Single puncture percutaneous nephrolithomy for management of complex renal stones

Overall stone-free rate was 74.8%. Patients with residual stones were managed by one session of shock wave lithotripsy (SWL). Mean operative time was (80 minutes ± 27.4) for branched stones and (49.1 minutes ± 15.9) for multiple stones. No significant blood loss reported. Perforation of pelvicalyceal system occurred in 2 patients (11.5%) with no serious sequelae. Only 1 patient developed secondary hemorrhage which necessitated blood transfusion and selective angio-embolization.In our hands, the efficacy and safety of single lower calyceal puncture PCNL in management of complex renal stones are comparable to those of the general procedure stated in literature.Renal stone disease is a challenging problem in urologic practice especially in our locality because of large stone burden and recurrence. The goal of stone treatment is to use a less morbid, minimally invasive and effective modality [1]. The management of stone disease has witnessed a revolution since the introduction of shock wave lithotripsy (SWL) and percutaneous nephrolithotomy (PCNL) [2,3]. The refinement of nephroscopes, the introduction of simple, commercially available nephrostomy sets and development of stone disintegration techniques have paved the way of PCNL [4]. After the introduction of SWL; PCNL became the spare wheel and was mostly indicated when SWL was likely to fail as in patients with large stone burden or stag horn calculi [4].In a trial to cut the renal trauma to the minimum, we evaluate the efficacy and safety of PCNL through a single lower pole puncture for management of branched and multiple renal calculi.After approval of the study by the ethical committee of the Faculty of Medicine, Assiut University, the study was carried out in a prospective non randomized fashion. A total of 26 patients (21 males and 5 females) with complex (branched or multiple) renal calculi among those admitted to Urology Department, Assiut University Hospital in the period from May 2003 and May 2004 were includ