Category: Clinical Stones: PCNL
Introduction & Objective :
Objective: 1. To evaluate the impact of percutaneous nephrolithotomy(PCNL) on renal function for patients with staghorn renal stones and renal insufficiency. 2. to determine risk factors for renal function deterioration.
Methods : Materials and
Methods: A total of forty-seven patients with staghorn renal stones and Treated side GFR(TGFR)≤30ml/min were included, and the renal function of these patients were evaluated by 99mTc-mercaptoacetyltriglycine(99mTc-MAG3) nuclear renography Pre/Post PCNL. Patients demographic data, number of percutaneous access, complications, Pre/Post renal function, and other risk factors that may affect renal function were recorded. Univariate and multivariate analyses were performed to determine risk factors for renal function deterioration.
Results: Forty-seven patients were followed up for an average of 9.76±11.42 months. Thirty-one(65.96%) patients had stone free with complication rate of 21.28%. Fourteen patients(29.79%) achieved improved TGFR. Seventeen patients (37.17%) showed stationary TGFR and sixteen patients(34.04%) had decreased renal function. Twenty-one patients had severe renal insufficiency(TGFR≤15ml/min). The post-PCNL TGFR improved significantly than pre-PCNL renal function, 16.13±10.13 VS 11.33±3.11ml/min, P=0.037. Of the 21 patients, fifteen patients(71.43%) showed improved or stationary TGFR. On univariate analysis, pyonephrosis and residual stones were significant risk factors for deterioration of the kidney function after percutaneous nephrolithotomy. Pyonephrosis was an independent risk factor on multivariate analysis.
Conclusions : Conclution: Our results indicated that most patients presenting with staghorn renal stones and renal insufficiency experience improvement or stabilization of renal function after PCNL. Patients with TGFR≤15ml/min also can achieve good results. Pyonephrosis and residual stones are important risk factors of renal function impairment.
The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
Guangzhou, Guangdong, China (People's Republic)
Professor Zeng is currently the Vice- President of The First Affiliated Hospital of Guangzhou Medical University, Chief of Guangdong key lab of Urology and Chief of Guangzhou Urology Research Institute. Director of certified fellowship program by Endourology Society. President of Guangdong provincial urological association, Associate member of EULIS.
He completed his Master of Urology training in 1992, and his PhD in Urology in 2000. Clinical endourology fellowship at UT Southwestern Medical Center at Dallas in 2007. As an experienced endourologist, he has finished more than 12000 endourological procedures including all kinds of PCNLs, rigid URS and RIRS procedures and Uro-laparoscopic procedures. Leading the development of RIRS in China, he and his group perform more than 1000 RIRS per year. Prof. Zeng and his colleagues also created a unique mini-PCNL technique, namely Chinese Mini-PCNL, in which more than 30000 Chinese Mini-PCNLs surgeries has been performed by Prof. Zeng and his team with good clinical outcome. He also invented a new minimally invasive technique in treatment of middle size renal stones, called “Super-Mini-PCNL (SMP)”.Main innovation in SMP technique is irrigation and suction in the same sheath, it totally solve all problems in Mini-perc technique including low irrigation flow, difficulty in removal stone fragements, high intrarenal pressure and so on, SMP technique has the advantages of a good irrigation, fast stone fragements evacuation and lower intrarenal pressure, So SMP technique is a conception revolution for mini-perc technique.
Prof. Zeng has gained 5 research projects for stone disease from National Natural Science Foundation. More than 100 academic papers have been published in national and international journals, 10 books about stone disease have been published.