Percutaneous nephrolithotomy (PCNL) for staghorn calculi in lateral position

Abstract

Background : Thoracic complications are still high during supracostal PCNL with a 6 percent-32 percent incidence of hydrothorax.About 4-12 percent of supracostal punctures are required draninage.Pitfalls of traditional technique will be discussed.

Objective : To compare the safety and efficacy of PCNL for staghorn calculi between ultrasound guided-lateral position and fluoroscopic guided-prone position technique.

Material and Method : All cases of staghorn calculi that were done PCNL in Prapokklao Hospital from Dec 2004-Jan 2008 were analized.There are 45 patients (m:f =32.13) with 47 renal units.The average stone surface area was 1964 mm . PCNL single stagemonotherapy were performed under ultrasound guided puncture and tract access.All patients are operated in lateral position except two cases in prone position for bilateral simultaneous PCNL.Rigid nephoscopy were checked at the end of procedure for removed hiding caliceal stones.

Result :The stone free rate was 87.2 percent (less than 2 mm) operative time was 157 inutes/kidney.Fluoroscopic time was 147 secondes/kidney.Number of procedures were 1.4 sessions/47 kidneys) there were 39 from 63 tracts above 12 rib wothour thoracic complication.There were no intestinal,liver or splenic injury.Sepsis was found in one case (2.1 percent).

Conclusion : Staghorn calculi is the one of the most difficulty group of PCNL.However when PCNL was performed by an aid of ultrasound guidance in lateral position,the complications of adjacent organ injury especially thoracic were much reduced.While the efficacy is comparable with fluoroscopic guide-prone position technique.