Percutaneous nephrolithotomy in the management of complex upper urinary tract calculi: the Singapore General Hospital experience.
OBJECTIVE
Presently, percutaneous nephrolithotomy (PCNL) is a well-established and effective method of treating upper urinary tract stones at our institution. The aim of this paper was to evaluate a single surgeon's four-year experience of PCNL in the Singapore General Hospital.


METHODS
Between January 1996 and December 2000, 300 PCNLs were performed on 280 renal units. The mean age was 53.7 years. PCNL was performed on 57 complete staghorn calculi (20.4%), 83 partial staghorn calculi (29.6%), 66 large pelvic calculi (23.6%), 60 impacted uretero-pelvic junction (UPJ) and upper ureteric stones (21.4%) that failed extracorporeal shock wave lithotripsy (ESWL) and 14 symptomatic lower pole calculi (5%).


RESULTS
The stone-free rate on discharge was 88.2% (n = 247). At 3 months and 1-year post PCNL, the stone-free rate was 91.1% (n = 255) and 95.7% (n = 268), respectively. The average postoperative stay was 4.5 days. Complications included 1 urosepsis post-PCNL (0.4%) and 2 arterio-venous fistulae (0.7%). Only 1 patient (0.4%) required blood transfusion. Thirty-four patients (12.1%) required ESWL and 4 needed ureteroscopy (1.3%).


CONCLUSIONS
In experienced hands, the use of PCNL for upper urinary tract calculi is safe and effective.
Nguyen
H D
HD
Department of Urology, Singapore General Hospital, Outram Road, Singapore 169608.
Tan
Y H
YH
Wong
M Y C
MY
Nguyen
H C
HC
D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data; D005260:Female; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects* / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications; D012189:Retrospective Studies; D012846:Singapore; D013997:Time Factors; D014545:Urinary Calculi / Q000601:surgery*; D014551:Urinary Tract / Q000601:surgery*