Role or Percutaneous Nephrolithotomy in the Era of Extracorporeal Shock Wave Lithotripsy / 대한비뇨기과학회지

ABSTRACT

Since the introduction of extracorporeal shock wave lithotripsy(ESWL), percutaneous nephrolithotomy(PNL) has been performed in limited cases of the patients requiring a stone procedure. The roles of PNL in the era of ESWL were reviewed through analysis of 86 patients treated with PNL. From July 1987 to December 1994, 86 patients(89 renal units) underwent percutaneous extraction of renal or upper ureteral stone. From July 1987 to January 1990, PNL was performed as the first choice for the treatment of 69 cases out of 119 renal or upper ureteral stone, and PNL was done in 58.0% (69/119) of the cases. From February 1990 to December 1994 when ESWL was available at our hospital, PNL was done in 20 cases of ESWL resistant stone or large volume stone, and PNL was done in 1.5%(20/1,362) of renal or upper ureteral stone. In the era of ESWL in our hospital, ESWL were performed in 94.5% of renal or upper ureteral stone, open surgery in 3.0%, PNL in 1.5% and conservative treatment in 1.0%. Initial success rate of PNL was 86.9%(60/69 cases) and subsequently when ESWL was available at our hospital, it became 95.0%(19/20 cases), probably due to accumulated experiences. Subsequently decreased complications of PNL such as persistent urinary leakage, prolonged hematuria, ureteral perforation and paralytic ileus. Though the introduction of ESWL in our hospital also brought about dramatic ally decreased use of PNL, PNL continues to have a primary role in the management of renal or upper ureteral stone in limited cases such as patients refusing ESWL, ESWL resistant stone or large volume stone.