Percutaneous nephrolithotomy for patients with upper urinary tract calculi and spinal deformity

Luo Hongbo; Liu Xiuheng; Lyu Shengqi; Guo Jia; Cheng Zhiyuang

doi:10.19558/j.cnki.10-1020/r.2017.06.007

Abstract：Objective:To explore the feasibility and safety of percutaneous nephrolithotomy (PCNL)for pa-tients with upper urinary tract calculi and spinal deformity.Methods:A total of 15 patients (8 males,7 females, age range:41-69 years)with upper urinary tract calculi diagnosed by enhanced CT scanning or CTU were enrolled in the study.The average size of calculi was (35 ±19)mm.There were 10 cases of scoliosis,2 cases of thoracic kyphosis and 3 cases of lumbar kyphosis.Operative positions (prone or lateral supine position)were determined based on the different conditions of spinal deformity.Patients underwent ultrasonography-guided PCNL.Two or more percutaneous accesses were established when necessary.Holmium laser lithotripsy or pneumatic lithotripsy was used in the operation.Results:Among the 15 patients,PCNL was performed on 19 sides.Single percutaneous access was established in 15 cases,and 2 accesses in 4 cases.One-stage stone clearance rate was 73.7％ (14/19). Among the 5 cases with residual stones,1 case underwent second-stage PCNL and 2 cases were given PCNL com-bined with flexible ureteroscopy (RIRS),and KUB showed the complete removal of calculi one month later;two patients were not treated thereafter.The total stone clearance rate was 89.5％ (17/19).Two patients developed hemorrhage after the operation and recovered after conservative treatment.Fever occurred in 3 cases.No other complications were found,such as septic shock,injuries of organs and great vessels in the abdominal cavity.Con-clusions:Minimal invasive PCNL is effective and safe for the treatment of patients with upper urinary tract calculi and spine deformity.Ultrasonography-guided puncture is found to be effective and safe,and can effectively avoid the injuries of abdominal organs.