Shīrāz, Iran
Shīrāz, Iran

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Aminsharifi A.,Shiraz University of Medical Sciences | Aminsharifi A.,Shaheed Faghihi Hospital | Eslahi A.,Shiraz University of Medical Sciences | Safarpour A.R.,Shiraz University of Medical Sciences | Mehrabi S.,Hamedan University of Medical science
Urolithiasis | Year: 2014

The purpose of this study was to evaluate how the upper calyx–lower calyx infundibular (ULI) angle influences intrarenal stone migration during percutaneous nephrolithotomy (PCNL) in patients with a solitary renal pelvis stone and significant hydronephrosis. 50 adult patients with a solitary renal pelvis stone larger than 20 mm were considered for PCNL with a pneumatic lithotriptor for stone fragmentation. Inclusion criteria were moderate to severe hydronephrosis and upper calyx infundibular width >10 mm, and access point was the lower calyx in all cases. The ULI angle as well as stone fragment migration from the renal pelvis toward the upper calyx was noted during the operation. To determine the “critical” angle above which the probability of stone migration would be increased significantly, receiver operating characteristic curve was used. Mean stone size was 33.8 ± 13.2 mm. In 23 patients (46 %) the stone migrated toward the upper calyx during stone fragmentation. Mean ULI angle was significantly wider in patients whose stone migrated (120.2 ± 20.5 versus 102.2 ± 21.4, P = 0.004, 99 % CI = 6.04–29.9). A ULI angle of 117.5° was the critical angle, above which the rate of stone migration rose significantly (P < 0.008). One-session stone-free rate was significantly higher in patients without stone migration (P = 0.03). In patients with a solitary renal pelvis stone and significant hydronephrosis, a wider ULI angle was associated with a greater likelihood of stone scattering which could potentially affect the outcome of PCNL with pneumatic lithotriptor. A cut-off angle of 117.5° was the critical angle, above which access via a calyx other than the lower calyx (example: middle or upper calyx) seems advisable. © Springer-Verlag Berlin Heidelberg 2014.


Aminsharifi A.,Shiraz University of Medical Sciences | Aminsharifi A.,Shaheed Faghihi Hospital | Hosseini M.-M.,Shiraz University of Medical Sciences | Khakbaz A.,Shiraz University of Medical Sciences
Urological Research | Year: 2013

To prospectively compare the outcome of laparoscopic pyelolithotomy (LP) versus percutaneous nephrolithotomy (PCNL) in patients with a solitary renal pelvis stone larger than 30 mm. We analyzed demographic and perioperative parameters and intermediate outcome in 30 adults who underwent transperitoneal LP for solitary renal pelvis stone larger than 30 mm (Group I) and compared the results with 30 patients who underwent PCNL (Group II). The two groups were matched for age, sex and stone size (Group I 35.3 ± 7.33 mm, Group II 36.6 ± 7.0 mm; P = 0.47). Mean operative time was significantly longer in LP group (120.5 ± 39.94 min versus 98.1 ± 23.28 min; P = 0.01, 95 % CI 5.43-39.23). Stone-free rate after LP was significantly higher than after PCNL (100 % versus 76.7 %; P = 0.01). On the discharge day, no residual stone was found in LP group, and significant residual stone (mean size 9.8 mm, range 7-15 mm) was found in seven patients (23.3 %) in PCNL group. After the ancillary procedures, the stone-free rates were 100 % in LP and 96.6 % in PCNL group at the end of follow-up. The average overall treatment cost was significantly lower in LP (683.9 USD versus 815.9 USD; P>0.001). Mean postoperative decreases in hemoglobin was similar in both groups. Given adequate laparoscopic experience, for patients with a solitary renal pelvis stone larger than 3 cm, LP can be considered as an appropriate second choice to PCNL. It can be a potentially cost-effective treatment option in terms of one-session stone-free rate and postoperative complications. However, the potential benefits of LP need to be weighed against the more invasive nature of this procedure.© Springer-Verlag Berlin Heidelberg 2013.


Aminsharifi A.,Shiraz University of Medical Sciences | Aminsharifi A.,Shaheed Faghihi Hospital | Shakeri S.,Shiraz University of Medical Sciences | Yousofzade J.,Shiraz University of Medical Sciences | Pakbaz S.,Shiraz University of Medical Sciences
Urologia Internationalis | Year: 2011

Purpose: To evaluate the application of a reversed intact ileal patch for augmentation cystoplasty in terms of improvements in bladder urodynamics and to eliminate the need for bowel anastomosis in an experimental model. Methods: 12 cross-bred adult dogs were used for reversed seromuscular ileocystoplasty with intact bowel segment. The procedure was comprised of selecting a 7- to 10-cm ileal loop from about 20 cm proximal to the ileocecal valve. The seromuscular layer of the ileal loop from its antimesenteric aspect was sutured to the bladder mucosa of the previously bivalved bladder with running stitches. Results: 10 animals survived and completed their 4-week follow-up period. Postoperative urodynamic study revealed a 26% increase of mean maximal cystometric capacity [from 226 to 285 ml (p = 0.002)] and a significant increase in mean bladder compliance [from 11.8 to 17.8 ml/cm H2O (p = 0.002)]. Mean maximal detrusor filling pressure decreased significantly from 20 to 16.1 cm H2O (p = 0.011). Histopathologic examination of the augmented bladder showed complete epithelialization of the serosal surface of ileum with layers of transitional urothelium. Conclusions: The early results of this less invasive technique were promising in terms of improvements in bladder urodynamic variables and growth of transitional urothelium. Longer follow-up is necessary to show the durability of these effects. Copyright © 2010 S. Karger AG, Basel.


Aminsharifi A.,Shiraz University of Medical Sciences | Aminsharifi A.,Shaheed Faghihi Hospital | Haghpanah R.,Shiraz University of Medical Sciences | Haghpanah S.,Shiraz University of Medical Sciences
Urolithiasis | Year: 2014

To determine the magnitude of renal displacement (a major cause of access failure or loss) during the renal access steps in percutaneous nephrolithotomy (PCNL), investigate predictors of excessive renal displacement, and compare the effect of one-stage versus gradual dilation on renal displacement during access. Sixty-six adult patients undergoing PCNL were randomized into two groups containing 33 patients each: Group 1 underwent gradual tract dilation with Alken metal dilators, and Group 2 received one-stage tract dilation. In each patient, maximum renal displacement was measured in three planes (cephalocaudal, anteroposterior, and mediolateral) during the three access steps (needle puncture, Alken guide insertion, and dilator advancement). The patients' demographic data and intraoperative parameters were compared. In both groups, net renal displacement during the three access steps was in the cephalad, medial, and anterior directions. There were no significant differences in the magnitude of renal displacement in patients with gradual versus one-stage tract dilation. Renal displacement was significantly more pronounced in all planes and in all access steps in female patients and in those with no previous history of open stone surgery on the ipsilateral kidney. High body mass index (BMI) showed a significant negative correlation with cephalad and anterior renal displacement, but not with medial displacement. Three-dimensional movement of the kidney during percutaneous access in PCNL is similar when gradual versus one-stage tract dilation is used. Inherent patient characteristics, such as female sex, BMI, and a previous ipsilateral flank scar are major determinants of the magnitude of renal displacement during the PCNL access steps. © 2013 Springer-Verlag Berlin Heidelberg.


Aminsharifi A.,Shaheed Faghihi Hospital | Taddayun A.,Shaheed Faghihi Hospital | Niroomand R.,Shaheed Faghihi Hospital | Hosseini M.-M.,Shaheed Faghihi Hospital | And 2 more authors.
Journal of Urology | Year: 2011

Purpose Previous renal surgery is a relative contraindication to laparoscopic nephrectomy because adhesion formation makes surgical dissection difficult. We determined whether previous surgery at the same anatomical site would affected the surgical outcome in patients who underwent transperitoneal laparoscopic nephrectomy. Materials and Methods During the study period 79 consecutive patients who underwent transperitoneal laparoscopic nephrectomy were evaluated prospectively. All patients had symptomatic nonfunctioning small or hydronephrotic kidneys. Patients were divided into 29 with and 50 without prior surgery at the same anatomical site. Previous surgery included open nephrolithotomy in 16 patients, percutaneous nephrolithotomy in 8, open and percutaneous nephrolithotomy in 3, pyelolithotomy in 1 and pyeloplasty in 1. Results Patients who underwent prior surgery were older than patients who did not (average age 46.6 vs 34.9 years, p = 0.008). Other patient characteristics, including gender ratio, body mass index and side of surgery, did not differ significantly between the 2 groups. Mean operative time was longer in patients with previous surgery than in the other group (98.6 vs 62.3 minutes, p = 0.03). Other operative data, including blood loss, intraoperative and postoperative complications, open conversion and hospital stay, were similar in the groups. One case per group was converted to open surgery due to difficult pedicle dissection. Conclusions Transperitoneal laparoscopic nephrectomy in patients with a history of ipsilateral renal surgery can be done safely in timely fashion. Although mean operative time was longer, there was no significant increase in the operative complication rate in patients with prior surgery. © 2011 American Urological Association Education and Research, Inc.

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