Percutaneous nephrolithotomy outcomes: Re-audit in 2005

Aim: To evaluate the outcomes of percutaneous nephrolithotomy (PCNL) for upper urinary tract stones in 2005 in our hospital and to compare with the results obtained in 2000. Methods: The present study reviewed the outcomes of standardized PCNL, a one‐stage procedure under sedo‐analgesia, for upper urinary tract stones in 2000 and 2005 in Queen Elizabeth Hospital. In 2000, 74 PCNL were carried out using holmium laser, Swiss lithoclast or electrohydraulic lithotripsy (EHL) for stone fragmentation. Thirty to 40% of staghorn stones and 80–100% of complicated renal and upper ureteric stones achieved stone‐free clearance after single‐session PCNL. In 2005, 82 PCNL were performed after the introduction of three strategies, namely: multiple tract access, flexible nephroscopic exploration and the new‐generation ultrasonic lithotripter. The outcomes were evaluated and compared to those in 2000 according to the different categories of stones. Results: The results in 2005 were improved in terms of increased overall stone‐free rates (20% in single session and 5% after the final session), retreatment rate reduction (15%), and raised efficiency quotient (21.5), while the overall complication rate remained low (13.9%) compared to that in 2000. In 2005, in particular, the single‐session stone‐free rates of staghorn stones and renal pelvis stones were significantly improved to 70–80% (30–40% in 2000) and 100%, respectively (50–60% in 2000). Single‐session stone‐free rates for other stones remained at 90–100%. Conclusion: Our outcomes improvement could be attributed to the maturation of the PCNL technique, use of multiple tract access, use of flexible nephroscopy, and ultrasonic lithotripsy.