Percutaneous nephrolithotomy (PCNL) is a classic operation for the presence of large calculi in the kidneys. A channel size of 24–30 Fr is a standard surgical access incision. The smaller surgical access incisions (<18 Fr) were originally introduced in pediatrics, but are now increasingly used in the treatment of adults.
Access to the renal cavity system in most clinics is performed under X-ray control, but the combination of this method with ultrasound control demonstrates a number of advantages over the mono-control method.
The objective: to analyze the results of treatment of patients with kidney stones by the method of mini-percutaneous nephrolithotomy (mini-PCNL) under fluoroscopic and combined (ultrasound and fluoroscopic) control, to determine the optimal control method during puncture, dilatation and intraoperative assessment of Stone-free status.
Materials and methods. For a realization of the research aim, a retrospective analysis of medical documentation was conducted on the basis of the “Institute of Urology named after Academician O. F. Vozianov of the National Academy of Medical Sciences of Ukraine”. The study included 178 medical cards of patients from 18 to 72 years old with kidney stones, in which mini-PCNL was performed under combined control in 95 cases (Group 1), and under fluoroscopic control (Group 2) in 83 cases.
Clinically relevant parameters were studied, including the dynamics of postoperative serum creatinine and hemoglobin, blood loss, total operative time, duration of ionizing radiation, and duration of hospital stay. Postoperative complications that occurred in patients during their stay in the hospital were classified according to the Clavien-Dindo system.
To assess the Stone-free state at the stage of discharge from the hospital, the patients were performed kidney ultrasound and general urography. The Student’s t-test and the chi-square test were used to compare anthropometric indicators and clinical results associated with both methods of control in mini-PCNL. Statistical data analysis was performed using program STATISTICA 10 (StatSoft.Inc). Data were calculated as mean ± standard deviation or percentage with a significance level of p<0.05.
Results. Groups of patients were identical by age, sex, anthropometric parameters, and characteristics of calculi. However, the average operation time for mini-PCNL under combined control was significantly shorter (96.2±23.0 vs. 127.4±33.1 min; p<0.05). The average duration of ionizing radiation was significantly shorter in the group with combined control (10.6±4.8 vs. 284.0±86.0 sec; p<0.05).
Conclusions. Combined control offers a wider range of incision access to the renal cavity system and the creation of a safe percutaneous working channel in real-time mode. Mini-PCNL under combined control has comparable clinical results to intervention under fluoroscopic control with significantly lower indicators of the duration of the operation time and a reduction in the radiation time of the patient and the operating team.
