Assessment of the Effects of Access Count in Percutaneous Nephrolithotomy on Renal Functions by Technetium-99M-Dimercaptosuccinic Acid Scintigraphy
Condition: Renal Parenchymal Loss After the Percutaneous Nephrolithotomy
Study type: Interventional

Summary: 
      In this study 37 patients who had undergone percutaneous nephrolithotomy were included.
      Preoperative DMSA scans were performed a day before the surgery, whereas postoperative scans
      were randomized by evaluating them before (n=25) and after (n=12) the 6th postoperative
      month. A DMSA scan was read by using a technique that divides both kidneys into three paired
      poles. In this way functional changes were investigated in the renal units. Twenty six of 37
      cases underwent percutaneous nephrolithotomy with a single access site and 11 with multiple
      access sites. When each of the poles of a kidney was admitted as a surgical unit separately,
      there were 51 units.
    

Detailed description: 
      Total 37 patients who had undergone PCNL were included between June 2007-June 2009. All
      patients were evaluated routinely with physical examination, complete blood count (CBC),
      blood urine nitrogen (BUN), creatinine levels, and urinalysis. None of the patients had
      experienced pyelonephritis, and none had a solitary kidney, renal ectopy or history of any
      other urinary abnormality. At least one of the following techniques; namely computed
      tomography (CT), intravenous urography or ultrasonography, was preferred routinely before
      surgery in order to visualize the urinary system. Unilateral PCNL was performed in all
      patients. Postoperative CBC and BUN creatine levels were repeated.

      Preoperative DMSA scans were performed a day before the surgery, whereas postoperative scans
      were randomized to indicate early and late term. The aim of randomization was to determine an
      optimal time for assessing patients. A DMSA scan was read by using a technique that divides
      both kidneys into three paired poles. In addition the uptake of all opposite poles was
      measured together and calculated as a percentage value separately (Figure-1), e.g., the two
      upper poles' uptake was measured together as if they were renal units and each poles' own
      portion in this total uptake was declared separately as a percentage. How the differential
      functions were changed between the sides undergoing PCNL and the opposite sides, as well the
      changes before and 6 months after surgery are manifested by using these parameters.

      Twenty six of 37 cases underwent PCNL with a single access site (70.3%) and 11 separately
      with multiple accesses (29.7%). When each of the poles of a kidney was considered as a
      surgical unit, there were 51 units. In this manner the functional change of a unit would show
      the surgical trauma inflicted on the poles by PCNL access.
    

Intervention name(s): Percutaneous nephrolithotomy
Intervention type(s): Procedure
Intervention description(s): The procedure is done under general anesthesia in the supine position. A Retrograde pyelogram is done to locate the stone in the kidney. With a small incision in the flank, the percutaneous nephrolithotomy (PCN) needle is passed into the pelvis of the kidney. The position of the needle is confirmed by fluoroscopy. A guide wire is passed through the needle into the pelvis. The needle is then withdrawn with the guide wire still inside the pelvis. Over the guide wire the dilators are passed and a working sheath is introduced. A nephroscope is then passed inside and stones are taken out.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: percutaneous nephrolithotomy; urinary Stones; 99m-Technetium-Dimercaptosuccinic Acid