Marek Urban 1, Beata Chrapko 2, Krzysztof Bar 1, Robert Klijer 1
- 1 Katedra i Klinika Urologii i Onkologii Urologicznej AM w Lublinie
2 Katedra i Zakład Medycyny Nuklearnej AM w Lublinie
- Introduction. Percutaneous nephrolithotripsy (PCNL) beside ESWL is the basic method of treatment of upper urinary tract calculosis. The advantage of the method is possibility of complete removal of stones with low risk of renal parenchyma damage. Although PCNL is commonly thought to be a low-invasive method there is a lack of well documented reliable studies determining its influence on renal function.
- The aim of the study. The aim of the study is to evaluate function of the kidney subjected to PCNL in comparison with preoperative period by means of dynamic renoscintigraphy.
- Material and methods. 19 patients aged on average 56 years old were introduced into the study. They were subjected to percutaneous nephrolithotripsy due to staghorn calculus (4 persons), multiple renal stones (5) and single stones in upper urinary tract (10). In 17 patients PCNL was performed in a single stage, in 2 cases second stage was necessary. The collecting system of the kidney was made accessible by only one nephrostomy. Study was performed before PCNL (initial study) and 2 and 4 weeks after the procedure (I and II control). Renal scintigraphy (30sec/frame for 30 min) was performed after I. V. injecton of 370 MBq Tc99m ethylene-dicysteine (Tc99m EC). Supplementary diuretic test was done in all cases. Quantitative and qualitative evaluation was performed. Parameters defined by renoscintigraphy were: relative perfusion, relative renal function, ERPF, Tmax and Tmax1/2.
- Results. Comparing results of studies carried out before PCNL with the first postoperative check considerable shortening of renal excretory function exponent - Tmax1/2 was revealed (mean: 30.1 (R) 14.12). However the second check did not show successive improvement of this parameter (ean: 16.12). There were no significant differences between parameters determining function of renal parenchyma in all studies: relative renal function (mean: 43.9 (R) 41.4 (R) 42.4), ERPF (mean: 210.8 (R) 203.4 (R) 213.7), Tmax (mean: 7.78 (R)7.46 (R) 8.34). Moreover relative perfusion remained on the same level (mean: 45.9 (R) 43.2 (R) 44.07).
- Conclusions. When performed technically properly, PCNL does not result in deterioration of perfusion and function of renal parenchyma. Significant improvement of excretory function of the kidney takes place within 2 weeks after procedure. Renoscintigraphy is a useful and noninvasive method of monitoring results of treatment of renal calculosis.