Context: Percutaneous nephrolithotomy (PCNL) in renal fusion, ectopia, renal rotational anomalies, renal hypoplasia, and pelvicaliceal aberration for complex calculi is challenging for fear of inaccessibility, vascular, colonic, and splanchnic injury. We report our experience with 48 such patients.
Patients and methods: From 2002 to July 2007, 48 patients (mean age, 28 years) underwent PCNL for mean stone size of 39 mm. Fourteen patients had malrotated kidneys, 12 patients had bifid renal pelvis with complete or incomplete double ureter, 10 horseshoe kidneys, 8 hypo plastic kidneys, 3 with crossed fused ectopia, and 1 had pelvic kidney. After appropriate evaluation, the procedure was performed in one session either in prone or supine position with or without nephrostomy tube making amendments to the conventional procedure as deemed necessary befitting the requirements.
Results: Complete stone clearance was achieved in 39 patients (81%) after single session of PCNL. Seven patients treated subsequently with extracorporeal shockwave lithotripsy (SWL) for residual stone also became stone free, achieving final stone-free status of 96%. Three patients had more than one tract creation; 25 patients had this procedure in supine position. Mean hospital stay was 3 days (range, 2-7 days). Three patients required transfusion, and two had perinephric collection. No incidence of bowel, vascular, and splanchnic injury was recorded. Stone analysis showed calcium oxalate composition in 83% calculi.
Conclusion: Universal application of PCNL in all diverse situations like renal fusion, renal ectopia, renal malrotation, renal hypoplasia, and pelvicaliceal variations yields comparable results demanding firm resolve and mandatory surgical skill on behalf of the surgeon.