Fourteen-Year Analysis of Percutaneous Nephrolithotripsy Outcomes: Evolution of Technique and Future Perspectives

Abstract

Purpose: The treatment of kidney stones has undergone continuous evolution. Despite the evolution of retrograde intrarenal surgery, percutaneous nephrolithotomy (PNL) remains the gold standard treatment for large and complex stones. We aimed to evaluate and analyze the temporal evolution of the results of the PNLs conducted at two teaching hospitals.

Results: Data from 2660 patients were studied between 2009 and 2022. The rate of complex stones (Guy's 3 and 4) was 55.3%. Supine position was used in 82.1% of the cases. In 74.7% of cases, only 1 puncture was performed. The median surgery time was 120 min (15-240 min). The overall complication rate was 12.2%, the transfusion rate was 4.5%, and the success rate was 59.8%. Regarding temporal evolution, the use of the supine position increased from 73% in 2009 to 100% in 2022 (p < 0.001). The use of nephrostomy dropped from 81.8% to 26.5% (p<0.001), the median duration of surgery dropped from 145 to 130 min, the median time of use of fluoroscopy went from 12 to 8 min, the rate of blood transfusions dropped from 11.5% to 2.8% (p= 0.009), and the complication rate dropped from 18.2% to 12% (p= 0.002), while the average length of stay dropped from 81.8 hours to 50 hours.

Conclusions: PNL is an effective surgical option for treating complex kidney stones. The implementation of several technical aspects, along with the standardization of the procedure, led to a significant improvement in most outcomes, reducing complication rates but leaving room for technique improvements in terms of success rates.

Keywords: General Surgery; Kidney Calculi; Nephrolithotomy, Percutaneous.