Percutaneous Nephrolithotomy: Primary Patients versus Patients with History of Open Renal Surgery

Background and Purpose: Percutaneous nephrolithotomy (PCNL) is the management choice for stones larger than 2 cm or for staghorn calculi. PCNL in secondary or tertiary patients poses some difficulties. In this study, we compared these patients with patients who were operated on for the first time. Patients and Methods: A total of 328 PCNLs were performed between January 2003 and June 2007. One hundred and forty-two patients who had undergone open renal surgery in the past (126 secondary and 16 tertiary) were compared with patients who had no previous history of open renal stone surgery. The tract was formed by balloon dilators, and in situations where it was necessary, fascial dilators were used. The operation was concluded by inserting a 14Ch Malecot nephrostomy tube in all cases. The number of tracts, operative time, transfusion rate, hospitalization time, and residual stones were recorded. Results: Significant differences are not observed when the results are compared with the primary cases in terms of tract numbers (multiple tracts: 8.5% v 10.2%), operative time (2.3 v 2.2 hours) (P > 0.05), transfusion rate (540 v 495 mL) (P = 0.21), hospitalization time (4.4 v 4.2 days) (P = 0.94), complication rate (1.4% v 3%) (P > 0.05), and residual stones (5% v 3%) (P > 0.05). Conclusions: Although the anatomic positional differences of the kidney and fibrosis makes access and the procedure technically difficult in secondary or tertiary cases, PCNL can be performed with low complication and high success rates if safety rules are followed strictly. Difficult access can be overcome either by newly developed high-pressure balloons, assistance of fascial dilators, or by mechanical dilators.