title: Percutaneous nephrolithotomy in patients who previously underwent open nephrolithotomy.
abstract: OBJECTIVE
  Open stone surgery nowdays is rare. However, some patients who are treated today have in the past undergone open nephrolithotomy. The aim of this study was to determine the possible impact of open nephrolithotomy on the efficacy and morbidity of subsequent percutaneous nephrolithotomy (PCNL).
  
  
  METHODS
  We reviewed the files of all 167 patients undergoing PCNL at our institution between December 2000 and December 2003. The same surgeon performed all of the procedures. We compared 21 patients undergoing PCNL after open nephrolithotomy to the same kidney with all other patients undergoing PCNL. The groups did not differ in terms of age or stone burden (mean size, number of stones, percentage with staghorn calculi). The outcomes measured were operating time, necessity for secondary procedures, stonefree rate, and intraoperative and postoperative complications.
  
  
  RESULTS
  The operating time (203+/-92 v 177+/-52 minutes) and percentage of secondary procedures (29% v 12%) were significantly higher in patients who had previously undergone open stone surgery. However, the stone-free rate (95% v 93%), intraoperative complication rate (10% v 9%), and postoperative complication rate (10% v 11%) did not differ significantly.
  
  
  CONCLUSIONS
  A PCNL in a patient with a history of open nephrolithotomy may take longer and lead to a higher percentage of auxiliary procedures, probably because of scar tissue and anatomic changes in the kidney. However, the morbidity and efficacy of PCNL appear to remain the same in these patients.
authors.affiliation: Minimally Invasive Urology, Rabin Medical Center-Golda Campus, Petach Tikva, Israel. sdmargel@bezeqint.net
authors.forename: David
authors.initials: D
authors.lastname: Margel
authors.forename: David A
authors.initials: DA
authors.lastname: Lifshitz
authors.forename: Valentina
authors.initials: V
authors.lastname: Kugel
authors.forename: Dov
authors.initials: D
authors.lastname: Dorfmann
authors.forename: Dov
authors.initials: D
authors.lastname: Lask
authors.forename: Pinhas M
authors.initials: PM
authors.lastname: Livne
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome