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Percutaneous nephrolithotomy in previously operated patients: A prospective study
Anil Gulani1, Ujwal Kumar2, Sher Singh Yadav3
1Consultant Urology, Medanta, Ganganagar, Rajasthan, India.
Urology Annals
|April 26, 2021
Summary
Percutaneous nephrolithotomy (PCNL) is effective for kidney stones, even after prior surgery. Previous open surgery for kidney stones led to more complex PCNL procedures but similar outcomes and complication rates.
Area of Science:
- Urology
- Nephrology
- Surgical Innovation
Background:
- Renal stone surgery aims to remove kidney stones effectively.
- Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for kidney stone removal.
- Previous renal surgery may impact the outcomes of subsequent PCNL procedures.
Purpose of the Study:
- To evaluate the impact of prior percutaneous nephrolithotomy (PCNL) or open renal stone surgery on PCNL outcomes and complications.
- To compare PCNL results in surgery-naive patients versus those with a history of PCNL or open stone surgery.
Main Methods:
- A comparative study involving 300 patients divided into three groups: surgery-naive (Group A), prior PCNL (Group B), and prior open renal surgery (Group C).
- Patients were assessed for stone characteristics (Guy's stone score) and PCNL procedure details.
- Outcomes and complications were analyzed using the modified Clavien grading system.
Main Results:
- No significant differences were observed in age, gender, BMI, stone burden, or opacity across the groups.
- Group C (prior open surgery) showed a trend towards longer operative and fluoroscopy times, and required significantly more multiple accesses.
- Postoperative complications were slightly higher in patients with previous stone surgery but did not reach statistical significance.
Conclusions:
- Percutaneous nephrolithotomy (PCNL) is a safe and effective treatment for renal stones, irrespective of a patient's surgical history.
- Prior renal stone surgery, including open procedures, does not preclude successful PCNL outcomes.
- The study supports the continued use of PCNL as a primary treatment option for kidney stones in patients with a history of prior interventions.
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