engleski

Working hard in a small-volume center: Our experiences with percutaneus nephrolithotomy

Introduction Percutaneus nephrolihotomy (PCNL) is recognized as treatment option for staghorn stones, large stones, multiple stones, stones in inferior calyx or after failed ESWL therapy1, 2, 3. It is a very specific procedure that requires special equipment, instruments and training, all greatly affected with technological development. We will present our results as presentation that such procedure is well done and can be a part of a small-volume center „menu“. Methods First PCNL was performed at our department in 1986, but from 1994 till present day we usually perform about a 15 PCNL per year and so far 239 patients were treated with PCNL, within that number are 22 cases of patients with multiple PCNL. We do a single channel PCNL, with rigid instruments and we use electrokinetic as modality for fragmentation (rarely ultrasound probe). Only 165 medical histories were present for analysis since some medical histories were lost (war damage to archives) or patients were from another state. Average age of our patients was 53, 9 years (min:23, max:78) and was almost same for both sexes. Males were slightly predominant (ratio to female 1.13), and left side was affected in 52, 4%, with one case of bilateral PCNL. Average diameter of stones was 3.48 cm, but 51 stones were staghorn stones affecting at least 2/3 of collecting system. Mean anesthesia time was 130 minutes (min:45, max:360). Significant co- morbidity was present in 60.4% of patients, and 19, 5% of them had previous pyelolithotomy or nephrolithotomy (detailed in Table 1.) Results Placement of JJ stent was found to be necessary in 40.5% of patients and stents were removed at first control check-up. ESWL prior to PCNL was done in 50.6% (we do have tendency to do a bimodal- therapy) and in 45.7% of patients after PCNL. Numbers for ureterorenoscopy were much smaller: prior to PCNL in 4.8% and after in 13.4% (mostly as salvage procedure for urethral fragments). Complications were noted in 31, 7% cases: fever (more than 1 day) in 52 patients (32.1%), transfusion in 11 patients (6.8%), stein-strasse (treated with URS) in 4 patients, conversion to open-procedure in 3 patients and one nephrectomy (due to AV fistula, unable to do sclerosation). Rate of complication was correlated only to staghorn stones (Table 2.). No injury to adherent organs or mortality was recorded. Overall stone free rate was 73.8% (modified 83, 1% in those in whom a bimodal therapy was done) (detailed in Table 3.). Conclusion Although our SFR is slightly smaller, one must bear in mind a large number of staghorn stones4. Also we do have limited resources, so we don’t use laser or flexible instruments, but we do like a bimodal-therapy1, 2. However, our complication rates were as reported or even better, with practically no major complications1, 5, 6. This shows that with careful selection of patients even in small volume centers a PCNL can be offered as valid treatment option.

kidney; stones; percutaneus

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