Percutaneous nephrolithotripsy in complex renal stones
Wednesday, 15 April 2009- A group of Swedish researchers evaluated the impact of an extended radiological preoperative planning with 3D CT in patients with complex renal stones.
Brehmer, M. et al., hypothesised that an extended preoperative planning would optimise the results as well as minimise the risks for complications such as bleeding by, for example, decreasing the need of multiple dilated access tracts.
A total of 33 consecutive patients with complex renal stones were included in a prospective study. Initially the patients were examined with IVP or abdominal CT. In consensus, an endourologist and a radiologist decided an optimal access tract from these images. All patients were then examined with CT with thin slices and 3D reconstructions of the collecting system and the stone/stones.
In order to simulate the anatomical relations during surgery the patients were scanned in a prone position and with a wedge cushion under the lower part of the abdomen. In consensus and blinded for the result from the initial decision an access tract was estimated from the 3D CT. Subsequently all patients underwent percutaneous nephrolithotripsy (PNL).
From the initial examination an access tract was planned in 26 patients whereas in seven cases planning was not possible. After the 3D CT, initial decision was changed in 15 of the 26 patients. In those cases where planning had previously not been possible, 3D CT enabled estimation of an adequate access tract.
In 31/33 patients a tract for PNL was established in agreement with the last decision taken. In 16 cases the access tract was supra costal. A total of 23 patients were successfully treated in one PNL session and in 20 of these, only one tract was dilated. Ten patients required further treatment with ESWL (4), PNL (2) or ureteroscopy (4). All secondary PNL procedures were performed through the initial tract. Hydrothorax occurred in 3 patients due to supra costal punctures and two patients had infections needing additional antibiotic treatment. No patient had significant bleeding.
The researchers concluded that an extended preoperative planning with 3D CT may optimise the results and minimise complications in the treatment of complex renal stones with PNL.
Source: Brehmer, M.1, Magnusson, A., et al. Poster Session, Abstract 566, "PNL in complex renal stones - optimizing the results and minimizing the risks by using 3D CT for preoperative planning," 24th Annual EAU Congress, Stockholm, Sweden.