Investigating the therapeutic effect of percutaneous surgery in the treatment of kidney stones compared to open surgery in Kamkar Hospital from 2008 to 2010

Abstract

Introduction: It is estimated that about 2 to 3 percent of people in the society suffer from urinary tract stones. Basic work cannot be done for the prevention and medical treatment of these patients, but simple and convenient surgical methods have been devised to remove stones. In this study, we decided to compare the new PCNL method with open stone surgery.

Materials and methods: Patients with stones larger than 2 cm were selected and divided into 2 groups, PCNL and open surgery, according to the surgeon's opinion. In the hospital, the length of time to return to work, the number of narcotic doses received, the duration of surgery, the complications of surgery, the percentage of complete stone free rate and the number of pack cell units received were compared.

Results: 15 PCNL patients and 20 surgery patients were opened. Significantly, the length of stay in the hospital, the time of return to work, the amount of narcotic dose and the duration The operation in PCNL was less than open surgery. On the other hand, the number of pack cell units received was significantly less in open surgery than in PCNL. There was no significant difference between the other variables in the 2 groups.

Conclusion: With the advancement of technology, the era of open surgery is coming to an end. The surgical incision is small and suitable in terms of aesthetics, the duration of hospitalization and return to work is less in the PCNL method. will expand the use of this method day by day.

Key words: urinary stones, percutaneous surgery, open surgery

Introduction

Considering the many problems of urinary system stones, including pain and discomfort for the person, ureter dilation , pelvis, and even kidney failure (1), the correct treatment of these patients will improve their quality of life.

Most urinary stones pass by themselves, but most of the larger stones require surgery and stone removal (2). Due to these side effects, OSS (open surgery for urinary stones) has slowly been withdrawn and a less invasive method called PCNL (percutaneous nephrolithotripsy) has been introduced, so we decided to investigate the therapeutic value of this method in the treatment of kidney stones. We pass the guidewire and dilate this tract, we insert a 3 French cylinder into the surgical tract and from there we insert the nephroscope, see the stone and break it.

PCNL has a small surgical incision, the length of stay in the hospital is shorter, the use of analgesics is much less, and it is also a less invasive method. Urinary system stones include large stones, including They are very common in Iran, if a patient undergoes OSS once, because these stones often recur, it is much more difficult to perform the second operation, so it is easier to perform PCNL first or in someone who needs repeated surgery due to stone recurrence.

Available services: Currently, the OSS method is used in Iran in non-provincial centers, and we intend to investigate the PCNL method that has just been launched in Qom province.

In this research, we want to investigate the therapeutic value of PCNL in a prospective and case-control manner.

A - The main goal of the project:

To investigate the therapeutic value of PCNL and compare it with open surgery. stone (OSS) in patients with urinary tract stones in Kamkar Hospital from 1388 to 1390.

B- Sub-objectives of the project:

1. Comparison of the length of stay of patients treated with PCNL with OSS in patients with urinary stones in Kamkar Hospital from 1388 to 1390.

2. Comparison of the amount of narcotic drug needed in both methods.

3. Determination of the time to return to work in both methods.

4. Determination of the duration of the operation in both methods.

5. Determination of the amount of bleeding in both methods.

6. Comparison of complications in both methods.

C- Assumptions - questions:

1. Therapeutic value of PCNL from OSS in the treatment of patients with urinary tract stones in Kamkar Hospital from 1388 to 1390 more

2. The length of hospitalization in PCNL treatment with OSS in patients with urinary tract stones in Kamkar Hospital from 1388 to 1390 varies. is.

4. The duration of operation in PCNL method is shorter than OSS in patients with urinary tract stones in Kamkar Hospital from 1388 to 1390.

5. The amount of bleeding in PCNL method is different from OSS in patients with urinary tract stones in Kamkar Hospital from 1388 to 1390.

6. The rate of complications in PCNL from OSS in patients with urinary tract stones in Kamkar Hospital from 1388 to 1390 is less.

7. The amount of narcotic drug required for PCNL from OSS in patients with urinary tract stones in Kamkar Hospital from 1388 to 1390 is less.

Research limitations:

Defects in patient records and limited performance of PCNL

Words and terms:

Urinary stones

PCNL: (percutaneous nephrolithotripsy)

OSS: (open stone surgery)

Chapter Two

Knowledge available in the research

Part I: Conceptual framework

Urinary stones are the third most common disease of the urinary tract and the only urinary infections and pathological conditions. Prostate is more common than that. These stones are common in both humans and animals. Words and terms related to urinary stone diseases have been adopted from various sources. For example, struvite stones, which are composed of magnesium ammonium phosphate hexahydrate, are named after H.C.G. von Struve (1772-1851), a Russian naturalist. Before the time of this scientist, the mentioned stones were called ragwanite, because magnesium ammonium phosphate is clearly present in the batdropping. Calcium oxalate dihydrate rock is often called wadlite, because this rock is found abundantly in the bed of the Weddell Sea in Antarctica. The history of terms related to urolithiasis is complex, as is the evolution of interventional techniques for their treatment. Urinary stones have been bothering humans since the beginning of the first civilizations. There are still many points to ponder about the etiology of stones. If the urine content of both kidneys is similar and there is no evidence of obstruction, why do most stones appear unilaterally? Why are small stones not expelled through the ureter without causing any problems in the initial solution of their formation? Why do some people have one big stone and others have many small stones? Many events have been raised about these and other questions.

?The advancement of surgical methods for the treatment of urinary stones has increased our understanding of their etiology. Our minds, like internal specialists, are aware of finding correct diagnoses and effective treatments.