Comparative Study Of Staged Vs Simultaneous Bilateral Percutaneous Nephrolithotomy

ObjectiveTo investigate the safety and efficacy of simultaneous bilateral percutaneous nephrolithotomy (SBPCNL) compared with staged percutaneous nephrolithotomy (PCNL) in cases of bilateral complex upper urinary tract stones, and assess the characters of the twoapproaches of SBPCNL and staged PCNL.MethodsA total of 132 cases of bilateral complex upper urinary tract stones, in which 59 patients undergoing SBPCNL (Group 1) comparing with a similar group of 73 patients undergoing a staged PCNL (Group 2), were selected into the study prospectively. The relative indexes of the two groups were detected and recorded to compare with each other. Preoperative indexes included gender, age, course and average stone size. Intraoperative indexes, such as operative time, blood loss, were recorded too. Postoperative indexes involved success rate, incidence of blood transfusion, stone-free rate, hospital stays, etc, were also presented. And serum creatinine (SCr), glomerular filtration rate (GFR) of the patients about renal failure were detected regularly to assess the renal function. The two-group t-test or x2-test were performed for statistical analysis.Results53 SBPCNLs were performed in group 1, 69 staged PCNLs were accomplished in group 2, with the success rate of 88.1% and 94.5% respectively. Both of the two groups were comparable in gender, age and course preoperatively, in mean total operative time and mean blood loss intraoperatively, in stone-free rate and success rate postoperatively. The comparison of average stone size (25.6±0.6) mm and (29.9±0.7) mm, preoperatively showed statistically significant (P=0.000), and postoperatively indicated significant statistical difference in SCr and GFR of the patients about renal failure between the two groups at week 1 and month 1 after the first side of PCNL (P=0.0056 and P=0.0094, P=0.0004 and P=0.0044). Detailed analysis has revealed a significant cost advantage and short length of hospital stay for SBPCNL versus staged bilateral PCNL.ConclusionsBilateral PCNL is the gold standard for the surgical management of bilateral complex upper urinary tract stones, and it includes two approaches of SBPCNL and staged PCNL. In properly selected patients, SBPCNL is safe and effective and has the advantage of improving bilateral renal function for SBPCNL versus staged PCNL. Despite the best of intentions, there are a number of anticipated SBPCNL cases might be limited to single-sided PCNL. Thus, it is indispensable for staged PCNL to be carried out at clinic.