SAFETY AND EFFICACYOF PLANNED MULTIPLE TRACTSPERCUTANEOUS NEPHROLITHOTOMY (PCNL) IN MANAGEMENT OF COMPLEX RENAL STONES

Abstract

T he results of our study have shown that an aggressive approach to complex renal calculi using multiple tracts PCNL is safe and effective in achieving a great stone clearance rate with non significant rate bleeding and blood transfusion. When the tracts punctured right at the outset (planned), and the guidewires secured, the percutaneous needle placement in an intact collecting system will be achieved, this will overcome the problem of extravasation of fluid and contrast that makes confirmation of precise calyceal puncture difficult when a single tract has been dilated before the establishment of other punctures. The rate of post operative pain was significantly increased with increase number of tracts. There was improvement in the level of serum creatinine postoperatively in 100% of patients presented with high serum creatinine level. Without need for second-look PCNL and/or adjunctive ESWL, a clearance rate of 100% was achieved with very acceptable morbidity. The lower calyceal approach can be used more often to gain optimal access to complex calculi without increasing the risk of significant complications. Increase operative time was significantly associated with increase number of percutaneous tracts. Number of percutaneous tracts needed for stone clearance was increasedwith increase stone complexity. When planning to perform multiple tracts, the anatomy of the collecting system, namely the angle, length and width of infundibulum should be considered in addition to stone burden.