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Purpose:
To review our experience of using minimally invasive percutaneous nephrolithotomy (MPCNL) in patients with autosomal dominant polycystic kidney disease (ADPKD).
Patients and methods:
We retrospectively reviewed 23 renal units in 23 patients with ADPKD who underwent MPCNL in our center between January 2007 and December 2012. The data on...
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... Only 1 study reported the case definition of ADPKD, which defined ADPKD using the validated, Ravine ultrasonographic criteria. 34,41 Definition for stone-free status post-intervention was highly variable across studies. Seven of the 25 studies specified and defined stone-free status as complete clearance or residual fragments less than a prespecified size. ...
... 13,14,23,27,33,35,38 One study recruited patients from an outpatient setting, 21 and 4 studies recruited patients from a hospital setting. 18,25,34,40 For the latter, it was unclear whether the cases were recruited from a same day surgery setting, emergency department, inpatient, or an outpatient hospital-based clinic. ...
... Sixteen case series 14,23,27,[28][29][30][31][32][33][34][35][36][37][38][39][40] and 1 cohort study 26 reported the use of PCNL for stone removal in adults with ADPKD, with 3 to 29 patients per series (3 to 30 kidneys) (in total, 237 patients). Percutaneous nephrolithotomy-specific characteristics of each study are detailed in Table 5. ...
Background
Reduced kidney function and distorted kidney anatomy in patients with autosomal dominant polycystic kidney disease (ADPKD) may complicate stone interventions more compared with the general population.
Objectives
To review studies describing the safety and efficacy of the 3 main stone interventions in adults with ADPKD: shock wave lithotripsy (SWL), ureteroscopy, and percutaneous nephrolithotomy (PCNL).
Design
Systematic review.
Setting
Any country of origin.
Patients
Adults with ADPKD who underwent SWL, ureteroscopy, or PCNL.
Measurements
Being stone free after the intervention and postoperative complications as reported by each study, which included pain, bleeding, and fever.
Methods
Relevant studies published until February 2019 were identified through a comprehensive search of MEDLINE, EMBASE, Web of Science, BIOSIS PREVIEW, and CINAHL. Studies were eligible for review if they reported at least one outcome following SWL, ureteroscopy, and/or PCNL in adults with ADPKD. We then abstracted information on study characteristics, patient characteristics, intervention details, and postintervention outcomes and assessed the methodological quality of each study using a modified Downs and Black checklist.
Results
We screened 221 citations from which we identified 24 studies that met our review criteria. We identified an additional article when manually reviewing the reference list of an included article, yielding a total of 25 studies describing 311 patients (32 SWL, 42 ureteroscopy, and 237 PCNL). The percentage of patients who were stone free after 1 session ranged from 0% to 69% after SWL, 73% to 100% after ureteroscopy, and 45% to 100% after PCNL. The percentage of patients with ADPKD that experienced at least one postoperative complication ranged from 0% to 33% for SWL, 0% to 27% for ureteroscopy, and 0% to 100% for PCNL.
Limitations
The number and quality of studies published to date are limited.
Conclusions
The efficacy and safety of stone interventions in patients with ADPKD remains uncertain, with wide-ranging estimates reported in the literature.
Trial Registration
We did not register the protocol of this systematic review.
... Abstract The objective of the study was to compare the therapeutic outcomes between the ultrasonography-guided (USG) and the fluoroscopy-guided (FG) mini-percutaneous nephrolithotomy (MPCNL) for the treatment of large or complex upper urinary tract stones (S.T.O.N.E. scores [5][6][7][8][9][10][11] in patients with autosomal dominant polycystic kidney disease (ADPKD). 45 ADPKD patients who were suffering from large or complex upper urinary tract stones (S.T.O.N.E. ...
... There was no significant difference between these two groups in terms of major complications (Clavien score 3a-4a) (p = 0.542). In our center, the FG MPCNL was a superior modality to the USG MPCNL in the treatment of large or complex kidney stones in the Both fluoroscopy-guided (FG) and ultrasonographyguided (USG) punctures have been used for obtaining the percutaneous renal access during PCNL in the ADPKD patients [3,7,8]. There is yet no consensus as which is the better puncture technique for these patients. ...
... Satisfactory outcomes during PCNL are often dependent on the optimal access to the kidney. Both FG and USG percutaneous renal access for PCNL in ADPKD patients have been reported in several studies [3,[6][7][8]16]. Zhang et al. [8] reported twelve satisfactory USG PCNL in eleven ADPKD patients without major complications. ...
The objective of the study was to compare the therapeutic outcomes between the ultrasonography-guided (USG) and the fluoroscopy-guided (FG) mini-percutaneous nephrolithotomy (MPCNL) for the treatment of large or complex upper urinary tract stones (S.T.O.N.E. scores 5–11) in patients with autosomal dominant polycystic kidney disease (ADPKD). 45 ADPKD patients who were suffering from large or complex upper urinary tract stones (S.T.O.N.E. scores 5–11, mean score 7.6) in 45 renal units were accrued into this retrospective study. They were treated by either USG (20 patients) or FG (25 patients) MPCNL in our center. The treatment results as well as the complications according to the modified Clavien system were assessed and compared. The FG MPCNL group had a higher success rate in accessing the targeted calyces than the USG MPCNL group (96 vs. 70 %, p = 0.048). There was no significant difference observed between the two groups with respect to the operative time, the mean hemoglobin drop, and the stone free rate. The overall operative complications and the perioperative blood transfusion rates were significantly higher in the USG than the FG MPCNL groups, 71.4 vs. 29.2 %, p = 0.011, and 35.7 vs. 4.2 %, p = 0.018, respectively. There was no significant difference between these two groups in terms of major complications (Clavien score 3a–4a) (p = 0.542). In our center, the FG MPCNL was a superior modality to the USG MPCNL in the treatment of large or complex kidney stones in the ADPKD patients. It resulted in higher successful calyceal punctures and less operative complications.
... Lei et al. claimed 69.9% patients were stone-free after the primary MPCNL. After the second-look MPCNL, only 4.3% of patients still had residual stone [15]. Compared with flexible ureteroscopy and holmium laser lithotripsy therapy, PCNL has the same stone-free rate. ...
... The urinary oxalate and urinary crystallization were significantly higher in patients with ADPKD and nephrolithiasis. Lei et al. found the most common stone composition was calcium oxalate; uric acid and magnesium ammonium phosphate were also detected in some patients [15]. Liu et al. treat the patients with calculus and ADPKD with flexible ureteroscopy and holmium laser lithotripsy therapy, but the mean size of the stone was 5.6 mm [16]. ...
Nephrolithiasis accelerates the renal failure in the patients with ADPKD. In order to evaluate the role of percutaneous nephrolithotomy in management of calculus in these patients, 11 patients with autosomal dominant polycystic kidney disease and renal stones were included in the study. Two patients had bilateral renal stones. All patients were treated by percutaneous nephrolithotomy under ultrasound guidance. 13 percutaneous nephrolithotomy procedures were performed in 1 stage by the urology team under ultrasound guidance. 5 people received second operation with flexible nephroscopy in lateral position. The success rate and morbidity and mortality of the technique and hospital stay were recorded. Results . The puncture procedure was fully successful in all cases. The renal function improved in these patients. 5 patients had moderate fever after the surgery. 5 patients received flexible nephroscopy to take out the residual calculi. 2 persons had ESWL therapy after the surgery. Conclusion . PCNL is an ideal, safe, and effective method to remove the stones from those patients with no definite increase in the risk of complication. The outcome and stone-free rate are satisfactory comparable to the PCNL in the patients without ADPKD.
... This surgery is usually performed in urologic transplantation academic centres after collegial decision including nephrologist and urologist. The important rate of complications inherent to removal of polycystic kidney has led to develop medical or less invasive treatment options of cyst complications (infection, high blood pressure, pain, lithiasis) instead of surgery [14,15,16]. However, nephrectomy is still required in up to 18.5 % of patients with ADPKD when medical treatment failed [17]. ...
Purpose:
To evaluate and compare perioperative outcomes in patients undergoing either transperitoneal (TP) or retroperitoneal (RP) laparoscopic nephrectomy for autosomal dominant polycystic kidney disease (ADPKD).
Methods:
All patients with ADPKD who underwent unilateral laparoscopic nephrectomy between 2000 and 2012 in two academic departments were retrospectively included. The perioperative parameters were compared between the TP and RP groups.
Results:
A total of 82 patients were included, 43 patients in the TP group and 39 in the RP group. The patients' characteristics were similar between TP set and RP set, except for the time from dialysis onset to nephrectomy (p = 0.02). Complication rates (25.6 vs 33.3 %, p = 0.44), transfusion rates (11.6 vs 20.5 %, p = 0.27) and conversion to open surgery (4.6 vs 7.7 %, p = 0.56) were similar between the TP and RP groups, respectively. Operative time was shorter for TP procedures (171.6 vs 210.5 min, p = 0.002), but there was no difference between the two approaches after 20 surgeries (p = 0.06). Patients in TP group had a shorter length of hospital stay (5.3 ± 1.9 vs 7.2 ± 2.5 days, p = 0.002). However, there was a trend towards shorter return of bowel function in the RP group (2.1 ± 0.9 vs 2.4 ± 0.8 days, p = 0.09).
Conclusion:
TP and RP laparoscopic nephrectomies provide good outcomes in patients with ADPKD. The choice of a TP route could decrease the length of hospital stay and the operative time during the beginning of the learning curve period.
... Al-Kandari ve ark.'larının 20 olguluk, Srivastava ve ark.'larının 22 olguluk ve Lei ve ark'larının 23 olguluk çalışmalarında sırasıyla taşsızlık oranı %89.4, %88, %95.7 olarak bildirilmiştir (73)(74)(75). PNL seçimindeki temel zorluk ilk girişte kist içine ve toplayıcı sisteme girilip girilemediğinin anlaşılamamasıdır. Toplayıcı sisteme girildiğini doğrulamak için retrograd olarak toplayıcı sistem metilen mavisi ile doldurulur. ...
Objectives
Patients with autosomal dominant polycystic kidney disease (ADPKD) showed relatively high incidence of urinary stones. Enlarged kidneys occupied by cysts could make the stone-removal surgery relatively difficult. This study aimed to compare the efficacy and safety of retroperitoneal laparoscopic ureterolithotomy (RPLU), flexible ureteroscopic lithotripsy (FURL) and percutaneous nephrolithotomy (PCNL) in the ADPKD patients with upper urinary stones.Methods
In this study, 45 patients with ADPKD who underwent RPLU, FURL and PCNL procedures were evaluated. Demographic and serum parameters, stone features, outcomes and complications were analyzed.Results45 patients were included in the present study, 13 received RPLU, 21 received FURL, and 11 received PCNL. There were no significant differences in demographic and serum parameters between the three groups. Stone-free rates of the three approaches are 100%, 85.7% and 90.9%, respectively. Patients who underwent FURL had shorter mean operative time and postoperative hospital stay. Compared to RPLU and PCNL, FURL resulted in fewer complications, but the difference is statistically non-significant.ConclusionsRPLU, FURL and PCNL are commonly used surgical methods to solve upper urinary calculi in ADPKD patients and could achieve satisfactory stone clearance. Among them, FURL showed a relative high safety and faster recovery.
There are several special situations in which urinary lithiasis presents management challenges to the urologist. An in-depth knowledge of the pathophysiology, unique anatomy, and treatment options is crucial in order to maintain good health in these patients. In this review, we summarize the current literature on the management of the following scenarios: bladder stones, stones in bowel disease, during pregnancy, in association with renal anomalies, with skeletal deformities, in urinary diversions, and in children.
Autosomal dominant polycystic kidney disease is the most common inherited kidney disease in the United States, causing hypertension, cerebral aneurysms, nephrolithiasis, and kidney failure. This article reviews the pathogenesis, diagnosis, associated complications, and current treatment recommendations for the condition.
Introduction:
Renal function following percutaneous nephrolithotomy (PCNL) has long been a concern to urologists, especially in the setting of multi-tract access. We undertook a study to determine if the risk of renal injury after multi-tract PCNL was greater than with a single access approach.
Materials and methods:
We performed a retrospective review of 307 consecutive patients undergoing PCNL from 2011-2012 at Wake Forest Health. Perioperative Tc99m-MAG3 nuclear renogram parameters along with serum creatinine values were assessed within 1 year of the procedure. Patients were stratified by single vs multi-access (≥2).
Results:
We identified 110 cases in which renography was done both before and after PCNL. A total of 74 patients (67.3%) underwent single access PCNL while 36 (32.7%) underwent multi-access PCNL. Serum creatinine was not significantly different between the two cohorts postoperatively (p=0.09). There was a significant decrease in the renal function based on MAG3 nuclear renogram results following PCNL of the affected kidney in patients with multiple accesses (2.28% decrease, p<0.01). This relationship was not observed when patients were stratified by multiple comorbidities associated with nephrolithiasis.
Conclusion:
Multi-access PCNL is associated with a small reduction in the renal function of the targeted kidney as compared to a single access approach.
To investigate all the predictors of operative duration, hospital stay and stone-free rate post-minimally invasive percutaneous nephrolithotomy (MPCNL) and to establish a logistic regression formula to predict the probability of stone-free post-MPCNL. From August 2009 to August 2012, 396 patients were enrolled in the present study. The patients' characteristics, history, laboratory examination and imaging information were used as independent variables, and operative duration, hospital stay, residuals (≥4 mm) as outcomes. Univariate and multiple regression analysis were performed to determine independent variables. According to the result of multiple logistic regression analysis, a logistic regression formula was established to predict the stone-free probability post-MPCNL. The predictors of operative duration were type of stones and stone burden. Factors affecting hospital stay included leucocytes, stone burden, type of stones and hemoglobin. Residuals were significantly related with stone burden and type of stones. With the above results, we developed a logistic regression formula, which can effectively predict the probability of stone-free with 91.7 % of sensitivity, 70.4 % of specificity and 85.9 % of overall accuracy.
