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Urinary Tract Calculi VI: Surgical Management01:25

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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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Cardiac catheterization is an invasive diagnostic technique used to identify and evaluate structural and functional diseases of the heart and major blood vessels. This technique diagnoses congenital heart disease, coronary artery disease, valvular heart disease, and coronary spasms and assesses ventricular function. It helps guide treatment decisions, including the need for revascularization procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and...
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Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
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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...
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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...
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Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
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Mini-Percutaneous Nephrolithotomy Less Injurious to the Kidney?

Juan Serna1, Raymond Khargi1, Kavita Gupta1

  • 1Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Journal of Endourology
|September 3, 2025
PubMed
Summary
This summary is machine-generated.

Mini-percutaneous nephrolithotomy (mPCNL) and standard PCNL (sPCNL) show temporary increases in kidney injury biomarkers after surgery. These biomarker levels normalize within days, regardless of the sheath size used in the percutaneous nephrolithotomy procedure.

Keywords:
mini-percutaneous nephrolithotomypercutaneous nephrolithotomyrenal stonesrenal tubular injuryurinary biomarkers

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Area of Science:

  • Nephrology
  • Urology
  • Biomarker Research

Background:

  • Percutaneous nephrolithotomy (PCNL) techniques are evolving towards smaller access sheaths, leading to various miniPCNL (mPCNL) systems.
  • Urinary biomarkers like KIM-1, NGAL, and β2M are established noninvasive indicators of renal cellular injury.
  • The study compares perioperative changes in urinary biomarkers across suction mPCNL (s-mPCNL), non-suction mPCNL (ns-mPCNL), and standard PCNL (sPCNL) systems.

Purpose of the Study:

  • To evaluate and compare the changes in urinary biomarker levels (KIM-1, NGAL, β2M) in the perioperative setting.
  • To assess the impact of different PCNL systems (s-mPCNL, ns-mPCNL, sPCNL) on renal cellular injury markers.

Main Methods:

  • Three PCNL systems were used: s-mPCNL (18F), ns-mPCNL (17.5F), and sPCNL (24F).
  • Urine samples were collected preoperatively (V1), 1 hour postoperatively (V2), and 10 days postoperatively (V3).
  • Urinary biomarkers (KIM-1, NGAL, β2M) were measured using ELISA and normalized to urine creatinine.

Main Results:

  • A statistically significant increase in NGAL levels was observed in both ns-mPCNL and s-mPCNL groups during the early postoperative interval (V1-V2).
  • Urinary biomarker levels showed a significant decrease during the recovery interval (V2-V3) for all PCNL types.
  • No significant differences in biomarker levels were found across all PCNL forms in the long-term injury interval (V1-V3).

Conclusions:

  • A transient surge in urinary biomarkers occurs immediately after PCNL, indicating early tubular injury.
  • This rise in biomarkers appears more pronounced with ns-mPCNL systems utilizing metal sheaths.
  • The observed renal injury markers normalize within days, irrespective of the PCNL sheath size employed.