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Objective: To investigate the effect of spinal anesthesia (SA) vs general anesthesia (GA) administration on the safety and efficiency of percutaneous nephrolithotomy (PCNL)., Methods: We retrospectively evaluated 1478 patients who underwent PCNL in our clinic between 2004 and 2011. We excluded the patients with bilateral PCNL, renal abnormality, or solitary kidney. The remaining 1004 adult patients were divided into 2 groups according to anesthesia administration as GA (n = 564) or SA (n = 440). The groups were compared according to operative and postoperative properties. Complications of PCNL were evaluated according to the modified Clavien classification. Independent t test, chi-square test, and analysis of covariance were used for the comparison of groups., Results: The durations of hospitalization, operation, and fluoroscopy of patients in the SA group were significantly shorter than that of the patients in the GA group (P <.01). The number of patients with postoperative requirement of narcotic analgesic and blood transfusion was significantly higher in the GA group (P <.01). The GA group had more grades 2, 3a, 3b, and 4b complications according to modified Clavien classification (P <.05). The significant differences in postoperative analgesic requirement and hospitalization duration between the groups did not affect postoperative urinary drainage (P <.01; adjusted r(2) = 0.064)., Conclusion: PCNL with SA demonstrated shorter hospitalization, operation, and fluoroscopy durations. GA has some disadvantages as a greater requirement of narcotic analgesic and greater frequency of major complications. SA administration is a safe and effective method in appropriately selected patients with PCNL., (Copyright © 2014 Elsevier Inc. All rights reserved.)

We aimed to investigate the safety and efficacy of tubeless percutaneous nephrolithotomy (PCNL) with ureteral catheter or double-J stent in comparison with standard PCNL in our study. We retrospectively evaluated 707 of 1,469 patients with stone area under 800 mm(2) and only one subcostal nephrostomy access that was underwent PCNL between March 2004 and October 2011 in our clinic. Patients with 14F nephrostomy tube (Malecot or Re-entry catheter), with ureteral stent and with antegrade double-J stent were included into Group 1 (n = 180), Group 2 (n = 148) and Group 3 (n = 120), respectively. The mean hospitalization time of patients in Group 1 was significantly longer. The mean VAS was significantly higher in Group 1. On the other hand the mean fluoroscopy and operation time of patients in Group 2 were significantly shorter in comparison with other groups. Number of patients with postoperative transfusion requirement was significantly higher in Group 1. The number of patients with postoperative narcotic analgesic requirement was also significantly higher in Group 1. The most frequent complication in our study was prolonged drainage. The postoperative complications were seen more frequently in Group 1. Both ureter catheter and double j stent were more comfortable, effective and safe in urinary drainage following PCNL with single sub-costal access. On the other hand, double-J stent has a disadvantage as requirement additional cystoscopy for removal. We suggest ureter catheter or double-J stent to preserve short- and long-term urinary drainage.

Purpose: In this multicenter study we compared the outcome of percutaneous nephrolithotomy in patients with and without malrotated kidneys., Materials and Methods: A total of 44 patients (group 1) at 6 institutions who underwent percutaneous nephrolithotomy for kidneys with simple malrotation were enrolled in our study. Attending physicians in our group also provided the same number of cases of percutaneous nephrolithotomy done for nonmalrotated (normal) kidneys (group 2). Group 2 patients were selected by match pairing. Operative and postoperative data on the 2 groups were compared using the chi-square, Student t and Fisher exact tests., Results: As a result of match pairing, the 2 groups were similar in age, gender, body mass index, and stone size and site. Mean ± SD stone size was 5.9 ± 3.5 cm(2) in group 1. Multiple access attempts were required in 9 (20.5%) and 7 cases (15.9%) in groups 1 and 2, respectively (p >0.05). Mean fluoroscopy time was 7.0 ± 3.9 minutes in the malrotated kidney group and 7.3 ± 4.5 minutes in the nonmalrotated kidney group (p >0.05). The mean hemoglobin decrease after percutaneous nephrolithotomy was significantly higher in group 1 (-1.9 vs -1.3 gm/dl, p = 0.008) but the blood transfusion rate was similar in the 2 groups. The procedure success rate in groups 1 and 2 was 77.3% and 79.5%, respectively (p >0.05)., Conclusions: Percutaneous nephrolithotomy is safe and effective even in patients with larger kidney stones and malrotated kidneys., (Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Purpose: In this multicenter study we aimed to evaluate the efficacy and safety of percutaneous nephrolithotomy in children with respect to different features and using the Clavien classification system., Materials and Methods: Percutaneous nephrolithotomies performed in children at 3 urology departments between March 2006 and May 2010 were included in the study. Results are presented for complex/simple renal stones, tubeless/totally tubeless percutaneous nephrolithotomy, simultaneous bilateral percutaneous nephrolithotomy, instrument size and age groups. Patients were divided into 3 distinct groups, infants and toddlers (3 years or younger, group 1), preschool children (4 to 7 years, group 2) and school children (8 to 16 years, group 3). Perioperative complications are presented according to the modified Clavien classification system., Results: A total of 140 percutaneous nephrolithotomies were performed in 130 patients (41.5% female, mean age 10.17 years). There were 23, 25 and 92 renal units in groups 1, 2 and 3, respectively. Pediatric instruments were used in 60 renal units and adult-sized instruments in 80. General assessment of complications showed Clavien grade I complications in 17 patients, II in 4, IIIa in 11 and IIIb in 7. There were no grade IV or V complications., Conclusions: Percutaneous nephrolithotomy can be applied safely in children of varying ages, even infants. Complications, as assessed with Clavien classification, are comparable to those seen in adults provided there is enough experience with the technique., (Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Objectives: To compare the feasibility and morbidity of tubeless, totally tubeless, and standard percutaneous nephrolithotomy (PNL) with nephrostomy tube in a single center with selected patient population., Methods: Between July 2006 and February 2008, PNL was performed in 176 patients in this retrospective study. Patients with no serious bleeding or perforation in the collecting system during the operation, stone-free status, or clinically insignificant residual fragments (<4 mm) at the end of the procedure and patients with no more than one access were enrolled in the study. Patients were categorized into 3 groups. In group 1 (n = 43), no nephrostomy or ureter catheters were placed after PNL (totally tubeless group); in group 2 (n = 41), no nephrostomy catheter was placed but antegrade J-stent was used (tubeless group), and in group 3 (n = 92), standard nephrostomy catheters were placed (standard group). Three groups were compared with respect to age, stone volume, postoperative hemoglobin change, transfusion rate, operation time, analgesic requirement, hospitalization time, and complication rates., Results: No significant differences were found in mean stone volume, operation time, transfusion rates, and hemoglobin level change between the groups. However, hospitalization time and the amount of narcotic analgesic required were significantly higher in group 3 compared with the other groups (P <.05). Complications were observed in 2 (4.6%), 3 (7.3%), and 7 (7.6%) patients in groups 1, 2, and 3, respectively (P = .738)., Conclusions: In patients with no major intraoperative bleeding and calyceal perforation, tubeless approach is safe with decreased analgesia requirement and hospital stay., (Copyright 2010 Elsevier Inc. All rights reserved.)

Objective: We aimed to evaluate the efficacy and safety of percutaneous nephrolithotomy (PNL) in infants and small children (12-36 months)., Methods: The PNL applications conducted in children <3 years of age in two centers were evaluated. Whereas pediatric PNL instrumentation was used in the first center, adult-size instrumentation was utilized in the second center. The complications were given according to the modified Clavien classification system., Results: The mean age of the patients was 22.76 months (5-36 months) and the mean body weight was 11.51 kg (6-15 kg). In twelve renal units, pediatric instrumentation was used and among these, two had miniperc. In the other eight renal units, adult-size instrumentation was employed. Except for the patient with complex renal stones, all patients were stone free after the intervention and none required a conversion to open surgery. There were grade 1-2 complications in 3 patients. The postoperative hemoglobin drop was greater in the children who underwent PNL with adult-size instrumentation., Conclusion: In this young age group, in addition to standard PNL, simultaneous bilateral PNL, tubeless PNL and in urgent cases of renal failure, urgent PNL, are safe and effective treatment modalities provided patients are selected properly and the surgeon performing the procedure has the necessary experience., (Copyright © 2010 S. Karger AG, Basel.)

Purpose: To evaluate the feasibility and safety of bilateral simultaneous tubeless percutaneous nephrolithotomy (PCNL)., Patients and Methods: From August 2007 to January 2008, six patients underwent bilateral simultaneous totally tubeless PCNL. Patients who needed more than one access, who had significant intraoperative bleeding, and who had pelvicaliceal system perforations or a residual stone were excluded from the study group. Preliminary results were analyzed in six patients., Results: Five men and one woman patient with a mean age of 50.1 years underwent a bilateral totally tubeless procedure. The mean stone burden was 524.5 mm(2) (range 100 mm(2)-1800 mm(2)). The mean drop in hemoglobin was 1.55 g/dL (range 0.6-2.6 g/dL). No blood transfusion was necessary in any patient. The mean hospitalization time was 1.8 days (range 1-4 d). A complications was encountered in one patient; the patient had anuria postoperatively for 16 hours, which resolved after the insertion of bilateral Double-J stents., Conclusions: Bilateral simultaneous tubeless PCNL procedure should be kept in mind for selected patients. Prospective randomized studies with large series are necessary for further evaluation of the procedure.

Objectives: Compared with the standard technique, the number of percutaneous nephrolithotomy (PCNL) operations without a drainage catheter is increasing in recent years. In this prospective randomized study, we compared the morbidity of totally tubeless (tubeless and stentless) PCNL operations with the standard operation technique in a single center with a selected patient population., Methods: Ninety patients who fulfilled the criteria were included. Forty-five patients underwent totally tubeless PCNL (Group 1) and a 14F malecot nephrostomy catheter was used in another set of 45 patients (Group 2). Inclusion criteria for the study were no serious bleeding or perforation in the collecting system during the operation, stone free or clinically insignificant residual fragments (CIRF <4 mm), and no more than one access., Results: When two groups were compared with regard to age, stone volume, postoperative hemoglobin change, transfusion rate, and operation time, no significant differences were found between the two groups. However, a significant difference was found in hospitalization time between the two groups (P < 0.05). The amount of non-steroidal analgesic (tenoxicam) needed and non-steroidal analgesia-resistant pain which was resolved with narcotic analgesics (meperidine) were significantly lower in Group 1 (P < 0.05). Complications were observed in two patients (4.5%) in Group 1 (one retroperitoneal hematoma, one long-lasting renal colic) and in six patients (13.3%) in Group 2 (five prolonged urine drainage, one long-lasting fever) (P < 0.05)., Conclusions: Tubeless and stentless PCNL is a safe method and reduces hospitalization time and analgesic requirement, and promotes quality of life in selected patients.

Purpose: We prospectively analyzed the outcome of tubeless percutaneous nephrolithotomies (PCNLs) using two different stenting techniques (i.e., externalized ureteral catheter compared with Double-J placement) without strict exclusion or inclusion criteria., Patients and Methods: Forty-six patients who were undergoing tubeless PCNL were randomized to two groups: Group 1 (tubeless PCNL with externalized ureteral catheter) and group 2 (tubeless PCNL with Double-J placement). The only exclusion criterion was presence of significant residual stones. The two groups were comparable with regard to age, sex, stone laterality, stone burden, and number of previous open renal surgeries. Factors evaluated included operative time, stent-related symptoms, analgesic requirement, postoperative pain, postoperative morbidity, hospital stay, blood loss, and success rates., Results: The mean operative times, mean number of accesses, percentage of supracostal accesses, mean visual analog scale scores, analgesic requirements, mean decreases in hemoglobin level, blood transfusion rates, success rates, and mean hospital stays were not statistically significant in both groups. The only statistically significant difference between groups was the postoperative stent-related symptoms. In group 2, 52.1% experienced some sort of stent-related symptoms. In most of the patients, these symptoms were not severe; however, in two of them (16.6 %), oral medication therapy with anticholinergics was needed. None of the patients in group 1 had stent-related symptoms and needed medication (P < 0.01)., Conclusions: Tubeless PCNL with externalized ureteral catheter is as feasible as Double-J stenting. Moreover, stent-related discomforts because of the presence of a Double-J stent and the need for postoperative cystoscopy to remove the Double-J stent can be avoided with an externalized ureteral catheter.

Objectives: To review our experiences with percutaneous nephrolithotomy in children with complex renal calculi., Patients and Methods: We retrospectively analyzed the records of 31 children with complex renal calculi who were treated by percutaneous nephrolithotomy at 2 hospitals of our university between June 2003 and June 2008. The mean age of the patients was 10.4 years (range 22 months to 15 years). Three patients were aged < or =5 years. Stone clearance and complications were recorded., Results: The mean operating time (time from insertion of the ureteral catheter to placement of a nephrostomy tube) was 87.4 (range 50-180) min. In 2 patients the procedures were staged because of a large residual stone load. The extent of percutaneous tract dilation was undertaken taking patient age and the presence of hydronephrosis into consideration. Complete stone clearance with percutaneous nephrolithotomy was achieved in 21 (67.7%) of 31 patients. Adding extracorporeal lithotripsy increased total clearance to 24/31 (77.4%). The most common complication was bleeding that necessitated blood transfusion (7/31, 22.5%)., Conclusion: Percutaneous nephrolithotomy is as safe and effective in children as it is in adults. The clearance rate can be increased with dual therapy. Tract dilation should be tailored according to patient age and the extent of hydronephrosis., (Copyright 2009 S. Karger AG, Basel.)

Aim: To evaluate the preoperative and intraoperative factors that might affect development of fever following percutaneous nephrolithotomy (PCNL) and to investigate the clinical significance of intraoperative microbiologic evaluation in managing postoperative infectious complications., Patients and Methods: Sixty-one consecutive patients who had undergone PCNL between October 2006 and June 2007 were prospectively recruited into the study. Preoperative urine cultures and intraoperative stone and pelvic urine cultures were obtained from all patients. Postoperatively, patients were closely monitored for fever and other signs of systemic inflammatory response syndrome., Results: Of 61 patients, 10 (16.8%) had at least one body temperature recorded at 38 degrees C (group 1), the remaining patients were afebrile (group 2). Fever was associated with a systemic inflammatory response syndrome in one patient (1.6%); in that patient, the antibiotic regimen was altered. There were statistically significantly more positive stone culture results for patients in group 1 than there were for patients in group 2 (5/10 versus 9/51, P < 0.05). There were statistically significantly more positive pelvic urine culture results for patients in group 1 than there were for patients in group 2 (3/10 versus 2/51, P < 0.05). Patients in group 1 also had longer operative times and larger stone burdens than did patients in group 2., Conclusions: Intraoperative microbiologic evaluation may be important in postoperative antibiotic selection and should be routinely used.

Purpose: In this study, we present our experience using balloon and Amplatz dilatation to establish a percutaneous tract. We also discuss advantages and risk factors of both techniques., Materials and Methods: We retrospectively reviewed medical records of 229 patients who had undergone 235 percutaneous nephrolithotomy procedures. The nephrostomy tract had been dilated using a balloon (42 patients) or Amplatz (187 patients) dilator. Total operating time, preoperative and postoperative hemoglobin concentrations, number of tracts required, stone burden, blood transfusion rates, tract dilatation failures, and the cost of the dilatation system were compared between the groups., Results: There were no statistically significant differences in operative time (85.7+/-43.2 v 86.3+/-41.2 minutes; P=0.42), preoperative hemoglobin concentration (14.1+/-1.1 v 13.8+/-1.4 mg/dL; P= .153), postoperative hemoglobin concentration (11.6+/-1.7 v 11.2+/-1.5 mg/dL; P= .601), or blood transfusion rate (18.6% v 21.3%; P= .687) between the two groups. Also, there were no differences in failure rates between the two groups., Conclusions: The Amplatz dilator is comparable with the balloon dilator with regard to efficacy, speed, and safety. The Amplatz dilator is more cost-effective than the balloon dilator. However, kidney hypermobility may be a significant problem during Amplatz dilatation.

A 39-year-old man underwent percutaneous nephrolithotomy (PCNL) for bilateral renal stone without stent and tube insertion. To our knowledge, this is the first report of bilateral simultaneous tubeless and stentless PCNL. The advantage of this technique in renal stone surgery is discussed.