Abstract
ObjectiveTo report our experience with Chinese minimally invasive percutaneous nephrolithotomy (Chinese MPCNL) to manage patients with intrarenal stones in solitary kidney, and evaluate the safety, efficiency and feasibility of this technique.MethodsForty-one patients with intrarenal stones in solitary kidney underwent Chinese MPCNL in our department from March 2009 to February 2011. Demographic characteristics, operative parameters, number of tracts, stone-free rates (SFRs), stone analyses, hemoglobin levels, nephrostomy tube removal time, hospitalization time, and complications were evaluated. Serum creatinine (Scr) and glomerular filtration rate (GFR) were measured preoperatively, postoperatively at 1 month, and each follow-up visit. The 5-stage classification of chronic kidney disease (CKD) was used according to the National Kidney Foundation guidelines.ResultsThe initial stone-free status was achieved in 35 (85.4%) patients after Chinese MPCNL. The mean follow-up time was 16.9±4.7 months (range: 12–24), and the final SFR improved to 97.6% after auxiliary procedures. Among all patients, complex stones were detected in 26 (63.4%) patients, and 9 (22.0%) required multiple tracts. The mean operative time and mean hospitalization time were 71.3±23.5 min (range: 40–139) and 6.1±0.5 days (range: 5–11), respectively. During preoperative period and postoperative period (1 month), Scr were 132.1±41.3 umol/L (range: 78.2–231.4) and 108.9±30.7 umol/L (range: 71.6–136.9), respectively (P<0.05), while GFR were 74.9±24.2 ml/min (range: 35–110) and 83.9±27.4 ml/min (range: 65–110), respectively (P<0.05). According to CKD classification, the renal function was stable, improved, and worse in 29 (70.7%), 11 (26.8%), and 1 (2.5%) patients, compared with the preoperative levels. No patient progressed to end-stage renal disease requiring dialysis.ConclusionsOur experience with Chinese MPCNL demonstrates that it is safe, feasible and efficient for managing the intrarenal calculi in solitary kidney with a low complication rate. At long-term follow-up, renal function stabilized or even improved in the majority of patients with solitary kidney.
Highlights
Percutaneous nephrolithotomy (PCNL) has become the first method of choice for patients with large and complex calculi since its introduction in 1976 [1]
Especially uncontrolled hemorrhage, some urologists have modified the technique of standard PCNL by performing it with a miniature endoscope by way of a small size tract (12–20 F) and named it as MPCNL [4,5,6]
We evaluated the safety, efficiency and feasibility of Chinese MPCNL on management of intrarenal stones in solitary kidney and evaluated the long-term renal function
Summary
Percutaneous nephrolithotomy (PCNL) has become the first method of choice for patients with large and complex calculi since its introduction in 1976 [1]. Especially uncontrolled hemorrhage, some urologists have modified the technique of standard PCNL by performing it with a miniature endoscope by way of a small size tract (12–20 F) and named it as MPCNL [4,5,6]. MPCNL has exhibited advantages with respect to hemorrhage, injury to renal parenchyma, postoperative pain, and shortened hospitalization time [4,7,8], the disadvantages of need for specialized equipments and relatively low efficiency to fragment large stones than standard PCNL limited its indications. The indications of MPCNL are only limited to pediatric patients or adult patients with stone diameter less than 2 cm or as a secondary tract of standard PCNL [4,5,6]
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