Percutaneous nephrolithotomy – effective method in contemporary treatment of renal lithiasis. Clinical implementation experience

Abstract

Background: Percutaneous nephrolithotomy (PNL) is the minimally invasive treatment elected for large kidney calculi (>2cm), staghorn calculi, inferior calyceal lithiasis, hard consistency calculi (calcium oxalate monohydrate or cystine) and lithiasis at the level of a malformed kidney. The aim was to analyse the results, which were obtained in the clinic for one year from the implementation of the method in patients with urolithiasis treated by PNL. Material and methods: The transversal descriptive study was performed in the group of 43 patients with urolithiasis, subjected to PNL treatment, throughout 2019. Results: The mean age of kidney stone patients treated by PNL was 55±7 years, among them 29 (67.5%) women and 14 (32.5%) men. The anatomical distribution of nephrolithiasis was: right kidney – 21(48.9%) patients, left kidney –22 (51.1%) patients. The post-operative period in most cases was 5 days. Most of the operated calculi had the following dimensions: 2-2.5 cm in 18 (41.86%) patients, 2.6-4 cm in 16 (37.2%) patients and over 4.5 cm in 9 (20.93%) patients. Postoperative complications were detected and distributed according to Clavien-Dindo scale (CDS). The majority of detected complications were minor (CDS grade 1) in 31 (72%) patients, CDS 2 in 7 (14%) patients and CDS 3b in 6 (14%) patients. Patients with CDS complications grade 4 and 5 were not detected. In 3 (7%) patients the procedure was of “tube-less” type and in 1 (2.3%) patient with double-pointed canal. Conclusions: The success of PNL intervention depends on multiple factors, such as calculus composition, dimension and location in the urinary tract, the patient’s body mass index, as well as collecting system anatomy. PNL is a safe and effective procedure with a 90-100% stone-free rate and minor complications.