Abdul Majid Rana.
Percutaneous Nephrolithotomy (PCNL) as most effective monotherapy for large renal stones.
Med Channel Jan ;11(2):23-5.

OBJECTIVE: To evaluate and analyze the results of PCNL and determine stone clearance percentage acquired through single sitting and to determine requirement of ancillary procedures. MATERIALS AND METHODS: One hundred patients , 60 males and 40 females with 108 renal units were reviewed who underwent PCNL for renal calculi between January 2001 to February 2005. 13 patients had previous renal surgery, 9 had renal insufficiency, 7 had solitary functioning kidney and 8 patients required simultaneous ureteroscopy and intra corporeal lithotripsy for ureteral calculi Mean size of the stone dealt with was 41 mm. Retrograde urography and placement of ureteral catheter was followed by antegrade percutaneous access and tract dilatation up to 28 Fr. Swiss pneumatic lithoclast remained the only tool used for stone fragmentation. Most of the patients had nephrostomy tube placed per operatively. Plain radio graph KUB was done on first postoperative day to make decision about either removal of nephrostomy tube, ureteral and uretheral catheters or need for ancillary procedures for residual stones. Patients were followed up in the clinic till declared stone free or residual stone could be labelled as clinically insignificant residual fragment. (CIRF). RESULTS: In 100 patients a total of 108 percutaneous nephrolithotomy procedures were performed. 69 (64%) renal units had partial or complete stag horn stone. Mean stone size was 41mm (range 31mm - 92 mm). average operating time 85 minutes ( range 45 - 195 nun). Irrigation fluid mean consumption stood at 23 litres (range 8 - 76 litres). The 71 % stone free rate was achieved using PCNL as monotherapy in single sitting which improved to 97% when combined with extracorporeal shock wave lithotripsy. Main complications were haemorrhage, Post operative pyrexia, leakage from the nephrostomy tube, urinary tract infection and puncture site wound infection. Mean hospital stay was 3.75 days (range 2-7 days). CONCLUSION: PCNL is most effective monotherapy for large renal stones and gives value added results when combined with ESWL. It yields higher stone clearance rate compared to ESWL monotherapy and open surgery for Staghornstones. It is truly minimally invasive with very low incidence of complications. It can be carried out with comparable safety in patients with renal insufficiency, solitary kidney, horse shoe kidney. It is a safe treatment in children with encouraging results. It is cost effective in terms of hospital stay, loss of work hours and has the best cosmetic results.

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