Percutaneous nephrolithotomy--results and clinical experience.
Percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) have largely replaced open surgical intervention for the management of upper urinary tract calculi. ESWL is the preferred treatment modality for calculi less than or equal to 2 cm in diameter as morbidity is lower than PCNL and success rates are comparable. However, the morbidity of ESWL rises substantially for stones greater than 2 cm in diameter while stone-free rate is less when compared to PCNL, suggesting that PCNL is the preferred treatment modality for most larger stones. PCNL was performed on 86 patients with 87 renal calculi. The indication for this approach was either high stone burden as in 72 patients (83%) or failed previous ESWL as in 15 patients (17%). The success rate was 74.7% and this was associated with minimal morbidity which included; symptomatic urinary tract infection (9.2%), pleural effusion (2.3%) and the formation of a pseudo-aneurysm (2.3%). Blood transfusion was required in one patient (1.1%) and we had one postoperative death due to massive pulmonary embolism (1.1%). PCNL is the preferred approach to patient with difficult renal calculi at our institution.
Li
M K
MK
Department of Urology, Singapore General Hospital, Singapore.
Wong
M Y
MY
Toh
K L
KL
Ho
G H
GH
Foo
K T
KT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008096:Lithotripsy / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology*; D012846:Singapore; D015996:Survival Rate; D016896:Treatment Outcome