Karthikeyan, K (2013) A Study of Percutaneous Nephrolithotomy (PCNL) and grading of complexity of PCNL procedures using Guy's Stone Score. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION : During the last two decades , the management of kidney stones has vastly changed. Prior to these modifications all the kidney stones were managed by open pyelolithotomy or nephrolithotomy which caused a significant morbidity for the majority of patient. Percutaneous Nephrolithotomy (PCNL) has now largely replaced open surgery as a safe and effective treatment for renal stones. It is now well recognized among surgeons that PCNL procedures have different degrees of complexity which affects stone clearance. The “Guy’s Stone Score” proposed by Thomas K and Smith et al, is a valuable tool to stratify the complexity of PCNL procedures into four groups based on the stone burden and the anatomy of both patient and renal tract. Grade I : Solitary stone in mid / lower pole or solitary stone in pelvis with simple anatomy. Grade II : Solitary stone in upper pole or multiple stones in patient with simple anatomy or solitary stone in patient with abnormal anatomy. Grade III : Multiple stones in a patient with abnormal anatomy or stones in a caliceal diverticulum or partial Staghorn calculus. Grade IV : Staghorn calculus or any stone in a patient with spina bifida/spinal injury. AIMS AND OBJECTIVES : To evaluate patients with renal stones at our institution. To study the indications for PCNL and to assess the outcome of procedure in patients with renal stones. To study the grading and complexity of PCNL procedures using “Guy’s Stone Score”. MATERIAL AND METHODS : 50 patients with symptomatic renal stones presenting to Urology OPD are evaluated and included in the study after informed consent. The indications for surgery are studied and patient is taken up for the same after anaesthetic fitness. PCNL is done using standard techniques. The complexity of procedure is graded using radiological studies and the outcome assessed based on “Guy’s Stone Score” and modified Clavien system. Inclusion Criteria: Patients with renal stone undergoing surgery-Percutaneous Nephrolithotomy. Exclusion Criteria: Patients not fit for surgery – bleeding diathesis, high cardiac risk, infection/ sepsis. CONCLUSION : In this study involving a relatively lesser number of cases from a tertiary care and resident training institute, the complication rates after PCNL was around 50 % mainly because of the learning curve in doing a new procedure. Most of the complications were minor which were treated conservatively. The Guy’s stones score predicted the stone free rates correctly with higher Guy’s stones score needing ancillary procedures mainly in the form of extracorporeal shock wave lithotripsy for stone clearance. Guy’s stones score correlated well with the modified clavien system of grading for perioperative complications. The Guy’s stone score is easy to use and reproducible. It can be used as an objective and reliable method for describing the complexity of PCNL predicting the stone free rate, and stratifying cases between surgeons of different experience and reporting results.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Percutaneous Nephrolithotomy ; grading ; complexity ; PCNL procedures ; Guy's Stone Score. |
| Subjects: | MEDICAL > Urology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 08 Aug 2017 02:33 |
| Last Modified: | 08 Aug 2017 02:41 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2568 |
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