The percutaneous nephrolithotomy. One year clinical experience

Abstract

Introduction. Percutaneous nephrolithotomy (PCNL) is a minimally-invasive procedure to remove kidney stones by a small incision through the skin in lumbar region, up to 2 cm. This procedure is accepted as standard of care for patients with kidney stones that are large, very firm, or resistant to other forms of stone treatment, and it has replaced open operations for kidney stones in the vast majority of patients. The benefits of PCNL: Are the greater than 97% post-procedure stone free rate less post-operative pain and fewer complications as compared to open surgery, due to minimally invasive access to the kidney, quicker return to daily activities and work, better stone free rates post-procedure for larger and more complex stones as compared to less invasive options (ESWL and uretheroscopy). The tubeless PCNL offers patients the benefits of no urine leakage, no discomfort from an external drainage tube. Aim of the study. Analysis of the results obtained in the clinic following PCNL intervention applied to patients with urolithiasis, during one year. Materials and methods.. The study was performed in the Department of Urology and Surgical nephrology of the State University of Medicine and Pharmacy "Nicolae Testemitanu", within the Republican Clinical Hospital "Timofei Moşneaga", on a batch of 43 patients with the diagnosis of Urolithiasis, treated by the (PCNL), during the year 2019. Patients were subjected to a cross-sectional study (extraction of data from the hospital patient's medical record). Results. The gender distribution of patients was as follows: 29 (67,5%) women and 14 (32,5%) men diagnosed with urolithiasis. The average age of the patients was : 55 years Anatomical distribution of renal stones: right kidney 21 (48,9%) patients, left kidney 22 (51,1%) patients. The stone’s dimensions ranged from 2 cm up to massive staghorn stones( > 4,5cm). The postoperative hospitalization period on average was 5 days. The localization and size of calculi were as follow: Renal pelvis 18 (41,8%) patients, caliceal stones 16 (37,2%) patients, staghorn stones 9 (21%) patients. Stones dimensions: 2-2,5 cm-18 (41,86%) patients; 2,6- 4 cm -16 (37,2%) patients; >4,5cm – 9 (20,93%) patients. The stratification of the surgical postoperative complications was done according to the Clavien-Dindo score. CDS I, 31 (72,1 %); patients CDS II, 5 (11.6 %) patients, CDS III, 3 (7 %) patients. Patients with CDS IV and V, were not detected. From the group of patients, 3 (7%) of them were tubeless and 1 (2,3%) patient with two puncture channels. Conclusions. The success of PCNL is dependent on many factors such as stone composition, stone size, number of stones, location within the urinary tract, patient body habitus (obesity), and anatomy of the collecting system of the kidney. Surgeons carefully consider all of the aforementioned variables in order to maximize success of PCNL . Overall stone free success rate is approximately 90% following an initial PCNL and 90-100% following a “second look” procedure.