Percutaneous nephrolithotomy for management of large renal stones. Experience at Prince Hussein Bin Ab dull ah Urology Center

ABSTRACT

The aim of this study was to evaluate and to review our experience with percutaneous nephrolithotomy [PCNL] in management of large renal stones. Between January 2005 and December 2009, 786 patients underwent PCNL for treatment of renal stones at our center, 108 renal units were with big stone burden. All procedures were performed in prone position after retrograde insertion of ureteral catheter under fluoroscopic guidance for creating the PCNL tract. 27F rigid nephroscope was used to identify the stones, fragmentation was done using electrohydrulic or pneumatic lithoclast. Stones fragments were removed by forceps and suction. 20F foley catheter inserted in all cases as nephrostomy, and postoperative stone clearance was documented by plain abdominal X-ray KUB. 108 renal units of 92 patients were treated [67 men and 25 women] with mean age of 41 years [range 17- 74 years]; the average stone size was 4.9cm [range 3.0-6.8cm]. 83 renal units were treated with PCNL monotherapy [76.9%], with mean operative time of 75 minutes [range 55-100 minutes]. 18 renal units required a second look for significant residual stones through the same tract after 72 hours [16.7%], 7 renal units required a second look through a different calyx [6.5%]. Complete stone removal achieved by PCNL alone in 89 renal units [82.4%], with ESWL for the residual small stones we achieved 91.7% stone clearance rate. The mean hospital stay was 3.7 days [mean 3-8 days]. No Serious complications were encountered, 9 patients required blood transfusion [8.3%], 18 patients developed transient post operative pyrexia [16.7%] and three patient had persistent urine leak [2.8%]. PCNL is the first line treatment option for management of large renal stones. Selection of the patient, establishing percutaneous renal access, a well standardized technique and post-operative follow up are mandatory for early detection of complication and achieving a high stone free clearance rate. With significant residual stones in PCNL procedure, a second look at 48-72 hours interval is preferable in centers where flexible instruments and laser therapy are not available