FFinal-1282.pdf 903Vol. 10 | No. 2 | Spring 2013 |U R O LO G Y J O U R N A L A Novel Irrigation System in Percutaneous Renal Surgery Mohammad Mehdi Hosseini, Mohammad Amin Afrasiabi, Eskandar Negahdari, Alireza Aminsharifi, Saeed Shakeri, Alireza Tadayon, Ejaz Ahmad, Farhad Manaheji Keywords: percutaneous nephrolithotomy, kidney, treatment outcome, lithotripsy INTRODUCTION Percutaneous nephrolithotomy (PCNL) is known as an alternative for open surgery and a minimally-invasive modality for management of large or complex renal stones.(1) In this procedure, stone is fragmented with pneumatic, ultrasonic, or electrohydrolic devices and its particles are removed with irrigation.(2) may also result in contamination if the stone is infected (Figure 1). We designed, manufactured, and used a closed system to overcome this problem during percutaneous renal surgeries, such as PCNL. CASE REPORT Between September 2005 and September 2012, 1137 adult patients, including 674 men and 463 women, with a mean age of 38.2 years (range, 19 to 67 years) and mean stone size of 25.5 mm (range,15 to 50 mm) underwent PCNL in our referral training center. Of 1137 patients, 516 had right-sided and 621 had left-sided stones. Most of the patients (64%) 1). All the patients were evaluated by our team, including a urologist, an anesthesiologist, and a cardiologist if needed. - ney, ureters, and bladder x-ray), intravenous urography, or computed tomography scan. Com- Corresponding Author: Mohammad Mehdi Hosseini, MD Nephrology-Urology Research Center, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Tel: +98 711 233 1006 Fax: +98 711 233 0724 E-mail: mmhosseini@sums. ac.ir Received December 2011 Accepted January 2012 Nephrology-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran POINT OF TECHNIQUE *Abstract of the preliminary study was presented as a video presentation in 25th WCE, Cancun, Mexico, 2007. 904 | Point of Technique checked. Patients with staghorn calculi or positive culture received admitted 6 to 12 hours before the operation, and received par- TECHNIQUE We designed and manufactured a closed system that can be connected to the external, free end of the Amplatz sheath to 30F with or without two lock-washers for watertight connec- the open end of the Amplatz sheath by a piece of a matched When this device is connected to the Amplatz sheath, the - fore, before this connection, the Amplatz sheath should be shortened to match with the length of the nephroscope. Dur- draining port into the collection bottle passively with little volume used for irrigation during the surgery. In all (1137 patients) but 27 cases, the procedure was done 27 morbid obese patients, the standard Amplatz sheath was were unable to mount the 3-way connector in this setting. DISCUSSION In the present study, we showed the feasibility of our home- - Table 1. Demographic characteristics of the patients who underwent percutaneous nephrolithotomy with closed irrigation system. Male/Female 678/459 Mean age (range), y 38.2 (19 to 67) Mean stone size (range), mm 25.5 (15 to 50) Right/left side 516/621 Comorbidities Solitary kidney Diabetes mellitus Hypertension Heart diseases Renal insufficiency Morbid obesity 47 (4.1%) 44 (3.8%) 113 (9.9%) 74 (6.5%) 22 (2.0%) 27 (2.4%) Figure 1. Conventional irrigation system in percutaneous renal surgery. Figure 2. Elements of the connector used for closed irrigation system. 905Vol. 10 | No. 2 | Spring 2013 |U R O LO G Y J O U R N A L ful to measure the volume of the irrigation used for proce- aware that this system converts an open irrigation system to a closed one. Any obstruction in the draining port (eg, stone fragments) may lead to an increased intrarenal pressure. Al- though we did not encounter any major complication with the closed irrigation system, a comparative study would be help- ful to observe if this system affects the outcome of PCNL. CONFLICT OF INTEREST None declared. Irrigation in Percutaneous Renal Surgery | Hosseini et al Table 2. Results and complications of novel irrigation system. Stone-free rate, n (%) 1029 (90.5%) Mean operative time (range), min 75 (40 to 115) Mean irrigation volume (range), L 11.5 (6 to 18) Complications (Clavien classification) Grade I: Fever (T: 38.3ยบ), bleeding, PCS perforation 44 (23,18,11) Grade II: Transfusion, ileus, pneumonia 23 (12,7,4) Grade III: Redo PCNL, URS, late hematuria 7 (3, 2, 2) Grade IV: Myocardial infarction, sepsis 5 (4,1) Grade V: Death 2 PCS indicates pelvicaliceal system; PCNL, percutaneous nephrolithoto- my; and URS, ureteroscopy. Figure 3. Closed irrigation system during percutaneous nephro- lithotomy using our novel device. REFERENCES 1. Basiri A, Ziaee SA, Nasseh H, et al. Totally ultrasonography- guided percutaneous nephrolithotomy in the flank posi- tion. J Endourol. 2008;22:1453-7. 2. Peterson GN, Krieger JN, Glauber DT. Anaesthetic experi- ence with percutaneous lithotripsy. A review of potential and actual complications. Anaesthesia. 1985;40:460-4.