[Application of one-stop diagnosis and treatment plan in percutaneous nephrolithotomy for patients with complex renal...

To evaluate the safety and efficacy of preoperative computed tomography urography (CTU) three-dimensional reconstruction, intraoperative radiology and ultrasound guidance followed by percutaneous nephrolithotomy (PCNL) in the treatment of complex renal calculi.

We summarized the clinical data of 210 patients with complex renal calculi treated at our hospital from December 2008 to December 2011 in this retrospective study. In the one-stop diagnosis and treatment group (n = 119), the optimal puncture approach was designed according to CTU imaging and three-dimensional reconstruction. Percutaneous track was established by ultrasound and radiology guided puncture. PCNL was performed with EMS system. The control group (n = 91) underwent PCNL without radiological guidance. The success rate of puncture, mean accessing time, mean operative duration, intraoperative volume of blood loss and stone-free rate after one operative session were observed. Post-operative follow-ups were conducted until June 2012.

Compared to the control group, the one-stop diagnosis and treatment group showed a higher success rate of puncture [98.3% (117/119) vs 92.3% (84/91), P = 0.037], a shorter operative duration [97.8 ± 13.20 vs 110.0 ± 14.73 min, P = 0.043] and a higher stone-free rate after one operative session [92.4% (110/119) vs 83.5% (76/91), P = 0.037]. No significant difference was detected in the mean accessing time[15.3 ± 3.7 vs 13.9 ± 3.9 min, P = 0.398] or intraoperative volume of blood loss [195.8 ± 84.15 vs 263.3 ± 82.06 ml, P = 0.059]. No severe complications occurred. No recurrence of calculi was noted during the follow-up period.

One-stop diagnosis and treatment plan (CTU 3-D reconstruction plus radiology, ultrasound guidance followed by PCNL) may identify the puncture path, improve the successful rate of puncture and stone-free rates and reduce the complications of PCNL.