Qazi Fasihuddin, Mubasher H Turi, Hanif S.
PCNL (Percutaneous Nephrolithotomy): first year experience.
J Pak Med Assoc Jan ;54(12):625.

Twenty five patients with mean age of 35+15 years, with 17 male and rest females were subjected to PCNL. Investigations like ultrasonography, intravenous urography and renal scan were done where indicated along with other relevant supportive tests. General anaesthesia was given in all the patients. Fluoroscopic antegrade approach was adopted. With patient in lithotomy position an open ended 5Fr ureteric catheter was passed and secured to a foleys catheter, allowing injection of contrast material to opacify and distend the collecting system. With patient in prone position access was gained to the collecting system via suitable calyx, dilation of the tract over a .032-inch guide wire to 30 Fr allowed insertion of an amplatz sheath through which rigid nephroscope was passed. Fragmentation of calculi was performed using pneumatic and ultrasound probes. Red rubber 16 Fr catheter was used in all cases as nephrostomy. Ureteric stenting was done at the end of the procedure. Nephrostomy tube was taken out on the first postoperative day after clamping for few hours and couple of hours later stent was removed. In 22 patients procedure was successfully carried out. Clearance of stone was highly dependent on stone location. Stones in renal pelvis had a high stone clearance rate. Residual stones were treated with ESWL. Three patients required pyelolithotomy; two due to excessive bleeding and in one there was tract access failure. Urosepsis was the main complication occuring in 3 (12%) patients while urinary fistula wound infection and residual ureteric stone occurred in 1(4%) patients each. All were treated successfully.

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