Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 2010 , Vol 1, Issue 1
Percutaneous Nephrolithotomy In Kyphoscoliotic Patients With Renal Stones
Murat Tuğrul Eren1, Ahmet Şahin1, Kubilay İnci2, Cenk Yücel Bilen2, Haluk Özen2
1Acıbadem Üniversitesi, Tıp Fakültesi, Üroloji Anabilim Dalı, İstanbul, Türkiye
2Hacettepe Üniversitesi, Tıp Fakültesi, Üroloji Anabilim Dalı, Ankara, Türkiye
Purpose: When kyphoscoliotic patients have indication of endourological interventions like percutaneous nephrotithotomy, (PCNL) the operational process may be challenging because of their disrupted and unpredictable anatomy, as much as aenesthesiological process due to impairment of chest wall. Here we present PCNL data of kyphoscoliotic patients operated for renal stones.

Patients and Methods: Data of 5 kyphoscoliotic patients planned to be treated by PCNL was reviewed. Eight PCNL operations performed for 7 renal unites of 3 adults and one pediatric patient. PCNL could not be performed to one kyphoscoliotic patient due to unsuccesful access to the kidney and treatment was managed by retrograde intrarenal surgery. All patients were evaluated radiographically to determine stone size and anatomy of the kidney. Available operational position and access site had been checked by fluoroscopy preoperatively. All patients were followed-up at the postoperative care unit of aenesthesiology for 24 hours due to possibility of mechanical ventilation requirement.

Results: Mean stone burden was calculated as 434. 2 mm.2. Four stones were located at lower poles whereas one at pelvis and the other at ureteropevic junction. Two renal units had multiple stones. One patient had concominant ureteral calculi. Mean hospitalization time was 7.6 day. All patients were stone-free except the patient with unsuccessful PCNL. Aenesthesiology department followed patients at postoperative care unit in which no patients were subject to fluctuations of vital signs and/or prolonged mechanical ventilation.

Conclusion: Although PCNL treatment of kyphpscoliotic patients with renal stones can be challenging, it is a safe and successful treatment modality. When a successful access is achieved and flexible nephroscopy is used, the other operational parameters of PCNL did not significantly diff er from the other patients operated by PCNL. Keywords : nephrostomy, percutaneous + lithotripsy, kyphosis, scoliosis