PL 28. Treatment of upper urinary calculi with Chinese MPCNL: a single-center experience with 10,452 cases
Introduction & Objectives: The aim of this study was to present our experience for treating upper urinary calculi with Chinese minimally invasive tract percutaneous nephrolithotomy (MPCNL) and evaluate its clinical indications, efficacy and safety.
Material & Methods: From June 1992 to September 2010, a total of 10,452 patients (6,060 men and 4,392 women, 1.38:1) with a mean age of 47.6±3.7 (7 months -93 years) years were retrospectively investigated in our center. All of the patients suffered from upper urinary calculi and were treated with Chinese MPCNL. The history, stone location and burden, operative procedure and time, stone-free rate, complications, hospital stay, results of who had stone composition and 24h urine analyzed were reviewed.
Results: Of 10,452 cases, 11,801 procedures were performed on 10,876 (5,493 left and 5,383 right) renal units including 10,102 first stage procedures, 1,604 second took procedures, 86 third procedures and 9 fourth procedures respectively, and there were 4,097 (39.2%) cases of bilateral calculi, 4,600 (44.10%) cases of multiple calices calculi, 1,900 (18.18%) cases of staghorn calculi, 395 (3.78%) cases of simple pelvis stone, 645 (6.17%) cases of simple lower caliceal stone, 358 (3.43%) cases of solitary renal stone, 430 (4.11%) cases of simple upper ureteral stone, 236 (2.26%) cases of steinstrasse after ESWL, 269 (2.57%) cases of residual stone after open surgery , 132 (1.26%) cases of children younger than 14 years ,65 (0.62%) cases of horseshoe kidney, 19 (0.18%) cases of transported kidney, 16 (0.15%) cases of duplex kidney and 2 (0.02%) cases of ectopic kidney. Of 10,876 renal units, a total of 11,830 tracts were established and 1,207 (10.20%), 9,174 (77.55%), 1,449 (12.25%) tracts were punctured to upper, middle and lower renal calyx respectively. 956 (9.23%) renal units were managed with multiple tracts, which contained 846 (7.78%) units required 2 tracts, 85 (0.78%) units required 3tracts, 18 (0.17%) units required 4 tracts and 7 (0.06%) units required 5 tracts. The lithotripsy used on these patients were 7,637 (73.07%) cases of Swiss Lithoclast , 2454 (23.49%) cases of Homium: YAG laser and 189 (1.81%)cases of combining with Swiss Lithoclast and Homium: YAG laser respectively. 762 (7.29%) cases needed ESWL to clean the stone after MPCNL. The mean stone burden was 777.44±40.34 (20-4,080) mm2 and the average operative time was 101.3±4.23 (10-240) minutes. The stone free rate was 89.9%, which increased to 93% with adjunctive ESWL and the mean hospital stay was 13.20±.43 (2-72) days. The significant complications were happened on 319 (3.05%) cases including 294 (2.81%) cases of blood transfusion, which contained 53 (0.51%) cases needed super-selective renal arterial embolization, 9 (0.09%) cases of pleura injury, 12 (0.11%) cases of sepsis, 2 (0.02%) cases of colon injury and 2 (0.02%) cases of death. The main stone composition of 4,345 in 10,452 cases were analyzed in which calcium oxalate, calcium phosphate, magnesium ammonium phosphate, uric acid, ammonium urate, carbapatite and cystin was 91.74%, 90.33%, 14.91%, 17.77%, 4.83%, 8.47% and 0.51% respectively. And the average volume, phosphate, calcium, magnesium, sodium, uric acid, oxalate, and citrate of 24 h urine was 2, 214.45±78.07(700-5,600) mL/ 24 h, 560.02±33.19(33-3,370) mg/24 h, 195.74±14.68(8-769) mg/24 h, 80.07±3.00(1-465 ) mg/24 h, 4.56±.29(1-15.40) g/24 h, 630.67±80.24 (111-2,098) mg/24, 33.15±6.04(3-332) mg/24 h and 206.64±79.51(18-1,235) mg/24 h respectively of 227 adult patients.
Conclusions: Chinese MPCNL is an effective and safe treatment for all kinds of upper urinary calculi in all ages patients with a high stone free rate and low significant complication rate.
