Percutaneous nephrolithotomy with ultrasonography‐guided renal access: experience from over 300 cases

Abstract

OBJECTIVE To report our experience with over 300 patients treated with percutaneous nephrolithotomy (PNL), for although PNL was established as a treatment in the 1970s, its use diminished with the introduction of extracorporeal shockwave lithotripsy (ESWL); clinical experience with ESWL showed its limitations, and the role of PNL for treating urolithiasis was redefined, which with improvements in instruments and lithotripsy technology has expanded the capability of percutaneous stone disintegration. PATIENTS AND METHODS The study included 315 patients (156 males, 159 females, aged 13–85 years) treated with PNL in our department between 1987 and 2002. The mean (range) stone diameter was 27 (7–52) mm. The kidney was punctured under ultrasonography guidance via a lower‐pole calyx whenever possible. The working channel was dilated using an Alken dilator under X‐ray control. If necessary, a flexible renoscope was used. Ultrasonic, pneumatic and laser probes were used for lithotripsy. RESULTS Four weeks after treatment the total stone‐free rate was 96.5%; 45.7% of all patients were primarily stone‐free, 21.3% had clinically insignificant residual stones that passed spontaneously within 4 weeks after PNL, and 33% of the patients needed auxiliary measures (a second PNL, ESWL, ureterorenoscopy). Overall, the early complication rate was 50.8%, the most common complications being transient fever (27.6%), clinically insignificant bleeding (7.6%) or both (3.2%); 3.5% of the patients developed urinary tract infections (with no signs of urosepsis), 3.2% had renal colic and 2.9% upper urinary tract obstruction. One patient (0.3%) developed acute pancreatitis after PNL; one died from urosepsis and one needed selective angiographic embolization of the punctured kidney due to bleeding. No patient required transfusions and there were no injuries to neighbouring organs. CONCLUSIONS These results show that PNL causes no significant blood loss or major complications in almost all patients. Two aspects may especially reduce the potential complications: ultrasonography‐guided renal puncture and using PNL in an experienced centre. PNL is a highly efficient procedure that provides fast and safe stone removal.

Complications rates of non-oncologic urologic procedures in population-based data: a comparison to published series

“…For percutaneous nephrostomy, two published single-center series had significantly lower mortality rates than the population-based data set (0.31% and 0.32% vs. 2.7%, p < 0.001). The overall rate of complications in the population-based data was higher than published data for percutaneous nephrostomy performed for urinary obstruction (10.0% vs. 3.4%, p < 0.001), but similar to the rate observed when nephrostomy was performed with percutaneous nephrolithotomy (10.1%) (8,9).…”

“…The publications for each procedure are included in Table-2, along with the corresponding publication date, number of patients, and patient accrual period, when available (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

Types of Renal Calculi and Management Regimen for Chinese Minimally Invasive Percutaneous Nephrolithotomy

“…Type I and II cases had calculi in the upper ureteral, UPJ, or pelvic calculi combined with middle/severe hydronephrosis. The calculi could be satisfactorily removed with X-ray or B ultrasound by puncturing the renal middle calyx at the 11th intercostal or the subcostal space [10][11][12]. Although this puncture operation is simple, the upper calyx calculi can be easily removed because the channel is established through the lower calyx.…”

“…Two or more channels in this type should be established conventionally to complete the operation, thereby resulting in the highest residual rate. The use of an ultrasonic lithotripter (EMS) can significantly improve the efficiency of stone extraction and reduce the residual stones as well as the number of the established channels [10,12,13]. (3) Perfusion pressure should be maintained at the lowest possible rate during operation, and the operation time should be strictly controlled.…”

“…Plain abdominal radiograph or CT was repeated after the operation. For cases with more residual calculi, the second or third mini-PCNL was performed 5 to 7 days after the previous operation [10][11][12][13].…”