PCNL Takes Longer with Bigger Kidney Stones

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Percutaneous nephrolithotomy (PCNL) takes longer to perform in patients with larger kidney stones, as well as those with coraliform stones and hydronephrosis, according to researchers.

Tolga Akman, MD, and colleagues at Haseki Teaching and Research Hospital in Istanbul, Turkey, reviewed the clinical records of 1,897 patients with renal calculi who underwent PCNL. The investigators divided subjects into two groups based on median operative time (group 1: 60 minutes or less; group 2: more than 60 minutes). The mean stone size was 642 mm2 in group 1 and 976 mm2 in group 2. Group 2 had a significantly higher incidence of staghorn stones compared with group 1 (42.2% vs. 19%).

In multivariate analysis, operative time was 2.1 times longer in patients with coraliform stones than in those with other stone types and 2.4 times longer in those with a stone size greater than 1,000 m2 compared with subjects who had smaller stones, the investigators reported in the Journal of Endourology (2011;25:1269-1273).

The mean operative time was 44% shorter for procedures performed prior to 2006 compared with those performed in 2006 and thereafter.

“The duration of the [PCNL] procedure is as an important perioperative factor in determining intraoperative and postoperative complications,” the authors observed. “The correlation between operative time and periooperative blood loss in PCNL has been reported by many studies. Furthermore, operative time is important because cost-effectiveness is an issue in helping tocontain costs and manage health care economics.”

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