Comparison of the Two-stage Procedure with the One-stage Procedure for Percutaneous Nephrolithotomy

Abstract

Purpose: We evaluated the advantages of the two-stage procedure for percutaneous nephrolithotomy (PNL) for the management of renal calculi. Materials and Methods: Between November 1999 and November 2003, 49 patients with renal calculi were treated with one-stage or two-stage PNL. The medical records of all the patients were retrospectively reviewed for complications associated with percutaneous nephrostomy (PCN), stone size, operation time, success rate, treatments for the postoperative remnant stones, the hospital stay and the complications associated with operation. Results: Thirty cases underwent two-stage PNL and 19 cases underwent one-stage PNL. The mean age of the one-stage PNL group and the twostage group were 55.6±14.7 years old and 58.9±12.5 years old, respectively. There were no significant differences between the two-stage PNL and one-stage PNL for the complications associated with the PCN procedure, stone size, the success rate and the hospital stay. The total operative time was significantly different between the two-stage and one stage PNL groups (136.1±51.6 min vs 191.1±56.9 min, respectively, p=0.02). Eleven total patients with postoperative remnant stones underwent additional extracorporeal shock wave lithotripsy in 8 cases, ureteroscopic removal of stone in 2 cases and PNL in 1 case. The complications associated with two-stage and one-stage PNL were fever, ureteral obstruction by fragmented stones, A-V fistula and discharge through the percutaneous nephrostomy catheter. Conclusions: Two-stage PNL is a more effective approach for the patients with renal calculi comparing to one-stage PNL in terms of the operation time, the operation-associated complications and the psychological and physical pressures on the patients and operators. (Korean J Urol 2006;47: 512-516) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ