Kidney Stone Removal: Percutaneous Versus Surgical Lithotomy

Abstract

Percutaneous removal of most urinary tract calculi may be performed as a 1-stage effort with techniques and skills developed recently in the specialties of urology and radiology. Ultrasonic fragmentation of most calculi was done to permit their extraction. Percutaneous ultrasonic lithotripsy was performed on 250 consecutive (a single exception) patients bearing stones that required removal. Targeted calculi were removed successfully from 97 per cent of these patients. One patient required surgical lithotomy. The previous 100 patients with stones underwent surgical lithotomy with 96 per cent success. Complications of percutaneous ultrasonic lithotripsy appeared equitable with those of surgical lithotomy. Of the patients who underwent percutaneous ultrasonic lithotripsy 6 (6 per cent) required extended hospital days or additional procedures for management of complications. None of these patients required a surgical incision. Anesthesia times were similar for both groups--average 159 plus or minus 4 (standard error) minutes for percutaneous ultrasonic lithotripsy and 193 plus or minus 8 minutes for surgical lithotomy. Hospital recovery days averaged 5.5 plus or minus 0.3 for percutaneous ultrasonic lithotripsy and 8.4 plus or minus 0.5 for surgical lithotomy (p less than 0.01). Associated costs averaged $7,203 plus or minus 55 for lithotripsy and $8,849 plus or minus 660 for lithotomy (p less than 0.01). The number of narcotic administrations per patient (days 1 to 5 postoperatively) averaged 9.88 plus or minus 0.70 for lithotripsy and 16.82 plus or minus 0.78 for lithotomy (p less than 0.01). The average patient who underwent percutaneous ultrasonic lithotripsy felt capable of full activity 2.0 plus or minus 0.2 weeks following stone removal, whereas no patient who underwent previous surgical lithotomy recalls a recovery period of less than 3 weeks (p less than 0.01). We believe that most upper urinary tract calculi may be removed cost-effectively with a percutaneous approach. Compared to surgical lithotomy, percutaneous ultrasonic lithotripsy may result in rapid convalescence with diminished pain.

Contemporary Practice of Percutaneous Nephrolithotomy: Review of Practice in a Single Region of the UK

“…This has been aided by advances in technology and equipment resulting in stone removal with less morbidity, shorter convalescence, and reduced cost compared with open surgery. 2,3 Excellent outcomes have been reported following PCNL with stone-free rates approaching 95%. Nevertheless, most published series of PCNL are from single centres with a dedicated sub-specialist interest in stone management.…”

PCNL Monotherapy for Renal Calculi — An Initial Experience

“…Nevertheless, a failure rate of 6.8 per cent was encountered, which is higher than the accepted figure of 1.5 per cent in similar series [9]. However if the outcome is viewed in light of the fact that every new procedure carries a learning curve of experience, and this is a small series, it may not be unduly sanguine to expect better results in the future.…”

Direct percutaneous ureterolithotomy

“…No catheter larger than 8-French was ever placed through the ureterotomy, which meant that the size of the ureteral opening was limited to that created by the 9-French tip of the lithotripsy probe. Given the known ability of the perforated urinary tract to heal [6], it is not surprising that a puncture of this size can be made into the ureter without complication. …”