Background Amplatz dilation and balloon dilation are different methods in creating the accesses during percutaneous nephrolithotomy(PCNL). The aim of this study was to review the surgical experiences of managing stagh...Background Amplatz dilation and balloon dilation are different methods in creating the accesses during percutaneous nephrolithotomy(PCNL). The aim of this study was to review the surgical experiences of managing staghorn calculi by Amplatz dilation and balloon dilation for 3 years.Methods We retrospectively analyzed clinical data from 125 patients(129 kidneys) with staghorn kidney stones who underwent PCNL from January 2010 to December 2012, of whom 60 patients underwent Amplatz dilation(AD group) and 65 underwent balloon dilation(BD group) during PCNL.Results The AD and BD groups were similar in age, male–female ratio, stone burden, stone type, hydronephrosis, and proportion of patients who had undergone extracorporeal lithotripsy. However, these two groups showed significant differences in terms of duration of percutaneous access(15.1±3.6) minutes vs.(10.0±3.3) minutes, one-attempt success rate of dilation via a single access 88.9%(72/81) vs. 97.8%(91/93), hemoglobin drop after surgery(3.5±0.9) g/dl vs.(1.7±0.9) g/dl, number of cases requiring intraoperative and postoperative blood transfusion 27.9%(n=17) vs. 13.2%(n=9), changes of central venous pressure before and after surgery(2.3±1.2) cmH2 O vs.(1.2±0.7) cmH2 O, number of patients who experienced postoperative fever >37.5°C 21(34.4%) vs. 13(19.1%)(all P <0.05). No injury of adjacent organs, including pleura, liver, spleen, or bowel, was noted in patients.Conclusions During ultrasound-guided PCNL for staghorn stones, balloon dilation and Amplatz dilation are all effective and safe. Compared with Amplatz dilation, balloon dilation is a better choice, as it has a higher access creation success rate, shorter access creation time less blood loss, and lower proportions of circulatory overload and postoperative fever.展开更多
Staghorn calculi comprise a unique subset of complex kidney stone disease. Percutaneousnephrolithotomy (PCNL) is the gold standard treatment for staghorn stones. Despitecontinuous refinements to the technique and inst...Staghorn calculi comprise a unique subset of complex kidney stone disease. Percutaneousnephrolithotomy (PCNL) is the gold standard treatment for staghorn stones. Despitecontinuous refinements to the technique and instrumentation of PCNL, these stones remaina troublesome challenge for endourologists and are associated with a higher rate of perioperativecomplications than that for non-staghorn stones. Common and notable intraoperativecomplications include bleeding, renal collecting system injury, injury of visceral organs, pulmonarycomplications, thromboembolic complications, extrarenal stone migration, andmisplacement of the nephrostomy tube. Postoperative complications include infection and urosepsis,bleeding, persistent nephrocutaneous urine leakage, infundibular stenosis, and death.In this review, we report recommendations regarding troubleshooting measures that can beused to identify and characterize these complications. Additionally, we include informationregarding management strategies for complications associated with PCNL for staghorn calculi.展开更多
Percutaneous nephrolithotomy （PCNL） has been the first-line treatment for renal staghorn calculi for many years. Several techniques have been described for percutaneous access and stone removal, but a multi-access a...Percutaneous nephrolithotomy （PCNL） has been the first-line treatment for renal staghorn calculi for many years. Several techniques have been described for percutaneous access and stone removal, but a multi-access approach is the mainstay of treatment. The main concern about PCNL is the resultant morbidity： Complications such as bleeding, parenchymal damage, and organ injury hindered the adoption of PCNL in primary hospitals in China.展开更多
Objective:Staghorn calculi present a particular and challenging entity of stone morphology.Treatment is associated with lower stone-free rates and higher complication rates compared to non-staghorn stones.In this revi...Objective:Staghorn calculi present a particular and challenging entity of stone morphology.Treatment is associated with lower stone-free rates and higher complication rates compared to non-staghorn stones.In this review we looked for the most relevant data on preoperative imaging and access planning to help decision making for percutaneous surgery with this complex condition.Methods:We conducted a PubMed search of publications in the past 2 decades that include relevant information on the planning for management of staghorn stones.Non-contrast computerized tomography(NCCT)is indeed the standard imaging tool for percutaneous nephrolithotomy(PCNL);additional tools such as three-dimensional computed tomography(CT)reconstruction of the staghorn calculus may help plan access in complex cases.Ultrasound guided percutaneous access may be considered for staghorn stones when planning upper pole access in kidney malposition or complex intrarenal anatomy or with complex body habitus.Wideband doppler ultrasound and real-time virtual sonography can assist.New technologies to improve kidney access such as Uro Dyna-CT or electromagnetic sensor have been reported,but have not shown utilization in staghorn cases.Staghorn morphometry-based prediction algorithms may predict the number of tract(s)and stage(s)for PCNL monotherapy.Lower pole access can be equally effective as upper pole when planning for staghorn and complex stones,with significantly less complications rate;Stone-Tract length-Obstruction-Number of involved calyces-Essence of stone density(STONE)nephrolithometry seems to be the best system to predict outcomes of PCNL in staghorn cases.There is a growing trend of endoscopic combined intrarenal surgery(ECIRS)in concordance with PCNL to treat larger stones.Conservative management of staghorn calculi is an undesired option,but can be an alternative for a carefully selected group of high-risk patients.Conclusion:Staghorn stones may lead to deterioration of renal function and life-threatening urosepsis.This entity should be 展开更多
Staghorn calculi are branched stones which occupy a majority portion of the pelvicaliceal system.An untreated staghorn calculus over time can damage the kidney and deteriorate its function and/or cause life threatenin...Staghorn calculi are branched stones which occupy a majority portion of the pelvicaliceal system.An untreated staghorn calculus over time can damage the kidney and deteriorate its function and/or cause life threatening sepsis.Total stone clearance is an important goal in order to eradicate any infective focus,relieve obstruction,prevent recurrence and preserve the kidney function.Percutaneous nephrolithotomy(PCNL)is currently the accepted first-line treatment option for staghorn calculi.The options available are single-tract PCNL with an auxiliary procedure like shockwave lithotripsy,single-tract PCNL with flexible nephroscopy,or multitract PCNL.Each has its own pros and cons.But the ultimate goal of treatment for any patient with staghorn calculi should be safety,cost-effectiveness,and to achieve total stone clearance.With this article,we review the management of staghorn calculi with multiple percutaneous(“multitract”)access,its advantages and disadvantages and its current position by studying the various published materials across the globe.展开更多
Technological advances in minimally invasive treatment of stone disease and its integration with concomitant clinical practice are amongst the most important achievements in urology.Despite the wealth of information a...Technological advances in minimally invasive treatment of stone disease and its integration with concomitant clinical practice are amongst the most important achievements in urology.Despite the wealth of information accumulated over the years and the richness of existing literature,the knowledge about the definition,treatment and outcomes of residual stone fragments after percutaneous nephrolithotomy(PNL)is still insufficient.Due to the high stone load a lot of patients with staghorn stones have residual fragments(RFs)after treatment with PNL,which depends on the size of tract,definition of stone free rate(SFR),timing of evaluation and the imaging used.No consensus exists on the imaging modality or their timing in the evaluation of possible RFs.The treatment of residual stones is apparently different depending on the facilities of the department and the preference of the surgeon,which includes active surveillance,shock wave lithotripsy(SWL),retrograde intrarenal surgery(RIRS)or a second look PNL.展开更多
BACKGROUND It is possible that this condition will lead to urosepsis and progressive deterioration of renal function in the absence of surgical intervention.Several recent clinical studies have shown that multi-tract ...BACKGROUND It is possible that this condition will lead to urosepsis and progressive deterioration of renal function in the absence of surgical intervention.Several recent clinical studies have shown that multi-tract percutaneous nephrolithotomy(MPCNL)has a similar stone free rate(SFR)as standard percutaneous nephrolithotomy(S-PCNL).As a result,M-PCNL was also recommended as a treatment option for staghorn calculi.AIM To examine the perioperative and long-term results of ultrasonography-guided single-and M-PCNL.METHODS This was a retrospective cohort study.Between March 2021 and January 2022,the urology department of our hospital selected patients for the treatment of staghorn calculi using percutaneous nephrolithotomy.The primary outcomes were com plication rate and SFR,and the characteristics of patients,operative parameters,laboratory measurements were also collected.RESULTS In total,345 patients were enrolled in the study(186 in the S-PCNL group and 159 in the M-PCNL group).The SFR in the M-PCNL group was significantly higher than that in the S-PCNL group(P=0.033).Moreover,the incidence rates of hydrothorax(P=0.03)and postoperative infection(P=0.012)were higher in the M-PCNL group than in the S-PCNL group.Logistic regression analysis demonstrated that post-operative white blood cell count(OR=2.57,95%CI:1.90-3.47,P<0.001)and stone size(OR=1.59,95%CI:1.27-2.00,P<0.001)were associated with a higher overall complication rate in the S-PCNL group.Body mass index(OR=1.22,95%CI:1.06-1.40,P=0.004)and stone size(OR=1.70,95%CI:1.35-2.15,P<0.001)were associated with increased overall complications in the M-PCNL group.CONCLUSION Multiple access tracts can facilitate higher SFR while slightly increasing the incidence of acceptable complications.展开更多
Objective:To define the role of ureteroscopy for treatment of staghorn calculi.Methods:A systematic review was conducted using the Scopus and Medline databases.Original articles and systematic reviews were selected ac...Objective:To define the role of ureteroscopy for treatment of staghorn calculi.Methods:A systematic review was conducted using the Scopus and Medline databases.Original articles and systematic reviews were selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.Only studies relating to the role of ureteroscopy for treatment of staghorn calculi were included.Results:In five studies on ureteroscopic monotherapy,stone-free rate(SFR)ranged from 33%to 93%,with a maximum four ureteroscopy sessions per patient and no major complications.Endoscopic combined intrarenal surgery(ECIRS)was compared with percutaneous nephrolithotomy(PNL)in two studies and reached significantly higher SFR(88%e91%vs.59%e65%)and lower operative times(84e110 min vs.105e129 min).The role of salvage ureteroscopy for residual stones after primary PNL has been highlighted by two studies with a final SFR of 83%e89%.One study reported on the feasibility of ureteroscopy for ureteral stones and same-session PNL for contralateral staghorn calculi,with a SFR of 92%.Conclusion:Ureteroscopy plays a pivotal role in the setting of a combined approach to staghorn calculi.Ureteroscopy is also particularly suitable for clearance of residual stones.In specific cases,ureteroscopy may become the sole applicable therapeutic option to staghorn calculi.Technological advances and refinement of techniques suggest a major role of ureteroscopy for staghorn calculi treatment in close future.展开更多
Hemangiopericytoma (HPC) is a rare vascular tumor arising from capillary pericytes. This tumor represents 3% - 5% of all soft tissue sarcomas and 1% of all vascular tumors. Only 15% - 30% of cases occur in the head an...Hemangiopericytoma (HPC) is a rare vascular tumor arising from capillary pericytes. This tumor represents 3% - 5% of all soft tissue sarcomas and 1% of all vascular tumors. Only 15% - 30% of cases occur in the head and neck region, among which sinonasal hemangiopericytoma (HPC) is accounted for around 5% of cases. Hemangiopericytoma (HPC) has a tendency for recurrence. Here, a case of recurrent nasal hemangiopericytoma (HPC) after 12 years of treatment is reported.展开更多
We present a case report of a 65-year-old woman who underwent resection of a chest wall tumor. In contrast with computed tomography, the tumor exhibited hypervascularity and was fed from the 9th intercostals artery. H...We present a case report of a 65-year-old woman who underwent resection of a chest wall tumor. In contrast with computed tomography, the tumor exhibited hypervascularity and was fed from the 9th intercostals artery. Histologically, the tumor was diagnosed as a cellular variant of solitary fibrous tumor of the pleura, with branching “staghorn” vessels and hypervascularity. The tumor thus resembled a chest wall hemangiopericytoma.展开更多
Urolithiasis or nephrolithiasis is a common ailment in the emergency room. The clinical presentation of a kidney stone includes fever, nausea, vomiting, acute flank pain radiating to the groin or the back. The pain is...Urolithiasis or nephrolithiasis is a common ailment in the emergency room. The clinical presentation of a kidney stone includes fever, nausea, vomiting, acute flank pain radiating to the groin or the back. The pain is often described as stabbing and there is tachycardia, with or without hematuria for the severe patient. For the triad for urinary or kidney stones, some people say they are fever, vomiting, and acute flank pain. So in acute setting analgesia is given with or without an antiemetic to prevent vomiting IV fluids administered carefully. Noncontrast computed tomography (CT) is the gold standard for diagnosis. Most of urinary stones get washouts spontaneously if it is less than 5 mm without any intervention. However, if intervention is required either it is done by elective or as soon as possible by the intervention. I mean surgical management and surgical management will depend on how big the kidney stone is in there as well as where the kidney stone is if it is within the ureter or within the actual kidney.展开更多
Staghorn renal calculi are large renal calculi that occupy nearly the entirety of the renal collecting system.They may be composed of metabolic or infection stone types.They are often associated with specific metaboli...Staghorn renal calculi are large renal calculi that occupy nearly the entirety of the renal collecting system.They may be composed of metabolic or infection stone types.They are often associated with specific metabolic defects.Infection stones are associated with urease-producing bacterial urinary tract infections.The ideal treatment for staghorn calculi is maximal surgical removal.However,some patients are either unwilling or unable to proceed with that modality of treatment,and therefore other management must be used.One such technique is the metabolic evaluation with directed medical management.Based on contemporary evidence that the majority of staghorn stones are metabolic in etiology,and furthermore that even infection stones are usually associated with metabolic abnormalities,metabolic evaluation with directed medical management is recommended for all staghorn stone formers.The scientific basis of this recommendation is reviewed in the present work.展开更多
The main goals for urinary stone treatment are to preserve renal function, reduce or avoid complications related to calculi, and to render the patient free of calculi as soon as possible. Anatrophic nephrolithotomy(AN...The main goals for urinary stone treatment are to preserve renal function, reduce or avoid complications related to calculi, and to render the patient free of calculi as soon as possible. Anatrophic nephrolithotomy(ANL) is a valid and useful alternative for conventional staghorn calculi excision. Although excellent stone free rates can be achieved with ANL there are some drawbacks that may be of concern. Morbidity related to intraoperative and postoperative complications isone of them. Another, great concern is the possibility of reduction on renal function related to the procedure itself. This may be related to nephron injury during nephrotomy and parenchymal closure or to ischemic injury. In this review we assess functional results after anatrophic nephrolithotomy.展开更多
文摘Background Amplatz dilation and balloon dilation are different methods in creating the accesses during percutaneous nephrolithotomy(PCNL). The aim of this study was to review the surgical experiences of managing staghorn calculi by Amplatz dilation and balloon dilation for 3 years.Methods We retrospectively analyzed clinical data from 125 patients(129 kidneys) with staghorn kidney stones who underwent PCNL from January 2010 to December 2012, of whom 60 patients underwent Amplatz dilation(AD group) and 65 underwent balloon dilation(BD group) during PCNL.Results The AD and BD groups were similar in age, male–female ratio, stone burden, stone type, hydronephrosis, and proportion of patients who had undergone extracorporeal lithotripsy. However, these two groups showed significant differences in terms of duration of percutaneous access(15.1±3.6) minutes vs.(10.0±3.3) minutes, one-attempt success rate of dilation via a single access 88.9%(72/81) vs. 97.8%(91/93), hemoglobin drop after surgery(3.5±0.9) g/dl vs.(1.7±0.9) g/dl, number of cases requiring intraoperative and postoperative blood transfusion 27.9%(n=17) vs. 13.2%(n=9), changes of central venous pressure before and after surgery(2.3±1.2) cmH2 O vs.(1.2±0.7) cmH2 O, number of patients who experienced postoperative fever >37.5°C 21(34.4%) vs. 13(19.1%)(all P <0.05). No injury of adjacent organs, including pleura, liver, spleen, or bowel, was noted in patients.Conclusions During ultrasound-guided PCNL for staghorn stones, balloon dilation and Amplatz dilation are all effective and safe. Compared with Amplatz dilation, balloon dilation is a better choice, as it has a higher access creation success rate, shorter access creation time less blood loss, and lower proportions of circulatory overload and postoperative fever.
文摘Staghorn calculi comprise a unique subset of complex kidney stone disease. Percutaneousnephrolithotomy (PCNL) is the gold standard treatment for staghorn stones. Despitecontinuous refinements to the technique and instrumentation of PCNL, these stones remaina troublesome challenge for endourologists and are associated with a higher rate of perioperativecomplications than that for non-staghorn stones. Common and notable intraoperativecomplications include bleeding, renal collecting system injury, injury of visceral organs, pulmonarycomplications, thromboembolic complications, extrarenal stone migration, andmisplacement of the nephrostomy tube. Postoperative complications include infection and urosepsis,bleeding, persistent nephrocutaneous urine leakage, infundibular stenosis, and death.In this review, we report recommendations regarding troubleshooting measures that can beused to identify and characterize these complications. Additionally, we include informationregarding management strategies for complications associated with PCNL for staghorn calculi.
文摘Percutaneous nephrolithotomy （PCNL） has been the first-line treatment for renal staghorn calculi for many years. Several techniques have been described for percutaneous access and stone removal, but a multi-access approach is the mainstay of treatment. The main concern about PCNL is the resultant morbidity： Complications such as bleeding, parenchymal damage, and organ injury hindered the adoption of PCNL in primary hospitals in China.
文摘Objective:Staghorn calculi present a particular and challenging entity of stone morphology.Treatment is associated with lower stone-free rates and higher complication rates compared to non-staghorn stones.In this review we looked for the most relevant data on preoperative imaging and access planning to help decision making for percutaneous surgery with this complex condition.Methods:We conducted a PubMed search of publications in the past 2 decades that include relevant information on the planning for management of staghorn stones.Non-contrast computerized tomography(NCCT)is indeed the standard imaging tool for percutaneous nephrolithotomy(PCNL);additional tools such as three-dimensional computed tomography(CT)reconstruction of the staghorn calculus may help plan access in complex cases.Ultrasound guided percutaneous access may be considered for staghorn stones when planning upper pole access in kidney malposition or complex intrarenal anatomy or with complex body habitus.Wideband doppler ultrasound and real-time virtual sonography can assist.New technologies to improve kidney access such as Uro Dyna-CT or electromagnetic sensor have been reported,but have not shown utilization in staghorn cases.Staghorn morphometry-based prediction algorithms may predict the number of tract(s)and stage(s)for PCNL monotherapy.Lower pole access can be equally effective as upper pole when planning for staghorn and complex stones,with significantly less complications rate;Stone-Tract length-Obstruction-Number of involved calyces-Essence of stone density(STONE)nephrolithometry seems to be the best system to predict outcomes of PCNL in staghorn cases.There is a growing trend of endoscopic combined intrarenal surgery(ECIRS)in concordance with PCNL to treat larger stones.Conservative management of staghorn calculi is an undesired option,but can be an alternative for a carefully selected group of high-risk patients.Conclusion:Staghorn stones may lead to deterioration of renal function and life-threatening urosepsis.This entity should be
文摘Staghorn calculi are branched stones which occupy a majority portion of the pelvicaliceal system.An untreated staghorn calculus over time can damage the kidney and deteriorate its function and/or cause life threatening sepsis.Total stone clearance is an important goal in order to eradicate any infective focus,relieve obstruction,prevent recurrence and preserve the kidney function.Percutaneous nephrolithotomy(PCNL)is currently the accepted first-line treatment option for staghorn calculi.The options available are single-tract PCNL with an auxiliary procedure like shockwave lithotripsy,single-tract PCNL with flexible nephroscopy,or multitract PCNL.Each has its own pros and cons.But the ultimate goal of treatment for any patient with staghorn calculi should be safety,cost-effectiveness,and to achieve total stone clearance.With this article,we review the management of staghorn calculi with multiple percutaneous(“multitract”)access,its advantages and disadvantages and its current position by studying the various published materials across the globe.
文摘Technological advances in minimally invasive treatment of stone disease and its integration with concomitant clinical practice are amongst the most important achievements in urology.Despite the wealth of information accumulated over the years and the richness of existing literature,the knowledge about the definition,treatment and outcomes of residual stone fragments after percutaneous nephrolithotomy(PNL)is still insufficient.Due to the high stone load a lot of patients with staghorn stones have residual fragments(RFs)after treatment with PNL,which depends on the size of tract,definition of stone free rate(SFR),timing of evaluation and the imaging used.No consensus exists on the imaging modality or their timing in the evaluation of possible RFs.The treatment of residual stones is apparently different depending on the facilities of the department and the preference of the surgeon,which includes active surveillance,shock wave lithotripsy(SWL),retrograde intrarenal surgery(RIRS)or a second look PNL.
文摘BACKGROUND It is possible that this condition will lead to urosepsis and progressive deterioration of renal function in the absence of surgical intervention.Several recent clinical studies have shown that multi-tract percutaneous nephrolithotomy(MPCNL)has a similar stone free rate(SFR)as standard percutaneous nephrolithotomy(S-PCNL).As a result,M-PCNL was also recommended as a treatment option for staghorn calculi.AIM To examine the perioperative and long-term results of ultrasonography-guided single-and M-PCNL.METHODS This was a retrospective cohort study.Between March 2021 and January 2022,the urology department of our hospital selected patients for the treatment of staghorn calculi using percutaneous nephrolithotomy.The primary outcomes were com plication rate and SFR,and the characteristics of patients,operative parameters,laboratory measurements were also collected.RESULTS In total,345 patients were enrolled in the study(186 in the S-PCNL group and 159 in the M-PCNL group).The SFR in the M-PCNL group was significantly higher than that in the S-PCNL group(P=0.033).Moreover,the incidence rates of hydrothorax(P=0.03)and postoperative infection(P=0.012)were higher in the M-PCNL group than in the S-PCNL group.Logistic regression analysis demonstrated that post-operative white blood cell count(OR=2.57,95%CI:1.90-3.47,P<0.001)and stone size(OR=1.59,95%CI:1.27-2.00,P<0.001)were associated with a higher overall complication rate in the S-PCNL group.Body mass index(OR=1.22,95%CI:1.06-1.40,P=0.004)and stone size(OR=1.70,95%CI:1.35-2.15,P<0.001)were associated with increased overall complications in the M-PCNL group.CONCLUSION Multiple access tracts can facilitate higher SFR while slightly increasing the incidence of acceptable complications.
文摘Objective:To define the role of ureteroscopy for treatment of staghorn calculi.Methods:A systematic review was conducted using the Scopus and Medline databases.Original articles and systematic reviews were selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.Only studies relating to the role of ureteroscopy for treatment of staghorn calculi were included.Results:In five studies on ureteroscopic monotherapy,stone-free rate(SFR)ranged from 33%to 93%,with a maximum four ureteroscopy sessions per patient and no major complications.Endoscopic combined intrarenal surgery(ECIRS)was compared with percutaneous nephrolithotomy(PNL)in two studies and reached significantly higher SFR(88%e91%vs.59%e65%)and lower operative times(84e110 min vs.105e129 min).The role of salvage ureteroscopy for residual stones after primary PNL has been highlighted by two studies with a final SFR of 83%e89%.One study reported on the feasibility of ureteroscopy for ureteral stones and same-session PNL for contralateral staghorn calculi,with a SFR of 92%.Conclusion:Ureteroscopy plays a pivotal role in the setting of a combined approach to staghorn calculi.Ureteroscopy is also particularly suitable for clearance of residual stones.In specific cases,ureteroscopy may become the sole applicable therapeutic option to staghorn calculi.Technological advances and refinement of techniques suggest a major role of ureteroscopy for staghorn calculi treatment in close future.
文摘Hemangiopericytoma (HPC) is a rare vascular tumor arising from capillary pericytes. This tumor represents 3% - 5% of all soft tissue sarcomas and 1% of all vascular tumors. Only 15% - 30% of cases occur in the head and neck region, among which sinonasal hemangiopericytoma (HPC) is accounted for around 5% of cases. Hemangiopericytoma (HPC) has a tendency for recurrence. Here, a case of recurrent nasal hemangiopericytoma (HPC) after 12 years of treatment is reported.
文摘We present a case report of a 65-year-old woman who underwent resection of a chest wall tumor. In contrast with computed tomography, the tumor exhibited hypervascularity and was fed from the 9th intercostals artery. Histologically, the tumor was diagnosed as a cellular variant of solitary fibrous tumor of the pleura, with branching “staghorn” vessels and hypervascularity. The tumor thus resembled a chest wall hemangiopericytoma.
文摘Urolithiasis or nephrolithiasis is a common ailment in the emergency room. The clinical presentation of a kidney stone includes fever, nausea, vomiting, acute flank pain radiating to the groin or the back. The pain is often described as stabbing and there is tachycardia, with or without hematuria for the severe patient. For the triad for urinary or kidney stones, some people say they are fever, vomiting, and acute flank pain. So in acute setting analgesia is given with or without an antiemetic to prevent vomiting IV fluids administered carefully. Noncontrast computed tomography (CT) is the gold standard for diagnosis. Most of urinary stones get washouts spontaneously if it is less than 5 mm without any intervention. However, if intervention is required either it is done by elective or as soon as possible by the intervention. I mean surgical management and surgical management will depend on how big the kidney stone is in there as well as where the kidney stone is if it is within the ureter or within the actual kidney.
文摘Staghorn renal calculi are large renal calculi that occupy nearly the entirety of the renal collecting system.They may be composed of metabolic or infection stone types.They are often associated with specific metabolic defects.Infection stones are associated with urease-producing bacterial urinary tract infections.The ideal treatment for staghorn calculi is maximal surgical removal.However,some patients are either unwilling or unable to proceed with that modality of treatment,and therefore other management must be used.One such technique is the metabolic evaluation with directed medical management.Based on contemporary evidence that the majority of staghorn stones are metabolic in etiology,and furthermore that even infection stones are usually associated with metabolic abnormalities,metabolic evaluation with directed medical management is recommended for all staghorn stone formers.The scientific basis of this recommendation is reviewed in the present work.
文摘The main goals for urinary stone treatment are to preserve renal function, reduce or avoid complications related to calculi, and to render the patient free of calculi as soon as possible. Anatrophic nephrolithotomy(ANL) is a valid and useful alternative for conventional staghorn calculi excision. Although excellent stone free rates can be achieved with ANL there are some drawbacks that may be of concern. Morbidity related to intraoperative and postoperative complications isone of them. Another, great concern is the possibility of reduction on renal function related to the procedure itself. This may be related to nephron injury during nephrotomy and parenchymal closure or to ischemic injury. In this review we assess functional results after anatrophic nephrolithotomy.
