Combined antegrade with retrograde irrigation increasing clearances rates of stones during PCNL

Abstract

Background:The increasing incidence of kidney stones globally is linked to evolving lifestyles. Percutaneous Nephrolithotomy (PCNL) has emerged as a safe and effective treatment for renal stones, relying on continuous irrigation to enhance visibility and remove stone fragments and blood clots. The effectiveness of PCNL can be influenced by factors such as the type, pressure, speed, and volume of irrigation fluids, which may impact renal function during the procedure. Operative vision clarity, stone washout efficiency, native CT scan stone clearance, operation duration, stone clearance percentage, postoperative temperatures, blood transfusions, time until patient walking, and nephrostomy removal time were compared. Method: In this study, 44 patients undergoing PCNL for kidney stone removal were randomly assigned into two groups: Group I, using antegrade irrigation only, and Group II, employing a combined antegrade and retrograde approach via a ureteric catheter. Patients were monitored for various parameters including operative vision, stone washout, stone clearance (assessed by native CT scan), operation time, stone clearance percentage, postoperative temperatures, blood transfusion necessity, patient mobility postsurgery, and nephrostomy removal time. Results: indicated that Group II (Combined irrigation) had a clearer vision during the operation compared to Group I (antegrade only). The operation time was shorter in Group II, ranging from 23 to 45 minutes, whereas Group I operations lasted between 30 to 60 minutes. Stone clearance was higher in Group II at 99%, compared to 96% in Group I. Additionally, stone washout occurred more rapidly in the combined group. Conclusion:Patients with group II have lower duration of surgery, vision is more clear during surgery and stone clearance is more.