Comparison of Success and Complication Rates of Percutaneous Nephrolithotomy Operations According to Kidney Stone Localization

Year 2023, , 115 - 124, 30.09.2023

Mehmet Taşkıran , Kazım Dogan

https://doi.org/10.54233/endouroloji.20231503-1346626

Abstract

Objective: Percutaneous nephrolithotomy (PNL) is first-line treatment modality for large and complex
stones, however it is associated with potential morbidity and severe complications. Therefore, we aimed to
evaluate the success and complication rates according to stone localization in large sample group following
PNL.
Material and Methods: Total number of 782 patients who underwent PNL, were included in this
retrospective multicenter study. Patients were divided into two major groups; simple stones group (upper
pole, pelvis, lower pole) and complex stones group (partial staghorn, multi-caliceal, pelvis+lower pole,
complete staghorn). Surgery time, fluoroscopy time, complications, hospitalization and nephrostomy
catheter removal day were recorded.
Results: In our study, 525 cases (67.1%) had simple stones, 257 (32.9%) complex stones. The most
frequent (34.3%) stone localization was lower pole. Overall blood transfusion rate was 15.1%. Significantly
increased in mean number of accesses, surgery time, fluoroscopy time, nephrostomy removal time and
hospitalization documented in cases with complex stones (p-values = 0.000, 0.000, 0.009, 0.000 and 0.000,
respectively). Overall complication rate was 9.7% (n=76) and the most frequent complication (4.4%) was
severe hemorrhage. Overall stone-free rates (SFR) are 74.6% (n=583). Furthermore, complication rate (14.4%
vs. 7.4%) was statistically higher and SFR (57.6% vs. 82.9%) was lower in cases with complex stones than
simple stones (p-values = 0.002 and 0.000, respectively).
Conclusions: Our findings clearly demonstrated that PNL achieved higher success rate and lower
complication risk in patients with simple stones than complex stones. PNL is significantly associated with
shorter operation duration and hospitalization in simple stones group. Furthermore, PNL provided relatively
higher overall SFR and lower complication rates in our large sample group compared to the published data.

Keywords

Kidney stones;, Urolithiasis;, Percutaneous nephrolithotomy, Stone-free rates

Böbrek Taş Lokalizasyonuna Göre Perkütan Nefrolitotomi Operasyonlarının Başarı Ve Komplikasyon Oranlarının Karşılaştırılması

Abstract

Amaç: Perkütan nefrolitotomi (PNL), büyük ve kompleks böbrek taşları için birinci basamak cerrahi
tedavi yöntemidir, ancak potansiyel morbidite ve ciddi komplikasyonlar gelişebilmektedir. Bu nedenle
çalışmamızda geniş örneklem grubunda PNL sonrası taş lokalizasyonuna göre başarı ve komplikasyon
oranlarını değerlendirmeyi amaçladık.
Gereç ve Yöntemler: Bu çalışmaya PNL uygulanan toplam 782 hasta retrospektif olarak dahil edilmiştir.
Hastalar iki ana gruba ayrıldı; basit taş grubu (üst pol, pelvis, alt pol) ve kompleks taş grubu (parsiyel
staghorn, multikalisyel, pelvis+alt pol, komplet staghorn). Tüm olgularda operasyon süresi, floroskopi süresi,
hastanede yatış süresi ve nefrostomi kateteri çıkarma zamanı kaydedildi.
Bulgular: Olgularda taşların %67,1’i (n=525) basit taşlarken, %32,9’u (n=257) kompleks taşlardı. Çalışmamızda
en sık %34,3 oranıyla alt kaliks taşı gözlendi. Olguların %15,1’inde kan transfüzyonu gerçekleştirildi. Kompleks
taşa sahip olgularda ölçülen ortalama akses sayısı, operasyon süresi, floroskopi süresi, nefrostomi alınma
zamanı ve hastanede yatış sürelerinin, basit taş gözlenen gruba kıyasla anlamlı şekilde yüksek olduğu
belirlenmiştir (Sırasıyla p-değerleri = 0.000, 0.000, 0.009, 0.000 ve 0.000). Total komplikasyon oranı %9,7
(n=36) olarak belirlenirken; en sık komplikasyon (%4,4) ciddi kanama idi. Çalışmamızda total başarı oranı
%74,6 (n=583) olarak belirlendi. Kompleks taşa sahip olgularda hesaplanan komplikasyon oranının (%14.4),
basit taş gözlenen gruba (%7.4) kıyasla istatistiksel olarak anlamlı olacak şekilde yüksek (p=0.002), taşsızlık
oranlarının (sırasıyla; 57.6% ve 82.9%) ise düşük olduğu belirlendi (p=0.000).
Sonuç: Çalışmamızda PNL prosedürünün basit taşa sahip olgularda, kompleks taşlı gruba kıyasla anlamlı
şekilde yüksek başarı oranı ve düşük komplikasyon riski sağladığı açıkça gösterilmiştir. PNL, basit taşlı
olgularda daha kısa ameliyat süresi ve hastanede yatış ile anlamlı olarak ilişkilendirilmiştir. Ayrıca geniş
örneklem grubuna sahip çalışmamızın bulguları, yayınlanmış verilerle karşılaştırıldığında nispeten yüksek
taşsızlık oranı ve düşük komplikasyon oranları gözlenmiştir.

Keywords

Böbrek taş, Ürolitiyazis, Perkütan nefrolitotomi, Taşsızlık oranı, Komplikasyon

Ethical Statement

İstinye University Human Research Ethics Committee Institutional Review Board protocol approval number: 23/199, date: 08.08.2023.

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