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. 2017 Aug 24;17(1):67.
doi: 10.1186/s12894-017-0257-8.

The application of a novel integrated rigid and flexible Nephroscope in percutaneous nephrolithotomy for renal staghorn stones

Huan Yang  1 , Jianxing Li  2 , Gang Long  3 , Shaogang Wang  4
Affiliations

The application of a novel integrated rigid and flexible Nephroscope in percutaneous nephrolithotomy for renal staghorn stones

Huan Yang et al. BMC Urol. .

Abstract

Background: Renal staghorn stones are challenging for urologists to ensure maximum stone clearance and minimal morbidity. Percutaneous nephrolithotomy (PCNL) has become the gold standard treatment for renal staghorn stones. To assess the safety and efficacy of a novel integrated rigid and flexible percutaneous nephroscope(Rigi-flex nephroscope) in PCNL for renal staghorn stones.We present our initial experience with this new technique.

Methods: From March to July 2016, a prospective analysis of 3 patients with staghorn stones treated with Rigi-flex nephroscope in PCNLunder totally ultrasound guidance by paravertebral block (PVB) anesthesia was done. PCNL was performed with the rigid section of a 13-Fr Rigi-flex nephroscope firstly and the stones were disintegrated into fragments by holmium laser.Then the stones were removed by active flushout, followed by a search for residual stones in other inaccessible calyces with the flexible section. Finally, the residual stones were disintegrated into small fractions by holmium laser in situ or repositioned with a set of disposable retrieval baskets to pelvic or other accessible areas. The whole procedure was accomplished via only one nephrostomy tract. The operating time, stone-free rates (SFR), postoperative hemoglobin drop, complications, length of hospitalization, were recorded.

Results: The operation time were 89, 62 and 45 min, respectively, the postoperative hemoglobin drop was 1, 0.8 and 0.9 mg/dl, respectively.The postoperative Kidney-Ureter-Bladder (KUB) radiograph of the three patients showed no residual fragment >3 mm. No patients needed blood transfusion and suffered significant complications. The length of hospitalization was 9, 6 and 4 days, respectively. No patient needed multiple tracts PCNL or staged auxiliary measures one month after the operation.

Conclusions: The application of Rigi-flex nephroscope in PCNL under ultrasound guidance for staghorn stones has its unique advantages as monotherapy with increasing procedural stone free rate (SFR) via single nephrostomy tract, hence there is less morbidity as it does not require additional tracts dilation and staged auxiliary procedures combination. However, SFR should also be evaluated at a longer follow-up, particularly for staghorn stone, further large-scale multicenter prospective clinical trial are needed to verify its feasibility.

Keywords: Integrated rigid and flexible Nephroscope; Percutaneous nephrolithotomy; Renal staghorn stones; Single nephrostomy tract; Ultrasound guidance.

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Conflict of interest statement

Ethics approval and consent to participate

This study was a retrospective review of cases of patients treated at the hospital. It was approved by the ethics committees of Tongji Hospital Affiliated to Huazhong University of Science and Technology (TJ-C20160108). All patients gave written informed consent for the PCNL procedures and the use of their information in our research as well according to the Helsinki II declaration.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
External view of Rigi-flex nephroscope
Fig. 2
Fig. 2
Endoscopic view from Rigi-flex nephroscope demonstrating the digital image quality in operation
Fig. 3
Fig. 3
Pre and post-operative radiology for the 3 patients
See this image and copyright information in PMC

References

    1. Al-Kohlany KM, Shokeir AA, Mosbah A, et al. Treatment of complete staghorn stones: a prospective randomized comparison of open surgery versus percutaneous nephrolithotomy. J Urol. 2005;173(2):469–473. doi: 10.1097/01.ju.0000150519.49495.88. - DOI - PubMed
    1. Türk C, Petrik A, Sarica K, et al. EAU guidelines on interventional treatment for Urolithiasis. Eur Urol. 2016;69(3):475–482. doi: 10.1016/j.eururo.2015.07.041. - DOI - PubMed
    1. Assimos D, Krambeck A, Miller NL, et al. Surgical Management of Stones: American urological association/Endourological society guideline PART II. J Urol. 2016;196(4):1161–1169. doi: 10.1016/j.juro.2016.05.091. - DOI - PubMed
    1. Bryniarski P, Paradysz A, Zyczkowski M. Et al.a randomized controlled study to analyze the safety and efficacy of percutaneous nephrolithotripsy and retrograde intrarenal surgery in the management of renal stones more than 2 cm in diameter. J Endourol. 2012;26(1):52–57. doi: 10.1089/end.2011.0235. - DOI - PubMed
    1. Ahmed R, El-Nahas IE, Shokeir AA, et al. Percutaneous nephrolithotomy for treating staghorn stones: 10 years of experience of a tertiary-care centre. Arab J Urol. 2012;10(3):324–329. doi: 10.1016/j.aju.2012.03.002. - DOI - PMC - PubMed

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