Do previous percutaneous renal procedures affect the outcome of ultrasound-guided PCNL? A study at a large-volume center.

PURPOSE: This study aimed to investigate the influence of previous percutaneous renal procedures on the outcome of ultrasound (US)-guided percutaneous nephrolithotomy (PCNL) in patients with upper urinary tract stones.

PATIENTS AND

METHODS

Patients with a history of percutaneous renal procedures (PCNL/renal nephrostomy) from July 2017 to June 2023 were enrolled in this study as Group 1 (n = 77). Patients who underwent PCNL during the same period and had no history of percutaneous renal puncture surgery were enrolled in Group 2 (n = 160). All the procedures were performed under US guidance. Standard access (22-24 Fr) was achieved in all patients in the prone position. Relevant patient characteristics, operative variables, and postoperative data were collected and analyzed, focusing on the stone-free rate (SFR) and complications.

RESULTS

The procedure was successful in all patients. The patients' basic characteristics (gender, age, BMI, and stone size) were similar between the two groups. Puncture time and access creation time were significantly longer in Group 1 than in Group 2 (p = 0.02, p = 0.01). Similarly, Group 1 demonstrated a significantly higher number of access tracts compared to Group 2 (p = 0.02). The final SFR in Group 1 showed no significant difference compared to Group 2 (p = 0.09). Operative duration in Group 1 was longer than in Group 2 (p = 0.1). Postoperative hospitalization, hemoglobin loss, transfusion rate, embolization rate, and overall complication rate were not significantly different between the two groups.

CONCLUSION

Ultrasound-guided PCNL is safe and effective for patients with prior PCNL history, demonstrating an acceptable SFR. However, these cases exhibited prolonged access creation time, increased operative duration, and required more surgical tracts compared to naive cases.