TECHNIQUES TO IMPROVE OUTCOMES OF PERCUTANEOUS NEPHROLITHOTOMY: SINGLE CENTER EXPERIENCE

Authors

  • Sarwar Noori Mahmood Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.

DOI:

https://doi.org/10.17656/jsmc.10143

Keywords:

Flexible nephroscope, Percutaneous nephrolithotomy (PCNL), Renal calculus

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.

References

Canes D, Hegarty NJ, Kamoi K, et al. Functional outcomes following percutaneous surgery in the solitary kidney. J Urol 2009; 181:154–160. DOI: https://doi.org/10.1016/j.juro.2008.09.023

Falahatkar S, Panahandeh Z, Ashoori E, et al. What is the difference between percutaneous nephrolithotomy in patients with and without previous open renal surgery? J Endourol 2009; 23:1107–1110. DOI: https://doi.org/10.1089/end.2008.0630

Caione P, Matarazzo E, Battaglia S. Stone treatment in children: where we are today? Arch Ital Urol Androl 2010; 82:45–48.

jean j.M.C.H. de la rosetta, Maria P. Laguana, jeans J . rassweiller, Pierre conort. Training in percutaneous nephrolithotomy- A critical review. European urology (2008); 54:994-1003. DOI: https://doi.org/10.1016/j.eururo.2008.03.052

Cecilia M. Cracco, Cesar M. Scoffone and Roberto M. Scarpa. New developments in percutaneous techniques for simple and complex branched stones. current opinion in urology (2011);21:000-000. DOI: https://doi.org/10.1097/MOU.0b013e3283436d32

Park S, Pearle MS. Imaging for percutaneous renal access and management of renal calculi. Urol Clin North Am 2006;33:353-364. DOI: https://doi.org/10.1016/j.ucl.2006.03.003

Smith RC, Rosenfield AT, Choe KA,et al . Acute flank pain: Comparison of non-contrast–enhanced CT and intravenous urography. Radiology 1995;194:789–794. DOI: https://doi.org/10.1148/radiology.194.3.7862980

Thiruchelvam N, Mostafid H, Ubhayakar G. planning percutaneous nephrolithotomy using multidetector computer tomography urography , multiplanar reconstruction and three-dimensional reformatting. BJU Int 2005;95:1280-4 (3b/c). DOI: https://doi.org/10.1111/j.1464-410X.2005.05519.x

Helal M, Black T, Lockhart J, Figueroa TE. The Hickman peel-away sheath: alternative for pediatric percutaneous nephrolithomy. J Endourol 1997;11:171-2 . DOI: https://doi.org/10.1089/end.1997.11.171

Preminger GM, Assimos DG, Lingeman JE et al: Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol 2005; 173: 1991.

Sarwar Noori Mahmood. Percutaneous nephrolithotomy: our initial experience with 125 cases. JSMC, 2016; 6 (2) :84-91. DOI: https://doi.org/10.17656/jsmc.10091

S. V. Krishna Reddy , Ahammad Basha Shaik . Outcome and complications of percutaneous nephrolithotomy as primary versus secondary procedure for renal calculi. Int Braz J Urol. 2016; 42(2): 262–269. DOI: https://doi.org/10.1590/S1677-5538.IBJU.2014.0619

Al-Kohlany KM, Shokeir AA, Mosbah A, et al. Treatment of complete staghorn stones: a prospective randomized comparison of open surgery versus percutaneous nephrolithotomy. J Urol. 2005 Feb; 173(2):469-73. DOI: https://doi.org/10.1097/01.ju.0000150519.49495.88

Chandhoke PS. Cost-effectiveness of different treatment options for staghorn calculi. J Urol. 1996 Nov; 156(5):1567-71. DOI: https://doi.org/10.1016/S0022-5347(01)65448-X

Srisubt A, Potisat S, Lojanapiwat B, Setthawong V, Laopaiboon M.

Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev 2009; 7 : CD007044.

Fuchs G, Miller K, Rassweiler J, Eisenberger F. Extracorporeal shockwave lithotripsy: one-year experience with the Dornier lithotripter. Eur Urol 1985;11: 145–9. DOI: https://doi.org/10.1159/000472479

Rodrigues NN, Claro JA, Ferreira U. Is percutaneous monotherapy for staghorn calculus still indicated in the era of extracorporeal shockwave lithotripsy? J Endourol 1994;8: 195–7. DOI: https://doi.org/10.1089/end.1994.8.195

Arvind P. Ganpule, Mahesh R. Desai. What’s new in percutaneous nephrolithomy. Arab journal of urology 2012;10:317-323 DOI: https://doi.org/10.1016/j.aju.2012.07.005

kukreja R, Desai M, Patel S et al. factors affecting blood loss during percutaneous nephrolithomy: prospective study. J endourol2004; 18:715-722. DOI: https://doi.org/10.1089/end.2004.18.715

Arvind P. Ganpule. Amit Satish Bhattu. Mahesh R. Desai. PCNL in the twenty-first century: role of Microperc, Miniperc, and Ultraminiperc. world I Urol 2014; DOI: https://doi.org/10.1007/s00345-014-1415-1

Jackman SV, Docimo SG, Cadeddu JA, et al . The ‘mini-perc’ technique: a less invasive alternative to percutaneous nephrolithotomy. World J Urol 1998;16: 371–46. DOI: https://doi.org/10.1007/s003450050083

Jackman SV, Hedican SP, Peters CA, Docimo SG. Percutaneous nephrolithotomy in infants and preschool age children: experience with a new technique. Urology 1998;52: 697–701. DOI: https://doi.org/10.1016/S0090-4295(98)00315-X

Mahesh Desai, Prashant Jain, Arvind Ganpule, Ravindra Sabnis, Snehal Patel and Prajay Shrivastav. Developments in technique and technology: the effect on the results of percutaneous nephrolithotomy for staghorn calculi. BJUI 2009; 104, 542–548. DOI: https://doi.org/10.1111/j.1464-410X.2009.08472.x

Beaghler MA, Poon MW, Dushinski JW, Lingeman JE. Expanding role of flexible nephroscopy in the upper urinary tract. J Endourol 1999; 13:93–7. DOI: https://doi.org/10.1089/end.1999.13.93

Arvind P. Ganpule, Shashikant Mishra, and Mahesh R. Desai. Multiperc Versus Single Perc with Flexible Instrumentation for Staghorn Calculi. Journal of endourology 2009; 23: 1675–1678. DOI: https://doi.org/10.1089/end.2009.1535

Williams SK, Leveillee RJ. A single percutaneous access and flexible nephroscopy is the best treatment for a full staghorn calculus. J Endourol 2008;22:1835–183. DOI: https://doi.org/10.1089/end.2008.9795

Undre S, Olsen S, Mustafa N, Patel A. ‘‘Pass the ball!’’ Simultaneous flexible nephroscopy and retrograde intrarenal surgery for large residual upper-pole staghorn stone. J Endourol 2004;18:844–847. DOI: https://doi.org/10.1089/end.2004.18.844

Preminger GM, Assimos DG, Lingman JE, Nakada SY, Pearle MS, Wolf JS. AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol 2005;173:1991-2000. DOI: https://doi.org/10.1097/01.ju.0000161171.67806.2a

Published

2017-12-21

How to Cite

1.
Mahmood S. TECHNIQUES TO IMPROVE OUTCOMES OF PERCUTANEOUS NEPHROLITHOTOMY: SINGLE CENTER EXPERIENCE. JSMC [Internet]. 2017 Dec. 21 [cited 2024 Jul. 15];7(4):399-405. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10143

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