Retrospective evoluation of success and complication rates of percutaneous nephrolithotomy in comlex (staghorn, semi-staghorn, multple) kidney stones

Purpose: Success and complication rates of PNL operations performed forcomplex kidney stones between July 2007 and January 2010 were evaluatedretrospectively. The aim was to determine the efficacy and safety of PNL techniquefor complex kidney stones.Patients and Methods: Sixty-one patients (68 renal units) were included in the study.All the patients were evaluated with a clinical questionnaire for age, sex, symptoms,procedures conducted for Stone disease and coexisting diseases. Seven patients hadbilateral Stones and five had solitary kidney. Seven patients were at childhood ages. Theoperation position, technique and anesthesia protocol was similar for all patients. Thepatients were followed up for 3-32 (14±7, 31) months. Stone free condition wasdetermined by a KUB roentgenogram at postoperative 3rd day and if necessary, byKUB, IVP, ultrasonography or non-contrast spiral CT at 1 to 3 months. For residualstones, ESWL, URS or re-PNL was conducted as auxiliary procedure. Residual Stonesafterwards was evaluated as failure to treat. Complications were recorded as minor ormajor.Results: Stone free outcome was achieved at 45 (66,2 %) patients after initialprocedure. Clinically insignificant fragments (CIF) were revealed in 7 (10,3 %) patients.With CIF, the success rate was % 76,5. Auxiliary procedure was conducted for 16 (23,5%) patients with residual Stones in KUB. Among them, 1 (1,5 %) was completely Stonefree while 15 (22 %) patients went on with auxiliary procedures and at the end of 3months, 12 (17,6 %) renal units were Stone free. Total success rate was (95,6 %). Three(4,4 %) renal units that had residual Stones despite auxiliary procedures were noted as61treatment failure. Access to kidney was achieved from mid, lower and upper calices in44 (64,7 %), 16 (23,5 %) and 2 (2,9 %) renal units, respectively. Multiple punctureswere performed in 6 (8,8 %) renal units. Puncture site was subcostal in 64 (94,1 %),intercostal in 2 (2,9 %) and both subcostal and intercostal in 2 (2,9 %) renal units.Single puncture was performed in 62 (91,2 %) renal units while multiple punctures wasnecessary in 6 (8,8 %). Major and minor complication rates were ( 26,5 %) and ( 47,1%), respectively. As major complications, 15 (22,1 %) patients received bloodtransfusion due to postoperative bleeding. Two (2,9 %) patients with sustainedhematuria underwent renal angiography and AV fistula were treated by embolization atdays 7 and 8. One patient had a chest tube due to a hemopneumothorax. Minorcomplications were postoperative fever in 15 (22,1 %) urinary infection in 3 (4,4 %),perirenal hematoma in 3 (4,4 %) and urinary extravasations in 7 (10,3 %) patients. Fourpatients had DJ stents for prolonged urine drainage over 48 hrs.Conclusion: PNL is effective in the treatment of complex kidney Stones. Yet, it mustbe conducted with caution due to high risk of complications.Key Words: Complex Renal Stones (Staghorn, Semistaghorn, Multiple), PercutaneousNephrolithotomy (PCNL), Success, Complications.