The visual percutaneous nephrolithotomy versus the conventional percutaneous nephrolithotomy in treatment for renal...

To report our initial experience using a self-made optical system to visually identify the quality of the chosen access before the operating tract dilation.

We retrospectively reviewed the data on patients with renal stones treated by percutaneous nephrolithotomy (PCNL) in our hospital. The patients were divided into Groups A and B, according to those who received treatment by visual PCNL and conventional PCNL modalities, respectively. Based on the degree of hydronephrosis, the patients in each group were further divided into two subgroups, the patients with mild hydronephrosis (subgroup 1) and the patients with moderate or severe hydronephrosis (subgroup 2). The demographics and perioperative parameters were analyzed.

The study included 124 patients who underwent PCNL. Group A (N.=62): 47 patients were assigned to subgroup 1 and 15 to subgroup 2; group B (N.=62): 40 patients were assigned to r subgroup 1 and 22 to subgroup 2. The demographics were not significantly different between Group A and Group B (P>0.05). The puncture times were shorter in Group A and in subgroups (P<0.01), whereas the access loss rates were not significantly different (P>0.05). The mean decrease in hemoglobin levels, repuncture rates, blood transfusions and hospitalization times in Group A and Group A subgroup 1 were significantly lower than in Group B and Group B subgroup 1, respectively, (P<0.05), but no significant differences in subgroup 2 (P>0.05). When the complications were compared, the collecting system injury rates were significantly different between the two groups and in subgroup 1 (P<0.05). However the rates of fever and urinary sepsis were not statistically different in the two groups and in the subgroups (P>0.05).

We found that visual PCNL was a safe and efficacious treatment for renal stones that may be considered as an alternative to conventional PCNL, especially in patients with mild hydronephrosis. Further prospective randomized controlled trials are needed to confirm the results of this study.