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Stepwise case selection using Guy's stone score reduces complications during percutaneous nephrolithotomy training.

Jiten Jaipuria1, Manav Suryavanshi2, Amitsinh P Desai1

  • 1Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Prasanthigram, Andhra Pradesh, India.

Indian Journal of Urology : IJU : Journal of the Urological Society of India
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Summary

Stepwise training for percutaneous nephrolithotomy (PCNL) significantly reduces operative time and complications compared to traditional methods. This structured approach improves outcomes by addressing the learning curve for different kidney stone complexities.

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Area of Science:

  • Urology
  • Surgical Education
  • Nephrolithiasis Management

Background:

  • Traditional percutaneous nephrolithotomy (PCNL) training relied on subjective case allocation.
  • A new training protocol was implemented, structuring PCNL case progression based on the Guy's stone score (GSS).

Purpose of the Study:

  • To compare the efficacy and safety of traditional PCNL training with a novel stepwise GSS-based approach.
  • To evaluate the impact of training methodology on patient outcomes and procedural efficiency.

Main Methods:

  • A comparative study of 400 consecutive PCNL cases, equally divided between traditional and stepwise training groups.
  • Outcomes assessed included complications (Clavien-Dindo), stone-free rate (SFR), operative time, and fluoroscopy time.
  • Multivariable regression analysis adjusted for patient comorbidities and procedural variables.

Main Results:

  • Stepwise training demonstrated significantly shorter operative time (100 vs. 120 min) and reduced overall (29.5% vs. 43.5%) and major complications (3% vs. 8.5%).
  • Multivariable analysis confirmed stepwise training as an independent predictor of lower complications.
  • Stepwise training outcomes were comparable to those of an expert surgeon regarding fluoroscopy time and final stone clearance.

Conclusions:

  • Percutaneous nephrolithotomy (PCNL) exhibits a complexity-specific learning curve.
  • A structured, stepwise training protocol based on stone complexity demonstrably enhances patient safety and procedural efficiency in PCNL.