Percutaneous Nephrolithotomy in High-Risk Patients: A Single-Center Experience with More than 350 Cases

Abstract

Purpose: To assess the surgical outcomes and peri- and postoperative complications following percutaneous nephrolithotomy (PCNL) in high- and low-risk patients according to the American Society of Anesthesiologists (ASA) score. Materials and Methods: We reviewed the patient records of 2,281 cases older than 18 years who had undergone PCNL in the 3 previous years. The patients were divided into two groups: a low-risk group (ASA score 1, 2: 1,922 cases) and a high-risk group (ASA score 3, 4: 359 cases). Results: Analysis of the location and size of the stone, number and type of access, surgical approach, post-PCNL serum hemoglobin and decrease in glomerular filtration rate revealed no significant difference between the two groups. The stone-free rate was similar in both groups and the hospital stay in the high-risk patients was significantly greater than in the low-risk cases. 95% of low-risk and 91% of high-risk cases had surgical complications compatible with grade ≤II (Clavien system) and overall distribution of different grades of surgical complications was similar between the two groups (p = 0.177). Conclusion: Success rate and surgical complications of PCNL in high-risk patients were comparable to low-risk patients. It seems that PCNL may be a safe and effective procedure even in high-risk patients.

Comparison of intraoperative and postoperative complications based on ASA risks in patients who underwent percutaneous nephrolithotomy

“…[10] In elder people evaluation of surgical outcomes, and complications may predict surgical prognosis in patients with high risk. [11] In a study published by Unsal et al [12] in the year 2012, increases in preoperative comorbidity, and postoperative complications in parallel with age were reported. This study tends to support the study by Resorlu et al [13] In other words statistically significant increases in the incidence of postoperative bleeding in line with increases in Charlson Comorbidity Index (a scoring system for the determination of the number, and grade of underlying diseases) scores are seen.…”

“…[21] Still in a separate study, a statistically significant difference was not detected between ASA risk groups,and any Clavien complication class. [22] In two separate studies performed by Toksöz et al [23] , and Nouralizadeh et al [11] the patients were divided into low (ASA I-II), and high risk (ASA III-IV) groups. According to Clavien classification, a statistically significant intergroup difference was not found regarding postoperative complications, and safe application of PNL even in high-risk patients was reported.…”

Ambulatory percutaneous nephrolithotomy is safe and effective in patients with extended selection criteria

“…However, the impact of patient comorbidities and stone burden on outcomes after inpatient PCNL have been examined extensively in other studies and was not the focus of our study. 14,[18][19][20] We also did not evaluate any patient reported outcomes. Strengths of our study were the large sample size (second largest ambulatory PCNL cohort that has been published).…”

The effect of the American Society of Anesthesiology classification scores on complications associated with percutaneous nephrolithotomy

“…(PCNL) is a standard operation in following cases: staghorn stones larger than 20 mm, stones resistant to shock wave lithotripsy (SWL), cystine stones, patients with anatomically anomalous upper urinary system, patients with anatomical defects (scoliosis, kyphosis or spasticity), lower pole stones larger than 15 mm and stones in transplant kidneys (2,3). The reliability, efficacy and complication rates of the PCNL operation in elderly patients have been evaluated in many studies, just like the impact of the American Society of Anesthesiologist (ASA) classification scores (4)(5)(6)(7)(8)(9)(10). The prevalence of systemic diseases increases with aging.…”