Comparison of Systemic Stress Responses Between Percutaneous Nephrolithotomy (PCNL) and Open Nephrolithotomy

Abstract

Stimulation of patient's immune response and therefore increasing inflammatory indices in patients who underwent invasive treatment methods for kidney stone removing can be predictable. In the present study, we tried to evaluate the differences of inflammatory indices in percutaneous nephrolithotomy (PCNL) and compared them with open stone surgery in patients with kidney stones. In a clinical trial study, 15 adult patients that scheduled to undergo PCNL and 15 patients who were candidate for open stone surgery matched for sex and age were included. Body temperature and concentrations of white blood cell, hemoglobin, C-reactive protein, interleukin-6, 24-hour urine cortisol levels, fibrinogen, TNF-alpha, and total antioxidant status (TAS) were measured. Pain severity was also measured on the basis of verbal rating scale (VRS). All measurements were recorded immediately before and 24 hours after operation. Patients that underwent open surgery had more severe pain than PCNL group (P = 0.001). Postoperative fever in the first group was more prevalent than other group (P = 0.020). Also, surgery time (P < 0.001), and total length of stay in hospital (P < 0.001) were higher in open surgery group. Differences rate of white blood cell (P = 0.003), C-reactive protein (P = 0.005), 24-hour urine cortisol level at 24 and 48 hours after open surgery were significantly more than PCNL (P = 0.02, P = 0.048, respectively). According to the higher postoperative complications and patient's inflammatory response in open stone surgery in comparison with PCNL, stone removing by PCNL has lower impact in terms of stress response in comparison to open surgery to the treatment of kidney stones.