Abstract：Objective: To explore the feasibility and safety of percutaneous nephrolithotomy (PCNL) for patients with upper urinary tract calculi and spinal deformity. Methods: A total of 15 patients (8 males, 7 females, age range: 41-69 years) with upper urinary tract calculi diagnosed by enhanced CT scanning or CTU were enrolled in the study. The average size of calculi was (35±19) mm. There were 10 cases of scoliosis, 2 cases of thoracic kyphosis and 3 cases of lumbar kyphosis. Operative positions (prone or lateral supine position) were determined based on the different conditions of spinal deformity. Patients underwent ultrasonography-guided PCNL. Two or more percutaneous accesses were established when necessary. Holmium laser lithotripsy or pneumatic lithotripsy was used in the operation. Results: Among the 15 patients, PCNL was performed on 19 sides. Single percutaneous access was established in 15 cases, and 2 accesses in 4 cases. One-stage stone clearance rate was 73.7% (14/19). Among the 5 cases with residual stones, 1 case underwent second-stage PCNL and 2 cases were given PCNL combined with flexible ureteroscopy (RIRS), and KUB showed the complete removal of calculi one month later; two patients were not treated thereafter. The total stone clearance rate was 89.5% (17/19). Two patients developed hemorrhage after the operation and recovered after conservative treatment. Fever occurred in 3 cases. No other complications were found, such as septic shock, injuries of organs and great vessels in the abdominal cavity. Conclusions: Minimal invasive PCNL is effective and safe for the treatment of patients with upper urinary tract calculi and spine deformity. Ultrasonography-guided puncture is found to be effective and safe, and can effectively avoid the injuries of abdominal organs.
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