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

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%.