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A rare complication of ureteral stenting: Case report of a uretero-arterial fistula and revision of uro prostata pool pharmacy council literature Alois Mahlknecht, Leonardo Bizzotto, Christoph Gamper, Anton Wieser. Management of uro prostata pool pharmacy council orchiectomy in psychiatric patient.

Uro prostata pool pharmacy council University, Dr. Patients and methods: Departmental files of 88 cases with radiopaque kidney stones in horseshoe kidneys undergoing two different approaches PNL vs RIRS were evaluated with respect to the success and complication rates of in a retrospective manner. In addition to the factors related with the procedures success and complication rates, additional procedurespatient and stone characteristics were all well evaluated.

Findings obtained in both groups were evaluated in a comparative manner with respect to the uro prostata pool pharmacy council significance. Results: Stone free rates were comparable in both groups after 1-week period As well as 3 months evaluation Mean duration of the procedure was slightly higher in RIRS group and based on Clavien scoring system, despite a higher risk of Hb drop noted in patients treated with PNL, all complication rates were found to be similar in both groups.

Conclusion: Our uro prostata pool pharmacy council demonstrate that of the available minimally invasive treatment alternatives, both PNL and RIRS could be safe and effective alternatives for renal stone removal in patients with HSK. Submitted 8 March ; Accepted 29 April Being observed in approximately 1 in to 1 in births, horseshoe kidney HSK is the most common renal fusion anomaly 1, 2. Anterior displacement of the renal pelvis and high insertion of the involved ureter cause urinary abnormal drainage with flow hinderance and.

On the other hand again, abnormal position of the kidney due to congenital fusion abnormality and unusual course of the ureter over the isthmus bring the management of stones in such kidneys into more challenging position. Although open surgery has been performed commonly in the past, currently all uro prostata pool pharmacy council minimal invasive treatment alternatives such as extracorporeal shock wave lithotripsy SWLretrograde intrarenal surgery RIRS and percutaneous nephrolithotripsy PNL are being performed with varying success rates 4.

Although adequate fragmentation can be achieved by SWL, the anatomic abnormalities may prevent fragment passage in a substantial number of these patients. As a second alternative, PNL has already been found to be efficient in the management of relatively large stones cases with HSK with varying success rates. Due to the relatively lower position of the kidneys most upper as well as mid renal calyces are found to be located below the twelfth rib, thereby making the supracostal puncture relatively safe in these patients.

However, despite the higher success rates obtained, the invasive nature of this method and higher risk of major complications complication rates Stone clearance rates after PNL in series with relatively limited number of renal units have been reported to be Last but not least, retrograde intrarenal surgery by using flexible ureterorenoscope has also been shown to be an effective management option; the uro prostata pool pharmacy council rate and associ.

Eryildirim, E. Kucuk, G. Atis, M. Ozturk, T. Senkul, M. Tuncer, A. Tahra, T. Turan, O. Koca, F. Ates, O. Yilmaz, C. Gurbuz, K. Despite acceptable stone free rates reported in some trials with relatively limited number uro prostata pool pharmacy council cases, due to the anatomical abnormality, a second look is usually required to render the patient completely stone free.

In this present study we aimed to evaluate the clinical efficacy of two different approaches, RIRS combined with holmium laser lithotripter and PNL, in treating renal calculi in horseshoe kidney. Statistical Analysis: The Prism 5. Data are presented as mean standard error of mean.

All evaluated with respect to the success and complication steps of the study were planned and applied carefully rates of each procedure in a retrospective manner. While according to Helsinki Declaration. All PNL procedures prostatite completed in one session, but All treatment related parameters stone free rates, numthe mean number the sessions for uro prostata pool pharmacy council undergoing RIRS ber of sessions, treatment duration, hospitalization time, was 1.

On the other hand, while the mean duraPrior to the above mentioned procedures, in addition to tion of hospital stay was 3. Patients cases All dure Evaluation of the degree of hydronephropatients were given prophylactic antibiotics at the time of sis revealed a mean value of 2. Age year Middle calyx 9 Table 2. Evaluation of the outcomes of the procedures in terms of success rates as well as early post-operative follow-up data. Week 3. A double J stent was again inserted in only 1 of these 3 cases prior to URS due to the obstruction induced by ureteral stones.

PNL was unsucessful in 2 cases due to the difficulty in accessing the uro prostata pool pharmacy council 5. On the other hand, RIRS was unsuccessful in 3 cases 6.

A mini-PNL was performed in all these 3 cases with successful stone removal. All these cases were excluded from the study program and were not included in any of these groups Table 2. Table 3. Evaluation of the type and grade of complications according to modified Clavien classification in both groups. Gradecomplication 1. Evaluation of the results obtained with two different techniques revealed following findings.

This was also true during post-operative 3 months evaluation period where uro prostata pool pharmacy council During the 3-months follow-up period while 1 case in PNL group passed these fragments spontaneously, fragments passed into the ureter in the other 3 cases.

A JJ stent have already been inserted in 2 of these 3 cases due to the severe obstruction. Fragments were removed with URS in these 3 cases. On the other hand, regarding. Evaluation of complication rates All complications observed in both 0.

Regarding these complications, although fever after the 3 6. No severe Grade IV-V complication was uro prostata pool pharmacy council in any Prostatite cronica. Last but not least stone street formation due to the fragment passage into the ureter has been observed in 1 case undergoing PNL in whom a double J stent placement and ureteroscopic stone removal have been performed. Representing the most common congenital renal fusion anomaly; HSK is mainly associated with the abnormal position of the kidney associated with the unusual course of upper ureter over the isthmus 2.

Published data and clinical experience have clearly shown that these anatomical abnormalities cause impaired renal pelvic drainage due to ureteropelvic junction obstruction and resultant hydronephrosis may cause not only with Archivio Italiano di Urologia e Andrologia ; 90, 3. Concerning the stone management principles in these patients, all available minimally invasive stone removal procedures namely SWL, PNL and RIRS have been applied as with varying stone-free rates in these patients.

Although limited, published data so far has demonstrated that while altered pyelocalyceal system anatomy and high ureteropelvic junction position may lead to relatively poor results of SWL and RIRS; similar to the kidneys with normal anatomy, PNL has been reported as an efficient treatment modality for stones located in HSK 13, Related with this issue, as a non-invasive and safe alternative, although SWL has been well tolerated by the majority of patients, stone-free rates have been reported to be significantly lower after this procedure.

When compared with the patients demonstrating normal kidneys, lower efficiency of this approach could be well explained with some certain factors such as greater skin-to-stone distance particularly for calyceal stones value and of more importantly restricted urinary drainage.

On the other hand again, developments in instruments technology and increasing experience in minimally invasive management of stones have changed the treatment concepts of urinary calculi meaningfully over the past two decades. However, it is well-known that these higher stonefree rates are being obtained at the expense of some certain severe complications In the light of the evident lower stone uro prostata pool pharmacy council rates uro prostata pool pharmacy council SWL due to the certain factors mentioned above however, accumulated data so far clearly demonstrate that PNL may constitute a preferred alternative in cases with HSK in experienced uro prostata pool pharmacy council 3, Related with this issue, clinical experience showed that while access to the upper pole calyces during Uro prostata pool pharmacy council often requires a supracostal approach with the associated risk of pleural injury in patients with normal renal anatomy, due to the relatively lower level of the upper pole, a supracostal puncture appears to be relatively safe in these kidneys.

Access through the lower pole are not usually recommended due to the posterior location of these calyces. Furthermore, upper-pole access in HSK allows the surgeon to remove all stone burden in one session, as the alignment of the nephroscope with the long axis of the kidney aids manipulation of the scope into the upper calyces, renal pelvis, lower calyces, UPJ ureteropelvic junction and proximal ureter in a practical and safe manner.

However, as mentined above despite the higher success rates obtained, the complicated nature of this method and higher risk of major complications led the endourologists to look for more feasible and less invasive options 3, 9, Evaluation of the literature with respect to the success as. In a single session operation impotenza only one tract without any flexible nephroscope, Etemadian M.

In their original study again, El Ghoneimy MN et al. In a study of 24 cases with HSK again, Raj et al. They were also able to note that the use of flexible nephroscope was usually required for a satisfactory stone clearance rate, given as Last but not least, in relatively larger series of cases Symons SJ et uro prostata pool pharmacy council.

An alternative to the percutaneous approaches in these cases is flexible ureteroscopy, also referred to as RIRS that has been basically used to treat the lower pole stones resistant to SWL As a result of increasing experience, relatively larger renal stones have also uro prostata pool pharmacy council treated with this approach and first serie of RIRS in HSK patients was published in where a stone clearance was achieved in 3 of the 4 patients Following this publication, in their original study Molimard et al.

As mentioned above altered orientation of the calyces and high insertion of the ureter coupled with the increased likelihood of UPJ obstruction, endourologits may face evident technical difficulties during RIRS procedure in these cases. With the advancement of technology, smaller activelydeflectable flexible ureteroscopy f-URSequipped with. In this present study we mainly aimed to Prostatite cronica the efficacy and safety of two different techniques PNL vs RIRS in the management of renal stones in patients with horseshoe kidneys.

To our knowledge our study is the first one comparing the efficacy of two different valuable alternatives in the management of renal stones in HSK Prostatite cronica. Regarding the mean degree of hydronephrosis in both groups, there was a statistically significant difference in favour of cases undergoing PNL and this uro prostata pool pharmacy council be best explained by the preference of the surgeons for PNL in uro prostata pool pharmacy council with relatively higher degree of dilatation.

Last but not least regarding the complications as uro prostata pool pharmacy council on the basis of modified Clavien scoring system uro prostata pool pharmacy council they were similar in both groups; evaluation of mean fluoroscopy time as well as mean Hb drop rate in both groups clearly revealed them to be higher in cases undergoing PNL Prostatite cronica. In the light of our findings and the reported literature data as well, we may say that both PNL and RIRS procedures are equally effective treatment alternatives in the management of renal stones in patients with HSK.

Although majority of the patients were stone free after a single session of PNL, taking the more invasive nature of this approach with certain complications bleeding, extravasationwe believe that RIRS may prove itself a valuable alternative with comparable stone free rates despite possible repeated sessions. Morover, higher risk of radiation exposure as demonstrated uro prostata pool pharmacy council our cases may be another disadvantage of PNL.

Depending on the experience of the surgeon and the availability of these systems, best management plan could be made in an individualized basis by considering the patient as well as stone related factors. The major limitation of the current study may be the retrospective nature of our trial and the lack of randomization. Additionally management of the cases uro prostata pool pharmacy council 7 different surgeons with variable level of experience could constitute another drawback.

However, taking the limited number of studies in small series of cases available in the literature, we believe that as the first trial on this subject comparing RIRS vs PCNL in renal stone cases with HSK into account, our findings will be contributive enough to the existing literature.

Management of renal stones could uro prostata pool pharmacy council challenging depending on the anatomy as well as stone related fac. Of the available minimally invasive treatment alternatives, in the light of the lower stone free rates with SWL reported in the published data; uro prostata pool pharmacy council PNL and RIRS could be safe and effective alternatives for renal stone removal in patients with HSK. Impotenza, we belive that a proper plan could be instituted by considering the experience of the surgeon and availability of the technical equipment.

Further studies with larger series of cases focusing on the comparative evaluation of both procedures are certainly needed. Bauer S. Anomalies of the upper urinary tract. Philadelphia: Elsevier Saunders.

Category: Uncategorized

Determining the incidence of horseshoe kidney from radiographic data at a single institution. J Urol. Percutaneous management of calculi within horseshoe kidneys. Yohannes P, Smith AD. The endourological management of complications associated with horseshoe kidney. Extracorporeal shockwave lithotripsy for stones in abnormal urinary tracts: analysis of results and comparison with normal urinary tracts. J Endourol. Effectiveness of extracorporeal shockwave lithotripsy in the management of stone-bearing horseshoe kidneys.

Extracorporeal shock wave uro prostata pool pharmacy council in anomalous kidneys: year experience with two second-generation lithotripters. Sixteen years of experience with stone management in horseshoe kidneys. Urol Int. The presence of horseshoe kidney does not affect the outcome of percutaneous nephrolithotomy. Urolithiasis in the horseshoe kidney: a single-centre experience. BJU Int. Outcome of ureteroscopy for stone disease in patients with horseshoe uro prostata pool pharmacy council Review of world literature.

uro prostata pool pharmacy council

Urology Annals. Classification of surgical complications: a new proposal with evaluation in a cohort of patients and results of a survey.

Ann Surg. Stening SG, Bourne S. Supracostal percutaneous nephrolithotomy for upper pole caliceal calculi. Percutaneous nephrolithotomy in horseshoe kidneys: factors affecting stone- free rate.

Guidelines on urolithiasis. European Urological Association Web site. Updated Categorisation of Archivio Italiano di Urologia e Andrologia ; 90, 3. Ureteroscopic management of renal calculi in anomalous kidneys. Eur Urol. Percutaneous stone removal in horseshoe kidneys. Flexible ureterorenoscopy with holmium laser in horseshoe kidneys. Percutaneous uro prostata pool pharmacy council in horseshoe kidney: our 5-year experience. Urology Journal.

Retrograde intrarenal surgery in patients with horseshoe kidneys. Percutaneous nephrolithotomy in horseshoe kidneys: is rigid nephroscopy sufficient tool for complete clearance? A case series study.

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