title: Wideband Doppler Ultrasound-guided Mini-endoscopic Combined Intrarenal Surgery as an Effective and Safe Procedure for Management of Large Renal Stones: A Preliminary Report.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of wideband Doppler ultrasound-guided mini-endoscopic combined intrarenal surgery (mini-ECIRS) for large renal stones.
  
  
  METHODS
  This study included 41 patients with large renal stones (>30 mm) treated by mini-ECIRS using a retrograde flexible ureteroscope and miniature nephroscope by wideband Doppler ultrasound guidance in the modified Valdivia position from January 2013 to September 2015. Surgical parameters, including the stone-free rate, operative time, complications (especially hemorrhagic complications), and hemoglobin drop were recorded and analyzed. Univariate analysis was performed to identify risk factors for a hemoglobin drop of ≥1 g/dL.
  
  
  RESULTS
  The mean stone size, including staghorn calculi in 41.4% of cases, was 45.5 ± 14.7 mm. Percutaneous access into the calices using wideband Doppler ultrasound was successful in all cases. The mean total operative time was 158.4 ± 51.3 minutes. The mean mini-ECIRS time (from first percutaneous puncture to end of procedure) was 106.2 ± 36.0 minutes. The initial stone-free rate was 73.2% (n = 30). The final stone-free rate after auxiliary treatment was 97.5% (n = 40). The mean hemoglobin drop was 0.54 ± 0.65 g/dL. Three (7.3%) postoperative modified Clavien grade II complications occurred. Univariate analysis revealed no significant risk factors for a hemoglobin drop of ≥1 g/dL.
  
  
  CONCLUSIONS
  Wideband Doppler ultrasound-guided renal puncture is safe and feasible. Wideband Doppler ultrasound-guided mini-ECIRS is a beneficial, versatile, and safe treatment option for management of large renal stones of >30 mm.
authors.affiliation: Department of Urology and Stone Center, Takii-Hospital of Kansai Medical University, Moriguchi, Osaka, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan.
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Kinoshita
authors.affiliation: Department of Urology, Gyotoku General Hospital, Ichikawa, Chiba, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Okada
authors.affiliation: Department of Nephrourology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Shuzo
authors.initials: S
authors.lastname: Hamamoto
authors.affiliation: Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Taguchi
authors.affiliation: Department of Urology and Stone Center, Takii-Hospital of Kansai Medical University, Moriguchi, Osaka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Murota
authors.affiliation: Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan. Electronic address: matsudat@hirakata.kmu.ac.jp.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Matsuda
mesh_terms: D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D018608:Ultrasonography, Doppler / Q000379:methods*; D018666:Ureteroscopy / Q000379:methods*; D013520:Urologic Surgical Procedures / Q000379:methods