title: Salvage Percutaneous Nephrolithotomy: Analysis of Outcomes following Initial Treatment Failure.
abstract: OBJECTIVE
  Percutaneous nephrolithotomy has high potential for morbidity or failure. There are limited data regarding risk factors for failure and to our knowledge no published reports of surgical outcomes in patients with prior failed attempts at percutaneous stone removal.
  
  
  METHODS
  We identified patients referred to 3 medical centers after prior failed attempts at percutaneous nephrolithotomy. A retrospective chart review was performed to analyze reasons for initial failure and outcomes of salvage percutaneous nephrolithotomy. Outcomes were compared to those in a prospectively maintained database of more than 1,200 patients treated with a primary procedure.
  
  
  RESULTS
  Salvage percutaneous nephrolithotomy was performed in 31 patients. Unsuitable access to the stone was the reason for failure in 80% of cases. Other reasons included infection, bleeding and inadequate instrument availability in 6.5% of cases each. Compared to patients who underwent primary percutaneous nephrolithotomy those treated with salvage were more likely to have staghorn calculi (61.3% vs 31.4%, p <0.01) and a larger maximum stone diameter (3.7 vs 2.5 cm, p <0.01), and require a secondary procedure (65.5% vs 42.1%, p <0.01). There was no significant difference between the cohorts in the remaining demographics or perioperative outcomes. All patients were deemed completely stone free except one who elected observation for a 3 mm nonobstructing fragment.
  
  
  CONCLUSIONS
  Despite the more challenging nature and prior unsuccessful attempts at treatment, the outcomes of salvage percutaneous nephrolithotomy were no different from those of primary percutaneous nephrolithotomy when performed by experienced surgeons.
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indiana University Health at Methodist Hospital, Indianapolis, Indiana.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Borofsky
authors.affiliation: Department of Urology, New York University Langone Medical Center, New York, New York.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Wollin
authors.affiliation: Department of Urology, University of Alabama-Birmingham, Birmingham, Alabama.
authors.forename: Thanmaya
authors.initials: T
authors.lastname: Reddy
authors.affiliation: Department of Urology, New York University Langone Medical Center, New York, New York.
authors.forename: Ojas
authors.initials: O
authors.lastname: Shah
authors.affiliation: Department of Urology, University of Alabama-Birmingham, Birmingham, Alabama.
authors.forename: Dean G
authors.initials: DG
authors.lastname: Assimos
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indiana University Health at Methodist Hospital, Indianapolis, Indiana. Electronic address: jlingeman@iuhealth.org.
authors.forename: James E
authors.initials: JE
authors.lastname: Lingeman
mesh_terms: D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D012189:Retrospective Studies; D016879:Salvage Therapy; D017211:Treatment Failure
keywords: complications; kidney; nephrolithiasis; nephrostomy, percutaneous; treatment failure