Guohua Zeng

A Prospective, Randomised Trial Comparing Plasmakinetic Enucleation to Standard Transurethral Resection of the Prostate for Symptomatic Benign Prostatic Hyperplasia: Three-year Follow-up Results

BACKGROUND Plasmakinetic enucleation of the prostate (PKEP) has recently been proved a safe and technically feasible procedure for benign prostatic hyperplasia (BPH). However, its long-term safety, efficacy, and durability in comparison with the gold-standard transurethral resection of the prostate (TURP) have not yet been reported. OBJECTIVE To report the 3-yr follow-up results of a prospective, randomised clinical trial comparing PKEP with standard TURP for symptomatic BPH. DESIGN, SETTING, AND PARTICIPANTS A total of 204 patients with bladder outflow obstruction (BOO) secondary to BPH were prospectively randomised 1:1 into either the PKEP group or the TURP group. INTERVENTION The patients in each group underwent the procedure accordingly. MEASUREMENTS All patients were assessed perioperatively and followed at 1, 3, 6, 12, 18, 24, and 36 mo postoperatively. The preoperative and postoperative parameters included International Prostate Symptom Score (IPSS), quality of life (QoL) scores, the International Index of Erectile Function (IIEF) questionnaire, maximum urinary flow rates (Q(max)), transrectal ultrasound (TRUS)-assessed prostate volume, postvoid residual urine (PVRU) volume, and serum prostate-specific antigen (PSA) level. Patient baseline characteristics, perioperative data, and postoperative outcomes were compared. All complications were recorded. RESULTS AND LIMITATIONS PKEP was significantly superior to TURP in terms of the drop in haemoglobin (0.74±0.33 g/dl vs 1.88±1.06 g/dl; p<0.001), intraoperative irrigation volume (11.7±4.5 l vs 15.4±6.2 l; p<0.001), postoperative irrigation volume and time (18.5±7.6 l vs. 30.0±11.4 l and 16.6±5.2 h vs 25.3±8.5 h; all p<0.001), recovery room stay (67.3±11.1 min vs 82.0±16.4 min; p<0.001), catheterisation time (51.7±26.3 h vs 80.5±31.6 h; p<0.001), hospital stay (98.4±20.4 h vs 134.2±31.5 h; p<0.001), and resected tissue (56.4±12.8 g vs 43.8±15.5 g; p<0.001). There were no statistical differences in operation time and sexual function between the two groups. At 36 mo postoperatively, the PKEP group had a maintained and statistically significant improvement in IPSS (2.4±2.2 vs 4.3±2.9; p<0.001), QoL (0.6±0.5 vs 1.6±1.4; p<0.001), Q(max) (28.8±10.1 ml/s vs 25.1±8.0 ml/s; p=0.017), and TRUS volume (21.0±7.3 ml vs 26.4±6.8 ml; p<0.001), with urodynamically proven deobstruction (Schäfer grade 0.2±0.02 vs 0.8±0.1; p<0.001). More extensive clinical trials are required to validate these results. CONCLUSIONS PKEP is a safe and highly effective technique for relieving BOO. At 3-yr follow-up, the clinical efficacy of PKEP is durable and compares favourably with TURP.

Does a smaller tract in percutaneous nephrolithotomy contribute to high renal pelvic pressure and postoperative fever

OBJECTIVE High renal pelvic pressure brings systemic absorption of irrigation fluid containing bacteria or endotoxins, which leads to postoperative fever. We inspected the renal pelvic pressure (RPP) in vivo during minimally invasive percutaneous nephrolithotomy (MPCNL) to investigate whether a 14- to 18-French percutaneous tract and perfusion would bring high RPP and postoperative fever. PATIENTS AND METHODS Between July 2005 and December 2007, 80 patients were selected for RPP measurement during MPCNL. The RPP was measured by a baroceptor connected to the open-ended ureteric catheter, which was indwelling retrogradely in the renal pelvic. A computer recorded the RPP each second, and all the data were evaluated statistically with SPSS 12.0 software. RESULTS During MPCNL with 14-, 16-, 18-, and double-16-French percutaneous tracts, the mean RPP was 24.55, 16.49, 11.22, and 6.64 mm Hg, respectively. Logistical analysis suggested that postoperative fever did not correlate to gender (P = 0.195), age (P = 0.641), urinary tract infection (P = 0.663), white blood cell > or = 10 x 10(9)/L in routine postoperative blood examination (P = 0.751), or an occurrence of renal pelvic pressure > or = 30 mm Hg in the operation (P = 0.662), although infection calculi (P = 0.000), percutaneous tract (P = 0.029), mean RPP (P = 0.036), mean RPP > or = 20 mm Hg (P = 0.013), accumulated time of RPP > or = 30 mm Hg (P = 0.010), and RPP > or = 30 mm Hg longer than 50 s (P = 0.024) may contribute a postoperative fever. CONCLUSION Renal pelvic pressure generally remains lower than the backflow level (30 mm Hg) during MPCNL via a 14- to 18-French percutaneous tract. Any factors that brought about poor drainage would result in temporarily elevated RPP greater than 30 mm Hg, and many such occurrences of high pressure would have an accumulating effect, which means enough backflow to cause bacteremia and postoperative fever.

A Novel Technique of Ultra-Mini-Percutaneous Nephrolithotomy: Introduction and an Initial Experience for Treatment of Upper Urinary Calculi Less Than 2 cm

Objectives. To describe our novel modified technique of ultra-mini-percutaneous nephrolithotomy (UMP) using of a novel 6 Fr mininephroscope through an 11–13 Fr metal sheath to perform holmium: YAG laser lithotripsy. Methods. The medical records of 36 patients with moderate-sized (<20 mm) kidney stones treated with UMP from April to July 2012 were retrospectively reviewed. Patients were assessed at the 1st day and 1st month postoperatively by KUB and US to assess stone-free status. Results. The mean stone size was 14.9 ± 4.1 mm (rang: 6–20). The average operative time was 59.8 ± 15.9 (30–90) min. The stone-free rate at postoperative 1st day and 1st month was 88.9% and 97.2%. The mean hospital stay was 3.0 ± 0.9 (2–5) days. Complications were noted in 6 (16.7%) cases according to the Clavien classification, including sepsis in 2 (5.6%) cases (grade II), urinary extravasations in 1 (2.8%) case (grade IIIa), and fever in 3 (8.3%) cases (grade II). No patients needed blood transfusion. Conclusions. UMP is technically feasible, safe, and efficacious for moderate-sized renal stones with an advantage of high stone-free rates and low complication rates. However, due to the limits of its current unexplored indications, UMP is therefore a supplement to, not a substitute for, the standard mini-PCNL technology.

A multicentre, prospective, randomized trial: comparative efficacy of tamsulosin and nifedipine in medical expulsive therapy for distal ureteric stones with renal colic

Study Type – Therapy (RCT)

Chinese Minimally Invasive Percutaneous Nephrolithotomy: The Guangzhou Experience

BACKGROUND AND PURPOSE Percutaneous nephrolithotomy (PCNL) using a small tract is controversial, and its indication is considered limited. In our center, however, we have performed Chinese minimally invasive PCNL regularly for managing upper-tract calculi. We report our experience. PATIENTS AND METHODS Our technique is not just about using smaller instruments and tracts. Our overall approach is different from the standard PCNL. We preferred a middle caliceal puncture via the 11th rib space and also relied mainly on a strong irrigant current for stone fragment removal. We reviewed and analyzed the prospectively collected database on patients who underwent minimally invasive (MPCNL) from 2001 to 2005. RESULTS A total of 4760 MPCNL procedures were performed in 3610 kidneys. There were 1240 staghorn stones and 85 ureteral stones. There were 14 transplanted kidneys and 27 cases of horseshoe kidneys. The average operative time was 78 minutes. The stone-free rate at postoperative day 2 was 89%. The major complication rate was 0.86%. CONCLUSION Our experience with the Chinese MPCNL shows that it is safe and effective for managing all kinds of upper-tract calculi.

Minimally Invasive Percutaneous Nephrolithotomy for Simple and Complex Renal Caliceal Stones: A Comparative Analysis of More Than 10,000 Cases

PURPOSE To determine whether minimally invasive PCNL (MPCNL) is as safe and effective in the management of complex renal caliceal stones as it is for simple renal stones. PATIENTS AND METHODS We retrospectively reviewed 5761(41.2%) simple caliceal stones (isolated renal pelvis including isolated calix) and 8223 (58.8%) complex caliceal stones (renal pelvis accompanying two calices at least) that were managed by MPCNL between 1992 nd 2011. The safety, efficacy, and outcome were compared and analyzed. RESULTS Stone burden was larger in complex caliceal stones (1763.0 vs 1018.6 mm(2), P<0.05). Patients with simple stones had significantly shorter operative time, less frequency of multiple percutaneous accesses, and less hemoglobin drop. They also had a higher initial stone-free rate (SFR) (77.6% vs 66.4%) after a single session of MPCNL (P<0.05). The differences diminished in the final SFR (86.7% vs 86.1%) after relook and/or auxiliary procedures (P>0.05). The complication rate (17.9% vs 19.0%) and blood transfusion rate (grade II) (2.2% vs 3.2%) were similar in both groups (P>0.05). Both groups had a low rate of high Clavien grade complications. Renal vascular embolizations (grade III), however, were significantly higher in patients with complex caliceal stones (P<0.05). CONCLUSIONS MPCNL is a safe and effective treatment option for patients with complex caliceal stones except there is a slightly higher frequency rate of embolization. There was a higher initial SFR in simple stones, but this difference diminished with secondary procedures.

Super-mini percutaneous nephrolithotomy (SMP): a new concept in technique and instrumentation

To present a novel miniature endoscopic system designed to improve the safety and efficacy of percutaneous nephrolithotomy, named the ‘super‐mini percutaneous nephrolithotomy’ (SMP).

Systemic Inflammatory Response Syndrome After Flexible Ureteroscopic Lithotripsy: A Study of Risk Factors

OBJECTIVE To evaluate the risk factors for systemic inflammatory response syndrome (SIRS) after flexible ureteroscopic lithotripsy (FUL). MATERIALS AND METHODS Patients who underwent FUL between October 2012 and November 2013 were studied. Complete data was available for 260 adult patients who met this criteria. Preoperative and intraoperative risk factors that potentially contribute to SIRS were compared in patients who developed postoperative SIRS and those who did not. Furthermore, multivariable logistic regression analysis was performed and the odds ratio (OR) and 95% confidence interval (CI) were calculated to identify the independent risk factors for SIRS after FUL. RESULTS The incidence of SIRS after FUL was 8.1%. In the univariate test analysis, significant correlation between SIRS and four factors was noted: sex of the patient (P<0.001), stone size (P=0.001), irrigation flow rate (P<0.001), and irrigation volume (P<0.001). Multivariable logistic regression analysis identified stone size (OR=1.691; 95% CI,0.879-3.255), small-caliber ureteral access sheath (UAS) (OR=2.293; 95% CI, 0.730-7.200), irrigation flow rate (OR=1.161; 95% CI, 1.096-1.230), and struvite calculi (OR=3.331; 95% CI, 0.971-11.426) as independent risk factors for SIRS after FUL. CONCLUSIONS We recommend that the length of lithotripsy be well controlled in patients with large stone burden and struvite calculi. Staging procedures are also required. Additionally, irrigating with a low flow rate and low pressure and using a large-caliber UAS for better drainage are required to keep a low renal pelvic pressure during FUL procedures.

Prevalence of kidney stones in China: an ultrasonography based cross-sectional study

To investigate the prevalence and associated factors of kidney stones among adults in China.

Comparison of children versus adults undergoing mini-percutaneous nephrolithotomy: large-scale analysis of a single institution.

Objective As almost any version of percutaneous nephrolithotomy (PCNL) was safely and efficiently applied for adults as well as children without age being a limiting risk factor, the aim of the study was to compare the different characteristics as well as the efficacy, outcome, and safety of the pediatric and adult patients who had undergone mini-PCNL (MPCNL) in a single institution. Methods We retrospective reviewed 331 renal units in children and 8537 renal units in adults that had undergone MPCNL for upper urinary tract stones between the years of 2000–2012. The safety, efficacy, and outcome were analyzed and compared. Results The children had a smaller stone size (2.3 vs. 3.1 cm) but had smilar stone distribution (number and locations). The children required fewer percutaneous accesses, smaller nephrostomy tract, shorter operative time and less hemoglobin drop. The children also had higher initial stone free rate (SFR) (80.4% vs. 78.6%) after single session of MPCNL (p<0.05); but no difference was noted in the final SFR (94.7% vs. 93.5%) after auxiliary procedures. The complication rate (15.6% vs. 16.3%) and blood transfusion rate (3.1% vs. 2.9%) were similar in both group (p>0.05). Both groups had low rate of high grade Clavien complications. There was no grade III, IV, V complications and no angiographic embolization required in pediatric group. One important caveat, children who required multiple percutaneous nephrostomy tracts had significant higher transfusion rate than in adults (18.8% vs. 4.5%, p = 0.007). Conclusions This contemporary largest-scale analysis confirms that the stone-free rate in pediatric patients is at least as good as in adults without an increase of complication rates. However, multiple percutaneous nephrostomy tracts should be practiced with caution in children.