Ultra-mini percutaneous nephrolithotomy and extracorporal shock-wave lithotripsy in patients with nephrolithiasis
A comparative analysis of two methods of lithotripsy was carried out in 68 patients with nephrolithiasis. In the first group, ultra-mini percutaneous nephrolithotomy (PNL) was performed using sheath with outer diameter of 11Ch (23 patients). Extracorporal shock-wave lithotripsy (ESWL) was used in the second group (45 patients). The mean operation time in the second group was shorter (43.7 ± 11.0 min) than in the first one (85.3 ± 4.3 min), but fluoroscopy time was shorter in the first group — 126.0 ± 33.1 sec in comparison to the second — 239.0 ± 3.2 sec. Mean hemoglobin drop in the first group was 10.8 ± 3.8 g/l, in the second — 2.9 ±1.3 g/l. Ureteroscopy, ureterolitho-extraction and insertion of double J stent in a retrograde manner were performed in 14 (31 %) patients of the second group due to “Steinstrasse”. Increased frequency of double J stent placement was noted in patients of the second group with stone density greater than 1,000 HU, stone size greater than 1.5 cm (p = 0.01). One month after lithotripsy, stone free rate in the first group was 95 %, in the second one — 75 %. According to the results, we can conclude that ESWL is more preferable to use in patients with stones up to 1.5 cm in diameter and stone density less than 1,000 HU, located in upper and middle renal calyces. Ultra-mini PNL is method of choice in patients with stones < 2.0 cm in diameter, stone density greater than 1,000 HU, located in lower calyces, especially with unfavorable anatomy for stone clearance.
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