The importance of hydronephrosis in percutaneous nephrolithotomy operation

Abstract

Objective: The aim of this study is to investigate the relation between hydronephrosis grade and preoperative, peroperative and postoperative data and to evaluate the clinical significance of hydronephrosis in percutaneous nephrolithotomy (PNL). Methods: One hundred and thirty-two patients who had undergone PNL operation by same surgeon between February 2009 and February 2013 were reviewed retrospectively. Patients\' characteristics, preoperative kidney status, operative data were investigated. Grade 1, 2 hydronephrosis were determined as Group I, Grade 3, 4 hydronephrosis were determined as Group II. Preoperative, peroperative and postoperative property differences between groups were compared statistically. For the multivariate analysis, logistic regression analysis was used to determine independent predictors of hydronephrosis. Results: Patients mean age was 46.2±13.7 years (8-73). Operation mean time was 101(10-250) minutes. 56 and 76 patients\' data were analyzed in Group I and Group II, respectively. There was no difference in age, gender, BMI, and surgeon experience between groups. Dropping stone history in same kidney (p=0.012), stone diameter (p=0.022), the number of calyceal stones (p=0.005), presence stone in the other kidney (p=0.027), renal parenchymal thickness (p=0.026) and operation time (p=0.011) had significantly in univariate analysis. In logistic regression model, dropping stone history in the same kidney, the number of calyceal stones, presence stone in the other kidney and operation time had a relationship with hydronephrosis. Conclusion: In PNL, patients with low-grade hydronephrosis might have decreased complication rates due to diminished operation time, which resulted in reduced number of calyceal stones and stone size.

Keywords

• Percutaneous nephrolithotomy, PNL, hydronephrosis, outcome

Perkütan nefrolitotomi ameliyatında hidronefrozun önemi

Abstract

Amaç: Bu çalışmanın amacı perkütan nefrolitotomi (PNL) ameliyatlarında renal hidronefroz derecesinin preoperatif, peroperatif ve postoperatif verilerle ilişkisini araştırmak ve klinik önemini incelemektir. Yöntemler: Şubat 2009 ile Şubat 2013 arasında aynı cerrah tarafından yapılan 132 PNL ameliyatı geriye dönük olarak tarandı. Hastaların demografik verileri, preoperatif böbrek özellikleri, peroperatif ve postoperatif verileri değerlendirildi. Grade 1 ve 2 hidronefroz grup I; grade 3 ve 4 hidronefroz grup II olarak belirlendi. Gruplar ile preoperotif, peroperatif ve postoperatif özelliklerin farkları istatistiksel olarak karşılaştırıldı. Hidronefrozun bağımsız belirleyicilerini saptamak için multivariat analiz olarak lojistik regresyon analizi kullanıldı. Bulgular: Yaş ortalaması 46,2±13,7 yıl (8 -73) idi. Operasyon süresi ortalama 101 dakika (10-250) olarak hesaplandı. Grup I\'de 56, Grup II\'de 76 hastanın verileri analiz edildi. İki grup arasında yaş, cinsiyet, vücut kitle indeksi ve cerrahi tecrübe açısından fark saptanmadı. Preoperatif verilerden, opere böbrekte daha önce taş düşürme öyküsü (p=0,012), taşın çapı (p=0,022), taşın bulunduğu kaliks sayısı (p=0,005), karşı böbrekte taş varlığı (p=0,027), renal parankim kalınlığı (p=0,026); peroperatif verilerden, operasyon süresinde (p=0,011); univaryant analizde anlamlı fark saptandı. Lojistik regresyon analizinde, opere böbrekte taş öyküsü, taşın bulunduğu kaliks sayısı, karşı böbrekte taş varlığı, operasyon süresi ile hidronefroz arasında ilişki izlendi. Sonuç: Perkütan nefrolitotomi operasyonlarında düşük dereceli hidronefrotik böbreklerde, taş çapının ve taşın bulunduğu kaliks sayısı azalması dolayısı ile operasyon süresinin kısa olması sonucunda komplikasyon daha az olacaktır.

Keywords

• Perkütan nefrolitotomi, PNL, hidronefroz, sonuç

References

1. Binbay M, Akman T, Ozgor F, et al. Does pelvicaliceal sys- tem anatomy affect success of percutaneous nephrolithoto- my? Urology 2011;78:733-773.
2. Davarcı M, Rifaioglu M, Yalçınkaya FR, İnci M. Üriner Sistem Taş Tedavisinde İki Senelik ESWL Sonuçlarının Değerlendirilmesi [Evaluation of the results of ESWL ther- apy in urinary system stone disease for two years]. Dicle Med J 2012;3: 377-380
3. Kim SC, Kuo RL, Lingeman JE. Percutaneous nephrolithot- omy: an update. Curr Opin Urol 2003;13:235-241.
4. Ramakumar S, Segura JW. Renal calculi. Percutaneous man- agement. Urol Clin North Am 2000;27:617-622.
5. Zhu Z, Wang S, Xi Q, Bai J, Yu X, Liu J. Logistic regression model for predicting stone-free rate after minimally invasive percutaneous nephrolithotomy. Urology 2011;78:32-36.
6. Akman T, Binbay M, Yuruk E, et al. Tubeless procedure is most important factor in reducing length of hospitalization after percutaneous nephrolithotomy: results of univariable and multivariable models. Urology 2011;77:299-304.
7. Rassweiler JJ, Renner C, Eisenberger F. The management of complex renal stones. BJU Int 2000;86:919-928.
8. Ziaee SA, Sichani MM, Kashi AH, Samzadeh M. Evaluation of the learning curve for percutaneous nephrolithotomy. Urol J 2010;7:226-231.

9. Elbahnasy AM, Shalhav AL, Hoenig DM, et al. Lower cali- ceal stone clearance after shock wave lithotripsy or ure- teroscopy: the impact of lower pole radiographic anatomy. J Urol 1998;159:676-682.
10. Geavlete P, Multescu R, Geavlete B. Influence of pyelo- caliceal anatomy on the success of flexible ureteroscopic approach. J Endourol 2008;22:2235-2239.
11. Gupta NP, Singh DV, Hemal AK, Mandal S. Infundibulo- pelvic anatomy and clearance of inferior caliceal calculi with shock wave lithotripsy. J Urol 2000;163:24-27.
12. Akman T, Binbay M, Sari E, et al. Factors affecting bleed- ing during percutaneous nephrolithotomy: single surgeon experience. J Endourol 2011;25:327-333.
13. El-Nahas AR, Shokeir AA, El-Assmy AM, et al. Post-per- cutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. J Urol 2007;177:576-579.
14. Akman T, Binbay M, Akcay M, et al. Variables that influ- ence operative time during percutaneous nephrolithotomy: an analysis of 1897 cases. J Endourol 2011;25:1269-1273.
15. Gambaro G, Favaro S, D’Angelo A. Risk for renal failure in nephrolithiasis. Am J Kidney Dis 2001;37:233-243.