Over the past three decades,there has been increasing interest in miniaturized percutaneous nephrolithotomy(mPCNL)techniques featuring smaller tracts as they offer potential solutions to mitigate complications associa...Over the past three decades,there has been increasing interest in miniaturized percutaneous nephrolithotomy(mPCNL)techniques featuring smaller tracts as they offer potential solutions to mitigate complications associated with standard PCNL(sPCNL).However,despite this growing acceptance and recognition of its benefits,unresolved controversies and acknowledged limitations continue to impede widespread adoption due to a lack of consensus on optimal perioperative management strategies and procedural tips and tricks.In response to these challenges,an international panel comprising experts from the International Alliance of Urolithiasis(IAU)took on the task of compiling an expert consensus document on mPCNL procedures aimed at providing urologists with a comprehensive clinical framework for practice.This endeavor involved conducting a systematic literature review to identify research gaps(RGs),which formed the foundation for developing a structured questionnaire survey.Subsequently,a two-round modified Delphi survey was implemented,culminating in a group meeting to generate final evidence-based comments.All 64 experts completed the second-round survey,resulting in a response rate of 100.0%.Fifty-eight key questions were raised focusing on mPCNLs within 4 main domains,including general information(13 questions),preoperative work-up(13 questions),procedural tips and tricks(19 questions),and postoperative evaluation and follow-up(13 questions).Additionally,9 questions evaluated the experts’experience with PCNLs.Consensus was reached on 30 questions after the second-round survey,while professional statements for the remaining 28 key questions were provided after discussion in an online panel meeting.mPCNL,characterized by a tract smaller than 18 Fr and an innovative lithotripsy technique,has firmly established itself as a viable and effective approach for managing upper urinary tract stones in both adults and pediatrics.It offers several advantages over sPCNL including reduced bleeding,fewer requirements for nephrostomy tubes,decreased pain,and shorter hospital stays.The series of detailed techniques presented here serve as a comprehensive guide for urologists,aiming to improve their procedural understanding and optimize patient outcomes.展开更多
The purpose of the review was to present the latest updates on percutaneous nephrolithotomy(PCNL)procedure in terms of indications and evolving techniques,and to identify the advantages and disadvantages of each modal...The purpose of the review was to present the latest updates on percutaneous nephrolithotomy(PCNL)procedure in terms of indications and evolving techniques,and to identify the advantages and disadvantages of each modality.The data for this review were collected after a thorough PubMed search in core clinical journals in English language.The key words included“PCNL”and“PNL”in combination with“indications”,“techniques”,“review”and“miniaturized PCNL”.Publications relevant to the subject were retrieved and critically reviewed.Current European and American Urology Association Nephrolithiasis Guidelines were included as well.The indications for standard PCNL have been changed through the past decade.Despite evolution of the procedure,innovations and the development of new technical approaches,the indications for miniaturized PCNL have not been standardized yet.There is a need for well-constructed randomized trials to explore the indications,complications and results for each evolving approach.A continuous reduction of tract size is not the only revolution of the last years.There is constant ongoing interest in developing new efficient miniature instruments,intracorporeal lithotripters and sophisticated tract creation methods.We can summarize that,PCNL represents a valuable well-known tool in the field of endourology.We should be open minded to future changes in surgical approaches and technological improvements.展开更多
Background/Aims:Current guidelines suggest that the indications for pelvic lymph node(LN)dissection(PLND)during radical pros-tatectomy(RP)should rely on nomograms predicting their involvement.Positron emission tomogra...Background/Aims:Current guidelines suggest that the indications for pelvic lymph node(LN)dissection(PLND)during radical pros-tatectomy(RP)should rely on nomograms predicting their involvement.Positron emission tomography/computed tomography(PET/CT)with prostate-specific membrane antigen(PSMA)radioligand is gaining acceptance as routine diagnostic test before RP in patients with intermediate/high-risk prostate cancer(PC).In this study,we examined the effect of preoperative PET/CT on the accuracy of the nomograms.Materials and methods:Patients with intermediate/high risk PC showing no extraprostatic disease on PET/CT-PSMA underwent RP with PLND and were followed postoperatively for at least 6 months.Patients with detectable(>0.1 ng/mL)postoperative prostate-specific antigen levels underwent re-evaluation with PET/CT-PSMA.Results:A total of 70 patients underwent RP for intermediate(34 patients)or high-risk disease(36 patients).According to the Partin,MSKCC,and Briganti 2012 nomograms,positive LNs were expected in 7,13,and 12 patients,respectively.At PLND,1 positive LN was found in a single patient(p<0.05 compared with the expected number of patients from all nomograms).Postoperatively,10 pa-tients developed detectable prostate-specific antigen levels.One patient exhibited radioligand uptake that could indicate LN involve-ment.Considering these 2 patients as failures,the negative predictive value of PSMA-PET/CT for LN involvement was 97.1%.Conclusions:Preoperative PSMA-PET/CT with no extraprostatic uptake before RP in patients with intermediate to high-grade PC is highly accurate for ruling out LN involvement,superior to the routinely used nomograms.Its use induced stage migration,rendering pre-dictive nomograms irrelevant.展开更多
Background:Urological guidelines assert that"urine culture should be obtained"before surgical management of ureteral or kidney stones.Thus,many surgeries are delayed by 1-3 days until the results of urine cu...Background:Urological guidelines assert that"urine culture should be obtained"before surgical management of ureteral or kidney stones.Thus,many surgeries are delayed by 1-3 days until the results of urine culture are available.During this time,the patient frequently experience pain and possible kidney damage.We investigated the hypothesis that it is possible to predict the results of urine culture in candidates for surgical intervention using parameters that are accessible immediately upon admission.Materials and methods:A database of 1000 patients who underwent either percutaneous nephrolithotomy(PCNL)or ureteroscopy/retrograde intrarenal surgery was analyzed.Eleven parameters potentially related to urinary infections and accessible to the clinician at the emergency department were correlated with the preoperative urine culture results.Results:Of the patients,234(23.4%)had positive cultures.On multivariate analysis,only sex,hydronephrosis grade,and history of previous nephrolithotomy were significantly associated with a positive preoperative urine culture.The risk of a positive culture can be easily determined from a simple table or an Excel-based calculator.This risk could be as low as 0.45%for a man without a history of PCNL and no hydronephrosis(4%in a woman with similar parameters)or as high as 79.5%in a man with a history of PCNL and hydronephrosis(85%in a woman with similar parameters).Conclusions:The risk of preoperative positive urine culture can be predicted using 3 parameters that are accessible upon admission.In low-risk cases,prompt surgical treatment can be provided,eliminating the anticipation time for urine culture results.展开更多
文摘Over the past three decades,there has been increasing interest in miniaturized percutaneous nephrolithotomy(mPCNL)techniques featuring smaller tracts as they offer potential solutions to mitigate complications associated with standard PCNL(sPCNL).However,despite this growing acceptance and recognition of its benefits,unresolved controversies and acknowledged limitations continue to impede widespread adoption due to a lack of consensus on optimal perioperative management strategies and procedural tips and tricks.In response to these challenges,an international panel comprising experts from the International Alliance of Urolithiasis(IAU)took on the task of compiling an expert consensus document on mPCNL procedures aimed at providing urologists with a comprehensive clinical framework for practice.This endeavor involved conducting a systematic literature review to identify research gaps(RGs),which formed the foundation for developing a structured questionnaire survey.Subsequently,a two-round modified Delphi survey was implemented,culminating in a group meeting to generate final evidence-based comments.All 64 experts completed the second-round survey,resulting in a response rate of 100.0%.Fifty-eight key questions were raised focusing on mPCNLs within 4 main domains,including general information(13 questions),preoperative work-up(13 questions),procedural tips and tricks(19 questions),and postoperative evaluation and follow-up(13 questions).Additionally,9 questions evaluated the experts’experience with PCNLs.Consensus was reached on 30 questions after the second-round survey,while professional statements for the remaining 28 key questions were provided after discussion in an online panel meeting.mPCNL,characterized by a tract smaller than 18 Fr and an innovative lithotripsy technique,has firmly established itself as a viable and effective approach for managing upper urinary tract stones in both adults and pediatrics.It offers several advantages over sPCNL including reduced bleeding,fewer requirements for nephrostomy tubes,decreased pain,and shorter hospital stays.The series of detailed techniques presented here serve as a comprehensive guide for urologists,aiming to improve their procedural understanding and optimize patient outcomes.
文摘The purpose of the review was to present the latest updates on percutaneous nephrolithotomy(PCNL)procedure in terms of indications and evolving techniques,and to identify the advantages and disadvantages of each modality.The data for this review were collected after a thorough PubMed search in core clinical journals in English language.The key words included“PCNL”and“PNL”in combination with“indications”,“techniques”,“review”and“miniaturized PCNL”.Publications relevant to the subject were retrieved and critically reviewed.Current European and American Urology Association Nephrolithiasis Guidelines were included as well.The indications for standard PCNL have been changed through the past decade.Despite evolution of the procedure,innovations and the development of new technical approaches,the indications for miniaturized PCNL have not been standardized yet.There is a need for well-constructed randomized trials to explore the indications,complications and results for each evolving approach.A continuous reduction of tract size is not the only revolution of the last years.There is constant ongoing interest in developing new efficient miniature instruments,intracorporeal lithotripters and sophisticated tract creation methods.We can summarize that,PCNL represents a valuable well-known tool in the field of endourology.We should be open minded to future changes in surgical approaches and technological improvements.
文摘Background/Aims:Current guidelines suggest that the indications for pelvic lymph node(LN)dissection(PLND)during radical pros-tatectomy(RP)should rely on nomograms predicting their involvement.Positron emission tomography/computed tomography(PET/CT)with prostate-specific membrane antigen(PSMA)radioligand is gaining acceptance as routine diagnostic test before RP in patients with intermediate/high-risk prostate cancer(PC).In this study,we examined the effect of preoperative PET/CT on the accuracy of the nomograms.Materials and methods:Patients with intermediate/high risk PC showing no extraprostatic disease on PET/CT-PSMA underwent RP with PLND and were followed postoperatively for at least 6 months.Patients with detectable(>0.1 ng/mL)postoperative prostate-specific antigen levels underwent re-evaluation with PET/CT-PSMA.Results:A total of 70 patients underwent RP for intermediate(34 patients)or high-risk disease(36 patients).According to the Partin,MSKCC,and Briganti 2012 nomograms,positive LNs were expected in 7,13,and 12 patients,respectively.At PLND,1 positive LN was found in a single patient(p<0.05 compared with the expected number of patients from all nomograms).Postoperatively,10 pa-tients developed detectable prostate-specific antigen levels.One patient exhibited radioligand uptake that could indicate LN involve-ment.Considering these 2 patients as failures,the negative predictive value of PSMA-PET/CT for LN involvement was 97.1%.Conclusions:Preoperative PSMA-PET/CT with no extraprostatic uptake before RP in patients with intermediate to high-grade PC is highly accurate for ruling out LN involvement,superior to the routinely used nomograms.Its use induced stage migration,rendering pre-dictive nomograms irrelevant.
文摘Background:Urological guidelines assert that"urine culture should be obtained"before surgical management of ureteral or kidney stones.Thus,many surgeries are delayed by 1-3 days until the results of urine culture are available.During this time,the patient frequently experience pain and possible kidney damage.We investigated the hypothesis that it is possible to predict the results of urine culture in candidates for surgical intervention using parameters that are accessible immediately upon admission.Materials and methods:A database of 1000 patients who underwent either percutaneous nephrolithotomy(PCNL)or ureteroscopy/retrograde intrarenal surgery was analyzed.Eleven parameters potentially related to urinary infections and accessible to the clinician at the emergency department were correlated with the preoperative urine culture results.Results:Of the patients,234(23.4%)had positive cultures.On multivariate analysis,only sex,hydronephrosis grade,and history of previous nephrolithotomy were significantly associated with a positive preoperative urine culture.The risk of a positive culture can be easily determined from a simple table or an Excel-based calculator.This risk could be as low as 0.45%for a man without a history of PCNL and no hydronephrosis(4%in a woman with similar parameters)or as high as 79.5%in a man with a history of PCNL and hydronephrosis(85%in a woman with similar parameters).Conclusions:The risk of preoperative positive urine culture can be predicted using 3 parameters that are accessible upon admission.In low-risk cases,prompt surgical treatment can be provided,eliminating the anticipation time for urine culture results.
