Contemporary aspects of treatment of nephrolithiasis - the advantages of percutaneos nephrolithotomy

Abstract

Introduction: The stone disease is a major public health problem with increasing incidence and predominantly affecting active social segment (20-50 years). Nephrolithiasis determine through its complications a high rate of disablement (~ 11%) and decreases life expectancy in (5-20%) of cases. The aim of the study was to analyze current treatment strategies for patients with urolithiasis with more detailed evaluation of the benefits of percutaneous nephrolithotomy (PCNL).

Material and methods: For the study and realization of the purpose of this work were selected 116 bibliographical sources relevant to these issues. We reviewed data from the articles from (1980- 2012) of medical data base research PubMed, EMBASE, HINARI. The search is based on National Clinical Protocol provisions "Urolithiasis in Adult" (2009, updated in 2011) and complies with the actual provisions of Guidelines of European Association of Urology and American Urological Association.

Results: After the analysis of special literature we found that, worldwide, in the treatment of urolithiasis, the most common are 4 ways: extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy ( PCNL ); retrograde ureteroscopy (URS) and "open" classical surgery. The most rational method to treat complex forms of urolithiasis is percutaneous nephrolithotomy by: the preservation and restoration of renal function with minimal damage, morbidity {transfusion of blood ( 5-53% ), fever ( 12 -64% ), pneumothorax ( 12% ), septic complications ( 2% )}, the decrease of hospitalization time ( about 9.5 days ) and increased patient quality of life (full recovery in 21 to 30 days). PCNL is safety and efficacy in use for stones management in various renal anomalies (horseshoe kidneys, solitary kidney,polycystic kidney); in large and staghorn calculi; in cases of spinal deformities; in compensated diabetes; including children and old people.

Conclusions: Nephrolithiasis is a major health and social problem. The most common methods in the treatment of urolithiasis are considered: ESWL, PCNL, retrograde (URS) and "open" classical surgery. The elective method in treatment of complex forms of urolithiasis is PCNL through: minimal invasion, reduction of hospitalization and morbidity, decreased complication rates. PCNL is useful in many cases of urolithiasis, in all ages.