Percutaneous Nephrolithotomy Combined with Pneumatic and Ultrasonic Lithotripsy for Complex Renal Calculi:Report of 150 Cases / 中国微创外科杂志

ABSTRACT

Objective To evaluate the clinical efficacy of percutaneous nephrolithotomy (PNL) in combination with pneumatic and ultrasonic lithotripsy in the treatment of complex renal calculi. Methods Under general anesthesia,an ureteral stent was placed into the patient by cystoscopy. With the prone position,percutaneous access was established by inserting an access needle into the intended calix under the guidance of ultrasonography or fluoroscopy. Afterwards,combined pneumatic and ultrasonic probes were used by nephroscopy for lithotripsy. Results A single tract was used in 137 patients,while two or three tracts were created in the other patients (11 and 2 respectively). One-step procedure to remove the stones was achieved in 119 patients,while a second intervention was performed in 27,and three procedures was carried out in 4. The mean time of the operations were (88?34) min. After the operation,one patient developed infectious shock,and then was cured by anti-shock therapy;two patients showed secondary hemorrhage in two weeks postoperation,and was cured by conservative therapy. In this series,the rate of stone clearance was 84.7% (127/150);23 cases had residual stones,10 of them received ESWL (the stone was removed completely in 7 of the 10 cases),and the other 13 were treated by oral medicines. Six months after the operation,follow-up examination showed a stone-free rate of 89.3% (134/150). Conclusion Combination of ultrasonic and pneumatic intracorporeal lithotripsy is effective and safe for complex renal calculi,which is intractable by open surgery.