الفهرس 
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Abstract
This study was done in Minoufyia Urology Department including 85 patients with renal stones planned for PCNL in the period from Feb 2010 to May 2012. -Patients with stones less than 2 cm to whom ESWL was offered as a primary management, uncontrollable bleeding disorders or medically unfit for surgery are excluded from this study. All patients were subjected to the following: detailed medical history, physical examination, laboratory evaluation (complete blood picture serum creatinine liver function --liver enzymes, prothrmbine time and conc., complete urine analysis, radiological evaluation (K.U.B. and U.S.) and imaging study as IVU or spiral CT for planning for puncture & technique . Operative evaluation as operation time, intraoperative complications was done. Postoperative evaluation in the form of stone free rate, hospital stay, postoperative complications if present transfusion rate if indicated is recorded. Results of this study is as follow: • We divided the cases in our study into 4 groups according to degree of hydronephrosis . • The mean stone burden for the 4 groups was ranging from 4.18 cm for Group A (no hydronephrosis) , 4.52 cm for Group C (moderate hydronephrosis), 5.22 cm for Group B (mild hydronephrosis) to 5.64 cm for Group D (marked hydronephrosis) with mean stone buden for all cases 4.99 cm & SD 1.92 . • Loin pain was the commonest main complain in our study in (87%) , while (91.8%) patients has pain in their symptoms . • Most of stones in our study were complex occupying more than one calyx & radioopaque . • 34.1% of cases were having recurrent stones after open surgery. • Recurrent stones after open surgery couldn’t affect operative time with insignificant differences in morbidity outcomes. • Traditional IVU was used as a main maging modality in most of cases. • The mean operative time & puncture time showed near figures for planning with IVU versus Spiral CT. • Planning with spiral CT showed superiority in no. of trials before getting successful puncture to kidney & stone free rate in relation to IVU planning . • All of cases were done in prone position except four cases in supine position . The mean operative time & puncture time were longer in supine patients . • PCNL punctures of (91.8%) of patients were done fluoroscopy guided while 4 cases were done ultrasound guided & 3 cases were done with combined ultrasound & fluoroscopy guided puncture . • We used Alken dilators In most of our cases (71.8 %) . • Pneumatic Egyptian Lithotripter was used for stone fragmentation in 81.2% of our patients. • Exposure time to radiation is markedly shorter in Group D (marked hydronephrosis) , mean fluroscoy time : 8.19 min. • Our distribution of morbidity scores in modified Clavien grades was: No complication (56.5%), I (20%), II (4.7%), IIIa (5.9%), IIIb (7.1%), IVa (1.2%), IVb (3.5%), and V in one case (1.2%). • The mean postoperative hospital stay for the cases with Nelaton nephrostomy tube was ( 4.63 days) which is near to the group with Foley’s ballon nephrostomy tubes (4.23 days). • The mean operative time for all cases 111.27 min with SD 50.04 with mean stone burden 4.99 cm. Group D ( marked hydronephrosis ) showed shorter mean operative time 97 min. Group A (No BP) show short mean operative time 95.22 min. with less mean stone burden 4.18 cm. while Group B ( mild hydronephrosis ) & Group C (moderate hydronephrosis) mean operative time were 127.20 min for the former & 110.54 min for the later.