Kidney Stone Removal: Percutaneous Versus Surgical Lithotomy

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Abstract
Percutaneous removal of most urinary tract calculi may be performed as a 1-stage effort with techniques and skills developed recently in the specialities of urology and radiology. Ultrasonic fragmentation of most calculi was done to permit their extraction. Percutaneous ultrasonic lithotripsy was performed on 250 consecutive (a single exception) patients bearing stones that required removal. Targeted calculi were removed successfully from 97% of these patients. One patient required surgical lithotomy. The previous 100 patients with stones underwent surgical lithotomy with 96% success. Complications of percutaneous ultrasonic lithotripsy appeared equitable with those of surgical lithotomy. Of the patients who underwent percutaneous ultrasonic lithotripsy 6 (6%) required extended hospital days or additional procedures for management of complications. None of these patients required a surgical incision. Anesthesia times were similar for both groups (average 159 .+-. 4 (SE) min for percutaneous ultrasonic lithotripsy and 193 .+-. 8 min for surgical lithotomy). Hospital recovery days averaged 5.5 .+-. 0.3 for percutaneous ultrasonic lithotripsy and 8.4 .+-. 0.5 for surgical lithotomy (P < 0.01). Associated costs averaged $7203 .+-. 55 for lithotripsy and $8849 .+-. 660 for lithotomy (P < 0.01). The number of narcotic administrations per patient (days 1-5, postoperatively) averaged 9.88 .+-. 0.70 for lithotripsy and 16.82 .+-. 0.78 for lithotomy (P < 0.01). The average patient who underwent percutaneous ultrasonic lithotripsy felt capable of full activity 2.0 .+-. 0.2 wk following stone removal, whereas no patient who underwent previous surgical lithotomy recalls a recovery period of < 3 wk (P < 0.01). Most upper urinary tract calculi may be removed cost-effectively with a percutaneous approach. Compared to surgical lithotomy, percutaneous ultrasonic lithotripsy may result in rapid convalescence with diminished pain.