Urolithiasis DOI 10.1007/s00240-015-0798-9
ORIGINAL PAPER
Does previous open renal surgery or percutaneous nephrolithotomy affect the outcomes and complications of percutaneous nephrolithotomy Faruk Ozgor1 · Onur Kucuktopcu1 · Omer Sarılar1 · Mehmet Toptas1 · Abdulmuttalip Simsek1 · Zafer Gokhan Gurbuz1 · Mehmet Fatih Akbulut1 · Ahmet Yaser Muslumanoglu1 · Murat Binbay1
Received: 28 March 2015 / Accepted: 18 June 2015 © Springer-Verlag Berlin Heidelberg 2015
Abstract In this study, we aim to evaluate the effectiveness and safety of PNL in patients with a history of open renal surgery or PNL by comparing with primary patients and to compare impact of previous open renal surgery and PNL on the success and complications of subsequent PNL. Charts of patients, who underwent PNL at our institute, were analyzed retrospectively. Patients were divided into three groups according to history of renal stone surgery. Patients without history of renal surgery were enrolled into Group 1. Other patients with previous PNL and previous open surgery were categorized as Group 2 and Group 3. Preoperative characteristic, perioperative data, stone-free status, and complication rates were compared between the groups. Stone-free status was accepted as completing clearance of stone and residual fragment smaller than 4 mm. Eventually, 2070 patients were enrolled into the study. Open renal surgery and PNL had been done in 410 (Group 2) and 131 (Group 3) patients, retrospectively. The mean operation time was longer (71.3 ± 33.5 min) in Group 2 and the mean fluoroscopy time was longer (8.6 ± 5.0) in Group 3 but there was no statistically significant difference between the groups. Highest stone clearance was achieved in primary PNL patients (81.62 %) compared to the other groups (77.10 % in Group 2 and 75.61 % in Group 3). Stone-free rate was not significantly different between Group 2 and Group 3. Fever, pulmonary complications, and blood transfusion requirement were not statically different between groups but angioembolization was significantly higher in Group 2. Percutaneous nephrolithotomy
* Faruk Ozgor [email protected] 1
Department of Urology, Haseki Training and Research Hospital, Millet Cad. No: 11, Fatih, 34096 Istanbul, Turkey
is a safe and effective treatment modality for patients with renal stones regardless history of previous PNL or open renal surgery. However, history of open renal surgery but not PNL significantly reduced PNL success. Keywords Kidney stone · Percutaneous nephrolithotomy · Open renal surgery
Introduction Although kidney stone disease is not often fatal disorder, it has a repetitive nature, so it disrupts the quality of life and causes high cost to the health system [1]. Despite appropriate surgical approach and medical prophylactic program, half of patients who have previously been treated for renal stones will face stone recurrence within 5–7 years [2]. Thus, number of patients who needed second surgical intervention increases [3]. Its well known that previous renal stone surgery is associated with perinephritic scar, distortions on pelvicaliceal anatomy, and bowel displacement that may affect on second intervention results [4]. Currently, percutaneous nephrolithotomy (PNL) is the first surgical option for stones larger than 2 cm and staghorn calculus [5]. PNL has replaced open surgery because of its minimal invasive nature, cost effectiveness, shorter operative time, shorter hospitalization time, lower complication, and higher success rates [6]. In the pre PNL era, open renal surgery was common and it is still an option for stone removal especially in developing countries [7]. Consequently, considering the possibility of stone recurrence, many patients, who previously were treated with open stone surgery or PNL, present with a stone recurrence in the same kidney and need PNL.
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Urolithiasis
The first objective of this paper was to assess the effectiveness and safety of PNL in patients with a history of open renal surgery or PNL by comparing with primary patients. Additionally, we compare the impact of previous open renal surgery and PNL on the success and complications of subsequent PNL.
Materials and methods A total of 2420 PNLs for kidney stones were performed at our institute between September 2002 and January 2015. Patient demographic characteristic such as age, gender, diabetes, hypertension, body mass index (BMI), stone burden, history of open renal surgery, and PNL were recorded. Preoperative laboratory tests including hemoglobin, serum creatinine level, platelet count, and a coagulation screening test were performed for all patients. Excretory urogram and/or abdominal CT were done in all cases. Stone dimension was calculated as the surface area according to European Association of Urology guidelines [8]. Before surgical intervention, sterile urine culture was done in all patients. If positive urine culture was seen preoperatively, they were treated according to antibiotic sensitivity tests. In this study, patients who underwent PNL were divided into three groups according to their history of renal stone surgery. Patients without a history of open renal surgery or PNL were included in Group 1. Other patients with previous PNL were enrolled as Group 2 and patients with previous open surgery history were enrolled in Group 3. Patients with congenital renal abnormality such ureteropelvic junction obstruction, horseshoe, or ectopic kidney, patients with BMI ≥35 and patients under 18-year old were excluded from the study. Also patients who underwent both PNL and open renal surgery were excluded.
Technique Briefly, all procedures were done under C-arm fluoroscopy using an 18-G needle in prone position as previously described in detail. The tract was dilated with a high-pressure balloon dilator (Nephromax TM Microvasive Boston Scientific Corporation, Natick, MA, USA) or telescopic dilatators. Stone fragmentation was performed using an ultrasonic lithotripter (Swiss Lithoclast®, EMS Electro Medical System, Nyon, Switzerland) or pneumatic (Vibrolith®, Elmed, Ankara, Turkey). A 14-F nephrostomy tube was placed inside the renal pelvis or into the involved calyx upon termination of the intervention in most cases. The operative duration was accepted as the time from the puncture for pelvicaliceal system to the final placement of a nephrostomy tube.
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Patients’ data in each group including demographic characteristic, preoperative and post-operative hematocrit and creatinine level, operative, and fluoroscopy screening time were analyzed. Also, hospitalization time, stone-free status and complication rates were compared between groups. Stone-free status was evaluated with KUB graph on the first operative day and abdominal CT at the 3 months postoperatively. Patients with complete clearance of stone and residual fragment smaller than 4 mm were accepted as stone free. Statistical analyses were performed by computer software IBM SPSS 16.0. Data were presented as numbers, percentages, means, and standard deviations. During comparison of results between groups percentages were compared using the χ2 test. Comparison of means of scale data were performed by one-way ANOVA test because the number of groups was more than two. Post hoc analyses were performed by Tamhane test because all the scale data were distributed heterogeneously.
Results Eventually, 2070 patients were enrolled into the study. Open renal surgery and PNL had been done in 410 (Group 2) and 131 (Group 3) patients, retrospectively. There were no differences between the three groups in age, gender, stone burden, and stone opacity. The mean BMI was significantly higher in Group 2. The mean preoperative creatinine level was significantly higher in Group 3 than the other groups. Additionally, degree of hydronephrosis and stone in multiple calyx location is more in Group 3. The patients’ characteristics were listed in Table 1. The mean operation time was longer (71.3 ± 33.5 min) in Group 2 and the mean fluoroscopy time was longer (8.6 ± 5.0) in Group 3 but there was no statistically significant difference between groups. Multiple access was significantly more common in patients with history open surgery compared to other two groups (p
ORIGINAL PAPER
Does previous open renal surgery or percutaneous nephrolithotomy affect the outcomes and complications of percutaneous nephrolithotomy Faruk Ozgor1 · Onur Kucuktopcu1 · Omer Sarılar1 · Mehmet Toptas1 · Abdulmuttalip Simsek1 · Zafer Gokhan Gurbuz1 · Mehmet Fatih Akbulut1 · Ahmet Yaser Muslumanoglu1 · Murat Binbay1
Received: 28 March 2015 / Accepted: 18 June 2015 © Springer-Verlag Berlin Heidelberg 2015
Abstract In this study, we aim to evaluate the effectiveness and safety of PNL in patients with a history of open renal surgery or PNL by comparing with primary patients and to compare impact of previous open renal surgery and PNL on the success and complications of subsequent PNL. Charts of patients, who underwent PNL at our institute, were analyzed retrospectively. Patients were divided into three groups according to history of renal stone surgery. Patients without history of renal surgery were enrolled into Group 1. Other patients with previous PNL and previous open surgery were categorized as Group 2 and Group 3. Preoperative characteristic, perioperative data, stone-free status, and complication rates were compared between the groups. Stone-free status was accepted as completing clearance of stone and residual fragment smaller than 4 mm. Eventually, 2070 patients were enrolled into the study. Open renal surgery and PNL had been done in 410 (Group 2) and 131 (Group 3) patients, retrospectively. The mean operation time was longer (71.3 ± 33.5 min) in Group 2 and the mean fluoroscopy time was longer (8.6 ± 5.0) in Group 3 but there was no statistically significant difference between the groups. Highest stone clearance was achieved in primary PNL patients (81.62 %) compared to the other groups (77.10 % in Group 2 and 75.61 % in Group 3). Stone-free rate was not significantly different between Group 2 and Group 3. Fever, pulmonary complications, and blood transfusion requirement were not statically different between groups but angioembolization was significantly higher in Group 2. Percutaneous nephrolithotomy
* Faruk Ozgor [email protected] 1
Department of Urology, Haseki Training and Research Hospital, Millet Cad. No: 11, Fatih, 34096 Istanbul, Turkey
is a safe and effective treatment modality for patients with renal stones regardless history of previous PNL or open renal surgery. However, history of open renal surgery but not PNL significantly reduced PNL success. Keywords Kidney stone · Percutaneous nephrolithotomy · Open renal surgery
Introduction Although kidney stone disease is not often fatal disorder, it has a repetitive nature, so it disrupts the quality of life and causes high cost to the health system [1]. Despite appropriate surgical approach and medical prophylactic program, half of patients who have previously been treated for renal stones will face stone recurrence within 5–7 years [2]. Thus, number of patients who needed second surgical intervention increases [3]. Its well known that previous renal stone surgery is associated with perinephritic scar, distortions on pelvicaliceal anatomy, and bowel displacement that may affect on second intervention results [4]. Currently, percutaneous nephrolithotomy (PNL) is the first surgical option for stones larger than 2 cm and staghorn calculus [5]. PNL has replaced open surgery because of its minimal invasive nature, cost effectiveness, shorter operative time, shorter hospitalization time, lower complication, and higher success rates [6]. In the pre PNL era, open renal surgery was common and it is still an option for stone removal especially in developing countries [7]. Consequently, considering the possibility of stone recurrence, many patients, who previously were treated with open stone surgery or PNL, present with a stone recurrence in the same kidney and need PNL.
13
Urolithiasis
The first objective of this paper was to assess the effectiveness and safety of PNL in patients with a history of open renal surgery or PNL by comparing with primary patients. Additionally, we compare the impact of previous open renal surgery and PNL on the success and complications of subsequent PNL.
Materials and methods A total of 2420 PNLs for kidney stones were performed at our institute between September 2002 and January 2015. Patient demographic characteristic such as age, gender, diabetes, hypertension, body mass index (BMI), stone burden, history of open renal surgery, and PNL were recorded. Preoperative laboratory tests including hemoglobin, serum creatinine level, platelet count, and a coagulation screening test were performed for all patients. Excretory urogram and/or abdominal CT were done in all cases. Stone dimension was calculated as the surface area according to European Association of Urology guidelines [8]. Before surgical intervention, sterile urine culture was done in all patients. If positive urine culture was seen preoperatively, they were treated according to antibiotic sensitivity tests. In this study, patients who underwent PNL were divided into three groups according to their history of renal stone surgery. Patients without a history of open renal surgery or PNL were included in Group 1. Other patients with previous PNL were enrolled as Group 2 and patients with previous open surgery history were enrolled in Group 3. Patients with congenital renal abnormality such ureteropelvic junction obstruction, horseshoe, or ectopic kidney, patients with BMI ≥35 and patients under 18-year old were excluded from the study. Also patients who underwent both PNL and open renal surgery were excluded.
Technique Briefly, all procedures were done under C-arm fluoroscopy using an 18-G needle in prone position as previously described in detail. The tract was dilated with a high-pressure balloon dilator (Nephromax TM Microvasive Boston Scientific Corporation, Natick, MA, USA) or telescopic dilatators. Stone fragmentation was performed using an ultrasonic lithotripter (Swiss Lithoclast®, EMS Electro Medical System, Nyon, Switzerland) or pneumatic (Vibrolith®, Elmed, Ankara, Turkey). A 14-F nephrostomy tube was placed inside the renal pelvis or into the involved calyx upon termination of the intervention in most cases. The operative duration was accepted as the time from the puncture for pelvicaliceal system to the final placement of a nephrostomy tube.
13
Patients’ data in each group including demographic characteristic, preoperative and post-operative hematocrit and creatinine level, operative, and fluoroscopy screening time were analyzed. Also, hospitalization time, stone-free status and complication rates were compared between groups. Stone-free status was evaluated with KUB graph on the first operative day and abdominal CT at the 3 months postoperatively. Patients with complete clearance of stone and residual fragment smaller than 4 mm were accepted as stone free. Statistical analyses were performed by computer software IBM SPSS 16.0. Data were presented as numbers, percentages, means, and standard deviations. During comparison of results between groups percentages were compared using the χ2 test. Comparison of means of scale data were performed by one-way ANOVA test because the number of groups was more than two. Post hoc analyses were performed by Tamhane test because all the scale data were distributed heterogeneously.
Results Eventually, 2070 patients were enrolled into the study. Open renal surgery and PNL had been done in 410 (Group 2) and 131 (Group 3) patients, retrospectively. There were no differences between the three groups in age, gender, stone burden, and stone opacity. The mean BMI was significantly higher in Group 2. The mean preoperative creatinine level was significantly higher in Group 3 than the other groups. Additionally, degree of hydronephrosis and stone in multiple calyx location is more in Group 3. The patients’ characteristics were listed in Table 1. The mean operation time was longer (71.3 ± 33.5 min) in Group 2 and the mean fluoroscopy time was longer (8.6 ± 5.0) in Group 3 but there was no statistically significant difference between groups. Multiple access was significantly more common in patients with history open surgery compared to other two groups (p
