Comprehensive analysis of factors associated with significant blood loss during percutaneous nephrolithotomy.

Introduction: The objective of this study is to conduct a thorough investigation of the risk factors associated with blood loss during PCNL, within the setting of a US urban tertiary care center.

Materials And Methods: We conducted a retrospective analysis of our endourology database to identify adult patients who underwent PCNL for stone extraction at our tertiary stone center between October 2014 and December 2022. Patients were categorized into two groups based on the extent of blood loss: significant blood loss (SBL) and no significant blood loss (NSBL).

Reverse Trendelenburg Positioning Minimizes Stone Retropulsion During Ureteroscopic Laser Lithotripsy: A Prospective Randomized Study.

Retropulsion of stone fragments during ureteroscopic laser lithotripsy (URSLL) remains a challenge for urologists and is associated with increased operative time and reduced stone-free rate (SFR). In this study, we compared the rate of retropulsion of ureteral stones during URSLL between the standard dorsal lithotomy (SDL) position and dorsal lithotomy position with reverse Trendelenburg (RT). Patients with ureteral stones requiring surgical intervention between May 2019 and January 2022 were randomized to undergo URSLL in either SDL or RT positions.

The effects of continuing aspirin on blood loss and postoperative outcomes in percutaneous nephrolithotomy.

Background: Percutaneous nephrolithotomy (PCNL) is an effective surgery for complex kidney stones yet with inherent bleeding risks. It remains unclear whether aspirin should be discontinued prior to PCNL. We aimed to further substantiate the safety of continuing aspirin during PCNL surgery and to determine whether aspirin status affects postoperative outcomes following PCNL.

Mini-Incision Direct Festoon Access, Cauterization, and Excision (MIDFACE): A 12-Year Analysis of a Novel Festoon Surgery.

Background: Surgical festoon management often entails aggressive dissection, flaps, unsightly scars, prolonged recovery, and high recurrence rates. The authors present outcomes with subjective and objective evaluation of an office-based, novel, minimally invasive (1-cm incision) festoon repair: mini-incision direct festoon access, cauterization, and excision (MIDFACE).

Methods: Charts of 75 consecutive patients from 2007 to 2019 were evaluated.

Displacement of Lower Pole Stones During Retrograde Intrarenal Surgery Improves Stone-free Status: A Prospective Randomized Controlled Trial.

Purpose: Lower pole renal stones are associated with the lowest stone-free status of any location in the urinary tract during retrograde intrarenal surgery. Prior work has suggested displacing lower pole stones to a more accessible part of the kidney to improve stone-free status. We sought to prospectively compare the efficacy of laser lithotripsy in situ vs after displacement during retrograde intrarenal surgery for lower pole stones.

A prospective randomized study evaluating the necessity of narcotics following ureteroscopy for urinary stone disease.

Purpose: To evaluate the efficacy of non-narcotic analgesics and preoperative counseling in managing postoperative pain and narcotic use following ureteroscopic laser lithotripsy (URS).

Methods: Adult patients at a single academic center undergoing URS for nephrourolithiasis were recruited. After informed consent, subjects were randomized into three groups: NARC-15 tablets oxycodone-acetaminophen 5/325 mg (A-OXY), 2.

Long-Term Complications of Open and Robot-Assisted Laparoscopic Radical Prostatectomy in an Afro-Caribbean Population.

Background With the Afro-Caribbean population increasing in the United States, their complication profiles following open (ORP) and robot-assisted laparoscopic (RALP) radical prostatectomy warrants investigation. The purpose of this pilot study was to evaluate differences in long-term complications between ORP and RALP in Afro-Caribbeans. Methods A retrospective review of patients undergoing ORP or RALP between April 2010 and August 2019 at an academic medical center and county hospital was conducted.

Do Infection-Associated Stone Subtypes Behave the Same Clinically? A Retrospective Bicenter Study.

Infection-associated renal stones are commonly composed of magnesium-ammonium-phosphate (MAP) and carbonate apatite (CA). The clinical implications of these two different, but closely related stone types, are unknown. We sought to compare the clinical, microbiologic, and metabolic characteristics of patients with MAP and CA stone types.

Is metformin use associated with changes in urinary parameters in stone formers?

Introduction: Diabetes mellitus (DM) is associated with an increased risk of nephrolithiasis and is often treated with metformin. The relationship between metformin and nephrolithiasis formation remains unclear, as studies have demonstrated conflicting results.

Methods: We conducted a cross-sectional analysis of stone-forming patients at our stone clinic prior to the initiation of stone-directed medical management.

The impact of metabolic syndrome components on urinary parameters and risk of stone formation.

Purpose: To investigate the relationship between metabolic syndrome (MS) and urinary abnormalities in stone-forming patients. Additionally, to delineate whether severity of urinary derangements is impacted by the number of co-occurring MS components.

Methods: Stone-forming patients who underwent initial metabolic workup prior to medical intervention at a comprehensive stone clinic were retrospectively reviewed and included in the study.

Prospective Randomized Evaluation of Idiopathic Hyperoxaluria Treatments.

Calcium oxalate (CaOx) stone formation is influenced by urinary oxalate excretion. Stone formers with elevated urinary oxalate are commonly prescribed a low-oxalate diet or oral supplementation with vitamin B6 and magnesium to reduce urinary oxalate excretion. This study aims to compare the effects of dietary modification supplementation a combination of both on urinary oxalate.

Factors Affecting Patient Radiation Exposure During Prone and Supine Percutaneous Nephrolithotomy.

Radiation exposure from fluoroscopy poses risks to patients and surgeons. Percutaneous nephrolithotomy (PCNL) has traditionally required fluoroscopy, however, the use of ultrasound (US) has decreased radiation exposure. US guidance in supine PCNL (S-PCNL) may further reduce radiation exposure.

Ultrasound-Guided Totally Tubeless Mini-Percutaneous Nephrolithotomy for a Completely Excluded Caliceal Diverticulum Associated with Challenging Anatomy.

Mini-percutaneous nephrolithotomy (mini-PCNL) has been described as a safe and effective technique to eliminate stones in patients in whom a less-invasive approach is desired. It was originally developed to treat stones in the pediatric population, but has since been adapted to serve a role in the adult urologic community. This approach has been reported to result in less blood loss and postoperative pain when compared with traditional PCNL.

Deceived by a CT Scan: The Case of the Misrepresented Stone Size.

CT has become the gold standard for radiographic evaluation of urolithiasis. CT is highly sensitive for detecting kidney stones and provides valuable information regarding stone size, composition, location, and overall stone burden. Although CT can provide reliable estimations of stone size, we have encountered an instance in which it can be deceiving.

Peri-Calculus Ureteral Thickness on Computed Tomography Predicts Stone Impaction at Time of Surgery: A Prospective Study.

Ureteroscopic management of impacted ureteral stones poses multiple challenges. We examined whether ureteral thickness measured on preoperative noncontrast computed tomography (CT) is predictive of stone impaction at the time of ureteroscopy (URS). Thirty-eight patients with preoperative CT scan and undergoing URS for ureteral stones were prospectively studied.

What Factors Drive Staghorn Nonstaghorn Pattern Growth in Patients with Metabolic Stones?

There has been an increase in the number of staghorn calculi that form in the absence of infection (metabolic staghorns). It is unknown why some large metabolic calculi form as solitary or multiple separate, nonbranching caliceal stones, whereas others develop as staghorn stones forming a cast of the collecting system. We sought to compare these two groups of metabolic stone formers (SFs) in an attempt to shed light on these disparate stone-forming phenomena.

Clinical and Metabolic Correlates of Calcium Oxalate Stone Subtypes: Implications for Etiology and Management.

Calcium oxalate (CaOx) is the predominate component within renal calculi and can be divided into two subtypes: CaOx-monohydrate (COM) and CaOx-dihydrate (COD). COM and COD form in differing urinary environments, which suggest differential underlying metabolic abnormalities associated with each subtype. We compared clinical and metabolic findings in CaOx stone formers to delineate factors differentiating COD and COM stone formers and the implication this holds in terms of etiology and treatment.

Predicting the Impacted Ureteral Stone with Computed Tomography.

Objective: To evaluate whether preoperative computed tomography (CT) findings could predict the presence of an impacted stone. Preoperative identification of an impacted ureteral stone may influence patient preparation and operative decisions. Factors predicting ureteral stone impaction have not been clearly identified.