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Submitted: 03 Jan 2021
Accepted: 15 Mar 2021
ePublished: 20 May 2021
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J Renal Inj Prev. 2022;11(1): e7-e7.
doi: 10.34172/jrip.2022.07
  Abstract View: 443
  PDF Download: 290

Original

Ultrasonographic percutaneous nephrolithotomy, with or without ureteral catheter

Telma Zahirian Moghadam 1 ORCID logo, Hamed Mohseni Rad 2 * ORCID logo, Ali Hossein Khani 2 ORCID logo, Ahmad Ghazi 3 ORCID logo

1 Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
2 Department of Surgery, School of Medicine and Allied Medical Sciences, Imam Reza Hospital, Ardabil University of Medical Sciences, Ardabil, Iran
3 Department of Surgery, School of Medicine and Allied Medical Sciences, Alavi Hospital, Ardabil University of Medical Sciences, Ardabil, Iran
*Corresponding author: Hamed Mohseni Rad, Email: h.mohsenirad@arums.ac.ir

Abstract

Introduction: Access by ultrasonography rather than fluoroscopy in addition to reducing radiation exposure to the patient and staff, is safe and effective. Access by ultrasonography is bi-planar and real-time compared to fluoroscopy, because it provides fewer side effects and more stone free rate.

Objectives: To study the complications and outcome of PCNL (percutaneous nephrolithotomy) with or without using ureteral catheter.

Patients and Methods: We studied 59 patients with at least 2 cm diameter of renal stone from January to December of 2018. After general anesthesia, 35 patients in the ureteral stent group were prepared in bladder lithotomy position. Then 5-French (Fr) ureteral catheters were introduced endoscopically in stone affected side and fixed to 16 Fr urethral Foley catheters in the patients. Other 24 patients in the non-stent group following anesthesia were directed to prone position instantly. In all of the patients, ultrasonography was performed in posterior auxiliary line below the ribs in prone position. Retrograde instillation of normal saline was performed through ureteral catheter in stent-group. Then we inserted 18G Chiba needle to desired calyx without needle holder guidance in all patients. Our approach according to probe was transverse.

Results: Our patients comprised of 24 men and 35 women aged 24 to 66 years. Thirteen of them had no hydronephrosis and their stone sizes ranged from 21 mm to 65 mm. Patients in the ureteral stent group were more obese compared to the non-stent group (P=0.02) in addition to significantly more operation time (P=0.03). However hydronephrosis was not significantly different between groups (P=0.3). Postoperative residual stone rate, hospital stay days and complications (Fever, blood transfusion) were the same between both groups. Only urinary leak was more common in the non-stent group (P=0.04)

Conclusion: Ultra-sonographic-PCNL without inserting ureteral catheter before surgery is conceivable especially in patients with lower body mass index (BMI). Advantages and complications are same in ureteral stent and non-stent patients except urinary leak that is more common in non-stent patients.

Keywords: Percutaneous nephrolithotomy, Ureteral catheter, Urinary leak

Implication for health policy/practice/research/medical education:

PCNL (percutaneous nephrolithotomy) is a minimally invasive procedure to treat renal stones larger than 2 cm. This procedure innovated 30 to 40 years ago based on X-ray scan-ning. Latter, ultrasonography became popular to access the kidney rather than X-ray. Usually at the start of surgery a ureteral catheter will be inserted endoscopically to help detect the collecting system by contrast or air or water injection retrograde. Then in prone position by a nephroscope the kidney stones will break with pneumatic or ultrasonic energy. At last a nephrostomy tube may be inserted.

Please cite this paper as: Zahirian Moghadam T, Mohseni Rad H, Hossein Khani A, Ghazi A. Ultrasonographic percutaneous nephrolithotomy, with or without ureteral catheter. J Renal Inj Prev. 2022; 11(1): e07. doi: 10.34172/jrip.2022.07.

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