Clinical Analysis Of Minimal Invasive Percutaneous Nephrolithotomy In Treatment Of Upper Urinary Tract Calculi

OBJECTIVE The approach to urinary stone disease has changed dramatically over the last three decades with a transition from open surgery to minimally invasive procedures. Percutaneous nephrolithotripsy (PCNL) is a cornerstone of the treatment of kidney and continues to evolve with advances in techniques and instrumentation. minimally invasive percutaneous nephrolithotomy (mPCNL) developed fastly in china .The purpose of this study was to assess the efficacy and the safty of mPCNL in the treatment of kindney calculus and give outcomes and trends of this technology.METHODS From April 2004 to December 2007,222 cases of kindney calculus including pelvic calculus 43 cases,calyceal calculus 78 cases,multiple calculus 31 cases,partical staghorn calculus 38 cases and total staghorn calculus 32 cases underwent mPCNL at our institute,the clinical datas about operative time,stone clearance rate and operative complications were retrospectively analysed. RESULTS In 222 cases , They were treated with one-stage operation in 199 cases (89. 6%), two-stage in 23 cases (10.4%),of which single channel was used in 206 cases (92.8%),two-channel in 16 cases(7.2%). Complete stone clearance was achieved in 188 renal units,giving an overall clearance rate of 84.7%. The average operative time was 87 minutes. The duration of hospitalization was 5 to 8 days with an average of 6.5 days in one-stage stone-free clearance patients. 22 patients(8.98%) compcatied with fever ( > 38.5℃) after operation. Urinry tract infection (UTI) (T > 38.5℃,> 2 days) after operation was seen in 12 patients (4.89%);6 (2.45%) patients required 400ml blood transfusion after operation. 3 patients complicated with severe bleeding after operation were successfully treated with blood transfusion and super-selective arterial embolization.CONCLUSION In our experience,we found that Holmium:YAG laser and pneumatic lithoclast are both effective and safe lithotriptors for percutaneous stone removal. mPCNL is the technical innovation for tranditinal PCNL with less suffering and shorter recovery time. mPCNL is a highly effective procedure in tueatment kindney calculus with excellent stone-free rates with low morbidity. OBJECTIVE To assess the efficacy and the safty of minimal invasive percutaneous nephrolithotomy(mPCNL)in the treatment of impacted proximal ureteral calculi.METHODS From February 2004 to October 2007,98 cases of impacted proximal ureteral calculi underwent mPCNL at our institute,the clinical data were retrospectively analysed.RESULTS All the 98 patients (100%)were rendered stone- free at one- stage operation. The operation time was 55～75 minutes,average operation time was 62 minutes. The duration of hospitalization was 4～8 days with an average of 6 days. Urinry tract infection( > 38.5℃)after operation was seen in 6 patients;No major complications were observed. No ureteral stricture occurred in 72 patients after a follow-up from 3 to 24 months. CONCLUSION mPCNL has definite efficacy and safty in treatment of proximal ureteral calculi with less suffering and shorter recovery time,especially for large and impacted proximal ureteral calculi.