Retrospective evaluation of outcome of percutaneous nephrolithotomy at a tertiary care center in eastern Nepal

Authors

  • Rikesh Jung Karkee Urology Division, Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
  • Samir Chaudhary Urology Division, Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
  • Awaj Kafle Urology Division, Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
  • Shailesh Maharjan Urology Division, Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
  • Inzmamul Haque Raque Urology Division, Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
  • Karun Devkota Department of Radiodiagnosis, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
  • Deependra Prasad Sarraf Department of Clinical Pharmacology and Therapeutics, B. P. Koirala Institute of Health Sciences, Dharan, Nepal

DOI:

https://doi.org/10.18203/2349-2902.isj20230255

Keywords:

Mini nephroscope, PCNL, Stone free rate

Abstract

Background: Percutaneous nephrolithotomy (PCNL) is considered as the standard treatment for renal tract stones. It is a successful procedure with low complication rate. Objective was to evaluate the outcome measures in large renal stone including stone free rates and complications in patients underwent PCNL.

Methods: A retrospective study was conducted in 120 patients who underwent PCNL for renal stone size 2 to 2.5 cm, between 2019 and 2021. Ethical clearance was obtained from the institutional review committee (IRC/2430/022). The data were collected from the records available in the medical record section. The data were analyzed for patient demographics, investigations, site of puncture, stone-free rates (SFRs), type of nephroscope, use of nephrostomy tube, blood transfusion, hospital stay and complications.

Results: Out of 120 cases, 64 (53.3%) were males and 67 (55.8%) presented with renal stone on the right kidney. Renal stone was in pelvis in 47 (39.2%) patients. In 47 (39.2%) cases puncture was made in the lower pole. Stone free clearance rate was 92.5% and 4.2% patients required blood transfusion. There was no statistical difference in intraoperative complication like bleeding in supracostal puncture group and subcostal puncture group [25% vs 13.2%; p=0.13] and in tube group and tubeless group (43.9% vs 3.8%; p<0.001). There was significant difference in length of hospital stay and duration of Foley’s catheter removal between supracostal group vs subcostal group and tube group vs tubeless group (p<0.05). Postoperative complications like fever were seen in 14 (23.0%) and four (6.8%) patients with standard nephroscope group and mini nephroscope group respectively and it was statistically significant (p<0.05).

Conclusions: Mini and tubeless PCNL had a good success rate with minimal complication. The total stone clearance rate in our study was 92.5%.

Metrics

Metrics Loading ...

References

Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M et al. EAU guidelines on diagnosis and conservative management of urolithiasis. Eur Urol. 2016;69(3):468-74.

Delfan B, Baharvand-Ahmadi B, Bahmani M, Mohseni N, Saki K, Rafieian-Kopaei M et al. An ethnobotanical study of medicinal plants used in treatment of kidney stones and kidney pain in Lorestan province, Iran. J Chem Pharm Sci. 2015;8(4):693-9.

Liu Y, Chen Y, Liao B, Luo D, Wang K, Li H et al. Epidemiology of urolithiasis in Asia. Asian J Urol. 2018;5:205‑14.

Zhang L, Zhang X, Pu Y, Zhang Y, Fan J. Global, regional, and national burden of urolithiasis from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. Clin Epidemiol. 2022;14:971-83.

Lageju N, Neupane D, Kafle A, Kumar H. Epidemiological profile of patients with urolithiasis in a tertiary care center of Eastern Nepal: a retrospective cross-sectional study. Int J Community Med Public Heal. 2022;9:1632-6.

Knoll T, Buchholz N, Wendt-Nordahl G. Extracorporeal shockwave lithotripsy vs. percutaneous nephrolithotomy vs. flexible ureterorenoscopy for lower-pole stones. Arab J Urol. 2012;10:336-41.

de la Rosette J, Assimos D, Desai M, Gutierrez J, Lingeman J, Scarpa R. The clinical research office of the endourological society percutaneous nephrolithotomy global study: indications, complications, and outcomes in 5803 patients. J Endourol. 2011;25:11-7.

Preminger GM, Assimos DG, Lingeman JE, Nakada SY, Pearle MS, Wolf JS, Jr et al. Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol. 2005;173:1991-2000.

Vicentini FC, Gomes CM, Danilovic A, Neto EA, Mazzucchi E, Srougi M. Percutaneous nephrolithotomy: Current concepts. Indian J Urol. 2009;25(1):4-10.

JE Lingeman, YI Siegel, B Steele. Management of lower pole nephrolithiasis. J Urol. 2005;173:469e473.

Nakamon T, Kitirattrakarn P, Lojanapiwat B. Outcomes of percutaneous nephrolithotomy: comparison of elderly and younger patients. Int Braz J Urol. 2013;39(5):692-701.

Raya A, Bhatta PN, Yadav AP, Shahi SK. Outcomes of Percutaneous Nephrolithotomy in a Tertiary Care Hospital. Med Phoenix. 2022;7(1):47-50.

Spivacow FR, Negri AL, Del Valle EE, Calviño I, Zanchetta JR. Clinical and metabolic risk factor evaluation in young adults with kidney stones. Int Urol Nephrol. 2010;42(2):471-5.

Karki K. Bhusal N. Infectious complications during the initial 225 cases ofstandard PCNL: A single center experience. J Soc Surg Nep. 2021;24(2):51-7.

Rizvi SAH, Hussain M, Askari SH, Hashmi A, Lal M, Zafar MN. Surgical outcomes of percutaneous nephrolithotomy in 3402 patients and results of stone analysis in 1559 patients. BJU Int. 2017;120(5):702-9.

Heller HJ, Sakhaee K, Moe OW, Pak CY. Etiological role of estrogen status in renal stone formation. J Urol. 2002;168(5):1923-7.

Raya A, Bhatta PN, Yadav AP, Shahi SK. Outcomes of percutaneous nephrolithotomy in a tertiary care hospital. Med Phoenix. 2022;7(1):47-50.

Leslie SW, Sajjad H, Murphy PB. Renal Calculi. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2022.

Wen CC, Nakada SY. Treatment selection and outcomes: renal calculi. Urol Clin N Am. 2007;34:409-19.

Ali S, Kumar N, Baloch U. Outcome of percutaneous nephrolithotomy. J Coll Physicians Surg Pak. 2014;24(4):261-4.

Deole S, Ghagane S, Patel P, Nerli R, Patil S, Dixit N. Outcome of percutaneous nephrolithotomy in a tertiary care center in North Karnataka. World J Nephrol Urol. 2020;9(2):35-9.

Wishahi M, Elganzoury H, Elkhouly A, Kamal AM, Badawi M, Eseaily K et al. Computed tomography versus plain radiogram in evaluation of residual stones after percutaneous nephrolithotomy or pyelonephrolithotomy for complex multiple and branched kidney stones. J Egypt Soc Parasitol. 2015;45(2):321-4.

Armitage JN, Irving SO, Burgess NA. Percutaneous nephrolithotomy in the United Kingdom: results of a prospective data registry. Eur Urol. 2012;61(6):1188-93.

Sekar H, Krishnamoorthy S, Kumaresan N, Ramanan V. Supracostal punctures for PCNL: factors that predict safety, success and stone free rate in stag horn and non-stag horn stones: a single centre experience and review of literature. J Clin Diagn Res. 2016;10(9):PC17-21.

Qin P, Zhang D, Huang T, Fang L, Cheng Y. Comparison of mini percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for renal stones >2 cm: a systematic review and meta-analysis. Int Braz J Urol. 2022;48(4):637-48.

Agrawal MS, Agrawal M. Tubeless percutaneous nephrolithotomy. Indian J Urol. 2010;26(1):16-24.

Downloads

Published

2023-01-27

Issue

Vol. 10 No. 2 (2023): February 2023

Section

Original Research Articles