Evaluation of factors affecting the success of percutaneous nephrolithotomy in kidney stones sized 2 cm and above
Keywords:Percutaneous nephrolithotomy, Kidney stones, Surgical experience
Aim: Although percutaneous nephrolithotomy (PNL) is the preferred minimally invasive treatment method for large and complex kidney stones, complications may develop, and the operation may fail. In this study, we aimed to evaluate the factors affecting the success of PNL as well as the significance of surgical experience.
Methods: In this retrospective cohort study, the reports of 106 patients who underwent PNL between September 2017 and August 2019 were analyzed. The features of the stones and urinary system, operation parameters and postoperative findings of all patients were noted. The surgical experience was divided into two groups as the first 53 and the last 53 cases. The stones were classified as simple stones and complex stones by their location in the kidney. The patients were evaluated with kidney ureter bladder (KUB) x-ray on the first day after the operation and by non-contrasted computed tomography (CT) in the 3rd postoperative month.
Results: Among 106 patients who underwent PNL, 64 (60.3%) were male, 42 were female (39.7%), and the mean age was 52.65 (9.36) years. The mean size of the stones in the patients was 4.25 (1.37) cm, and 48 of them had simple stones and 58 had complex stones. The mean operation time was 58.70 (9.41) minutes, and the mean duration of hospitalization was 52.11 (8.62) hours. KUB was successful in 90 (84.9%) of 106 kidney stone cases in the first postoperative day. Following additional treatment administration in 8 cases, this rate increased to 92.4% in the 3rd postoperative month, in which the rate of stone-free cases was 91.7% in simple kidney stones, and 79.3% in complex kidney stones. Assessment of surgical experience revealed that failure rate was 22.7% in the first 53 cases and 7.6% in the last 53 cases (P=0.016).
Conclusion: PNL is a minimally invasive treatment method that may be preferred in simple and complex kidney stones of 2 cm and above. The size of the stone, the localization of the stone, the number of percutaneous interventions and surgical experience are crucial factors affecting success rates.
Fernstrom I, Johannson B. Percutaneous pyelithotomy: A new extraction technique. Scand J Urol Nephrol. 1976;10:257-9.
Kısa E, Uçar M, Yüce1 Cem, Süelözgen Tufan, İlbey YÖ. Effects of the stone density on the outcome of percutaneous nephrolithotomy in pediatric population. J Surg Med. 2019;3(7):498-502.
Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016;69(3):475-82.
de la Rosette J, Assimos D, Desai M, Gutierrez J, Lingeman J, Scarpa R, et al. CROES PCNL Study Group. The Clinical Research Ofﬁce of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients. J Endourol. 2011;25:11–7.
Ramakumar S, Segura JW. Renal calculi. Percutaneous management. Urol Clin North Am. 2000;27:617-22.
Smith A, Averch TD, Shahrour K, Opondo D, Daels FP, Labate G, et al. CROES PCNL Study Group. A Nephrolithometric Nomogram For Predicting Treatment Success In Percutaneous Nephrolithotomy. J Urol. 2013;190(1):149-56.
Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, et al. Nephrolithiasis clinical guidelines panel summary report on the managenment of ureteral calculi. J Urol. 1994;151:1648-51.
Hasun R, Ryan PC, Marberger M. Percutaneous coagulum nephrolithotripsy: a new approach. Br J Urol. 1985;57:605-9.
Goldwasser B, John L, Carson C, Dunnick NR. Factors effecting the success rate of percutaneous nephrolithotripsy and the incidence of retained fragments. J Urol. 1986;136:358-60.
Segura JW. The role of Percutaneus surgery in renal and ureteral stone removal J Urol. 1989;141:780-1.
Muslumanoğlu AY, Tefekli AH, Taş A, Cakır T, Sarılar O. Oğrenme eğrisinde ilk 100 perkutan nefrolitotomi olgusunun analizi. Turk Uroloji Dergisi. 2004;30:339-47.
Unsal A, Cimentepe E, Sağlam R. İlk 50 perkutan nefrolitotomi deneyimimiz. Turk Uroloji Dergisi. 2002;28:422-7.
Lingeman JE, Coury TA, Newman DM, Kahnoski RJ, Mertz JH, Mosbaugh PG, et al. Comparison of results and morbidity of percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy. J Urol. 1987;138(3):485-90.
Lee WJ, Snyder JA, Smith AD. Staghorn calculi: endourologic management in 120 patients. Radiology. 1987;165:85-8.
Merhej S, Jabbour M, Samaha E, Chalouhi E, Moukarzel M, Khour R, et al. Treatment of staghorn calculi by percutaneous nephrolithotomy and SWL: the Hotel Dieu de France experience. J Endourol. 1998;12:5-8.
Soucy F, Ko R, Duvdevani M, Nott L, Denstedt JD, Razvi H. Percutaneous nephrolithotomy for staghorn calculi: a single center’s experience over 15 years. J Endourol. 2009;23(10):1669–73.
El-Nahas AR, Eraky I, Shokeir AA, Shoma AM, El-Assmy AM, El-Tabey NA, et al. Percutaneous nephrolithotomy for treating staghorn stones: 10 years of experience of a tertiary-care centre. Arab J Urol. 2012;10(3):324–9.
Desai M, Lisa AD, Turna B, Rioja J, Walfridsson H, D'Addessi A, et al. The clinical research office of the endourological society percutaneous nephrolithotomy global study: staghorn versus nonstaghorn stones. J Endourol. 2011;25(8):1263–8.
Kurtulus FO, Fazlioglu A, Tandogdu Z, Aydin M, Karaca S, Cek M. Percutaneous nephrolithotomy: primary patients versus patients with history of open renal surgery. J Endourol. 2008;22(12):2671–5.
Jones DJ, Russell GL, Kellett MJ, Wickham JE. The changing practice of percutaneous stone surgery. Review of 1000 cases 1981-1988. Br J Urol. 1990;66(1):1–5.
Sofikerim M, Şahin A, Akdogan B, Ekici S, Atsü N, Özgen S, et al. Percutaneus nephrolitotomy: our outcomes in 500 cases. Üroloji Bülteni. 2004;13(1);25-9.
Tanriverdi O Boylu U, Kendirci M, Kadihasanoglu M, Horasanli K, Miroglu C: The learning curve in the training of percutaneous nephrolithotomy. Eur Urol. 2007;52:206-211.
Segura JW, Patterson DE, LeRoy AJ: Percutaneous removal of kidney stones. Review of 1000 cases. J Urol. 1985;134:1077-81.
Lee WJ, Smith AD, Cubelli V, Badlani GH, Lewin B, Vernace F, et al. Complications of percutaneous nephrolithotomy. AJR Am J Roentgenol. 1987;148:177.
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