Abstract
Percutaneous Nephrolithotomy is currently the preferred first line treatment for simple & complex renal calculi. The technique also being used increasingly for smaller stones that have failed ESWL. Aim of the study is to share our experience in PCNL in course of time. This study was conducted from January 2009 to December 2012, 131 patient's with 142 renal units of 5-75 yrs of age, PCNL were performed in NIKDU, BSMMU & JBFH. Stone were classified into simple (isolated renal pelvis or isolated calyceal stones) or complex (partial or complete staghorn stones, renal pelvic stone with accompanying calyceal stones). The stone size was 1.5-5cm approximately. We asses our initial puncture technique, need for multi-tract, supra 12th rib access, stone free rate, operative duration, postoperative complication, number of transfusion and hospital stay. Operative durations were 60 min -180 minutes. Puncture technique improved in course of time. 14 patients need multi-puncture and tract, all are supra 12th access. Out of 142 renal units 120 (83%) were stone free after first procedure, another 22 need and auxiliary procedure, (5 2nd look PCNL, 6 URS, 11 ESWL) to become stone free result in a 95% stone free rate. Complications occurred in 17 procedures which dealt accordingly. This study revealed PCNL is an effective, versatile safe and cosmetically acceptable procedure for all age groups in simple and complex renal stone.
Highlights
The advent and continuous evolution of percutaneous nephrolithotomy (PCNL) have led to a revolution in the management of renal stones[1,2]
Based on personal experience and an overview of the literature, we present PCNL as a step-by-step approach including the stone clearance, the description of possible complications and their origin and management adequately
PCNL was performed in National Institute of Kidney Diseases & Urology (NIKDU), Bangobandhu Sheikh Mujib Medical University (BSMMU) & Japan Bangladesh Friendship Hospital (JBFH)
Summary
The advent and continuous evolution of percutaneous nephrolithotomy (PCNL) have led to a revolution in the management of renal stones[1,2]. PCNL is the preferred treatment for patients with renal calculi and is a safe and successful method used for removal of different types of stones[3]. The technique is being used increasingly for smaller stones that have failed Extra Corporeal Shockwave lithotripsy (ESWL) or where in the anatomy of the collecting system would likely result in a lesser chance of success with ESWL. The traditional subcostal access is preferred in percutaneous renal surgery to avoid injury to the lungs and pleura[7]. In some patients, such as those with upper calyceal stones, impacted upper ureteral stones, staghorn calculi, and in obtaining access to the ureteropelvic junction (UPJ), the supracostal approach may be the most direct means to achieve a satisfactory result. Knowledge of the pleural and diaphragmatic anatomy and refinement of the surgical technique have reduced these complications to a minimum
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