Abstract:
BACKGROUND AND PURPOSE:To assess the feasibility and efficacy of percutaneous nephrolithotomy (PCNL) in patients with spinal deformities. PATIENTS AND METHODS:Between 1999 and 2008, eight patients (nine renal units) with spinal deformities underwent 10 PCNLs. Mean stone burden was 372 mm(2) (160-840 mm(2)). Preoperative investigation of the respiratory function, evaluation of anatomy by intravenous pyelography or CT spiral scan, and preoperative planning of the percutaneous access by ultrasonography (US) were performed in all patients. Patients were either in a prone (n = 5) or supine (n = 5) position during PCNL. US-guided fluoroscopic adjusted percutaneous puncture of the desired calix was performed in all the patients. RESULTS:There was a 40% complication rate related to the number of procedures, with 20% of patients needing blood transfusion and 10% experiencing major complications. Complete stone clearance per kidney after one PCNL was 55.5% (5/9 PCNLs), increasing to 66.6% (6/9 PCNLs) after a second PCNL. Four of nine (44.4%) renal units needed additional procedures after one PCNL (shockwave lithotripsy [SWL], retrograde intrarenal surgery [RIRS], combined simultaneous PCNL and RIRS). At the 3-month follow-up, the overall stone-free rate was 88.8% (eight renal units). CONCLUSION:PCNL in patients with spinal deformities is challenging. Accurate preoperative evaluation of the anatomy and respiratory function and a precise preoperative planning are mandatory. US-guided puncture of the collecting system permits avoiding visceral injury. Supine PCNL offers advantages in terms of patient comfort, protection of cardiorespiratory function, and the ability to perform a simultaneous combined ureteroscopic approach, although the prone position, if feasible with the patient's body habitus, may offer a wider space for percutaneous access. Combination therapy with either SWL or RIRS after PCNL improves stone-free rates.
journal_name
J Endouroljournal_title
Journal of endourologyauthors
Goumas-Kartalas I,Montanari Edoi
10.1089/end.2010.0095subject
Has Abstractpub_date
2010-07-01 00:00:00pages
1081-9issue
7eissn
0892-7790issn
1557-900Xjournal_volume
24pub_type
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pub_type: 临床试验,杂志文章
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pub_type: 杂志文章
doi:10.1089/end.1996.10.545
更新日期:1996-12-01 00:00:00
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journal_title:Journal of endourology
pub_type: 杂志文章
doi:10.1089/end.1998.12.41
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