naa a22 4500 510740650 CHVBK 20180411083027.0 cr unu---uuuuu 180411e20130901xx s 000 0 eng 10.1007/s11845-012-0888-4 doi (NATIONALLICENCE)springer-10.1007/s11845-012-0888-4 Percutaneous nephrolithotomy in adult patients with spina bifida, severe spinal deformity and large renal stones [Elektronische Daten] [M. Alsinnawi, W. Torreggiani, R. Flynn, T. McDermott, R. Grainger, J. Thornhill] Aims: To present our experience in patients with spina bifida with severe spinal abnormality undergoing percutaneous nephrolithotomy (PCNL) for large stone burden. Patients and methods: A retrospective review identified five spina bifida patients with abnormal spinal curvature who had a PCNL for large kidney stones. The mean age was 28years. In two patients, stones were on the concave side of the scoliotic spine further limiting percutaneous access. Mean stone burden was 940mm2. All patients were paraplegic, three patients had symptomatic stone disease. We performed initial percutaneous renal access in radiology department and staged nephrolithotomy in operating room. Tract dilatation was accomplished using Amplatz dilators and a 24Ch or 26Ch nephroscope was used. Fragmentation and stone removal were accomplished in all patients using pneumatic and or ultrasound lithotripter and a retrieval grasper. Results: No anaesthetic complications were recorded. One patient required multiple percutaneous tracts, four had single tract to access stones. Three patients were stone free after PCNL. One required second PCNL through the same tract and another patient had multiple adjunctive ESWL. All five patients were stone clear after the final procedure. Two patients required blood transfusion. No patient had major complication or admission to intensive care unit. Conclusions: Percutaneous nephrolithotomy in patients with spina bifida is challenging but safe. Detailed pre-operative anaesthetic assessment and precise uroradiological evaluation of renal anatomy is essential. Second-look PCNL and additional ESWL/URS treatment may be required to completely clear stones. Royal Academy of Medicine in Ireland, 2012 Percutaneous nephrolithotomy nationallicence Spina bifida nationallicence Spinal deformity nationallicence Large renal stones nationallicence Alsinnawi M. Department of Urology, The Adelaide and Meath Hospital Dublin, Incorporating The National Children's Hospital, Tallaght, Dublin 24, Ireland aut Torreggiani W. Department of Radiology, The Adelaide and Meath Hospital Dublin, Incorporating The National Children's Hospital, Tallaght, Dublin 24, Ireland aut Flynn R. Department of Urology, The Adelaide and Meath Hospital Dublin, Incorporating The National Children's Hospital, Tallaght, Dublin 24, Ireland aut McDermott T. Department of Urology, The Adelaide and Meath Hospital Dublin, Incorporating The National Children's Hospital, Tallaght, Dublin 24, Ireland aut Grainger R. Department of Urology, The Adelaide and Meath Hospital Dublin, Incorporating The National Children's Hospital, Tallaght, Dublin 24, Ireland aut Thornhill J. Department of Urology, The Adelaide and Meath Hospital Dublin, Incorporating The National Children's Hospital, Tallaght, Dublin 24, Ireland aut Irish Journal of Medical Science Springer-Verlag 182/3(2013-09-01), 357-361 0021-1265 182:3<357 2013 182 11845 https://doi.org/10.1007/s11845-012-0888-4 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s11845-012-0888-4 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Alsinnawi M. Department of Urology, The Adelaide and Meath Hospital Dublin, Incorporating The National Children's Hospital, Tallaght, Dublin 24, Ireland aut NATIONALLICENCE 700 1- Torreggiani W. Department of Radiology, The Adelaide and Meath Hospital Dublin, Incorporating The National Children's Hospital, Tallaght, Dublin 24, Ireland aut NATIONALLICENCE 700 1- Flynn R. Department of Urology, The Adelaide and Meath Hospital Dublin, Incorporating The National Children's Hospital, Tallaght, Dublin 24, Ireland aut NATIONALLICENCE 700 1- McDermott T. Department of Urology, The Adelaide and Meath Hospital Dublin, Incorporating The National Children's Hospital, Tallaght, Dublin 24, Ireland aut NATIONALLICENCE 700 1- Grainger R. Department of Urology, The Adelaide and Meath Hospital Dublin, Incorporating The National Children's Hospital, Tallaght, Dublin 24, Ireland aut NATIONALLICENCE 700 1- Thornhill J. Department of Urology, The Adelaide and Meath Hospital Dublin, Incorporating The National Children's Hospital, Tallaght, Dublin 24, Ireland aut NATIONALLICENCE 773 0- Irish Journal of Medical Science Springer-Verlag 182/3(2013-09-01), 357-361 0021-1265 182:3<357 2013 182 11845 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer