Category: Clinical Stones: PCNL

MP7-12 - The Abandoned PCNL – How does it differ from a successfully completed procedure?

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

Introduction & Objective :

PCNL is a complex Endourological procedure with a number of stone and patient factors contributing to the complexity of the cases. In a small number of cases, unexpected difficulties result in the procedure being abandoned. Identifying differences in peri and post-operative outcomes for abandoned PCNL will better enable the surgeon to counsel his patient for this uncommon event.


Methods :

Between 2014 and 2016 6269 cases were submitted to the BAUS PCNL registry. 291 abandoned procedures were identified and these procedures were analysed for demographics, outcomes, complications, and compared with completed PCNL cases from the same period.


Results :

PCNL was abandoned in 4.6% of cases. The mean patient age was 53.7yrs, BMI 28.7 and did not significantly differ from non-abandoned cases. Supine positioning was similar in both groups (27% vs 26.3% p0.84). Non-significant difference s in the median age adjusted Charlson comorbidity score (1 vs 0) and stone complexity measured by GSS (GSS 3 vs GSS 2) were seen when compared with completed cases. Documented difficulty with access was significantly higher with abandoned cases (49.6% vs 17.5% p0.0001). Urologists performing access had a lower rate of abandonment (3.5% vs 5.4% p0.0006). Post-op complication rate was significantly higher in abandoned cases (20.5% vs 10% p0.0001), with more Clavien 3a complications seen. No deaths were recorded against abandoned cases. Unusual complications were also more common (17.3% vs 3.4% p0.0001).  The transfusion requirement was higher in abandoned cases (5.7% vs 2.1%) with a median 3 unit transfusion given. Incidence of post-op fever was similar to completed cases but SIRS-SEPSIS was more common (5 vs 2.9% p0.05). Unplanned ITU admission was significantly more common (3.2% vs 1.2% p0.0006).


Conclusions :

The abandoned PCNL is rare in UK practice. BMI is not influential, but a trend towards higher comorbidities and stone complexity is noted. Unusual and post-operative complications are more common, along with blood transfusion, SIRS-Sepsis and unplanned admission to ITU. Discussion of the consequences of an abandoned PCNL should form a routine part of counselling patients to PCNL.

William Finch

Consultant Urological Surgeon
Norfolk and Norwich University Hospitals
Norwich, England, United Kingdom

Jim Armitage

Cambridge, England, United Kingdom

John Withington

Urology Registrar
Royal Free Hospital NHS Trust
London, England, United Kingdom

Stuart Irving

Norfolk and Norwich University Hospitals
Norwich, England, United Kingdom

Sarah Fowler

London, England, United Kingdom

Daron Smith

Consultant Urological Surgeon
Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust
London, England, United Kingdom

Daron Smith is a consultant urological surgeon at the Institute of Urology at University College Hospital. His practice is "endoluminal endourology" and encompasses the comprehensive management of Urinary Tract Stone disease, and includes the endourological management of ureteric obstruction, ureteric injuries, and the endoscopic diagnosis and management of upper tract TCC. He is the vice-chairman of the BAUS Section of Endourology, having been its Secretary from 2015-17 and a committee member since 2013, is the Consulting Editor on stone disease for the BJUI and the deputy editor of the Journal of Endoluminal Endourology

Neil Burgess

Norwich, England, United Kingdom

Oliver Wiseman

Urologist
Cambridge University Hospitals, Urology, Cambridge, United Kingdom
CAMBRIDGE, England, United Kingdom

Oliver is a Consultant Urologist based at Cambridge University Teaching Hospitaks NHS Trust Cambridge, UK. He specialises in the treatment of kidney stones, their metabolic management and in the devlopment of patient reported outcomes for stone disease. He runs a number of training courses teaching stone surgery, and has been invited to operate and lecture nationally and internationally on stone disease.
He qualified in Cambridge and following basic surgical training, he underwent specialist training in urology in London, including at Guys Hospital and UCLH ("The Institute of Urology"). He has published widely including articles relating to the management of patients with renal stone disease.
He is a trustee of BAUS, honorary treasurer elect of BAUS, a member of the BAUS Section of Endourology Committee, and on the Endourological Society Awards and Medals Committee. He is training program director for Urology for the East of England.