Mini-percutaneous nephrolithotomy in the treatment of un-hydronephrotic cata-staghorn renal calculi.
- Author:
Ning GAO
1
;
He-Qun CHEN
;
Lin QI
;
Zhong-Qing YANG
;
Fan QI
;
Xiang-Yang ZHANG
Author Information
1. Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China. gaoningwlq@126.com
- Publication Type:Journal Article
- MeSH:
Adult;
Endoscopy;
Female;
Humans;
Kidney Calculi;
surgery;
Male;
Middle Aged;
Nephrostomy, Percutaneous;
methods;
Retrospective Studies;
Treatment Outcome
- From:
Journal of Central South University(Medical Sciences)
2007;32(4):718-722
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To evaluate the surgical techniques and clinical effects of mini-percutaneous nephrolithotomy (mini-PCNL) in the treatment of un-hydronephrotic cata-staghorn renal calculi.
METHODS:The clinical data of 46 cases (31 males and 15 females) treated by mini-PCNL were retrospectively analyzed. There were mono-renal calculi in 38 patients (3 patients were the isolated renal calculi) while the other 8 combined opposite side upper urinary tract calculi. The diameter of calculi ranged from 4.2 to 6.4 (mean=5.2) cm. Puncturation was guided by B-type ultrasound. Lithotripsy by air pressure path lithotripter and/or holmium laser was done when the pervium was established.
RESULTS:The pervium in the 46 patients was successfully established by one-session puncturation with B-type ultrasonography guidance. The operative time ranged from 140 to 280 (mean=190) min. The amount of blood ranged from 50 to 200 (mean=100) mL and no one needed blood transfusion. Calculus was completely removed in 18 patients (39.1%). Calculi in 10 patients (21.7%) were completely removed among the 20 patients who underwent second-look mini-PCNL. Calculi in 1 of the 3 cases were completely removed by third-look mini-PCNL. Left-over calculi in 17 patients (8 patients after the first time mini-PCNL, 7 patients after second-look, and 2 patients after third-look) were treated by extracorporeal shock-wave lithotripsy (ESWL) and 8 were removed completely. All the 46 patients were followed up for 4 to 48 months. None of them had nephro-hydrops or stenosis. Renal function re-investigation showed that 8 patients recovered and 2 improved in the 10 patients who had azotemia before. Two (5.4%, 2/37) had calculus recurrence in 37 cases which calculi were completely removed before. The size and amount of left-over calculi in 3 patients (33.3%, 3/9) were increasing.
CONCLUSION:Mini-PCNL is effective and causes less trauma for un-hydronephrotic cata-staghorn renal calculi. Mini-PCNL combined ESWL may substitute the open operation and is the preferred method for un-hydronephrotic renal cata-staghorn calculi.
