Estimation of the Efficacy and Safety of Totally Real-Time Ultrasonography-Guided Percutaneous Nephrolithotomy: A Single Center Study Alwan Ahmed Abdul Ameer1, Abd Ahmed Hamza2,*, Ajeel Hussain T.2 1Urosurgeon Department of Surgery, College of Medicine, University of Al-Qadisiyah, Iraq 2Urosurgeon, Department of Urology, AL-Diwaniyah Teaching Hospital, Iraq *Corresponding Author: Ahmed Hamza Abd, Urosurgeon, Department of Urology, AL-Diwaniyah Teaching Hospital, Iraq, Email: salwan_ali2000@yahoo.com
Online published on 23 December, 2019. Abstract Background Percutaneous removal of urinary calculi is superior to open surgical removal in terms of morbidity, recovery and expenses. Even for large complex renal stones PCNL now considered the first choice of treatment at most institutes. The aim of current study was to determine the efficacy and safety of percutaneous nephrolithotomy under total ultrasound-guidance. Methodology From January 2015 to March 2018, a total of 300 patients, (200 males and 100 females) their age ranged from 20 to 65 years with a Mean ± SD age of 40.75 ± 11.8 years who visited the outpatient urology clinic and presented with stones size ranged (20-50mm) with a mean size of 33.5mm, were included in this study. All calculi were situated in the renal pelvis with different degrees of hydronephrosis ranging from mild to severe hydronephrosis as appreciated by radiological investigations. The patients were positioned in the standard lithotomy position, a double J stent was placed cystoscopically, and urethral catheter was also inserted. Then the position of patient was changed to prone position. The PCS was punctured by using an 18-gauge nephrostomy needle through the lower pole calyx, and all steps of the operation were performed under ultrasonography guidance. Lithotripsy was done by using pneumatic probes. Results Data showed that 276 (92%) patients had complete stone clearance in patients with single stone (180 patients). The stone-free rate was 100% and in patients with multiple or staghorn stone (120 patients), the stone-free rate was 80% (120 patients). In addition, 20%(16 patients) had residual stones;10 patients of them had insignificant residual fragments that passed spontaneously four weeks postoperatively and 6 patients needed SWL for clearance of stone fragments. The complication rate was 30%, the most common complications being mild fever (35%), clinically insignificant hemorrhage (8%), urinary tract infections in 5%, 5% had flank pain and there were no injuries to adjacent organs. The Mean ± SD time of the operation was 70 ± 35.68 minutes (range was 35–160 minutes). The Mean ± SD time of hospitalization was 2.8 ± 1.15 days (2–5 days). Conclusion Totally ultrasonography-guided PCNL has excellent results in comparison to the ordinary method of PCNL with no major complications and with the benefit of precluding radiation exposures and injury to the neighboring organs. Top Keywords PCNL, ultrasound, renal stone, nephrostomy, hydronephrosis. Top |