Is percutaneous nephrolithotomy suitable for patients with scoliosis: single-center experience

To present our experience with percutaneous nephrolithotomy (PCNL) for treating urolithiasis in patients with scoliosis.

We retrospectively reviewed the records of 5 patients with congenital scoliosis who had undergone PCNL. The demographic data, number and location of access sites, hemoglobin values, stone analyses, and complications were studied. Of the 5 patients, 3 had a history of failed shock wave lithotripsy, and 2 had undergone stone intervention in same kidney. All procedures were performed with the patient in the prone position after retrograde ureteral catheterization. Tract dilation was accomplished using Amplatz dilators of ≤24F or 28F. PCNL was accomplished using a rigid nephroscope with ultrasound and/or pneumatic lithotriptor with the patient under general anesthesia.

Of the 5 patients, 2 were men and 3 were women, and the mean age was 36.8 years (range 32-44), and the mean stone burden was 475 mm2 (range 400-1350). The mean operative and fluoroscopic screening time was 62.2 minutes (range 50-90) and 3.1 minutes (range 2-5), respectively. Of the 5 patients, 3 were stone free after PCNL. Auxiliary procedures were required in 2 patients and included second-look PCNL in 1 and ureteroscopy in 1. Thus, all 5 patients were rendered completely stone free after the final procedure. No severe complications, either from anesthesia or the surgical procedure, were observed in the patients. Two of the patients had to stay for 24 hours to screen for pulmonary and cardiac signs in the intensive care unit after PCNL.

Larger stones or shock wave lithotripsy-refractory stones can be managed safely and effectively with PCNL in patients with scoliosis when they have been appropriately assessed before PCNL.