title: Effectiveness of ureteroscopy-assisted retrograde nephrostomy (UARN) for percutaneous nephrolithotomy (PCNL).
abstract: OBJECTIVE
  To determine the impact of ureteroscopy-assisted retrograde nephrostomy (UARN) during percutaneous nephrolithotomy (PCNL).
  
  
  METHODS
  From April 2009 to September 2011, a total of 50 patients underwent PCNL for large renal stones (stone burden >2 cm). We performed UARN in the Galdakao-modified Valdivia position for 27 patients (UARN PCNL) and ultrasonography-assisted percutaneous nephrostomy in the prone position for 23 patients (prone PCNL).
  
  
  RESULTS
  UARN PCNL significantly improved the stone-free rate (81.5% vs 52.2%) and the rate of residual stones (<4 mm, 92.6% vs 65.2%, P<0.05). The median length of the operation was significantly shorter for UARN PCNL, at 160 min, compared to 299 min for prone PCNL (P<0.001). There was one intraoperative complication in prone PCNL, namely a hemorrhage that resulted in stopping the initial treatment, but it was cured conservatively. The postoperative complications included a high grade fever that persisted for three days in two UARN PCNL patients (7.4%) and six prone PCNL patients (26.1%). The Clavien grading scores showed significantly lower postoperative complications for UARN PCNL compared to prone PCNL.
  
  
  CONCLUSIONS
  UARN is associated with a higher stone-free rate, shorter operation time, and fewer complications during PCNL than prone PCNL.
authors.affiliation: Department of Urology, Ohguchi Higashi General Hospital, Yokohama, Kanagawa, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawahara
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ito
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Terao
authors.forename: Yoshitake
authors.initials: Y
authors.lastname: Kato
authors.forename: Hiroji
authors.initials: H
authors.lastname: Uemura
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kubota
authors.forename: Junichi
authors.initials: J
authors.lastname: Matsuzaki
mesh_terms: D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007668:Kidney / Q000601:surgery*; D007669:Kidney Calculi / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000009:adverse effects / Q000379:methods*