Kamaljot S Kaler1, Egor Parkhomenko2, Zhamshid Okunohov2, Roshan M Patel2, Jaime Landman2, Ralph V Clayman2, Carlos A Uribe3. 1. Department of Urology, University of California Irvine (UCI), 333 City Blvd West, Suite 2100, Orange, Irvine, CA, 92868, USA. kkaler@uci.edu. 2. Department of Urology, University of California Irvine (UCI), 333 City Blvd West, Suite 2100, Orange, Irvine, CA, 92868, USA. 3. Department of Urology, Hospital Pablo Tobon Uribe (HPTU), Medellin, Colombia.
Abstract
INTRODUCTION AND OBJECTIVES:Percutaneous nephrolithotomy remains a challenging procedure primarily due to difficulties obtaining access. Indeed, few urologists obtain their own access due to difficulties using a fluoroscopic or ultrasonic based antegrade puncture technique. Herein we report the first experience using holmium laser energy to obtain access in a retrograde fashion. METHODS: After a pretreatment week of tamsulosin 0.4 mg/day (one center only) and following a documented sterile urine, a total of ten patients underwent retrograde holmium laser-assisted endoscopic-guided nephrostomy access in a prone split leg position. RESULTS: In nine of ten patients, ureteroscopic guided, holmium laser access via an upper pole posterior calyx was achieved. In one patient, the laser tract could not be safely dilated and antegrade endoscopic and fluoroscopic guided access was performed. The mean operative time was 202 min; the mean fluoroscopy time was 32 s (6/9 cases). The mean pre-operative stone volume was 14,420 mm3. CT imaging on post-operative day 1 revealed 6/6 patients had residual stone fragments with total mean volume of 250 mm3 (96% reduction); there were no residual fragments in three patients who were evaluated with non-CT radiographic imaging (KUB). There was a single complication requiring angioembolization due to a subcapsular hematoma with associated secondary tearing of an inter-polar vessel remote from the nephrostomy site. CONCLUSIONS:Holmium laser-assisted endoscopic-guided retrograde access in a prone split-leg position was successfully performed at two institutions. The accuracy of nephrostomy placement and lessening of fluoroscopy time are two potential benefits of this approach.
RCT Entities:
INTRODUCTION AND OBJECTIVES: Percutaneous nephrolithotomy remains a challenging procedure primarily due to difficulties obtaining access. Indeed, few urologists obtain their own access due to difficulties using a fluoroscopic or ultrasonic based antegrade puncture technique. Herein we report the first experience using holmium laser energy to obtain access in a retrograde fashion. METHODS: After a pretreatment week of tamsulosin 0.4 mg/day (one center only) and following a documented sterile urine, a total of ten patients underwent retrograde holmium laser-assisted endoscopic-guided nephrostomy access in a prone split leg position. RESULTS: In nine of ten patients, ureteroscopic guided, holmium laser access via an upper pole posterior calyx was achieved. In one patient, the laser tract could not be safely dilated and antegrade endoscopic and fluoroscopic guided access was performed. The mean operative time was 202 min; the mean fluoroscopy time was 32 s (6/9 cases). The mean pre-operative stone volume was 14,420 mm3. CT imaging on post-operative day 1 revealed 6/6 patients had residual stone fragments with total mean volume of 250 mm3 (96% reduction); there were no residual fragments in three patients who were evaluated with non-CT radiographic imaging (KUB). There was a single complication requiring angioembolization due to a subcapsular hematoma with associated secondary tearing of an inter-polar vessel remote from the nephrostomy site. CONCLUSIONS: Holmium laser-assisted endoscopic-guided retrograde access in a prone split-leg position was successfully performed at two institutions. The accuracy of nephrostomy placement and lessening of fluoroscopy time are two potential benefits of this approach.
Authors: Dean Assimos; Amy Krambeck; Nicole L Miller; Manoj Monga; M Hassan Murad; Caleb P Nelson; Kenneth T Pace; Vernon M Pais; Margaret S Pearle; Glenn M Preminger; Hassan Razvi; Ojas Shah; Brian R Matlaga Journal: J Urol Date: 2016-05-27 Impact factor: 7.450
Authors: Kamaljot S Kaler; Egor Parkhomenko; Cyrus Y Lin; Zachary A Valley; William K Kim; Zhamshid Okhunov; Roshan M Patel; Jaime Landman Journal: J Endourol Case Rep Date: 2018-11-29