RE: Percutaneous nephrolithotomy for isolated calyceal stones: How important is the stone location?
I read with great interest the article “Percutaneous nephrolithotomy for isolated calyceal stones: How important is the stone location?” by Ozgor et al.[1] This article highlights an interesting outcome of isolated calyceal stones which were managed by percutaneous nephrolithotomy (PCNL). The...
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| Format: | Article |
| Language: | English |
| Published: |
Turkish Association of Urology
2016
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| Online Access: | http://irep.iium.edu.my/50704/ http://irep.iium.edu.my/50704/ http://irep.iium.edu.my/50704/ http://irep.iium.edu.my/50704/1/115-116.pdf |
| Summary: | I read with great interest the article
“Percutaneous nephrolithotomy for isolated
calyceal stones: How important is the stone
location?” by Ozgor et al.[1] This article highlights
an interesting outcome of isolated calyceal
stones which were managed by percutaneous
nephrolithotomy (PCNL). The isolated
upper pole calyceal stone has been shown
to have statistically significant difference in
term of thoracic complications, longer nephrostomy
duration, and hospital stay in comparison
to middle calyceal stone. Besides
that, post-operative bleeding also appeared
to be higher and stone clearance rate was
lower in upper pole puncture but there was
no statistically significant difference between
the groups. All those parameters suggest that
the direct puncture for treating isolated upper
pole calyceal stone has higher risks with
lower effectiveness. In my opinion a definite
conclusion cannot be drawn from this study as
it was a retrospective review which had some
limitations. In this study various modifications
of conventional PCNL as a special measure
was not clearly elaborated. The use of balloon
dilatation and single stage dilatation
with Amplatz dilator was found to have less
bleeding in comparison to serial Amplatz dilatation.[2]
Whereas properly selected site and
timing of the puncture was found to reduce
the thoracic complications. Ko et al.[3] found
that careful placing the puncture site at lateral
half of the ribs will avoid pleural and supracostal
puncture. Whereas, puncturing kidney
during fully expiration will push the lung base
two interspaces higher. Both tricks will avoid
from puncturing pleura, thus reduce thoracic
complications. |
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