title: Doppler ultrasound-guided percutaneous nephrolithotomy with two-step tract dilation for management of complex renal stones.
abstract: OBJECTIVE
  To report our experience and assess the safety and efficacy of Doppler ultrasound-guided percutaneous nephrolithotomy (PCNL) with 2-step tract dilation for complex renal stones.
  
  
  METHODS
  From March 2009 to February 2011, 262 patients underwent PCNL. Eighty-three patients had a complete and 105 had partial staghorn calculus, and 74 had a renal pelvic stone of >2 cm in diameter. Thirty-five patients had renal surgical history. Doppler ultrasound-guided PCNL with 2-step tract dilation were performed. Stones were fragmented and cleared using a combination of ultrasonic and pneumatic lithotripters.
  
  
  RESULTS
  All PCNL procedures were successful. Successful access to the collecting system was 100%. Although most of the cases (231/262) were managed satisfactorily by a single tract, a second tract was used in 31 cases. Mean operation time was 56 minutes (range 25-145). The primary stone-free rate of PCNL was 80.9%. There were 39 auxiliary procedures (13 second PCNL and 26 extracorporeal shock wave lithotripsy). One month after treatment, the overall stone-free rate was 92.7%. Five patients (1.9%) received blood transfusion. Eight patients (3.1%) with a postoperative fever of ≥38.5°C were cured by intravenous antibiotics. No other severe complications occurred. The mean postoperative stay was 3.8 days (range 2-12).
  
  
  CONCLUSIONS
  Doppler ultrasound-guided PCNL with 2-step tract dilation for complex renal stones is safe, effective, and worthy of wider use in clinical practice.
authors.affiliation: Department of Urology, Hubei Provincial Corps Hospital, Chinese People's Armed Police Forces, Wuhan, China.
authors.forename: Youming
authors.initials: Y
authors.lastname: Xu
authors.forename: Zhonghua
authors.initials: Z
authors.lastname: Wu
authors.forename: Jianhua
authors.initials: J
authors.lastname: Yu
authors.forename: Shulong
authors.initials: S
authors.lastname: Wang
authors.forename: Fang
authors.initials: F
authors.lastname: Li
authors.forename: Jiushun
authors.initials: J
authors.lastname: Chen
authors.forename: Jin
authors.initials: J
authors.lastname: Liu
authors.forename: Kan
authors.initials: K
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D004106:Dilatation / Q000379:methods*; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D018608:Ultrasonography, Doppler; D018666:Ureteroscopy; D055815:Young Adult