MP22-11 SAFETY AND SURGICAL OUTCOMES OF PERCUTANEOUS NEPHROLITOTOMY IN PATIENTS WITH POOR RENAL FUNCTION.

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You have accessJournal of UrologyStone Disease: Surgical Therapy I1 Apr 2016MP22-11 SAFETY AND SURGICAL OUTCOMES OF PERCUTANEOUS NEPHROLITOTOMY IN PATIENTS WITH POOR RENAL FUNCTION. Alexander Heinze, Miguel Villalobos, Eduardo Cruz-Nuricumbo, Lizzette Gomez de Regil, Rodrigo Suarez-Ibarrola, Carlos Otilio García-Jiménez, María Teresa del Carmen Moreno y Suarez, Eddie Noj-Moreno, Maria Dolores Alsina, Joey Piccolo, and Kassandra Oliva Alexander HeinzeAlexander Heinze More articles by this author , Miguel VillalobosMiguel Villalobos More articles by this author , Eduardo Cruz-NuricumboEduardo Cruz-Nuricumbo More articles by this author , Lizzette Gomez de RegilLizzette Gomez de Regil More articles by this author , Rodrigo Suarez-IbarrolaRodrigo Suarez-Ibarrola More articles by this author , Carlos Otilio García-JiménezCarlos Otilio García-Jiménez More articles by this author , María Teresa del Carmen Moreno y SuarezMaría Teresa del Carmen Moreno y Suarez More articles by this author , Eddie Noj-MorenoEddie Noj-Moreno More articles by this author , Maria Dolores AlsinaMaria Dolores Alsina More articles by this author , Joey PiccoloJoey Piccolo More articles by this author , and Kassandra OlivaKassandra Oliva More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.699AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous nephrolitotomy (PCNL) is today's standard of care for patients with kidney stones >20mm. Recently studies have been focused on preventing complications and predicting surgical outcomes. Urolithiasis is frequently associated to chronic kidney disease due to its obstructive and infectious implications. The glomerular function rate (GFR) can be calculated from various formulas and is used to evaluate renal function and be staged accordingly (KDIGO, Kidney Disease Improving Global Outcomes). We investigated surgical outcomes of percutaneous nephrolitotomy (PCNL) in patients with poor renal function (GFR <60 mL/min/1.73m2) in a reference center with a high proportion of staghorn stones and large stone burden (mean stone diameter 39.8, range 5-89mm). METHODS We systematically reviewed all patients who underwent PCNL in our center from June 2009 to May 2015. We assed patients renal function using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Then classified them into their KDIGO stage. Posteriorly we subdivided them in two different groups, group 1 (KDIGO 1 and 2) and group 2 (KDIGO 3, 4 and 5). We analyze both groups and compared them according to sociodemographic, biochemical, surgical, and clinical outcomes. RESULTS A total of 257 patients were reviewed in the present study. 181 patients in group 1 and 76 into group 2. When classified according to KDIGO, 110, 56, 42, 13 and 14 were in stage 1 to 5, respectively. Group 2 had significantly higher mean patient age (49.2 vs 42.4 yrs in group 1), higher proportion of single kidney (26% vs 0.6% in group 1, p<0.001), lower levels of preoperative hemoglobin (11.9 vs 12.77mg/dl in group 1, p=0.001), larger stone diameter (43.6 vs 38.2 mm in group 1, p=0.001), nephroscopy time (113 min compared to 87 min in group 1, p=0.003), higher incidence of incidental purulent urine (35.53% vs 17.67% in group 1, p=0.002) and lower stone-free rate (27.1 vs 47.0% in group 2, p=0.005). No statistical difference was found in estimated blood loss, need for blood transfusion, nor surgical complications as evaluated by Clavien-Dindo classification. CONCLUSIONS PCNL in patients with poor renal function are usually older, have lower hemoglobin levels although this does not translate into higher transfusion rate. Their stones are larger and have a higher incidence of purulent urine. Importantly, PCNL can be performed safely in this subgroup of patients. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e257 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Alexander Heinze More articles by this author Miguel Villalobos More articles by this author Eduardo Cruz-Nuricumbo More articles by this author Lizzette Gomez de Regil More articles by this author Rodrigo Suarez-Ibarrola More articles by this author Carlos Otilio García-Jiménez More articles by this author María Teresa del Carmen Moreno y Suarez More articles by this author Eddie Noj-Moreno More articles by this author Maria Dolores Alsina More articles by this author Joey Piccolo More articles by this author Kassandra Oliva More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...