Stone clearance rate of percutaneous nephrolithotomy with intraoperative flexible nephroscopy at IIUM Medical Centre, Kuantan, Pahang

Abstract

Percutaneous Nephrolithotomy (PCNL) is mainstay management of large renal stone. The advent of flexible nephroscopy during PCN L has improved its stone clearance rate in many literature reviews. This study aims to look for stone clearance rate of PCNL in IIUM Medical Centre, a teaching hospital with intra-operative flexible nephroscopy (IFN). A single-centre, cross-sectional study was conducted in all patients who underwent PCNL with IFN between December 2017 to October 2020. All patients that had IFN performed during PCNL recruited (n=l 9). We looked at our local stone clearance rate and factors that contribute to stone clearance and evaluate the complications rate, hospitalization period with IFN during PCNL. The stone clearance rate is 74%. We analysed the demographics (gender, ethnicity, comorbid), stone profile (size, counts, location, appearance), intraoperative puncture for nephrolithotomy access were not significantly associated with stone clearance rate. Mean duration for op was 146 minutes and about three-quarter of our patient had three days or less of hospitalization. In our sub-analysis of the detection rate ofresidual stone, we found that IFN can increase to detection rate up to 37% (n=7) and hence increased the final stone clearance rate about 16%. The increased detection rate of residual stone during PCNL with IFN is statistically significant with stone clearance rate (p=0.2) by bivariate analysis. A further analysis of the association of stone profile with increased detection rate of residual stone was not statistically significant. In conclusion, in our study, IFN proved to significantly detect residual stone during PCNL and improved stone clearance rate. The finding is crucial, where IFN able to facilitate in achieving maximal stone clearance in a staghorn or complex renal stone disease as it helps to alleviate the patients from the complication of renal stone such worsening renal function, recurrent pain and infection and may help to improve quality of life after PCNL.