Third prize: 2006 endourological society essay - Competition contemporary percutaneous nephrolithotripsy: 1585 procedures in 1338 consecutive patients

Background and Purpose: The approach to urinary-stone disease has changed dramatically over the last three decades with a transition from open surgery to minimally invasive procedures. Percutaneous nephrolithotripsy (PCNL) is a cornerstone of the treatment of kidney and selected upper-ureteral stones and continues to evolve with advances in techniques and instrumentation. The purpose of this study was to assess outcomes and trends prospectively in a large contemporary group of patients undergoing PCNL. Patients and Methods: Between July 1990 and December 2005, all 1338 patients at a single center scheduled for PCNL ( N = 1585 procedures) were enrolled. Their mean age was 53 years ( range 4-89 years). Data including comorbidities, stone burden, stone location, surgical time, hospital length of stay, rate of secondary procedures, and adverse events were collected prospectively. The primary outcome measures were stone- free rate and complications. Results: There was a substantial incidence of comorbid medical conditions ( 48.8%) and anatomic renal abnormalities ( 25.3%), demonstrating the diverse and challenging patient population in this contemporary series. The overall stone-free rate at 3 to 6 months of follow-up was 94.8%. Conclusions: Percutaneous nephrolithotripsy is a highly effective procedure and may be performed in a diverse group of patients with comorbid conditions and renal abnormalities. Improved intracorporeal lithotripters, balloon dilation of the tract, use of flexible instruments, and liberal use of secondary nephroscopy result in excellent stone-free rates with low morbidity.