Efficacy and Safety of Percutaneous Nephrolithotomy: A Single-center Initial Experience

Abstract

BACKGROUND: In the age of modern medicine, thanks to the development of small-caliber nephroscope as well as various types of intracorporeal lithotripters, treatment options for renal stones have changed dramatically, and the area of percutaneous nephrolithotomy (PCNL) has expanded. Nowadays, PCNL is not only the first choice in the treatment of stones >2 cm, as well as complicated renal stones (staghorn stones, multiple stones, and stones associated with abnormal renal anatomy), but is also the method of optimal treatment for medium-sized stones not treated with other less invasive methods.

AIM: The purpose of this study is to assess the efficacy and safety of PCNL as monotherapy in the treatment of renal stones larger than 15 mm.

MATERIALS AND METHODS: This study presents a retrospectively prospective study of 14 (4 retrospective and 10 prospective) consecutive patients with renal stones larger than 15 mm treated with PCNL in the period from January 2020 to March 2020 at the GH “8 September” – Skopje. Pre-operative preparation of patients included: A history along with physical examination, a complete blood count and radiological examinations to assess the size of the stones, the anatomical features of the kidney and its function, and to accurately plan the operative approach. PCNL was performed in the prone-position; lithotripsy was performed with a double, pneumatic and ultrasonic intracorporeal lithotripter Swiss LithoClast Master with the use of the Karl Storz 24–26 fr nephroscope. Postoperatively, patients were monitored on the 1st, 7th, and 30th post-operative day, determining the demographic and clinical characteristics, the efficacy of PCNL, perioperative blood loss, the duration of the operative procedure, the duration of hospital stay, and the resulting intraoperative and post-operative complications.

RESULTS: The study included eight men (57.1%) and six women (42.8%). The mean age of the patients was 52.35 ± 11.00. In 5 (35.71%) patients, the stones were localized in the left kidney, and in 9 (64.28%) patients in the right kidney. The average body mass index was 25.11 ± 3.92 kg/m². The average area of the stones was 371.24 ± 131.86 mm². Eleven (78.57%) patients had simplex stones, while 3 (21.42%) had complex stones (staghorn stones and multiple stones). The stones were localized in the renal pelvis, upper, middle, and lower calyx at 5 (35.71%), 2 (14.28%), 4 (28.57%), and 3 (21.42%) patients, respectively. The mean value of pre- and post-operative serum hemoglobin was 13.94 ± 1.00 g/dl and 11.77 ± 1.51 g/dl, respectively. The effectiveness of the procedure on the 1st post-operative day assessed by ultrasound diagnostics and kidney-ureter-bladder X-ray was 78.57%. The success rate on the 30th post-operative day after additional procedures was 92.85%. The average operating time in the entire series was 119.28 ± 9.42 min. The average hospital stay was 5.57 ± 1.11 days. The average operative blood loss was 2.19 ± 0.88 g/dl.

CONCLUSION: The results of this retrospectively prospective study confirm that PCNL is a minimally invasive, safe, and effective method for removing renal stones. This method, with the development of new technologies, has an increasingly important role in the modern surgical treatment of nephrolithiasis. PCNL can also be performed in the early stages of the learning curve without compromising patient safety and treatment benefits. The procedure is safe and effective, performed even by less experienced urologists if the protocols established for this procedure are followed. This can achieve a rate of success comparable to most established standards without causing major complications.