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J Urol. 2016 Jul;196(1):131-6. doi: 10.1016/j.juro.2016.01.121. Epub 2016 Feb 27.

Evaluation of Renal Function after Percutaneous Nephrolithotomy-Does the Number of Percutaneous Access Tracts Matter?

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  • 1Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, North Carolina; Department of Urology, University of Alabama (DGA), Birmingham, Alabama.
  • 2Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, North Carolina; Department of Urology, University of Alabama (DGA), Birmingham, Alabama. Electronic address: shemal@wakehealth.edu.

Abstract

PURPOSE:

Renal function following percutaneous nephrolithotomy has long been a concern to urologists, especially in the setting of multi-tract access. We determined whether the risk of renal injury after multi-tract percutaneous nephrolithotomy was greater than after a single access approach.

MATERIALS AND METHODS:

We retrospectively reviewed the records of 307 consecutive patients treated with percutaneous nephrolithotomy from 2011 to 2012 at Wake Forest Health. Perioperative (99m)Tc-mercaptoacetyltriglycine nuclear renogram parameters along with serum creatinine values were assessed within 1 year of the procedure. Patients were stratified by single access vs multi-access (2 or more).

RESULTS:

We identified 110 cases in which renography was done before and after percutaneous nephrolithotomy. A total of 74 patients (67.3%) underwent single access percutaneous nephrolithotomy while 36 (32.7%) underwent multi-access percutaneous nephrolithotomy. Serum creatinine did not significantly differ between the 2 cohorts postoperatively (p = 0.09). There was a significant 2.28% decrease in renal function based on mercaptoacetyltriglycine nuclear renogram results after percutaneous nephrolithotomy of the affected kidney in patients with multiple accesses (p <0.01). This relationship was not observed when patients were stratified by multiple comorbidities associated with nephrolithiasis.

CONCLUSIONS:

Multi-access percutaneous nephrolithotomy is associated with a small reduction in the function of the targeted kidney compared to a single access approach.

KEYWORDS:

kidney; nephrolithiasis; nephrostomy, percutaneous; radioisotope renography; technetium TC 99m mertiatide

PMID:
26925873
DOI:
10.1016/j.juro.2016.01.121
[PubMed - in process]
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