Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt Praxis und Beruf Seltene Erkrankungen GOÄ & EBM
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Fachpsychotherapie Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende Patientenratgeber
Erweiterte Suche
Anmelden
nach oben
Current Urology Reports
Erschienen in:

07.07.2023

Outcome of Mini-PCNL Under Loco-Regional Anesthesia: Outcomes of a Systematic Review

verfasst von: Mohammed Shahait, Ala’a Farkouh, Philip Mucksavage, Bhaskar Somani

Erschienen in: Current Urology Reports | Ausgabe 9/2023

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Miniaturized PCNL (mi-PCNL) for stone disease is performed under a general anesthesia. However, the role of loco-regional anesthesia in mi-PCNL and its outcomes are not well defined yet. Here, we review the outcomes and complications of loco-regional anesthesia for mi-PCNL. A Cochrane-style review was performed in accordance with the preferred reporting items for systematic reviews to evaluate the outcomes of loco-reginal anesthesia for URS in stone disease, including all English language articles from January 1980 and October 2021.

Recent Findings

Ten studies with a total of 1663 patients underwent mi-PCNL under loco-regional anesthesia. The stone-free rate (SFR) for mi-PCNL under neuro-axial anesthesia ranged between 88.3 and 93.6%, while it ranged between 85.7 and 93.3% for mi-PCNL under local anesthesia (LA). The conversion rate to another anesthesia modality was 0.5%. The complications ranged widely between 3.3 and 85.7%. The majority were Grade I-II complications and none of the patients had grade V complications.

Summary

Our review shows that mi-PCNL under loco-regional anesthesia is feasible with good SFR and a low risk of major complications. The conversion to general anesthesia is needed in a small minority, with the procedure itself being well tolerated and a big step towards establishing an ambulatory pathway for these patients.
Literatur
1.
Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, et al. Surgical management of stones: American Urological Association/Endourological Society Guideline. PART II J Urol. 2016;196(4):1161–9.CrossRefPubMed
2.
Jones P, Elmussareh M, Aboumarzouk OM, Mucksavage P, Somani BK. Role of minimally invasive (micro and ultra-mini) PCNL for adult urinary stone disease in the modern era: evidence from a systematic review. Curr Urol Rep. 2018;19(4):27.CrossRefPubMedPubMedCentral
3.
Ferakis N, Stavropoulos M. Mini percutaneous nephrolithotomy in the treatment of renal and upper ureteral stones: lessons learned from a review of the literature. Urol Ann. 2015;7(2):141–8.CrossRefPubMedPubMedCentral
4.
Cicek T, Gonulalan U, Dogan R, Kosan M, Istanbulluoglu O, Gonen M, et al. Spinal anesthesia is an efficient and safe anesthetic method for percutaneous nephrolithotomy. Urology. 2014;83(1):50–5.CrossRefPubMed
5.
Bhatia VP, Aro T, Smith SM, Samson P, Lynch E, Gaunay G, et al. Frailty as predictor of complications in patients undergoing percutaneous nephrolithotomy (PCNL). World J Urol. 2021;39(10):3971–7.CrossRefPubMed
6.
Malik I, Wadhwa R. Percutaneous nephrolithotomy: current clinical opinions and anesthesiologists perspective. Anesthesiol Res Pract. 2016;2016:9036872.PubMedPubMedCentral
7.
8.
Yu Y, Hu J, Liu W, Peng Z, Wang M, Zhou X, et al. Performing percutaneous nephrolithotomy under modified local anesthesia. Front Surg. 2022;9: 922158.CrossRefPubMedPubMedCentral
9.
Pan TJ, Li GC, Ye ZQ, Wen HD, Shen GQ, Zhang JQ. Flank suspended supine position for percutaneous nephrolithotomy. Urologia. 2012;79(1):58–61.CrossRefPubMed
10.
Chen Y, Zhou Z, Sun W, Zhao T, Wang H. Minimally invasive percutaneous nephrolithotomy under peritubal local infiltration anesthesia. World J Urol. 2011;29(6):773–7.CrossRefPubMed
11.
Chen K, Xu K, Li B, Wang S, Xiang S, Li H. Predictive factors of stone-free rate and complications in patients undergoing minimally invasive percutaneous nephrolithotomy under local infiltration anesthesia. World J Urol. 2020;38(10):2637–43.CrossRefPubMed
12.
• El-Shaer W, Shaboob E, Abdel-Lateef S. Minipercutaneous nephrolithotomy under mixture of local anesthesia: a randomized controlled study. J Endourol. 2021;35(12):1750–6. A randomized trial evaluting the feasibility of Mi-PCNL under local anesthesia.
13.
Aravantinos E, Anagnostou T, Samarinas M, Ioannides K, Ziavliakis K, Ntafos A, et al. Two-step minipercutaneous ureterolithotripsy under multimodal analgesia for complicated impacted calculi in proximal ureter. Urology. 2013;81(6):1147–52.CrossRefPubMed
14.
Giannakopoulos S, Giannopoulos S, Gardikis S, Bantis A, Kalaitzis C, Zissimopoulos A, et al. Second-look flexible nephroscopy combined with holmium: yttrium-aluminum-garnet laser lithotripsy under local anesthesia: a prospective study. Urology. 2017;99:27–32.CrossRefPubMed
15.
Karatag T, Tepeler A, Buldu I, Akcay M, Tosun M, Istanbulluoglu MO, et al. Is micro-percutaneous nephrolithotomy surgery technically feasible and efficient under spinal anesthesia? Urolithiasis. 2015;43(3):249–54.CrossRefPubMed
16.
Khadgi S, Shrestha B, Ibrahim H, Shrestha S, ElSheemy MS, Al-Kandari AM. Mini-percutaneous nephrolithotomy for stones in anomalous-kidneys: a prospective study. Urolithiasis. 2017;45(4):407–14.CrossRefPubMed
17.
ElSheemy MS, Ghoneima W, Elmarakbi AA, Al-Kandari AM, Ibrahim H, Shrestha S, et al. Bilateral single-session vs staged mini-percutaneous nephrolithotomy for renal stones: a comparative study. Urology. 2018;120:62–7.CrossRefPubMed
18.
Zeng G, Zhao Z, Wan S, Mai Z, Wu W, Zhong W, et al. Minimally invasive percutaneous nephrolithotomy for simple and complex renal caliceal stones: a comparative analysis of more than 10,000 cases. J Endourol. 2013;27(10):1203–8.CrossRefPubMedPubMedCentral
19.
Schembri M, Agarwal V, Pietropaolo A, Somani B. Outcomes of loco-regional anaesthesia in ureteroscopy for stone disease: a systematic review. Curr Opin Urol. 2020;30(5):726–34.PubMed
20.
• Guglielmo L, Pignataro A, Di Fiore G, Lanza V, Mercadante S. Conversion of spinal anesthesia into general anesthesia: an evaluation of more than 35,000 spinal anesthetics. Minerva Anesthesiol. 2010;76(9):714–9. This review discuss throughly the advantages and disadvantges of spinal anesthesia for PCNL, areas for improvement, and predictors for conversion to general anesthesia.
21.
Alhalaseh YN, Elshabrawy HA, Erashdi M, Shahait M, Abu-Humdan AM, Al-Hussaini M. Allocation of the “already” limited medical resources amid the COVID-19 pandemic, an iterative ethical encounter including suggested solutions from a real life encounter. Front Med (Lausanne). 2020;7: 616277.CrossRefPubMed
22.
NIHR Global Health Unit on Global Surgery; COVIDsurg collaborative. Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries. Lancet. 2022;400(10363):1607–17.
23.
Lee MS, Assmus MA, Agarwal DK, Rivera ME, Large T, Krambeck AE. Ambulatory percutaneous nephrolithotomy may be cost-effective compared to standard percutaneous nephrolithotomy. J Endourol. 2022;36(2):176–82.CrossRefPubMed
24.
Thomas K, Smith NC, Hegarty N, Glass JM. The Guy’s stone score–grading the complexity of percutaneous nephrolithotomy procedures. Urology. 2011;78(2):277–81.CrossRefPubMed
25.
de la Rosette JJ, Opondo D, Daels FP, Giusti G, Serrano A, Kandasami SV, et al. Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy. Eur Urol. 2012;62(2):246–55.CrossRefPubMed
26.
Jones P, Bennett G, Aboumarzouk OM, Griffin S, Somani BK. Role of minimally invasive percutaneous nephrolithotomy techniques-micro and ultra-mini PCNL (<15F) in the pediatric population: a systematic review. J Endourol. 2017;31(9):816–24.CrossRefPubMed
27.
Somani BK, Desai M, Traxer O, Lahme S. Stone-free rate (SFR): a new proposal for defining levels of SFR. Urolithiasis. 2014;42(2):95.CrossRefPubMed
Metadaten
Titel
Outcome of Mini-PCNL Under Loco-Regional Anesthesia: Outcomes of a Systematic Review
verfasst von
Mohammed Shahait
Ala’a Farkouh
Philip Mucksavage
Bhaskar Somani
Publikationsdatum
07.07.2023
Verlag
Springer US
Erschienen in
Current Urology Reports / Ausgabe 9/2023
Print ISSN: 1527-2737
Elektronische ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-023-01169-2

Weitere Artikel der Ausgabe 9/2023

Prostatic Arterial Embolization for Treatment of Lower Urinary Tract Symptoms Associated with Benign Prostatic Enlargement

Imaging Techniques to Differentiate Benign Testicular Masses from Germ Cell Tumors

  • Open Access

Holmium and Thulium Fiber Laser Safety in Endourological Practice: What Does the Clinician Need to Know?

  • Open Access

Contemporary Use of Computed Tomography (CT) Imaging in Suspected Urolithiasis in Pregnancy

Neu im Fachgebiet Urologie

Weniger aggressive Prostatakrebs-Therapie, gleiche Prognose

Erhalten ältere Prostatakrebs-Patienten vor Therapiebeginn ein geriatrisches Assessment, führt dies häufig zu einer Deeskalation der Behandlung – ohne dass ihre Prognose dadurch schlechter würde. Darauf deuten Erfahrungen aus Frankreich hin. 

Hängen Sarkopenie und Harninkontinenz auch bei jüngeren Frauen zusammen?

Ein Zusammenhang zwischen Sarkopenie und Blasenschwäche ist bei älteren Menschen bereits belegt. Ein chinesisches Forschungsteam untersuchte nun, ob auch bei Frauen unter 60 Jahren der Verlust an Muskelmasse mit einem signifikant erhöhten Risiko für Harninkontinenz einhergeht.

Frühzeitige HPV-Impfung schützt auch Männer!

Die HPV-Impfung schützt auch Männer effektiv vor Genitalwarzen, so das Ergebnis einer Literaturstudie. Inwieweit sich mit der Impfung jedoch Karzinome verhindern lassen, vor allem bei Risikogruppen, bleibt unklar.

Subkutanes Pembrolizumab als Therapiealternative?

  • 16.04.2025
  • NSCLC
  • Nachrichten

Pembrolizumab ist unter anderem beim nichtkleinzelligen Bronchialkarzinom (NSCLC) in intravenöser Form zugelassen. Eine subkutane Gabe (s.c.) könnte die Therapie angenehmer und effizienter gestalten. In einer Phase-3-Studie wurde nun untersucht, ob die s.c. Injektion in Kombination mit Chemotherapie der i.v. Therapie bei NSCLC-Erkrankten unterlegen ist.

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise