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Percutaneous kidney stone surgery and radiation exposure: A review

Asian Journal of Urology 2020年第1期7卷 10-17页

作者： Bohdan Baralo Patrick Samson david hoenig Arthur Smith Urology Department National Pirogov Memorial Medical UniversityVinnytsyaUkraine Department of Urology Smith Institute for UrologyNorthwell HealthNew Hyde ParkNYUSA

During the past 3 decades,radiation exposure(RE)has increased drastically among patients undergoing percutaneous nephrolithotomy(PCNL),thus potentially causing new cases of cancer each *** effective dose received by patients comes from pre-and postoperative computed tomography(CT)and intraoperative fluoroscopy(FL).We reviewed literature to find novel techniques and approaches that help to decrease RE of patients and *** performed PubMed search using keywords percutaneous nephrolithotomy,intraoperative fluoroscopy,radiation exposure,imaging,percutaneous access,ultrasound,computed tomography,endoscopy,reconstruction,innovations,and augmented ***-four relevant articles were included in this *** much as 20%of patients with first diagnosed urolithiasis exceed background RE level almost *** diagnosing purposes using low-dose and ultra-low-dose CT,as well as low-dose dual energy scan protocols can be efficient ways to decrease RE while maintaining decent *** with urinary stones can be effectively monitored with digital tomosynthesis,ultrasound alone or ultrasound combined with plain film of the *** access(PCA)into the kidney can be performed with reduced or even no RE,using novel PCA *** from conventional imaging techniques during diagnosis and treatment increase probability of non-stochastic radiation *** should be aware of protocols that decrease RE from CT and FL in diagnosis and management of urinary *** of recently developed imaging modalities and PCA techniques will also aid in adherence to the“as low as reasonably achievable”principle.

关键词： PCNL Urolithiasis Reduction of radiation exposure Percutaneous kidney access Diagnostic imaging Training

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Advances in percutaneous stone surgery

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Asian Journal of Urology 2015年第1期2卷 26-32页

作者： Christopher Hartman Nikhil Gupta david Leavitt david hoenig Zeph Okeke Arthur Smith Hofstra North Shore-LIJ School of Medicine The Arthur Smith Institute for UrologyNew Hyde ParkNYUSA

Treatment of large renal stones has changed considerably in recent *** increasing prevalence of nephrolithiasis has mandated that urologists perform more surgeries for large renal calculi than before,and this has been met with improvements in percutaneous stone *** this review paper,we examine recent developments in percutaneous stone surgery,including advances in diagnosis and preoperative planning,renal access,patient position,tract dilation,nephroscopes,lithotripsy,exit strategies,and post-operative antibiotic prophylaxis.

关键词： Nephrolithiasis Kidney calculi Percutaneous nephrolithotomy

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Prediction of surgical complications in the elderly:Can we improve outcomes?

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Asian Journal of Urology 2017年第1期4卷 44-49页

作者： Preeya K.Mistry Geoffrey S.Gaunay david M.hoenig The Smith Institute for Urology Northwell Health-Hofstra University School of MedicineNew Hyde ParkNYUSA

As the number of Americans aged 65 years and older continues to rise,there is projected to be a corresponding increase in demand for major surgeries within this ***,it is important to utilize accurate preoperative risk stratification techniques that are applicable to elderly ***,commonly used preoperative risk assessments are subjective and often do not account for elderly-specific syndromes that may pose a hazard for geriatric patients if not *** to accurately risk-stratify these patients may increase the risk of postoperative complications,morbidity,and ***,we aimed to identify and discuss the more objective and better-validated measurements indicative of poor surgical outcomes in the elderly with special focus on frailty,patient optimization,functional status,and cognitive ability.

关键词： Frailty Prediction Outcomes Surgical risks Complications

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Percutaneous nephrolithotomy in octogenarians and beyond:How old is too old?

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Asian Journal of Urology 2015年第4期2卷 208-213页

作者： Bradley Morganstern Riccardo Galli Piruz Motamedinia david Leavitt Mohamed Keheila Eric Ghiraldi david hoenig Arthur Smith Zeph Okeke The Smith Institute for Urology NorthShore-Long Island Jewish Health SystemNew Hyde ParkNYUSA

Objective:To specifically report perioperative characteristics and outcomes in patients 80 years and older undergoing percutaneous nephrolithotomy(PCNL).PCNL has been established as feasible in the elderly;however,to our knowledge no one has specifically reported feasibility in patients 80 years and ***:We retrospectively reviewed perioperative data of octogenarians who underwent PCNL at a high stone volume single institution,and matched them to patients<65 years of age by stone burden and *** demographics,perioperative outcomes and postoperative complications were ***:Thirty-three octogenarians(mean age 83.6 years)with 36 renal units were matched to 67 controls(mean age 48.6 years)with 72 renal *** had a higher mean American Society of Anesthesiologists(ASA)score,more comorbidities,and worse renal *** were no differences in operative characteristics,length of hospital stay or stone free *** the patients with preoperative urinary decompression(ureteral stent or nephrostomy tube)prior to PCNL,the elderly were more likely to have a history of *** did not experience more minor Clavien(Ⅰ-Ⅱ)or major Clavien(Ⅲa-Ⅳb)***:Octogenarians who undergo PCNL were more likely to have cardiovascular comorbidities and a prior history of *** these risk factors,in appropriately selected patients PCNL can be safely and successfully performed in octogenarians without increased perioperative complications relative to a younger cohort.

关键词： Percutaneous nephrolithotomy Elderly Percutaneous stone extraction complications Clavien Octogenarians Percutaneous stone extraction

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Renal functional outcomes are not adversely affected by selective angioembolization following percutaneous nephrolithotomy

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Asian Journal of Urology 2017年第1期4卷 27-30页

作者： Ricardo Palmerola Vinay Patel Christopher Hartman Chris Sung david hoenig Arthur D.Smith Zeph Okeke Smith Institute for Urology Northwell HealthNew Hyde ParkNYUSA Interventional Radiology Northwell HealthNew Hyde ParkNYUSA

Objective:Selective angioembolization(SAE)effectively diagnoses and treats iatrogenic vascular complications following percutaneous nephrolithotomy(PCNL).Methods:We retrospectively reviewed 1329 consecutive PCNLs and identified patients who underwent SAE following PCNL with at least 12-month *** glomerular filtration rate(eGFR)was calculated for all patients preoperatively,postoperatively and at last followup.A 1:2 matched cohort analysis was ***:Twenty-three patients underwent SAE and matched to 46 *** was no statistically significant difference in preoperative,postoperative,and follow-up eGFR when comparing patients who underwent SAE and those with an uneventful ***:Long-term eGFR is comparable in patients who undergo uncomplicated PCNL and those requiring SAE.

关键词： Selective angioembolization Percutaneous nephrolithotomy Urologic complications Contrast induced nephropathy Postoperative hemorrhage

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Bilateral nephrolithiasis and upper tract transitional cell carcinoma in horseshoe kidney

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Current Urology 2024年第3期18卷 247-249页

作者： Jacob M.Gaines Eric J.Macdonald Arun Rai david hoenig Arthur Smith Zeph Okeke Tareq Aro The Smith Institute for Urology Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellLake SuccessNYUSA

Nephroureterectomy is currently the criterion-standard treatment for high-grade upper tract urothelial carcinoma(UTUC).Current guidelines and expert opinions propose some exceptions to this approach based on patient characteristics,disease status,and function of the contralateral *** present a rare case of a patient with horseshoe kidney,bilateral large nephrolithiasis,high-grade UTUC in one moiety,and relative parenchymal thinning of the contralateral *** patient was treated with a percutaneous,minimally invasive,nephron sparing *** patient also had intracollecting system instillations of gemcitabine and *** invasive percutaneous resection of high-grade UTUC is a safe procedure in select *** guidelines may not apply to all patients;unique scenarios with UTUC may require personalized decision-making and treatment at specialized centers.

关键词： Upper tract urothelial cancer Percutaneous resection Horseshoe kidney Nephrolithiasis

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