A combination of minimally invasive percutaneous nephrolithotomy and extracorporeal shockwave lithotripsy for solitary renal staghorn calculi in patients with renal insufficiency / 中国微创外科杂志

ABSTRACT

Objective To explore the curative effect of combined use of minimally invasive percutaneous nephrolithotomy (MPCNL) and extracorporeal shockwave lithotripsy (ESWL) for the treatment of solitary renal staghorn calculi in patients with renal insufficiency. Methods Eight cases of solitary renal staghorn calculi associated with renal insufficiency were treated by a combination of MPCNL and ESWL. Results Stones were completely cleared away in 5 cases, while residual stones were found in 3 cases. No blood transfusion was required and no severe surgery-related complications were encountered. After surgery variable degrees of improvement in renal functions was observed. The serum creatinine (Cr) decreased from 289?166 ?mol/L pre-operation to 155?33 ?mol/L post-operation (t=4.69, P=0.004), and the blood urea nitrogen (BUN) decreased from 15.1?7.9 mmol/L to 8.3?1.9 mmol/L (t=4.00, P=0.005). The emission computed tomography (ECT) examinations showed the glomerular filtration rate (GFR) was elevated from 48.8?12.4 ml/s before operation to 63.0?8.4 ml/s after operation (t=4.68, P=0.003). Post-renal obstruction disappeared after operation. Follow-up for 0.5~4.5 years (mean, 2.8 years) in the 8 cases revealed no obvious changes in renal functions. Conclusions Combination of MPCNL and ESWL for solitary renal staghorn calculi associated with renal insufficiency is safe and effective.