Percutaneous nephrolithotomy can be safely performed in the high-risk patient.
OBJECTIVE
To determine whether percutaneous nephrolithotomy (PCNL) can be safely performed in the high-risk patient.


METHODS
The records of 84 patients undergoing 98 consecutive PCNL procedures from January 2005 to January 2007 at a single institution were examined. Patients were divided into a high-risk preoperative group, which comprised patients having American Society of Anesthesiologist scores of III or IV (n = 25) and a low-risk preoperative group of patients with an American Society of Anesthesiologist score of II or less (n = 59).


RESULTS
A total of 33 and 65 procedures were performed in the high- and low-risk groups, respectively. The high-risk group had significantly more comorbidities than the low-risk group (5.4 vs 1.5) (P <.001). No significant difference was noted in the mean cumulative stone size for single or multiple stones in either group. A significant difference was observed between the average anesthesia time (45 vs 25 minutes) and average length of hospital stay (4.0 +/- 3.5 vs 2.7 +/- 1.2 days) but no significant difference in estimated blood loss (132 vs 150 mL) or mean operative time (118 vs 100 minutes) between the high- and low-risk groups, respectively. The overall complication rate was similar between the high-risk (12.1%) and low-risk (12.3%) groups (P = .41). The stone-free rate for the high-risk group was 61% compared with 92% for the low-risk group (P = .028).


CONCLUSIONS
PCNL can be safely performed in the high-risk preoperative patient population.
Section of Minimally Invasive Urologic Surgery & The Stone Therapy Center of New England, Division of Urology, Department of Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Sutchin R
SR
Patel
George E
GE
Haleblian
Gyan
G
Pareek
D006801:Humans; D007669:Kidney Calculi / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D012307:Risk Factors