Introduction: Over time, the incidence of nephrolithiasis has risen significantly, and patient populations have become increasingly complex. Our study aimed to determine the impact of changes in patient demographics on percutaneous nephrolithotomy (PCNL) outcomes.
Methods: A retrospective analysis of a prospectively collected database was carried out from 1990-2015. Patient demographics, comorbidities, stone and procedure characteristics were analyzed. Multivariate logistic regression was used to evaluate differences in operative duration, complications, stone-free rate, and length of stay.
Results: A total of 2486 patients with a mean age of 54±15 years, body mass index (BMI) of 31±8, and stone surface area of 895±602 mm2 were analyzed; 47% of patients had comorbidities, including hypertension (22%), diabetes mellitus (14%), and cardiac disease (13%). Complication rate was 19%, including a 2% rate of major complications (Clavien grade III-V). There was a statistically significant increase in patient age, BMI, and comorbidities over time, which was correlated with an increased complication rate (odds ratio [OR] 1.15; p=0.010). The overall transfusion rate was 1.0% and remained stable (p=0.131). With time, both OR duration (mean Δ 16 minutes; p<0.001) and hospital length of stay (mean Δ 2.4 days; p<0.001) decreased significantly. Stone-free rate of 1873 patients with available three-month followup was 87% and decreased significantly over time (OR 1.09; p<0.001), but was correlated with an increased use of computed tomography (CT) scans for followup imaging.
Conclusions: Despite an increasingly complex patient population, PCNL remains a safe and effective procedure with a high stone-free rate and low risk of complications.
Conflict of interest statement
A Comparison of Outcomes After Percutaneous Nephrolithotomy in Children and Adults: A Matched Cohort StudyLC Lee et al. J Pediatr Urol 11 (5), 250.e1-6. PMID 26001769.Although principles of PCNL were developed in adults, this study affirms the safety and efficacy of PCNL in both pediatric and adult patients.
Outcomes Following 'Mini' Percutaneous Nephrolithotomy for Renal Calculi in Children. A Single-Centre StudyKE Brodie et al. J Pediatr Urol 11 (3), 120.e1-5. PMID 26048706.Mini PCNL is an effective and safe procedure for the treatment of paediatric renal stones. In the present series, all children achieved greater than 80% stone clearance, …
A Critical Appraisal of Complications of Percutaneous Nephrolithotomy in Paediatric Patients Using Adult InstrumentsNK Goyal et al. BJU Int 113 (5), 801-10. PMID 24127943.Percutaneous nephrolithotomy in children using adult instruments is an effective and safe procedure for managing simple as well as complex renal calculi. Assignment of sp …
Safety, Feasibility, and Efficacy of Bilateral Synchronous Percutaneous Nephrolithotomy for Bilateral Stone Disease: Evidence From a Systematic ReviewP Jones et al. J Endourol 31 (4), 334-340. PMID 28326800. - ReviewBS-PCNL seems to be a good endourologic approach for patients with bilateral stone disease, which can render high SFRs and maintain a noninferior safety profile compared …
Effect of Obesity on Outcomes of Percutaneous Nephrolithotomy in Renal Stone Management: A Systematic Review and Meta-AnalysisX Zhou et al. Urol Int 98 (4), 382-390. PMID 28152527. - ReviewThe PCNL performed in normal-weight, obese, and super-obese individuals for kidney stone treatment showed similar outcomes, except that operation time was longer among su …