Feasibility of percutaneous nephrolithotomy after urology residency training in the 2nd stage state hospital

Abstract

Purpose: It was aimed to evaluate the results and complications of percutaneous nephrolithotomy (PCNL) in a second stage state hospital by a surgeon after Urology residency.
Materials and methods: Between January 2019 and January 2020, PCNL was applied to 102 renal units in 97
patients with kidney stones in a second stage state hospital. Standard PCNL was performed in all patients in the prone position with a 26 Fr rigid nephroscope and pneumatic lithotripter. The data of the patients were collected retrospectively. Success rates, length of stay, and complications were evaluated in the light of the literature.
Results: The average age of 97 patients who underwent PCNL was 41.7±10.5 (8-71) and 54 (55.7%) of these
patients were male and 43 (44.3%) were female. Access was provided to 102 renal units. 42 (41.2%) of them
were left and 60 (58.8%) were right. The mean stone surface area was 8.3±5.5 (2-34) cm2 and the number
of stones per patient was 2.4. Operation time was measured as 85>32 (40-170) minutes. The duration of
fluoroscopy was observed as 1.2±0.2 (0.5-9) minutes. The stone free rate was achieved in 86 (84.3%) of 102
cases. Including clinically insignificant residual fragments (>4 mm), the overall success rate was 93.1%. The
hospital stay of the patients was 2.7 (1-11) days. The number of patients with major and minor complications was 21 (20.6%).
Conclusion: We thought that PCNL can be applied safely and effectively in 2nd stage state hospitals with
acceptable complications and success rates in line by the literature.

Keywords

• Percutaneous nephrolithotomy
• kidney stone
• complication

Uzmanlık eğitimi sonrasi perkütan nefrolitotominin 2. basamak ilçe devlet hastanesinde uygulanabilirliği

Öz

Amaç: Bu çalışmada; uzmanlık eğitimi sonrasında perkütan nefrolitotomiyi (PNL) 2. basamak ilçe devlet
hastanesinde gerçekleştiren bir cerrahın başarı oranları ve karşılaşılan komplikasyonları değerlendirmek
amaçlandı.
Gereç ve yöntem: Ocak 2019 ile Ocak 2020 tarihleri arasında böbrek taşı olan 97 hastadaki 102 renal üniteye
2. basamak devlet hastanesinde PNL uygulandı. Tüm hastalara standart PNL 26 Fr rijit nefroskop ve pnömotik litotriptör kullanılarak prone pozisyonda uygulandı. Hastaların verileri retrospektif olarak toplandı. Başarı oranları, yatış süreleri, karşılaşılan komplikasyonlar literatür eşliğinde değerlendirildi.
Bulgular: PNL yapılan 97 hastanın yaş ortalaması 41,7±10,5 ve bu hastaların 54’ü (%55,7) erkek, 43’ü (%44,3)
kadındı. 42’si (%41,2) sol, 60’ı (%58,8) sağ böbrek olmak üzere 102 renal üniteye giriş sağlandı. Ortalama
taş yükü 8,3±5,5 cm2 ve ortalama taş sayısı 2,4 olarak tespit edildi. Operasyon süresi ortalama 85±32 dakika olarak ölçüldü. Skopi süresi ortalama 1,2±0,2 dakika olarak izlendi. Toplam 102 vakanın 86’sında (%84,3) taşsızlık sağlandı. Klinik önemsiz rezidüel fragmanlar (>4 mm) da dahil edildiğinde genel başarı oranı %93,1 idi. Hastaların hastanede kalış süresi 2,7 (1-11) gün olarak izlendi. Majör ve minör komplikasyon görülen hasta sayısı 21 (%20,6)’di.
Sonuç: PNL uzmanlık eğitimi sonrası 2. basamak ilçe devlet hastanelerinde literatürle uyumlu komplikasyon ve başarı oranları ile güvenli ve etkin bir şekilde uygulanabileceğini düşünmekteyiz.

Anahtar Kelimeler

• Perkütan nefrolitotomi
• böbrek taşı
• komplikasyon

Kaynakça

1. Fernström, I., and B. Johansson. "Percutaneous pyelolithotomy: a new extraction technique." Scandinavian journal of urology and nephrology 10.3 (1976): 257-259. https://doi.org/10.1080/21681805.1976.11882084
2. Türk, C., et al. "Guidelines on urolithiasis." European association of urology (2011).
3. de la Rosette, Jean JMCH, et al."Training in percutaneous nephrolithotomy a critical review." European urology 54.5 (2008): 994-1003. https://doi.org/10.1016/j.eururo.2008.03.052
4. Bayar, Goksel, et al. "The effect of stone localization on the success and complication rates of percutaneous nephrolithotomy." Urology journal 11.06 (2014): 1938-1942. https://doi.org/10.22037/uj.v11i06.2507
5. Bıçaklıoğlu, Fatih, Murat Yavuz Koparal, and Ender Cem Bulut. "Perkütan nefrolitotomi'ye 2. basamak devlet hastanesinde başlamak güvenli ve etkin mi?: ilk 60 vaka." Kocaeli Tıp Dergisi 8.1 (2019): 115-124. https://doi.org/10.5505/ktd.2019.05826
6. Tefekli, Ahmet, et al. "Classification of percutaneous nephrolithotomy complications using the modified clavien grading system: looking for a standard." European urology 53.1 (2008): 184-190. https://doi.org/10.1016/j.eururo.2007.06.049
7. Ramakumar, Sanjay, and Joseph W. Segura. "Renal calculi: percutaneous management." Urologic Clinics of North America 27.4 (2000): 617-622. https://doi.org/10.1016/S0094-0143(05)70111-7
8. Rosette, Jean de la, et al. "The clinical research office of the endourological society percutaneous nephrolithotomy global study: indications, complications, and outcomes in 5803 patients." Journal of endourology 25.1 (2011): 11-17. https://doi.org/ 10.1089/end.2010.0424

9. Skolarikos, A., G. Alivizatos, and J. J. M. C. H. De La Rosette. "Percutaneous nephrolithotomy and its legacy." European urology 47.1 (2005): 22-28. https://doi.org/10.1016/j.eururo.2004.08.009
10. Benli, Erdal, et al. "Perkütan Nefrolitotripsi Deneyimimiz." Van Tıp Dergisi 19.3 (2012): 102-107.
11. Preminger, Glenn M., et al. "Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations." The Journal of urology 173.6 (2005): 1991-2000. https://doi.org/10.1097/01.ju.0000161171.67806.2a
12. De La Rosette, Jean JMCH, et al. "Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy." European urology 62.2 (2012): 246-255. https://doi.org/10.1016/j.eururo.2012.03.055
13. Ganpule, Arvind P., Amit Satish Bhattu, and Mahesh Desai. "PCNL in the twenty-first century: role of Microperc, Miniperc, and Ultraminiperc." World journal of urology 33.2 (2015): 235-240. https://doi.org/10.1007/s00345-014-1415-1
14. Kervancioglu, Selim, Feyza Gelebek Yilmaz, and Sakip Erturhan. "Endovascular management of vascular complications after percutaneous nephrolithotomy." Vasa 43.6 (2014): 459-464. DOI: 10.1024/0301-1526/a000393
15. Yalçin, V., et al. "Böbrek taşlarının tedavisinde perkütan nefrolitotomi." Türk Üroloji Dergisi/Turkish Journal of Urology 28.2 (2002): 194-200.