Percutaneous nephrolithotomy in previously operated patients: A prospective study
Anil Gulani1, Ujwal Kumar2, Sher Singh Yadav3, Rishi Raj Vohra4, Vivek Kumar Singh5
1 Consultant Urology, Medanta, Ganganagar, Rajasthan, India
2 Department of Urology and Renal Transplant, IKDRC, Ahmedabad, Gujarat, India
3 Department of Urology and Renal Transplant, SMS Medical College, Jaipur, Rajasthan, India
4 Consultant Urology, Shri Action Balaji Medical Institute, New Delhi, India
5 Senior Resident, Urology, KGMU, Lucknow, Uttar Pradesh, India
D701, Akshardham Towers, Near Shahibaug Underbridge, Shahibaug, Ahmedabad - 380 004, Gujarat
Source of Support: None, Conflict of Interest: None
Purpose: To determine the effect of previous renal stone surgery on result and complications of percutaneous nephrolithotomy (PCNL).
Materials and Methods: Total 300 patients were enrolled in the study. We enrolled 100 surgery-naive cases (those with no history of any renal surgery) as control and labeled them as Group A. Group B comprised 100 cases who had PCNL in the past. Group C constituted 100 patients who had open renal stone surgery in the past. Stones were classified using Guy's stone score. PCNL was performed by standard technique in prone position and technical features encountered during operation and outcomes were compared between groups. Complications were graded using modified Clavien grading system.
Results: There were no differences between the three groups in age, gender, body mass index, stone burden, and stone opacity. Multiple calyceal stones and distorted pelvicalyceal system anatomy were more in Group C, but stone score showed no statistically significant difference from other groups. The mean operative time (68.91 ± 21.27 min) and fluoroscopy time (264.40 ± 74.90 s) were longer in Group C, but there was no statistically significant difference between the groups. Multiple access was significantly more common in Group C compared to the other two groups (P < 0.001). Access location too did not show any statistically significant difference between the groups. Postoperative complications were more in previous stone surgery patients, but did not show statistically significant difference.
Conclusion: PCNL is a safe and effective treatment modality for patients with renal stones regardless of history of previous PCNL or open renal surgery.