Acute Kidney Injury and Postobstructive Diuresis Caused by a 4 mm Urinary Calculus

정의석,양은미,김찬종,Jung, Eui Seok,Yang, Eun Mi,Kim, Chan Jong Korean Society of Pediatric Nephrology 2013 Childhood kidney diseases Vol.17 No.2

결석으로 인한 요관 폐쇄는 신후성 신부전의 주요한 원인으로 즉각적인 치료가 필요하다. 폐색 후 이뇨는 폐쇄성 요로 질환의 막힘 제거될 때 흔히 나타날 수 있는 증상으로 특별한 치료 없이 회복되는 경우가 많으나 저혈압이나 전해질 이상 등의 소견이 나타날 경우에는 수액 요법을 통한 치료가 필요하다. 단일신 환아에서 4 mm 크기의 작은 결석으로 인한 신후성 신부전이 발생하였으며 결석이 배출되고 발생한 폐쇄 후 이뇨는 보존적 치료로 회복되었다. 대부분의 4 mm 미만의 작은 결석은 저절로 배출 된다고 알려져 있으나 저자들은 4 mm 크기의 결석으로 생긴 신후성 신부전 및 폐쇄 후 이뇨가 발생한 예를 경험하였기에 보고하는 바이다. Urinary obstructions from ureteral calculi are one of the causes of postrenal acute kidney injury (AKI). Here we present a case of AKI caused by a 4 mm ureteral calculus with postobstructive diuresis following the spontaneous passage of the calculus. A 13-year-old girl who underwent nephrectomy for the removal of a neuroblastoma eight years previously, visited our institution because anuria had developed over the preceding five days. The serum creatinine level was elevated at 13.4 mg/dL. Radiological examinations showed the right solitary kidney with moderate hydronephrosis and a 4 mm calculus in the upper right ureter. The patient immediately underwent hemodialysis. After the ureteral calculus was passed spontaneously on day 2 of hospitalization, urinary output increased to more than 5,200 mL per day. Intravenous fluid replacement with careful monitoring of weight, intake, output, and serum and urine electrolytes was performed. On day 5 of hospitalization, the patient's condition stabilized.

Is Tubeless Percutaneous Nephrolithotomy a Feasible Technique for the Treatment of Staghorn Calculi?

이상철,김창희,김광택,김태범,김계환,정한,윤상진,오진규 대한비뇨의학회 2013 Investigative and Clinical Urology Vol.54 No.10

Purpose: Tubeless percutaneous nephrolithotomy (PNL) remains a challenging technique for the surgical treatment of staghorn renal calculi. Our study was designed to compare surgical outcomes between conventional and tubeless PNL. Materials and Methods: We retrospectively enrolled consecutive patients who underwent conventional or tubeless PNL under general anesthesia performed by a single surgeon (H.J.) for the treatment of staghorn calculi between 2003 and 2012. All patients were divided into two groups: group 1 included patients who underwent conventional PNL and group 2 included patients who were managed by tubeless PNL for the treatment of staghorn calculi. Preoperative and postoperative parameters were analyzed between the two groups, including age, stone burden, complications, any interventions, and duration of hospital stay. Results: A total of 165 patients (group 1, 106; group 2, 59) were enrolled in the study. No significant differences in age, sex, body mass index, or stone laterality were observed between the two groups. The mean stone burdens (±standard deviation) of group 1 and group 2 were 633.6 (±667.4) and 529.9 (±362.8), respectively (p=0.271). The postoperative stone-free clearance rate was higher in group 2 (78.0%) than in group 1 (69.8%); however, the difference was not clinically significant (p=0.127). In addition, no significant differences in postoperative complications, including fever, bleeding, infection, or additional interventions, were observed between the two groups. Conclusions: Our results demonstrated that tubeless PNL has the same effectiveness and safety as conventional PNL in the treatment of staghorn calculi. Tubeless PNL may be feasible for managing renal staghorn calculi.

신녹각석에 동반된 신장 방선균증

이기수,지준엽,서영은,정진숙,조원열 대한요로생식기감염학회 2013 Urogenital Tract Infection Vol.8 No.1

Actinomycosis is a chronic infectious disease that is generally caused by Actinomyces israelii. Renal actinomycosis is a very rare disease, especially accompanying staghorn calculi formation. In this article, we present a case of renal actinomycosis with the staghorn calculi formation. A 52-year-old woman presented with a 3-month history of pain in the right upper quadrant. The abdominopelvic computed tomography scan showed staghorn calculi and severe dilatation of the pelvicalyceal system of the right kidney. A right simple nephrectomy and a partial resection of the infrahepatic inferior vena cava were performed. We anticipated that the final diagnosis would be xanthogranulomatous pyelonephritis, however histopathologic tests revealed renal actinomycosis with abscess formation and extensive inflammation, glomerulosclerosis and staghorn calculi.

The Learning Curve for Flank Percutaneous Nephrolithotomy for Kidney Calculi: A Single Surgeon’s Experience

장원식,최경화,양승철,한웅규 대한비뇨의학회 2011 Investigative and Clinical Urology Vol.52 No.4

Purpose: Percutaneous nephrolithotomy (PCNL) is conventionally conducted in the prone position. However, the prone position increases anesthesia-related morbidity and position changes lengthen the operation time. We report perioperative outcomes and the learning curve for flank PCNL on the basis of a single surgeon’s experience. Materials and Methods: This study investigated 53 cases of flank PCNL performed for renal stones at our institution from April 2008 to September 2010. We compared mean operative time, stone-free rate, drop in hemoglobin level, length of hospital stay, complications, and need for additional procedures after the surgery. The 53 cases were divided into three groups by case number to compare therapeutic effect, stability, and the learning curve for flank position PCNL. Results: The mean operation time for the 53 patients was 97.3±43.1 minutes. The mean operation time gradually decreased as the surgeon accumulated experience. From the 36th case, the mean operation time showed a statistically significant decrease to 72.2± 24.1 minutes (p=0.003). The overall stone-free rate was 64.2% for all procedures (range, 61.1-76.5%). There were no significant differences in the drop in hemoglobin level, stone-free rate, re-treatment, hospital stay, or complication rate. There was no injury to the bowel or renal vessels, and no other major complications occurred. Conclusions: Flank PCNL can be used to remove renal stones effectively while overcoming the disadvantages of the existing prone position PCNL. After 36 cases, the learning curve showed acquisition of surgical competence. The clinical experience reported here suggests that flank PCNL is a safe and feasible technique.

Feasibility and Efficacy of Intermediate-Supine Percutaneous Nephrolithotomy: Initial Experience

정두용,이주영,Kyu Hyun Kim,최재혁,조강수 전남대학교 의과학연구소 2014 전남의대학술지 Vol.50 No.2

We evaluated the feasibility and efficacy of intermediate-supine percutaneous nephrolithotomy(PCNL) in patients with renal calculi. Fifteen patients were included inthis study. The intermediate-supine operative position was modified by using a 1-L salinebag below the ipsilateral upper flank. A nephrostomy and stone extraction wereperformed as usual. After completion of the stone removal, a nephrostomy tube wasused when necessary according to the surgeon’s decision. If there was no significantbleeding or renal pelvic injury, tubeless PCNL was performed. The mean stone sizewas 5.48±5.69 cm2, the mean operative time was 78.93±38.72 minutes, and the meanhospital stay was 2.60±1.29 days. Tubeless PCNL was performed in 13 cases (86.7%),and retrograde procedures were simultaneously performed without a change of positionin 2 patients (ureteroscopic ureterolithotomy in one patient and transurethralplacement of an occlusion catheter in one patient). There were two complications accordingto the Clavien-Dindo classification (Grade I in one patient and Grade II in onepatient). The success rate was 80.0% and the complete stone-free rate was 73.3%. Threepatients with a significant remnant stone were also successfully managed with additionalprocedures (one patient underwent a second-look operation, and the remainingtwo patients were treated with shock wave lithotripsy). In the treatment of renal calculi,intermediate-supine PCNL may be a safe and effective choice that offers several advantageswith excellent outcomes. Thus, a prospective study with a larger population isneeded to verify our outcomes.

Development of sudden refractory hypotension resulting from urosepsis in the post-anesthesia care unit after percutaneous nephrolithotomy for renal calculi: a case report

Gi-Ho Koh,Doo-Hwan Kim,Jihion Yu,Seungsoo Ha,Sang-A Lee,Jai-Hyun Hwang,Young-Kug Kim,Jun-Young Park 조선대학교 의학연구원 2019 Medical Bilogical Science and Engineering Vol.2 No.2

Percutaneous nephrolithotomy (PNL) is a relatively safe and effective procedure for the management of nephrolithiasis but is associated with severe complications. We report the case of a 76-year-old woman who underwent PNL for renal calculi removal. Preoperative urinalysis detected a large number of white blood cells and, on culture, Escherichia coli was detected. After an uneventful recovery from general anesthesia, she developed tachycardia, high fever, severe shivering, and hypotension in the post-anesthesia care unit. She was diagnosed with urosepsis associated with PNL and was transferred to the intensive care unit. Urosepsis and refractory hypotension persisted despite meticulous fluid management and vasopressor and inotropic agent administration. On postoperative day 5, she was hemodynamically stable and was transferred to a general ward. On postoperative day 12, she was discharged without any complications. Urosepsis after PNL can be catastrophic; therefore, early detection and optimal treatment are necessary to improve the postoperative outcome.

Ultramini nephrostomy tract combined with flexible ureterorenoscopy for the treatment of multiple renal calculi in paediatric patients

Jingyang Guo,Wen Zeng Yang,Yanqiao Zhang,Feng An,Ruojing Wei,Yu Li,Haisong Zhang 대한비뇨의학회 2015 Investigative and Clinical Urology Vol.56 No.7

Purpose: To assess the safety and efficacy of an ultramini nephrostomy tract, which we were using for the first time, combinedwith flexible ureterorenoscopy (URS) in the treatment of pediatric patients with multiple renal calculi. Materials and Methods: Twenty pediatric patients (age, ≤6 years) underwent ultramini percutaneous nephrolithotomy (PCNL)combined with flexible URS. The group had multiple renal calculi, which were bilateral in 3 cases and were located in a total of 23sites. The calculi were located in 2 calyces in 10 cases, scattered in more than 2 calyces in 7 cases, and limited to 1 calyx in 3 cases. The average patient age was 37.35 months (range, 14–68 months). The average stone diameter was 2.0 cm (range, 1–3.0 cm). Inall patients, an ultramini nephrostomy tract was established under ultrasound guidance (dilated to F10) with simultaneous sheathplacement. The flexible URS was placed into the collecting system during holmium laser lithotripsy. Results: When ultramini PCNL was combined with flexible ureterorenoscopic holmium laser lithotripsy, the complete stone-freerate was 87% (20/23). The average level of hemoglobin decreased to 1.0 g/dL after the operation. No blood transfusions wereneeded. Levels of blood urea nitrogen, creatinine, and C-reactive protein were not significantly different before and after the operation. The average duration of hospitalization was approximately 4.85 days, and all cases were followed up for 6 to 12 months. No complications were found. Conclusions: Ultramini PCNL combined with flexible ureterorenoscopic holmium laser lithotripsy is a safe and effective treatmentfor children with multiple renal calculi.

Can a brief period of double J stenting improve the outcome of extracorporeal shock wave lithotripsy for renal calculi sized 1 to 2 cm?

Rakesh Sharma,Arpan Choudhary,Ranjit Kumar Das,Supriya Basu,Ranjan Kumar Dey,Rupesh Gupta,Partha Pratim Deb 대한비뇨의학회 2017 Investigative and Clinical Urology Vol.58 No.2

Purpose: Extracorporeal shock wave lithotripsy (ESWL) is an established modality for renal calculi. Its role for large stones is being questioned. A novel model of temporary double J (DJ) stenting followed by ESWL was devised and outcomes were assessed. Materials and Methods: The study included 95 patients with renal calculi sized 1 to 2 cm. Patients were randomized into 3 groups. Group 1 received ESWL only, whereas group 2 underwent stenting followed by ESWL. In group 3, a distinct model was applied in which the stent was kept for 1 week and then removed, followed by ESWL. Procedural details, analgesic requirements, and outcome were analyzed. Results: Eighty-eight patients (male, 47; female, 41) were available for analysis. The patients' mean age was 37.9±10.9 years. Stone profile was similar among groups. Group 3 received fewer shocks (mean, 3,155) than did group 1 (mean, 3,859; p=0.05) or group 2 (mean, 3,872; p=0.04). The fragmentation rate was similar in group 3 (96.7%) and groups 1 (81.5%, p=0.12) and 2 (87.1%, p=0.16). Overall clearance in group 3 was significantly improved (83.3%) compared with that in groups 1 (63.0%, p=0.02) and 2 (64.5%, p=0.02) and was maintained even in lower pole stones. The percentage successful outcome in groups 1, 2, and 3 was 66.7%, 64.5%, and 83.3%, respectively (p=0.21). The analgesic requirement in group 2 was higher than in the other groups (p=0.00). Group 2 patients also had more grade IIIa (2/3) and IIIB (1/2) complications. Conclusions: Stenting adversely affects stone clearance and also makes the later course uncomfortable. Our model of brief stenting followed by ESWL provided better clearance, comfort, and a modest improvement in outcome with fewer sittings and steinstrasse in selected patients with large renal calculi.

중등도 크기의 신석에 대한 충격파쇄석술시 요관부목 유치의 유용성

김영학,권칠훈 大韓泌尿器科學會 1998 Korean Journal of Urology Vol.39 No.9

Efficacy and safety of modified tract dilation technique using simultaneous pulling of proximal and distal ends of a guidewire for percutaneous nephrolithotomy in modified supine position

정재욱,하헌,박동진,하윤석,이준녕,천소영,권태균,김범수 대한비뇨의학회 2021 Investigative and Clinical Urology Vol.62 No.2

Purpose: Recently, the needs for supine percutaneous nephrolithotomy (PCNL) have become more increased because of an easy approach for endoscopic combined intrarenal surgery. However, making a nephrostomy tract during supine PCNL is more difficult than prone position due to movable kidney. To overcome this limitation, we used a modified nephrostomy tract dilation (MTD) technique using guidewire traction. Materials and Methods: From January 2014 to June 2019, a total of 259 patients underwent PCNL in the modified supine position. Among them, the MTD technique was performed in 171 patients. For the MTD technique, two hydrophilic guidewires were passed from the nephrostomy tract and brought out through the urethra, then both proximal and distal ends were contralaterally pulled with tension for the easy placement of a fascia-cutting needle and a balloon catheter. We analyzed the efficacy of this technique in comparison with the conventional method. Results: Intraoperative radiation exposure time (RET) (68.87 vs. 212.11 s) and hospital stay (5.90 vs. 6.74 days) were significantly shorter, while the success rate (77.2% vs. 63.6%) was significantly higher in the MTD group. Multivariate analysis showed that only the maximal stone diameter (odds ratio [OR], 1.928; 95% confidence interval [CI], 1.314–2.828; p=0.001) and MTD technique (OR, 0.017; 95% CI, 0.007–0.040; p<0.001) were independent factors for predicting short RET (<120 s). Conclusions: This study demonstrated that MTD technique can be effectively and safely performed in modified supine position PCNL, and it can be helpful in reducing RET and enhancing success rates.