Routine flexible nephroscopy for percutaneous nephrolithotomy for renal stones with low density: a prospective, randomized study.

Abstract

PURPOSE:

We evaluated the usefulness of routine flexible nephroscopy during percutaneous nephrolithotomy.

MATERIALS AND METHODS:

Patients diagnosed with kidney stones who were scheduled to undergo percutaneous nephrolithotomy between March 2011 and July 2012 were randomized into 2 groups. Group 1 underwent standard percutaneous nephrolithotomy using rigid nephroscopy. Group 2 underwent flexible nephroscopy, in addition to standard percutaneous nephrolithotomy and laser lithotripsy or basket catheter stone extraction, as needed. Surgery was performed subcostally and with minimal percutaneous access in group 2 to use the advantages of flexible nephroscopy. We compared the 2 groups in terms of preoperative stone characteristics and postoperative success criteria, including the stone-free rate, bleeding, number of access sites, etc.

RESULTS:

The study included 61 males (76.3%) and 19 females (23.8%) with a mean ± SD age of 43.75 ± 12.4 years (range 19 to 74). There was no significant difference in stone size, HU density or stone location between the 2 groups. Comparison of perioperative and postoperative parameters revealed a higher stone-free rate (92.5% vs 70%), fewer access sites and a lower hematocrit decrease in group 2. The stone-free rate was higher in patients with stones with a density of less than 677.5 HU (100% in group 2 vs 64.7% in group 1).

CONCLUSIONS:

Routine flexible nephroscopy during percutaneous nephrolithotomy was associated with a higher stone-free rate, fewer interventions and less bleeding, especially in patients with low HU density stones.

• Authors: Adnan Gücük, Eray Kemahlı, Uğur Üyetürk, Can Tuygun, Mevlüt Yıldız, Ahmet Metin
• Journal: The Journal of urology (J Urol) Vol. 190 Issue 1 Pg. 144-8 (Jul 2013) ISSN: 1527-3792 [Electronic] United States
• PMID: 23313202 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Chi-Square Distribution
• Endoscopy (methods)
• Female
• Follow-Up Studies
• Humans
• Intraoperative Care (methods)
• Kidney Calculi (diagnosis, surgery, therapy)
• Lithotripsy, Laser (methods)
• Male
• Middle Aged
• Minimally Invasive Surgical Procedures (instrumentation, methods)
• Nephrostomy, Percutaneous (methods)
• Pliability
• Prospective Studies
• Reference Values
• Risk Assessment
• Severity of Illness Index
• Statistics, Nonparametric
• Treatment Outcome
• Young Adult