Experience of percutaneous nephrolithotripsy of large kidney stones

Abstract

Topicality. Kidney stone disease is referred to wide spread diseases. According to the literature data its prevalence is 732,8 cases per 100 000 of Ukrainian population. During the last years the usage of minimally invasive techniques, such as: extracorporeal shock-wave lithotripsy (ESWL) and ureteroscopy with contact lithotripsy has significantly increased, but percutaneous lithotripsy (PNL) remains as a technique of choice among basic methods of treatment of large size kidney stones.
The purpose of the work. To evaluate the effectiveness of the percutaneous shock wave lithotripsy (PNL) in treatment of kidney stones larger than 50 mm.
Materials and methods. Twenty-eight patients, among them twenty-five (89,28%) male patients and three (10,71%) female patients, with large > 50 mm kidney stones treated in NMMCC from April 2016 to March 2020 were included to the research. Stone-free rate and complications rates were examined.
Results. In thirteen cases (46.42%) the stones were located in the right kidney, in fifteen cases (53,57%) the stones were located in the left kidney. The nineteen patients (67,85%) did not have any residual stones, and nine patients (32,14%) had residual stones. The extracorporeal shock-wave lithotripsy had been performed in 4 patients (14%), in 5 (17%) cases – contact lithotripsy of residual stones, which migrated to the lower third part of the ureter. After repeated intervention in 5 cases (17,86%) stone-free status was obtained. Stone-free rate index was 85,71%. Average duration of operation was 115±24,64 min. Hemoglobin level before and after operative intervention was 142 (117–159) g/l and 119 (94–132) g/l respectively (р <0,005). Length of hospital stay was 5,07 (4–9) days. Complications were observed in six patients (21,5%). Stone-free status was defined as absence of any residual stones during radioscopy at 1 day after the operation or during computer tomography after 3 months. Residual stones d Ј 4 mm and > 4 mm were considered as insignificant and significant respectfully.
Conclusions. Percutaneous nephrolitotripsy is an effective and reliable method of treatment and should be a method of choice in treatment of staghorn stones and large size stones of the kidneys.