Percutaneous Nephrolithotomy in Patients with or without a History of Open Nephrolithotomy

Basiri, Abbas; Karrami, Hossein; Moghaddam, Seyed Mohammadmehdi Hosseini; Shadpour, Pejman

doi:10.1089/089277903765444320

Cited by 48 publications

(37 citation statements)

References 16 publications

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“…Previous intervention, inflammation, and adhesions of renal parenchyma could lead neovascularization and fragile vessel wall. Nevertheless, Basiri et al found no differences in blood transfusion rate according to previous open renal surgery [25]. Controversially, in Sofikerim's study, the blood transfusion rates were 3.7 and 8.1 % in patients with and without previous renal surgery, respectively [16].…”

Section: Discussionmentioning

confidence: 93%

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

et al. 2015

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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.

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Section: Discussionmentioning

confidence: 93%

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

et al. 2015

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“…Furthermore, these systemic disorders are known to alter the mechanisms of hemostasis as well as wound healing. On the other hand, ages of the patients, history of previous renal surgery or extracorporeal SWL treatment, function of the effected kidney, and degree of hydronephrosis were shown to have no significant impact on the outcome [12,18] .…”

Section: Discussionmentioning

confidence: 94%

“…The relationship of hemorrhage during PNL and patient and procedural factors has been extensively investigated in the literature [7,9,[11][12][13][18][19][20][21][22] . Establishing optimal percutaneous access appears to be the key determinant of PNL-related blood loss [12] .…”

Section: Discussionmentioning

confidence: 99%

Impact of Percutaneous Access Point Number and Location on Complication and Success Rates in Percutaneous Nephrolithotomy

et al. 2006

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Objectives: Percutaneous nephrolithotomy (PNL) is sometimes associated with complications, especially in patients with complex stones. Herein, we review our experience with PNL to determine the impact of percutaneous access number and location on success and complication rates. Patients and Methods: During a 2-year period, a total of 275 patients with a mean age of 42.3 ± 14.8 (range: 13–75) years underwent PNL. Stones were classified as simple in 51.6%, and complex (staghorn calculi or renal pelvis stones coexisting with caliceal stones) in 48.4%. Percutaneous access was done under C-armed fluoroscopy and the tract was formed with a high-pressure balloon dilation system. One single percutaneous access was sufficient in 210 (76.4%), while 2 accesses were utilized in 44 (16%), and ≧3 accesses in 21 cases (7.6%). Supracostal access was performed in 23 (8.4%) patients. Results: An overall success rate of 94.9% was achieved. Stone location, but not the access point location, was the major determinant for success, which was 99.3 and 90.2% in patients with simple and complex stones, respectively (p < 0.01). Significant complications included bleeding necessitating blood transfusion in 28 (10.2%), and hydropneumothorax in 2 (0.7%) patients. Bleeding was observed in 39.1 and 7.5% of patients managed with supracostal access, and subcostal access, respectively (p < 0.01). An increased number of access points significantly augmented the risk for bleeding. Bleeding was encountered in 7.6% of patients managed with 1 percutaneous access point, and in 18.5% of cases managed with ≧2 access points (p < 0.05). Hydropneumothorax occurred in patients with supracostal access. Conclusion: Supracostal access as well as multiple punctures may be needed especially in the management of complex stones, and the need for multiple access points and supracostal access significantly increases complication rates.

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“…With the help of newly developed high-pressure balloons, assistance of fascial dilators, or by mechanical dilators, difficulty in establishing access may be overcomed 28 . In some other studies, it had been reported that open stone surgery can increase PCNL failure rate 31 , while others showed that previous open stone surgery does not affect PCNL outcome 32– 34 .…”

Section: Discussionmentioning

confidence: 97%

Factors affecting stone free rate of primary percutaneous nephrolithotomy on staghorn calculi: a single center experience of 15 years

2016

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Objectives: Percutaneous nephrolithotomy on staghorn calculi is challenging for urologists because it is difficult to remove all of the stones. The purpose of this study was to evaluate the associated factors of stone-free rate after primary percutaneous nephrolithotomy on staghorn calculi in a large series of patients at a single, tertiary referral, endourologic stone center. Methods: We collected data from medical record between January 2000 and December 2015. A total of 345 primary percutaneous nephrolithotomy procedures were performed for patients with staghorn calculi. This study included both and made no distinction between partial and complete staghorn calculi. Stone-free is defined as the absence of residual stones after undergoing percutaneous nephrolithotomy for the first time. Significant factors from univariate analysis that correlated with stone-free rate after primary percutaneous nephrolithotomy of staghorn stone were further analyzed using multivariate regression analysis. Results: The mean patient age was 52.23±10.38 years. The stone-free rate of percutaneous nephrolithotomy monotherapy was 62.6%. The mean operating time was 79.55±34.46 minutes. The mean length of stay in hospital was 4.29±3.00 days. Using the chi-square test, history of ipsilateral open renal stone surgery ( p = 0.01), stone burden ( p = < 0.001), and type of anesthesia ( p = 0.04) had a significant impact on the stone-free. From multivariate analysis, the history of ipsilateral open renal stone surgery [OR 0.48; 95% CI 0.28-0.81; p 0.01] and the stone burden [OR 0.28; 95% CI 0.18-0.45; p 0.00] were significant independent risk factors for stone-free.

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Percutaneous Nephrolithotomy in Patients with or without a History of Open Nephrolithotomy

Abstract: A history of open nephrolithotomy does not adversely affect the efficacy or morbidity of PCNL.

Cited by 48 publications

References 16 publications

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

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

Impact of Percutaneous Access Point Number and Location on Complication and Success Rates in Percutaneous Nephrolithotomy

Factors affecting stone free rate of primary percutaneous nephrolithotomy on staghorn calculi: a single center experience of 15 years

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