Extrarenal Stone Migration After PNL and RIRS: Effectiveness of Conservative Follow-up in Light of Literature

Yıl 2024, , 204 - 210, 30.12.2024

Ahmet Baytok , Gökhan Ecer

https://doi.org/10.47947/ijnls.1581596

Öz

This study aims to evaluate rare cases of extrarenal stone migration after endoscopic stone surgery in light of the literature. Complications such as stone migration can rarely be seen after flexible ureterorenoscopy (RIRS) and percutaneous nephrolithotomy (PNL), which are widely used in the treatment of urolithiasis. In this case report, extrarenal stone migration was detected in a 43-year-old man who had previously undergone PNL and RIRS, but since the patient was asymptomatic, conservative follow-up was applied instead of surgical intervention. In the patient's CT scans, it was seen that the stone was lateral to the psoas major muscle and did not cause significant inflammation or edema in the surrounding tissues. When the cases in the literature were examined, extrarenal stone migration is usually associated with symptoms such as pain, infection or loss of renal function and requires surgery, but in this case, surgery was not applied due to the asymptomatic course. This situation shows the importance of conservative approaches and that they can be an alternative to surgery. In conclusion, the increase in such cases reported in the literature may guide the management of extrarenal stone complications. This study emphasizes conservative treatment strategies, especially in patients with asymptomatic extrarenal stone migration.

Anahtar Kelimeler

Extrarenal Stone Migration, Percutaneous nephrolithotomy, Extraureteral stone, Endoscopic stone surgery

Etik Beyan

Ethical approval was not obtained because the study was a literature search conducted with a case report.

Kaynakça

• Akbulut, F., Ucpinar, B., Savun, M., Kucuktopcu, O., Ozgor, F., Simsek, A., & Gurbuz, G. (2015). A major complication in micropercutaneous nephrolithotomy: upper calyceal perforation with extrarenal migration of stone fragments due to increased intrarenal pelvic pressure. Case Reports in Urology, 2015 (1), 792780. https://doi.org/10.1155/2015/792780
• Akman, T., Sari, E., Binbay, M., Yuruk, E., Tepeler, A., Kaba, M., & Tefekli, A. (2010). Comparison of outcomes after percutaneous nephrolithotomy of staghorn calculi in those with single and multiple accesses. Journal of Endourology, 24 (6), 955-960. https://doi.org/10.1089/end.2009.0456
• Assimos, D., Krambeck, A., Miller, N. L., Monga, M., Murad, M. H., Nelson, C. P., & Preminger, G. M. (2016). Surgical management of stones: American Urological Association / Endourological Society Guideline, Part I. Journal of Urology, 196 (4), 1153-1160. https://doi.org/10.1016/j.juro.2016.05.090
• De La Rosette, J. J., Laguna, M. P., Rassweiler, J. J., & Conort, P. (2008). Training in percutaneous nephrolithotomy—a critical review. European Urology, 54 (5), 994-1003. https://doi.org/10.1016/j.eururo.2008.03.052
• Diri, A., Karakan, T., Resorlu, M., Kabar, M., & Germiyanoglu, C. (2014). Intraperitoneal stone migration during percutaneos nephrolithotomy. Archivio Italiano di Urologia e Andrologia, 86 (4), 293-294. https://doi.org/10.4081/aiua.2014.4.293
• Ecer, G., Sönmez, M. G., Aydın, A., Topçu, C., Alalam, H. N. I., Güven, S., & Balasar, M. (2022). Comparison of retrograde intrarenal stone surgery with and without a ureteral access sheath using kidney injury molecule-1 (KIM-1) levels: a prospective randomized study. Urolithiasis, 50 (5), 625-633. https://doi.org/10.1007/s00240-022-01345-y
• Erol, E., Ecer, G., Kiremit, M. C., Gokce, M. İ., Balasar, M., Sarikaya, A. F., & Sarica, K. (2024). Multicentric evaluation of high and low power lasers on RIRS success using propensity score analysis. Urolithiasis, 52 (1), 32. https://doi.org/10.1007/s00240-024-01535-w
• Harmon, W. J., Sershon, P. D., Blute, M. L., Patterson, D. E., & Segura, J. W. (1997). Ureteroscopy: current practice and long-term complications. The Journal of Urology, 157 (1), 28-32. https://doi.org/10.1016/s0022-5347(01)65272-8
• Jung, H., Nørby, B., Frimodt-Møller, P. C., & Osther, P. J. (2008). Endoluminal isoproterenol irrigation decreases renal pelvic pressure during flexible ureterorenoscopy: a clinical randomized, controlled study. European Urology, 54 (6), 1404-1413. https://doi.org/10.1016/j.eururo.2008.03.092
• Lopez-Alcina, E., Broseta, E., Oliver, F., Boronat, F., & Jiménez-Cruz, J. F. (1998). Paraureteral extrusion of calculi after endoscopic pulsed-dye laser lithotripsy. Journal of Endourology, 12 (6), 517-521. https://doi.org/10.1089/end.1998.12.517
• Moretti, K., Kellett, M., & Miller, R. (1989). Percutaneous removal of “extra-renal” residual urinary calculus. Urology, 33 (3), 202-203. https://doi.org/10.1016/0090-4295(89)90391-9
• Moretti, K., Miller, R., Kellett, M., & Wickham, J. (1991). Extrusion of calculi from upper urinarytract into perinephric and periureteric tissues during endourologic stone surgery. Urology, 38 (5), 447-449. https://doi.org/10.1016/0090-4295(91)80235-y
• Seitz, C., Desai, M., Häcker, A., Hakenberg, O. W., Liatsikos, E., Nagele, U., & Tolley, D. (2012). Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy. European Urology, 61 (1), 146-158. https://doi.org/10.1016/j.eururo.2011.09.016
• Suh, L. K., Rothberg, M. B., Landman, J., Katsumi, H., & Gupta, G. (2010). Intrarenal pressures generated during deployment of various antiretropulsion devices in an ex vivo porcine model. Journal of Endourology, 24 (7), 1165-1168. https://doi.org/10.1089/end.2010.0118
• Türk, C., Petřík, A., Sarica, K., Seitz, C., Skolarikos, A., Straub, M., & Knoll, T. (2016). EAU guidelines on interventional treatment for urolithiasis. European Urology, 69 (3), 475-482. https://doi.org/10.1016/j.eururo.2015.07.041
• Verstandig, A., Banner, M., Van Arsdalen, K., & Pollack, H. J. R. (1986). Upper urinary tract calculi: extrusion into perinephric and periureteric tissues during percutaneous management. Radiology, 158 (1), 215-218. https://doi.org/10.1148/radiology.158.1.3940385
• Wollin, D. A., & Preminger, G. M. (2018). Percutaneous nephrolithotomy: complications and how to deal with them. Urolithiasis, 46 (1), 87-97. https://doi.org/10.1007/s00240-017-1022-x