Percutaneous Nephrolithotomy, Pneumatic and Holmium Laser Lithotripsy for Urinary Calculi: Adopting the Paradigm Shift in Stone Management in Southern Nigeria

John Edoka Raphael^1, and Chizurum Ezenta¹

¹Urology Division, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Cite this paper:
John Edoka Raphael and Chizurum Ezenta. Percutaneous Nephrolithotomy, Pneumatic and Holmium Laser Lithotripsy for Urinary Calculi: Adopting the Paradigm Shift in Stone Management in Southern Nigeria. American Journal of Clinical Medicine Research. 2022; 10(1):10-16. doi: 10.12691/ajcmr-10-1-3

Abstract

Background: Medical advancement has led to endoscopic treatment becoming the first-line option in stone management. Holmium laser lithotripsy is the gold standard for stone fragmentation during retrograde intrarenal surgery (RIRS), as it can be applied with a flexible ureterorenoscope (fURS) to access the entire collecting system. Percutaneous nephrolithotomy (PCNL) is effective for large and multiple renal stones. Bladder stones can be crushed and evacuated using lithotrite, pneumatic and laser energy. While endourology is well established in the developed western countries, it remained budding in most of sub-Saharan Africa. This study aims to present our experience in percutaneous nephrolithotomy, RIRS and ureteroscopy with lithotripsy using holmium laser and pneumatic lithotripter for urinary calculi. Methods and Methodology: The study was a 4year retrospective study on patients presenting with urinary tract who had endoscopic management; including litholapaxy, pneumatic and holmium laser lithotripsy and PCNL. The case records of the patients were obtained. Their clinical records such as age, sex, CT urography, operative and post-operative notes and complications were extracted. This was coded into Excel format and then analyzed using SPSS Version 20. Results: There were 61 patients with an age range from 29 -80years and a mean age of 51.39± 14.40years with a male: female ratio of 3.5:1. The 40-49year age group had the highest prevalence {17(27.9%)}. Flank pain was the most frequent presenting complaint {49(80.3%)}. The mean size of the calculi was 19.28mm with a range from 3mm to a 120mm bladder stone. Renal stone was the most frequent, {40(65.6%)} followed by ureteric stones 12(19.7%). The mean Hounsfield of the stones was 738.60HU. There was an association between age and stone location, (p=0.039) but none between the sex of the patients, the development of stones, type of symptoms and the location of stones. RIRS with laser lithotripsy was the most frequently performed procedure. {31(50.8%)} followed by ureteroscopy with laser lithotripsy. Stone dusting was the most preferred setting used during RIRS. All but one was calcium oxalate stones. Majority were complication-free {28(70.5%)}, and fever {11(18.0%)} was the commonest. There was no mortality. Conclusion: RIRS and ureteroscopy with laser lithotripsy are the commonest procedures we now perform for upper urinary stones. The capacity to perform RIRS, ureteroscopy and laser lithotripsy and PCNL, and other forms of endoscopic stone management is a welcome development that will mitigate the morbidity associated with stone diseases in Nigeria and sub-Saharan Africa.

Keywords:
Laser lithotripsy RIRS Renal stones Ureteric calculi Ureteroscopy PCNL

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