Minimally Invasive Treatment of Urinary Stones

Treatment of Large Kidney Stones by Percutaneous Nephrolithotomy: Outcomes and Data
Douglas Modling, Jr., M.D.
Board Certified-Board of Urology
Endourological Society
Urology Centers of Alabama, P.C.

Many patients with stones too large to be fragmented into smaller pieces and passed require percutaneous nephrolithotomy. This procedure uses a needle to gain access into the kidney at a specific location. A wire is placed and a tract dilated to allow passage of a nephroscope to fragment and remove large stones without having to pass them.

I perform these procedures for 15 urologists at Urology Centers of Alabama, Birmingham, Alabama, and other regional urologists who refer patients for treatment. My technique is done with the patient under anesthesia for the entire procedure, and I obtain the access into the area of the kidney that allows the best chance of stone removal. Some urologists will send their patients to Radiology for a local access procedure and then to surgery for stone removal.

If the stone is not too large (<2.5 cm), it can often be removed at one procedure. If it is too large (>2.5 cm) or involves the entire collecting system (staghorn calculus), multiple procedures such as percutaneous nephrolithotomy, lithotripsy, or ureteroscopy may be needed to remove the stone.

In the community setting, a urologist will perform approximately five per year. We feel having one surgeon performing these procedures allows for better patient care resulting in less OR time and increased chance of retrieving the stones.

We have accumulated data for 1993 through 2007 as follows:

Additional procedures needed: Second PCNL, lithotripsy (stone fragmentation externally), ureteroscopy, hospital stay an average of 2.8 days

Complication rate: 6.9% overall (most minor such as UTI, pain, nausea, fluid in pleural area)

Bleeding was evaluated with arteriogram in 2/232, the vessel was embolized resolving the bleeding, and no abnormality was seen. In all others persistent bleeding resolved and was thought to be from a UTI.

In summary, large renal stones greater than 2.5 cm often require PCNL, a minimally invasive procedure, to be removed. Overall, success rates are 95%. Some patients require multiple procedures to safely remove all stone. We always attempt to remove all stone at one setting if we are able to do so. Our technique of obtaining the access allows the entire procedure to be done under anesthesia.