Affiliation:
1. Hatem Private Hospital
2. ISTINYE UNIVERSITY
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.