Category: Stones: PCNL

VS2-1 - "Puncture Flush technique": A novel intra-operative adjunct to clear residual stones in inaccessible calyces during percutaneous nephrolithotomy

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective :

Stones in inaccessible calyces pose difficulty during percutaneous nephrolithotomy (PNL). Techniques used for clearing such stones include use of flexible nephroscopy or creation of an additional access tract. However flexible nephroscopy needs expertise and is costly where as creation of additional access tract can lead to more bleeding. We describe our experience with a novel “Puncture Flush technique” for clearance of residual stones in inaccessible calyces during PNL.


Methods :

Retrospective data of patients who underwent PNL being operated by a single surgeon from January 2015 to April 2018 was collected from hospital records where “Puncture Flush technique” was used intra-operatively. The demographic data, operative details and outcome of Puncture Flush technique were analysed. Puncture flush technique was considered successful when we were able to flush completely the stones in inaccessible calyx into the pelvis for easy removal.


Results :

Thirty three out of 344 (9.59%) patients who underwent PNL during the study period needed Puncture Flush technique during surgery. Mean age of the patients was 39.09±13.26 years. Majority of the patients (90.9%) had either staghorn (13/33) or multiple calyceal stones (17/33). Puncture Flush technique was successful in 31 patients (93.33 %) in clearing stones in inaccessible calyces during PNL (Table1). In 26 patients (78.78%) this technique helped in achieving complete clearance of stones without the need for creation of an additional access tract.


Conclusions :

“Puncture Flush technique” is a novel reproducible technique to clear small residual stones in inaccessible calyces during PNL. It helps in achieving complete stone clearance during surgery without the need for flexible nephroscopy or creation of additional access tract.

Sudheer K. Devana

Assistant Professor
Post Graduate Institute Of Medical Education and Research
Chandigarh, Chandigarh, India

Dr.Sudheer Kumar Devana,
MBBS,MS,MCh Urology,
Assistant Professor,
Department Of Urology,
Postgraduate Institute of Medical Education and Research,
Chandigarh,
India-160012.

Aditya P. Sharma

Chandigarh, Chandigarh, India

Kalpesh M. Parmar

Chandigarh, Chandigarh, India

Girdhar S. Bora

Post Graduate Institute of Medical Education & Research
Chandigarh, Chandigarh, India

Ravimohan S. Mavuduru

Post Graduate Institute of Medical Education & Research
Chandigarh, Chandigarh, India

Santosh Kumar

Professor of urology
PGIMER,CHANDIGARH
Chandigarh, Chandigarh, India

As a professor of urology at a one of the most premier institute ie. PGIMER, Chandigarh • i published 160 article in international journal of repute ie PUBMED indexed.
Contributed significantly in theGenito-Urinary Carcinoma , stones, reconstructive and laparoscopic and Robotic surgical cases . New surgical techniques developed by me to simplify the surgery, reduce the blood loss in surgery, decrease hospital stay and operative duration.

• Actively involved in regular bed-sides teaching of junior and senior residents as a consultant.
.
• Regularly coordinating interdepartmental academics meets of radiotherapy and urology case related to management of genitourinary cancers.
• Regularly coordinating interdepartmental academics meets of urology and radiotherapy case related to management of genitourinary cancers, urology and nephrology clinical rounds, urology and radiology rounds..




Developed many new surgical techniques


Teaching:
• Teaching of both the MS (General surgery) and MCh (Urology ) residents by the way of taking teaching rounds, decision making, seminars and bed-side classes in both routine and emergency wards
• Teaching of residents of other disciplines like Radiology, Gynae & Obstetrics
• Teaching of ‘visitor residents’ from other institutions from other places coming to our hospital for training
• Teaching residents regarding publication and presenting in national and international conferences




Uttam Mete

Chandigarh, Chandigarh, India

Shrawan K. Singh

Chhandigarh, Chandigarh, India

Arup K. Mandal

Chandigarh, Chandigarh, India