Contemporary practice of percutaneous nephrolithotomy: review of practice in a single region of the UK.
BACKGROUND
Most series of percutaneous nephrolithotomy (PCNL) from single specialised centres represent optimum results achievable and may not reflect outcomes of everyday practice. We analysed the practice in our region.


METHODS
Medical records of 178 patients undergoing PCNL in 2002 in 12 participating hospital trusts were retrospectively analysed.


RESULTS
Even outside the tertiary referral centres, there was a 6-fold difference between trusts in the frequency of PCNL. In 28% of cases, another stone-removing modality had been tried first. Failed renal puncture was a major cause of abandoning surgery (9%). An indication of the difficulty in obtaining complete stone clearance is that only 107 (60%) operation notes recorded complete clearance, while 75 (42%) patients required a subsequent procedure (13% a secondary PCNL). Use of supra 12th rib punctures was small (6%) as was the rate of 'tube-less' PCNL (4%). Some 22% had simultaneous ureteric stent insertion. Approximately 8% of cases required a blood transfusion. Thirty-eight patients (23%) had a proven infection (UTI) pre-operatively (> 10(4) organisms; > 10 white blood cells) with almost all patients receiving antibiotics at anaesthesia induction. Postoperative sepsis rates (temperature > 38.5 degrees C) were similar in those with and without a pre-operative UTI (18.4% versus 14.3%) and pre-operative antibiotics appeared to have little extra protective effect. Severe sepsis was rare with no patient requiring intensive care admission for this reason. Median length of stay postoperatively was 5 days.


CONCLUSIONS
These results present important figures to quote when counselling patients pre-operatively, albeit that the degree of difficulty (and hence the likelihood of problems) is identifiable from stone and anatomical configurations. In addition, the present data are a more accurate reflection of urinary stone surgery in non-tertiary, general urological practice.
Srirangam
Shalom J
SJ
Department of Urology, Blackburn Royal Infirmary, Blackburn, UK. sjsrirangam@yahoo.co.uk
Darling
Richard
R
Stopford
Maureen
M
Neilson
Donald
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004106:Dilatation / Q000379:methods; D004739:England; D006760:Hospitalization; D006801:Humans; D007669:Kidney Calculi / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D007902:Length of Stay; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D011364:Professional Practice / Q000706:statistics & numerical data*; D011677:Punctures / Q000379:methods; D015641:Radiography, Interventional; D018805:Sepsis / Q000188:drug therapy / Q000209:etiology
D000900:Anti-Bacterial Agents