Percutaneous nephrolithotomy in the treatment of lithiasis

Abstract

Introduction. Urolithiasis is described by the presence of stones in uropoetic system and is a major health problem. In Moldova urolithiasis prevails in about 10% of the total population. Contemporary therapy consists of the non-invasive methods (extracorporeal shock wave lithotripsy - ESLW), minimal invasive methods, endoscopic (NLP) and open surgery. Percutaneous nephrolithotomy has been proven to be the most rational treatment method (NLP). Aim of the study. The research of strategies in the treatment of urolithiasis, with a detailed study of NLP. Materials and methods. This paper was created at the Department of Urology and Surgical Nephrology in accordance with the provisions of the National Clinical Protocol "Urolithiasis of adult", as well as guidelines of American Urological Association (AUA) and European Association of Urology (EAU). 116 bibliographic sources were studied. Results. During the research we found that: the effectiveness of NLP does not depend on the number of nephrostomy tracts, NLP being the most efficient method in the treatment of: kidney lithiasis with the horseshoe form, polycystosis with renal lithiasis, coraliform lithiasis, single kidney lithiasis, coraliform lithiasis on the unique kidney, transplanted kidney lithiasis, lithiasis in patients with diabetes, elderly patients, patients with spine deformities. Positioning the patient on the abdomen offers the most access for the procedure. The success rate of NLP is independent of the patient’s body weight, NLP provides better results than using classical surgical operations. The percentage of relapse after NLP is about 1.24%, with a follow-up average of 1 year. The probability of recurrence of coraliform stones in the first year is 10%, and in 5 years - 50%. Effectiveness of NLP treatment using NLP, complete elimination of stones in one stage is possible up to 70-75%, and after secondary nephroscopy or in combination with ESWL, up to 95-99%, with minimal trauma to classical surgery. Conclusions. AUA and EAU recommend 3 methods of treatment of lithiasis: NLP, ESLW and surgery. NLP method has the minimal duration of hospitalization, morbidity, trauma and complications. It is extensively used and has the lowest incidence of complications. Preoperative urological investigations, patient selection, correct application of the method, are key success factors.