Lessons learned from the CROES percutaneous nephrolithotomy global study

Area of Science:

• Urology
• Nephrology
• Surgical Outcomes

Background:

• Percutaneous Nephrolithotomy (PCNL) is a key procedure for kidney stone removal.
• Existing literature on PCNL outcomes is extensive but often lacks real-world, large-scale data.
• The CROES PCNL Global Study aimed to consolidate and analyze data from a diverse patient population.

Purpose of the Study:

• To provide a comprehensive overview of outcomes from the CROES PCNL Global Study.
• To compare findings with existing literature and clinical guidelines.
• To identify factors influencing PCNL success and complications.

Main Methods:

• Analysis of a large dataset from the CROES PCNL Global Study.
• Comparison of outcomes between prone and supine PCNL positions.
• Evaluation of factors such as surgeon experience, patient characteristics, and technique variations.
• Development of a predictive nomogram.

Main Results:

• Prone PCNL showed a longer operation time and lower stone-free rate (SFR) compared to supine, potentially due to definition discrepancies.
• Ultrasound-guided access reduced puncture time and radiation exposure.
• Complications included fever (10.5%) and bleeding (7.8%), with antibiotic prophylaxis significantly lowering fever rates.
• Bleeding risk increased with larger dilatation size; optimal center volume is ~120 PCNLs/year.
• Elderly, solitary kidney, and severe CKD patients faced higher risks; super-obese patients had more severe complications.

Conclusions:

• The CROES PCNL Global Study provides unprecedented real-world insights into PCNL outcomes across various conditions.
• Analysis of rare conditions and patient characteristics (severe CKD, solitary kidney, super obesity) was enabled by the large sample size.
• A novel nomogram was developed for enhanced patient counseling and decision-making.
• The study established the significant impact of caseload volume on PCNL results and complications.