Effect of access sheath diameter used in percutaneous nephrolithotomy on renal function: a prospective randomized...

Area of Science:

• Nephrology
• Urology
• Surgical Innovation

Background:

• Percutaneous nephrolithotomy (PNL) is a key procedure for kidney stone removal.
• The choice of access sheath diameter in PNL may influence post-operative renal function.
• Understanding factors affecting renal function post-PNL is crucial for patient outcomes.

Purpose of the Study:

• To evaluate the impact of different access sheath diameters (22 Fr vs. 28 Fr) in PNL on subsequent renal function.
• To identify predictors of impaired renal function following PNL.
• To assess changes in relative renal function (RRF) and glomerular filtration rate (GFR) post-PNL.

Main Methods:

• Prospective randomized study of 88 patients undergoing PNL, divided into 22 Fr and 28 Fr access sheath groups.
• Renal function assessed using technetium-99m dimercaptosuccinic acid scintigraphy for RRF and diethylenetriamine pentaacetic acid scintigraphy for GFR.
• Kidney Injury Molecule-1 (KIM-1) levels measured pre- and post-operatively; stone volume and demographic data collected.

Main Results:

• No statistically significant differences in RRF, GFR, or KIM-1/creatinine levels between the 22 Fr and 28 Fr groups.
• Overall, 6.8% of patients experienced significant RRF deterioration, with 3 patients in each group.
• Multivariate analysis identified stone volume as the only independent predictor of renal function loss (p=0.002).

Conclusions:

• Access sheath diameter used during PNL does not significantly affect renal function.
• Stone volume is a significant independent predictor of renal function impairment after PNL.
• Further research may explore strategies to mitigate functional loss in patients with large stone burdens.