Efficacy And Tolerability Of Percutaneous Nephrolithotomy In Patients With Renal Insufficiency

ObjectiveThrough comparing the renal insufficiency patients before and after operation in different periods in serum creatinine, hemoglobin and blood biochemical changes and recording stone clearance and complication rates, to evaluate the efficacy and tolerability of percutaneous nephrolithotomy (PCNL) in patients with renal insufficiency, further investigating PCNL in the clinical application.MethodsForty-six patients with renal insufficiency were treated with percutaneous nephrolithotomy. Record the patient's preoperative preparation, stone clearance rate and the incidence of complications. Serum creatinine were measured on admission, one week, one month and six month after PCNL to assess the impact of PCNL on the renal function. Serum potassium, creatinine and albumin were recorded before and one day after the procedure, to compare preoperative and postoperative hemoglobin and blood biochemical changes in availability of statistical significance. The results were analyzed using the software of SPSS 12.0 by means of Single factor analysis of variance and paired-damples t test.Results(1)Renal failure patients need hemodialysis, to improve the general condition of patients before PCNL. Thirteen patients received hemodialysis and 3 patients received blood transfusion before operation. Forty-six patients were performed PCNL treatment but 2 patients were suspended because bleeding or transient hypotension. Simultaneous bilateral percutaneous nephrolithotomy were performed in 19 patients, and synchronous percutaneous nephrostolithoto my and contralateral ureterorenoscopy in 16 patients, and 9 patients were performed PCNL and contralateral nephrostomy or untreated. One patient had residual stone fall into the ureter and was successfully cured by ESWL. The rest patients had no residual stones and the overall stone free rate was 93.5%. There were intraoperative or postoperative bleeding in 5 cases, high fever in 6, no pneumothorax, colon damage and other serious complications. (2) Over a follow- up of one week, one moth and six month, the mean serum creatinine decreased respectively to 254.0±139.2μmol/L, 236.6±143.9μmol/L and 209.46±144.4μmol/L, and there was a significant change (P <0.05) compared with the serum creatinine on admission which is 591±567.7μmol/L. Most patients showed improvement in their renal function, but some patients with chronic renal insufficiency required dialysis permanently. (3) No statistically significant differences occurred in mean hemoglobin (from 114.9±20.8 g/L to 105.3±12.6g/L), potas sium(from 4.2±0.6 mmol/L to 4.0±0.4 mmol/L), serum creatinine (from320.3±118.7μmol/L to 312.1±130.5μmol/L ) and albumin (from 32.2±4.4g/ L to 31.6±2.6 g/L) during perioperative period.ConclusionsPCNL is a safe and effective procedure with less complication and high stone free rate for the treatment of patients with renal insufficiency. The procedure can improve renal function and have no significant changes in electrolytes and metabolic status.