Characteristics of Patients Requiring Double-J Placement Because of Urine Leakage After Percutaneous Nephrolithotomy

Abstract

Prolonged urine leakage (PUL) from the percutaneous tract after percutaneous nephrolithotomy is a major complication that necessitates the placement of a urethral Double-J stent. We analyzed the characteristics of patients who had this complication to find out its risk factors. During a 6-year period, 1407 standard percutaneous nephrolithotomy procedures were performed at our institution. Medical charts were reviewed focusing on the patients who required Double-J placement because of PUL from the percutaneous tract for more than 24 hours after removal of the nephrostomy tube. A total of 81 patients in whom a Double-J stent was placed because of ureteropelvic injury or pelvicaliceal extravasation or as a part of percutaneous endopyelotomy were excluded from the study. Factors that are considered to have an impact on this untoward event were analyzed and compared. Double-J stent was placed in a total of 57 (4.3%) patients who were found to have PUL. Stone size was significantly larger in the stented group (10.0 +/- 5.6 cm(2) vs. 7.8 +/- 5.3 cm(2)). The stones were classified as complex in 68.4% of patients in the stented group and in 53.4% of patients in the nonstented group, and this difference was also statistically significant. Stone-free rate was significantly higher in the nonstented group (p < 0.05). Residual stone and additional treatment rates were statistically higher in the stented group (p < 0.05). Access number and location as well as per-operative bleeding were not predictive factors for PUL development. The necessity for Double-J placement due to PUL from the percutaneous tract, diminishes with increase in stone-free rates. Stone size and stone complexity are other predictive factors for PUL development.