تفتيت الحصيات الكلوية عبر الجلد

ackground & Objective: Extra-corporeal shock wave lithotripsy (ESWL) has failed to manage renal stones > 2cm in diameter. Percutaneous nephrolothotomy lithotripsy (PCNL) has proved to be a very effective alternative. This study is the first study in Syria about PCNL, reflecting our own experience. To review and to evaluate the results of percutaneous lithotripsy (PCNL) for kidney stones, especially in regard of indications, steps of the procedures and possible complications. Materials and Methods: Between 2002 and 2009, 105 patients underwent PCNL. Mean age 37 years (20-68 yr.). 72 patients were males and 33 were females. Mean stone volume was 3,2cm (2-4.5cm). In 87 patients (82.8%), stones were located in the lower calyx and pelvis, the rest in the middle and upper calyx and in one case only in the uretero-pelvic junction. In 60 cases (57.1%) the stones were in the right kidney and in 45 (42.8%) in the left kidney. The ultrasonic lithotripter was used to disintegrate the stones in 95 cases (90.4%) and laser was used for the rest (9.5%). Results: Failure of extracorporeal lithotripsy (ESWL) represented the indication for PCNL in 84 patients (80%), stone volume and location represented the indication in the rest of cases. Puncturing of the kidney was performed in 96 cases (91.4%) under fluoroscopy control in the operating room. In the rest of cases this puncturing was done in the outpatient office under ultrasonic control. The lower calyx was the site of puncture in 99 patients (94.2%), the middle calyx in and the upper calyx in only one case. The disintegration was complete in 77cases (73.3%), while the rest of stones needed further treatment with ESWL. We faced only 2 major complications that treated successfully. Conclusions: It is to consider that PCNL is a very effective method to treat high volume stones and stones located in the lower calyx, with acceptable rate of complications. Experience in proper puncturing of calyx under fluoroscopy and ultrasound control is crucial. In addition, equipments and experience to manage any complication that may happen, should be available