[Percutaneous nephrolithotomy (PCNL): evaluation of 250 PCNL by the same operator]

Area of Science:

• Urology
• Nephrolithiasis Management

Context:

• Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure for kidney stone removal.
• Managing complex kidney stones, such as staghorn and ureteric calculi, presents unique clinical challenges.
• Evaluating long-term surgical outcomes and complication profiles is crucial for establishing best practices in PCNL.

Purpose:

• To report the 8-year experience with percutaneous nephrolithotomy (PCNL) in a large cohort of patients.
• To analyze the efficacy and safety of PCNL in treating diverse kidney stone compositions and locations, including staghorn and ureteric stones.
• To detail the surgical technique, associated complications, and outcomes of PCNL.

Summary:

• This study presents an 8-year experience with PCNL in 250 patients, treating various stone burdens including 31 staghorn and 52 ureteric calculi.
• The technique involved a descending approach for staghorn and ureteric stones, with other stones located in the pelvis or calyx, and 4 cases in solitary kidneys.
• Immediate stone-free rates were 77.6%, rising to 82.8% after spontaneous passage of fragments or repeat procedures. Complications included infection (1 near-fatal case), hemorrhage (7 cases), and intestinal perforation (2 cases), none requiring surgical intervention. No deaths or nephrectomies occurred.

Impact:

• PCNL demonstrates a high success rate and acceptable safety profile for a wide spectrum of kidney stone disease.
• The findings support PCNL as a viable and effective treatment option, even for complex stone presentations.
• Understanding complication rates and management is essential for optimizing patient care and surgical planning in nephrolithotomy.