https://doi.org/10.4081/aiua.2023.11581

Safety and efficacy of percutaneous nephrolithotripsy in comorbid patients: A 3 years prospective observational study

Vol. 95 No. 3 (2023)
Submitted: July 11, 2023
Accepted: August 1, 2023
Published: September 12, 2023
Percutaneous nephrolithotripsy, Nephrostomy, Renal stones
Abstract Views: 715
PDF: 422
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Authors

Tamer A. Abouelgreed
dr_tamer_ali@yahoo.com
https://orcid.org/0000-0003-2640-3425
Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Hassan Ismail
https://orcid.org/0000-0002-0038-3078
Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Sameh S. Ali
Department of Radiology, Sheikh Khalifa general Hospital, UAQ, United Arab Emirates.
Ayman K. Koritenah
Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Yasser Badran
Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Mahmoud Ali
https://orcid.org/0009-0003-0258-0686
Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Rasha Ahmed
Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Mohamed Algammal
https://orcid.org/0009-0002-0472-4914
Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Ahmed Alrefaey 
Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Aly Gomaa
Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Mohame. F. Elebiary
https://orcid.org/0009-0007-5704-3916
Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Kazakhstan.
Hany A. Eldamanhory
Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Abdelhamid A. Khattab
Department of Urology, Damanhur Teaching Hospital, Albuheira Government, Egypt.
Nermeen M. Abdelmonem
Department of Radiology, Thumbay University Hospital, Ajman, United Arab Emirates.
Mohamed Thabet Alnajem
https://orcid.org/0009-0001-2934-2819
Department of Radiology, Tawam Hospital, Alain, United Arab Emirates.
Tamer G. Abdelhamid
https://orcid.org/0009-0009-7042-8153
Department of Anesthesia, Emirates specialty Hospital, Dubai, United Arab Emirates.
Ahmed A. Abdelwahed
Department of Radiology, Faculty of Medicine, Ain shams University, Cairo, Egypt.
Salma F. Abdelkader
Department of Radiology, Faculty of Medicine, Ain shams University, Cairo, Egypt.

Purpose: To report the result of percutaneous nephrolithotripsy (PCNL) via standard nephrostomy tract in a single training institution. The perioperative complications in relation to the comorbid state are particularly assessed. Patients and methods: A prospective interventional study between January 2019 to November 2022, included 210 patients scheduled for PCNL. The average age was 40.3 ± 11.8 years (range 18- 67 years). Patients were categorized into two groups. The first group comprised 146 cases (69 .5%) with no associated co-morbidities while the second group 64 (30.5%) had co-morbidities such as obesity in 4 cases (1.9%), hypertension (HTN) in 24 cases (11.4%) cases, diabetes mellitus (DM) in 17 (8.1%) cases, history of recurrent stone surgery in 11 (5.2%) cases and more than one in 8 cases (3.8%). Co-morbidities, stone burden, location of stone, time of surgery, stay in the hospital, further operations, and negative events were among the reported data. Complications and the stone-free rate were the main outcome indicators. Results: Intraoperative complications were reported in 40 (18.8%) patients (18 group 1 and 22 group 2) during PCNL. Bleeding occurred in 22 (10.5%) patients (9 group 1 and 13 group 2), blood transfusions were needed in 4 (1.9%) (2 group 1 and 2 group 2), extravasation was observed in 11 patients (5.2%) (6 group 1 and 5 group 2) and cardiac arrhythmia in 3 (1.4%) (1 group 1 and 2 group 2) patients. Postoperative complications occurred in 61 patients (29%) (24 group 1 and 37 group 2) in the form of fever in 10 patients (4.8 %) (3 group 1 and 7 group 2) and prolonged leakage in 50 patients (23.8%) (21 group 1 and 29 group 2). One patient of group 2 died from postoperative sepsis. Extravasation and postoperative leakage were higher in diabetic patients than in non-diabetics. Stonefree rate was 60.5% (127 of 210). Clinically significant residual fragments (CSRFs) found in 70 cases (33.3%) (33 group 1 and 37 group 2). In 13 cases (6.2%) (5 group 1 and 8 group 2), clinically insignificant residual fragments (CIRFs) were found. In 8 (3 group 1 and 5 group 2) of the 13 cases, spontaneous stone passage was observed within 4-6 weeks of surgery. Residual stones in three cases (1 group 1 and 2 group 2) were asymptomatic and 4 mm or less, whereas stones increased in two cases of group 2. Among all factors studied, stone burden was significantly correlated to both intraoperative and postoperative complications. The occurrence of postoperative fever increased with large stone burden. Conclusions: PCNL is a therapeutic modality that is effective, feasible, and safe for a wide range of patients with concurrent medical issues. A steep curve is required to reduce intraoperative and postoperative complications.

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Europe PMC
Karakoyunlu N, Goktug G, Sener NC, et al. A comparison of standard PCNL and staged retrograde FURS in pelvis stones over 2 cm in diameter: A prospective randomized study. Urolithiasis. 2015; 43:283e7.
Jessen JP, Honeck P, Knoll T, Wendt-Nordahl G. Percutaneous nephrolithotomy under combined sonographic/radiologic guided puncture: Results of a learning curve using the modified Clavien grading system. World J Urol. 2013; 31:1599e603. DOI: https://doi.org/10.1007/s00345-012-1016-9
Taylor E, Miller J, Chi T, Stoller ML. Complications associated with percutaneous nephrolithotomy. Transl Androl Urol. 2012; 1:223e8.
Tseng J-S, Lin W-R, Sun F-J, et al. Predicting Percutaneous Nephrolithotomy Outcomes and Complications in Elderly Patients Using Guy's Scoring System and Charlson Comorbidity Index, International Journal of Gerontology. 2018; 12:239-243. DOI: https://doi.org/10.1016/j.ijge.2018.05.001
Rizvi SAH, Hussain M, Askari SH, et al. Surgical outcomes of percutaneous nephrolithotomy in 3402 patients and results of stone analysis in 1559 patients. BJU Int. 2017; 120:702e709 DOI: https://doi.org/10.1111/bju.13848
Tefekli A, Karadag MA, Tepeler K, et al. Classification of Percutaneous Nephrolithotomy Complications Using the Modified Clavien Grading System: Looking for a Standard. Eur Urol. 2008; 53:184-190. DOI: https://doi.org/10.1016/j.eururo.2007.06.049
Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. Eur Urol. 2007; 51:899-906. DOI: https://doi.org/10.1016/j.eururo.2006.10.020
Karakoyunlu N, Goktug G, Sener NC, et al. A comparison of standard PCNL and staged retrograde FURS in pelvis stones over 2 cm in diameter: A prospective randomized study. Urolithiasis. 2015; 43:283e7. DOI: https://doi.org/10.1007/s00240-015-0768-2
Vorrakitpokatorn P, Permtongchuchai K, Raksamani EO, Phettongkam A. Perioperative complications and risk factors of percutaneous nephrolithotomy. J Med Assoc Thai. 2006; 89:826-833.
Olbert PJ, Hegele A, Schrader AJ. Pre and perioperative predictors of short-term clinical outcomes in patients undergoing percutaneous nephrolitholapaxy. Urol Res. 2007; 35:225. DOI: https://doi.org/10.1007/s00240-007-0112-6
Juan YS, Huang CH, Chuang SM. Colon perforation: a rare complication during percutaneous nephrolithotomy. Kaohsiung J Med Sci. 2006; 22:99-102. DOI: https://doi.org/10.1016/S1607-551X(09)70228-1
Lee WJ, Smith AD, Cubelli V, Vernace FM. Percutaneous nephrolithotomy: analysis of 500 consecutive cases. Urol Radiol. 1986; 8:61-66. DOI: https://doi.org/10.1007/BF02924078
Srivastava A, Singh KJ, Suri A. Vascular complications after percutaneous nephrolithotomy: are there any predictive factors? Urology. 2005; 66:38-40. DOI: https://doi.org/10.1016/j.urology.2005.02.010
Mousavi-Bahar SH, Mehrabi S, Moslemi MK. Percutaneous Nephrolithotomy Complications in 671 Consecutive Patients: A Single-Center Experience. Urol J. 2011; 8:271-276.
Al-Bareeq R, and Denstedt, JD. Percutaneous nephrolithotomy for the treatment of lower pole renal calculi. CUAJ. 2008; 2:628-630. DOI: https://doi.org/10.5489/cuaj.982
Turna B, Nazli O, Demiryoguran S, et al. Percutaneous nephrolithotomy: Variables that influence hemorrhage. Urology. 2007; 69:603-607. DOI: https://doi.org/10.1016/j.urology.2006.12.021
Yamaguchi A, Skolarikos A, Buchholz NN, et al. Operating Times and Bleeding Complications in Percutaneous Nephrolithotomy: A Comparison of Tract Dilation Methods in 5537 Patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study. J Endourol. 2011; 25:933-939. DOI: https://doi.org/10.1089/end.2010.0606
Bagrodia A, Gupta A, Raman JD, et al. Impact of body mass index on cost and clinical outcomes after percutaneous nephrostolithotomy. Urology. 2008; 72:756-760. DOI: https://doi.org/10.1016/j.urology.2008.06.054
Tomaszewski JJ, Smaldone MC, Schuster T, et al. Outcomes of Percutaneous Nephrolithotomy Stratified by Body Mass Index. J Endourol. 2010; 24:547-550. DOI: https://doi.org/10.1089/end.2009.0431
Rassweiler JJ, Renner C, Eisenberger F. Management of complex renal stones. BJU Int. 2000; 86:919-928. DOI: https://doi.org/10.1046/j.1464-410x.2000.00906.x
Liatsikos EN, Kapoor R, Lee B, et al. Angular percutaneous renal access. Multiple tracts through a single incision for staghorn calculous treatment in a single session. Eur Urol. 2005; 48:832-837. DOI: https://doi.org/10.1016/j.eururo.2005.08.009
Gupta R, Kumar A, Kapoor R, et al. Prospective evaluation of safety and efficacy of the supracostal approach for percutaneous nephrolithotomy. BJU Int. 2002; 90:809-813. DOI: https://doi.org/10.1046/j.1464-410X.2002.03051.x
Takeuchi H, Ueda M, Nonomura M. Fever attack in percutaneous nephrolithotomy and transurethral ureterolithotripsy. Hinyokika Kiyo. 1987; 32:1357-1363.
Dogan HS, Sahin A, Cetinkaya Y, et al. Antibiotic prophylaxis in percutaneous nephrolithotomy: prospective study in 81 patients. J Endourol. 2002; 16:649-53. DOI: https://doi.org/10.1089/089277902761402989
Aron M, Yadav R, Goel R. Multi-tract percutaneous nephrolithotomy for large complete staghorn calculi. Urol Int. 2005; 75:327-332. DOI: https://doi.org/10.1159/000089168
Osman M, Wendt-Nordahl G, Heger K, et al. Percutaneous nephrolithotomy with ultrasonography-guided renal access: experience from over 300 cases. BJU Int. 2005; 96:875-878. DOI: https://doi.org/10.1111/j.1464-410X.2005.05749.x
Altunrende F, Tefekli A, Stein RJ, et al. Clinically insignificant residual fragments after percutaneous nephrolithotomy: mediumterm follow-up. J Endourol. 2011; 25:941-945. DOI: https://doi.org/10.1089/end.2010.0491
Opondo D, Tefekli A, Esen T, et al.; CROES PCNL study group. Impact of case volumes on the outcomes of percutaneous nephrolithotomy. Eur Urol. 2012; 62:1181-7. DOI: https://doi.org/10.1016/j.eururo.2012.03.010
Margel D, Lifshitz DA, Kugel V, et al. Percutaneous nephrolithotomy in patients who previously underwent open nephrolithotomy. J Endourol. 2005; 19:1161-1164. DOI: https://doi.org/10.1089/end.2005.19.1161
Sofikerim M, Demirci D, Gulmez I, Karacagil M. Does previous open nephrolithotomy affect the outcome of percutaneous nephrolithotomy? J Endourol. 2007; 21:401-403. DOI: https://doi.org/10.1089/end.2006.0293

How to Cite

Abouelgreed, T. A., Ismail, H., Ali, S. S., Koritenah, A. K., Badran, Y., Ali, M., Ahmed, R., Algammal, M., Alrefaey , A., Gomaa, A., Elebiary, M. F., Eldamanhory, H. A., Khattab, A. A., Abdelmonem, N. M., Alnajem, M. T., Abdelhamid, T. G., Abdelwahed, A. A., & Abdelkader, S. F. (2023). Safety and efficacy of percutaneous nephrolithotripsy in comorbid patients: A 3 years prospective observational study. Archivio Italiano Di Urologia E Andrologia, 95(3). https://doi.org/10.4081/aiua.2023.11581
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