Mehmet Necmettin Mercimek

Modified Clavien classification in percutaneous nephrolithotomy: assessment of complications in children.

PURPOSE Although percutaneous nephrolithotomy has been accepted as an effective minimally invasive procedure in children, there is still no consensus on how to define and stratify complications by severity. MATERIALS AND METHODS We retrospectively reviewed data of children who underwent percutaneous nephrolithotomy at our center between January 2002 and March 2010. A total of 100 procedures were performed in 94 patients with a mean age of 9.5 years. Complications were recorded according to modified Clavien classification. RESULTS Average stone burden ranged from 100 to 2,850 mm(2) (mean ± SD 507.5 ± 475). Stones were located in the renal pelvis in 32 kidneys, calices in 20, renal pelvis and calices in 31, and upper ureter in 3. Stone-free rate after a single session of percutaneous nephrolithotomy was 85%. After auxiliary procedures in 7 cases stone-free rate increased to 89%. Grade I complications were seen in 7 patients postoperatively, grade II in 19 (hematuria requiring blood transfusion in 13 and nonseptic infection requiring antibiotics in 6) and grade III in 4 (hydrohemothorax in 2 and urine leakage requiring Double-J® stent in 2). No grade IV or V complications were observed. Regression analysis showed that stone burden (OR 1.006, 95% CI 1.001-1.011; p = 0.03) and operative time (OR 1.044, 95% CI 1.011-1.077; p = 0.009) were independent risk factors for complications. CONCLUSIONS Percutaneous nephrolithotomy in children is safe, feasible and effective. Stone burden and operative time are independent risk factors for complications. The modified Clavien system provides a straightforward and validated method to classify postoperative complications.

Horseshoe kidney: does it really have any negative impact on surgical outcomes of percutaneous nephrolithotomy?

OBJECTIVES To compare the stone-free rate and complications between horseshoe and normal kidneys. METHODS Between December 1997 and June 2008, a total of 2401 patients with 2618 renal units underwent percutaneous nephrolithotomy (PCNL). During this period, we retrospectively reviewed the data of 46 patients with 50 (1.9%) renal units with horseshoe kidneys treated by PCNL. We compared the success and complication rate in horseshoe kidney and normal kidney. RESULTS Fifty PCNL were performed in the above-mentioned 46 patients with a mean age of 41.6 years. The average stone burden ranged from 100 to 4900 mm(2) (mean, 644 +/- 135 mm(2)). The stones were located in the renal pelvis in 13 (26%), calices in 17 (34%), and in both in 11 kidneys (22%). A single tract was used in 42 kidneys (84%), and 2 tracts were created in the remaining 8 (16%). Major complications were seen in 8 PCNL procedures (16%). A detailed comparison between horseshoe and normal kidneys showed that stone burden, operation time, stone-free rates, and auxiliary procedure rates were similar. The only statistically significant difference was detected in the number of access, which is more in normal kidneys. Logistic regression analysis did not reveal that horseshoe kidney did not have any negative effect on success after PCNL. CONCLUSIONS Despite the anatomic abnormalities, PCNL is a safe and effective treatment option for calculi both in the horseshoe kidney and the normal kidney with the similar success and complications rates.

Percutaneous nephrolithotomy in pediatric age group: Assessment of effectiveness and complications.

Management of kidney stone disease in pediatric population is a challenging condition in urology practice. While the incidence of kidney stone is increasing in those group, technological innovations have conrtibuted to the development of minimally invasive treatment of urinary stone disease such as mini-percutenous nephrolitotomy (mini-PCNL), micro-PCNL, ultra mini-PCNL. In this review we tried to evaluate the effect of new teratment techniques on pediatric kidney stones.

Renal hydatid cyst treatment: Retroperitoneoscopic “closed cyst” pericystectomy

Cystic hydatid disease is an endemic disease caused by the larval form of Echinococcus spp. Isolated renal involvement is extremely rare. The treatment methods for renal hydatid disease require some form of intervention, ranging from traditional open techniques to laparoscopic techniques. Herein, we present a large hydatid cyst in the lower pole of the left kidney in a 43‐year‐old male patient who was treated by the “closed cyst” method via the retroperitoneal laparoscopic approach to prevent soiling of the peritoneal cavity. To our knowledge, this is the first case of a renal hydatid cyst treated by preserving the renal parenchyma by pericystectomy via the retroperitoneoscopic laparoscopic approach in an adult patient. No complications occurred during the perioperative and postoperative periods. After 9 months of follow up, the patient was asymptomatic with no evidence of clinical recurrence. Retroperitoneoscopic laparoscopic closed cyst pericystectomy can be an alternative minimally invasive treatment technique for the treatment of renal hydatid disease.

1549 LONG TERM OUTCOMES OF PERCUTANEOUS NEPHROLITHOTOMY IN PATIENTS WITH CHRONIC RENAL FAILURE: ONDOKUZ MAYIS UNIVERSITY EXPERIENCE

tomy tube insertion (p 0.0002, OR 6.4), and post operative fever (p 0.0001). CONCLUSIONS: For patients undergoing PCNL and URS, factors predisposing the development of sepsis include bladder outlet obstruction, positive pre-operative urine culture, and nephrostomy tube insertion. Treatment of a positive preoperative urine culture did not reduce the risk of sepsis, and cannot be considered a reliable preventative measure. A larger sample size is needed to perform multivariate analysis and logistic regression. This would elucidate relationships found on univariate analysis and enable further risk stratification.