Revisiting Standard Percutaneous Nephrolithotomy in the Mini-Percutaneous Nephrolithotomy/Retrograde Intrarenal...

Area of Science:

• Urology
• Nephrology
• Surgical Complications

Background:

• Percutaneous nephrolithotomy (PCNL) is a standard procedure for kidney stones.
• Emergence of mini-PCNL and retrograde intrarenal surgery (RIRS) necessitates re-evaluation of standard PCNL risk factors.

Purpose of the Study:

• To identify risk factors for postoperative complications in standard PCNL.
• To optimize outcomes in the era of minimally invasive stone treatments.

Main Methods:

• Retrospective study of patients undergoing standard PCNL (January 2018 - December 2023).
• Data collected included demographics, clinical presentation, stone characteristics, operative details, and complications (modified Clavien-Dindo).
• Logistic regression analysis used to identify significant predictors of complications.

Main Results:

• Age >55 years, urinary tract infection (UTI), diabetes, chronic kidney disease (CKD), stone burden, >1 percutaneous access tract, and Amplatz sheath size >30Fr are significant predictors (p<0.05).
• Increased number of calyces involved (OR 2.307, p=0.045) and longer operative time (OR 0.129, p=0.021) significantly increase complication odds.
• Standard PCNL demonstrated a low overall complication rate.

Conclusions:

• Standard PCNL is a viable treatment for large kidney stones, even with newer techniques.
• Preoperative optimization, minimizing access tracts, using smaller sheaths (24Fr), and reducing operative time can decrease complication rates.