Effect of previous open renal surgery and failed extracorporeal shockwave lithotripsy on the performance and outcomes of percutaneous nephrolithotomy.

PURPOSE

We evaluated the effects of previous open renal surgery and unsuccessful extracorporeal shockwave lithotripsy (SWL) treatment on the performance and outcomes of percutaneous nephrolithotomy (PCNL).

PATIENTS AND METHODS

A total of 410 consecutive PCNL procedures for renal calculi were performed at our institution from November 2006 to March 2009. Of these 410 patients, 86 (20.9%) with a history of failed SWL on the same side were categorized as group I, and 132 (32.2%) who had previous open renal surgery (+/-SWL) on the same kidney were categorized as group II. The remaining 192 patients (46.9%) without a history of SWL or open renal surgery comprised group III. Patient demographics, stone characteristics, operative findings, including operative time, time to access the collecting system, flouroscopy time, success rate, need for auxiliary treatments, and complications were documented in detail and compared in each group.

RESULTS

There were no differences between the three groups in age, sex, weight, and stone laterality. In the post-SWL group, mean stone burden was significantly lower than in groups II and III. Mean operative time, time to access the collecting system, fluoroscopic screening time, complication rates, nephrostomy removal times, and hospitalization times were similar in the each groups (P > 0.05 for each parameter). The stone-free rates after PCNL were 89.5% in group I; 87.1% in group II; and 88.5% in group III. These rates increased to 98.8%, 96.2%, and 96.8%, in groups I, II and III, respectively, after a second intervention (PCNL, SWL, or ureterorenoscopy).

CONCLUSIONS

Our study clearly demonstrates that PCNL with standard technique can be performed safely in patients with a history of open nephrolithotomy or SWL without a higher risk of complications and with a success rate similar to that of PCNL in patients with no previous intervention.