Percutaneous Nephrolithotomy Dec 2015 PCNL According to both AUA amp EAU guidelines PCNL is considered 1 st line treatment for renal stones gt2 cm 1 st PCNL was described by ID: 1007136
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1. Single-session Supine BilateralPercutaneous NephrolithotomyDec 2015
2. PCNLAccording to both AUA & EAU guidelines: PCNL is considered 1st -line treatment for renal stones >2 cm1st PCNL was described by Fernstrom & Johansson in 1976 and since then, this surgical approach has undergone significant changes with purpose of minimizing both invasivity & morbidity together with improving outcomesRemarkable progress achieved in surgical techniques & equipment have improved efficacy & reduced operative time and complications, expanding treatment options for complicated stone patients such as those with bilateral calculiProietti S, et al. Urology. 2015; 85: 304-310.
3. Proietti S, et al. Urology. 2015; 85: 304-310.Historically, patients with bilateral large stone burdens have always been therapeutic challenge to the urologistTraditionally, these patients had been treated with staged procedures, to avoid increased morbidity of bilateral kidney surgery & to prevent injury to orinfection of both renal units together
4. BPCNLNowadays, bilateral PCNL (BPCNL) performed in same operative session is considered, in high-volume centers & experienced hands to be a well-tolerated, safe and effective procedure for these patients, able to avoid risk of 2nd anesthesia, and to decrease morbidity and length of hospitalizationHowever, removal of large and/or complex bilateral renal stones still represents difficult task for urologistsAs a consequence, there are few studies on this challenging issue & most importantly, to date, none have described single-session BPCNL in supine positionProietti S, et al. Urology. 2015; 85: 304-310.
5. Single-session Supine BilateralPercutaneous NephrolithotomyObjective:To evaluate effectiveness & safety of supine bilateral percutaneous nephrolithotomy (BPCNL) performed in same session in patients affected with bilateral renal calculiMethods:RetrospectivePatients with bilateral renal stones with diameters >2 cm for each side, who had been treated with supine BPCNL in same session (Nov 2006 - April 2014)Proietti S, et al. Urology. 2015; 85: 304-310.
6. Single-session Supine BPCNL: MethodsDemographic & stone characteristics, intraoperative & perioperative outcomes, and complications related to procedure adopted were reviewedStone size was calculated by measuring maximum stone diameter by computed tomography scanStone-free rate was defined as clinically insignificant when residual fragments of 2 mm were detected by CT scanProietti S, et al. Urology. 2015; 85: 304-310.
7. Proietti S, et al. Urology. 2015; 85: 304-310.
8. Proietti S, et al. Urology. 2015; 85: 304-310.
9. Results25 patients were included in studyMean age: 51.9 11.4 yearsMean maximum stone diameter per renal unit: 3.1 ± 0.8 cmStatistical significant differences in creatinine serum levels were detected at day 1 postoperatively compared with baseline (P <.0001) values that became insignificant at 1 week & 1 month postoperatively (P >.05) Proietti S, et al. Urology. 2015; 85: 304-310.
10. Proietti S, et al. Urology. 2015; 85: 304-310.
11. Proietti S, et al. Urology. 2015; 85: 304-310.
12. ResultsPrimary stone-free rate was 80%; ancillary procedures were performed in 3 of 25 patients (12%)Grade I complications occurred in 3 patients (12%), grade II in 4 patients (16%) & grade IIIA in 1 patient (4%)Proietti S, et al. Urology. 2015; 85: 304-310.
13. Supine BPCNL performed in same session is safe & effective procedure in patients affected with bilateral renal calculiOn other hand, it is still a very challenging operation & consequently, it should be performed only by experienced surgeons in a tertiary centerProietti S, et al. Urology. 2015; 85: 304-310.Conclusion
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