INITIAL EXPERIENCE OF PERCUTANEOUS NEPHROLITHOTOMY IN HAZARA REGION
AbstractBackground: Renal stone disease affects a large population of the world and surgical management is the main stay treatment for larger stones. In comparison to open procedures, percutaneous nephrolithotomy (PCNL) has been known to offer almost similar stone clearance with least patient morbidity. The study was done with the objectives to evaluate our initial experience of PCNL in the management of nephrolithiasis in Abbottabad. Methods: A case series study was carried out at a private hospital, Valley Medical Complex, Abbottabad, including the 35 patients undergoing PCNL from January 2015 to February 2016. Results: 35 patients (23 male (65.7%) and 12 female (34.3%) underwent PCNL with a mean age of 35.57 years±6.701 and mean renal stones size of 24.49 mm±7.098. 28.6% stones (n=10) were located in the renal pelvis, 28.6% (n=10) in the lower pole of kidney and 42.9% (n=15) had stones in other sites of kidney. 25.7% patients (n=9) had mild, 57.1% (n=20) moderate and 17.1% (n=6) had gross hydronephrosis. 28.6% patients (n=10) had a single renal stone, 61.4% (n=18) had ≥2 stones whereas 7 patients (20%) had partial stag horn stone. Tract access was gained through upper pole in 8.6% patients (n=3), middle pole in 11.4% (n=2), and lower pole in 85.7% (n=30). Complete stone clearance was achieved in 30 patients (85.7%) whereas partial clearance accomplished in 3 patients (8.6%). 2 patients had PCNL failure due to failed tract access. Postoperatively 10 patients (28.6%) had significant pain, 06 patients (17.1%) had fever and 01 patients (2.9%) required blood transfusion. Conclusions: PCNL is a safe procedure for management of upper urinary tract stones and is still in evolution stages in Hazara region.Keywords: renal stones; percutaneous nephrolithotomy (PCNL); hazara; staghorn stone
Resnick Ml, Prsky L. Summary of the National Institutes of Arthritis, Diabetes, Digestive and Kidney Diseases Conference on Urolithiasis: state of the art and future research needs. J Urol 1995;153(1):4–9.
Moe OW. Kidney stones: Pathophysiology and medical management. Lancet 2006;367(9507):333–44.
Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol 2010;12(2-3):e86–96.
Naqvi SA. Regional problems in Pakistan-most prevalent kidney diseases and related problems. In Jakarta. 1989: p.283–8.
Buchholz NP, Abbas F, Afzal M, Khan R, Rizvi I, Talati J. The prevalence of silent kidney stones-an ultrasonographic screening study. J Pak Med Assoc 2003;53(1):24–5.
Goodwin WE, Casey WC, Woolf W. Percutaneous trocar (needle) nephrostomy in hydronephrosis. J Am Med Assoc 1955;157(11):891–4.
Fernstrom I, Johansson B. Percutaneous pyelolithotomy: a new extraction technique. Scand J Urol Nephrol 1976;10(3):257–9.
Türk C, Knoll T, Petrik A. Guidelines on urolithiasis. european urological association web site; 2014.
Brannen GE, Bush WH, Correa RJ, Gibbons RP, Elder JS. Kidney stone removal: percutaneous versus surgical lithotomy. J Urol 1985;133(1):6–12.
Lam HS, Lingeman JE, Mosbaugh PG, Steele RE, Knapp PM, Scott JW, et al. Evolution of the technique of combination therapy for staghorn calculi: a decreasing role for extracorporeal shock wave lithotripsy. J Urol 1992;148(3 Pt 2):1058–62.
Khan FA, Khan JH. Stone survey of Punjab hospitals. Pak Post Med J 1990;1:7–13.
Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. Eur Urol 2007;51(4):899–906.
Zilberman DE, Lipkin ME, de la Rosette JJ, Ferrandino MN, Mamoulakis C, Laguna MP, et al. Tubeless percutaneous nephrolithotomy-the new standard of care? J Urol 2010;184(4):1261–6.
James E, Lingeman DA, Lifshitz AP, editors. Campbell's urology. 9th ed. Philadelphia: Saunders; 2007.
Sahin A, Atsu N, Erdem E, Oner S, Bilen C, Bakkaloglu M, et al. Percutaneous nephrolithotomy in patients aged 60 years or older. J Endourol 2001;15(5):489–91.
Rassweller JJ, Renner C, Eisenberger F. The management of complex renal stones. Br J Urol 2000;86(8):919–28.
Kim SC, Kuo RL, Lingeman JE. Percutaneous nephrolithotomy: an update. Curr Opin Urol 2003;13(3):235–41.
Feng MI, Tamaddon K, Mikhail A, Kaptein JS, Bellman GC. Prospective randomized study of various techniques of percutaneous nephrolithotomy. Urology 2001;58(3):345–50.
Reddy PK, Hulbert JC, Lange PH, Clayman RV, Marcuzzi A, Lapointe S, et al. Percutaneous removal of renal and ureter calculi: experience with 400 cases. J Urol 1985;134(4):662–5.
Mariappan P, Smith G, Bariol SV, Moussa SA, Tolley DA. Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study. J Urol 2005;173(5):1610–4.