[Percutaneous nephrolithotomy - always effective and free of complications?].

PURPOSE

The purpose of this study was to evaluate the results and complications of percutaneous nephrolithotomies performed within 5 years in our patients.

MATERIALS AND METHODS

From 2001 to 2005 in our department 158 percutaneous nephrolithotomies (PNL) in 131 patients and 138 renal units were performed. The indications for PNL were calculus greater than 2 cm, failed ESWL, and when there is additional urinary obstruction which was not caused by the stone itself. Data concerning past medical history, about the procedure including complications and the postoperative course were collected and evaluated.

RESULTS

87 (63 %) of the patients had a history of prior stones. The main symptoms were flank pain, recurrent renal colic and urinary tract infection. The stones treated had a size from 5 to 60 mm. In 40 patients (29 %) relief of urinary obstruction (double-J-ureteral stent or percutaneous nephrostomy) or ESWL was performed prior to PNL. Mean operating time was 83 (30 - 235) minutes including retrograde placement of a ureteral catheter and nephrostomy. Complications occurred in 26 (16.5 %) procedures. Severe complications were: one fatal pulmonary embolism, one septicaemia, three open revisions (including one nephrectomy) and four blood transfusions for blood loss. In 94 patients (68 %) there was no residual stone or gravel after the first PNL. No further therapy was necessary in 17 (39 %) of the 44 patients with incomplete stone removal. 19 patients underwent a secondary PNL. In these procedures the efficacy decreased. 102 of 131 patients (138 renal units = 73.9 %) were discharged without residual stone after 158 procedures.

CONCLUSIONS

PNL is an efficient and rarely complicated procedure for larger stones of the upper urinary tract. Even so, the occurrence of severe complications must be considered. Complications can be minimised by the use of a standardised therapeutic pathway.