Revisiting Standard Percutaneous Nephrolithotomy in the Mini-Percutaneous Nephrolithotomy/Retrograde Intrarenal Surgery Era: A Retrospective Audit

Abstract

Objective This study aims to identify the risk factors associated with postoperative complications following standard percutaneous nephrolithotomy (PCNL) for better results with the emergence of mini-percutaneous nephrolithotomy (mini-PCNL)/retrograde intrarenal surgery (RIRS) in recent years. Methodology This retrospective study was conducted in the Department of Urology, Sri Ramachandra Institute of Higher Education and Research, tertiary health care center in Chennai, India, from January 2018 to December 2023. Records of demographic information, along with clinical presentations like any urinary tract infection (UTI), hematuria, or loin pain were recorded. Medical and surgical history noted. Characteristics such as stone burden, location, number of calyces involved, and partial or complete staghorn were noted. Patients had undergone standard PCNL, either prone or supine, as per the preference of the surgeon. Operative time, number of percutaneous puncture tracts, and other intraoperative factors were investigated. A modified Clavien-Dindo scoring system for PCNL was used to classify any complication that occurred during this time. All patients were assessed after one month for stone clearance status. Results IBM SPSS Statistics for Windows, version 29 (IBM Corp., Armonk, NY, USA) was used for statistical analysis. The logistic regression analysis results show that age >55 years, urinary tract infection (UTI), diabetes, CKD, stone burden, percutaneous access number >1, and Amplatz sheath size >30Fr are highly significant predictors of complications (p <0.05). A greater number of calyces involved significantly increases the odds of complications. The odds ratio is 2.307 with a significant p-value (0.045), indicating a significant association. Longer operative time substantially increases the odds of complications (odds ratio is 0.129 with p = 0.021). Conclusion Standard PCNL has a low overall complication rate and is still an excellent modality of treatment for large-burden kidney stones in the mini-PCNL/RIRS era. Preoperative optimization, reduction in percutaneous access tracts with smaller Amplatz sheath (24Fr), and shorter operative time will help to reduce the complications rate.

Keywords: complications; mini-percutaneous nephrolithotomy (mini-pcnl); modified clavien-dindo scoring system; percutaneous nephrolithotomy (pcnl); risk factors.