Abstract
Objective:
Percutaneous nephrolithotomy (PCNL) is an established minimally invasive modality for treating large renal stones. Even with newer crushing modalities, difficulties are encountered during intrarenal manipulation of complex pelvicalyceal anatomy. We are presenting a modified technique to overcome this difficulty by using Kuntz laser carrier and Sachse urethrotome sheath.
Materials and Methods:
This study was carried out from January 2000 to December 2005 in 294 renal units in 288 patients (age range, 20–70 years; mean age, 43 years; male:female = 211:77) on whom PCNL was performed with Holmium laser. From January 2000 to December 2002, 96 PCNL (group I) were performed by passing laser fiber through 26F nephroscope. From January 2003 to December 2005, in 197 PCNL (group II) after initial inspection with 26F nephroscope, laser stone fragmentation was performed using Kuntz laser carrier and Hopkins II telescope. This assembly was passed through 21F Sachse urethrotome sheath. In all patients, puncture and dilatation with insertion of 30F Amplatz sheath was carried out under Image Intensifier. LISA SPHINX Holmium laser (80 watts) was used in all cases; energy used was 20 to 40 watts. All stones were radio-opaque and well viewed on X-ray and fluoroscopically.
Results:
Overall stone clearance in group I was 87/96 (90.63%) and in group II was 185/197 (93.91%). Additional punctures were needed: 21/96 (21.88%) in group I and 19/197 (9.64%) in group II. Need for blood transfusion was 5/96 (5.20%) in group I and 2/197 (1.01%) in group II. Mean operating time was almost same for group I and group II. Mean stone size was 2644.70 ± 587.07 mm2 for group I and 2680.56 ± 674.98 mm2 for group II.
Conclusion:
With Kuntz laser carrier passed through Sachse sheath, precise delivery of laser energy is possible. Smaller sheath aids in increased intrarenal maneuverability; precise infundibulotomy helps in better stone clearance. Thus, requirement of additional punctures and blood transfusion rate being less in group II has been proven to be statistically significant.