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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...
Acute Pyelonephritis II: Diagnostic Studies and Management01:28

Acute Pyelonephritis II: Diagnostic Studies and Management

Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
Imaging Studies V: Intravenous Urography and Retrograde Pyelography01:22

Imaging Studies V: Intravenous Urography and Retrograde Pyelography

IntroductionIntravenous Urography (IVU) and Retrograde Pyelography (RP) are important diagnostic imaging techniques used to evaluate the urinary system. These methods help identify structural abnormalities, obstructions, and functional issues in the kidneys, ureters, and bladder. Both procedures use iodine-based contrast media to enhance the visibility of urinary tract structures on X-ray images, though they differ in their methods and indications.1. Intravenous Urography (IVU)Intravenous...
Kidney Transplant II: Surgical Procedure01:26

Kidney Transplant II: Surgical Procedure

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...
Acute Pyelonephritis I: Introduction01:27

Acute Pyelonephritis I: Introduction

Pyelonephritis is a bacterial infection that primarily affects the renal parenchyma and collecting system, including the renal pelvis, tubules, and interstitial tissue of one or both kidneys. It can be classified as either acute—a sudden, severe infection—or chronic, which refers to long-term or recurrent kidney infections.The primary cause of acute pyelonephritis (APN) is bacterial infection, with Escherichia coli accounting for approximately 70-80% of cases. Other bacteria, such as Proteus,...
Urinary Tract Calculi V: Nursing Management01:28

Urinary Tract Calculi V: Nursing Management

AssessmentSubjective Data: Obtain a detailed health history, including any recent or chronic urinary tract infections, periods of immobilization, previous episodes of renal calculi, and medical conditions such as gout, benign prostatic hyperplasia, or hyperparathyroidism. Review the medication history for drugs that may influence stone formation, including allopurinol, analgesics, loop diuretics, or thiazide diuretics. Document the use of long-term indwelling catheters and any past surgical...

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A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy
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Ambulatory percutaneous nephrolithotomy: initial series.

Walid Shahrour1, Sero Andonian

  • 1Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.

Urology
|December 7, 2010
PubMed
Summary

Ambulatory percutaneous nephrolithotomy (PCNL) is safe and feasible for select patients with large kidney stones. Further research is needed to confirm criteria for this outpatient approach.

Area of Science:

  • Urology
  • Nephrology
  • Minimally Invasive Surgery

Background:

  • Percutaneous nephrolithotomy (PCNL) is the standard treatment for large kidney stones.
  • Ambulatory PCNL, a same-day discharge approach, has not been extensively studied.
  • Tubeless PCNL has shown promise, but ambulatory PCNL requires further investigation.

Purpose of the Study:

  • To evaluate the safety and feasibility of performing PCNL on an outpatient basis.
  • To establish criteria for patient selection for ambulatory PCNL.
  • To assess outcomes and complications associated with same-day discharge PCNL.

Main Methods:

  • Prospective data collection on 10 patients undergoing ambulatory PCNL.
  • Criteria included single tract, stone-free status, adequate pain control, and stable postoperative parameters.

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  • Key metrics: operative time, fluoroscopy time, stone size, recovery room stay, and pain medication use.

    • Main Results:

    • No intraoperative complications or need for transfusions occurred.
    • Median recovery room stay was 240 minutes, with 30% of patients requiring home narcotics.
    • Two postoperative complications: deep vein thrombosis and a multidrug-resistant E. coli infection.

    Conclusions:

    • Ambulatory PCNL is a safe and feasible option for carefully selected patients.
    • Further studies with larger cohorts are necessary to validate selection criteria for ambulatory PCNL.