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Percutaneous Nephrolithotomy with and without Retrograde Pyelography: Preliminary Results of a Randomized Controlled Trial

Ali Tabibi, Hamed Akhavizadegan, Kia Noori Mahdavi, Mohammad Najafi Semnani, Mojgan Karbakhsh Davari, Ali Reza Niroomand




Introduction: Since the introduction of percutaneous nephrolithotomy (PNL), many modifications to entering the pyelocalyceal system have been made. One alternative is to insert a needle pointed to an opaque stone as a landmark. The aim of this study was to compare the outcomes of managing kidney calculi by PNL with and without retrograde pyelography.

Materials and Methods: In this randomized controlled trial, 55 candidates for PNL with a single opaque kidney calculus in the calyx alone, the pelvis alone, or both the calyx and the pelvis were assigned into 2 groups. Twenty-seven patients underwent PNL with a ureteral catheter, and 28 patients underwent PNL without a ureteral catheter. Clinical outcomes were compared between the 2 groups using plain radiographs taken on the first day after the procedure.

Results: Patients had similar distributions regarding sex, age, operative time, hospital stay, past surgical history on the kidneys, and stone size. There was a significantly greater decrease in postoperative hemoglobin level in patients having PNL with a ureteral catheter (P < .001) than in those having the procedure without a ureteral catheter. No differences were seen among patients in the 2 groups in terms of stone-free rate, and number of patients with insignificant residue, and those needing extracorporeal shock wave lithotripsy, a second PNL procedure, or transurethral lithotripsy.

Conclusions: Percutaneous nephrolithotomy without ureteral catheterization has specific benefits: urine leakage is lower and there is no need to perform cystoscopy. Patients with a single kidney calculus are good candidates for PNL without previous ureteral catheter insertion.

DOI: http://dx.doi.org/10.22037/uj.v2i3.235


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