Percutaneous Nephrolithotomy in Hypertensive Patients with Different Sizes of Instruments

Abstract

Objectives : The risk of major complications, especially hemorrhage, is significantly elevated during surgery in hypertensive patients. To determine whether percutaneous nephrolithotomy (PCNL) can be safely performed in the hypertensive patients using different sized instruments.

Methods : We reviewed the records of 602 patients undergoing PCNL at our institution and identified 53 who were on antihypertensive therapy at the time of surgery. Patients were categorized into three groups according to size of devices used in surgery: those 24 F percutaneous tract with 22 F nephroscope (Group 1, n = 12 [22.7%]; 26 F percutaneous tract with 24 F nephroscope (Group 2, n = 19 [35.8%]) and 30 F percutaneous tract with 26 F nephroscope (Group 3, n = 22 [41.5%]). We compared the groups with regard to baseline characteristics, intraoperative parameters, stone-free and complication rates, and the length of hospitalization.

Results : There were no differences between the three groups in age, gender, weight and stone laterality. Fluoroscopy time, access to the collecting system and mean operative time for per cm² stone did not differ between the groups. Hemoglobin decrease, postoperative hospital stay and blood transfusion rate was higher in group 3. Stones were completely cleared in 83.3%, 84.2% and 81.3% of patients, which increased to 91.6%, 89.5%, and 90.1% with adjunctive therapy in the group 1, 2 and 3, respectively.

Conclusions : PCNL with smaller devices is a safe and effective method in hypertensive patients. It has significantly a shorter hospital stay and less bleeding rates compared to classical PCNL.

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B. Resorlu

B. Resorlu Kardesler Koop. 182. cad, 175. Sok., No: 14/8 PK: 06010, Etlik, Ankara, Turkey Tel.: [phone] Fax: [phone] E-mail: [email protected] [email protected]