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Effect of percutaneous nephrolithotomy on differential renal function as measured by mercaptoacetyl triglycine
James R Chatham1, Thomas E Dykes, William G Kennon
1Urology Service, Tripler Army Medical Center, Honolulu, Hawaii, USA.
Objectives:
To determine the impact on differential renal function of percutaneous nephrolithotomy for complex renal calculi.
Methods:
From July 1999 to December 2000, 45 patients underwent percutaneous nephrolithotomy. Of these, 19 agreed to participate in the study. All patients completed a quantitative assessment of differential renal function preoperatively and postoperatively with technetium 99m mercaptoacetyl triglycine nuclear renography and serum creatinine measurements.
Results:
The mean patient age was 49 years (range 11 to 75) for the 13 female and 6 male patients. The mean stone burden was 1432 mm(2) (range 156 to 5220). The mean surgical time was 2.57 hours (range 1.17 to 5.08). The median hospital stay was 2.0 days (range 1 to 19). Of the 19 patients, 13 (68%) were stone free after one procedure. Four patients underwent ureteroscopy with stone extraction for residual fragments. One patient underwent secondary extracorporeal shock wave lithotripsy. One patient underwent nephrectomy for poor renal function. Renal function, for the entire group, increased from 36.8% preoperatively to 38.5% postoperatively. Renal function was preserved in 16 (84%) of 19 patients, including improvement of function in 7 (37%) of 19 patients. Serum creatinine was unchanged in the two groups.
Conclusions:
Percutaneous nephrolithotomy does not result in loss of renal function when treating complex renal calculi as measured by nuclear scintigraphy. Operative and hospitalization times were decreased compared with historical open nephrolithotomy and stone clearance was similar.