Percutaneous nephrolithotomy--results and clinical experience

Area of Science:

• Urology
• Nephrology
• Surgical Innovation

Background:

• Percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) are primary treatments for upper urinary tract calculi, largely replacing open surgery.
• ESWL is favored for stones ≤2 cm due to lower morbidity and comparable success rates to PCNL.
• PCNL becomes preferable for stones >2 cm, as ESWL morbidity increases and success rates decrease compared to PCNL.

Purpose of the Study:

• To evaluate the efficacy and safety of PCNL for managing renal calculi.
• To determine the success rate and associated morbidity of PCNL in a clinical setting.
• To establish PCNL as a preferred treatment for difficult or large renal calculi.

Main Methods:

• A retrospective analysis of 86 patients undergoing PCNL for 87 renal calculi.
• Indications for PCNL included high stone burden (83%) or failed ESWL (17%).
• Data collected on success rates, stone-free rates, and procedure-related morbidities.

Main Results:

• PCNL achieved a 74.7% success rate for renal calculi.
• Minimal morbidity was observed, including urinary tract infection (9.2%), pleural effusion (2.3%), and pseudo-aneurysm formation (2.3%).
• Complications requiring intervention included one blood transfusion (1.1%) and one postoperative death (1.1%) from pulmonary embolism.

Conclusions:

• PCNL demonstrates a favorable success rate with acceptable morbidity for treating renal calculi.
• The procedure is particularly effective for patients with high stone burden or those who have failed ESWL.
• PCNL is the recommended approach for difficult renal calculi at the institution.