Percutaneous Nephrolithotomy for Renal Calculi:A Single Surgeon Experience
Iraqi Postgraduate Medical Journal,
2013, Volume 12, Issue 4, Pages 576-580
Percutaneous nephrolithotomy (PCNL) for renal calculi is one of the more challenging endourologic procedures.PCNL remains the procedure of choice for most stones that are more than 2 cm in size, complex staghorn calculi, some lower-pole stones, stones in caliceal diverticuli, and larger renal stones that are refractory to shock wave lithotripsy( SWL).
The purpose of this study was to evaluate the outcomes and complications in patients who were undergoing PCNL for renal calculi at our center.
PATIENTS AND METHODS:
From January 2011 to December 2012, a total of 216 patients who had renal stones underwent PCNL by the same surgical team at our institution. All patients were evaluated preoperatively with intravenous urography (IVU) and/or computerized tomography(CT). Data analysis included procedure time, length of hospital stay, number of access tracts, transfusion rates, other complications, and stone-free status. Percutaneous access was performed using C-arm fluoroscopy with patients in the prone position. The access tract was dilated with a balloon dilator or Amplatz dilators. Fragmentation of the stone burden was accomplished using an Ultrasonic lithotripter. No patients in this series underwent a tubeless technique. Nephrostomy tube was placed at the end of procedure and nephrostogram done in all patients on 2nd postoperative day.
Mean age was (42.43±13.17) yrs. The mean stone burden was (6.91±4.47)cm2 .The average procedure time was( 57.40±21.05) minutes. Mean pre and postoperative hemoglobin(Hb) levels were(13.43±1.34) and ( 11.71±1.86) g/dl respectively and Hb drop was ( 1.76±1.10) g/dl.PCNL via a single access tract was accomplished in( 93.51%) of procedures, while multiple tracts and intercostal access were used in( 4.62%) and (1.85% ) respectively of procedures.Mean fluoroscopy time during the whole procedure was (1.75±0.90) minutes.Mean hospitalization was (3.52±0.86) days. Stone-free rates at hospital discharge and at 3 months follow-up were (81.44%) and (92.07%), respectively. 30 patients received blood transfusion (13.88%).
PCNL is a safe and effective procedure for the management of renal stones. It has the advantages of lower morbidity, shorter hospital stay. The full of array of endourologic equipment and expertise remains essential to achieving a successful outcome.
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