Institutional Audit on Percutaneous Nephrolithotomy

Kumar Gaurav Mishra, Anshul Garg, Rajesh Tiwari, Kamlesh Gunjan, Pawan Kumar bharti

Abstract


Background: Percutaneous nephrolithotomy (PCNL) is commonly used in the management of large upper renal tract stones. It is highly effective but carries a greater risk of significant morbidity than less invasive treatment options such as ureteroscopy or extracorporeal shock wave lithotripsy

Aims and Objectives: To analyse contemporary PCNL practice within our institute with an emphasis on outcome measures, including stone free and reduced complication rates and compare our data with previously published series.

Material and Methods: A prospective study was conducted in 145 patients from January 2015 to June 2016 in Department of Urology, Indira Gandhi Institute of Medical Sciences who underwent PCNL procedure as per standard protocols. Effectiveness was assessed by stone-free rates and safety according to complications including blood transfusion, fever, and sepsis rates

Results: From January 2015 to June 2016, data on 145 patients who had PCNL procedures were collected. A total 17 of 145 procedures (11.7%) were for staghorncalculi, 84 (58%) for stones >2 cm, 41(28.3%) for stones 1–2 cm, and 3 (2.1%) for stones<1 cm. Complete stone clearance has been achieved in more than three fourth of the cases (76.6.%). Totally tubeless procedures were not associated with higher complication rates but did lead to a significant reduction in median length of stay (3 d vs 1.5 d; p <0.0001). Blood transfusion was required in 10 of 145 patients (6.4%). The incidence of postoperative fever was 19% and of sepsis was 4%.

Conclusion: The PCNL data registry is a unique resource providing vital information on current practice and critical outcome data. Using the registry, endourologists can audit their practice against national outcome data for this benchmark procedure. It will help surgeons counsel patients during consent for this complex endourologic procedure about the possible outcome in their hands.

Keywords


PCNL, Staghorn, calculi, urolithiassis, audit.

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