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Prognostic factors and percutaneous nephrolithotomy morbidity: a multivariate analysis of a contemporary series using
J J M C H de la Rosette1, J Rioja Zuazu, P Tsakiris
1Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. j.j.delarosette@amc.uva.nl
Insights
Performing percutaneous nephrolithotomy in a dedicated endourological center significantly reduces complication rates and improves patient outcomes. This expert setting leads to shorter procedures and hospital stays for kidney stone treatment.
Area of Science:
- Nephrology
- Urology
- Surgical Outcomes
Background:
- Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone management.
- Assessing factors influencing PCNL morbidity is crucial for optimizing patient care.
- Establishing an expert setting may enhance treatment efficacy and safety.
Purpose of the Study:
- To analyze factors impacting treatment morbidity in PCNL.
- To compare PCNL outcomes before and after establishing a dedicated endourological center.
- To demonstrate the benefits of PCNL within an expert surgical environment.
Main Methods:
- Retrospective analysis of 244 PCNL procedures, divided into pre-2002 (group 1) and post-2002 (group 2) cohorts.
- Utilized the modified Clavien classification to grade procedure-related complications.
- Employed univariate and multivariate logistic regression to identify independent predictors of morbidity.
Main Results:
- The complication rate decreased from 56.8% in group 1 to 37.2% in group 2 (p = 0.007).
- Multivariate analysis identified stone size, lithotripsy device type, and perioperative complications as independent factors for adverse outcomes.
- Dedicated center status correlated with reduced operative time and hospitalization.
Conclusions:
- A specialized endourological center setting for PCNL improves procedural efficiency and patient safety.
- The modified Clavien score is a valuable tool for objective comparison of renal stone treatment outcomes.
- Expertise in PCNL leads to decreased operative time, fewer complications, and shorter hospital stays.
Purpose:
We stratified factors affecting treatment morbidity, compared the outcomes of percutaneous nephrolithotomy procedures from a single department and provided evidence of treatment benefits when percutaneous nephrolithotomy is performed in an expert setting.
Materials And Methods:
Since the department became a dedicated endourological center in 2002 we grouped all percutaneous nephrolithotomy procedures into those performed before 2002 (group 1) and after 2002 (group 2). The modified Clavien classification was used to score morbidity. Independent variables with an influence on complications were studied including stone size, operating time, operative complications, dilation device, urine culture, group allocation and lithotripsy device. Contingency and logistic regression were used for univariate and multivariate analysis.
Results:
Of the 244 percutaneous nephrolithotomy procedures 68 comprised group 1 and 176 formed group 2. Statistical preoperative differences were patient age, the use of anticoagulants and positive urinary cultures. Group 1 had a complication rate of 56.8% and group 2 had a complication rate of 37.2%. There were significant differences between the groups (p = 0.007). Almost all complications were grade 1 to 2. On univariate analysis the influence variables were urine culture (OR 1.69), group allocation (OR 2.20), stone size (OR 2.28), dilation device (OR 4.8), lithotripsy device (OR 1.22), perioperative complications (OR 2.83) and surgical time (OR 1.87). On multivariate analysis the independent factors in the complicated outcome were stone size (OR 1.25), type of lithotripsy device (OR 1.35) and incidence of perioperative complications (OR 3.71).
Conclusions:
The dedicated setting for percutaneous nephrolithotomy at our center resulted in decreased operative time, more uneventful procedures and decreased hospitalization time. The modified Clavien morbidity score is a reliable tool for more objective outcome comparisons after renal stone treatment.
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