ObjectivesTo systematically review the efficacy and safety of laparoscopic pyelolithotomy (LP) versus percutaneous nephrolithotomy (PNL) in treating large (>2 cm) renal pelvic calculi.MethodsDatabases including PubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI and WanFang Data were searched for relevant randomized controlled trials (RCTs) comparing LP with PNL for the treatment of large renal pelvic calculi from inception to September 23th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of eligible studies. Meta-analysis was then performed by using RevMan 5.2 software.ResultsFive RCTs with 447 patients were included. The results of meta-analysis showed that: compared with PNL group, LP group provided a significantly higher stone-free rate (RR=1.07, 95%CI 1.01 to 1.13, P=0.01), lower auxiliary procedure rate (RR=0.36, 95%CI 0.13 to 1.01, P=0.05), less hemoglobin decrease (MD=–0.83, 95%CI –1.05 to –0.61, P<0.000 01) and lower postoperative fever rate (RR=0.36, 95%CI 0.18 to 0.72,P=0.004). However, no significant differences were detected in conversion rate (RR=0.76, 95%CI 0.19 to 3.07, P=0.70), blood transfusion rate (RR=0.40, 95%CI 0.14, to 1.12, P=0.08), postoperative leakage rate (RR=1.87, 95%CI 0.67 to 5.21, P=0.23), operative time (MD=10.49, 95%CI –17.14 to 38.13, P=0.46) and hospital stay (MD=0.53, 95%CI –0.22 to 1.28, P=0.17).ConclusionsLP is superior to PNL with regard to stone-free rate, auxiliary procedure rate, hemoglobin decrease and postoperative fever rate. Due to limited quality and quantity of included studies, more high quality studies are required to verify above conclusions.
Objective To compare clinical outcomes of percutaneous nephrolithotomy (PCNL) in patients who initially presented with and without urosepsis. Methods The study included patients who underwent PCNL for renal and ureter urolithiasis removal from January 2010 to December 2014 in our hospital. A 1∶1 matched-pair analysis was performed to compare outcomes and complications of patients who had obstructive urolithiasis with urosepsis initially (OUU) with patients who had obstructive urolithiasis with no urosepsis initially (NOUU) before PCNL. Results A total of 172 patients were included involving 122 (71%) males and 50 (29%) females with a mean age of 46.2 years (range 32 to 65 years). There were no significant differences between two groups in age, gender, BMI, complications, the size of the stones, stone's number and stone location (P>0.05). OUU groups had the similar stone-free rates (86.0%vs. 84.8%, P=0.829) as the NOUU group. OUU group had higher overall complications rate, longer duration of nephrostomy tube (NT), longer hospital length of stay (LOS), longer courses of postoperative antibiotics and higher grade of antibiotics after PCNL (all P<0.05). Higher fever developed postoperatively (11.6%vs. 3.5%, P=0.043), higher asymptomatic bacteriuria (11.6% vs. 3.5%, P=0.043) and symptomatic urinary tract infections (10.5% vs. 2.3%, P=0.029) were also found in OUU groups. There was no significant difference between two groups in sepsis (2.3% vs. 1.2%, P=0.560). Conclusion PCNL after decompression for urolithiasis-related urosepsis has similar success but higher complication rates than obstructive urolithiasis with no urosepsis initially.
ObjectiveTo systematically review the efficacy of different positions on the clinical outcomes of percutaneous nephrolithotomy (PCNL). MethodsThe PubMed, Web of Science, EBSCO, Cochrane Library, Embase, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect randomized controlled trials (RCTs) related to the objectives from January 2014 to April 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies, a network meta-analysis was conducted using Stata 18.0 software. ResultsA total of 54 RCTs involving 5 092 patients and 7 different positions were included. The results of the best probability ranking showed that for positioning time, the split-leg prone position required the shortest time, while the traditional prone position required the longest. For access establishment time, the recumbent lithotomy position had the shortest duration, and the traditional prone position the longest. Intraoperative blood loss was lowest in the supine position and highest in the traditional prone position. Surgical duration was shortest for the recumbent lithotomy position and longest for the traditional prone position. Postoperative hospital stay was shortest for the supine position and longest for the traditional prone position. Complication rates were lowest for the oblique supine position and highest for the traditional prone position. Stone clearance rates were highest for the modified curved prone position and lowest for the traditional prone position. Conclusion Current evidence shows that different body positions have different clinical effects on percutaneous nephrolithotomy. The recumbent lithotomy position may optimize access establishment and surgical duration, while the supine position offers advantages in reducing intraoperative blood loss and shortening postoperative hospitalization. The split-leg prone position minimizes positioning time, the oblique supine position lowers complication rates, and the modified curved prone position maximizes stone clearance. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To assess the efficacy and safety of the tubeless approach with a ureteral stent versus nephrostomy tube for postoperative drainage following percutaneous nephrolithotomy, and to provide guidance for clinical practice. Methods Randomized controlled trials (RCTs) were identified from PubMed (1966 to August 2008), Ovid (1966 to August 2008), Embase (1966 to August 2008), The Cochrane Library (Issue 3, 2008) and CBM (1978 to 2008). We also handsearched for relevant published and unpublished reports and check their references. The quality of the included trials was evaluated by two reviewers. We used The Cochrane Collaboration’s RevMan 5.0.16 software for meta-analysis. Results Eight studies involving 507 patients were included. We divided the patients into three groups: small (8~9 Fr), medium (16~18 Fr) and large (20~24 Fr) according to the diameter of nephrostomy tube for the analysis. Our meta-analyses showed: ①Hospital stay (hours): There was no statistically significant difference between tubeless and small bore tubes, but a difference was found in the comparison of tubeless versus medium and large bore tubes [WMD (95%CI) –32.4 (–33.64, –31.16) and –39.07 (–67.75, –10.39), respectively]; ② Puncture site urinary leakage: No statistically significant difference was found between tubeless and small bore tubes, of between tubeless versus medium tubes [RR= 0.07, 95%CI (0.00, 1.15), P=0.06]; ③ Visual analogue scale scores for postoperative pain on Day 1: There was no statistically significant difference between tubeless and small bore tubes, but there was a difference in tubeless versus medium and large bore tubes [MD (95%CI) –2.80 (–2.94, –2.66) and –2.04 (–2.29, –1.79), respectively];④No statistically significant difference was found in transfusion, fever or infection and operating time between tubeless and any size of nephrostomy tube. Conclusion No statistically significant difference between tubeless versus small bore tubes is found for any of the outcome measurements we analysed. Compared with medium and large bore tubes, tubeless PCNL of ureteral stent could reduce hospital stay, urine leakage and postoperative pain without an increase in complications. There is a moderate possibility of selection bias, performance bias and publication bias in this review, because of the small number of the included studies, which weakens the strength of the evidence of our results. Better evidence from more high-quality randomized controlled trials is needed.
ObjectiveTo explore the perioperative nursing mode for percutaneous nephrolithotomy (PCNL). MethodsA total of 866 patients with PCNL having undergone lithotripsy between January 2012 and December 2013 in our hospital were included in our study. Before surgery, they received position training, health education and psychological nursing. After surgery, patients received an integral medical wound care and pipeline management, as well as management of infectious shock and intercostal neuralgia. At the same time, we gave them dietary guidance and other health guidance. ResultsAll the patients were successfully discharged from hospital. Postoperative infection rate was 2.4%, septic shock rate was 0.2%, bleeding rate was 2.2%, urinary leakage rate was 1.5%, the rate of pneumothorax was 0.6%, subcutaneous emphysema rate was 0.3%, and intercostal neuralgia rate was 0.6%. The average hospital stay was (11.2±2.8) days. ConclusionThe innovative nursing mode and techniques have great significance on the success of PCNL surgery.
【摘要】 目的 探讨微创经皮肾镜碎石术后并发感染性休克的原因和防治措施。 方法 回顾性分析2005年1月-2010年12月5例经皮肾镜术300例，其中术后并发感染性休克5例的临床资料。男1例，女4例，均表现为术后2~8 h内出现寒战、高热、烦燥不安，血压降至80/50 mm Hg（1 mm Hg=0.133 kPa）以下，心率超过120次/min。所有患者均行抗感染和抗休克治疗。 结果 所有患者均在72 h内停用升压药，1周内体温及血常规恢复正常，术后15 d治愈出院。 结论 感染性休克是微创经皮肾镜碎石术严重的并发症之一，术前有效抗感染、术中低压灌注、术后加强生命体征的监测、早期发现并合理处理，可有效防治感染性休克的发生。【Abstract】 Objective To explore the etiology and treatment of septic shock after percutaneous nephrolithotomy. Methods From Janurary 2005 to December 2010, the clinical data of five patients with septic shock after percutaneous nephrolithotomy in our hospital were retrospectively analyzed. The patients, including one male and four females, had chillness and high temperature after the nephrolithotomy. The blood pressure decreased to under 80/50 mm Hg （1 mm Hg=0.133 kPa）, and the heart rate was more than 120 per minute. All patients underwent anti-shock and anti-infection therapies rapidly. Results Five patients were cured in the end, their temperature and blood routine tests returned to normal within one week. Conclusions Septic shock is one of the serious complications after percutaneous nephrolithotomy. Effective preoperative preparation, low pressure irrigation during operation, early diagnosis and treatment postoperatively are the effective ways to prevent the septic shock.
Objective To systematically review the effectiveness and safety of flexible ureteroscope lithtripsy (fURL) and percutaneous nephrolithotomy (PCNL) in treating renal calculus. Methods Such databases as MEDLINE, EMbase, The Cochrane Library, CNKI, CBM, VIP, and WanFang Data from January, 1990 to August, 2012 were searched to comprehensively collect the clinical trials that compared fURL and PCNL in treating renal calculus. Two reviewers independently screened studies according to exclusion and inclusion criteria, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.1 software. Results Eight non-randomized controlled trials involving 536 patients were included. The results of meta-analysis showed that, PCNL was better than fURL in stone clearance (OR=0.26, 95%CI 0.15 to 0.46), but fURL was better than PCNL in postoperative pyrexia (OR=0.1, 95%CI 0.42 to 3.35), the incidence of blood transfusion (OR=0.17, 95%CI 0.03 to 1.00), and the duration of hospitalization (P=0.45, I2=0%). Conclusion Current evidence has proved that PCNL is better than fURL in decreasing stone clearance, fURL is better than PCNL in complication, the duration of hospitalization, and medical costs.