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Mini-percutaneous nephrolithotomy for stones in anomalous-kidneys: a prospective study

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Abstract

To evaluate safety and efficacy of minipercutaneous nephrolithotomy (Mini-PNL) in management of stones in different types of renal anomalies. Patients with stones ≥2 cm or SWL-resistant stones in anomalous-kidneys treated by Mini-PNL between March 2010 and September 2012 were included prospectively. Mini-PNL was done under regional anesthesia in prone position with fluoroscopic guidance through 18 Fr sheath using semirigid ureteroscope (8.5/11.5 Fr) and pneumatic lithotripter. All patients were followed-up for 2–3 years. Stone-free rate was defined as absence of residual fragments ≥2 mm. Student-T, Mann–Whitney, Chi square (χ 2), Fisher-exact, one way ANOVA or Kruskal–Wallis test were used for analysis. Mini-PNL was performed for 59 patients (20 horseshoe, 15 malrotated, 7 polycystic, 13 duplex and 4 ectopic pelvic-kidneys). Mean age was 40.18 ± 12.75 (14–78) years. Mean stone burden was 31.72 ± 21.43 (7.85–141.3) mm2. Two tracts were required in 7 (11.9 %) patients. Tubeless Mini-PNL with double-J insertion was performed in all patients except two. Operative time was 50.17 ± 18.73 (15–105) min. Hemoglobin loss was 0.44 ± 0.30 (0–1.4) g/dL. Complications were reported in 15 (25.4 %) patients. No pleural injury, sepsis, perinephric-collection or renal-pelvis perforation were reported. Stone-free rate was 89.8 % (converted to open-surgery in one patient, second-look PNL in two patients, auxiliary SWL in three patients). Stone-free rate improved to 98.3 % after retreatment and auxiliary SWL. Site of puncture was mostly upper calyceal in horseshoe-kidney (80 %), mid calyceal in polycystic-kidney (85.7 %) and lower calyceal in duplex-kidney (46.2 %). Punctures were also significantly infracostal in horseshoe-kidney (100 %) and supracostal in both duplex (53.8 %) and malrotated-kidneys (66.7 %). Mini-PNL is safe for management of stones in anomalous-kidney with SFR comparable to standard-PNL but with less complications.

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Abbreviations

DJ:

Double-J stent

IVP:

Intravenous pyelography

KUB:

Plain abdominal radiography

Mini-PNL:

Mini-percutaneous nephrolithotripsy

NCCT:

Non-contrast computed tomography scan

PCN:

Percutaneous nephrostomy

PNL:

Percutaneous nephrolithotripsy

SFR:

Stone free rate

SWL:

Extracorporeal shockwave lithotripsy

UTI:

Urinary tract infection

US:

Abdominal ultrasonography

UPJ:

Ureteropelvic junction

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Authors and Affiliations

  1. Endourologists, Vayodah and Venus International Hospitals, Kathmandu, Nepal

    Sanjay Khadgi & Sunil Shrestha

  2. Vayodah and Venus International Hospitals, Kathmandu, Nepal

    Babu Shrestha

  3. Department of Anaesthesiology, Kathmandu Medical College, Kathmandu, Nepal

    Babu Shrestha

  4. Urology Department, Fayoum University, Fayoum, Egypt

    Hamdy Ibrahim

  5. Urology Department, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt

    Mohammed S. ElSheemy

  6. Kuwait University, Kuwait, Kuwait

    Ahmed M. Al-Kandari

Authors
  1. Sanjay Khadgi
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  2. Babu Shrestha
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  3. Hamdy Ibrahim
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  4. Sunil Shrestha
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  5. Mohammed S. ElSheemy
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  6. Ahmed M. Al-Kandari
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Corresponding author

Correspondence to Mohammed S. ElSheemy.

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The authors declare that they have no conflict of interest.

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None.

Ethical approval

The study was in accordance with the ethical standards of the local ethical committee and with the 1964 Helsinki declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Khadgi, S., Shrestha, B., Ibrahim, H. et al. Mini-percutaneous nephrolithotomy for stones in anomalous-kidneys: a prospective study. Urolithiasis 45, 407–414 (2017). https://doi.org/10.1007/s00240-016-0926-1

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  • DOI: https://doi.org/10.1007/s00240-016-0926-1

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