Abstract

 Introduction: Renal stone disease is a challenging problem in urologic practice especially in our locality because of large stone burden and recurrence. Since ,the early 1980s when percutaneous nephrolithotomy (PCNL) was established for management of renal stones, open surgical procedures have virtually been replaced. PCNL is a safe, effective and minimally invasive approach compared to open surgery for patients with large single, multiple or staghorn stones. The aim of this prospective study was to evaluate and to review our experience with PCNL in management of renal and upper ureteric stones.
 
 Methods: Prospective study carried out at Lumbini Medical College and Teaching Hospital during 1stJanuary 2011 to 31st October 2011. Sixty patients were evaluated and subjected to PCNL. After clinical investigations like ultrasonography (USG) and intravenous urography (IVU), once patients were found to have renal or upper ureteric stones they were informed and explained about PCNL, its likely complications, probable hospital stay, the cost of treatment and data were recorded along with the operative time, estimated blood loss, stone burden, stone-free rate, length of hospitalization and complications .Patients were followed up after three months to rule out recurrence of stones by plain abdominal x-ray of kidney, ureter and bladder and USG.
 
 Results: Out of 60 patients 35 were male and 25 were female (M: F=1.4:1) with mean age of 37 years and were subjected to PCNL monotherapy. With the average stone size of 3.26cm, the mean operative time was 78 minutes. Complete stone removal achieved by PCNL alone in 60 cases, with insignificant residual small stones we achieved 97% stone clearance rate. The mean hospital stay was 3.7 days. No Serious complications were encountered, 9 (15%) patients required blood transfusion and 3 (5%) patients developed transient post-operative pyrexia.
 
 Conclusion: PCNL is the first line treatment option for management of large renal stones which as monotherapy has advantages in removal of renal and upper ureteric stones and achieving excellent results with minimal morbidity.
Highlights
Renal stone disease is a challenging problem in urologic practice especially in our locality because of large stone burden and recurrence
In our study 60 patients were treated with percutaneous nephrolithotomy (PCNL) monotherapy for single, multiple and stag horn renal stones
Stones were approached through upper, middle, lower calyx and multiple sites as well in some patients with stag horn calculi Table 2 and 3
Summary
Renal stone disease is a challenging problem in urologic practice especially in our locality because of large stone burden and recurrence. PCNL is a safe, effective and minimally invasive approach compared to open surgery for patients with large single, multiple or staghorn stones The aim of this prospective study was to evaluate and to review our experience with PCNL in management of renal and upper ureteric stones. Lumbini Medical College Teaching Hospital, Palpa, Nepal (ESWL), Percutaneous nephrolithotomy (PCNL) is still the method of choice in patients with large single, multiple or stag horn stones, frequently as monotherapy.[1] PCNL began to be a routine procedure in developed countries since 1980s and has become a standard, well established procedure for the treatment of renal stones.[2,3] Efforts have been made to decrease the procedure morbidity by improving the techniques and the equipment’s used in PCNL procedure.[4]. Journal of Lumbini Medical College. 2013;1(1):35-8. doi:10.22502/jlmc.v1i1.11
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