Does previous open renal surgery or percutaneous nephrolithotomy affect the outcomes and complications of percutaneous nephrolithotomy

Abstract

In this study, we aim to evaluate the effectiveness and safety of PNL in patients with a history of open renal surgery or PNL by comparing with primary patients and to compare impact of previous open renal surgery and PNL on the success and complications of subsequent PNL. Charts of patients, who underwent PNL at our institute, were analyzed retrospectively. Patients were divided into three groups according to history of renal stone surgery. Patients without history of renal surgery were enrolled into Group 1. Other patients with previous PNL and previous open surgery were categorized as Group 2 and Group 3. Preoperative characteristic, perioperative data, stone-free status, and complication rates were compared between the groups. Stone-free status was accepted as completing clearance of stone and residual fragment smaller than 4 mm. Eventually, 2070 patients were enrolled into the study. Open renal surgery and PNL had been done in 410 (Group 2) and 131 (Group 3) patients, retrospectively. The mean operation time was longer (71.3 ± 33.5 min) in Group 2 and the mean fluoroscopy time was longer (8.6 ± 5.0) in Group 3 but there was no statistically significant difference between the groups. Highest stone clearance was achieved in primary PNL patients (81.62%) compared to the other groups (77.10% in Group 2 and 75.61% in Group 3). Stone-free rate was not significantly different between Group 2 and Group 3. Fever, pulmonary complications, and blood transfusion requirement were not statically different between groups but angioembolization was significantly higher in Group 2. Percutaneous nephrolithotomy is a safe and effective treatment modality for patients with renal stones regardless history of previous PNL or open renal surgery. However, history of open renal surgery but not PNL significantly reduced PNL success.

Previous Open Stone Surgery: Is It a Risk Factor for Bleeding in Percutaneous Nephrolithotomy

“…Interestingly, there are also some reports indicating that previous open renal stone surgery reduced blood loss during PNL (11). PNL success was stated to decrease in patients with previous open stone surgery in some studies (12). In our study, stonefree rates were 79.2% in the group with previous operation and 85.3% in the control group, and there was no statistically significant difference in success rate between the groups.…”

Two Different Renal Dilatation Techniques in Percutaneous Nephrolithotomy: One-Shot Dilation vs. Sequential Dilation

“…History of previous renal intervention results in inflammation, and neovascularization in the renal parenchyma and fragile vascular walls. [21] More radial force is applied to the renal parenchyma in cases undergoing OD. [22] This may be a factor that increases the risk of bleeding in patients undergoing secondary intervention.…”

Böbrek Taşı Olan Çocuklarda Önceki Taş Tedavisinin Perkütan Nefrolitotomi Sonuçlarına Etkisi

“…Bazı çalışmalarda daha önceden açık cerrahi geçirmiş olan hastalarda primer PNL olanlara göre istatiksel olarak anlamlı uzun operasyon süresi bildirilirken (9-11), diğer birçok çalışmada operasyon süresi açısından istatiksel bir farkın bulunmadığı rapor edilmiştir (12)(13)(14)(15)(16)(17)(18)(19). Literatürde, yetişkin hasta serilerinde anjioembolizasyon gerektiren vasküler komplikasyonların açık cerrahi (20) veya PNL (21) hikayesi olan hastalarda daha sık izlendiğine dair az sayıda çalışma olmasına rağmen, kan transfüzyonu gerektiren kanama oranlarını karşılaştıran birçok çalışmada istatiksel bir farkın bulunmadığı belirtilmiştir (13)(14)(15)(16)(17). Yine, PNL sonrası ikincil tedaviye gereksinimin açık cerrahi öyküsü olanlarda daha fazla olduğunu belirten bir dizi çalışmanın sonuçları (11,14) diğer çalışmalarda konfirme edilmemiştir (10,15,16).…”