Percutaneous nephrolithotomy and laparoscopic surgery efficacy and renal function outcomes for large and complex renal calculi
Pak Y. Kalyagina N. Yagudaev D.
1 December 2024Lippincott Williams and Wilkins
Current Urology
2024#18Issue 4268 - 272 pp.
Background There is limited published evidence regarding the incidence of intraoperative and postoperative events and the effect of percutaneous nephrolithotomy (PCNL) in supine and prone positions and laparoscopic pyelolithotomy on kidney function in patients with large and complex calculi. Materials and methods We evaluated the surgical outcomes of 97 patients with large and complex kidney stones. The patients were divided into 3 groups: those who underwent PCNL in the prone position, PCNL in the supine position, and pyelolithotomy by laparoscopy and retroperitoneoscopy. General surgical outcomes, size of residual stones, stone-free rate, glomerular filtration rate (GFR), and split GFR obtained from Tc-99m renal dynamic scintigrams were analyzed. Results Percutaneous nephrolithotomy in the prone position was correlated with improved function of the affected kidney. In the supine PCNL group, none of the analyzed indicators demonstrated a significant difference. Dynamic nephroscintigrams revealed negative changes in terms of accumulation and secretion of the affected kidney. A slight decrease in creatinine clearance was noted. However, positive dynamics in split GFR and secretory index were seen in this group. The laparoscopic group showed positive results in all analyzed parameters. However, full assessment of the function of the affected kidney in this group was limited due to restricted use of laparoscopic pyelolithotomy for complex stones. Conclusions Percutaneous nephrolithotomy in the prone position resulted in the most favorable renal functional outcomes for patients with high-grade renal calculi, whereas a laparoscopic approach may be preferred for patients with stones of lower grades. The most significant factors that adversely affected renal function were intraoperative bleeding volume, kidney stone size and density, and body mass index.
Dynamic nephroscintigraphy , Large and complex renal calculi , Lithotripsy , Percutaneous nephrolithotomy , Prone and supine positions , Renal function
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Cuc City Multidisciplinary Hospital No. 2, City Center of Urology, Nur-Sultan, Kazakhstan
Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russian Federation
National Research Nuclear University MEPhI, Moscow, Russian Federation
Peoples Friendship University of Russia (RUDN University), Moscow, Russian Federation
Central Clinical Hospital, Russian Railways-Medicine, Moscow, Russian Federation
Cuc City Multidisciplinary Hospital No. 2
Prokhorov General Physics Institute of the Russian Academy of Sciences
National Research Nuclear University MEPhI
Peoples Friendship University of Russia (RUDN University)
Central Clinical Hospital
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