Bilateral simultaneous percutaneous nephrolithotomy versus staged approach: a critical analysis of complications and renal function

Abstract

SUMMARY INTRODUCTION: Patients with bilateral kidney stones and burdened by large stones are challenging cases for endourologists. Simultaneous bilateral percutaneous nephrolithotomy (sbPCNL) is an option; however, it may be accompanied by important morbidity. An alternative is a staged PCNL, operating one side each time. Herein, we compare the impact of sbPCNL and staged PCNL on complication rates and renal function. METHODS: Patients who underwent sbPCNL or staged bilateral PCNL with a frame time of 6 months were searched in our prospectively collected kidney stone database. Groups were compared for age, gender, body mass index (BMI), comorbidities (classification by the American Society of Anesthesiology - ASA), stone size, Guy's score, stone-free status, renal function, blood loss, blood transfusion rate, complication rate, and length of hospital stay. RESULTS: Twenty-six patients and 52 kidney units were enrolled. The mean operative time was 134.7 min. Only 11.3% of cases had complications, all of them minor (Clavien ≤ 2). Overall, the stone-free rate was 61.50%. Comparing the groups, there was a significantly longer operative time in the sbPCNL group (172.5 vs. 126.3 min; p=0.016), as well as a higher transfusion rate (12.5% vs. 5.6%; p=0.036). There was no statistically significant difference in creatinine levels between the groups. Regarding the stone-free rate, there was a significantly higher proportion of patients in the staged PCNL group (64.9% vs. 43.8%; p=0.012). CONCLUSION: sbPCNL is a safe procedure; however, when compared to staged procedures it has a higher transfusion and lower stone-free rate.

Bilateral percutaneous mininephrolithotripsy: simultaneous or staged approach?

“…Основной риск связан с возможным травматическим повреждением обеих почек, возникновением послеоперационных осложнений и острым повреждением почек [2]. [11].…”

“…Достаточно много зарубежных публикации посвящено преимуществам одномоментной двусторонней нефролитотрипсии, к которым можно отнести [11,13 ] В нашем исследовании также было отмечено уменьшение суммарной продолжительности операции (121,0 ± 6,1 мин) у пациентов основной группы в сравнении со 147,0 ± 7,35 минутами у пациентов контрольной группы (суммарное время оперативного вмешательства в период первой и второй госпитализаций) и уменьшение продолжительности госпитализации (4,50 ± 0,23 дня) у пациентов основной группы по сравнению с пациентами группы контроля (10,0 ± 0,5 дня). Осложнения, наблюдаемые нами в двух группах, были сопоставимы между собой.…”