Our 5-year experience of performing percutaneous nephrolithotomy on patients with large and staghorn kidney stones

In this article we present our experience and analysis of peri- and postoperative complications after percutaneous nephrolithtomy (PCNL) in patients with large and staghorn kidney stones. In period from 2009 up to 2013 we have performed 1649 PCNLs with a growth tendency of 36% pro year. Median of the patient age was 51 years (IQR 36, 65). Median of the stone size was 51 mm (IQR 32, 68) with the median of volume 643,9 mm 3 (IQR 351,3, 1106,4). The stones with a size more than 2 cm were present in 552 (33,5%) patients. Staghorn stones of the stage 1-2 were evident in 461 (28%) patients, stage 3-4 - in 634 (38,5%) patients. The operation due to the stone recurrence was carried out in 947 (57,5%) patients. Among patients 1120 (67,9%) had a bacteriuria. Dilatation of the upper tract was present in 1056 (64,1%) patients. Median of the function deficiency of the kidney at the operation side was 28 % (IQR 29, 46). Stone-free rate was 76.7% (1264 patients). As clinically significant were considered stone fragments with a size more than 3 mm. Endopielothomy was carried out in 216 patients (13,1%) at time of the PCNL. Mean operation duration was 87,7±24,5 minutes. Intraoperative bleeding was evident in 246 patients out of 1648 (14,9%). Median of hospitalization duration was 9 (7-12) days. Postoperative complications were graded to the Clavien system. Grade I complications were present in 12.4% of patients, grade II - 24,9%, grade IIIa - 5,7%, grade IIIb - 2,5%, grade IVa - 0,12%, grade IVb - 1,5%. Grade V (death) complication were present in 0,12% of all patients (2 cases).