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Outcomes of more than 1 000 percutaneous nephrolithotomies and validation of Guy's stone score
Author(s) -
de Souza Melo Petronio Augusto,
Vicentini Fabio Carvalho,
Beraldi Artur Agostinho,
Hisano Marcelo,
Murta Claudio Bovolenta,
de Almeida Claro Joaquim Francisco
Publication year - 2018
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14129
Subject(s) - percutaneous nephrolithotomy , medicine , fluoroscopy , percutaneous , surgery , renal stone , computed tomography , nuclear medicine , urinary system
Objective To present the experience with percutaneous nephrolithotomy (PCNL) at a high‐volume Brazilian centre and to evaluate Guy's stone score (GSS) as a predictor of success and complications in PCNL. Patients and Methods We prospectively evaluated patients who underwent PCNL between June 2011 and October 2016. Indications for PCNL included renal stones >2 cm in size and stones <2 cm in size in which first‐line techniques had failed. All patients underwent a complete preoperative evaluation, including non‐contrast‐enhanced abdominal computed tomography (CT). Stone complexity was assessed using GSS. Success was defined as the absence of fragments >2 mm on CT on postoperative day 1. Complications were classified according to the Clavien grade. Results A total of 1 066 PCNLs were performed on 891 patients. In all, 20.2% were classified as GSS1, 27.4% as GSS2, 35.0% as GSS3, and 17.4% as GSS4. The mean operating time was 108.44 min, and the mean fluoroscopy time was 13.57 min. The overall immediate success rate based on postoperative day 1 CT was 43.8%. Complications occurred in 14.9% of cases, and the mean length of hospital stay was 54.55 h. Stratifying patients according to GSS, success rate was inversely proportional to the calculus complexity: GSS1: 87.9%; GSS2: 62.1%; GSS3: 44.0%; and GSS4: 24.3% ( P < 0.001). Higher GSS categories were significantly correlated with the number of puncture tracts ( P < 0.001), operating time ( P < 0.001), fluoroscopy time ( P < 0.001), blood transfusion rate ( P < 0.001), complications ( P < 0.001) and length of stay ( P < 0.001). Conclusion In a high‐volume centre, PCNL was a reliable surgical technique, with low morbidity and short hospital stay. GSS was confirmed to be a very useful tool for predicting the outcomes of PCNL, and its use should be encouraged.