Percutaneous Nephrolithotomy in the Management of Renal Stone: An Audit of Outcomes and Complications.

Abstract

Background: Percutaneous nephrolithotomy (PCNL) is considered one of the most significant advances in minimally invasive urologic surgery. It offers a better stone-free rate compared to other available treatment modalities of renal stones at a lower complication rate compared to open surgery. Despite the availability of extracorporeal shock wave lithotripsy and flexible ureteroscopy, PCNL remains the gold standard modality for large and complex renal stones. Here, we review our initial experience with standard PCNL in the prone position for renal stones >1.5 cm with respect to stone clearance rate and complications as seen in our patients.

Patients and methods: Records of 24 patients who had standard PCNL and pneumatic lithotripsy between September 2020 and September 2023 were reviewed retrospectively. All the patients who had the standard PCNL for renal stones >1.5 cm were the subjects of this study. Data on patients' demographics, indication for the surgery, location of stone, size of stone, postoperative nephrostomy placement, nephrostomy tract size, complications, duration of surgery, duration of hospital stay, and status of stone clearance were obtained, and the data were subjected to statistical analysis.

Results: A total of 24 patients underwent the standard PCNL. The mean age of the patients was 47.0 ± 10.28 years (16 males and 8 females; range: 17-68 years). Flank pain was the main indication for the surgery. The mean stone size was 2.5 cm (range: 1.6-3.3 cm). The mean Hounsfield unit was 1248.2 HU (range: 927-1502HU). At a single session, we achieved 100% stone clearance in 20 (83.3%) patients. Two (8.3%) of our patients required a second session of PCNL due to intraoperative bleeding and perforation of the pelvicalyceal system necessitating termination of the procedure and insertion of nephrostomy tube. In another 2 (8.3%) patients, the stones migrated and became inaccessible. One (4.2%) patient stayed for 10 days due to persistent urine leak, which eventually stopped after the insertion of a double-J stent and administration of antibiotics. The Clavien-Dindo grading system was used to classify postoperative complications. A total of 14 (58.3%) patients had Grade I complications, while 3 (12.5%) patients had Grade II and 1 (4.2%) had Grade IIIa complications.

Conclusion: PCNL is an effective minimally invasive technique for the treatment of large renal stones. Our initial experience suggests that the complication rate in PCNL is well within the acceptable limit.