Akademik Veri Yönetim Sistemi
Turk Uroloji Dergisi, cilt.30, sa.3, ss.313-319, 2004 (SCI-Expanded)
Introduction: Percutaneous nephrolithotomy (PNL) has been performed as a minimally invasive method of kidney stone surgery since 1976. Open surgery was preferred only selected cases in western country. In the last 20 years, 95-98% of urinary stones have been treated as a non-invasively or minimally invasive method when PNL are used the combination of other stone therapy modalities such as ureterorenoscopy and extracorporeal shock wave lithotripsy. In this study, we attempted to review the results of PNL in 119 renal units. Materials and Methods: Between April 1999 and February 2003, a total of 72 male and 43 female patients 9 to 71 years old (mean age 41.7) underwent 111 unilateral and 4 bilateral percutaneous access procedures. Of the 119 renal units accessed 62 were on the right and 57 were left side. A total of 10 patients were treated with percutaneous endopyelotomy due to ureteropelvic junction obstruction with a simultaneous renal calculus. Also, infundibulotomy were performed on 3 patients who had infundibular stenosis. All patients were evaluated by antegrade pyelography on early postoperative period. Auxiliary procedure such as repeat-PNL, ureterorenoscopy and extracorporeal shock wave lithotripsy was performed if residual stones are larger than 4mm on antegrade pyelography. Long-term follow-up was done with excretory urography and/or diuretic renal scan as well as urine analysis and culture. Results: The stone-free rate was 70.58% after one session of PNL. When the residual fragments less than 4mm were defined as insignificant, the success rate raised up to 82.35%. This rate raised up to 88.23% after auxiliary procedures such as repeat-PNL, ureterorenoscopy and extracorporeal shock wave lithotripsy. The overall complication rate was 22.68% (27/119). Complications included blood transfusion in 18 patients, hydrothorax in 5, hydroabdomen in 1. Also, one patient underwent nephrectomy because of severe hemorrhage the day after the operation, and one patient was lost because of myocardial infarction after 4 hours of operation, PNL was converted to pyelolithotomy in 1 patient due to inappropriate disposable materials. During follow-up of 3 to 40 months (average 10.8 months) no late complications were noted. Conclusion: In view of this experience, we suggested that PNL is safe and effective in all locations of kidney stones that required surgery. To maximize the success rate of operation, reserve disposable materials that are used during the operation should be kept in stock. Also the angiography department should be checked to be sure before surgery if angiography apparatus is operational in case of complications.