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Related Concept Videos

Urinary Tract Calculi VI: Surgical Management01:25

Urinary Tract Calculi VI: Surgical Management

Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living donor...

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A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy
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Published on: September 13, 2022

Transsplenic percutaneous nephrolithotomy.

Anthony J Schaeffer1, Shelly E Handa, James E Lingeman

  • 1James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.

Journal of Endourology
|October 22, 2008
PubMed
Summary
This summary is machine-generated.

Splenic injury during percutaneous nephrolithotomy (PNL) is rare but manageable. Conservative treatment, including prolonged nephrostomy drainage, is effective for stable patients with this PNL complication.

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Area of Science:

  • Urology
  • Nephrology
  • Surgical Complications

Background:

  • Percutaneous nephrolithotomy (PNL) is a primary treatment for large renal calculi.
  • Splenic injury is a rare but documented complication of PNL.
  • Management strategies for post-PNL splenic injury require definition.

Purpose of the Study:

  • To define a management strategy for splenic injuries occurring during PNL.
  • To analyze outcomes of conservative management for splenic trauma post-PNL.

Main Methods:

  • Retrospective, multi-institutional study.
  • Identification of cases with splenic injury during PNL.
  • Review of patient records and imaging for treatment and outcomes.

Main Results:

  • Three cases of transsplenic PNL with upper pole, supracostal left kidney access identified.
  • Injuries detected post-procedure via CT scan or during nephrostomy tube removal.
  • Successful spleen-preserving conservative management in all three patients, avoiding exploratory surgery.

Conclusions:

  • Splenic injury during PNL is uncommon, typically associated with supracostal, upper-pole left renal access.
  • Hemodynamically stable patients with splenic injury can be managed conservatively.
  • Prolonged nephrostomy drainage and monitored observation are key components of conservative management.