Assessment of the Effects of Access Count in Percutaneous Nephrolithotomy on Renal Functions by Technetium-99m-Dimercaptosuccinic Acid Scintigraphy

Objective. To determine the effects of percutaneous nephrolithotomy on renal functions by using DMSA scintigraphy while considering access counts. Material and Methods. A total of 37 patients who had undergone percutaneous nephrolithotomy were included. Preoperative DMSA scans were performed a day before the surgery, whereas postoperative scans were randomized by evaluating them before ( ) and after ( ) the 6th postoperative month. Twenty-six of 37 cases underwent percutaneous nephrolithotomy with a single access site and 11 with multiple access sites. Results. There were no significant changes of total renal functions in the whole study group ( ). In the single access group, total functions were significantly elevated ( ) In the multiple access group, while treated site functions were significantly decreased ( ), total functions did not change significantly ( ). There was an insignificant decrease in those evaluated before the 6th postoperative month ( ) and an insignificant increase in the others ( ). Conclusion. We could not find a superiority of single access over multiple accesses. There is a temporary functional loss in the treated site. 1. Introduction Urinary stone disease (USD) is an important and frequently seen health problem. The main problem is recurrence. In human beings it can recur at a rate of approximately 50% in five years [1]. Therefore, USD still does not have a definitive treatment. Meticulous clearance of stones, minimal morbidity, maximal nephron sparing, and slower recurrence rate should be aimed at during treatment. In this context extracorporeal shockwave lithotripsy (ESWL) and minimally invasive surgeries are generally performed instead of open surgery nowadays [2]. Although there are numerous reports about the percutaneous nephrolithotomy (PCNL) technique and results, its effects on renal functions are not well known quantitatively [3]. 99m-Technetium-Dimercaptosuccinic Acid (DMSA) scintigraphy is very helpful for assessing parenchymal function after a surgical intervention [4]. In this study we aimed to determine the effects of PCNL on renal functions by using DMSA scintigraphy while considering tract and dilatation counts. In addition, we discussed the effect of surgical trauma on the local surgical area (dilatation site on the kidney). 2. Material and Methods This study was approved by the local ethics committee (ID: 07/45). The informed consent was signed by all patients. Total 37 patients who had undergone PCNL were included between June 2007 and June 2009. All patients were evaluated routinely with physical