Uvod: Perkutana nefrolitolapaksija (PCNL) predstavlja metodu izbora u lečenju kamena
(kalkulusa) u bubregu većeg od 2 cm. Metoda pripada grupi endoskopskih minimalno
invazivnih procedura. Uprkos manjoj invazivnosti u odnosu na otvorene hirurške tehnike,
metoda ima i svoje specifičnosti, na polju bezbednosti i potencijalnih komplikacija.
Pristup kamenu se obavlja širenjem kanala kroz parenhim bubrega, nakon ulaska iglom
do željenog dela sabirnog sistema bubrega i kamena. Kao i ostale tehnike fragmentisanja
kamena u bubregu i PCNL može da ima uticaj na bubrežnu funkciju.
Cilj: Analiza (1) uspešnosti PCNL u lečenju kamena u bubregu u odnosu na veličinu,
anatomske odnose i lokalizaciju, (2) učestalosti komplikacija kod bolesnika lečenih ovom
metodom, u odnosu na veličinu, anatomske odnose i lokalizaciju, (3) uticaja metode na
bubrežnu funkciju i eventualnog stepena oštećenja bubrega i (4) učestalosti recidiva.
Materijal i metode: Kohortnom studijom su obuhvaćeni pacijenati Klinike za urologiju
KCS koji su u periodu od 2010. do 2014. godine operisani PCNL metodom, od strane
jednog hirurga. Selekcija pacijenata obavljena je prema preporukama za tretman
kalkuloze bubrega Evropske asocijacije urologa i svi su imali kamen veći od 2 cm.
Nakon sprovedenih radiografskih procedura karakteristike kalkulusa, veličina, broj i
položaj, kao i anatomska građa sabirnog sistema bubrega i samog bubrega sagledavani su
korišćenjem „Guy’s Stone Score“ klasifikacije (GSS) i bolesnici su svrstavani u jednu od
četiri ponuđene kategorije. Klasifikacija komplikacija izvršena je prema modifikovanom
Clavien-Dindo sistemu. Uspeh procedure je definisan kao izostanak rezidualnih
fragmenata > 3 mm. Bubrežna funkcija je praćena određivanjem β2-mikroglobulina i
mikroalbuminurije. Tri meseca nakon operacije vršena je procena učestalosti recidiva.
Rezultati: Ispitivanu populaciju činilo je 111 bolesnika. Medijana starosti bolesnika je
iznosila 48 godina. Medijana veličine kamena iznosila je 51 mm. Najmanji kamen bio
promera 21 mm, a najveći 91 mm. Klasifikovani prema GSS klasifikaciji, 16,2%
bolesnika je pripadalo grupi GSS 1, 18,9% GSS 2, 26,2% GSS 3 i 38,7% grupi GSS 4...INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is considered today as a
treatment of choice for kidney stones bigger than 2 cm. PCNL is endoscopic, minimally
invasive procedure. Beside its low aggressiveness it is accompanied with few specific,
critical steps and possible complications. The crucial step to perform successful and safe
procedure is renal access. Precise access to the planed and desired part of the kidney
collecting system is followed with careful dilatation of the working tract. As all other
techniques of kidney stones disintegration, PCNL can possibly impact renal function.
OBJECTIVE: The aim of the present study was to investigate 1) PCNL efficacy and 2)
PCNL safety, overall and dependent on stone complexity, respectively, 3) possible
mechanism of impact on renal function and 4) the frequency of stone recurrence.
MATERIAL AND METHODS: The study cohort evaluated all patients of Clinic of
urology in Belgrade who underwent PCNL by a single surgeon, between August 2010
and December 2014. The patients were selected according to the Guideline of the
European Association of Urology and all stones were bigger than 2 cm. After the
appropriate radiological and laboratory investigation the complexity of the stones, but
also of kidney anatomy was determined by Guy’s Stone Score classification. Stones were
classified to one of the four offered groups. Complications were evaluated using modified
Clavien-Dindo classification. For detection of possible impact of PCNL on renal function
the micro albumin and β2-microglobulin levels in urine were evaluated. Three months
following PCNL the frequency of recurrence was determined.
RESULTS: Study cohort gained 111 patients. The median age of the patients was 48
years, while the median stone diameter was 51 mm. The smallest stone was 21 mm and
the biggest 91 mm. According to Guy’s Stone Score (GSS) 16,2% of the patients were
classified in GSS 1 group, 18,9% in GSS 2, 26,2% in GSS 3 and 38,7% in GSS 4 groups,
respectively. The overall efficacy of the study was 75%, as 83 out of 111 patients were
stone free after the procedure..
