COMPLICATIONS ANALYSIS OF PERCUTANEOUS NEPHROLITHOTOMY: AN INSIGHT FROM A TERTIARY CARE HOSPITAL

Abstract

Background: Renal stone disease is a common urological condition affecting a significant proportion of the global population. For stones larger than 2 cm, percutaneous nephrolithotomy (PCNL) is recommended as the first-line treatment by both the European Association of Urology and the American Urological Association. While PCNL offers high stone clearance rates, it is associated with a range of complications. Understanding these risks is essential to improve perioperative outcomes and enhance patient safety.

Objective: To evaluate the intra-operative and early post-operative complications associated with PCNL in patients presenting with renal stones at a tertiary care hospital.

Methods: This prospective descriptive study was conducted in the Department of Urology at the Institute of Kidney Diseases, Peshawar, over a six-month period from October 2024 to March 2025. A total of 174 patients aged 18–65 years who underwent elective PCNL were enrolled using a consecutive non-probability sampling technique. Patient demographics, clinical data, and complications were documented using a structured proforma. All procedures were performed under general anesthesia, and complications were recorded according to predefined criteria. Statistical analysis was conducted using IBM SPSS version 23.

Results: Among the 174 patients, 96 (55.2%) were males and 78 (44.8%) females, with a mean age of 41.7 ± 13.12 years. The mean stone size was 29.5 ± 6 mm, and the average stone density was 1409.9 ± 116 HU. Stone clearance was achieved in 140 (80.5%) patients. Intra-operative complications included hypotension in 4 (2.3%) patients, severe bleeding requiring transfusion in 9 (5.2%), and renal pelvis perforation in 5 (2.9%). Post-operative complications included fever in 44 (25.3%), hematuria in 38 (21.8%), urine leakage in 11 (6.3%), and urosepsis in 5 (2.9%). Angio-embolization was required in 2 (1.1%) cases. Most complications were managed conservatively.

Conclusion: PCNL is a relatively safe and effective procedure for the management of large renal stones; however, awareness and prompt management of potential complications are essential to minimize morbidity.