Studies on Renal Damage from Percutaneous Nephrolitholapaxy

Abstract

To study in detail the effects of percutaneous nephrolitholapaxy on renal function, a consecutive series of 11 patients were investigated preoperatively by excretory urography, gamma camera renography for determination of individual renal function and computerized tomography of the kidneys. Postoperatively, gamma camera examination, computerized tomography, antegrade nephrostography, renal angiography and excretory urography were performed. With 2 exceptions, percutaneous nephrostomy, dilation of the tract and stone removal were done in 1 stage with the patient under continuous epidural anesthesia. Nephrostomy tract dilation was done with an Olbert type balloon catheter or Alken metallic dilators. Thickening of Gerota's fascia was demonstrated by computerized tomography in most cases, and small to moderate perirenal hematomas were found in several. At gamma camera examination decrease of renal function was noted regularly on postoperative day 1 and returned to near initial levels 2 weeks postoperatively in most cases. Angiography in 10 patients showed discrete parenchymal scarring in some and a peripheral arteriovenous fistula in 1. We conclude that percutaneous renal stone surgery usually is tolerated well by the kidney.

Renal Functional Effects of Multiple-Tract Percutaneous Access

“…[4][5][6][7][8][9][10] Localized trauma and acute ischemia to kidney tissue are hallmarks of the PCNL access procedure, 11 and it is perhaps not surprising that both clinical and animal studies have shown that single-tract PCNL leads to an acute decline in renal filtration and perfusion. [11][12][13] The reduction in renal function is generally transient with full recovery observed within several weeks for most patients. [12][13][14][15][16][17] With respect to multiple-tract PCNL, a greater amount of renal mass is injured with each additional access and it is unknown whether this translates to the acute reduction in renal function being more severe than that after single-tract access.…”

Review on renal recovery after anatrophic nephrolithotomy: Are we really healing our patients?

“…Several studies have assessed the impact of PNL on renal function [25][26][27][28][29][30][31][32] . Usually there is an immediate decrease on renal function after surgery with return to baseline on long term.…”

Indications for Open Stone Removal of Urinary Calculi

“…In cases of complete staghorn calculi, we found that an endoscopic approach by PNL often requires several treat ments. Concerning the risks, especially the high propor tion of obstructive pyelonephritides (30%) must be men tioned [3][4][5], ESWL for staghorn calculi, used as mono therapy, is also of limited alternative value to open stone removal because of the length of treatment time [6,7], Therefore we are of the opinion that the treatment of a staghorn calculus by PNL is theoretical possible. Because of the long-lasting therapy and the high proportion of complications, it would be advisable to perform an open operation in these cases.…”