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Treatments Of Mini-PCNL, Flexible Nephroscopy, Standards PCNL, plus LASER Lithotripsy

Mini-PCNL is a variation of the standard PCNL procedure and is typically used for smaller stones (less than 2 cm) or in cases where access to the kidney is limited. Flexible nephroscopy is a newer variation of PCNL that involves the use of a flexible nephroscope rather than a rigid one, making it easier to access stones in difficult-to-reach areas. Standard PCNL is the traditional method for treating large kidney stones (larger than 2 cm) and is typically performed under general anesthesia. Laser lithotripsy is a minimally invasive procedure that uses laser energy to break up kidney stones into smaller pieces that can be more easily passed out of the body. Mini-PCNL has advantages including a shorter procedure time, less discomfort, and fewer complications compared to standard PCNL. Flexible nephroscopy is typically used for stones that are too large to be treated with ureteroscopy but too small for standard PCNL. Standard PCNL has the advantage of effectiveness in treating large stones and a relatively low rate of complications. Staghorn calculi are complex renal stones that occupy the majority of the renal collecting system. These stones are associated with high morbidity and can lead to recurrent urinary tract infections, urosepsis, renal deterioration, and death if left untreated. Managing patients with staghorn calculi can be challenging. Fortunately, advances in technology and endourology techniques like PCNL have enabled urologists to effectively treat these stones with minimal morbidity to the patient. If you are looking for the best urology hospital in Hyderabad for PCNL Treatment, plus LASER Lithotripsy, Dr Vamsi Urology clinic is the place to be. Treatment for Staghorn Calculi by PCNL Treatment is often complicated for Staghorn calculi, but necessary given that untreated stones can lead to recurrent urinary tract infections, urosepsis, renal deterioration, and death. Staghorn calculi were historically thought to be primarily struvite, but modern investigations reveal they can be one of many compositions. These stones are still often associated with infection and urea-splitting organisms. The treatment goal for most patients is complete stone removal to prevent regrowth on persistent stone debris. However, achieving a stone-free state can be difficult, requiring a staged or combined approach. Imaging Imaging is a critical step in the evaluation of patients with staghorn calculi. Computed tomography (CT) scan without intravenous contrast is the imaging modality of choice when evaluating a patient for renal calculi that may need intervention. Preoperative imaging is imperative for surgical planning and can aid in choosing what intervention is most appropriate. CT imaging allows for accurate assessment of stone morphology and location, which helps guide percutaneous access when percutaneous nephrolithotomy (PCNL) is planned. Characteristics of the stone on CT imaging such as the attenuation, or Hounsfield measurement, may be helpful when determining stone fragility and stone composition. Staghorn calculi branch into multiple calyces and are often designated as ‘partial’ or ‘complete’ depending on the size of the stone and number of calyces occupied. There is no clear consensus on what defines a partial versus a complete staghorn calculus, such as volume criteria or a number of calyces occupied. However, a staghorn calculus is generally considered a branching renal stone that occupies multiple portions of the renal collecting system. Operative management: Complete removal of staghorn calculi should remain the goal in patients whose comorbidities do not preclude treatment. Treatment options for staghorn calculi include PCNL, shock wave lithotripsy (SWL), ureteroscopy, or a combination of two or more of these treatments. Less commonly, invasive open or laparoscopic/robotic-assisted stone surgery is indicated. Irrigation of the collecting system with agents to dissolve stones, such as Renacidin®, with or without surgery has also been evaluated but is not commonly used. Important considerations when determining the ideal treatment for staghorn calculi include stone-free rates, number of required procedures, and complication rates. PCNL remains the gold standard first-line treatment for the majority of staghorn calculi. With the advent of less invasive procedures, miniaturized equipment, and better fragmentation and extraction devices, surgical management of these complex stones continues to improve. Complex or Staghorn Renal Calculi, are removed by a fine hole placed into the kidney. Robotic and laparoscopic Robotic and laparoscopic approaches have been adapted from open surgical techniques for the removal of large renal stones. These approaches require renal hilum exposure, renal vessel clamping, nephrotomy, collecting system closure, and parenchymal closure. Laparoscopic ultrasound may be used for intraoperative assessment of remaining stone fragments since fluoroscopy is not feasible during robotic surgery. While these techniques have been shown to be feasible with relatively good stone-free rates, they remain second-line therapies when compared with less invasive endourological techniques secondary to cost and lack of outcomes demonstrating superiority. Why PCNL? – Conclusion. PCNL (Percutaneous Nephrolithotomy) has remained the gold standard when treating these complex stones and the advent of smaller instruments and sheaths have broadened the arsenal of tools urologists have to completely clear these stones from the collecting system.