Percutaneous Nephrolithotomy in High-Risk Patients: A Single-Center Experience with More than 350 Cases

Purpose: To assess the surgical outcomes and peri- and postoperative complications following percutaneous nephrolithotomy (PCNL) in high- and low-risk patients according to the American Society of Anesthesiologists (ASA) score. Materials and Methods: We reviewed the patient records of 2,281 cases older than 18 years who had undergone PCNL in the 3 previous years. The patients were divided into two groups: a low-risk group (ASA score 1, 2: 1,922 cases) and a high-risk group (ASA score 3, 4: 359 cases). Results: Analysis of the location and size of the stone, number and type of access, surgical approach, post-PCNL serum hemoglobin and decrease in glomerular filtration rate revealed no significant difference between the two groups. The stone-free rate was similar in both groups and the hospital stay in the high-risk patients was significantly greater than in the low-risk cases. 95% of low-risk and 91% of high-risk cases had surgical complications compatible with grade ≤II (Clavien system) and overall distribution of different grades of surgical complications was similar between the two groups (p = 0.177). Conclusion: Success rate and surgical complications of PCNL in high-risk patients were comparable to low-risk patients. It seems that PCNL may be a safe and effective procedure even in high-risk patients.