ESTABLISHMENT OF PERCUTANEOUS NEPHROURETEROLITHOTOMY AND ITS CLINICAL EXPERIENCES

Abstract

After numerous investigations since our first experience of percutaneous nephroureterolithotomy (PNL) in 1981, which was the first successful case treated by single stage PNL in the literature, we have established an appropriate original technique for PNL.
Percutaneous nephrostomy (PNS) has been performed under the guidance of realtime ultrasound and has been dilated by a set of telescopic metal dilators. Small stones could be removed using a flexible fiberscope and a grasping forceps. Large stones were finely fragmented by an electric drill system which was newly developed in our clinic. Large and hard stones were crushed by confined blasting which was also developed in our clinic.
From July, 1981, to February, 1987, we experienced 268 cases of PNL. Complete stone removal was achieved in 228 cases (85.1%). In 36 cases (13.4%), small stone fragments not requiring surgery were retained. In 4 cases (1.5%), the treatment was unsuccessful. In 135 cases, stone was removed by stone forcepses. 68 cases were treated by the electric drill, 46 cases by ultrasonic lithotriptor and 15 cases by confined blasting.
Several complications were encountered, such as fever over 38.5°C (54 cases, 20.1%), gross renal bleeding-(3 cases, 1.1%), pulmonary edema (2 cases, 0.7%) or intestinal fistula (1 cases, 0.4%). These could be cured by conservative therapy. Ureteral stenosis occurred in one case, which was treated by open surgery.