Percutaneous nephrolithotomy (PNL) surgeries are performed with different patient positions, anesthesia methods and different-sized access sheaths in order to reduce the complication rates. Supine positioned PNL can be performed safely in the high-risk group patients with comorbidities. Herein, we present a patient who had a past surgical history of right pneumonectomy and underwent a supine PNL procedure under regional anesthesia for a staghorn renal stone in the right kidney.

• Klíčová slova
• Endourology, Percutaneous nephrolithotomy, Solitary lung, Supine,
• MeSH
• lidé MeSH
• perkutánní nefrolitotomie * MeSH
• plíce MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• přehledy MeSH

Mainz pouch II is a reliable and viable technique of continent urinary diversion. Patients are at increased risk of long-term complications including urolithiasis of the upper urinary tract and reservoir. We report the case of a 67-year-old male with prior Mainz pouch II due to invasive bladder cancer treated for a large renal calculus. Percutaneous nephrolithotomy (PCNL) was successfully performed. Stone management in these type of patients is of increased interest due to existed "anatomical challenges" concerning the access and safety during the procedure. To our knowledge this is the first case of PCNL in a patient with Mainz pouch II that has been reported in the literature.

• Klíčová slova
• Lithotripsy, Mainz pouch, Percutaneous nephrolithotomy, Urolithiasis,
• MeSH
• diverze moči metody   MeSH
• kontinentní náhrady močového měchýře * MeSH
• lidé MeSH
• obstrukce močovodu chirurgie   MeSH
• perkutánní nefrostomie metody   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

CONTEXT: Miniaturized instruments for percutaneous nephrolithotomy (PNL), utilizing tracts sized ≤22 Fr, have been developed in an effort to reduce the morbidity and increase the efficiency of stone removal compared with standard PNL (>22 Fr). OBJECTIVE: We systematically reviewed all available evidence on the efficacy and safety of miniaturized PNL for removing renal calculi. EVIDENCE ACQUISITION: The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Since it was not possible to perform a meta-analysis, the data were summarized in a narrative synthesis. EVIDENCE SYNTHESIS: After screening 2945 abstracts, 18 studies were included (two randomized controlled trials [RCTs], six nonrandomized comparative studies, and 10 case series). Thirteen studies were full-text articles and five were only available as congress abstracts. The size of tracts used in miniaturized procedures ranged from 22 Fr to 4.8 Fr. The largest mean stone size treated using small instruments was 980mm2. Stone-free rates were comparable in miniaturized and standard PNL procedures. Procedures performed with small instruments tended to be associated with significantly lower blood loss, while the procedure duration tended to be significantly longer. Other complications were not notably different between PNL types. Study designs and populations were heterogeneous. Study limitations included selection and outcome reporting bias, as well as a lack of information on relevant confounding factors. CONCLUSIONS: The studies suggest that miniaturized PNL is at least as efficacious and safe as standard PNL for the removal of renal calculi. However, the quality of the evidence was poor, drawn mainly from small studies, the majority of which were single-arm case series, and only two of which were RCTs. Furthermore, the tract sizes used and types of stones treated were heterogeneous. Hence, the risks of bias and confounding were high, highlighting the need for more reliable data from RCTs. PATIENT SUMMARY: Removing kidney stones via percutaneous nephrolithotomy (PNL) using smaller sized instruments (mini-PNL) appears to be as effective and safe as using larger (traditional) instruments, but more clinical research is needed.

• Klíčová slova
• Mini-perc, Percutaneous nephrolithotomy, Residual fragments, Stenting, Stone surgery, Systematic review, Urinary calculi,
• MeSH
• chirurgické nástroje * normy   MeSH
• design vybavení MeSH
• dítě MeSH
• dodržování směrnic MeSH
• dospělí MeSH
• kojenec MeSH
• ledvinové kameny diagnóza   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniaturizace MeSH
• mladiství MeSH
• mladý dospělý MeSH
• perkutánní nefrolitotomie škodlivé účinky   přístrojové vybavení   normy   MeSH
• předškolní dítě MeSH
• senioři MeSH
• směrnice pro lékařskou praxi jako téma * normy   MeSH
• společnosti lékařské * normy   MeSH
• urologie normy   MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• systematický přehled MeSH

BACKGROUND: The aim of this study was to reach a consensus in the classification and standardized reporting for the different types of PCNLs. METHODS: The RAND/UCLA appropriateness methodology was used to reach a consensus. Thirty-two statements were formulated reviewing the literature on guidelines and consensus on PCNLs, and included procedure specific details, outcome measurements and a classification for PCNLs. Experts were invited to two rounds of input, the first enabled independent modifications of the proposed statements and provided the option to add statements. The second round facilitated scoring of all statements. Each statement was discussed in the third round to decide which statements to include. Any suggestion or disagreement was debated and discussed to reach a consensual agreement. RESULTS: Twenty-five recommendations were identified to provide standardized reporting of procedure and outcomes. Consensual scoring above 80% were strongly agreed upon by the panel. The top treatment related outcomes were size of sheath used (99.1%) and position for PCNL (93.5%). The highest ranked Outcome Measures included definition of postoperative hospital length of stay (94.4%) and estimated blood loss (93.5%). CONCLUSIONS: The consensus statements will be useful to clarify operative technique, in the design of clinical trials and standardized reporting, and presentation of results to compare outcomes of different types of PCNLs.

• MeSH
• hodnocení výsledků zdravotní péče MeSH
• konsensus MeSH
• lidé MeSH
• perkutánní nefrolitotomie * metody   MeSH
• urolitiáza * chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Within eight years, since October 1985 till June 1993, we had been operating on 409 patients, who had been subjected to 500 percutaneous nephrolithotomies. In 30% per cent of all the operations we had used mechanical, electrohydraulic or ultrasound lithotripsy. Out of the total number of the patients, 7 per cent had been discharged with the residual stones, but in 5.6 per cent the ESWL or spontaneous exodus had been presumed. Serious complications we had registered at 10 patients (e.g. 2 per cent of all operations). None of them however had required an emergency nephrectomy. The authors discuss the today's position of the PNL among the other operative methods of treatment of urolithiasis.

• MeSH
• dospělí MeSH
• ledvinové kameny chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• perkutánní nefrostomie * škodlivé účinky   metody   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

BACKGROUND: Percutaneous nephrolithotomy is an effective less invasive method for the treatment of nephrolithiasis. Authors retrospectively analysed results of this procedure performed in a single centre (Department of Urology, General University Hospital, Prague) from January 2005 till June 2007. METHODS AND RESULTS: Patients were acquired by an analysis of operating reports performed over a period January 2005 till June 2007 and subsequently a retrospective analysis of electronic and paper patient's records was carried out. Percutaneous nephrolithotomy was performed in 150 patients. Of those, 117 (78%) patients underwent primary and 33 (21.3%) secondary procedure. Analysed group consisted of 85 (56.7%) men and 65 (43.3%) women. Right-sided procedure was performed in 46% (69 times) and left-sided in 54% (81 times) of cases. Mean patient's age was 52.9 years (SD +/- 16.3). Mean stone size was 18.3 (SD +/- 9.5) mm. Staghorn calculi were present in 19 (12.7%) patients and 77 (51.3%) patients had more than 1 stone. Intracorporeal lithotripsy was necessary in 82 (54.7%) cases. Seventy eight (52.9%) patients were stone free after the procedure. There were 24 (16%) patients with an anatomic abnormality of upper urinary tract. The most common (in 64.3%) component in analysed stones was a calcium oxalate. CONCLUSIONS: The amount of stone free patients is rather lower compared to the literature results. However, definitive results are always affected by auxiliary procedures (mainly extracorporeal shock wave lithotripsy), which are not included in the analysis.

• MeSH
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• močové kameny chirurgie   MeSH
• perkutánní nefrostomie * MeSH
• předškolní dítě MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

PURPOSE: The European Association of Urology (EAU) has updated its guidelines on clinical best practice in urolithiasis for 2021. We therefore aimed to present a summary of best clinical practice in surgical intervention for patients with upper tract urolithiasis. MATERIALS AND METHODS: The panel performed a comprehensive literature review of novel data up to May 2021. The guidelines were updated and a strength rating was given for each recommendation, graded using the modified Grading of Recommendations, Assessment, Development, and Evaluations methodology. RESULTS: The choice of surgical intervention depends on stone characteristics, patient anatomy, comorbidities, and choice. For shockwave lithotripsy (SWL), the optimal shock frequency is 1.0-1.5 Hz. For ureteroscopy (URS), a postoperative stent is not needed in uncomplicated cases. Flexible URS is an alternative if percutaneous nephrolithotomy (PCNL) or SWL is contraindicated, even for stones >2 cm. For PCNL, prone and supine approaches are equally safe. For uncomplicated PCNL cases, a nephrostomy tube after PCNL is not necessary. Radiation exposure for endourological procedures should follow the as low as reasonably achievable principles. CONCLUSIONS: This is a summary of the EAU urolithiasis guidelines on best clinical practice in interventional management of urolithiasis. The full guideline is available at https://uroweb.org/guidelines/urolithiasis. PATIENT SUMMARY: The European Association of Urology has produced guidelines on the best management of kidney stones, which are summarised in this paper. Kidney stone disease is a common condition; computed tomography (CT) is increasingly used to diagnose it. The guidelines aim to decrease radiation exposure to patients by minimising the use of x-rays and CT scans. We detail specific advice around the common operations for kidney stones.

• Klíčová slova
• Kidney stones, Percutaneous nephrolithotomy, Shockwave lithotripsy, Treatment, Ureteroscopy,
• MeSH
• ledvinové kameny * chirurgie   komplikace   MeSH
• lidé MeSH
• perkutánní nefrostomie * metody   MeSH
• ureteroskopie metody   MeSH
• urolitiáza * chirurgie   komplikace   MeSH
• urologie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• směrnice pro lékařskou praxi MeSH

CONTEXT: Management of urinary stones is a major issue for most urologists. Treatment modalities are minimally invasive and include extracorporeal shockwave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PNL). Technological advances and changing treatment patterns have had an impact on current treatment recommendations, which have clearly shifted towards endourologic procedures. These guidelines describe recent recommendations on treatment indications and the choice of modality for ureteral and renal calculi. OBJECTIVE: To evaluate the optimal measures for treatment of urinary stone disease. EVIDENCE ACQUISITION: Several databases were searched to identify studies on interventional treatment of urolithiasis, with special attention to the level of evidence. EVIDENCE SYNTHESIS: Treatment decisions are made individually according to stone size, location, and (if known) composition, as well as patient preference and local expertise. Treatment recommendations have shifted to endourologic procedures such as URS and PNL, and SWL has lost its place as the first-line modality for many indications despite its proven efficacy. Open and laparoscopic techniques are restricted to limited indications. Best clinical practice standards have been established for all treatments, making all options minimally invasive with low complication rates. CONCLUSION: Active treatment of urolithiasis is currently a minimally invasive intervention, with preference for endourologic techniques. PATIENT SUMMARY: For active removal of stones from the kidney or ureter, technological advances have made it possible to use less invasive surgical techniques. These interventions are safe and are generally associated with shorter recovery times and less discomfort for the patient.

• Klíčová slova
• Laparoscopy, Medical expulsive therapy, Percutaneous nephrolithotomy, Pregnancy, Residual fragments, Shock wave lithotripsy, Stenting, Stone surgery, Ureteroscopy, Urinary calculi,
• MeSH
• katetrizace močového měchýře normy   MeSH
• laparoskopie normy   MeSH
• lidé MeSH
• litotripse normy   MeSH
• perkutánní nefrostomie normy   MeSH
• pooperační komplikace etiologie   MeSH
• rizikové faktory MeSH
• stenty MeSH
• ureteroskopie normy   MeSH
• urolitiáza diagnóza   chirurgie   MeSH
• urologické chirurgické výkony škodlivé účinky   přístrojové vybavení   normy   MeSH
• urologie normy   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• směrnice pro lékařskou praxi MeSH

BACKGROUND: The purpose of the study was to compare the efficacy of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy for lower pole nephrolithiasis. METHODS AND RESULTS: We retrospectively analyzed results of lower pole nephrolithiasis treatment in 396 patients (221 treated by extracorporeal shock wave lithotripsy and 175 by percutaneuos nephrolithotomy). We evaluated results of the treatment in the 3 months interval after the procedure in groups classified according to the stone size: <10 mm, 10-20 mm, >20 mm. Stone free status was achieved in these groups after 96 (66%), 43 (38 %) and 2 (25%) shock wave lithotripsies and 48 (84%), 75 (76%) and 25 (74%) percutaneous nepholithotomies. The efficacy irrespective of insignificant residual fragments (< 4 mm) was in 176 (66%) lithotripsies and 156 (82%) single percutaneuos nephrolithotomies. CONCLUSIONS: Percutaneous nephrolithotomy is more effective methods in the treatment for lower pole nephrolithiasis than extracorporeal shock wave lithotripsy especially for stone size >10 mm.

• MeSH
• dítě MeSH
• dospělí MeSH
• ledvinové kameny chirurgie   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• litotripse * MeSH
• mladiství MeSH
• perkutánní nefrostomie * MeSH
• předškolní dítě MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• srovnávací studie MeSH

CONTEXT: Endourological procedures frequently require fluoroscopic guidance, which results in harmful radiation exposure to patients and staff. One clinician-controlled method for decreasing exposure to ionising radiation in patients with urolithiasis is to avoid the use of intraoperative fluoroscopy during stone intervention procedures. OBJECTIVE: To comparatively assess the benefits and risks of "fluoroscopy-free" and fluoroscopic endourological interventions in patients with urolithiasis. EVIDENCE ACQUISITION: A systematic review of the literature from 1970 to 2022 was performed using the MEDLINE/PubMed, Embase, and Cochrane controlled trials databases and ClinicalTrials.gov. Primary outcomes assessed were complications and the stone-free rate (SFR). Studies reporting data on ureteroscopy and percutaneous nephrolithotomy (PCNL) were eligible for inclusion. Secondary outcomes were operative duration, hospital length of stay, conversion from a fluoroscopy-free to a fluoroscopic procedure, and requirement for an auxiliary procedure to achieve stone clearance. EVIDENCE SYNTHESIS: In total, 24 studies (12 randomised and 12 observational) out of 834 abstracts screened were eligible for analysis. There were 4564 patients with urolithiasis in total, of whom 2309 underwent a fluoroscopy-free procedure and 2255 underwent a comparative fluoroscopic procedure for treatment of urolithiasis. Pooled analysis of all procedures revealed no significant difference between the groups in SFR (p = 0.84), operative duration (p = 0.11), or length of stay (p = 0.13). Complication rates were significantly higher in the fluoroscopy group (p = 0.009). The incidence of conversion from a fluoroscopy-free to a fluoroscopic procedure was 2.84%. Similar results were noted in subanalyses for ureteroscopy (n = 2647) and PCNL (n = 1917). When only randomised studies were analysed (n = 12), the overall complication rate was significantly in the fluoroscopy group (p < 0.001). CONCLUSIONS: For carefully selected patients with urolithiasis, fluoroscopy-free and fluoroscopic endourological procedures have comparable stone-free and complication rates when performed by experienced urologists. In addition, the conversion rate from a fluoroscopy-free to a fluoroscopic endourological procedure is low at 2.84%. These findings are important for clinicians and patients, as the detrimental health effects of ionising radiation are negated with fluoroscopy-free procedures. PATIENT SUMMARY: We compared treatments for kidney stones with and without the use of radiation. We found that kidney stone procedures without the use of radiation can be safely performed by experienced urologists in patients with normal kidney anatomy. These findings are important, as they indicate that the harmful effects of radiation can be avoided during kidney stone surgery.

• Klíčová slova
• Flexible ureterorenoscopy, Flexible ureteroscopy, Fluoroless, Fluoroscopy, Fluoroscopy-free, Ionising radiation, Percutaneous nephrolithotomy, Radiation, Ureteroscopy,
• MeSH
• fluoroskopie MeSH
• ledvinové kameny * chirurgie   MeSH
• lidé MeSH
• urolitiáza * chirurgie   MeSH
• urologie * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• systematický přehled MeSH