Category: Clinical Stones: PCNL

MP7-19 - Impact of Percutaneous Nephrolithotomy on Renal Function

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective : PCNL remains the gold-standard surgical intervention for the treatment of large volume renal stones, including staghorn calculi.  Since it involves traversing the renal parenchyma with a tract that ranges in circumference from 16F to 30F, there is always some degree of renal injury. We sought to examine the impact of PCNL on renal function and complications in patients with normal and reduced renal function.


Methods : We retrospectively analyzed all consecutive tubeless PCNLs performed at our Institution between 2012 and 2017 that had a creatinine and eGFR measurement pre and post procedure and a follow-up visit at our centre. Data was collected on patient and stone characteristics, and patients were divided in two groups according based on their pre-op eGFR (Group 1: eGFR=50ml/min).  


Results : A total of 220 patients were included in the study: 25 (11.4%) in Group 1 (mean creatinine 168.4µmol/L ± 59.2) and 195 (88.6%) in Group 2 (mean creatinine 80.5µmol/L ± 19.5). There were no differences in gender, stone side, stone area and composition, but patients in Group 1 were older (66.6 years ± 10.8 vs. 54.1 ± 13.3, p=<0.001) and had a lower BMI (26.4 ± 3.7 vs. 29.0 ± 5.9, p=0.031). Patients with eGFR <50 were more likely to have a pre-op nephrostomy tube (NT) or stent (32% vs 10.3%, p=0.002) and more likely to require multiple tracts (16% vs 3.6%, p=0.007).  Patients with eGFR<50 did not have more post-op complications (12% vs 15.9%, NS). Creatinine values changed only marginally post-op, but less so in patients with pre-op eGFR<50 (mean increase in creatinine 1.8% ± 20.1 vs. -10.1% ± 19.2, p=0.043).


Conclusions :

Patients with baseline reduced renal function often have more complex and obstructing stone disease, requiring more pre-operative drainage tubes and greater need for multiple tracts.  Despite this, PCNL can be performed safely, with no increase in complications and minimal negative impact on renal function acutely.

Luke F. Reynolds

Clinical Fellow
St. Michael's Hospital - University of Toronto
Toronto, Ontario, Canada

Daniela Ghiculete

Clinical Research Coordinator III
St. Michael's Hospital - University of Toronto
Toronto, Ontario, Canada

Monica Farcas

Clinical Associate
St. Michael's Hosital - University of Toronto
Toronto, Ontario, Canada

R John D'A.. Honey

Professor
St. Michael's Hospital - University of Toronto
Toronto, Ontario, Canada

Michael Ordon

Associate Professor
St. Michael's Hospital - University of Toronto
Toronto, Ontario, Canada

Jason Lee

Assistant Professor
Toronto General Hospital - University of Toronto
Toronto, Ontario, Canada

Kenneth Pace

Associate Professor
St. Michael's Hospital - University of Toronto
Toronto, Ontario, Canada