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Vol. 40, No. 6, 2001
Issue release date: December 2001

Minimally Invasive PCNL in Patients with Renal Pelvic and Calyceal Stones

Lahme S. · Bichler K.-H. · Strohmaier W.L. · Götz T.
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Abstract

Stones of the renal pelvis can be treated either by extracorporeal shock wave lithotripsy (SWL) or percutaneous nephrolithotomy (PCNL). As a low–risk procedure with a longer treatment period, SWL often leads to persistent residual stone fragments, whereas conventional PCNL achieves a higher stone–free rate and allows a shorter treatment period albeit with a somewhat higher surgical risk. To reduce the invasiveness of conventional PCNL, the application of a miniaturised instrument for PCNL (MPCNL) was evaluated. For MPCNL a rigid nephroscope with a calibre of 12 F was developed and used in 19 patients. After puncture of the kidney under ultrasound control and single–step dilatation, a 15 F Amplatz sheath was placed. Data on the stone size and location, stone–free rate, blood transfusions, operating time and complications were recorded. In all patients, the part of the kidney afflicted by the stone was successfully punctured. On average, retreatment rate was 0.7. The mean stone size was 2.4 cm2. The average operating time was 99.2 min. In every case, the absence of residual stones was confirmed radiologically and nephroscopically. Hemorrhages requiring a blood transfusion did not occur. A febrile pyelonephritis occurred as a postoperative complication in one patient (= 5.3%). MPCNL represents an alternative to SWL for renal calculi with a size from 1 to 2 cm located in the renal pelvis and calices, especially the lower calix. The advantages are the short treatment time, the high stone–free rate and the accessibility of lower pole stones which are less amenable to SWL. MPCNL is not suitable for large concrements since the limited sheath diameter would increase the operating time. Due to this limitation, MPCNL represents an extension of the indication for conventional PCNL that it can in no way replace.



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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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References

  1. Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, Macaluso JN Jr, McCullough DL: Nephrolithiasis Clinical Guidelines Panel summary report on the management of staghorn calculi. The American Urological Association Nephrolithiasis Clinical Guidelines Panel. J Urol 1994;151: 1648–1651.
  2. Netto NR Jr, Claro JF, Lemos GC, Cortado PL: Renal calculi in lower pole calices: what is the best method of treatment? J Urol 1991;146: 721–723.
  3. Webb DR, Payne SR, Wickham JE: Extracorporeal shock wave lithotripsy and percutaneous renal surgery: Comparisons, combinations and conclusions. Br J Urol 1986;58:1–5.
  4. Eisenberger F, Fuchs G, Miller K, Bub P, Rassweiler J: Extracorporeal shock wave lithotripsy (ESWL) and endourology: An ideal combination for the treatment of kidney stones, World J Urol 1985;3:41–47.
  5. Leroy AJ, Segura JW, Williams HJ Jr, Patterson DE: Percutaneous renal calculus removal in an extracorporeal shock wave lithotripsy practice. J Urol 1987;138:703–706.
  6. Jackman SV, Hedican SP, Peters CA, Docimo SG: Percutaneous nephrolithotomy in infants and preschool age children: Experience with a new technique. Urology 1988;52:697–701.
  7. Jackman SV, Docimo SG, Cadeddu JA, Bishoff JT, Kavoussi LR, Jarrett TW: The Amini–perc@ technique: A less invasive alternative to percutaneous nephrolithtomy. World J Urol 1998;16:371–374.
  8. Cass AS: Extracorporeal shock wave lithotripsy or percutaneous nephrolithomy for lower pole nepholithiasis? J Endourol 1996;10:17– 20.
  9. McDougall EM, Denstedt JD, Brown RD, Clayman RV, Preminger GM, McClennan BL: Comparison of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy for the treatment of renal calculi in lower pole calices, J Endourol 1989;3:265–271.
  10. Netto NR, Claro JF, Ferreira U: Is percutaneous monotherapy for staghorn calculus still indicated in the era of extracorporeal shock wave lithotripsy? J Endourol 1994;8:195–197.
  11. Boddy SAM, Kellett MJ, Fletscher MS, Ransley PG, Paris AMI, Whitfield HN, Wickham JEA: Extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy in children. J Pediatr Surg 1982;22:223–227.
  12. Cadeddu JA, Chen R, Bishoff J, Micali S, Kumar A, Moore RG, Kavoussi LR: Clinical significance of fever after percutaneous nephrolithotomy. Urology 1998;51:48–50.

    External Resources

  13. Desai M, Ridhorkar V, Patel S, Bapat S, Desai M: Pediatric percutaneous nephrolithotomy: Assessing impact of technical innovations on safety and efficacy. J Endourol 1999;13:359– 364.
  14. Jewett MA, Bombardier C, Menchions CW: Comparative costs of the various strategies of urinary stone disease management. Urology 1995;46(3 suppl A):15–22.


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