A contemporary Australian percutaneous nephrolithotomy practice audit.

1. No. 039 A contemporary Australian percutaneousnephrolithotomy practice audit. Benchmarking against international results. T Smith, E Havranek, L Van Den Boogaard, P MacTaggert, M Lawson, S Wood Urology Department, Princess Alexandra Hospital, Brisbane • Results • The mean age of patients undergoing PCNL was 55 (range 22 to 84) and 55% were male, similar to the population from the BAUS audit. • 57% of stones were >2cm with 34% either partial or complete staghorns. Only 12% of stones in the BAUS audit were staghorns. 23% of our cases had difficult access due to obesity, calycealdiverticulae, neuropathology or ileal conduits. • There was greater reliance on CT at PAH with 79% of patients undergoing preoperative CT, compared with 49% in the BAUS cohort. The two groups also differed significantly in the proportion of punctures performed by urologists over radiologists. • Overall 28% of patients required adjuvant therapy, with 15% undergoing repeat PCNL. The stone free rate at three month follow up was 63%, comparative to the BAUS rate of 62%. For patients with staghorn calculi the clearance rate was 68% at three months, higher than the 50% rate from the BAUS group. • The procedure was abandoned in 17% of patients due to failed access, inaccessible stones or intraoperative bleeding, compared with 20% in the BAUS group. 6% of patients required transfusion and 2.6% experienced urine leak compared with 3.4% and 1% respectively in the BAUS group. There were no visceral injuries or deaths in the PAH cohort. Introduction There is a paucity of contemporary outcome data on the practice of percutaneousnephrolithotomy (PCNL) in Australia. The British Association of Urological Surgeons (BAUS) recently conducted a retrospective audit of PCNL practice in the United Kingdom, and now maintains an online prospective data registry for the procedure. 82% 18% 74% 9% 94% 6% 86% 8% 0.4% PA Hospital BAUS Radiologist Urologist • Aim • To benchmark contemporary PCNL practice at a single Australian hospital against data from the multi-centre retrospective audit conducted by the BAUS in 2007 (1). 10% 90% 70% 28% Subcostal Supracostal 1 tract 2 tracts 3 tracts Comparison of puncture techniques between groups Methods Records were obtained for 115 consecutive patients who underwent PCNL at the Princess Alexandra Hospital (PAH), a tertiary level teaching hospital in Brisbane, between January 2007 and March 2010. A comprehensive retrospective review of each patient’s operation note, inpatient progress notes, discharge summary, radiology and pathology results, and outpatient notes was conducted. Data was collected for the BAUS PCNL audit dataset. The results were compared to the published outcomes of the 2010 BAUS retrospective audit. 70% 65% 60% 55% 50% 45% 40% 68% 68% 63% 63% 62% 56% 56% 50% • Conclusions • The results from this audit compare favourably to the international multi-centre series published by the BAUS. Results from both PAH and BAUS reflect the difficult technical challenges in dealing with staghorn calculi. This series will be useful for other Australian Hospitals to benchmark their results against. 1-2cm >2cm Staghorn Total PA Hospital BAUS Percentage of patients stone free at three month follow up • References • 1. Bayles A, Chitale S, Irving S, Burgess N. An audit of percutaneousnephrolithotomy in the United Kingdom. British Journal of Medical and Surgical Urology. 2011 May;4(3):119–125. • Acknowledgements • Thank you to Ian Wilson, research assistant at the PAH Urology Department. Poster presentation sponsor