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Percutaneous Nephrolithotomy

Percutaneous Nephrolithotomy. Jim Armitage, Stuart Irving and Neil Burgess on behalf of the BAUS Section of Endourology Annual Meeting 1 st September 2011. Demographics. 9 th January 2010 - 21 st July 2011 (18 months) 52 consultants from 41 centres 926 cases 484 male ; 432 female

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Percutaneous Nephrolithotomy

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  1. Percutaneous Nephrolithotomy Jim Armitage, Stuart Irving and Neil Burgess on behalf of the BAUS Section of Endourology Annual Meeting 1st September 2011

  2. Demographics 9th January 2010 - 21st July 2011 (18 months) 52 consultants from 41 centres 926 cases 484 male ; 432 female Median number of cases per consultant 11 (Range 1-76)

  3. Operative details • Stone size • 0-1cm - 7% 1-2cm - 26% >2cm - 47% • Complete staghorn - 9% Partial staghorn - 10% • Multiple stones - 54% • Side • 512 Left ; 371 Right • 95% Prone ; 5% Supine

  4. Operative details • Renal Access • Urologist - 40% Radiologist - 60% • Subcostal - 92% Supracostal - 8% • Fluoroscopy - 71% • Ultrasound - 3% • Both - 26% • CT - 0.1% • Number of Tracts • 1 - 93% 2 - 6% 3 - 0.7%

  5. Operative details • Pre-op MSU • 91% • Fragmentation • Ultrasound - 41% • Lithoclast - 31% • Lift out - 21% • Laser - 7% • Flexible renoscopy • 48%

  6. Operative details • Complete stone clearance • Fluoroscopy - 81% • Day 1 post-op imaging - 69% • Staghorn calculi • Fluoroscopy - 58% • Day 1 post-op imaging - 44%

  7. Operative details • Drainage • Nephrostomy only - 53% • Ureteric stent only - 8% • Nephrostomy + Stent - 15% • Ureteric catheter only - 1% • Nephrostomy + Ureteric catheter - 8% • Totally tubeless - 15% • Median post-operative stay • 3 days (Range 1-72)

  8. Morbidity • Procedure abandoned • 4% • Failed access, n=6 • Inaccessible stones, n=7 • Bleeding, n=5 • Other, n=4 • Visceral injury • 0.5% • Pleural injury, n=3 • Colon injury, n=1

  9. Morbidity • Transfusion • 2.4% • Infection • Fever - 17% • SIRS/sepsis - 2% • HDU admission • 3.4% (approximately two-thirds planned)

  10. Mortality • 10 deaths (1.1%) • Cancer (non-urological), n=4 • Cancer (urological), n=1 • Non-cancer, n=4 • Unknown, n=1

  11. Personal feedback • Number of cases • Stone characteristics • Procedures abandoned • Transfusion rate • Sepsis rate • Visceral injury • Length of stay • Stone free rate - fluoroscopy

  12. Conclusions • The first prospectively maintained PCNL registry with online data entry • Facilitates personal audit against national standards • Data quality is good • 78% of records had complete data on stone size, visceral injury, transfusion, sepsis and stone clearance rates • Recording of areas such as grading of stone complexity, classification of complications and post-operative imaging could be improved

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