The Effect of One-shot Multi-access Percutaneous Nephrolithotomy on Complications

Objective: Kidney stones can be seen as single and pelvic stones as well as complex and multiple calculi. For this reason, single-access is not always sufficient for the treatment of kidney stones and multi-access percutaneous nephrolithotomy (PCNL) may sometimes be necessary for stone removal. In this study, we aimed to investigate the effect of multi-access PCNL using the one-shot dilation technique on kidney functions and related complications. Materials and Methods: The effects of access number on the hemoglobin and creatinine alterations, duration of operation, need for transfusion, postoperative fever, and length of hospital stay were investigated in patients who underwent PCNL due to renal stones. Results: Single- and multi-access PCNL using the one-shot technique was performed in 329 and 79 patients, respectively. Duration of operation, duration of scopy, and length of hospital stay as well as alterations in hemoglobin and creatinine values were found to be statistically higher in the multi-access group. Conclusion: One-shot multi-access PCNL can be safely performed for complex kidney stones due to its high stone-free rates, despite some potential complications.

Çoklu Access Perkütan Nefrolitotominin Komplikasyonlara Etkisi

Amaç: Böbrek taşları her zaman tek ve pelvis taşı değil kompleks ve multipl taşlar şeklinde görülebilmektedir. Bu nedenle böbrek taşlarının tedavisinde her zaman tek access yeterli olmamakta ve çoklu access taşların temizlenmesi için gerekebilmektedir. Bu çalışmamızda çoklu accessin böbrek fonksiyonları ve komplikasyonlara etkisini incelemeyi amaçladık. Gereç ve Yöntem: Böbrek taşı nedeniyle perkütan nefrolitotomi (PCNL) yapılan hastalarda access sayısının hemoglobin ve kreatinin değişimi, operasyon süresi, transfüzyon ihtiyacı, postoperatif ateş yüksekliği ve hastanede kalış sürelerine etkisi incelendi. Bulgular: Tek access ve çoklu access PCNL yapılan, sırasıyla 329 ve 79 hasta incelendi. Operasyon süresi, skopi süresi, hastanede yatış süresi, hemoglobin değişimi ve kreatinin değişimi çoklu access grubunda istatistiksel anlamlı daha yüksek bulundu. Sonuç: Kompleks böbrek taşları için çoklu access PCNL olası bazı komplikasyonlarla birlikte yüksek taşsızlık oranları nedeniyle güvenle uygulanabilecek bir yöntemdir.

Kaynakça

1. Binbay M, Akman T, Ozgor F, Yazici O, Sari E, Erbin A, Kezer C, Sarilar O, Berberoglu Y, Muslumanoglu AY. Does pelvicaliceal system anatomy affect success of percutaneous nephrolithotomy? Urology 2011;78:733-773.

2. Türk C, Knoll T, Petrik A, et al. Guidelines on Urolithiasis. European Association of Urology; 2016.

3. Cho HJ, Lee JY, Kim SW, Hwang TK. Percutaneous nephrolithotomy for complex renal calculi: is multi-tract approach ok? Can J Urol 2012;19:6360.

4. Gorbachinsky I, Wood K, Colaco M, Hemal S, Mettu J, Mirzazadeh M, Assimos DG, Gutierrez-Aćeves J. Evaluation of Renal Function after Percutaneous Nephrolithotomy-Does the Number of Percutaneous Access Tracts Matter? J Urol 2016;196:131-136.

5. Zhu Z, Wang S, Xi Q, Bai J, Yu X, Liu J. Logistic regression model for predicting stone-free rate after minimally invasive percutaneous nephrolithotomy. Urology 2011;78:32-36.

6. Rassweiler JJ, Renner C, Eisenberger F. The management of complex renal stones. BJU Int 2000;86:919-928.

7. Akman T, Binbay M, Sari E, Yuruk E, Tepeler A, Akcay M, Muslumanoglu AY, Tefekli A. Factors affecting bleeding during percutaneous nephrolithotomy: single surgeon experience. J Endourol 2011;25:327-333.

8. Preminger GM, Assimos DG, Lingeman JE, Nakada SY, Pearle MS, Wolf JS Jr; AUA Nephrolithiasis Guideline Panel). AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol 2005;173:1991-2000.

9. Auge B, Dahm P, Bach T, et al. Critical analysis of multiple access PNL in managing complex renal calculi. J Endourol 2001;15:60.

10. Hegarty NJ, Desai MM. Percutaneous nephrolithotomy requiring multiple tracts: comparison of morbidity with single-tract procedures. J Endourol 2006;20:753-760.

11. Netto NR Jr, Ikonomidis J, Ikari O, Claro JA. Comparative study of percutaneous access for stag horn calculi. Urology 2005;65:659-662.

12. Singla M, Srivastava A, Kapoor R, Gupta N, Ansari MS, Dubey D, Kumar A. Aggressive approach to staghorn calculi-safety and efficacy of multiple tracts percutaneous nephrolithotomy. Urology 2008;71:1039-1042.

13. Hegarty NJ, Desai MM. Percutaneous nephrolithotomy requiring multiple tracts: comparison of morbidity with single-tract procedures. J Endourol 2006;20:753-760.

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