Objective: To evaluate the efficacy and morbidity of 24F-tract percutaneous nephrolithotomy (PNL) accessed by two-step dilation.
Methods: A total of 3052 patients with 3 366 kidneys or upper ureter calculi underwent 24F-tract PNL accessed by two-step dilation between Aug., 2003 and Jan., 2008, including 108 patients with solitary kidney, 68 with kidney cysts, 44 with horseshoe kidney, 26 with vertebral column deformity, 24 with medullary sponge kidney and 1 transplanted kidney. Stone burdens were (47.2+/-35.6) mm in length.
Results: 99.4% of 3740 operations were successful in one-session access,in which 3348 PNLs were accessed by single tract (89.5%), 366 by double tracts (9.7%) and 26 by triple tracts (0.7%). The mean operating time was (68.4+/-30.9) min, the mean first accessing time were (17.6+/-11.1) min. and the mean calculi-dealing time were (35.0+/-55.3) min. The stone-free rate after one session operation was 100% for single calculus and 72.3% for multiple or staghorn calculi. of all the kidneys, 374 (11.1%) accepted another PNL to remove the residual calculi, and the last stone-free rate of PNL was 88.6%. During and after operation, 52 cases (1.4%) needed transfusion, 12 (0.3%) underwent selective embolization of renal artery and 1 (0.03%) accepted nephrectomy for bleeding control. No injury of organs occurred except for 3 cases with pneumatothorax and 19 (0.5%) with urinary extravazation. No septic shock occurred.
Conclusion: 24F-tract PNL accessed by two-step dilation wtih ultrasound-guided puncture is effective and safe.