Percutaneous management of large renal stones in a private practice community setting.
OBJECTIVE
Recent evidence suggests that increasing numbers of patients with large renal stones are treated at tertiary care centers. Studies of practice patterns in the community have demonstrated that private practice urologists perform few percutaneous nephrolithotomies (PCNLs) and rely heavily on interventional radiologists to obtain renal access. We reviewed our series of PCNLs performed in a community setting, with a focus on success rates and complications, to compare results and effectiveness rates with those of tertiary care centers.


METHODS
All patients undergoing PCNL for large renal calculi from 1993 to 2006 were included. All procedures were performed by a single surgeon who obtained percutaneous renal access without the assistance of a radiologist. Data were retrospectively reviewed to determine clinical success rates, intraoperative and postoperative complications, and rate of additional procedures.


RESULTS
Two hundred and four PCNLs were performed in 170 patients. In 43 cases, more than one percutaneous tract was created. Mean blood loss was 260 mL (range 50-800 mL), and transfusion was necessary in 2% (4/204). In 194 (95.1%) procedures, treatment was considered successful with asymptomatic fragments of 4 mm or smaller. Of these, there was no significant stone burden after a single procedure in 117. Mean hospital stay was 3 days (range 1-15 days). No intraoperative complications occurred. The overall complication rate was 6.9%.


CONCLUSIONS
The high success rate of our single, private practice experience is comparable to that of major academic centers. We believe PCNL can be safely and effectively performed in the private practice setting by urologists trained in the procedure.
Meinbach
David S
DS
Urology Centers of Alabama, Birmingham, Alabama, USA. dmeinbach@gmail.com
Modling
Douglas
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003151:Community Health Centers; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D011331:Private Practice; D012189:Retrospective Studies; D016896:Treatment Outcome