as a standard treatment.

The effect of body mass index on stone free rate in patients treated with ESWL

Al Daham Naif, Hassan Mohammed,

Muhammed Tahir Malik, Al Bakri Ayman

Department of Urology, Security Forces Hospital, Riyadh, KSA

Purpose: To determine effect of body mass index on stone clearance rate in patients with upper urinary tract stones treated with extracorporeal shockwave lithotripsy only.

Materials and Methods: We retrospectively reviewed the files of 151 patients who underwent ESWL from 2012 to 2013 in SFH for upper urinary tract stone in comparative manner with stone size of 5-15 mm. BMI was calculated for each patient. Follow-up was based on CT scan (plain) and/or with KUB X-ray after 6-9 weeks from the last session of ESWL and then patients were categorized into stone free (SF) or residual stone (RS).

Results: Patients were stratified into three groups according to their BMI (<25, 25-30 and >30). There is a no statistical significant (P = 0.735) difference between mean clearance rate in different BMI groups. But we can emphasize higher the level of BMI would be lower level of stone clearance rate of patients.

Conclusions: There was no statistically significant difference in stone clearance with ESWL in patients with different BMI. ESWL is a valid option for management of urinary stones in obese patients.

Bladder explosion, a rare complication of TURP: A case report

F. Alharbi, H. Alakrash, A. alzahrani, T. Alafraa

Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia

Objective: Present a rare complication of TURP.

Case Report/Methods/Results: A 60-year-old male patient, medically free, with Obstructive Benign Prostatic Hyperplasia. Prostate size is 72 mm as seen in ultrasound. While performing TURP, Fr.26 resectoscope was used with 2% glycerin as irrigant. Loop electrode setting at 80 watts for coagulation and cutting. In the middle of the procedure a small bleeding was noted in the bladder neck at 12 O'clock. While initiation of cautery, a pop was heared with presence of air bubbles. After that, the procedure was stopped and abdominal distention was present. Abdominal exploration was done which showed intraperitoneal bladder rupture at the posterior wall. No sign of resection was seen in the bladder, repair was done and 3-way Foley's catheter was inserted and abdominal drain was kept.

Bladder rupture, even though rare and unexpected, can be prevented with precautionary measures.

Evaluation of ureteroscopy after a period of ureteral stenting in adults having ureteral stones

Mamdouh M. Abol-Nasr, Alayman F. Hussein,

Fahad M. Alfahaidy

El-Minia University Hospital, Egypt, Prince Salman Hospital, Riyadh, KSA

Objective: Evaluation of ureteroscopic stone manipulation, in adult patients with a unilateral ureteral stones, after a period of ureteral stenting that was done for many indications.

Patents and Methods: Eighty-one adult patients with unilateral ureteral stones were included in this study. All patients had a double-J stent inserted into the ureters for different indications. On stent removal, the semi-rigid ureteroscope was used for stone manipulation and extraction. The procedures and events accompanying ureteroscopy were studied and evaluated.

Results: The male:female ratio of the patients was 5:1. The mean age was 36.3 ΁ 15.7 years. The ureteroscope could be inserted up to the ureter without dilatation of the ureter in all patients. Spontaneous stone passage was confirmed in three patients (3.7%). Thirty-six percent of the patients were unreliable and came late for the second session ureteroscopy. Seventy-eight patients underwent ureteroscopic manipulation of the ureteral stones. Stone-free rate of 95% was achieved without any major ureteral injuries. Small perforation occurred in one patient (1%) during stone disintegration. Stone migration occurred in four patients having upper ureteral stones (5%).

Ureteral stenting are to overcome certain calculus-related situations most commonly obstructive pyelonephritis, complicated and difficult ureteroscopy. Ureteral stenting induces passive ureteral dilatation that provides a better endoscopic environment that paves the way to an easier and less complicated interval semi-rigid ureteroscopic manipulation of ureteral stones that is associated with high stone-free rates. Pre-stenting should be considered in complicated and challenging cases of ureteral stones.

Peoples' awareness and desire to have minimally invasive surgery and robotic surgery in developing countries

Mohammed Elawdy

Ministry of Health, Oman

In Less Developed Countries (LDC), no previous studies have been done yet to assess public awareness and the desire to have robotic surgery (RS). Such studies may help to predict when this technology can be established in LDC.

Materials and Methods: A cross-sectional survey, between March and July 2014. A simple Arabic questionnaire was conducted on the Egyptian population above 17 years. The objective was to assess people's knowledge and their desire to have RS and/or minimally invasive surgery (MIS). Data was collected and analyzed by two medical students using SPSS; version 16.

Results: We had 2,276 completed questionnaires. Only 36% of the Egyptian population knew or had heard about RS in comparison to 80% for MIS and 95% had heard about medical laser applications. For RS, the main source of information had been the media (55%), while word of mouth was responsible for MIS knowledge and exposure (60%). To assess whether or not patients would opt for MIS, 70% of the participants left the decision to their physician and only 5% selected open surgery. If financial support was not available for MIS, 50% of the respondents considered searching for other types of financial support.

Conclusion: In Egypt, despite people's better understanding of MIS, there remains poor knowledge regarding robotic surgery. The majority would choose to have an MIS operation even if they lacked the financial support. People trust their physicians to make the right decision. This could be an asset for counseling patients in the future who may require robotic surgery.

Safety and efficacy of percutaneous nephrolithotomy for the treatment of pediatrics renal stones

Mousa Tawhary

King Saud University, Riyadh, Saudi Arabia

Introduction: We present our experience with pediatrics PCNL for renal calculi in children under 18 years in Saudi Arabia.

Methods: All patients undergoing PCNL at our institution between May 2005 and October 2014 were reviewed. Demographics, surgical details and post-operative follow-up information were obtained to identify stone free rates and complications.

PCNL was performed in 23 renal units in 17 patients (mean age: 7.6 years). The mean stone diameter was 39 mm (range: 16-55 mm). 14 cases required single puncture and 8 required two tracts. Overall, 15 staghorn stones, 8 single stones were treated. 15 patients (91%) were completely stone free following initial PCNL. There was no significant bleeding encountered either during the operation or in the post-operative setting. One patient required a blood transfusion. One patient complicated with renal pelvis perforation, one UTI and one with hydrothorax required chest drain.

Conclusions: Pediatrics PCNL can be performed safely with minimal morbidity for large stone burden with 91% stone free rate.

Urinary bladder and ureteral stent changes in stone-forming adults clinical and cystoscopic evaluation

Mamdouh M. Abol-Nasr, Fahad Alfahaidy

Prince Salman Bin Abdulaziz Hospital, Riyadh, Saudi Arabia

Objective: The indications of insertion and symptoms of ureteral stents were reviewed in adult patients with ureteral stones. The cystoscopic changes in the bladder and in the stents were detected on removal.

Patients and Methods: Eighty-one adult patients with ureteral stones were included in this study. All patients had a double pigtail stent inserted for many different indications. Patients were studied for urologic symptoms during the period of stenting. Changes in urinary bladder mucosa and in the stents distal bladder coil were detected.

Results: The male to female sex ratio was 3.8:1 and the mean was 33.7 ΁ 17.5 years. Obstructive pyelonephritis is the most common indication for stenting (43%). During the period of ureteral stenting, the most common patients' complaint was dysuria (49%) followed by frequency of voiding (28%). Cystoscopy revealed that trigonal hyperemia was encountered in (22%), hyperemia and prominence of the stented ureteral orifice in (11%), bullous edema around the stented ureteral orifice in (17%), and multiple bladder gravels in (8.6%) of patients respectively. Ureteral stent distal coil changes included encrustation in (17%), muddy precipitation in (10%), and stent migration in (2.5%).

Conclusion: Obstructive pyelonephritis is the most common and beneficial indication for ureteral stenting in patients with ureteral stones. Ureteral stents might lead to bothersome voiding symptoms commonly dysuria and increased voiding frequency. However, most symptoms could be managed conservatively. Bladder trigone may develop mucosal changes caused by its irritation by the stent. Stent encrustation develops especially with

prolongation of the period of stenting. Early removal of the ureteral stent with definitive stone management is recommended.

Value of intraoperative ultrsound in degreasing the risk of residaul radiolucent stones post PCNL

Mohamed S. Aboelmagd, Tamer Barakat,

Shady Soliman, Jalal M. Al Shareef

Department of Urology, Al-Hada Armed Forces Hospitals, Taif, KSA

Introduction: The main goal of any intervention for urolithiasis is complete stone removal in order to achieve a stone free status. Complete stone removal assures resolution of the immediate adverse outcomes of the stone disease, and prevents possible long-term complications such as pain, obstruction and stone growth. Percutaneous nephrolithotomy is an effective procedure which is being considered as the gold standard in the treatment of large/complex renal calculi. Reported stone free rates are up to 90%, probably reflecting the level of experience, stone properties and equipment employed in the procedure. It is well established that higher incidence of residual fragments increases the complication rates and needs further interventions. The main reason for failure of complete radiolucent stone clearance is inability to visualize the residual stones either by nephroscope or by fluoroscopy. The use of intra operative Ultrasound for assessment of residual radiolucet stones during percutaneous nephrolithotomy, will help to increase stone free rate.

Materials and Methods: Between September 2010 and September 2014 intra operative ultrasound was used in 74 cases of large complex radiolucent renal stones.

Results: It showed stone free rate 100% in 68 patients, false negative in 4 patients (5%) and there was difficult scanning in 2 patients (3%).

Conclusions: The use of intra operative ultrasound for assessment of residual radiolucet stones during Percutaneous nephrolithotomy, it will help to increase stone free rate.


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