Effects of Previous Unsuccessful Extracorporeal Shockwave Lithotripsy Treatment on the Performance and Outcome of Percutaneous Nephrolithotomy

Abstract

BACKGROUNDMajority of renal stones diagnosed today are below 2 cm, perhaps due to easy and early accessibility to x-ray and ultrasonography. The preferred treatment of < 1 cm stone is extracorporeal shockwave lithotripsy (ESWL), while standard of care for renal stone > 2 cm is percutaneous nephrolithotomy (PCNL). The procedure of choice for 1 -2 cm renal stones is still a subject of debate. Controversy exists with regard to optimum management of these stones by percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) with reference to stone clearance, hospital stay and complications. The primary goal while treating renal stones is to achieve complete clearance, while causing minimal morbidity to the patient. Treatment of renal stone depends on stone size and location plus patient related factors including anatomy of pelvicalyceal system. In our study, previous ESWL treatment had no influence on the PCNL stone-free rate, operation time, incidence of postoperative complications and LOS in patients with similar stone burdens. However, bleeding during PCNL was more prevalent in the ESWL-treated patients, so close attention should be paid to bleeding in patients who have been pretreated with ESWL.The objective of this study is to evaluate the effects of previous unsuccessful extracorporeal shockwave lithotripsy (ESWL) treatment on the performance and outcome of percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODSOf 115 PCNL procedures performed in our institute with similar stone burden and number of accesses was included in the present study. We categorised the study patients into two groups according to whether they underwent ESWL within 1 year prior to PCNL or not. Accordingly, Group 1 comprised of 42 (36.5%) ESWL-treated patients and Group 2 comprised of 73 (63.4%) non-ESWLtreated patients. RESULTSThere were no statistically significant differences between the groups for length of hospital stay (LOS), nephrostomy tube removal time and the presence of residual stones. When we evaluated the groups for both the preoperative and postoperative haemoglobin (Hb) drop and blood transfusion rate, manifest Hb declined and more transfusions were required in the ESWL-treated patients (both P= 0.01). CONCLUSIONMany patients who undergo PCNL have undergone ESWL treatment beforehand. The renal side-effects of ESWL are well known, the duration of which varies between studies. In the present study, we found that previous ESWL had an effect on bleeding during the PCNL procedure.