EVOLVING TECHNIQUE OF PERCUTANEOUS NEPHROLITHOTOMY IN A DEVELOPING-COUNTRY - SINGAPORE GENERAL-HOSPITAL EXPERIENCE

At our institution, percutaneous nephrolithotomy (PCNL) is the preferr ed treatment modality for renal calculi with a large stone burden (exa mple, staghorn calculi) and renal calculi which have failed extracorpo real shockwave lithotripsy (SWL), The aim of this paper is to present the technical refinements in PCNL and the results obtained by a single surgeon. From June 1995 to July 1997, 135 PCNL procedures were perfor med on 114 renal units, The mean age of the patients in the series was 51 years, The PCNL was performed on 28 complete staghorn calculi (25 %), 24 partial staghorn calculi (21%), 25 large renal calculi (22%), 2 6 impacted ureteropelvic junction calculi (22%), 5 impacted ureteral s tones (4%), and 6 symptomatic lower-pole calculi (5%), Most patients ( 97%) had a successful outcome (82% stone-free and 15% only insignifica nt residual fragments), Of the four failures, three had previous open renal split operations. The average postoperative stay was 5.2 days. O nly one patient (0.7%) had urosepsis, and another had an arteriovenous fistula and was the only patient to require blood transfusion in our series, Only 21% (n = 24) required SWL after PCNL, and one patient req uired ureteroscopy, Technical refinements in PCNL include: (1) single- stage PCNL with percutaneous access obtained by the urologist in the o perating room; (2) flexible endoscopy to inspect the whole pelvicalice al system systematically; (3) liberal use of secondary PCNL to ensure stone-free status; and decreased reliance on SWL after PCNL, The trend is to rely on PCNL monotherapy to manage staghorn calculi rather than PCNL and SWL combination therapy.