Journals / Türk Üroloji Dergisi/Turkish Journal of Urology / 2006 / Cilt: 32 - Sayı: 4
Percutaneous nephrolithotomy in the management of staghorn renal calculus
- Pages
- 506–509
- DOI
- —
Abstract
Introduction: Staghorn renal calculi are branched stones that occupy a large portion of the collecting system. The term partial staghorn calculus defines a branched stone that occupies the part but not entire collecting system while complete staghorn calculus defines a stone that occupies the entire collecting system. There are 4 potential treatment alternatives are present in the treatment of staghorn renal calculi, these are: Percutaneous nephrolithotomy, Extracorporeal shock wave lithotripsy (ESWL), combinations of percutaneous nephrolithotomy and ESWL, open surgery. In this study we investigated the role of percutaneous nephrolithotomy in the treatment of staghorn renal stones retrospectively. Materials and Methods: From October 2003 to June 2006 a total of 30 patients with 32 staghorn renal calculi were treated with percutaneous nephrolithotomy. 17 of these staghorn calculi were complete while remaining 15 were partial. 8 (25%) renal units has had previous open surgery history. 30 renal units were operated under general anesthesia while remaining 2 were operated under spinal anesthesia. In one patient horseshoe kidney and in another patient pitotic kidney anomaly was present. First generation cephalosporins were given to all patients for prophylaxis. All procedures were performed in the prone position after retrograde ureteral catheterization. Percutaneous renal access was done under C-armed flouroscopy control using 18 g needle. The tract was dilateted with Amplatz dilatators and a 30-34F Amplatz sheath was placed. Percutaneous stone disintegration and stone removal was performed with a 26 F rigid nephroscope and a pneumatic lithotriptor. At the end of the procedure a nephrostomy tube was placed to all patients. Patients were evaluated with plain abdominal graphy on postoperative second day. On postoperative third months patients were also evaluated with intravenous pyelography or spiral non-contrast computed tomography. Results: Total of 33 percutaneous nephrolithotomy procedures were performed to 32 renal units including one second look procedure. The surface area of stones was ranged between 1200 to 5600 mm2. Mean stone surface area was 2315 mm2. Mean operative time was 153 min (100-360). The number of tracts required per patient was 2.2 (1-7). In 10 patients accesses were only subcostal in 19 patients both subcostal and intercostal accesses were performed. In remaining 3 patients only intercostal accesses were performed. Mean hospitalization duration was 4.2 days (3-9). Stone-free rate was 59.3% (19/32). If stones smaller than 4 mm were ignored, this ratio increased to 78.1% (25/32). Patients with 5 mm and larger residual fragments were considered for ESWL treatment (7/32). Complications were blood transfusion (n=11) (34.4%), fever (>38C°) (n=4) (12.5%), prolonged drainage (>48 hours) (n=2) (6.2%), prolonged ileus (>72 hours) (n=1) (3.1%) and late hematuria (n=1) (3.1%). Conclusion: Percutaneous nephrolithotomy has an important role in the treatment of staghorn calculi with short hospital stay, low morbidity and considerable success rate compared with open surgery. According to us open surgery should kept for the management of giant and complex staghorn calculi.
Özet
Geyik boynuzu böbrek taşlarının tedavisinde başlıca kullanılan yöntemler; perkütan nefrolitotomi, beden dışı şok dalga ile taş kırma (ESWL), perkütan nefrolitotomi ve ESWL kombinasyonları, açık cerrahidir. Bu çalışmada perkütan nefrolitotomi yöntemi ile tedavi ettiğimiz geyik boynuzu taşlı hastalarımızı geriye dönük olarak inceledik. Ekim 2003 ile Haziran 2006 yılları arasında yaş ortalaması 46.6 (18-76) yıl olan 30 hasta çalışmaya alındı. Hastalardan 2’sinde iki taraflı geyik boynuzu taş vardı. Toplam 32 böbrek hastasına perkütan nefrolitotomi uygulandı. Ortalama taş yükü 2315 mm2 (1200-5600) idi. Hastaların 10’una sadece subkostal, 19’una interkostal ve subkostal, 3’üne ise sadece interkostal giriş yapılarak perkütan nefrolitotomi uygulandı. İşlemler sonrası toplam tam taşsızlık (19/32) %59.3 oldu. ≤4 mm olan klinik önemsiz taş parçacıkları da başarılı kabul edildiğinde toplam başarı oranı (25/32) %78.1 oldu. 11 olguda (%34.4) kanama nedeni ile kan transfüzyonu uygulandı. 4 olguda (%12.5) ameliyat sonrası dönemde yüksek ateş (>38C°) gelişti. 2 olguda (%6.2) uzamış drenaj tespit edildi (>48 saat). 1 olguda (%3.1) uzamış ileus (>72 saat) gelişti. 1 olgu ise (%3.1) taburcu olduktan sonra geç dönemde hematüri gelişmesi nedeni ile hastanemize başvurdu. Sonuç olarak geyik boynuzu böbrek taşlarının tedavisinde perkütan nefrolitotomi yüksek başarı oranına sahip, etkili ve güvenilir bir tedavi yöntemidir