Percutaneous nephrolithotomy and laparoscopic surgery efficacy and renal function outcomes for large and complex renal calculi

Abstract

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.

Keywords

Dynamic nephroscintigraphy / Large and complex renal calculi / Lithotripsy / Percutaneous nephrolithotomy / Prone and supine positions / Renal function

Acknowledgment

We gratefully acknowledge the assistance of the statistical team of the CUC “City Multidisciplinary Hospital No. 2,” RUDN, and the organizers of the “RUDN University Program 5-100.”

Statement of ethics

The study was approved by the Ethics Committee of CUC “City Multidisciplinary Hospital No. 2,” Nur-Sultan, Kazakhstan (Jan 18, 2012/No. 5-01/2012). This study was performed in line with the principles of the Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study.

Conflict of interest statement

The authors declare they have no conflicts of interest.

Funding source

None.

Author contributions

YP: Conceptualization of the study, study methodology, data validation and analysis, drafting of the original manuscript;

NK: Data management and analysis, review and editing of the manuscrip;

DY: Conceptualization of the study, study methodology, project supervision;

All authors contributed to study conception and design and approved the final version of the manuscript.

Data avaliability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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