CU 24. Percutaneous nephrolithotomy in patients with Spinal deformities: Report of 8 cases

Objective: To evaluate the efficacy and feasibility of percutaneous nephrolithotomy (PCNL) in patients with spinal deformities.

Methods: We retrospectively reviewed the clinical data of 8 patients with spinal deformities underwent PCNL from March 2004 to May 2010 in our hospital. Preoperative investigation of the respiratory function and evaluation of anatomy by intravenous pyelography and CT spiral scan were performed in all patients. Demographic data, number of accesses, location of accesses, hemoglobin values, and complications were recorded.

Results: Of these 8 patients, the male to female ratio was 3:1 and the mean age was 39.5 years (range, 22-48 years). Among them, 5 patients required a single standard tract, while 3 needed a single standard tract and a micro-tract. A double-J catheter was inserted in all patients and it was removed 4 weeks after the operation. Of them, no patient encountered septic shock. One patient needed blood transfusion. The complete stone clearance rate was 75% (6/8). Two patients required extracorporeal shock wave lithotripsy (SWL). During the 3-month follow-up, the overall stone-free rate was 87.5% (7/8).

Conclusions: PCNL in patients with spinal deformities is challenging. Accurate preoperative evaluation of the anatomy and respiratory function and a precise preoperative planning are compulsory. Prone position may offer a wider space for percutaneous access. The complete stone clearance rate is acceptable. Combination therapy with SWL after PCNL improves stone-free rate.