Int Urol Nephrol (2015) 47:441–444 DOI 10.1007/s11255-014-0907-7
UROLOGY – ORIGINAL PAPER
Does the presence of hydronephrosis have effects on micropercutaneous nephrolithotomy? Tuna Karatag · Ibrahim Buldu · Mehmet Kaynar · Ramazan Inan · Mustafa Okan Istanbulluoglu
Received: 31 October 2014 / Accepted: 17 December 2014 / Published online: 7 January 2015 © Springer Science+Business Media Dordrecht 2015
Abstract Purpose To evaluate the effects of presence of hydronephrosis on micropercutaneous nephrolithotomy (microPNL) surgery. Patients and methods A retrospective analysis of 112 patients who underwent microperc surgery between December 2012 and April 2014 was performed. Patients were evaluated in two groups according to whether the presence of hydronephrosis. Stone size and location, fluoroscopy and operation time, stone-free rates and patientrelated parameters were prospectively recorded into a centralized computer-generated system. Results A total of 58 patients in Group 1 with hydronephrosis and 54 patients in Group 2 with no hydronephrosis were analyzed. There was no statistically significant difference in terms of stone sizes and body mass indexes (BMI) in comparison of groups (155.2 ± 93.06 vs. 143.70 ± 70.77 mm2, p = 0.856 and 27.6 ± 4.2 vs. 26.7 ± 3.2 kg/m2, p = 0.625). The success rates were similar (91.3 vs. 92.5 %, p = 0.341). While the mean operation time and fluoroscopy time in Group 1 were 44.2 ± 23.62 min and 105.3 ± 47 s, it was 38.8 ± 26.4 min and 112.53 ± 68.3 s in Group 2, but there was no statistical difference in comparison of both groups. The mean attempts of percutan puncture were 1.35 ± 0.47 in Group 1 and 1.76 ± 0.31 in Group 2 (p = 0.185). We also found no statistical differences regarding mean hemoglobin T. Karatag (*) · I. Buldu · R. Inan · M. O. Istanbulluoglu Department of Urology, Faculty of Medicine, Mevlana University, Konya 42200, Turkey e-mail: [email protected] M. Kaynar Department of Urology, Faculty of Medicine, Selcuk University, Konya, Turkey
change and hospitalization time, respectively (p = 0.685 and p = 0753). In comparison of grades of hydronephrosis, there was no statistically significant difference in subgroups analysis. Conclusions The presence of hydronephrosis does not affect success rates and operative time in micro-PNL procedures significantly. Micropercutaneous nephrolithotomy is technically feasible and efficacious both in hydronephrotic and non-hydronephrotic kidneys. Keywords Micropercutaneous nephrolithotomy · Hydronephrosis · Success rate Abbreviations SWL Shock wave lithotripsy EAU European Association of Urology PNL Percutaneous nephrolithotomy RIRS Retrograde intrarenal surgery CT Computed tomography CIRF Clinically insignificant residual fragment BMI Body mass index SFU Society of Fetal Urology
Introduction Micropercutaneous nephrolithotomy procedures have been considered as an option for the treatment of moderate-sized kidney stones with the advantages of providing single step percutaneous renal access under direct vision through a 4.8Fr sheath since 2011 [1]. Although there have been no recommendation in guidelines yet, the initial reports have suggested that micropercutaneous nephrolithotomy technique was feasible, safe and efficacious for the small- and moderate-sized kidney stones [2–4].
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Int Urol Nephrol (2015) 47:441–444
The presence of hydronephrosis might be an advantage for accessing to kidney but also might be disadvantage during the fragmentation due to mobilization of stones in hydronephrotic kidneys. Therefore, presence of hydronephrosis might affect the success rates and operative time of PNL procedures. However, operative time is an important factor which may affect surgical outcomes and anesthesia-related complications. Several published clinical trials focusing this issue demonstrated that many factors such as hydronephrosis may influence the operation time and success rate of conventional percutaneous nephrolithotomy surgery [5, 6]. No clinical study is available for microperc nephrolithotomy yet. In this study, we evaluated the effects of the presence of hydronephrosis on microperc nephrolithotomy surgery.
on the first month of follow-up. The postoperative complications were evaluated using Clavien grading system [8]. Stone size and location, the number of attempts for an accurate access, fluoroscopy and operation time, stone-free rates and patient-related parameters were prospectively recorded into a centralized computer-generated system. The ethical consent was obtained from the Ethics Committee of the Faculty of Medicine of Mevlana University. Data collections were performed using the SPSS statistical package (ver 16.0J; SPSS, Inc., Chicago, IL). Patient- and operative-related parameters were compared between the groups using Mann–Whitney U test for numerical variables and Chi-square test for categorical variables. p values of
UROLOGY – ORIGINAL PAPER
Does the presence of hydronephrosis have effects on micropercutaneous nephrolithotomy? Tuna Karatag · Ibrahim Buldu · Mehmet Kaynar · Ramazan Inan · Mustafa Okan Istanbulluoglu
Received: 31 October 2014 / Accepted: 17 December 2014 / Published online: 7 January 2015 © Springer Science+Business Media Dordrecht 2015
Abstract Purpose To evaluate the effects of presence of hydronephrosis on micropercutaneous nephrolithotomy (microPNL) surgery. Patients and methods A retrospective analysis of 112 patients who underwent microperc surgery between December 2012 and April 2014 was performed. Patients were evaluated in two groups according to whether the presence of hydronephrosis. Stone size and location, fluoroscopy and operation time, stone-free rates and patientrelated parameters were prospectively recorded into a centralized computer-generated system. Results A total of 58 patients in Group 1 with hydronephrosis and 54 patients in Group 2 with no hydronephrosis were analyzed. There was no statistically significant difference in terms of stone sizes and body mass indexes (BMI) in comparison of groups (155.2 ± 93.06 vs. 143.70 ± 70.77 mm2, p = 0.856 and 27.6 ± 4.2 vs. 26.7 ± 3.2 kg/m2, p = 0.625). The success rates were similar (91.3 vs. 92.5 %, p = 0.341). While the mean operation time and fluoroscopy time in Group 1 were 44.2 ± 23.62 min and 105.3 ± 47 s, it was 38.8 ± 26.4 min and 112.53 ± 68.3 s in Group 2, but there was no statistical difference in comparison of both groups. The mean attempts of percutan puncture were 1.35 ± 0.47 in Group 1 and 1.76 ± 0.31 in Group 2 (p = 0.185). We also found no statistical differences regarding mean hemoglobin T. Karatag (*) · I. Buldu · R. Inan · M. O. Istanbulluoglu Department of Urology, Faculty of Medicine, Mevlana University, Konya 42200, Turkey e-mail: [email protected] M. Kaynar Department of Urology, Faculty of Medicine, Selcuk University, Konya, Turkey
change and hospitalization time, respectively (p = 0.685 and p = 0753). In comparison of grades of hydronephrosis, there was no statistically significant difference in subgroups analysis. Conclusions The presence of hydronephrosis does not affect success rates and operative time in micro-PNL procedures significantly. Micropercutaneous nephrolithotomy is technically feasible and efficacious both in hydronephrotic and non-hydronephrotic kidneys. Keywords Micropercutaneous nephrolithotomy · Hydronephrosis · Success rate Abbreviations SWL Shock wave lithotripsy EAU European Association of Urology PNL Percutaneous nephrolithotomy RIRS Retrograde intrarenal surgery CT Computed tomography CIRF Clinically insignificant residual fragment BMI Body mass index SFU Society of Fetal Urology
Introduction Micropercutaneous nephrolithotomy procedures have been considered as an option for the treatment of moderate-sized kidney stones with the advantages of providing single step percutaneous renal access under direct vision through a 4.8Fr sheath since 2011 [1]. Although there have been no recommendation in guidelines yet, the initial reports have suggested that micropercutaneous nephrolithotomy technique was feasible, safe and efficacious for the small- and moderate-sized kidney stones [2–4].
13
442
Int Urol Nephrol (2015) 47:441–444
The presence of hydronephrosis might be an advantage for accessing to kidney but also might be disadvantage during the fragmentation due to mobilization of stones in hydronephrotic kidneys. Therefore, presence of hydronephrosis might affect the success rates and operative time of PNL procedures. However, operative time is an important factor which may affect surgical outcomes and anesthesia-related complications. Several published clinical trials focusing this issue demonstrated that many factors such as hydronephrosis may influence the operation time and success rate of conventional percutaneous nephrolithotomy surgery [5, 6]. No clinical study is available for microperc nephrolithotomy yet. In this study, we evaluated the effects of the presence of hydronephrosis on microperc nephrolithotomy surgery.
on the first month of follow-up. The postoperative complications were evaluated using Clavien grading system [8]. Stone size and location, the number of attempts for an accurate access, fluoroscopy and operation time, stone-free rates and patient-related parameters were prospectively recorded into a centralized computer-generated system. The ethical consent was obtained from the Ethics Committee of the Faculty of Medicine of Mevlana University. Data collections were performed using the SPSS statistical package (ver 16.0J; SPSS, Inc., Chicago, IL). Patient- and operative-related parameters were compared between the groups using Mann–Whitney U test for numerical variables and Chi-square test for categorical variables. p values of
