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Bilateral renal calculi: assessment of staged v synchronous percutaneous nephrolithotomy.

Publication ,  Journal Article
Silverstein, AD; Terranova, SA; Auge, BK; Weizer, AZ; Delvecchio, FC; Pietrow, PK; Munver, R; Albala, DM; Preminger, GM
Published in: J Endourol
March 2004

BACKGROUND AND PURPOSE: Percutaneous stone removal has replaced open renal surgery and has become the treatment of choice for large or complex renal calculi. However, patients with large bilateral stone burdens still present a challenge. Simultaneous bilateral percutaneous nephrolithotomy (PCNL) has been demonstrated to be a well-tolerated, safe, cost-effective, and expeditious treatment. We present what is, to our knowledge, the first large retrospective series comparing synchronous and asynchronous bilateral PCNL. PATIENTS AND METHODS: A chart review was performed on 26 patients undergoing 57 PCNLs for bilateral renal calculi over a 7-year period. Seven patients received synchronous PCNL (same anesthesia; Group 1), and 19 patients underwent asynchronous PNL (procedures separated by 1-3 months; Group 2). Complete surgical and hospital records were available on all patients. The average stone burden for Group 1 was 8.03 cm(2) on the left and 9.18 cm(2) on the right v 10.1 cm(2) on the left and 14.23 cm(2) on the right for Group 2 (P> 0.05). Variables of interest included anesthesia time, operative time, blood loss, transfusion rates, length of hospital stay, and complication rates. Each variable was evaluated per operation and per renal unit. Follow-up imaging with stone assessment was available on 20 patients. RESULTS: Group 1 required 1.14 access tracts per renal unit to attempt complete clearance of the targeted stones v 1.88 tracts per renal unit in Group 2 (P> 0.05). The average operative time per renal unit was significantly less in Group 1 (83 minutes) than in Group 2 (168.5 minutes) (P< 0.0001), as was blood loss (178.5 mL v 307.4 mL, respectively; P= 0.02). However, blood loss per operation was similar at 357 mL in Group 1 and 282 mL in Group 2. Comparable transfusion rates of 28.6% and 36.8%, respectively, were noted. Forty percent of the patients in Group 1 were completely stone free compared with 36% of the patients in Group 2; however, an additional 50% and 57%, respectively, had residual stone burden <4 mm (P> 0.05). Complications occurred in 2 of 7 operations (28%) in Group 1 and 8 of 42 operations (19%) in Group 2. The total length of hospital stay was nearly doubled for patients undergoing staged PCNL (P= 0.0005). CONCLUSIONS: These results demonstrate similar stone-free rates, blood loss per operation, and transfusion rates for simultaneous and staged bilateral PCNL. The reduced total operative time, hospital stay, and total blood loss, along with the requirement for only one anesthesia, makes synchronous bilateral PCNL an attractive option for select individuals. However, in patients with larger, less easily accessible stones, excessive bleeding may be encountered more frequently on the first side, thereby delaying management of the second side to a later date. Synchronous bilateral PCNL should be considered in patients in whom the first stage of stone removal is accomplished quickly and safely.

Duke Scholars

Published In

J Endourol

DOI

ISSN

0892-7790

Publication Date

March 2004

Volume

18

Issue

2

Start / End Page

145 / 151

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Treatment Outcome
  • Time Factors
  • Retrospective Studies
  • Nephrostomy, Percutaneous
  • Middle Aged
  • Male
  • Kidney Calculi
  • Humans
  • Female
 

Citation

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Chicago
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Silverstein, A. D., Terranova, S. A., Auge, B. K., Weizer, A. Z., Delvecchio, F. C., Pietrow, P. K., … Preminger, G. M. (2004). Bilateral renal calculi: assessment of staged v synchronous percutaneous nephrolithotomy. J Endourol, 18(2), 145–151. https://doi.org/10.1089/089277904322959770
Silverstein, Ari D., Steven A. Terranova, Brian K. Auge, Alon Z. Weizer, Fernando C. Delvecchio, Paul K. Pietrow, Ravi Munver, David M. Albala, and Glenn M. Preminger. “Bilateral renal calculi: assessment of staged v synchronous percutaneous nephrolithotomy.J Endourol 18, no. 2 (March 2004): 145–51. https://doi.org/10.1089/089277904322959770.
Silverstein AD, Terranova SA, Auge BK, Weizer AZ, Delvecchio FC, Pietrow PK, et al. Bilateral renal calculi: assessment of staged v synchronous percutaneous nephrolithotomy. J Endourol. 2004 Mar;18(2):145–51.
Silverstein, Ari D., et al. “Bilateral renal calculi: assessment of staged v synchronous percutaneous nephrolithotomy.J Endourol, vol. 18, no. 2, Mar. 2004, pp. 145–51. Pubmed, doi:10.1089/089277904322959770.
Silverstein AD, Terranova SA, Auge BK, Weizer AZ, Delvecchio FC, Pietrow PK, Munver R, Albala DM, Preminger GM. Bilateral renal calculi: assessment of staged v synchronous percutaneous nephrolithotomy. J Endourol. 2004 Mar;18(2):145–151.
Journal cover image

Published In

J Endourol

DOI

ISSN

0892-7790

Publication Date

March 2004

Volume

18

Issue

2

Start / End Page

145 / 151

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Treatment Outcome
  • Time Factors
  • Retrospective Studies
  • Nephrostomy, Percutaneous
  • Middle Aged
  • Male
  • Kidney Calculi
  • Humans
  • Female