Abstract
Objectives:To see the effect of intra operative antegrade flexible nephroscopy during Percutaneous nephrolithotomy on stone free rate.Methods:We retrospectively reviewed electronic medical records of patients who underwent percutaneous nephrolithotomy from 2010 to 2017 for renal stones >2cm. Patients found eligible were divided in, Group-I who did not have intraoperative Flexible nephroscopy and Group-II who had flexible nephroscopy during percutaneous nephrolithotomy. All procedures were done by senior consultants. Variables like Mean age, side, stone size, skin to stone distance and Hounsfield unit were compared. Outcomes like Stone free rate, hospital stay and operative time were compared between the groups.Results:The study included 248 patients, consisting 85 (34.3%) females and 163 (65.7%) males. Mean age ± SD was 45.8±13.8 years. Both group were similar in characteristics like mean age, stone size, skin to stone distance and Hounsfield units. The overall stone free rate was 71%. It was not significantly different between the groups, 76% in Group-II vs. 67% in Group-I. However stone free rate markedly improved with flexible nephroscopy in patients with staghorn calculi. Mean operative time and hospital stay were similar between the groups.Conclusions:Intraoperative flexible nephroscopy during percutaneous nephrolithotomy significantly increases stone free rate in patients with staghorn stones.
Highlights
Renal stones are a common pathology with annual prevalence of 2-3% worldwide.[1]
There was no significant differences among these groups regarding the age and gender ratio (Table-I). Both group were similar in characteristics like mean age, mean stone size, mean skin to stone distance and mean Hounsfield units (Table-I)
Percutaneous nephrolithotomy (PCNL) has been the standard of care for renal stone >2cm giving high success rates.[11]
Summary
Renal stones are a common pathology with annual prevalence of 2-3% worldwide.[1] Pakistan is located in the middle of the Afro-Asian stone belt, with stone prevalence of 12–15%. Stone disease comprise of 50% of urological workload in adults, while 60% in children.[2] Percutaneous nephrolithotomy (PCNL) represents the standard of treatment for renal stones >2cm. It is a minimally invasive procedure providing high success rates with an excellent safety profile.[2,3,4,5,6]. Intraoperative detection of residual fragments during PCNL may be challenging.
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