Objective: Percutaneous nephrolithotomy (PNL) surgery has become the gold standard treatment for many kidney stones. In this study, we aimed to evaluate the factors that affect suc-cess rate of PNL and the effect of surgical expe-rience in PNL.
Materials and Methods: Between 2005 and 2011, the records of 200 renal stone patients who underwent PNL in İzmir Atatürk Training and Research Hospital were reviewed retros-pectively. Patient related factors such as age, stone size and localization were noted. Number and localization of access, blood transfusion requirement, surgical experience, success rate, lenght of hospitalization, intraoperative and postoperative complications and additional therapy requirements were reviewed. Patients were divided to 4 groups according to surgical experience; as the as the first 50 cases, second 50 cases, third 50 cases, fourth 50 cases, res-pectively. Stones were classified according to kidney localization as simple... as simple (sing-le calyx veya pelvic stones) or complex stones (choraliform, partial choraliform, pelvic + calyx stones or multiple calyx stones). Patients wereevaluated with direct urinary tract X-ray on postoperative first day and with intravenous pyelography at postoperative third month.
Results: Stones were located at 47.5% right side, 52.5% left side, mean stone burden was determined as 7.36 + 6.31 cm2 in patients who underwent PNL. 91 patients had simple stones and 109 pati-ents had complex stones. Seventy-nine percentage (158 renal unit) success rate clinically insignificant residual stone (CIRF) + Stone free) was achieved at postoperative 1st day. There was statistically significant difference on success rate between the groups according to stone location. It was found that stone burden increases, rate of success decreases(p=0.002). Additional therapy was applied 24 pa-tients (12%), success rate was increased to 83% at postoperative 3rd month. Considering influence of surgical experience, the differen-ce was no statistically significiant between four groups(p=0.492). It was found that increasing of complex stone rate effects this situation(p=0.003) Complications occured in 29% of patients who underwent PNL. Thirty-two patients required blood transfusion. (16%). There was no per-operative mortality. Hydrothorax occured in 2 cases and drainage was achieved by chest tube. Mean hospitali-zation time was 3.61 + 2.93 days.
Conclusion: PNL which needs surgical experience, can be con-sidered as an effective and safe treatment option for renal stones with high success rates, short duration of hospitalization, and ac-ceptable complication rates. Surgeon’s experience, stone burden and stone location affect the success rate of PNL.
Key Words: Kidney stones; percutaneous nefrolithotomy; tre-atment; surgical experience
Abstract
Objective: Percutaneous nephrolithotomy (PNL) surgery has become the gold standard treatment for many kidney stones. In this study, we aimed to evaluate the factors that affect suc-cess rate of PNL and the effect of surgical expe-rience in PNL.
Materials and Methods: Between 2005 and 2011, the records of 200 renal stone patients who underwent PNL in İzmir Atatürk Training and Research Hospital were reviewed retros-pectively. Patient related factors such as age, stone size and localization were noted. Number and localization of access, blood transfusion requirement, surgical experience, success rate, lenght of hospitalization, intraoperative and postoperative complications and additional therapy requirements were reviewed. Patients were divided to 4 groups according to surgical experience; as the as the first 50 cases, second 50 cases, third 50 cases, fourth 50 cases, res-pectively. Stones were classified according to kidney localization as simple... as simple (sing-le calyx veya pelvic stones) or complex stones (choraliform, partial choraliform, pelvic + calyx stones or multiple calyx stones). Patients wereevaluated with direct urinary tract X-ray on postoperative first day and with intravenous pyelography at postoperative third month.
Results: Stones were located at 47.5% right side, 52.5% left side, mean stone burden was determined as 7.36 + 6.31 cm2 in patients who underwent PNL. 91 patients had simple stones and 109 pati-ents had complex stones. Seventy-nine percentage (158 renal unit) success rate clinically insignificant residual stone (CIRF) + Stone free) was achieved at postoperative 1st day. There was statistically significant difference on success rate between the groups according to stone location. It was found that stone burden increases, rate of success decreases(p=0.002). Additional therapy was applied 24 pa-tients (12%), success rate was increased to 83% at postoperative 3rd month. Considering influence of surgical experience, the differen-ce was no statistically significiant between four groups(p=0.492). It was found that increasing of complex stone rate effects this situation(p=0.003) Complications occured in 29% of patients who underwent PNL. Thirty-two patients required blood transfusion. (16%). There was no per-operative mortality. Hydrothorax occured in 2 cases and drainage was achieved by chest tube. Mean hospitali-zation time was 3.61 + 2.93 days.
Conclusion: PNL which needs surgical experience, can be con-sidered as an effective and safe treatment option for renal stones with high success rates, short duration of hospitalization, and ac-ceptable complication rates. Surgeon’s experience, stone burden and stone location affect the success rate of PNL.
Key Words: Kidney stones; percutaneous nefrolithotomy; tre-atment; surgical experience