31.12.6 Determine the Outcome of Multiple Tract Percutaneous Nephrolithotomy for Renal Staghorn Calculus

Original Article

 

Nephrolithotomy for Renal Staghorn Calculus

Determine the Outcome of Multiple Tract Percutaneous Nephrolithotomy for Renal Staghorn Calculus

Nizamud Din1, Irfan Ahmed3, Mumtaz Ali Shah4, Fazal Elahi1, Fazal Akbar2 and Rashidullah1

ABSTRACT

Objective: To determine the outcomes of PCNL (multitract percutaneous nephrolithotomy) in patients presented with renal staghorn calculus.

Study Design: Descriptive case series study.

Place and Duration of Study: This study was conducted at the Department of Urology Saidu Teaching Hospital Swat and PIMS Islamabad, during from the period December 2018 to December 2019.

Materials and Methods: Two hundred and ten patients of both genders with renal staghorn calculi of >20 mm in size were included. Patients detailed demographics were recorded after taking written consent. Multiple tract PCNL was done after completion of all investigations. All patients were given prophylactic antibiotics. Stone clearance post-operatively was assessed by CT-KUB. Follow-up was taken at 1 month postoperatively. Data was analyzed by SPSS 24.0.

Results: There were 100 (47.62%) males while 110 (52.38%) were females. Mean age of 42.26±12.68 years. Mean BMI was 24.68±2.13 kg/m2. Mean size of the stone was 24.88±4.73 mm. Postoperative complications found in 40 (19.05%) patients, in which 20 (9.52%) patients had fever, blood transfusion in 8 (3.81%) patients, wound infection in 6 (2.86%), hydrothorax in 4 (1.90%) patients and 2 (0.95%) patient had septic shock. Overall stone clearance rate with multiple tract PCNL was 87.92%.

Conclusion: It is concluded that multitract PCNL is safe and very effective treatment modality for staghorn caculi with higher stone clearance rate and fewer postoperative complications.

Key Words: Multiple tract percutaneous nephrolithotomy (PCNL), Renal staghorn calculus, Stone clearance

Citation of article: Din N, Ahmed I, Shah MA, Elahi F, Akbar F, Rashidullah. Determine the Outcome of Multiple Tract Percutaneous Nephrolithotomy for Renal Staghorn Calculus. Med Forum 2020;31(12):26-29.

 

 

INTRODUCTION

The stone-polluted stonic calculus is known as the renal calculus which has a branch structure with a large portion of the collector system [1]. This procedure also incorporates open operation, percutaneous nephrolytomy, extracorporeal shock lithotrypsis and a combination Staghorn calculus therapy option. The emphasis of staghorn computer management is to clear stones entirely, so that blockages are removed and the further formation of stones prevented, as well as causative organisms eradicated [2].

 

 

1. Department of Urology / General Surgery2, Saidu Teaching Hospital Swat.

3. Department of Urology, PIMS, Islamabad.

4. Department of Urology, Nawaz Sharif Kidney Hospital Swat.

 

 

Correspondence: Dr. Nizamud Din, Associate Professor Urology, Saidu Teaching Hospital Swat.

Contact No: 03335601451

Email: nizam3urol@gmail.com

 

 

Received:    May, 2020

Accepted:    September, 2020

Printed:        December, 2020

 

 

 

Despite this excellence in stone clearance, many international studies with suitable amounts of surgical complications and which have particular relevance to blood transfusion are documented[3]. Percutaneous nephrolithotomy is also controversial with numerous tracts which may lead to additional complications such as serious bleeding from multitractal renal parenchyma trauma [4].

The effect of percutaneous neprolithotomy on the transient deterioration of renal function is similar, however, either with a single or multi-accès tract. Thus the clearance of steel with a considerably complicated rates in percutaneous staghorn nephritomy with many accesses can be seen as an efficacious and competitive approach [6].

Therefore, many complex staghorn stones require many access in different sizes to reach and remove all parts of the stone [6]. [4]. The discussion continues to see whether a single PCNL-loop procedure or sandwich treatment is to be carried out in which the initial PCNL is paired with the lithotripsy extracorporeal shock wave (SWL) and then another 2nd PCNL look or rather a PCNL-loop multitract to make the patient stone free in one session. In addition, the discussion continues. Later, the rate can be 84–95% without stone [7]. In addition, multitracting one-session PCNL would considerably lower costs if multiple procedures of all forms were avoided [8]. Compared to combination therapies, multitract PCNL has a comparable complication rate[9], although studies indicate that multiple tracts cause peri-operative bleeding[10].

MATERIALS AND METHODS

This descriptive study was conducted at Department of Urology Saidu Teaching Hospital Swat and PIMS Islamabad, during from the period December 2018 to December 2019. Total 210 patients of both genders with renal staghorn calculi of >20 mm in size were included. Patients detailed demographics including age, sex, body mass index and size of stone were recorded after taking written consent. Patients ages were ranging between18 to 70 years. Patients with uncontrolled bleeding disorders INR>1.5, ectopic pelvic kidney and urinary tract infection diagnosed on urine culture and sensitivity were excluded. Detailed medical history and examination, renal function tests (serum urea and creatinine), urine complete examination and urine culture, X ray KUB, ultrasonograhy and computed tomography (KUB) were done.

All the patients were received Multiple tract PCNL was. All patients were given prophylactic antibiotics. All procedures were performed under general anesthesia. Postoperative complications such as fever, blood transfusion, hydrothorax, septic shock and wound infection were examined. Stone clearance post-operatively was assessed by CT-KUB. Follow-up was taken at 1 month postoperatively. Data was analyzed by SPSS 24.0.

RESULTS

There were 100 (47.62%) males while 110 (52.38%) were females. Mean age of 42.26±12.68 years. Mean BMI was 24.68±2.13 kg/m2. Mean size of the stone was 24.88±4.73 mm. (Table 1).

Table No 1: Baseline details of all the patients

Variables

Frequency No.

% age

Mean Age (Years)

42.26±12.68

-

Mean BMI

24.68±2.13

-

Mean Stone Size (mm)

24.88±4.73

-

Gender

Male

100

47.62

Female

110

52.38

Table No 2: Postoperative complications

Po complications

Frequency No.

% age

Fever

20

9.52

Transfusion

8

3.81

Wound Infection

6

2.86

Hydrothorax

4

1.9

Septic Shock

2

0.95

Postoperative complications found in 40 (19.05%) patients, in which 20 (9.52%) patients had fever, blood transfusion in 8 (3.81%) patients, wound infection in 6 (2.86%), hydrothorax in 4 (1.90%) patients and 2 (0.95%) patient had septic shock. (Table 2).

184 (87.92%) patients had successful treatment and found complete stone clearance while 26 (12.08%) had not complete stone clearance. (Figure 1).

Figure No.1: Frequency of Stone Clearance

DISCUSSION

Complex stones are very detrimental to the kidney as they cause inflammation, atrophy, renal failure and cancer. To obtain maximum clearance and to prevent second vision procedures such as ESWL or retrospective inner arrest surgery, multiple tracts are often required for treatment (RIRS). Nevertheless, some tracts frequently have a higher risk of bleeding [11]. Moreover, multitract PCNL is very difficult to learn and needs a lot of expertise, even though device and technology have been developed over the recent decades [12]. Some studies have shown that open or laparoscopic stone surgery is an effective way to treat complex renal stones and is related to a higher one-session stone-free rate [13]. We conducted present study to determine the outcomes of renal staghorn calculi treated with multiple tract PCNL. In this regard 210 patients with staghorn calculi were enrolled. Majority 52.38% patients were females while males were 47.62%. Mean age of patients was 42.26±12.68 years. These results showed similarity to some previous studies in which females were high in numbers 55% to 60% and average age of patients was 45 years [14-15].

In present study stone clearance rate associated with PCNL was 87.92%. These results were comparable to many of previous studies in which multiple tract PCNL had high successful rate with stone clearance rate 85% to 92% [7, 16]. A study conducted by Rashid AO et al [17] reported that out 65 patients received multitract PCNL and among them stone clearance rate was 85%.

A study conducted by Liang T et al [18] regarding multiple tract PCNL for complex renal stone and they reported that complete stone clearance rate was 88.9%.

Chan J et al [19] used multiple tract PCNL for the treatment of renal staghorn calculi and in their study out of 117 patients 54.2% patients got complete stone clearance while 45.8% patients had partial stone clearance.

A study by Gadelmoula M et al [20] regarding outcomes of PCNL for renal stone, in their study the stone clearance rate was 87.7% patients.

In our study postoperative complications found in 40 (19.05%) patients, in which 20 (9.52%) patients had fever, blood transfusion in 8 (3.81%) patients, wound infection in 6 (2.86%), hydrothorax in 4 (1.90%) patients and 2 (0.95%) patient had septic shock. Many of previous studies showed similarity to our study findings in which bleeding, fever, hydrothorax and septic shock were associated with PCNL [21-22].

CONCLUSION

The multiple tract PCNL is gold standard technique for staghorn calcului with reasonable operative duration, low morbidity and good success rate.

Author’s Contribution:

Concept & Design of Study:

Nizamud Din

Drafting:

Irfan Ahmed, Mumtaz Ali Shah

Data Analysis:

Fazal Elahi, Fazal Akbar, Rashidullah

Revisiting Critically:

Nizamud Din, Irfan Ahmed

Final Approval of version:

Nizamud Din

Conflict of Interest: The study has no conflict of interest to declare by any author.

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