Percutaneous Nephrolithotomy: Assessment of a Lower Volume Practice

Abstract

Background: High volume percutaneous nephrolithotomy (PCNL) surgeons (>25 cases annually) historically report stone-free rates of 80–90%. We investigated whether a lower volume primary PCNL practice (<10 cases annually) yields comparable results. Methods: Charts of 42 PCNL procedures performed by one surgeon over 4.5 years (9 cases per year average) were reviewed; 37 complete records were analyzed. Body mass index (BMI), stone burden, estimated blood loss (EBL), operative time, intraoperative assessment of stone-free status, outcomes and complications were recorded. Results: Average patient BMI was 31 (range 18–57). Average operative time was 163 minutes (range 55–375 minutes) and EBL was 139 ml (range 5–400 ml). Twenty-eight patients (76%) were ‘stone free’ post-PCNL (residual fragments = 4 mm), 21 of whom (57%) had no residual fragments identified. Patients not rendered stone-free had greater average BMI (35 vs. 30), EBL (180 vs. 137 ml), operative time (208 vs. 149 minutes) and >2.5 cm stone burden rate (89 vs. 61%). Eleven percents with intraoperative concern for residual stone burden were rendered stone-free. Complications included urinary extravasation (n = 2), blood transfusion (n = 2), pneumothorax (n = 1) and urinary tract infection (n = 1). Conclusions: A lower volume PCNL practice may yield stone-free and complication rates approaching those of higher volume referral practices.