Is percutaneous nephrolithotripsy still a reasonable treatment option for large upper ureteric stones?

Abstract

Objective: To assess the efficacy of standard percutaneous nephrolithotripsy (PNL) in patients with large upper ureteric stones. Materials and methods:Between September 2009 and March 2011, 27 patients underwent standard PNL for renal stones or large upper ureteric stones. The stones were located between the ureteropelvic junction and 4th lumbar vertebra. Stone burden, success rate, operating time, access, hemoglobin drop, analgesic requirement, serum creatinine level, hospital stay, and complications were evaluated. Results:The mean stone burden was 374.1 mm 2 and the operating time was 73.3 min. The total success rate was 85.1%. Single access was used in 26 (96.2%) patients and a second access was necessary in 1 (3.8%) patient. Access was achieved to the upper, middle, and lower calix in 3 (10.7%), 21 (75%), and 4(14.3%) patients, respectively. The pre-and postoperative serum creatinine levels were 1.0±0.2 and 1.1±0.3 mg/dL, respectively (p>0.05). The mean hemoglobin decrease was 2.1 mg/dL, analgesic requirement was 230.7 mg, and hospital stay was 2.3 days. The total complication rate was 29.6%. Open surgery was required in 1 (3.7%) patient. The blood transfusion rate was 11.1%. Fever (>38.5°C), pelvic perforation, and prolonged urinary drainage were seen in 2 (7.4%), 1 (3.7%), and 1 (3.7%) patient, respectively. Auxiliary procedures were needed in 4 (14.9%) patients (extracorporeal shock wave lithotripsy in 2, and ureteroscopy and double J stenting in 1 patient each). Conclusion:PNL is still a reasonable procedure for treating large upper ureteric stones, and it can be performed safely with a favorable outcome in experienced hands. Key words:Complications; lithotripsy; percutaneous; treatment outcome; ureteral calculi. ÖZETAmaç: Büyük çaplı üst üreter taşı olan olgularda standart perkütan nefrolitotripsinin (PNL) etkinliğini değerlendirmek. Gereç ve yöntem:Eylül 2009 ile Mart 2011 tarihleri arasında 27 hastaya böbrek taşı ve/veya büyük çaplı üst üreter taşı nedeniyle standart PNL uygulandı. Taşların yerleşimi üreteropelvik bileşke ile 4. lomber vertebra arasında idi. Taş yükü, başarı oranı, operasyon süresi, giriş, hemoglobin düşüşü, analjezik gereksinimi, serum kreatinin düzeyi, hastanede kalış süresi ve komplikasyonlar değerlendirildi. Bulgular:Ortalama taş yükü 374.1 mm² ve operasyon süresi 73.3 dakika idi. Genel başarı oranı %85.1 idi. Hastaların 26'sına (%96.2) tek giriş ve 1'ine (%3.8) ise iki giriş yapıldı. Olguların 3'ünde (%10.7) üst kaliksten, 21'inde (%75) orta kaliksten, 4'ünde (%14.3) alt kaliksten giriş sağlandı. Operasyon öncesi serum kreatinin düzeyi 1.0±0.2 mg/dL ve operasyon sonrası serum kreatinin düzeyi ise 1.1±0.3 mg/dL idi (p>0.05). Ortalama hemoglobin düşüşü 2.1 mg/dL, ağrı kesici gereksinimi 230.7 mg ve hastanede kalış süresi 2.3 gün idi. Genel komplikasyon oranı %29.6 idi. Bir (%3.7) hastada açık cerrahi gereksinimi oldu. Kan transfüzyon oranı %11.1 idi. Ateş (>38.5°C), pelvik perforasyon ve uzamış idrar drenajı sırasıyla 2 (%7.4), 1 (%3.7), 1 (%3.7) olguda gözlendi. Yardımcı ...