Surgical treatment for coral nephrolithiasis

Resumo

262 cases of coral nephrolithiasis (CN) treated for the last 5 years
(mean age 51.6 years) have been analysed. Of them, 46 (17.9%) patients
have undergone 2 to 4 operations, 14 (5.4%) patients had bilateral
nephrolithiasis. Open surgical interventions (section nephrolithotomy,
pyelonephrolithotomy) were performed in 31 and 106 patients,
respectively. All of them had a severe form K-3 or K-4. Extracorporeal
shock-wave lithotropsy (ESWL) was conducted in 72
(27.5%) patients with coral concrements K-l, K-2.'Mean number of
the procedures per a stone was 4.2. Transcutaneous puncture nephrolithotripsy
(TPNT) was made in 53 (20.2%) patients (K-2, K-3).
The results of the treatment were assessed at discharge and 12 months
after it. The efficacy of the treatment was judged by completeness of
the stone elimination, postoperative complications and interventions
to correct these complications. Open operations eliminated the stones
completely in 71.2% patients, in combination with ESWL - in 91.6%,
TPNT - in 78%, in combination with ESWL - in 94.5%. Efficacy of
ESWL as monotherapy + stent reached 68.1%. Open operations entailed
complications in 41.6% (of them 68.5% in section nephrolithotomy),
TPNT - in 18.2%, ESWL - in 16.3%. Coral nephrolithiasis
should be treated by skilled specialists in clinics furnished with modern
facilities, combination of which minimizes traumatic complica-
tions and raises treatment efficacy.