Search

Objectives To evaluate the effectiveness and safety of simultaneous bilateral percutaneous nephrolithotomy performed in patients affected with bilateral renal calculi. Materials and methods This is a prospective study from September 2012 to November 2016. Patients diagnosed of bilateral kidney stones with abdominal CT scan were included. Surgical technique prone position, renal puncture guided by fluoroscopy and tract dilation up to 24Ch. We reviewed demographic and stone characteristics, stone free rate, clinical success, complications and follow-up. Results During the study period, 732 percutaneous nephrolithotomies were performed. Eighteen patients were included (36 renal units, 2.5%), 13 men and 5 women, with a median age of 58 years and an interquartile range (IQR) of 40–66. Median stone burden was 228 mm2 (IQR 134–389); median operative time, 150 min (IQR 97–180); and median hospital stay, 5 days (IQR 5–15). Stone free rate was 80%. Residual calculi were encountered in 8 renal units (22.2%) and required other complementary techniques for their complete resolution 4 external shockwave lithotripsies, one open ureterolithotomy, 2 ureteroscopies and one second look. Major complications included 4 cases of severe hemorrhage managed with angiographic embolization. The median follow-up was 36 months (range 26–46). Conclusions Simultaneous bilateral percutaneous nephrolithotomy is an effective and safe procedure in patients affected with bilateral renal calculi. It is a surgical challenge that should be performed in selected patients and in centers with experience.

Introduction Clavien-Dindo classification system has been proposed to grade perioperative complications in percutaneous nephrolithotomy. The complications of this technique that have taken place in the last 2 years are reported in this article according Clavien-Dindo classification. Materials and methods Between 2011 and 2012, a total of 255 percutaneous nephrolithotomy were performed at our center for stones more than 2 cm in size. In order to determine the incidence of complications classified in the modified Clavien-Dindo system, statistical analysis of the data obtained was carried out. Results During the period analyzed, 255 percutaneous nephrolithotomy were performed in 249 patients, 41% of the right side, 57% of the left side and 2% bilateral and simultaneous. 137 and 112 patients were males and females, respectively. The most prevalent comorbidities were: hypertension (AHT) in 101 patients (40.6%), BMI > 30 in 81 patients (32%), diabetes mellitus in 46 patients (18.5%) and coagulation abnormalities in 24 patients (9.6%). A total of 70 cases (27.4%) were distributed according to Clavien-Dindo classification: grade i 8.4%, grade ii 8.4%, grade iiia 4.4%, grade iiib 6% grade iva 0.8%, grade ivb: 0% and grade v 0%. Conclusions A graded classification scheme for reporting the complications of percutaneous nephrolithotomy is useful for monitoring and reporting outcomes. We propose a standardized use of this classification in order to make the results comparable among different centers performing the technique.