Percutaneous nephrolithotomy: Analysis of 500 consecutive cases

Abstract

The first 500 patients who underwent percutaneous stone removal at our hospital and who have been evaluated for at least 8 months were reviewed. Comparison of the first 100 patients with the entire series showed a sharp improvement in the success rate as the radiologic and urologic team gained experience. The success rate for simple pelvicaliceal stones was 98% in the entire series (vs. 89% in the first 100 cases) and 87% for staghorn calculi. The most common complication was bleeding, with 12% of the patients requiring transfusion. Other complications include infection (0.6%), retained stone fragments (4%), and ureteropelvic junction stricture (1%). There was 1 death, an obese diabetic woman who suffered a myocardial infarction. Successful stone extraction requires a properly placed nephrostomy tract, and radiologic and urologic expertise. The advent of extracorporeal shock-wave lithotripsy will not abolish the need for nephrostolithotomy.

Percutaneous Nephrostomy with Extensions of the Technique: Step by Step

“…A large-diameter track may be necessary for percutaneous stone therapy, nephroscopy, or antegrade ureteroscopy (13)(14)(15)(16). For such complex manipulations, a "safety" wire is always placed in a stable position (preferably down the ureter) in addition to the working wire.…”

Renal pelvic stones: choosing shock wave lithotripsy or percutaneous nephrolithotomy

“…In a review by Lee et al of 500 patients undergoing PNL, the most common complications were bleeding necessitating transfusion (12%) and pulmonary problems (7%) (44). The majority of bleeding incidents (88%) in this series occurred at the time of, or immediately following, the procedure, and the remainder were delayed and due to pseudoaneurysm formation.…”

Complications of percutaneous nephrostomy in the treatment of malignant ureteral obstructions: single–centre review

“…The 12th rib, the iliac crest and the posterior axillary line are important cutaneous landmarks, and the path of calyx branches ideally should be projected by the physician on the dorsolumbar access site. Direct puncture of the renal pelvis should be avoided in connection with the risk of urinary leakage and proximity of vascular hilar structures that could be harmed during the procedure [45]. The ideal approach should be performed in posterolateral projection, at the joining of anterior two thirds of the renal parenchyma with posterior one third by pricking a calyx of the inferior group, as this is a relatively avascular area [16,45].…”

“…Direct puncture of the renal pelvis should be avoided in connection with the risk of urinary leakage and proximity of vascular hilar structures that could be harmed during the procedure [45]. The ideal approach should be performed in posterolateral projection, at the joining of anterior two thirds of the renal parenchyma with posterior one third by pricking a calyx of the inferior group, as this is a relatively avascular area [16,45]. As a matter of fact, the renal artery divides into two major branches, ventral and dorsal, and its division creates an avascular zone known as Brödel's line, which lies between the vascular districts of the ventral and dorsal branch of the renal artery [41,42].…”