Percutaneous Nephrolithotomy Combined with Minimally Invasive Percutaneous Nephrolithotomy for Large and Complex Renal Calculi

Objectives To summarize the surgical management of large and complex renal calculi by percutancous nephrolithotomy(PCNL) combined with minimally invasive percutaneous nephrolithotomy(MPCNL).Methods The clinical data of 441 patients(461 renal units) with large and complex renal calculi who underwent PCNL combined with MPCNL were retrospectively reviewed.Results The average operation time was 70 minutes.The average hospital stay was 11 days(range from 8 to 28 days).The number of tracts required per procedure was 3 in 2 cases,2 in 20 cases,and 1 in 419 cases.The average preoperative hemoglobin level was(115±26)g·L-1,and the level was(96±21) g·L-1 1~3 days after first look procedure.Complications were peritoneal injury in 3 cases,duodenal injury in 1,high fever in 8,septic shock in 3,and acute renal failure in 5.In addition,extracorporeal shock wave lithotripsy was used to treat residual stones in 35 patients.The overall stone-free rate was 92%.Conclusion PCNL combined with MPCNL for treating large and complex renal calculi has advantages of less trauma,rapid recovery and fewer complications.However,attention should be paid during and after surgery to prevent complications.