Delayed versus same-day percutaneous nephrolithotomy in patients with aspirated cloudy urine. (41/143)

INTRODUCTION: We present our experience in continuing percutaneous nephrolithotomy (PCNL) versus delayed PCNL when purulent fluid is aspirated during access to the pyelocaliceal system. MATERIALS AND METHODS: This randomized controlled study was carried out on patients who had purulent urine in the pyelocaliceal system at the initial puncturing during PCNL. Patients with recent untreated urinary tract infection, thick or foul pus in aspirated urine, fever, and immunocompromised condition were excluded. Thirty-one patients were randomly divided into 2 groups. In group 1, PCNL was continued, but in group 2, nephrostomy tube was placed and PCNL was performed 10 days later after documented sterile nephrostomy urine. The preoperative and postoperative findings were compared. RESULTS: There were 16 and 15 patients in groups 1 and 2, respectively. All patients had negative urine cultures for microorganisms, preoperatively. The purulent aspirated fluid was infected in 43.8% and 40.0% of the patients in groups 1 and 2, respectively. Postoperative fever was seen in 25.0% and 26.7% of the patients, respectively. No statistical differences were observed between the two groups in terms of bacteriuria, bacteremia, positive calculus cultures, or stone-free rates, and duration of hospitalization between groups 1 and 2, respectively. More analysis with linear regression model showed that postoperative positive blood culture (P < .001), fever (P = .001), and postoperative positive urine culture (P = .02) correlated with duration of hospitalization. CONCLUSION: In the absence of untreated recent UTI and aspiration of thick or foul pus, continuing PCNL can be safe while purulent urine is encountered.  (+info)

Percutaneous nephrostomy for treatment of posttransplant ureteral obstructions. (42/143)

INTRODUCTION: We report our experience with percutaneous management of urologic complications following kidney transplantation. MATERIALS AND METHODS: Of 1402 consecutive kidney transplant recipients from living donors at our hospital, 21 required percutaneous nephrostomy (PCN) for the treatment of obstructive lymphocele (n = 11), urinary calculus (n = 8), and stricture of the ureterovesical junction anastomosis (n = 2). We had also 11 kidney recipients with urine leakage from the ureter who were treated only by indwelling ureteral catheter. Urinary complications were diagnosed based on the clinical symptoms, elevated serum creatinine levels, ultrasonography and renal scintigraphy. Patients with ureteral obstruction or urine leakage were compared with kidney recipients without urologic complications. RESULTS: A mean decline of 3.1 +/- 3.0 mg/dL (range, 0.1 to 10.7 mg/dL) in serum creatinine level was detected (P < .001) after PCN. All of the patients remained symptom free for a mean follow-up period of 34.2 +/- 20.1 months (range, 3 to 81 months). Patient and graft survival rates were not different between the patients undergoing PCN and other kidney recipients. The only difference was the history of using antilymphocyte globulin which was significantly more frequent in the patients of the PCN group (P = .01). CONCLUSION: In our experience, PCN is a safe and effective method for the treatment of ureteral obstructions in kidney allograft recipients. This method provided long-term success with few recurrences and low morbidity and mortality rates.  (+info)

Evaluation of intra-operative tramadol for prevention of catheter-related bladder discomfort: a prospective, randomized, double-blind study. (43/143)

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Percutaneous management of ureteral injuries that are diagnosed late after cesarean section. (44/143)

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Percutaneous management of urinary calculi in horseshoe kidneys. (45/143)

Urolithiasis in horseshoe kidney presents a unique challenge in decision-making and technical aspects of calculus treatment. We present our experience with a group of patients with symptomatic calculi in their horseshoe kidneys. We had 8 patients with 9 horseshoe kidneys bearing calculi. They all underwent percutaneous nephrolithotomy. The median size of the calculi was 21 mm (range, 12 to 45 mm). Auxiliary therapeutic procedures were required in 2 patients who had residual calculi on control imaging. The stone-free status was observed in 6 patients (75.0%) at discharge, and in 7 (87.5%) after 3 months of follow-up. Surgical complications included bleeding in 2 patients that was controlled with complete bed rest and blood transfusion, and pleural injury in 1 which was managed conservatively.  (+info)

Radial dilation of nephrostomy balloons: a comparative analysis. (46/143)

PURPOSE: The dynamics of percutaneous balloon expansion may differ with increasing extrinsic compressive forces and increasing inflation pressures. This study compares the ability of percutaneous balloons to expand under different radial constrictive forces. MATERIALS AND METHODS: Three 30F nephrostomy balloons were tested: Bard X-Force, Boston Scientific Microvasive Amplatz Tractmaster, and Cook Ultraxx. With a super stiff guidewire in place, the balloon tip was secured by elevated vice grips on either side of the balloon. A string was wrapped around the balloon center once, and incremental increases in load were added (2g, 42g, 82g, and 122g) to represent increasing extrinsic compression. The balloon was inflated with a contrast agent and circumference changes were measured at increments of 4 ATM, 10 ATM, and burst pressure. Balloons were tested in triplicate for each load. RESULTS: All balloons were unable to reach 90% of their expected diameter with larger constrictive loads (122g) at low (4 ATM) and nominal (10 ATM) inflation pressures. Only the Bard and Cook balloons reached at least 90% of the expected diameter with a coefficient of variance (CV) less than 10% at burst pressure under the larger constrictive load (122g), 94.3% +/- 6.7%, CV 7.1% and 96.3% +/- 2.9%, CV 3.0% respectively. All balloons performed well under low constriction forces and reached at least 80% of the expected diameter by 10 ATM under all constrictive loads. CONCLUSIONS: The Bard X-Force and Cook Ultraxx percutaneous nephrostomy balloons achieved the most reliable radial dilation against large constrictive forces simulating fascial or retroperitoneal scar tissue.  (+info)

A formal test of the hypothesis that idiopathic calcium oxalate stones grow on Randall's plaque. (47/143)

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Risks and benefits of the intercostal approach for percutaneous nephrolithotripsy. (48/143)

OBJECTIVE: The objective of our retrospective study was to provide evidence on the efficacy of the intercostal versus subcostal access route for percutaneous nephrolithotripsy. MATERIALS AND METHODS: 642 patients underwent nephrolithotomy or nephrolithotripsy from 1996 to 2005. A total of 127 had an intercostal access tract (11th or 12th); 515 had a subcostal access tract. RESULTS: Major complications included one pneumothorax (1.0%), one arterio-calyceal fistula (1.0%) and three arteriovenous fistulae (2.7%) for intercostal upper pole access; two pneumothoraces (1.7%), one arteriovenous fistula (1.0%), one pseudoaneurysm (1.0%), one ruptured uretero-pelvic junction (1.0%), 4 perforated ureters (3.4%) for subcostal upper pole access; one hemothorax (1.6%), one colo-calyceal fistula (1.6%), one AV fistula (1.6%), and two perforated ureters (3.2%) with subcostal interpolar access. Diffuse bleeding from the tract with a subcostal interpolar approach occurred 3.2% of the time compared with 2.4% with a lower pole approach. Staghorn calculi demonstrated similar rates of complications. CONCLUSION: Considering the advantages that the intercostal access route offers the surgeon, it is reasonable to recommend its use after proper pre-procedural assessment of the anatomy, and particularly the respiratory lung motion.  (+info)