10-year Surgical Outcomes of Percutaneous Nephrolithotomy, A Single-Center Retrospective Study from Thailand
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Abstract
OBJECTIVES: Percutaneous nephrolithotomy (PCNL) is an effective procedure for treating renal stones, particularly when the stone size is a staghorn stone or larger than 20 millimeters, or when it is between 10 and 20 millimeters in size and located in the lower calyx. Previous studies of PCNL have shown high stone-free rates (SFR) with minimal complications. Although previous studies have examined SFRs following PCNL in Thailand, the objective of this research is to expand the national database on PCNL outcomes. This study aims to evaluate the outcomes, including the efficacy and safety, of PCNL performed at Vajira Hospital.
MATERIALS AND METHODS: We conducted a single-center, retrospective descriptive study that enrolled patients who underwent PCNL at Vajira Hospital, Thailand, between January 2012 and December 2022. SFR was defined as a residual stone size of less than 4 millimeters on imaging. Perioperative bleeding and postoperative urinary tract infections (UTIs) were recorded.
RESULTS: A total of 203 patients underwent PCNL. Among these, the types of stones were staghorn (n = 96, 47.3%), small non-staghorn stones sized between 10-20 millimeters (n = 23, 11.3%), and large non-staghorn stones larger than 20 millimeters (n = 84, 41.4%). The median preoperative glomerular filtration rate (GFR) was 84 mL/min/1.73 m² (range: 5-132). Preoperative UTI was present in 38.4% (n=78) of patients. SFR was 43.3%. Patients with non-staghorn stones had a significantly higher SFR compared to those with staghorn stones (56.1% vs. 29.2%, respectively, p < 0.01). There was no significant difference in SFR between the small and large non-staghorn stone groups (p = 0.601). Postoperative GFR were comparable between the stone-free group and the residual stone group. Postoperative UTI and bleeding were recorded at rates of 13.8% and 8.4%, respectively. CONCLUSION: In this study, SFR following PCNL was 43.3%. Patients with non-staghorn stones exhibited a higher SFR compared to those with staghorn stones. Additionally, the postoperative complication rates were considered acceptable.
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