Ming Lei1, Wei Zhu, Shaw P Wan, Yongda Liu, Guohua Zeng, Jian Yuan. 1. Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University , Guangzhou, Guangdong, China .
Abstract
PURPOSE: To review our experience of using minimally invasive percutaneous nephrolithotomy (MPCNL) in patients with autosomal dominant polycystic kidney disease (ADPKD). PATIENTS AND METHODS: We retrospectively reviewed 23 renal units in 23 patients with ADPKD who underwent MPCNL in our center between January 2007 and December 2012. The data on the stone burden, stone locations, patient characteristics, complications according to the modified Clavien system, and stone-free rates (SFR) were analyzed. RESULTS: The mean stone area (±standard deviation) was 1382.87±1080.17 mm2. There were 10 (43.5%) staghorn stones. Flank pain was noted in 87% of the cases. SFR after initial MPCNL was 69.6% (16/23 renal units). Of the remaining seven renal units, six underwent second-look MPCNL and were rendered stone free, a 95.7% final SFR. Clavien grade I or II complications occurred in nine patients and were managed conservatively. One case needed selective arterial embolization for severe bleeding. There was no deterioration of renal function noted. The mean preoperative creatinine (Cr) and postoperative Cr concentrations were 148.17 μmol/L and 149.24 μmol/L (P=0.48). CONCLUSION: The MPCNL was a safe and effective treatment for upper urinary tract stones in patients with ADPKD, even in patients with staghorn stone. It provided excellent SFR without compromising renal function. This procedure could be considered as a first-line treatment option for patients with ADPKD who have a large stone burden.
PURPOSE: To review our experience of using minimally invasive percutaneous nephrolithotomy (MPCNL) in patients with autosomal dominant polycystic kidney disease (ADPKD). PATIENTS AND METHODS: We retrospectively reviewed 23 renal units in 23 patients with ADPKD who underwent MPCNL in our center between January 2007 and December 2012. The data on the stone burden, stone locations, patient characteristics, complications according to the modified Clavien system, and stone-free rates (SFR) were analyzed. RESULTS: The mean stone area (±standard deviation) was 1382.87±1080.17 mm2. There were 10 (43.5%) staghorn stones. Flank pain was noted in 87% of the cases. SFR after initial MPCNL was 69.6% (16/23 renal units). Of the remaining seven renal units, six underwent second-look MPCNL and were rendered stone free, a 95.7% final SFR. Clavien grade I or II complications occurred in nine patients and were managed conservatively. One case needed selective arterial embolization for severe bleeding. There was no deterioration of renal function noted. The mean preoperative creatinine (Cr) and postoperative Cr concentrations were 148.17 μmol/L and 149.24 μmol/L (P=0.48). CONCLUSION: The MPCNL was a safe and effective treatment for upper urinary tract stones in patients with ADPKD, even in patients with staghorn stone. It provided excellent SFR without compromising renal function. This procedure could be considered as a first-line treatment option for patients with ADPKD who have a large stone burden.
Authors: Vinusha Kalatharan; Racquel Jandoc; Gary Grewal; Danielle M Nash; Blayne Welk; Sisira Sarma; York Pei; Amit X Garg Journal: Can J Kidney Health Dis Date: 2020-07-22