Percutaneous nephrolithotomy in patients with spinal deformities.

Area of Science:

• Urology
• Nephrology
• Surgical Innovation

Background:

• Spinal deformities present unique challenges for kidney stone treatment.
• Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stones.

Purpose of the Study:

• To evaluate the feasibility and effectiveness of PCNL in patients with spinal deformities.
• To identify optimal surgical approaches and preoperative planning strategies for this patient group.

Main Methods:

• Retrospective analysis of 10 PCNL procedures in 8 patients with spinal deformities (1999-2008).
• Preoperative assessment included respiratory function, anatomical imaging (IVP/CT), and ultrasonography (US) for access planning.
• Procedures were performed in either prone or supine positions, with US-guided puncture.

Main Results:

• A 40% complication rate was observed, with 20% requiring blood transfusion and 10% experiencing major complications.
• Initial complete stone clearance was 55.5%, increasing to 66.6% after a second procedure.
• The overall stone-free rate at 3 months was 88.8%, with 44.4% requiring additional interventions (SWL, RIRS).

Conclusions:

• PCNL in spinal deformity patients is technically demanding, necessitating thorough preoperative evaluation and planning.
• Ultrasonography-guided access minimizes visceral injury.
• Supine PCNL offers cardiorespiratory and simultaneous access benefits, while prone positioning may provide better access.
• Combination therapy (PCNL with SWL or RIRS) enhances stone clearance.