Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: EC:4.2.2.10 (PNL)
 341 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The main indication for renoscopy is percutaneous removal of concrements from the pyelocaliceal system (percutaneous nephrolithotripsy, PNL). Today, following the introduction of extra-corporeal shockwave lithotripsy (ESWL), PNL is still used for the treatment of staghorn stones. During ureteroscopy (URS), which is more frequently used, the ureter is examined retrogradely by a rigid instrument. Previously untreated ureteral stones and "steinstrasse" following ESWL can be successfully removed in one session. Since these techniques are invasive and require at least regional anesthesia, they are rarely used for diagnostic purposes only (e.g. ureteral stenosis of unknown origin, tumor biopsy).
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PMID:[Renoscopy and ureteroscopy]. 274 18

Statistical analysis of the inpatients and operations in our department from April, 1971 to December, 1986 revealed a total of 4,984 operations. Operations on the prostate were the most frequent (1,088 cases), followed by operations on the bladder (991 cases), on the ureter (816 cases), and kidney (719 cases). Among the operations, the percentage of endourological surgery and that of open surgery was 20.5% and 79.5% during the three years from 1975 to 1977, but in the recent three years from 1984 to 1986, these percentages were 62.6% and 37.4%, respectively, the rates being completely inverted. This shows that new endourological surgery, such as PNL, TUL, is progressing rapidly these years.
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PMID:[Statistics on operations at the Hara Genitourinary Hospital (1971-1986)]. 323 27

Forty-two (44 renal units) were treated by combination of ESWL and percutaneous nephrostomy or PNL. Staghorn calculi were found in 33, renal stones in 6 and ureter stones in 5. Residual stone rate was 18.2% in staghorn calculi. No severe complications were seen.
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PMID:[Clinical results of extracorporeal shock-wave lithotripsy (ESWL) and percutaneous nephroureterolithotripsy (PNL) in combination]. 337 13

Currently, PNL is the treatment of choice for large and/or otherwise complex urolithiasis. PNL was initially performed with the patient in a supine-oblique position, but later on the prone position became the conventional one for habit and handiness. The prone position provides a larger area for percutaneous renal access, a wider space for instrument manipulation, and a claimed lower risk of splanchnic injury. Nonetheless, it implies important anaesthesiological risks, including circulatory, haemodynamic, and ventilatory difficulties; need of several nurses to be present for intraoperative changes of the decubitus in case of simultaneous retrograde instrumentation of the ureter, implying evident risks related to pressure points; an increased radiological hazard to the urologist's hands; patient discomfort. To overcome these drawbacks, various safe and effective changes in patient positioning for PNL have been proposed over the years, including the reverse lithotomy position, the prone split-leg position, the lateral decubitus, the supine position, and the Galdakao-modified supine Valdivia (GMSV) position. Among these, the GMSV position is safe and effective, and seems profitable and ergonomic. It allows optimal cardiopulmonary control during general anaesthesia; an easy puncture of the kidney; a reduced risk of colonic injury; simultaneous antero-retrograde approach to the renal cavities (PNL and retrograde ureteroscopy = ECIRS, Endoscopic Combined IntraRenal Surgery), with no need of intraoperative repositioning of the anaesthetized patient, less need for nurses in the operating room, less occupational risk due to shifting of heavy loads, less risk of pressure injuries related to inaccurate repositioning, and reduced duration of the procedure; facilitated spontaneous evacuation of stone fragments; a comfortable sitting position and a restrained X-ray exposure of the hands for the urologist. But, first of all, GMSV position fully supports a new comprehensive attitude of the urologist towards a variety of upper urinary tract pathologies, facing them with a rich armamentarium of rigid and flexible endoscopes and a versatile antero-retrograde approach. Prone position may still be useful in case of important vertebral malformations, specifically hindering the supine position, or for simultaneous bilateral PNL, without having to move the patient intraoperatively, so is still present in the complementary techniques of a skilled endourologist.
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PMID:The patient position for PNL: does it matter? 2059 14