Outcome of Percutaneous Nephrolithotomy by Using Pneumatic Lithotripsy Alone and In Combination with Ultrasonic Lithotripsy.

Abstract

Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for large kidney stones. Recent advancements in endoscopic technology and operative techniques have significantly increased the success rate of PCNL while reducing associated complications and morbidity. A key development contributing to this progress is the introduction of various new lithotripter techniques, which facilitate rapid stone fragmentation and clearance. The objective of the study was to compare the outcome of PCNL using pneumatic lithotripsy alone and combined lithotripsy (pneumatic and ultrasonic). This quasi-experimental study was conducted in the Urology Department of the National Institute of Kidney Diseases and Urology (NIKDU) in Dhaka, Bangladesh from April 2019 to March 2020. Thirty patients in Group A underwent PCNL using pneumatic lithotripsy, while another thirty patients in Group B underwent PCNL using combined lithotripsy. The two groups were compared in terms of stone size, operative time, hospital stay, hemoglobin loss, ancillary procedures, and initial and overall stone clearance rates. The mean age was 34.33±9.72 years (range 22-65 years) in Group A and 36.83±12.61 years (range 19-62 years) in Group B, with homogeneous distribution. There are 45 males and 15 females in two groups, resulting in a male-to-female ratio of 3:1. The mean stone size was 3.36±1.07 cm (range 2-6 cm) in Group A and 3.67±0.88 cm (range 2.4-6.0 cm) in Group B, with no significant differences between the groups. The mean operation time was significantly different: 67.50±13.2 minutes (range 40-86 minutes) for PCNL with pneumatic lithotripsy compared to 57.30±10.9 minutes (range 45-95 minutes) for combined lithotripsy (p<0.05). The mean postoperative hemoglobin drop was 1.37±0.50 g/dL in the pneumatic lithotripsy group, significantly higher than the 1.12±0.46 g/dL drop in the combined lithotripsy group (p<0.05). Other variables, including stone-free rate, postoperative hospital stay, and postoperative complications, showed no significant differences between the groups. The combined lithotriptripsy (pneumatic and ultrasonic) signify superior efficacy in PCNL compared to the pneumatic lithotriptripsy alone, as it remarkably reduces both the total operative time and blood loss.