PURPOSE: The influence of the stone size and spatial anatomy of the lower pole was evaluated in relation to the stone clearance after shock wave lithotripsy (SWL) for lower calyceal stones. MATERIALS AND METHODS: SWL monotherapy was performed in 44 patients, with lower calyceal stone, using a Dornier Compact-S lithotriptor. The study was comprised of a retrospective analysis of 44 patients. The patients were divided into 2 groups, 33 who were considered to be clear of fragments 3 months after SWL, and 11 who had residual stones. The infundibulopelvic angle, infundibular width and length of lower calyces were determined from intravenous urograms. The stone-free status was assessed 3 months after the last shock wave lithotripsy session. RESULTS: The mean lower calyceal stone size, lower calyceal infundibulopelvic angle and lower calyceal infundibular length and width were 10.2mm, 32.2 degrees, 27.3mm and 5.7mm, respectively. The overall success rate was 75.0%. Success rates for the patients with an infundibulopelvic angle more than 30 degrees and less than 30 degrees were 85.2 and 52.9% respectively. For those with infundibular length more than 30mm and less than 30mm were 78.3 and 71.4%, respectively. For those with an infundibular width more than 5mm and less than 5mm were 76.5 and 74.1%, respectively. CONCLUSIONS: A low calyceal infundibulopelvic angle and the stone size had significant impacts on the stone clearance following shock wave lithotripsy. However, the infundibular length and width were not statistically significant factors associated with the stone clearance. Further examination of the lower pole renal anatomy, with a search for other contributing factors, is still warranted.
Calculi ; Humans ; Kidney Calices ; Lithotripsy* ; Retrospective Studies ; Shock*

INTRODUCTION: The goal of PCNL is to achieve a high stone-free rate while minimizing complications. Its success results from an interplay of patient, stone and renal anatomical characteristics, the access site and the level of surgical expertise. Data comparing upper versus lower calyceal PCNL as regard to efficacy and safety are limited.
OBJECTIVE: To compare the clinical efficacy and safety outcomes of upper versus lower calyceal access in patients who underwent PCNL at St. Luke's Medical Center.
METHODS: A retrospective chart review was done on patients who underwent PCNL at SLMC from January 2010-January 2015. The patients were classified based on the renal access site: Group 1 (upper calyceal) and Group 2 (lower calyceal). The stones were classified according to Guy Stone score and complications were summarized using the modified Clavien classification.
RESULTS: A total pf 91 patients underwent PCNL during the study period. Of these, only 84 patients were analyzed. Seven were excluded due to lack or incomplete postoperative imaging on follow up. Forty-one were included in Group 1, while 43 were included in Group 2. According to the Guy Stone score, the stones in Group 1 were 21(IV), 6(III), 7(II) and 6(I) while in Group 2, 18(IV), 5(III), 8(II), 12(I) (p-value=0.52) with a mean stone volume of 38.2± 44.24cm3 and 28.0± 31.04cm3 in Groups 1 and 2 respectively (p-value= 0.23). Success rate was 80.5% and 83.7% for Groups 1 and 2 (p-value=0.70), respectively and mean stone clearance rates of 98.5% and 95.8% (p-value=0.13),respectively. The mean operative time was 181.0±82.26 and 169.5±52.12mins for Groups 1 and 2 (p-value=0.451),respectively. A total of 36 complications (13 from Group 1 and 23 from Group 2) were evaluated. Fever (Grade 1) occurred in 10 (24%) and 17(39%) for Groups 1 and 2, respectively. Blood transfusion (Grade 2) was observed in 4(9%) patients and 3(7%) in Groups 1 and 2, respectively. Two patients (5%) in Group 2 required postoperative double-J sent insertion due to ureteral stone migration (Grade 3). There was no significant difference noted among the groups as regards complication rates (p-value=0.097) and length of hospital stay (p-value=0.687). There was no mortality in either group.
CONCLUSION: Based on our experience, both upper and lower calyceal access PCNL achieve equivalent efficacy and comparable safety profile in the treatment of complex renal stones.

Human ; Male ; Female ; Adult ; Blood Transfusion ; Kidney Calculi ; Kidney Calices ; Length Of Stay ; Operative Time ; Treatment Outcome ; Ureteral Calculi

OBJECTIVE: Precise entry to the upper posterior calyx is key to a successful and safe upper pole access PCNL. The surgeon's knowledge of the average skin to calyceal distance can serve as a guide to avoid inadvertent injury to both the kidney and collateral organs during the percutaneous puncture.
METHODS: The authors analyzed the radiologic images of 84 patients who underwent unenhanced 64-slice helical CT scan (Toshiba®). Skin-to-calyceal distance (SCD) to the upper posterior calyx were measured using the Vitrea® software inherent to the CT scan.
RESULTS: The mean SCDs is non-hydronephrotic kidneys were 54.9 ± 13.7 mm and 61.4 ± 12.5 mm on the right and left, respectively while in hydronephrotic kidneys, the mean SCDs were 60.3 ± 11.8 mm and 58.6 ± 13.1 mm on the right and left, respectively. There was no statistically significant difference between the right and left upper pole SCD in both groups (p = 0.84).
CONCLUSION: The mean SCD to the upper posterior calyx among Filipino adults is about 6.0 cm. By limiting the depth of the initial puncture to within the distance, the endourologist may avoid overshooting the targeted calyx, thus avoiding undue injury to the kidney or intraabdominal structures.

Human ; Male ; Female ; Adult ; Young Adult ; Kidney Calices ; Tomography, X-ray Computed ; Kidney ; Tomography, Spiral Computed ; Punctures ; Surgeons

OBJECTIVE: Traditionally, percutaneous nephrolithotomy (PCNL) for a lower pole stones are directly removed through an inferior polar access. The authors preferentially treated inferior pole calculi with an upper polar access and evaluated the clinical outcomes.
METHODS: Between January 2010 and April 2016, 32 patients with inferior calyceal stones were treated uPPCNL. All stones were diagnosed using an unenhanced CT scan. The efficacy (stone-free rate) was determined by comparing the preoperative and postoperative imaging. Clinical safety was assessed based on intraoperative parameters pertaining to operative time, blood loss, urinary extravasation, calyceal injury, pelvic perforation and other untoward events. These complications were summarized using the Clavien-Dindo grading system.
RESULTS: The male to female ratio is 1.1:1. All stones included in the study were pure inferior calyceal in location. The average stone size was 1.65±0.84cm (Range:0.6-4.4) with a mean durility of 936±298HU (Range: 350-1500). Stone-free rate was 96.8% (31/32) after a single session of PCNL. The mean operative time was 97±43 minutes (Range:40-230). According to the Clavien-Dindo classification, 26(81.3%) had no complication, 5 (15.6%) had Grade 1 (fever), and 1 (3.1%) had Grade 2.
CONCLUSION: uPPCNL is effective and safe for patients with inferior calyceal stones and confers the following advantages 1) shorter skin-to-calyceal distance 2) straight line to the UPJ and inferior pole 3) a panoramic view of the collecting system 4) less stone migration 5) minimal torque of the nephroscope. This minimally invasive procedure achieves a high stone clearance rate with acceptably low complication rates.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Hemorrhage ; Kidney ; Kidney Calculi ; Kidney Calices ; Nephrostomy, Percutaneous ; Operative Time ; Tomography, X-ray Computed ; Torque

OBJECTIVETo evaluate the efficacy and safety of management of renal stone in non-dilated collecting system by percutaneous nephrolithotripsy (PCNL) under ultrasound guidance.

METHODFrom September 2003 to April 2005, 132 cases of renal stone in non-dilated collecting system were performed by percutaneous nephrolithotripsy. A stent was first inserted into the pelvis through cystoscope, and saline was instilled to dilate collecting system. Antegrade percutaneous access was obtained by B-type ultrasound guidance. A combination pneumatic and ultrasonic lithotrite were used to disintegrate and remove stone under direct vision. Clinical data including operation time, complications and stone free rate were analyzed retrospectively.

RESULTSThe percutaneous renal access was successfully established under B-type ultrasound guidance in all patients, immediate phase I lithotripsy was performed in 129 cases and delayed phase II lithotripsy in 3 cases. Operation time ranged from 70 to 130 minutes, average time was (89 +/- 11) minutes, 3 cases were supported by blood transfusion, severe complications did not occur during nephrolithotripsy. Stones were cleared in 114 out of 132 cases (86.4%) during immediate phase I lithotripsy, residual stone fragment was found in 18 cases who received second PCNL or adjuvant extracorporeal shock wave lithotripsy.

CONCLUSIONThe management of renal stone in non-dilated collecting system using PCNL appears to be efficacious and safe under B-type ultrasound guidance.

Adult ; Aged ; Female ; Humans ; Kidney Calculi ; therapy ; Kidney Calices ; diagnostic imaging ; Lithotripsy ; methods ; Male ; Middle Aged ; Nephrostomy, Percutaneous ; methods ; Punctures ; methods ; Retrospective Studies ; Treatment Outcome ; Ultrasonography

OBJECTIVETo discuss the optimal approach of percutaneous nephrolithotomy (PCNL) for treatment of complicated renal calculi.

METHODSA total of 581 patients with complicated renal calculus were treated by PCNL through the upper pole calix access. Of the 581 patients, 55 had multiple upper pole calculi, 136 had staghorn stones, 145 had partial staghorn stones, and 245 had multiple renal calculi.

RESULTSPCNL through the upper pole calix access was completed successfully in all the cases. Of these patients, 90.3% (525/581) were stone-free after a single access, with a total stone-free rate of 94.6% (550/581). Thirty-five patients needed two accesses, 10 needed 3 accesses, 2 required 4 accesses, and 1 patients had 5 accesses. The operative time ranged from 30 to 150 min (mean 45 min). The successful rate of puncture was 100% without occurrence of severe injury of the pleura, intestine, peritoneum or other adjacent organs.

CONCLUSIONSPercutaneous nephrolithotomy through the upper pole calix access allows greater stone clearance rate due to its easy access into the intrarenal collecting system and can be an ideal approach for PCNL for complicated renal calculi.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Kidney Calculi ; surgery ; Kidney Calices ; Lithotripsy ; methods ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; instrumentation ; methods ; Nephrostomy, Percutaneous ; methods ; Young Adult

Renal angiomyolipomas are benign neoplasms composed of varying amounts of adipose tissue, smooth muscles and blood vessels. They typically contain macroscopic fat, which is seen as negative attenuation on computed tomography. Calcification and scarring is rarely seen in renal angiomyolipomas. We report the case of a 40-year-old man who was found to have a renal angiomyolipoma with a central stellate scar and focal calcification. The lesion was initially misdiagnosed as a calyceal calculus.
Adipose Tissue ; diagnostic imaging ; pathology ; Adult ; Angiomyolipoma ; diagnosis ; surgery ; Biopsy, Needle ; Calcinosis ; diagnostic imaging ; pathology ; Diagnosis, Differential ; Humans ; Immunohistochemistry ; Kidney Calculi ; diagnosis ; surgery ; Kidney Calices ; diagnostic imaging ; pathology ; Kidney Neoplasms ; diagnosis ; surgery ; Low Back Pain ; diagnosis ; etiology ; Male ; Risk Assessment ; Tomography, X-Ray Computed ; methods ; Treatment Outcome ; Urography ; methods