Minimally Invasive Percutaneous Nephrolithotomy with a Novel Vacuum-assisted Access Sheath for obstructive calculous pyonephrosis ：A Randomized Study
Vol. 17 No. 05 (2020),
30 October 2020
Purpose: To investigate the safety and efficacy of Minimally Invasive Percutaneous Nephrolithotomy (MPCNL) combined with Vacuum-assisted Access Sheath in the treatment of obstructive calculous pyonephrosis.
Materials and Methods: Seventy-six patients with obstructive calculous pyonephrosis, who were planned to receive MPCNL, were randomly divided into two groups. Group A was treated with Amplatz sheath combined with Cyberwand double probe ultrasound lithotripsy, and group B was treated with Vacuum-assisted Access Sheath (VAAS, ClearPetra, Well lead Medical) combined with holmium laser lithotripsy. The primary outcome was the operation successful rate. Other perioperative, and postoperative data such as operation time, stone free rate and complications were compared between groups.
Results: Single 20F access sheath was established in all cases. All patients underwent one-stage procedure. Compared with group A, group B had a higher initial stone-free rate (84.2% vs 63.1%, P= .037). The operation time of group B was 56.3 ± 19.83 min, significantly shorter than that of group A at 70.4 ± 14.83 min. The complication rate of B group was 15.8%, which was lower than that of group A (P= .035 ). Five patients (15.8 %) of group B had a postoperative fever (>38.5 ºC) (Clavien grade 2) that required additional antibiotics; whereas 8 patients (21.1 %) of group A (P= .361). There was no blood transfusion in group A, and one case in group B required transfusion.
Conclusion: One-stage MPCNL combined with Vacuum-assisted Access Sheath and holmium laser lithotripsy is a simple, safe, effective, and ergonomically practical method for selected patients with obstructive calculous pyonephrosis.
- Vacuum-assisted Access Sheath
- ultrasound lithotripsy
- obstructive calculous pyonephrosis
How to Cite
Zeng G, Mai Z, Zhao Z, et al. Treatment of upper urinary calculi with Chinese minimally invasive percutaneous nephrolithotomy: a single-center experience with 12,482 consecutive patients over 20 years. Urolithiasis. 2013;41(3):225-229.
Chen L, Li JX, Huang XB, Wang XF. [Analysis for risk factors of systemic inflammatory response syndrome after one-phase treatment for apyrexic calculous pyonephrosis by percutaneous nephrolithotomy]. Beijing Da Xue Xue Bao Yi Xue Ban. 2014;46(4):566-569.
Huang J, Song L, Xie D, et al. A Randomized Study of Minimally Invasive Percutaneous Nephrolithotomy (MPCNL) with the aid of a patented suctioning sheath in the treatment of renal calculus complicated by pyonephrosis by one surgery. BMC Urol. 2016;16(1):71.
Wang J, Zhou DQ, He M, et al. One-phase treatment for calculous pyonephrosis by percutaneous nephrolithotomy assisted by EMS LithoClast master. Chin Med J (Engl). 2013;126(8):1584-1586.
Yuruk E, Tuken M, Sulejman S, et al. Computerized tomography attenuation values can be used to differentiate hydronephrosis from pyonephrosis. World J Urol. 2017;35(3):437-442.
Krambeck AE, Miller NL, Humphreys MR, et al. Randomized controlled, multicentre clinical trial comparing a dual-probe ultrasonic lithotrite with a single-probe lithotrite for percutaneous nephrolithotomy. BJU Int. 2011;107(5):824-828.
Zhong W, Zeng G, Wu K, Li X, Chen W, Yang H. Does a smaller tract in percutaneous nephrolithotomy contribute to high renal pelvic pressure and postoperative fever? J Endourol. 2008;22(9):2147-2151.
El-Nahas AR, Elshal AM, El-Tabey NA, El-Assmy AM, Shokeir AA. Percutaneous nephrolithotomy for staghorn stones: a randomised trial comparing high-power holmium laser versus ultrasonic lithotripsy. BJU Int. 2016;118(2):307-312.
Xu G, He Y, Zhao H, et al. Mini-nephroscope combined with pressure suction: an effective tool in MPCNL for intrarenal stones in patients with urinary tract infections. Urolithiasis. 2016;44(5):445-450.
Khemees TA, Kenneson MA, Zynger DL, Knudsen BE. Histologic impact of dual-modality intracorporeal lithotripters to the renal pelvis. Urology. 2013;82(1):27-32.
Borofsky MS, El Tayeb MM, Paonessa JE, Lingeman JE. Initial Experience and Comparative Efficacy of the UreTron: A New Intracorporeal Ultrasonic Lithotriptor. Urology. 2015;85(6):1279-1283.
York NE, Borofsky MS, Chew BH, et al. Randomized Controlled Trial Comparing Three Different Modalities of Lithotrites for Intracorporeal Lithotripsy in Percutaneous Nephrolithotomy. J Endourol. 2017;31(11):1145-1151.
- Abstract Viewed: 0 times
- 5577 Downloaded: 0 times