Management of Splenic Injury During Percutaneous Nephrolithotomy: Report of Two Cases.

Percutaneous nephrolithotomy (PCNL) has become the standard of care for the removal of kidney stones >2 cm. Major complications, although rare, are between 1% and 7%. Splenic injury during PCNL is rare and can often be managed conservatively, but has the potential to be devastating, necessitating the importance of early diagnosis.

Endoscopic Management of Upper Urinary Tract Urothelial Carcinoma.

Introduction: Endoscopic management of upper tract urothelial carcinoma has become more popular over the last few decades as there has been an impetus for renal preservation in these patients. While radical nephroureterectomy has been the gold standard in treatment of this disease, ureteroscopic and percutaneous management has become a viable option for select patients.

Methods And Materials: The literature on endoscopic management of upper urinary tract tumors was explored.

Renal functional outcomes are not adversely affected by selective angioembolization following percutaneous nephrolithotomy.

Objective: Selective angioembolization (SAE) effectively diagnoses and treats iatrogenic vascular complications following percutaneous nephrolithotomy (PCNL).

Methods: We retrospectively reviewed 1329 consecutive PCNLs and identified patients who underwent SAE following PCNL with at least 12-month follow-up. Estimated glomerular filtration rate (eGFR) was calculated for all patients preoperatively, postoperatively and at last follow-up.

The genetic framework for development of nephrolithiasis.

Over 1%-15% of the population worldwide is affected by nephrolithiasis, which remains the most common and costly disease that urologists manage today. Identification of at-risk individuals remains a theoretical and technological challenge. The search for monogenic causes of stone disease has been largely unfruitful and a technological challenge; however, several candidate genes have been implicated in the development of nephrolithiasis.

Rigid-only versus combined rigid and flexible percutaneous nephrolithotomy: a systematic review.

Introduction: Percutaneous nephrolithotomy (PNL) is usually performed worldwide with a rigid-only antegrade approach. Daily practice suggests that adding flexible nephroscopy and/or ureteroscopy to conventional rigid PNL might improve its efficacy and safety, but available evidence is weak. Appraisal of reliable outcomes of such PNL techniques would better guide intraoperative choices and optimize surgical results.

Minimally Invasive Therapy for Upper Tract Urothelial Cell Cancer.

Minimally invasive therapy for upper tract urothelial cell cancer has assumed an important role in the management of this relatively uncommon genitourinary malignancy. In this review, current standards for patient selection, surgical approach, as well as overall outcomes will be discussed. Moreover, the use of intraluminal agents in upper tract disease is examined along with its efficacy and associated complications.

A Randomized Controlled Comparison of Nephrostomy Drainage vs Ureteral Stent Following Percutaneous Nephrolithotomy Using the Wisconsin StoneQOL.

Objective: We compared postoperative outcomes and quality of life (QoL) between patients who received a nephrostomy tube vs a ureteral stent following percutaneous nephrolithotomy (PCNL) in a prospective, double-blind, randomized manner.

Materials And Methods: Between September 2015 and March 2016, we randomized 30 patients undergoing PCNL to receive nephrostomy drainage (Group 1: 8F or 10F) or Double-J ureteral stent (Group 2) at conclusion of surgery. Nephrostomy tubes were removed within 48 hours (before discharge) and ureteral stents were removed at least 2 weeks after surgery.

Multicenter External Validation and Comparison of Stone Scoring Systems in Predicting Outcomes After Percutaneous Nephrolithotomy.

Background And Purpose: Several scoring systems have recently emerged to predict stone-free rate (SFR) and complications after percutaneous nephrolithotomy (PCNL). We aimed to compare the most commonly used scoring systems (Guy's stone score, S.T.

The Expanded Use of Percutaneous Resection for Upper Tract Urothelial Carcinoma: A 30-Year Comprehensive Experience.

Introduction: The gold standard treatment for upper tract urothelial carcinoma (UTUC) is radical nephroureterectomy (RNU). The role of endoscopic resection is limited to low-risk patients. In this study, we present our 30-year experience in the endoscopic management of UTUC.

Association of estimated glomerular filtration rate with 24-h urinalysis and stone composition.

The aim of this study is to determine the association of estimated glomerular filtration rate (eGFR) with 24-h urine analysis and stone composition. We performed a retrospective review of 1060 stone formers with 24-h urinalysis, of which 499 had stone composition analysis available. Comparisons of baseline patient characteristics and urinary abnormalities across eGFR groups (<60, 60-89.

Does Peak Inspiratory Pressure Increase in the Prone Position? An Analysis Related to Body Mass Index.

Purpose: Percutaneous nephrolithotomy is commonly performed with the patient prone. There is concern that the prone position, especially in obese patients, negatively affects ventilation due to the restriction of chest compliance and respiratory mechanics. We analyzed the change in airway resistance between supine and prone positioning of patients undergoing percutaneous nephrolithotomy.

Stenting for malignant ureteral obstruction: Tandem, metal or metal-mesh stents.

Extrinsic malignant compression of the ureter is not uncommon, often refractory to decompression with conventional polymeric ureteral stents, and frequently associated with limited survival. Alternative options for decompression include tandem ureteral stents, metallic stents and metal-mesh stents, though the preferred method remains controversial. We reviewed and updated our outcomes with tandem ureteral stents for malignant ureteral obstruction, and carried out a PubMed search using the terms "malignant ureteral obstruction," "tandem ureteral stents," "ipsilateral ureteral stents," "metal ureteral stent," "resonance stent," "silhouette stent" and "metal mesh stent.

Does hypertension impact 24-hour urine parameters in patients with nephrolithiasis?

Objective: To examine the differences in 24-hour urine parameters and stone composition between patients with and without systemic hypertension (HTN) in a large cohort of stone formers.

Materials And Methods: We performed a retrospective review over a 10-year period of patients with stone, who had completed a 24-hour urinalysis (Litholink) and for whom demographic information was available, including the presence of HTN. Univariate and multivariate analyses were performed, comparing the 24-hour urinalysis profiles of patients with HTN with that of normotensive patients.

Contemporary assessment of renal stone complexity using cross-sectional imaging.

Recently, several scoring systems have been proposed to predict outcomes of percutaneous nephrolithotomy, objectively and quantitatively assessing kidney calculi complexity using cross-sectional imaging. These scoring systems are promising new tools that can guide surgical decision making, predict surgical outcomes, counsel patients undergoing stone surgery, and improve standardized academic reporting in percutaneous kidney stone surgery. In this article, we review features of each of these systems, their similarities and differences, and their applicability in clinical practice and relevance in academic reporting.

Bladder Necrosis Associated with Placenta Accreta, Embolization, and Repair of Cystotomies.

Bladder necrosis is an unusual and potentially devastating complication of embolization of the hypogastric arterial branches. The rich collateral blood supply makes this an extremely rare event. We present the case of a patient with bladder necrosis following placenta accreta that was treated with total abdominal hysterectomy and uterine artery embolization and cystotomy repairs.

Percutaneous nephrolithotomy during uninterrupted aspirin therapy in high-cardiovascular risk patients: preliminary report.

Objective: To determine the feasibility and safety of performing percutaneous nephrolithotomy (PCNL) in high-cardiovascular risk patients remaining on aspirin therapy.

Methods: We retrospectively reviewed all PCNLs performed by 3 fellowship-trained endourologists at a single institution between July 2012 and January 2014. All patients remaining on aspirin for imperative indications through the day of surgery were evaluated for surgical outcomes and thromboembolic events.

Continuing aspirin therapy during percutaneous nephrolithotomy: unsafe or under-utilized?

Introduction: Aspirin, as an inhibitor of platelets, is traditionally discontinued prior to percutaneous nephrolithotomy (PCNL) given the concern for increased surgical hemorrhage. However, this practice is based on expert opinion only, and mounting evidence suggests holding aspirin perioperatively can be more harmful than once thought. We sought to compared PCNL outcomes and complications in patients continuing aspirin to those stopping aspirin perioperatively.

Association of serum biochemical metabolic panel with stone composition.

Introduction: To determine the association of the basic metabolic panel with stone type.

Methods: The present study was a retrospective review of 492 stone formers with both stone composition analysis and basic metabolic panel available. Analysis of a basic metabolic panel across stone types was carried out using Fisher's exact test and analysis of variance.

Evaluation and comparison of urolithiasis scoring systems used in percutaneous kidney stone surgery.

Purpose: Contemporary predictive tools for percutaneous nephrolithotomy outcomes include the Guy stone score, S.T.O.

Comparison of the metabolic profile of mixed calcium oxalate/uric acid stone formers to that of pure calcium oxalate and pure uric acid stone formers.

Objective: To compare the metabolic profile of patients who form mixed calcium oxalate (CaOx)/uric acid (UA) stones to those of pure CaOx and pure UA stone formers.

Methods: We performed a retrospective review of 232 patients, with both stone composition analysis and 24-hour urine collection, seen between March 2002 and April 2012. Analysis of 24-hour urine constituents across the 3 stone groups (pure UA, pure CaOx, and mixed CaOx/UA) was performed using univariate analysis of variance and multivariate linear regression models adjusting for clinical and demographic factors and 24-hour urine collection elements.

Performing in the surgical amphitheater of today: perception of urologists conducting live case demonstrations.

Purpose: To evaluate the perception of urologists who have participated in live case demonstrations (LCDs) regarding safety, educational value/benefits, and ethics.

Methods: A 19-question anonymous survey was sent to urologists who performed and/or moderated LCDs at the World Congress of Endourology meetings from 2008 to 2012. E-survey was distributed via e-mail, and automatic reminders were sent 2 weeks after original distribution if no response was obtained.

Differences in 24-h urine composition between nephrolithiasis patients with and without diabetes mellitus.

Objectives: To examine the differences in 24-h urine composition between nephrolithiasis patients with and without diabetes mellitus (DM) in a large cohort of stone-formers and to examine differences in stone composition between patients with and without DM.

Patients And Methods: A retrospective review of 1117 patients with nephrolithiasis and a 24-h urine analysis was completed. Univariable analysis of 24-h urine profiles and multivariable linear regression models were performed, comparing patients with and without DM.

Calyceal diverticula: a comprehensive review.

Calyceal diverticula are rare outpouchings of the upper collecting system that likely have a congenital origin. Stones can be found in up to 50% of calyceal diverticula, although, over the combined reported series, 96% of patients presented with stones. Diagnosis is best made by intravenous urography or computed tomography urogram.

Age-related changes in 24-hour urine composition must be considered in the medical management of nephrolithiasis.

Background And Purpose: Over the past 50 years, there has been an upward shift in the age of peak incidence of stone disease, yet less is known regarding how the urinary biochemical profile changes with aging. Therefore, we sought to examine the relationship between age and 24-hour urine composition.

Methods: We retrospectively reviewed a database of our tertiary care stone clinic patients seen from March 2002 to February 2012.