Percutaneous nephrolithotomy vs open pyelolithotomy for renal pelvis calculi.

ABSTRACT

Objective: To compare the stone free rate and morbidity of percutaneous nephrolithotomy (PCNL) and open pyelolithotomy for a single renal pelvis stone. Patients and methods: A retrospective study was performed by reviewing case records of patients who underwent stone removal surgery between August 1994 and March 1999. The inclusion criteria was a single renal pelvis stone which was not smaller than 3 cm2 in surface area. Patients in the open pyelolithotomy group who had concurrent nephrotomies were excluded. There were a total of 46 patients of which 25 had undergone PCNL and 21 had undergone pyelolithotomy. Both groups were compared in terms of age, sex, stone surface area, haematocrit, blood urea nitrogen, serum creatinine, operative time, complications, stone free rate, adjunctive procedures, doses of postoperative analgesic injection, length of hospital stay, and time to return to normal work. Statistical analysis was performed by Chi-square test and t-test. Results: Preoperative status of the two groups were similar. The operative time was comparable between the two groups. The stone free rate of the PCNL group and the pyelolithotomy group were 92% and 95% respectively which was not statistically different. Five patients in the PCNL group needed ancillary procedures while only one patient in pyelolithotomy group did. Overall complications of the PCNL group and the pyelolithotomy group were 28.6% and 28% respectively which were comparable. Severe bleeding due to arterio-venous fistula occurred in 2 patients of the PCNL group. However, the complication could be managed successfully by selective embolisation. Disruption of uretero-pelvic junction occurred in one patient of the pyelolithotomy group and was repaired successfully. The number of doses of postoperative pethidine injection to lessen pain was lower in the PCNL group when compared with the pyelolithotomy group (mean 0.96 dose vs 1.95 doses, p<0.003). Length of hospital stay was comparable between the two groups. Time to return to normal work was shorter in the PCNL group when compared with the pyelolithotomy group (mean 13.7 days vs 36.3 days, p<0.001). Conclusions: PCNL is a safe and effective method to treat renal pelvis stones compared to open pyelolithotomy and offers less postoperative discomfort and shorter recovery period.