TECHNIQUES TO IMPROVE OUTCOMES OF PERCUTANEOUS NEPHROLITHOTOMY: SINGLE CENTER EXPERIENCE  


Sarwar Noori Mahmood a



a Department of Surgery, College of Medicine, University of Sulaimani.

 
 
Submitted: 20/8/2017; Accepted: 1/12/2017; Published 21/12/2017


ABSTRACT


Background 

Percutaneous nephrolithotomy (PCNL) has become a well established procedure for the management of renal calculi, and there success relies on appropriate preoperative planning and optimal percutaneous access. 

Objectives 

To evaluate the technique of percutaneous nephrolithotomy, at our center since 2009, and assess the results and outcomes. We compare our initial and late experience.

Materials and Methods

We retrospectively analyzed the medical records of patients who had undergone percutaneous nephrolithotomy at our center since 2009. We divided the patients into two groups depending on the changes and developments in instrumentation and strategies. To improve the results, we incorporated newer ancillary procedures such as flexible nephroscopy and minipercs for clearance. The first group comprised of (125) cases, from April 2009 to April 2010; and the second group comprised of (142) cases, from June 2015 to January 2016.

Results

Demographic data and stone characteristics such as stone burden, the number of stones, and stone laterality were not different between the two groups. The mean operative time, decrease in hemoglobin level, blood transfusion rate, and hospital stay continued to decline and the stone-free rate increased as our experience improved. Bleeding requiring a transfusion during the operation time that occurred in group one and two was 10(8%), 2 (1.40%) patients respectively, (p = 0.0067). The mean (range) hospital stay for group one and two were 1.48 (1-8) days, and 1.15 (1-4) days respectively, (p = 0.0087). Stone clearances rate in group one and two were 88.0%, and 95.08%, respectively (p= 0.001). 

Conclusion

The success of PCNL in patients with renal calculi is highly dependent on the optimal access into the targeted kidney. Higher success rate and decrease morbidity can be markedly improved with increasing experience, decrease the size of the access tract, preoperative access plan, and liberal use of flexible nephroscopy.

KEYWORDS

Flexible nephroscope, Percutaneous nephrolithotomy (PCNL), Renal calculus.