Evaluation of the Factors Affecting Percutaneous Success and Complications of Nephrolithotomy

Abstract

INTRODUCTION[|]Nowadays, surgical procedures become more reliable as urinary system stone disease begins to be treated with minimally invasive methods. Percutaneous nephrolithotomy (PNL) is the first treatment option for kidney stones >2 cm. An increase in postoperative stone-free (SF) rates due to improvements in technology and experience, operation, and hospital stay is reduced. Over time, complications of PNL have been reduced and more standardized with classifications similar to the developed Clavien grading system. The aim of the present study was to comparatively investigate the factors that are considered to affect success and complications in PNL operation.[¤]METHODS[|]The present study included 928 patients (1011 renal units) who underwent PNL operation between November 2004 and January 2013 in our clinic. These patients had preoperative (sex, age, body mass index (BMI), operation side, previous stone operations, hydronephrosis and grade, stone localization, stone area, and volume), operative (operation time, fluoroscopy time, number of access, and calyces of access), and postoperative (hemoglobin, hematocrit, complication, transfusion, stone removal, nephrostomy withdrawal time, length of hospital stay, and need for additional intervention). The complications that occurred during and after the operation were classified according to the modified Clavien system. Subsequently, patients were divided into two groups: patients with complications (Group 1) and those with no complications (Group 2). The groups were analyzed comparatively.[¤]RESULTS[|]Overall, 628 male and 383 female (M/F: 8/5) patients were included in the study. The mean age of the patients was 41.9 years. Of the evaluated operations, 185 had minor or major complications, and 826 had no complications. Complications in PNL operation are classified according to the modified Clavien grading: 23 (2.27%) complications in grade 1, 143 (14.14%) complications in grade 2, 11 (1.08%) complications in grade 3A, 6 (0.59%) complications in grade 3B, 4 (0.39%) complications in grade 4A, and 15 (4.48%) complications in grade 4B. No complication according to grade 5 was observed. Statistically, stone size, preoperative hydronephrosis grade, time of operation and fluoroscopy, length of stay in the hospital, and SF rates were found to be effective parameters on complication development in both groups (p<0.05). Age, gender, BMI, number of access to the kidney, and postoperative complications were not found to be effective parameters in terms of complication development (p>0.05).[¤]DISCUSSION AND CONCLUSION[|]PNL is an effective and reliable method for the treatment of urinary stone disease. Most of the complications are minor. Stone size, presence of preoperative hydronephrosis, long operation times, and excessive access to the kidney collecting system increase the complication rates. Another important result obtained in the present study is that the complication rates are higher in patients with high SF rates than in other patients.[¤]

Keywords

• clavien ratings
• complication; percutaneous nephrolithotomy; stone.