[Percutaneous lithotripsy: how to make it safer. Personal experience]

Percutaneous surgery (PCN) is now a routinary method for the treatment of the majority of renal stones, since it has become safer than in the past, because, thanks to new endourologic instruments and to ultrasounds, it has been possible to reduce the mistakes of the renal puncture. Furthermore, the use of balloons catheters for the dilatation of the nephrostomic channel allows the reduction of operating time and hemorrhage risk. In this paper, the authors expose their experience in PCN operations carried out with the help of X-ray and ultrasonography, during the indirect laying of the stones, and the use of a balloon catheter for the creation of a working channel.

The Authors report their experience with the use of ultrasounds and concomitant X-rays for renal puncture, and of balloon catheter as track dilator, during 68 consecutive PCN carried out for renal lithiasis, 55 primary and 13 secondary to ESWL treatments; every stone has been cracked by a "Swiss-lithoclast" balistic lithotripter. For every patient, time of operation, complications and hospitalization-days were registered.

Only three patients (4.4%) had haemorrhages and in one case of A-V fistula nephrectomy was necessary. The patients stayed in hospital approx. four days; the nephrostomic drainage was generally removed 3 days after the operation.

The very low incidence of complications and the very short time of hospitalization suggest that ultrasounds and balloon-catheters may be useful to this surgery and may make it safer than in the past. Moreover, ultrasonography reduces the rate of X-rays exposition for operators and patients; the cost of the balloon is easily balanced by the reduction of operating times and hospitalization-days.