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EFFICACY OF PERCUTANEOUS NEPHROLITHOTOMY (PCNL) IN PREVIOUSLY OPERATED (PYLO / NEPHROLITHOTOMY) PATIENTS WITH RECURRENT RENAL STONES

Dr. Abdul Qayoom, Dr. Waqar Memon and Dr. Javed Altaf Jat

Background: Urolithiasis is a significant source of morbidity for our population which affects national health cost in billions annually and can be treated by Shockwave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), percutaneous Nephrolithotomy (PCNL), open surgery and/ or combination. Objective: To determine the efficacy of percutaneous nephrolithotomy (PCNL) in previously operated (pylo/nephrolithotomy) patients with recurrent renal stones. Patients and Methods: The cross sectional study comprises twenty nine patients seen at urology clinic with signs and symptoms of renal calculi and diagnosed on ultrasonography and CT-KUB/IVU and have past history of open renal surgery (pyelo/nephrolithotomy) were enrolled for the study and underwent PCNL during July 2018 to March 2019. Percutaneous nephrolithotomy was performed under general anesthesia by experienced and qualified Urologist team, the clearance of stones was documented as complete, i.e. (no visible stone or <4mm stone fragment and incomplete (residual fragement > 4mm visible stone fragment on flouroscopy and 1st postoperative X-ray KUB). The operative time, intraoperative and postoperative blood transfusion and complications were also recorded. On 1st postoperative day the patient haemoglobin, serum creatine and X-ray KUB were advised. The patients were discharged on 2nd to 3rd postoperative day after nephrostomy removal. DJ stent were removed after 2 weeks. The collected data was analyzed in SPSS version 23. Mean ± SD was calculated for numerical variables like age, stone size, time of procedure, pre and post operative haemoglobin. Frequency and percentages were calculated for categorical variables like gender of patients, co-morbids, nephrostomy placement, stone clearance and complications. Results: During nine months study period total twenty nine previously operated patients were underwent for percutaneous nephrolithotomy. The mean age ± SD of the patients was 41.79 ± 8.86 years while the mean size of the renal stones was 2.06 ±1.21 cm with a range of 2–3 cm. Females population was predominant as 15 patients (51.7%) while the male patients observed as 14 (48.3%). Regarding comorbids, the HCV positive was 17.2%, hypertension 10.3%, diabetes mellitus 3.4% while the mean ± SD for preoperative hemoglobin was 13.3 ± 1.83 g/dl and post operative was 11.1 ± 2.85 g/dl. Intraoperative blood transfusion was done in 13.8% and post operative blood transfusion was done in 6.9% of patients. The mean ± SD time of PCNL was 1.25 ± 0.32 hrs while the two punctures were done in 1 (3.4%) patient. Nephrostomy was done at the end of procedure in 75.9% of patients whereas the complete clearance of stone fragments was achieved in 93.1% and auxiliary procedure (DJ stenting) was accomplished in 3 patients (10.73%). Conclusion: In patients having past history of renal stone surgery the PCNL can be performed with low blood transfusion rate (intra-operative and post operative), acceptable procedure time, less complication and high success rates if safety rules are followed strictly. Key Words: Percutaneous nephrolithotomy, Kidney stones and Renal calculi

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