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Kwon, Bang, Kim, Shim, Ha, Hong, and Park: Percutaneous Nephrolithotomy: A Single Center Experience of 610 Cases
Original Article
Endourology/Urolithiasis
Korean Journal of Urology

Korean Journal of Urology 2009; 50(7): 669-674.

Published online: 21 July 2009

DOI: https://doi.org/10.4111/kju.2009.50.7.669

Percutaneous Nephrolithotomy: A Single Center Experience of 610 Cases

Taekmin Kwon, Jeong Kyoon Bang, Seong Chul Kim, Myungsun Shim, Seong-Heon Ha, Bumsik Hong, Hyung Keun Park

Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Correspondence to: Hyung Keun Park. Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-dong, Songpa-gu, Seoul 137-736, Korea. TEL: 02-3010-3737, FAX: 02-477-8928, hkpark@amc.seoul.kr

Received 19 March 2009       Accepted 30 June 2009

Copyright © The Korean Urological Association, 2009

Abstract

Purpose

We performed this study to evaluate the outcomes and complications of percutaneous nephrolithotomy (PCNL) at a single institute with a large series.

Materials and Methods

We reviewed the medical records of 610 patients who underwent PCNL between March 1995 and June 2008 for staghorn calculi in 139 (22.8%), partial staghorn calculi in 104 (17.0%), renal pelvis stone in 222 (36.4%), proximal ureter calculi in 60 (9.8%), and calculi within a caliceal diverticulum in 85 (13.9%) patients. Stone-free status was defined as no visible residual calcification or remnant calcification smaller than 4 mm in diameter (clinically insignificant residual fragment) on a plain KUB (X-ray examination of the kidney, ureter, and bladder) image. Characteristics of the stones, operation time, stone-free rate, and complications were evaluated.

Results

Initial stone burden was 665.9±600.6 mm2. Average operation time was 103.2±58.6 minutes. The mean hospital stay was 7.9 days. The stone-free rate was 84.9%, and ancillary procedures were required in 66 patients (10.8%), including 34 (5.6%) second-look PCNL and 26 (4.3%) ureteroscopic procedures. In the univariate analysis for prediction of stone-free rate, hydronephrosis, stone type, stone composition, and stone burden were significant prognostic factors. In the multivariate analysis, initial stone burden was the only independent factor affecting the stone-free rate. Complications were found in 95 patients (16.1%), 5 (0.8%) of whom needed embolization due to bleeding and 23 (3.8%) of whom showed pleural complications.

Conclusions

PCNL is an effective method for the treatment of staghorn, large calyceal, and some upper ureteral stones with acceptable complication rates.

Keywords: Percutaneous nephrolithotomy, Kidney calculi, Complications

Figures and Tables

Table 1
Patient characteristics
kju-50-669-i001

BMI: body mass index, a: applying the fomula for surface area (lengthxheight)

Table 2
Perioperative data of the patients
kju-50-669-i002
Table 3
Treatment outcomes of PCNL
kju-50-669-i003

PCNL: percutaneous nephrolithotomy

Table 4
Patient characteristics stratified by stone-free rate
kju-50-669-i004

BMI: body mass index, a: Student's t-test

Table 5
Multivariate analysis of prognostic factors affecting the stone-free rate
kju-50-669-i005

OR: odds ratio, CI: confidential interval, BMI: body mass index

Table 6
Complications of PCNL
kju-50-669-i006

PCNL: percutaneous nephrolithotomy, a: p=0.001 (supracostal 167 patients, subcostal 442 patients)

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Bumsik Hong
https://orcid.org/http://orcid.org/0000-0003-1991-1229

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