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Inicio Actas Urológicas Españolas (English Edition) Simultaneous bilateral percutaneous nephrolithotomy: Effectiveness and safety
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Vol. 42. Issue 5.
Pages 316-322 (June 2018)
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Vol. 42. Issue 5.
Pages 316-322 (June 2018)
Original article
Simultaneous bilateral percutaneous nephrolithotomy: Effectiveness and safety
Nefrolitotomía percutánea bilateral simultánea: Eficacia y seguridad”
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8
A. Narváez
Corresponding author
alonsonarvaezbarros@gmail.com

Corresponding author.
, C. Torrecilla, S. Colom, J.M. Cuadrado, J. Fernández-Concha, L. Riera, F. Vigués
Servicio de Urología, Hospital Universitario de Bellvitge, IDIBELLl, Barcelona, Spain
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Table 1. Demographic characteristics of the study group and details of the surgical procedure.
Table 2. Complications.
Table 3. Major studies reporting simultaneous bilateral percutaneous nephrolithotomy.
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Abstract
Objectives

To evaluate the effectiveness and safety of simultaneous bilateral percutaneous nephrolithotomy performed in patients affected with bilateral renal calculi.

Materials and methods

This is a prospective study from September 2012 to November 2016. Patients diagnosed of bilateral kidney stones with abdominal CT scan were included. Surgical technique prone position, renal puncture guided by fluoroscopy and tract dilation up to 24Ch. We reviewed demographic and stone characteristics, stone free rate, clinical success, complications and follow-up.

Results

During the study period, 732 percutaneous nephrolithotomies were performed. Eighteen patients were included (36 renal units, 2.5%), 13 men and 5 women, with a median age of 58 years and an interquartile range (IQR) of 40–66. Median stone burden was 228mm2 (IQR 134–389); median operative time, 150min (IQR 97–180); and median hospital stay, 5 days (IQR 5–15). Stone free rate was 80%. Residual calculi were encountered in 8 renal units (22.2%) and required other complementary techniques for their complete resolution 4 external shockwave lithotripsies, one open ureterolithotomy, 2 ureteroscopies and one second look. Major complications included 4 cases of severe hemorrhage managed with angiographic embolization. The median follow-up was 36 months (range 26–46).

Conclusions

Simultaneous bilateral percutaneous nephrolithotomy is an effective and safe procedure in patients affected with bilateral renal calculi. It is a surgical challenge that should be performed in selected patients and in centers with experience.

Keywords:
Nephrolithiasis
Simultaneous bilateral percutaneous nephrolithotomy
Resumen
Objetivos

Evaluar la efectividad y seguridad de la nefrolitotomía percutánea bilateral simultánea realizada en pacientes afectados de litiasis renales bilaterales.

Material y métodos

Estudio prospectivo, período de septiembre de 2012 a noviembre de 2016. Se incluyeron pacientes diagnosticados de litiasis renales bilaterales por TC abdominal. Técnica quirúrgica posición en prono, punción renal guiada por fluoroscopia y dilatación del tracto hasta 24Ch. Se revisaron las características demográficas y de las litiasis, la tasa libre de litiasis, el éxito clínico, las complicaciones y el seguimiento.

Resultados

Durante el período de estudio, se realizaron 732 nefrolitotomías percutáneas. Dieciocho pacientes (36 unidades renales; 2,5%), 13 hombres y 5 mujeres con una mediana de edad de 58 años y un rango intercuartílico (RIC) de 40-66. Tamaño de la litiasis mediana de 228mm2 (RIC 134-389), tiempo operativo mediana de 150min (RIC 97-180) y una estancia hospitalaria mediana de 5 días (RIC 5-15). La tasa libre de litiasis fue del 80%. Se reportaron litiasis residuales en 8 unidades renales (22,2%) que requirieron técnicas complementarias para su completa resolución, 4 litotricias extracorpóreas por ondas de choque, una ureterolitotomía por laparotomía, 2 ureteroscopias y un segundo procedimiento. Complicaciones mayores incluyeron 4 hemorragias manejadas mediante embolización por angiografía. Mediana de seguimiento 36 meses (rango 26-46).

Conclusiones

La nefrolitotomía percutánea bilateral simultánea es un procedimiento eficaz y seguro en pacientes afectados con cálculos renales bilaterales. Es un desafío quirúrgico que debe realizarse en pacientes seleccionados y en centros con experiencia.

Palabras clave:
Litiasis renal
Nefrolitotomía percutánea bilateral simultánea

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