Study of response rate to PCNL therapy for renal and upper ureteral stones

Percutaneous surgery is based on needle and guidewire access to the kidney and the upper urinary tract. This study designed to assess retrospectively the safety and efficacy of the percutaneous nephrolithotripsy [PCNL] for treating the renal and upper Ureteral stones. 613 patients underwent PCNL, between September 2000 and September 2004, for renal or upper ureteral stones in Ekbatan and Beheshti hospitals in Hamadan. PCNL was done as a standard method under X-ray guidance and after tract dilatation with metal dilators; pneumatic lithotripsy was used for fragmentation. Complete clearance was 90.7%. Complete stone free rate among patients who need 1 tract [93.8%] obviously was more than the others that more than 1 tract was needed [61.7%]. Variables such as age, sex, weight, grade of hydronephrosis, type of anesthesia, and incision site did not have effect on stone free rate. PCNL, is a safe and effective method for any type of renal and upper ureteral stone especially in developing countries that renal stone is more common

[Percutaneous nephrolithotomy in the management of pediatric renal calculi]

Pediatric renal calculus disease has been a management dilemma. Achieving excellent results with percutaneous nephrolithotomy [PCNL] in adults have led to use this technique in children. Our experience with this procedure in pediatric age group is reviewed and discussed. In a descriptive cross-sectional study, we retrospectively analyzed case records of 39 patients younger than 15 years who underwent PCNL between September 2000 and April 2004. Antegrade percutaneous access was obtained in all patients and the tract was dilated to 24F. Pneumatic lithotripsy and forceps extraction were used with a rigid nephroscope to disintegrate and remove stones. In all patients, a nephrostomy tube was placed intraoperatively, and a plain abdominal X-ray and nephrostogram were obtained postoperatively. Complete clearance was achieved in 36 patients [92.3%] and relative clearance in 3 patients [7.7%]. Of these, 33 [91.7%] required a single tract, while 2 [5.6%] required two tracts and only one patient [2.8%] required 3 tracts. The greatest stone diameter in 11 [30.5%] patients was less than 20 mm and in 20 [55.6%] patients was more than 20 mm or multiple; 5 [13.9%] patients had staghorn stones. Stone location was lower calyx in 2 [5.1%], upper calyx in 3 [7.7%], renal pelvis in 15 [38.5%], and staghorn or multiple in 19 [48.7%] subjects. Open surgery was not required in any patient, and patients with residual stone after second look surgery were sent for SWL treatment. There was no contiguous organ injury, and no open surgery or blood transfusions were required. Percutaneous nephrolithotomy is safe and effective in children, and should be considered as a viable management option. However, staghorn and multiple renal calculi may require alternative managements