Efficacy and morbidity following PCNL in patients with renal anomalies: the outcome from a randomized study comparing different imaging modalities for assessment.

AIM: The aim of this paper was to assess outcome of totally tubeless percutaneous nephrolithotomy (TPCNL) performing with and without preoperative computed tomography (CT) scan, in anomalous kidneys.

METHODS

A total of 50 patients with renal anomaly were randomly divided into two groups. Exclusion criteria was stone size >3.5 cm. Twenty six had malrotation, 21 had horseshoe kidney and 3 had ectopic pelvic kidneys. For 25 patients, TPCNL was performed with preoperative CT scan and in the remnant only intravenous urography and renal ultrasonography were done, preoperatively. The incidence of complications and outcomes were compared between two groups in a 1 month period.

RESULTS

In the group with preoperative CT scan, the mean (SD) stone size was 2.9 (0.75) vs. 2.7 (0.95) cm2. Between the two groups, there were not statistical differences in the mean (SD) analgesic requirement, hemoglobin drop, operation time, hospital stay, and return to normal activity. They were 7.5 (1.7) vs. 6.1 (1.9) mg of morphine, 1.20 (0.36) vs. 1.52 (0.27) mg/dl, 64 (13.2) vs. 59 (13.3) minutes, 1.9 (0.4) vs. 1.7 (0.45) and 12.4(2.9) vs. 10 (3.5) days, respectively. Only 2 patients required blood transfusion and one patient had postoperative pneumothorax in the group with CT while in the other group, three patients required postoperative transfusion and one showed postoperative fever. A successful outcome at the first attempt was 88% in group with CT vs. 80% in the other group.

CONCLUSION

It seems that TPCNL could be done with safety in renal anomalies by omitting preoperative CT scan.