title: Minimally invasive percutaneous nephrolithotomy guided by ultrasonography to treat upper urinary tract calculi complicated with severe spinal deformity.
abstract: OBJECTIVE
  To report our experience of minimally invasive percutaneous nephrolithotomy(MPCNL) in managing upper urinary tract calculi complicated with severe spinal deformity.
  
  
  METHODS
  Between August 2001 to December 2012, 16 upper urinary calculi in 13 patients with severe spinal deformity were treated by MPCNL. Preoperative investigation of the respiratory function, evaluation of anatomy by intravenous uro¬graphy (IVU) and CT scan, and preoperative kidney ultrasonagraphy with simulation of the percutaneous puncture were performed in all patients. The percutaneous puncture was guided by ultrasonography.
  
  
  RESULTS
  A total of 19 MPCNL procedures were performed in 16 kidneys, with an ave¬rage 1.2 procedures in each kidney. Three kidneys needed two sessions of MPCNL, and 2 kidneys needed combined treatment with retrograde flexible ureterscopic lithotripsy. All procedures were successfully completed with no major complications during or after surgery. The mean (range) operative duration was 67 (20-150) min and the mean postoperative haemoglobin drop was 1.0 (0.2-3.1) g/dL. Complete stone-free status was achieved in 14 kidneys. At a mean follow-up of 48(3-86) months, recurrence of small lower calyx stone was detected in one patient. Recurrent UTI was documented by urine culture in two patients and managed with sensitive antibiotics.
  
  
  CONCLUSIONS
  PCNL for patients with severe spinal deformities is challenging. Ultra¬sonography-assisted puncture can allow safe and successfully establishment of PCN tract through a narrow safety margin of puncture and avoid the injury to the adjacent organs. However, the operation should be performed in tertiary centers with significant expertise in managing complex urolithiasis.
authors: Department of Urology, Minimally Invasive Surgery Center, the first affiliated Hospital of Guangzhou Medical University. Guangdong Key laboratory of Urology Guangzhou, China.
authors: Zhaohui
authors: Z
authors: He
authors: Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, China.
authors: Caixia
authors: C
authors: Zhang
authors: Department of Urology, Minimally Invasive Surgery Center, the first affiliated Hospital of Guangzhou Medical University. Guangdong Key laboratory of Urology Guangzhou, China.
authors: Guohua
authors: G
authors: Zeng
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D056888:Patient Positioning / Q000379:methods; D011677:Punctures / Q000379:methods; D011859:Radiography; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013121:Spinal Curvatures / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*; D014545:Urinary Calculi / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*
keywords: Minimally Invasive Surgical Procedures; Nephrostomy, Percutaneous; Ultrasonography