PERCUTANEOUS NEPHROLITHOTOMY VERSUS OPEN SURGERY FOR RENAL CALCULUS DISEASE- A COMPARATIVE STUDY

Introduction: Renal stone disease is one of the most common disorders affecting mankind. Those who are treated for one stone event have a 50% risk of recurrence in next 5 years. PCNL is one of the more challenging Endo-urologic procedures. Although excellent stone free rates are universally reported in the literature, complication rates vary widely, especially related to the blood transfusion. Aim and objective: To compare the results of PCNL with open surgery for renal calculus disease. Material and methods: - This prospective study was conducted in Govt. Medical College Srinagar, Department of Surgery from June 2010 to July 2013. 120 patients with renal stones were included in the study, 60 patients had PCNL and 60 patients had open surgery. Results: Intra-operative complications occurred in 10 patients (16.67%) during PCNL and 16 patients (26.67%) during open surgery (p=0.347). The common intra-operative complication for both groups was bleeding that required blood transfusion. Postoperative complications occurred in 16 patients (26.66%) following PCNL and 40 patients (66.66) following open surgery (P=0.002).PCNL was associated with lower VAS Score and required less analgesic than open surgery. PCNL was associated with shorter operative time (89.917 ± 30.288 VS 116.833 ± 27.64 minutes (P= 0.001), shorter hospital stay (3.377 ± 1.198 VS 7.850 ± 2.406days (p< 0.001). The stone free rate was 90% after PCNL and 86.66 % after open surgery (P= 0.688). The cosmesis was better in PCNL than open surgery (p<0.0001) Conclusion: PCNL is a safe and effective procedure in the management of renal calculi, with less complications and stone free rates higher than that of open surgery. Moreover, it has lower morbidity, shorter operative time, shorter hospital stay, and better Cosmesis. Therefore, the results of the present study concur with prior literature stating that PCNL should be considered the first stage in the treatment for most patients with renal stones.