5 Year Outcome Comparing between Lower Pole and Non-Lower Pole Approach Percutaneous Nephrolithotripsy
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Abstract
Objectives: Percutaneous Nephrolithotomy (PCNL) is considered to be the principal treatment for large kidney stones. Nephrolithotripsy approaches—namely the Lower Pole Approach and the Non-Lower Pole Approach—are widely referred to and utilized today. Currently, there is no consensus as to which approach yields the best treatment outcome or results in lowest level of complication. This study reports both treatment outcome and complications from information acquired from patients, with all sizes of kidney stones, who received PCNL treatment under both techniques at Vajira Hospital.
Methods: According to the information collected in the past 5 years, there were 72 patients who had been treated with PCNL. The information was collected in terms of stone sizes, treatment techniques, and methods. In order to compare the treatment outcome between the Lower Pole Approach and Non-Lower Pole Approach, operative time and information gathered during follow-up sessions, including complications and hospital length of stay were analyzed.
Results: According to the results, 37 out of 72 patients (51.4%) underwent the Lower Pole Approach, and 35 out of 72 patients (48.6%) underwent the Non-Lower Pole Approach. The results revealed that the stone-free rate in the Lower Pole Approach group was indifferent to that in the Non-Lower Pole Approach group (56.8% vs. 54.3% respectively, level of confidence p=0.776), and so was the average operative time in minutes (151.62±40.43 in the Lower Pole Approach group vs. 148.00±60.34 in the Non-Lower Pole Approach group, p=0.765). There were more but milder complications in the Lower Pole Approach group compared to the Non-Lower Pole Approach group (16.2% vs. 5.7% respectively, p=0.033), latter of which resulted in one case of intrathoracic complication. Moreover, it was discovered that the average length of stay in days of the Lower Pole Approach group was significantly shorter than that of the Non-Lower Pole Approach group (6.38±3.09 vs 8.06±4.14 respectively, p=0.048).
Conclusion:The kidney stone treatment of the Lower Pole Approach has equal stone-free rate as the Non-Lower Pole Approach but has a higher rate of mild complications.
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References
Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A, Talati J, Lotan Y. Epidemiology of stone disease across the world. World J Urol 2017;35(9):1301–20.
Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol 2010;12 (2-3):e86–96.
Boyce CJ, Pickhardt PJ, Lawrence EM, Kim DH, Bruce RJ. Prevalence of urolithiasis in asymptomatic adults: objective determination using low dose non-contrast computerized tomography. J Urol 2010;183(3):1017–21.
Edvardsson VO, Indridason OS, Haraldsson G, Kjartansson O, Palsson R. Temporal trends in the incidence of kidney stone disease. Kidney Int 2013 ;83:146-52.
Pearle MS, Calhoun EA, Curhan GC. Urologic Diseases of America Project. Urologic diseases in America project: urolithiasis. J Urol 2005;173(3):848-57.
Johnson CM, Wilson DM, O'Fallon WM, Malek RS, Kurland LT. Renal stone epidemiology: a 25-year study in Rochester, Minnesota. Kidney Int 1979;16(5):624-31.
Marshall V, White RH, De Saintonge MC, Tresidder GC, Blandy JP. The natural history of renal and ureteric calculi. Br J Urol 1975;47(2):117-24.
Scales CD Jr, Smith AC, Hanley JM, Saigal CS; Urologic Diseases in America Project. Prevalence of kidney stones in the United States. Eur Urol 2012;62:160-5.
Ordon M, Welk B, Li Q, Wang J, Lavigne E, Yagouti A, et al. Ambient Temperature and the Risk of Renal Colic: A Population-Based Study of the Impact of Demographics and Comorbidity. J Endourol 2016 ;30(10):1138-43.
Geraghty RM, Proietti S, Traxer O, Archer M, Somani BK. Worldwide Impact of Warmer Seasons on the Incidence of Renal Colic and Kidney Stone Disease: Evidence from a Systematic Review of Literature. J Endourol 2017;31(8):729-35.
Yanagawa M, Kawamura J, Onishi T, Soga N, Kameda K, Sriboonlue P, et al. Incidence of urolithiasis in northeast Thailand. Int J Urol 1997;4(6):537-40.
Hübner W, Porpaczy P. Treatment of caliceal calculi. Br J Urol 1990; 66:9-11.
Honeck P, Wendt-Nordahl G, Krombach P, Bach T, Häcker A, Alken P, et al. Does open stone surgery still play a role in the treatment of urolithiasis? Data of a primary urolithiasis center. J Endourol 2009 ;23(7):1209-12.
Bas O, Bakirtas H, Sener NC, Ozturk U, Tuygun C, Goktug HN, et al. Comparison of shock wave lithotripsy, flexible ureterorenoscopy and percutaneous nephrolithotripsy on moderate size renal pelvis stones. Urolithiasis 2014;42(2):115-20.
Resorlu B, Diri A, Atmaca AF, Tuygun C, Oztuna D, Bozkurt OF, et al. Can we avoid percutaneous nephrolithotomy in high-risk elderly patients using the Charlson comorbidity index? Urology 2012;79(5):1042-7.
Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART II. J Urol 2016;196(4):1161-9.
Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis. Eur Urol 2016 ;69(3):468-74.
Albala DM, Assimos DG, Clayman RV, Denstedt JD, Grasso M, Gutierrez-Aceves J, et al. Lower pole I: a prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy for lower pole nephrolithiasis—initial results. J Urol 2001;166(6): 2072–80.
Akman T, Binbay M, Aslan R, Yuruk E, Ozgor F, Tekinarslan E, et al. Long-term outcomes of percutaneous nephrolithotomy in 177 patients with chronic kidney disease: a single center experience. J Urol 2012 ;187:173-7.
Bryniarski P, Paradysz A, Zyczkowski M, Kupilas A, Nowakowski K, Bogacki R. A randomized controlled study to analyze the safety and efficacy of percutaneous nephrolithotripsy and retrograde intrarenal surgery in the management of renal stones more than 2 cm in diameter. J Endourol 2012 ;26:52-7.
Coz F, Orvieto M, Bustos M, Lyng R, Stein C, Hinrichs A, et al. Extracorporeal shockwave lithotripsy of 2000 urinary calculi with the modulith SL-20: success and failure according to size and location of stones. J Endourol 2000;14(3):239-46.
Egilmez T, Tekin MI, Gonen M, Kilinc F, Goren R, Ozkardes H. Efficacy and safety of a newgeneration shockwave lithotripsy machine in the treatment of single renal or ureteral stones: Experience with 2670 patients. J Endourol 2007;21:23-7.
Preminger GM, Assimos DG, Lingeman JE, Nakada SY, Pearle MS, Wolf JS Jr; AUA Nephrolithiasis Guideline Panel. Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol 2005 ;173(6):1991-2000.
Shah HN, Hegde SS, Shah JN, Bansal MB. Safety and efficacy of supracostal access in tubeless percutaneous nephrolithotomy. J Endourol 2006;20(12):1016–21.
Sukumar S, Nair B, Ginil KP, Sanjeevan KV, Sanjay BH. Supracostal access for percutaneous nephrolithotomy: less morbid, more effective. Int Urol Nephrol 2008;40(2):263–7.
Netto NR Jr, Ikonomidis J, Ikari O, Claro JA. Comparative study of percutaneous access for staghorn calculi. Urology 2005;65(4):659–62.
Munver R, Delvecchio FC, Newman GE, Preminger GM. Critical analysis of supracostal access for percutaneous renal surgery. J Urol 2001;166(4):1242–6.
Ganpule AP, Desai M. Management of the staghorn calculus: multiple-tract versus single-tract percutaneous nephrolithotomy. Curr Opin Urol 2008;18(2):220-3.
Morris DS, Wei JT, Taub DA, Dunn RL, Wolf JS Jr, Hollenbeck BK. Temporal trends in the use of percutaneous nephrolithotomy. J Urol 2006;175(5):1731-6.
Williams SK, Leveillee RJ. A single percutaneous access and flexible nephroscopy is the best treatment for a full staghorn calculus. J Endourol 2008;22(9):1835-7.
Wosnitzer M, Xavier K, Gupta M. Novel use of a ureteroscopic stone entrapment device to prevent antegrade stone migration during percutaneous nephrolithotomy. J Endourol 2009;23(2):203-7.
Blum KA, Parkhomenko E, Thai J, Tran T, Gupta M. A contemporary lower pole approach for complete staghorn calculi: outcomes and efficacy. World J Urol 2018;36(9):1461-7.
Netto NR Jr, Ikonomidis J, Ikari O, Claro JA. Comparative study of percutaneous access for staghorn calculi. Urology 2005;65(4):659-62.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240(2):205-13.