Renal functional effects of multiple-tract percutaneous access

Rajash Handa, Andrew Evan, Lynn R. Willis, Cynthia D. Johnson, Bret A. Connors, Sujuan Gao, James E. Lingeman, Brian R. Matlaga, Nicole L. Miller, Shelly E. Handa

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Introduction: Percutaneous nephrolithotomy (PCNL) can involve establishing more than one access into the urinary collecting system. The present study examined whether multiple percutaneous accesses results in a more severe reduction in renal function than that after single-percutaneous access. Methods: Adult female pigs were anesthetized, and percutaneous access to the left urinary collecting system was achieved by puncturing the lower pole calyx (single-tract access, n = 16) or serially puncturing the lower pole, interpolar region, and upper pole calyces [multiple (three)-tract access, n = 11]. Renal function measurements included glomerular filtration rate and effective renal plasma flow, and were taken immediately before and 1.5 and 4.5 hours after percutaneous access. We also examined glomerular function in a group of adult patients with normal preoperative serum creatinine (Cr) levels (≤1.4 mg/dL) who underwent either unilateral single-tract PCNL (23 patients) or unilateral multiple (two)-tract PCNL (10 patients). Access tracts were dilated to 30F with a NephroMax balloon dilator system in animal and human patients. Results: Single- and multiple-tract percutaneous access procedures in pigs resulted in a similar renal functional response; both glomerular filtration rate and effective renal plasma flow significantly declined by ∼60% immediately after access and remained depressed throughout the experimental observation period. A retrospective analysis of patients with normal serum Crs (≤1.4 mg/dL) who underwent single- or multiple-tract PCNL demonstrated that the procedures produced similar and significant increases in serum Cr on postoperative day 1 (0.33 ± 0.09 [standard error of mean] mg/dL and 0.39 ± 0.11 mg/dL, respectively) and day 2 (0.33 ± 0.09 mg/dL and 0.25 ± 0.09 mg/dL, respectively). Conclusions: Multiple-tract access does not lead to a more severe reduction in renal function than single-tract access; that is, the acute renal hemodynamic response to PCNL appears independent of the number of access tracts.

Original languageEnglish
Pages (from-to)1951-1956
Number of pages6
JournalJournal of Endourology
Volume23
Issue number12
DOIs
StatePublished - Dec 1 2009

Fingerprint

Percutaneous Nephrostomy
Kidney
Effective Renal Plasma Flow
Glomerular Filtration Rate
Creatinine
Swine
Serum
Hemodynamics
Observation

ASJC Scopus subject areas

  • Urology

Cite this

Renal functional effects of multiple-tract percutaneous access. / Handa, Rajash; Evan, Andrew; Willis, Lynn R.; Johnson, Cynthia D.; Connors, Bret A.; Gao, Sujuan; Lingeman, James E.; Matlaga, Brian R.; Miller, Nicole L.; Handa, Shelly E.

In: Journal of Endourology, Vol. 23, No. 12, 01.12.2009, p. 1951-1956.

Research output: Contribution to journalArticle

Handa, R, Evan, A, Willis, LR, Johnson, CD, Connors, BA, Gao, S, Lingeman, JE, Matlaga, BR, Miller, NL & Handa, SE 2009, 'Renal functional effects of multiple-tract percutaneous access', Journal of Endourology, vol. 23, no. 12, pp. 1951-1956. https://doi.org/10.1089/end.2009.0159
Handa, Rajash ; Evan, Andrew ; Willis, Lynn R. ; Johnson, Cynthia D. ; Connors, Bret A. ; Gao, Sujuan ; Lingeman, James E. ; Matlaga, Brian R. ; Miller, Nicole L. ; Handa, Shelly E. / Renal functional effects of multiple-tract percutaneous access. In: Journal of Endourology. 2009 ; Vol. 23, No. 12. pp. 1951-1956.
@article{64d6a21430d2424da004cd7e0b311732,
title = "Renal functional effects of multiple-tract percutaneous access",
abstract = "Introduction: Percutaneous nephrolithotomy (PCNL) can involve establishing more than one access into the urinary collecting system. The present study examined whether multiple percutaneous accesses results in a more severe reduction in renal function than that after single-percutaneous access. Methods: Adult female pigs were anesthetized, and percutaneous access to the left urinary collecting system was achieved by puncturing the lower pole calyx (single-tract access, n = 16) or serially puncturing the lower pole, interpolar region, and upper pole calyces [multiple (three)-tract access, n = 11]. Renal function measurements included glomerular filtration rate and effective renal plasma flow, and were taken immediately before and 1.5 and 4.5 hours after percutaneous access. We also examined glomerular function in a group of adult patients with normal preoperative serum creatinine (Cr) levels (≤1.4 mg/dL) who underwent either unilateral single-tract PCNL (23 patients) or unilateral multiple (two)-tract PCNL (10 patients). Access tracts were dilated to 30F with a NephroMax balloon dilator system in animal and human patients. Results: Single- and multiple-tract percutaneous access procedures in pigs resulted in a similar renal functional response; both glomerular filtration rate and effective renal plasma flow significantly declined by ∼60{\%} immediately after access and remained depressed throughout the experimental observation period. A retrospective analysis of patients with normal serum Crs (≤1.4 mg/dL) who underwent single- or multiple-tract PCNL demonstrated that the procedures produced similar and significant increases in serum Cr on postoperative day 1 (0.33 ± 0.09 [standard error of mean] mg/dL and 0.39 ± 0.11 mg/dL, respectively) and day 2 (0.33 ± 0.09 mg/dL and 0.25 ± 0.09 mg/dL, respectively). Conclusions: Multiple-tract access does not lead to a more severe reduction in renal function than single-tract access; that is, the acute renal hemodynamic response to PCNL appears independent of the number of access tracts.",
author = "Rajash Handa and Andrew Evan and Willis, {Lynn R.} and Johnson, {Cynthia D.} and Connors, {Bret A.} and Sujuan Gao and Lingeman, {James E.} and Matlaga, {Brian R.} and Miller, {Nicole L.} and Handa, {Shelly E.}",
year = "2009",
month = "12",
day = "1",
doi = "10.1089/end.2009.0159",
language = "English",
volume = "23",
pages = "1951--1956",
journal = "Journal of Endourology",
issn = "0892-7790",
publisher = "Mary Ann Liebert Inc.",
number = "12",

}

TY - JOUR

T1 - Renal functional effects of multiple-tract percutaneous access

AU - Handa, Rajash

AU - Evan, Andrew

AU - Willis, Lynn R.

AU - Johnson, Cynthia D.

AU - Connors, Bret A.

AU - Gao, Sujuan

AU - Lingeman, James E.

AU - Matlaga, Brian R.

AU - Miller, Nicole L.

AU - Handa, Shelly E.

PY - 2009/12/1

Y1 - 2009/12/1

N2 - Introduction: Percutaneous nephrolithotomy (PCNL) can involve establishing more than one access into the urinary collecting system. The present study examined whether multiple percutaneous accesses results in a more severe reduction in renal function than that after single-percutaneous access. Methods: Adult female pigs were anesthetized, and percutaneous access to the left urinary collecting system was achieved by puncturing the lower pole calyx (single-tract access, n = 16) or serially puncturing the lower pole, interpolar region, and upper pole calyces [multiple (three)-tract access, n = 11]. Renal function measurements included glomerular filtration rate and effective renal plasma flow, and were taken immediately before and 1.5 and 4.5 hours after percutaneous access. We also examined glomerular function in a group of adult patients with normal preoperative serum creatinine (Cr) levels (≤1.4 mg/dL) who underwent either unilateral single-tract PCNL (23 patients) or unilateral multiple (two)-tract PCNL (10 patients). Access tracts were dilated to 30F with a NephroMax balloon dilator system in animal and human patients. Results: Single- and multiple-tract percutaneous access procedures in pigs resulted in a similar renal functional response; both glomerular filtration rate and effective renal plasma flow significantly declined by ∼60% immediately after access and remained depressed throughout the experimental observation period. A retrospective analysis of patients with normal serum Crs (≤1.4 mg/dL) who underwent single- or multiple-tract PCNL demonstrated that the procedures produced similar and significant increases in serum Cr on postoperative day 1 (0.33 ± 0.09 [standard error of mean] mg/dL and 0.39 ± 0.11 mg/dL, respectively) and day 2 (0.33 ± 0.09 mg/dL and 0.25 ± 0.09 mg/dL, respectively). Conclusions: Multiple-tract access does not lead to a more severe reduction in renal function than single-tract access; that is, the acute renal hemodynamic response to PCNL appears independent of the number of access tracts.

AB - Introduction: Percutaneous nephrolithotomy (PCNL) can involve establishing more than one access into the urinary collecting system. The present study examined whether multiple percutaneous accesses results in a more severe reduction in renal function than that after single-percutaneous access. Methods: Adult female pigs were anesthetized, and percutaneous access to the left urinary collecting system was achieved by puncturing the lower pole calyx (single-tract access, n = 16) or serially puncturing the lower pole, interpolar region, and upper pole calyces [multiple (three)-tract access, n = 11]. Renal function measurements included glomerular filtration rate and effective renal plasma flow, and were taken immediately before and 1.5 and 4.5 hours after percutaneous access. We also examined glomerular function in a group of adult patients with normal preoperative serum creatinine (Cr) levels (≤1.4 mg/dL) who underwent either unilateral single-tract PCNL (23 patients) or unilateral multiple (two)-tract PCNL (10 patients). Access tracts were dilated to 30F with a NephroMax balloon dilator system in animal and human patients. Results: Single- and multiple-tract percutaneous access procedures in pigs resulted in a similar renal functional response; both glomerular filtration rate and effective renal plasma flow significantly declined by ∼60% immediately after access and remained depressed throughout the experimental observation period. A retrospective analysis of patients with normal serum Crs (≤1.4 mg/dL) who underwent single- or multiple-tract PCNL demonstrated that the procedures produced similar and significant increases in serum Cr on postoperative day 1 (0.33 ± 0.09 [standard error of mean] mg/dL and 0.39 ± 0.11 mg/dL, respectively) and day 2 (0.33 ± 0.09 mg/dL and 0.25 ± 0.09 mg/dL, respectively). Conclusions: Multiple-tract access does not lead to a more severe reduction in renal function than single-tract access; that is, the acute renal hemodynamic response to PCNL appears independent of the number of access tracts.

UR - http://www.scopus.com/inward/record.url?scp=72449169618&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=72449169618&partnerID=8YFLogxK

U2 - 10.1089/end.2009.0159

DO - 10.1089/end.2009.0159

M3 - Article

C2 - 19909077

AN - SCOPUS:72449169618

VL - 23

SP - 1951

EP - 1956

JO - Journal of Endourology

JF - Journal of Endourology

SN - 0892-7790

IS - 12

ER -