Safety and Efficacy of Percutaneous Nephrolithotomy in Patients with Large Stones

Abstract

Aims: The aim of the study is to evaluate the safety and efficacy of tubeless percutaneous nephrolithotomy (PCNL) in patients with large stones. Subjects and Methods: From January 2011 to June 2016, 425 tubeless PCNLs were performed at our hospital. All patients underwent a single-stage procedure with a metal dilator. Of the 425 patients, 93 had stone sizes ≥5 cm (mean: 7.77 cm, Group 1) and 332 patients had stone sizes <5 cm (mean: 2.75 cm, Group 2). Data analysis was performed using Statistical Package for the Social Sciences, V. 21.0. Numerical variables were compared by independent-samples t-test. Categorical variables were compared by Chi-square or Fisher's exact test as appropriate. P < 0.05 was deemed statistically significant. Results: The duration of surgery was longer in Group 1 than in Group 2 (93.6 vs. 70.4 min, P < 0.001). There were no significant differences between the two groups in the incidence of postoperative fever (8% vs. 7%) or sepsis (both 1%). In addition, no significant difference was observed in the length of postoperative hospital stays (3.05 vs. 3.2 days) although the transfusion rate was higher in Group 1 (6/93 vs. 4/332, P = 0.003). No other major complications or conversion to open surgery occurred in either group. Conclusions: Tubeless PCNL performed in patients with stones ≥5 cm in size has a reasonable and acceptably higher transfusion rate, with no other associated major complications.