Simultaneous antegrade and retrograde endourological approach in Galdakao-modified supine Valdivia position for the mana
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UROLOGY - ORIGINAL PAPER
Simultaneous antegrade and retrograde endourological approach in Galdakao‑modified supine Valdivia position for the management of missed stents associated with complex renal stones: a non‑randomized pilot study A. M. Tawfeek1 · Mohamed Elmoazen1 · Ahmed Saafan1 · Ahmed Higazy1 · Ahmed Radwan1 · Hany Hamed Gad1 Received: 24 July 2020 / Accepted: 5 September 2020 © Springer Nature B.V. 2020
Abstract Purpose To evaluate the simultaneous antegrade and retrograde endourological approach in the Galdakao-modified supine Valdivia position (GMSVP) for the management of missed stent with complex renal stones. Methods Over 5 years, patients presented to our clinic or referred to our hospital with missed DJ stent and complex renal stones were included prospectively in our study. Inclusion criteria were patients with neglected DJ stents (more than 6 months) complicated with complex stone burden, in addition to stents that was Fragmented and required renal access for removal. Stent and stone removal were performed using a simultaneous antegrade and retrograde renal approach in the GMSVP. The success rate and any perioperative complications were recorded. Results 45 patients were available for evaluation. The average stone size was 3.9 ± 0.8 cm. Renal stones, ureteric stones, and bladder stones were present in 39, 24, and 10 patients, respectively .Two patients had fragmented DJs. Semirigid ureteroscopy with PCNL was used in 19 (42.2%) cases, ECIRS in 17 (37.7%) cases, Cystolitholapaxy and PCNL in 10 (22.2%) cases. Mean operative time was 70.8 ± 10.2 min, mean hospital stay was 2.3 ± 0.8 days. The stone-free rate was 93.3% after one procedure, two patients needed an auxiliary SWL for residual stones, postoperative complications were seen in 24.4% of patients. Conclusion Simultaneous antegrade and retrograde renal approach in the GMSVP is safe and effective in the management of missed DJ stents with a complex stone burden. Keywords Galdakao-modified supine Valdivia position · Stones · Neglected stent · Retrograde intrarenal surgery · Percutaneous nephrolithotomy · Supine position · Combined endoscopic intra-renal surgery
Introduction * Ahmed Higazy [email protected]; [email protected] A. M. Tawfeek [email protected] Mohamed Elmoazen [email protected] Ahmed Saafan [email protected] Ahmed Radwan [email protected] Hany Hamed Gad [email protected] 1
Ain Shams University Hospitals, Cairo 11361, Egypt
Since the introduction of percutaneous nephrolithotomy (PCNL) in 1976, the procedure has undergone considerable evolution until it became the gold standard in management renal stones larger than 2 cm [1]. One of the important aspects of this evolution was the patient’s position. The prone position has been the conventional method for performing PCNL for many years until Valdivia Uria and colleagues introduced the supine position as an alternative that is later was improved to the Galdakaomodified supine Valdivia position (GMSVP) which allows a
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