Abstract:
To determine the validity of some criteria that could guide in the decision to cancel or proceed
with the second side of planned bilateral simultaneous percutaneous nephrolithotomy
(bsPCNL).
METHODS Patients with an indication for bilateral PCNL were enrolled in this study. The operation was
stopped at the end of the initial side if operative time was 180 min, the hemoglobin level was
11 g/dL, the hemoglobin decrease was 3 g/dL, the systolic arterial pressure was 100 mm Hg,
the arterial oxygen saturation was 95%, the arterial blood pH was 7.35, or the blood sodium
was 128 mg/mL. The success and complication rates were compared in patients who underwent
second side PCNL (group 1) and those for whom the procedure was stopped after the initial side
(group 2).
RESULTS Of 42 planned bsPCNLs, 12 were stopped after the initial side, with the cause being prolonged
operative time in 7, hemoglobin decrease in 6, systolic arterial pressure decrease in 2, arterial
oxygen saturation decrease in 2, pH decrease in 1, and sodium decrease in 1. Differences in
patient characteristics, stone burdens, and overall success and complication rates were insignificant.
Transfusion, postoperative urinary infection, and prolonged urine drainage rates were
similar, but the total hospitalization time was significantly longer in group 2. One hydrothorax
and one renal pelvic perforation occurred in group 2. The need for transfusion correlated
positively with the number of nephrostomy tracts in group 2 (r 0.895, P .001). No such
correlation was found in group 1.
CONCLUSIONS Despite the best of intentions, about 30% of anticipated bsPCNL cases might be limited to
single-sided PCNL, depending on the intraoperative events. Our criteria seem reasonable,
because similar success and complication rates were obtained with bilateral, separate-session
PCNL and bsPCNL. These criteria can be considered in the decision making to omit the
advantages of a single session for safety.
