Ureteroscopic holmium laser-assisted retrograde nephrostomy access: a novel approach to percutaneous stone removal [documento electrónico] / Carlos Alberto Uribe Trujillo,  . - 2018.
Obra : World Journal of Urology

Idioma : Inglés (eng)

Palabras clave :	Holmium lase  nephrolithiasis  nephrostomy access  percutaneous nephrolithotomy  Retrograde nephrostomy  Technique
Resumen :	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.
Mención de responsabilidad :	Kamaljot S Kaler, Egor Parkhomenko, Zhamshid Okunohov, Roshan M Patel, Jaime Landman, Ralph V Clayman, Carlos A Uribe
Referencia :	World J Urol. 2018 Jun;36(6):963-969.
DOI (Digital Object Identifier) :	10.1007/s00345-018-2223-9
PMID :	29423876
En línea :	https://link.springer.com/article/10.1007%2Fs00345-018-2223-9
Enlace permanente :	https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4193