Bilateral single procedure percutaneous nephrolithotomy
Monday, 2 November 2009- Unlike shock wave lithotripsy (SWL) or ureteroscopy, the percutaneous renal approach is not limited by stone size. However, the inherent complications of this technique, some of which really significant, necessitate a rigorous selection of the cases.
At the EAU 9th Central European Meeting (CEM) held from October 23-24, 2009 in Ljubljana, Slovenia, Victor Mirciulescu and colleagues (Bucharest, Romania) presented their study titled "Bilateral single procedure percutaneous nephrolithotomy," during the abstract session, which won the Second Prize for Best Abstract from Karl Storz.
"Since introducing the percutaneous approach in our department in 2001, more than 2000 patients benefited from this surgical technique," said Mirciulescu. "With the continuously expanding experience, we approached more and more complex cases, with good results and a decreasing rate of complications."
Among the 2103 patients with lithiasis, 174 presented bilateral disease. 6 patients were operated by single session percutaneous approach. The selection criteria for these patients consisted of lack of urinary infections, severe associated diseases (such as renal failure, diabetes, heart failure, coagulation problems, extreme obesity etc.).
Patients' choice was also decisive. The surgical procedure was continued on the contra-lateral renal unit only when the first intervention took place in good conditions, without complications.
The results showed that the hospital stay was 5±1 days, without major complications. After suppressing the nephrostomy tubes, one patient developed unilateral lumbar fistula, which necessitated ureteral stenting for 14 days. One patient presented upper urinary tract infection, which required antibiotherapy.
In their conclusions, the authors wrote: "The renal percutaneous approach continues to remain an important alternative in the treatment of renal lithiasis, with no limitations related to stone size. Single session bilateral percutaneous nephrolithotomy may be used only in rigorously selected cases, in order to limit any eventual complications."
Source: V. Mirciulescu , V. Cauni, et al., "Bilateral single procedure percutaneous nephrolithotomy," Saint John Emergency Clinical Hospital, Dept. of Urology, Bucharest, Romania; Karl Storz Second Prize for Best Abstract, EAU 9th Central European Meeting, Ljubljana, Slovenia, October 23 to 24, 2009.