Outcomes Of Percutaneous Nephrolithotomy Research Articles

Evaluation of the Impact of Body Mass Index on the Outcomes of Supine Percutaneous Nephrolithotomy

Objective: This study aimed to evaluate the impact of obesity on the outcomes of supine percutaneous nephrolithotomy (PCNL) in a tertiary care center. Understanding surgical outcomes in obese patients, given their rising prevalence and urolithiasis risk, is crucial for optimizing treatment strategies. Materials and Methods: This retrospective study included data from 256 patients aged 18 and older who underwent PCNL in the Galdakao-Valdivia position between July 2021 and July 2024 at a tertiary care hospital. Patients were categorized into three groups based on their body mass index (BMI): normal weight (BMI: 18-24.9 kg/m²), overweight (BMI: 25-29.9 kg/m²), and obese (BMI: 30-34.9 kg/m²). Demographic data, stone characteristics, operative time, fluoroscopy time, hospital stay, nephrostomy duration, stone-free rates (SFR), and complications were analyzed and compared across the three groups. Results: There was no significant difference between the groups regarding age, sex, stone laterality, location, or size (p>0.05). Median BMI values were significantly different between the groups (p<0.001). The stone-free rates were 79.2%, 77%, and 75% for the normal, overweight, and obese groups, respectively (p>0.05). No significant differences were found in operative time, fluoroscopy time, hospital stay, or nephrostomy time among the groups (p>0.05). Minor and major complication rates were similar across all groups (p>0.05). Conclusion: Obesity does not appear to significantly impact the outcomes of supine PCNL, including operative time, stone-free rates, or complication rates. These findings suggest that with experienced surgeons, supine PCNL is a safe and effective treatment option for obese patients, though further prospective studies are needed to confirm these results.

Comparative Study between Outcome of Standard and Tubeless Percutaneous Nephrolithotomy (PCNL) at District Level Tertiary Hospitals in Bangladesh

Renal calculus is one of the commonest problems of the urinary tract. Surgical approach is more effective treatment option to remove it. Among all surgical procedures, Percutaneous Nephrolithotomy (PCNL) has gradually become a preferred option in last two decades for renal calculus that has largely replaced the open approach. Currently, it is the procedure of choice for renal calculus > 2 cm, or those are refractory to ESWL. The crucial step in Standard PCNL is placing a nephrostomy tube. In recent years, it has been reformed as 'Tubeless' PCNL with some modifications in which a Double-J (D-J) stent is placed without any nephrostomy tube for internal drainage. This study was done to compare the outcomes of Standard PCNL and Tubeless PCNL at district level tertiary hospitals in Bangladesh among 46 patients with renal calculus up to 3 cm size. Many authors agree that Tubeless PCNL or its modifications are effective as well as safe. Although, nephrostomy tube is responsible for an increase of post- operative morbidity, in our study, we did not find any statistically significant difference between these two procedures.

Editorial Comment on "Comparative Outcomes of Day-Case Percutaneous Nephrolithotomy vs Conventional Inpatient Surgery: A Systematic Review and Meta-Analysis"

Editorial Comment on "Comparative Outcomes of Day-Case Percutaneous Nephrolithotomy vs Conventional Inpatient Surgery: A Systematic Review and Meta-Analysis"

COMPARISON OF USING J TIP GUIDE WIRE VS STRAIGHT TIP GUIDE WIRE DURING PUNCTURE AND TRACT FORMATION IN PCNL

Percutaneous nephrolithotomy (PCNL) is a widely used surgical technique for removing large or complex kidney stones. The choice of guide wire during puncture and tract formation may influence the procedure's ease, safety, and success. Objective: This study aimed to compare J-tip guide wire versus straight-tip guide wire during puncture and tract formation in PCNL, focusing on ease of use, safety, and clinical outcomes. Methods: A comparative study was conducted at CMH, Lahore, from April 2024 to July 2024. A total of 89 patients were randomly assigned into two groups: Group A, using the J tip guide wire (n=45), and Group B, using the straight tip guide wire (n=44). Data were collected on ease of insertion, complication rates, procedural duration, and success rates. Statistical analysis was performed using SPSS software, with p<0.05 considered statistically significant. Results: The average age of patients in Group A was 52.3 ± 10.4 years and in Group B, 50.7 ± 11.2 years. Group A demonstrated significantly better ease of insertion with a mean score of 8.7 ± 0.9 compared to 7.5 ± 1.2 in Group B (p=0.003). Complication rates were lower in Group A (4.4%) versus Group B (22.7%, p=0.024), with fewer minor traumas (4.4% vs. 15.9%, p=0.048). The procedure duration was shorter in Group A (25.4 ± 5.1 minutes) compared to Group B (30.2 ± 6.3 minutes, p=0.001). The success rate was higher in Group A (97.8% vs. 90.9%), although this difference was not statistically significant (p=0.092). Conclusion: The J tip guide wire shows significant advantages over the straight tip guide wire in PCNL procedures, offering improved ease of use, reduced complication rates, and shorter procedural duration. These findings suggest that the J tip guide wire is valuable for enhancing PCNL outcomes.

Outcomes and Complications of Percutaneous Nephrolithotomy (PCNL): A Single-Center Experience.

Urolithiasis is extremely prevalent in Pakistan, with percutaneous nephrolithotomy (PCNL) emerging as the primary treatment modality over traditional open surgery. Despite its effectiveness, PCNL is associated with a risk of complications and residual stones. There is limited data on PCNL outcomes from Southern Punjab, necessitating an evaluation of its efficacy and safety in this region. We conducted a retrospective analysis of 399 patients who underwent PCNL at a tertiary care hospital in Muzaffargarh, Pakistan, between October 2016 and September 2022. Detailed preoperative assessments, surgical procedures, and postoperative outcomes were reviewed. Stone clearance and complication rates were assessed, and factors influencing these outcomes were analyzed. The median age of the study population was 39 years, with a male predominance. Stone clearance was achieved in 80.45% (321) of cases, with higher success rates observed in lower pole punctures. Complications occurred in 2% (13) of patients, predominantly hydrothorax following upper pole puncture. Patients with comorbidities had a higher risk of complications (P = 0.097). Residual stones were more common in staghorn stones and larger stone sizes (>3-4 cm). The median operative time was 60 minutes, shorter than reported in the literature, reflecting surgical expertise. PCNL is an effective and safe treatment option for urolithiasis in Southern Punjab, Pakistan, with favorable stone clearance rates and low complication rates. Tailoring treatment strategies based on patient characteristics and optimizing surgical techniques are essential for improving outcomes in this population.

Percutaneous nephrolithotomy versus open surgery for the treatment of unilateral staghorn stone, Erbil province

Background and objective: Staghorn stones are large branching stones that completely or partially occupy the renal pelvis and renal calyces. The developments in the urological field have decreased the role of open surgery (OS) and currently percutaneous nephrolithotomy (PCNL) is considered as the gold standard procedure for the management of staghorn stone. This study aimed to determine the outcomes of open surgery and percutaneous nephrolithotomy for the treatment of unilateral staghorn stone. Methods: This retrospective analysis included 76 patients with unilateral staghorn stone who had been treated with either percutaneous nephrolithotomy (57) or open surgery (19). A comparison was made between the mentioned groups (PCNL vs. OS). Results: The differences between the two groups were not significant in term of preoperative characteristics. In addition, there was no significant difference between the two groups for intraoperative, postoperative complications and the rate of stone clearance (P = 0.447, P = 0.180, P = 0.259 respectively). The means of postoperative hospital stay (days) and recovery time (weeks) were significantly lower in the PCNL than OS (P <0.001). However, the mean operative time was significantly less in the OS group (P = 0.018). Conclusion: The PCNL is a very efficient treatment option for staghorn stones. However, the open surgery still has a role in the treatment of kidney stones (especially staghorn stone).

Validation of stone-kidney size score to predict outcome and complications of pediatric percutaneous nephrolithotomy

The prevelance of urinary system stone disease in children is emphasizing the need for minimally invasive treatments to decrease morbidity and recurrence risk. Percutaneous nephrolithotomy (PCNL) has emerged as a preferred approach for pediatric patients with complex stones due to its minimally invasive nature, including miniaturized and vacuum-assisted access sheaths, advanced laser technology and tubeless and outpatient procedures. However, adult scoring systems have proven ineffective in predicting success and complications in pediatric PCNL. This highlights the need for specialized scoring systems, such as the Stone-Kidney Size (SKS) scoring system, tailored to pediatric patients and will be evaluated in our study for its association with the stone-free rate (SFR) and complications. The data of 144 patients aged <17 years who had undergone PCNL between January 2008 and December 2019 were evaluated retrospectively. Demographics, stone characteristics, perioperative/postoperative outcomes were recorded for each patient. The SKS scoring system comprises the stone kidney index (SKI) and the number of stones, assigns one or two points based on single or multiple stones and an SKI value of <0.3 or ≥0.3, respectively. The SKI is computed by dividing the stone's longest axis by the kidney's longest axis. Residual stones less than 4mm on non-contrast computed tomography are considered clinically insignificant residual fragments (CIRFs). Stone-free and CIRF patients were considered successful results. The relationship between the SKS scoring system and SFR, success, and complication rates after surgery was investigated. Statistical analyses were conducted using SPSS 22.0 software. The SFR was 67.36% and 74.31% when CIRF patients were included, respectively, with a complication rate of 27%. In multivariate analysis, stone treatment history, stone burden, and SKS score were statistically significantly associated with SFR (p<0.001, p=0.032, p<0.001, respectively). Furthermore, the SKS score was the only variable that showed a statistically significant relationship with success. No significant association was found between SKS score and complications (p=0.342). Our study demonstrates a relationship between the SKS scoring system and SFR in pediatric PCNL patients. However, shortcomings have been observed in its capacity to accurately predict post-PCNL complications. Despite being a retrospective analysis and having a single-center design, our study externally validates the relationship between the SKS scoring system and SFR after pediatric PCNL. The SKS scoring system is associated with SFR in pediatric patients undergoing PCNL; however, this relationship has not been established for complications.

The modified 5-item frailty index as a predictor of perioperative risk in patients undergoing percutaneous nephrolithotomy.

The modified 5-item frailty index is a relatively new tool to assess the post-operative complication risks. In urology, there is limited literature on the impact of frailty on percutaneous nephrolithotomy (PCNL) outcomes. We aimed to compare the predictive value of the modified 5-item frailty index (mFI-5) to identify high risk patients prior to PCNL. A database of patients undergoing PCNL, between 2015 and 2022, was analyzed. Patient frailty was assessed using the mFI-5 index. The mFI-5 index was calculated based on the presence of the five co-morbidities: congestive heart failure within 30days prior to surgery, diabetes mellitus, chronic obstructive pulmonary disease, partially dependent or totally dependent functional health status at time of surgery, and hypertension requiring medication. Patients were grouped as not frail (mFI-5 = 0), intermediate (mFI-5 = 1), and severely frail (mFI-5 ≥ 2). Primary outcomes were 30-day postoperative complications. Secondary outcomes were hospitalization: total hospital length of stay, reoperation, and unplanned readmission. From a total of 320 PCNL patients included for analysis, 54.06% (n = 173) were not frail, 17.81% (n = 57) were intermediate, and 28.12% (n = 90) were severely frail. Frail patients were likely to be older (p = 0.002) and have a higher American Society of Anesthesiologists score (p = 0.001), chronic kidney disease (p < 0.001). Patients of intermediate or severe frailty were more likely to exhibit postoperative sepsis (p = 0.042), significant blood loss (p = 0.036) and require intensive care units admissions (p = 0.0015). Frail patients had a longer hospital length of stay (p < 0.001) and tended to require reoperation (p = 0.001), and unplanned readmission (p = 0.02). Frailty assessment appears useful in stratifying those at risk of extended hospitalization, septic and hemorrhagic complications, readmission, or reoperation after PCNL. Preoperative assessment of frailty phenotype may give insight into treatment decisions and assist surgeons in counselling patients on expected course and hospital stay following PCNL.

Comprehensive Approaches to Urolithiasis in Renal Transplants: A Narrative Review.

This review addresses the management of urolithiasis in renal transplant recipients, a notably vulnerable group due to the unique anatomical and physiological alterations of the transplanted organ. The prevalence of nephrolithiasis in these patients varies between 0.1% and 6.3%, with a significant impact on graft longevity and function. Surgical access complications due to the renal graft's position on the iliac vessels and the variety of urinary anastomoses complicate the treatment approaches. This study evaluates the effectiveness and outcomes of percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS), two primary minimally invasive strategies for managing graft stones. Through a narrative review using the PubMed and EMBASE databases, it was found that PCNL offers high stone-free rates especially beneficial for large stones, whereas URS provides a less invasive option with a lower risk of complications for small stones. Both techniques require tailored approaches based on stone composition-mostly calcium oxalate-and specific patient anatomical factors. This review underscores the importance of early diagnosis, appropriate treatment selection, and continuous post-treatment monitoring to mitigate risks and promote long-term renal function in transplant recipients.

Incidence of metabolic syndrome in patients with unilateral or bilateral staghorn renal stones and its impact on percutaneous nephrolithotomy outcomes

BackgroundTo evaluate the incidence of metabolic syndrome (MetS) in patients with unilateral and bilateral staghorn calculi (SC) and evaluate the impact on the outcome of percutaneous nephrolithotomy (PCNL).MethodsThe clinical data of patients who underwent PCNL for the treatment of SC between 2019 and 2022 were retrospectively reviewed. SC was divided into unilateral and bilateral. The incidence of MetS was compared between the patients with unilateral SC and the patients with bilateral SC, and the impact on the outcome of PCNL was assessed.ResultsA total of 1778 patients underwent PCNL between 2019 and 2022. After screening computed tomography, 379 patients were confirmed to have SC, finally, leaving 310 patients with follow-up and complete data to be included in the study. Eighty-four had bilateral SC and 226 had unilateral SC. The patients with bilateral SC had a significantly higher body mass index and higher rates of complete staghorn stones and metabolic syndrome. Higher body mass index, hypertension, diabetes mellitus, hyperlipidaemia, and MetS were present in 62.58%, 44.84%, 21.94%, 60.65% and 27.42% of all patients, respectively. The number of MetS components remained significantly associated with bilateral SC. Specifically, when the number of MetS components increases from 0 to 3–4, the likelihood of developing bilateral staghorn calculi increases by 21.967 times. Eighty-five patients with MetS( +) had a higher rate of overall complications (number (N)(%), 29 (34.12) vs.33 (14.46), P < 0.001) and a comparable stone-free rate to 225 MetS(-) patients. Multivariable analysis confirmed that hyperlipidaemia (P = 0.044, odds ratio [OR] = 1.991, 95% confidence interval [CI] 1.020–3.888) and MetS (P = 0.005, OR = 2.427, 95% CI 1.316–4.477) were independent risk factors for overall complications.ConclusionsMetS is correlated with the formation of bilateral SC and is the main predictor for complications of PCNL especially for low-grade complications (I-II).

Comparison of conventional percutaneous nephrolithotomy versus endoscopic combined intrarenal surgery in complex renal calculus – Our institutional experience

Background: Complex renal calculi, characterized by their size, location, and composition, pose a significant challenge to urologists due to the potential for complications and the difficulty in achieving complete stone clearance. Conventional percutaneous nephrolithotomy (PCNL) and endoscopic combined intrarenal surgery (ECIRS) are two established techniques for managing these complex renal calculi. Aims and Objectives: The aims and objectives are to compare the effectiveness, safety, and outcomes of PCNL versus ECIRS in managing complex renal calculi in a cohort of 60 cases treated at GMKMCH-Salem. Materials and Methods: A retrospective analysis was conducted on 60 patients with complex renal calculi who underwent either conventional PCNL or ECIRS during a specified period at GMKMCH-Salem. Patient demographics, stone characteristics, procedural details, intraoperative and post-operative parameters, and complications were analyzed and compared between the two treatment groups. Results: The study found that both PCNL and ECIRS techniques were effective in treating complex renal calculi. However, significant differences were observed between the two groups in terms of outcomes. The ECIRS technique exhibited superior outcomes with higher stone clearance rates (P&lt;0.001), shorter operative times (P&lt;0.05), and reduced hospital stays (P&lt;0.05) compared to conventional PCNL. Conclusion: This study demonstrates that ECIRS is a promising alternative to conventional PCNL in the management of complex renal calculi. The ECIRS technique yielded higher stone clearance rates, shorter operative times, and reduced hospital stays, potentially improving patient outcomes and reducing health-care costs. Although our findings show favorable results for ECIRS, the decision between conventional PCNL and ECIRS should be based on individual patient characteristics, surgeon expertise, and resource availability.

Inter-Observer Reliability and Reproducibility of CROES, Guy’s and STONE Nephrolithometry Scoring Systems for Predicting Percutaneous Nephrolithotomy Outcomes

Objective: To assess inter-observer reliability and reproducibility of CROES, Guy’s and S.T.O.N.E. nephrolithometry scoring systems (NSS). Material and Methods: A total of 128 patients who underwent percutaneous nephrolithotomy (PNL) between January 2019 and January 2021 were included in the study. Calculation of the CROES, S.T.O.N.E, and Guy’s NSSs was made by three independent urologists with different academic levels. These were; a very experienced (&gt;500 PCNL cases) endourologist (Rater 1), a urologist who had just finished (&gt;100 PCNL cases) their urology education (Rater 2) and a 3rd year urology resident who had never performed a PCNL operation (Rater 3). All were blinded to the procedure outcomes. Results: An excellent correlation was found between three raters for Guy and S.T.O.N.E. scoring systems (kappa value 0.810-0.962). However, for the CROES score there is an excellent correlation between Rater 1 and Rater 2, but there were good correlations between Rater 1 vs Rater 3 and Rater 2 vs Rater 3 (kappa values 0.910 and 0.698-0.721 respectively). The highest correlation was between Rater 1 and Rater 2 for Guy score (kappa value 0.962) (Table 3). All intra-class correlations were statistically significant (p&lt;0.001). The highest intra-class correlations were seen for the S.T.O.N.E. score (ICC: 0.980). Conclusion: The present study revealed that all three NSS frequently used in current urology practice have reproducible and reliable results. Additionally, we believe that the application of CROES NSS by more experienced clinicians will be effective in obtaining clearer results.

Initial experience of percutaneous nephrolithotomy surgery in secondary hospital in Bali

Background. The formation of kidney stones is the result of the accumulation of crystals within the kidneys. Percutaneous nephrolithotomy (PCNL) is the preferred method for treating stones larger than 2 cm. This study aims to analyse outcomes and experiences of PCNL for kidney stone removal. Materials and methods. It was a descriptive study with a cross-sectional design, utilizing secondary data from electronic medical records in Klungkung General Hospital. There are 91 samples collected using total sampling between October 2020 and August 2023. The analysis was conducted using the SPSS Statistics 26. Results. The 51–60 age group (38.5 %) exhibited the highest prevalence of patients undergoing PCNL surgery. The most common type of stone was solitary (48.4 % of cases), with an average size of 3.570 ± 1.159 cm. The mean duration of the procedure was 38.630 ± 21.667 minutes, with a single puncture utilized in 68.1 % of cases. The pain levels experienced were generally low, with a mean score of 2 on a 10-point scale. The mean length of hospital stay was 2.330 ± 1.012 days. The outcomes of PCNL in patients with kidney stones were favourable, with a high stone-free rate of 92.3 % and minimal complications. Рostoperative complications were infrequent. Conclusions. It is suggested that PCNL is an effective and safe procedure for kidney stone removal.

Propensity Score-Matched Analysis of Perioperative Outcomes of Supine versus Prone Percutaneous Nephrolithotomy.

Objective: To compare the perioperative outcomes of supine and prone percutaneous nephrolithotomy (PCNL). Methods: A retrospective search of a tertiary medical center database yielded 517 patients who underwent supine (n = 91) or prone (n = 426) PCNL between September 2015 and July 2020. Data on demographics, baseline clinical parameters, and stone burden were included as predictors in a logistic regression model, generating a set of propensity scores. Seventy patients after supine PCNL were propensity score-matched 1:1 with patients after prone PCNL and compared for operative time, perioperative complications, system complexity, and stone-free rate. Results: We found that the operative time was significantly shorter in the supine PCNL group than in the prone PCNL group (85.5 ± 25.2 min vs. 96.4 ± 25.8 min, respectively; p = 0.012). The majority of both groups had low-grade (I-II) complexity systems (85.6% and 88.6%, respectively), with no significant difference among all grade groups (p = 0.749). There were no significant differences between the supine and prone PCNL groups in terms of the overall perioperative complication rate (8.6% vs. 4.3%, respectively; p = 0.301) or stone-free rate (74.3 vs. 65.7%, respectively; p = 0.356), while the rate of blood transfusion was significantly higher in the supine group (p = 0.023). Conclusions: In our study, we used propensity score matching to compare patients who underwent PCNL in the supine or prone position, adjusting for selection bias. Supine PCNL was associated with a shorter operative time but a higher blood transfusion rate, with no differences in the overall complication and stone-free rates.

Bilateral Single-session PCNL with Minimally Invasive Technique in Pediatric Nephrolithiasis.

To assess outcomes of bilateral single-session percutaneous nephrolithotomy (PCNL) with minimally invasive techniques in pediatric population. From August 2015 to July 2021, 45 children (including 12 infants) were treated with bilateral single-session PCNL, which included miniPCNL (12-16-Fr) and Microperc (4.8-Fr). Patient, stone and operation-related characteristics, stone-free rate (SFR) and complication rate (CR) were compared using ANOVA. Independent predictors were determined using multivariate linear regression. The mean stone burden was 3.2 cm in sum diameter for both kidneys. For bilateral kidneys, the mean operative time was 61.6min and SFR was 93.3%; CR was 53.3%, of which complications of Clavien grade 1 and 2 accounted for 46.7%. Bilateral Microperc, bilateral miniPCNL and Microperc plus miniPCNL was performed in 19, 14 and 12 children respectively. Both irrigation volume and postoperative stay were less in groups with Microperc. Both SFRs and CRs were satisfactory for the three groups. Self-limiting hematuria represented the most common complication of all cases (33.3%), especially in groups with miniPCNL. The stone burden was the only independent predictor for operative time (P < .001) and the postoperative complication (P = .008). Children with older age (P = .009), higher body mass index (P = .016) or a higher stone burden (P < .001) received larger irrigated fluid volume. Microperc was associated with less irrigated fluid volume (P = .001). Children with Clavien grade 3 complications (P = .004) spent prolonged postoperative hospital stay. With favourable SFR and acceptable CR, bilateral single-session PCNL with minimally invasive techniques might be an effective and safe procedure for pediatric nephrolithiasis.

Is the Mayo Adhesive Probability Score Predictive in Patients Undergoing Percutaneous Nephrolithotomy?

Introduction: Mayo Adhesive Probability (MAP) score was developed as a means to predict the presence of adherent perinephric fat. Our aim was to determine the predictive value of the MAP score on surgical outcomes in patients undergoing standard adult percutaneous nephrolithotomy (PCNL). Materials and Methods: We retrospectively analyzed the data from 130 renal units that underwent PCNL between January 2022 and 2023. MAP scores 0-2 were classified as low, whereas MAP scores 3-5 were classified as high. The impact of the MAP score on perioperative and postoperative outcomes was studied. All statistical analyses were performed using SPSS 24.0 for Windows. Results: The median age of the patients at the time of surgery was 48 (21) years, with a female-to-male ratio of 1:1.82. The median MAP score was 2 (2), with 43.8% of patients falling into the high MAP score group. Advanced age, hypertension history, low estimated glomerular filtration rate (eGFR) levels, and low renal parenchymal thickness were significantly higher in the high MAP score group (P = .010, P = .004, P = .001, and P = .005, respectively). Female patients had a significantly higher MAP score of 0 (P = .021). Operation time, postoperative hematocrit decrease, blood transfusion rate, postoperative fever rate, hospitalization, and stone-free rates were comparable between the low and high MAP score groups (P = .535, P = .209, P = .313, P = .289, P = .281, and P = .264, respectively). Gender and eGFR levels were shown to be significant predictors of a MAP ≥3 (P = .004 and P = .003, respectively). Conclusion: The present study showed that the MAP score groups had similar perioperative and postoperative results. Low eGFR levels and the male gender were associated with MAP score ≥3. To determine the predictive MAP score value for PCNL outcomes, more prospective studies are needed.

Stone Free Success Rate by Using Modified Guy’s Scoring System in Patients Undergoing Percutaneous Nephrolithotomy

Background: Renal stone disease (RSD) is a prevalent condition globally, with significant impacts on patient health and healthcare systems. The complexity of RSD management, particularly in achieving high stone-free rates (SFR) with minimal complications, necessitates ongoing research into effective treatment modalities. Percutaneous nephrolithotomy (PCNL) has emerged as a standard treatment, but predicting its success pre-operatively remains a challenge. Objective: The study aimed to evaluate the efficacy of the Modified Guy’s Stone Score (M-GSS) in predicting the SFR in patients undergoing PCNL, and to analyze the relationship between various patient and stone characteristics and the success of the procedure. Methods: This descriptive case series study involved 161 patients undergoing PCNL at a tertiary care center. Data on patient demographics, stone characteristics, and operative details were collected. Stones were classified using the M-GSS, and PCNL outcomes were assessed in terms of SFR. Statistical analysis was performed using SPSS 23.0, with a focus on the correlation between M-GSS grades and SFR. Results: The overall SFR was 59.6%. The majority of patients (38.5%) were classified as M-GSS grade 1. The mean stone size was 2.74 ± 1.6 cm, and the mean operative time was 73.4 ± 14.6 minutes. There was no significant difference in SFR across different M-GSS grades (p=0.236). Stone size was the only factor significantly affecting the SFR (p=0.0001). Conclusion: The study indicates that while M-GSS is a useful tool for preoperative assessment in PCNL, stone size remains a crucial determinant of SFR. The findings suggest the need for further research, particularly larger, multi-center randomized studies, to validate these results and refine preoperative patient counseling and outcome prediction strategies in PCNL.

Clinical Utility of S.T.O.N.E, Guy's Scoring System, and Renal Stone Complexity Scoring in Predicting Outcome of Single-Tract Percutaneous Nephrolithotomy.

Several imaging-basedscores have been developed to predict postoperative stone-free state (SFS) and complications. This study aimed to assess the accuracyof the S.T.O.N.E., Guy Scoring System (GSS), and Seoul National University Renal Stone Complexity (S-ReSCS) scores inpredicting theoutcomes of single-tract percutaneous nephrolithotomy (ST-PCNL). This scoring system holds paramount importance for low-incomeand low-middle-income countries (LMICs), as it is inexpensive and cost-effective for the healthcare system. This retrospective study was carried out with 147 participants. Based on the preoperative computerized tomographic (CT) scan, each patient's S.T.O.N.E. score, GSS, and S-ReSCS were recorded. The modified Clavien grading system was used to document intra- and postoperative complications. The mean age of the sample population was 45 years. SFS was achieved in 110 (74.8%) patients. The number of calyces involved (p = 0.008), S.T.O.N.E. scoring (p = 0.001), GSS (p = 0.008), and S-ReSCS (0.001) correlated well with the SFS. Forty-nine (33.33%) patients developed complications. The most common complications fell within Clavien grade II. No statistical significance was noted between the S.T.O.N.E. score, GSS, and S-ReSCS with the modified Clavien grading system. The S.T.O.N.E. scoring, GSS, and S-ReSCS have a high predictive value for achieving SFS in ST-PCNL. In addition, findings from LMICs are comparable with those from the rest of the world.

Outcomes and Complications of Percutaneous Nephrolithotomy (PCNL) at Al-Ribat Urology Center (Omer Sawi Hospital)

BACKGROUND: Percutaneous nephrolithotomy generally is safe, effective, and associated with a few but specific complications. However, the definition of complications of PCNL and their management still lacks consensus. PCNL is the first-line approach for large, multiple, and inferior calyx renal stones according to the European Association of Urology (EAU) guidelines. We aimed to evaluate the Technique, Outcome, and Complication of percutaneous Nephrolithotomy at Al-ribat Urology Center (Omer Sawi Hospital). METHODS: A prospective, institutional-based cross-sectional study was used to investigated all patients presented to the study area with renal stones during the period from November 2019 to January 2020 in Al-Rebat Hospital. . A total of 28 patients were enrolled using multi-stage sampling. The researcher completed a validated questionnaire consisting of several sections to assess outcomes and complications of percutaneous nephrolithotomy. RESULTS: the study assessed the outcome of PCNL among 28 patients. The study found that the mean size of stones recorded was 1.25 cm, and the stones were on the left and right kidneys in 53.6%, and 46.4% respectively. Stones present by a percentage of 10.7%,28.6%, and 53.6% in the upper and lower calyx and pelvis respectively. The stones were rounded in 78.6% and staghorn in 21.4%. the stone was single in 53.6% and multiple in 46.4%. all operations were done under fluoroscopy guidance. Patients were supine in 25% and prone in 75% of the operations. The mean operative time was 27.9 minutes calculated from puncture time does not include retrograde and positioning. In addition to that 57.1% of the patients had nephrostomy tubes and double J. 92.9% of the patients were stones-free at the end of the operation. Injury to the surrounding organs did not occur. Mild bleeding occurs in 10.7% of the patients, in which blood transfusion was necessary. Extravasation of fluid occurs in 10.7%. Fever occurs in 42.9%. Most of the patients stay for 1 day postoperatively 57.1%. CONCLUSION: This study demonstrated that PCNL is a safe elective, minimally invasive surgical modality with good outcomes and lower incidences of major complications.

Prediction of percutaneous nephrolithotomy outcomes and flexible ureteroscopy outcomes using nephrolithometry scoring systems.

Kidney stones account for a high proportion of urological emergencies. The main objective of this paper is to evaluate the predictive ability of five scoring systems for overall stone-free status and postoperative complications after percutaneous nephrolithotomy and retrograde ureteroscopy. This study retrospectively analysed 312 cases of kidney stone patients between January 2021 and May 2022 at our centre. Multivariate logistic regression as well as ROC curves were applied to determine the ability to evaluate each scale to predict stone-free rates and postoperative complications. 179 patients have undergone PCNL. After multivariate logistic regression, the S.T.O.N.E score and history of ipsilateral renal surgery were predictive of stone-free status, and the predictive power of the S.T.O.N.E score was higher than that of history of ipsilateral renal surgery. Grade 1 complications were considered to be related to Guy's score and grade 2 complications were considered to be related to history of diabetes mellitus. 133 patients have undergone f-URS. After multivariate logistic regression analysis, the modified S-ReSC score, RUSS score, and R.I.R.S score were predictive of stone-free status, with the R.I.R.S score being the strongest predictor. Evidence of grade 2 complications was considered to be related to abnormal renal function. For PCNL, the S.T.O.N.E score had the best efficacy in predicting stone-free status, and the Guy's score had the best efficacy in predicting postoperative complications; for f-URS, the R.I.R.S score had the best efficacy in predicting stone-free status, and no scoring system predicted postoperative complications.