Percutaneous nephrolithotomy in abnormal kidneys: single-center experience.
N P Gupta1, Saurabh Mishra, Amlesh Seth
1Department of Urology, All India Institute of Medical Sciences, New Delhi, India. narmadagupta@gmail.com
Urology
|February 6, 2009
Summary
Percutaneous nephrolithotomy (PCNL) offers excellent stone clearance in anomalous kidneys, even for large or shock wave lithotripsy-refractory stones. Careful technique is crucial for successful outcomes in these complex cases.
Area of Science:
- Urology
- Nephrology
- Surgical Innovation
Background:
- Renal anomalies present unique challenges for kidney stone treatment.
- Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stones.
- Outcomes of PCNL in patients with congenital renal abnormalities are not well-established.
Purpose of the Study:
- To evaluate the efficacy and safety of PCNL in patients with various renal anomalies.
- To assess the stone-free rates and complication profiles of PCNL in anomalous kidneys.
Main Methods:
- Retrospective analysis of 46 patients (52 renal units) with renal abnormalities undergoing PCNL between 2000 and 2007.
- Patients included those with fusion anomalies (horseshoe, crossed fused ectopia), malrotation, and ectopic pelvic kidneys.
- Laparoscopic-assisted PCNL was used for pelvic ectopic kidneys; tubeless PCNL was performed in select cases.
Main Results:
- Complete stone clearance was achieved in all renal units (45 on first attempt, 7 with re-look).
- 88.5% of stones were cleared via a single tract; 6 cases required two tracts.
- Mean operative time was 82.5 minutes, mean hospital stay was 3.2 days, with a mean hemoglobin decrease of 1.4 g/dL.
Conclusions:
- PCNL is a technically demanding but effective treatment for kidney stones in anomalous kidneys.
- Excellent stone clearance rates are achievable, particularly for large or ESWL-refractory stones.
- Careful surgical technique is paramount for successful PCNL outcomes in complex renal anatomy.
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