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Related Concept Videos

Urinary Tract Calculi VI: Surgical Management01:25

Urinary Tract Calculi VI: Surgical Management

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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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The Matryoshka technique in percutaneous nephrolithotomy.

Stefano Paolo Zanetti1, Matteo Fontana2, Elena Lievore3

  • 1Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano. stefano.p.zanetti@gmail.com.

Archivio Italiano Di Urologia, Andrologia : Organo Ufficiale [Di] Societa Italiana Di Ecografia Urologica E Nefrologica
|July 21, 2021
PubMed
Summary

The Matryoshka technique offers flexible percutaneous nephrolithotomy (PCNL) access, improving stone clearance and minimizing complications. This progressive approach enhances safety in complex kidney stone removal procedures.

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Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Nephrolithotomy

Background:

  • Miniaturized percutaneous nephrolithotomy (PCNL) offers reduced hemorrhagic risks but faces challenges with limited working space.
  • Intraoperative tailoring of percutaneous access is crucial for optimal outcomes in PCNL.

Purpose of the Study:

  • To describe the indications and procedural steps of the Matryoshka technique for percutaneous nephrolithotomy (PCNL).
  • To report the clinical outcomes of the Matryoshka technique in managing kidney stones.

Main Methods:

  • Retrospective analysis of 16 consecutive Matryoshka PCNL procedures.
  • The technique is indicated for guidewire positioning difficulties due to pyelocalyceal obstruction or narrowness.
  • Tract stabilization involves careful dilation and cautious lithotripsy to facilitate guidewire passage and upsizing.

Main Results:

  • Median stone volume was 3.49 cm³, with a median operative time of 112 minutes.
  • Four complications were reported (Clavien I-II fever, Clavien IIIB colon perforation); no blood transfusions were needed.
  • Complete stone clearance was achieved in 76.9% of patients not requiring staged retreatment.

Conclusions:

  • The Matryoshka technique provides secure and flexible percutaneous access for PCNL.
  • It allows for progressive tract dilation, potentially minimizing access-related complications.
  • This technique enhances the adaptability of PCNL in challenging cases.