title: Multi-tract percutaneous nephrolithotomy combined with EMS lithotripsy for bilateral complex renal stones: our experience.
abstract: BACKGROUND
  The treatment of bilateral complex renal stones is a tough challenge for urologists. This study aimed to evaluate the efficiency and safety of bilateral ultrasonography-guided multi-tract percutaneous nephrolithotomy (PCNL) combined with EMS lithotripsy for the treatment of such cases.
  
  
  METHODS
  Twenty-seven patients suffering from bilateral complex renal calculi underwent t bilateral multi-tract PCNL. The PCNL began with the establishment of percutaneous nephrostomy access, which was achieved under ultrasound guidance followed by stone fragment and removal by EMS lithotripsy. The same processes were then performed on the ipsilateral and contralateral renal units until the operation terminated. Sheaths left in situ to provide the tracts for the two-stage and the three-stage PCNL procedures. Peri- and postoperative clinical data were collected and analysed.
  
  
  RESULTS
  Renal stones of both sides were completely cleared within three PCNL sessions in 24 cases. Among them, four, thirteen, and seven cases underwent single, second-stage and third-stage procedures, respectively. The total stone-free rate was 88.9%. Three patients failed to receive complete stone clearance. Mean operation time was 78.7 (26-124) min, the mean estimated blood loss was 97.3 (30-250) ml, and the mean length of hospital stay was 18 (10-31) days. No patient required blood transfusion and postoperative fever occurred in 6 cases. Within the follow-up period, stone recurrence occurred in 6 patients.
  
  
  CONCLUSIONS
  Ultrasonography-guided multi-tract PCNL using EMS is an efficient method for the treatment of complex renal calculi. According to our experience, it is safe to make multiple tracts on both sides simultaneously.
authors.affiliation: Department of Urology, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China.
authors.forename: Taisheng
authors.initials: T
authors.lastname: Liang
authors.affiliation: Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Chenming
authors.initials: C
authors.lastname: Zhao
authors.affiliation: Department of Urology, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Wu
authors.affiliation: Department of Urology, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China.
authors.forename: Botao
authors.initials: B
authors.lastname: Tang
authors.affiliation: Department of Urology, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China.
authors.forename: Xiangdong
authors.initials: X
authors.lastname: Luo
authors.affiliation: Department of Urology, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China.
authors.forename: Shangguang
authors.initials: S
authors.lastname: Lu
authors.affiliation: Department of Urology, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Dong
authors.affiliation: Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. yhpz123@163.com.
authors.forename: Huan
authors.initials: H
authors.lastname: Yang
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000628:therapy*; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D061646:Operative Time; D011859:Radiography; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: Bilateral complex renal stones; Multi-tract; PCNL