Login to Access Video or Poster Abstract: MP50-17
Sources of Funding: None

Introduction

PCNL is an effective method of treating renal stones. Surgeons in the UK performing PCNL are mandated to submit data to the PCNL national registry. This study looks at differences in management and outcomes of patients with two subsets of stones: those under 1cm compared to all other stones and staghorn stones compared to all others treated by PCNL._x000D_

Methods

The registry was analysed for stone characteristics (stones up to 1cm, staghorn stones and all others), procedure details and outcomes (complications and stone free rates) for the two year period period January 2014 - December 2015. The fisher test was used for statistical analysis except for length of stay (LOS) which used confidence interval analysis._x000D_

Results

A total of 4166 procedures were performed by 183 UK surgeons (median number 17) over this time period. Of these 404 (9%) were for stones <1cm and 600 (14%) for staghorn stones. All other stones accounted for the remaining 3162. Females were more likely to have a staghorn stone (p < 0.01). Larger amplatz sheath sizes (27ch+) were used for staghorn stones (78% vs 29 % for smaller stones p<0.01). Staghorn stones were more likely to have a post-procedure nephrostomy tube (78% vs 69% for smaller stones, p<0.05) whereas stones <1cm were less likely to have a post-operative nephrostomy tube (p < 0.01).Overall intra-operative and post operative complications lower in the stones <1cm group (<0.05) where as these were higher in the staghorn group (sepsis p < 0.01 and transfusion rates p = 0.04) compared to all other stones. There was no difference in more severe (Clavien III+) complications in any of the stone size groups. LOS was significantly shorter for stones <1cm (mean LOS 3.09 days) and longer for staghorn stones (mean LOS 4.71 days). Stone free rates were as stones <1cm were as follows: 72.5% on fluoroscopic imaging and 77% on imaging at follow up. Stone free rates for staghorn stones were 44.8% on fluoroscopic imaging and 46.9% on imaging at follow up._x000D_

Conclusions

Around 10% of PCNLs in the UK between Jan 2014 and Dec 2015 were done for small stones <1cm. Excellent stone free rates are achieved with few complications. It is expected that with miniturisation techniques, PCNL for small stones will continue to be utilised as an effective treatment option. 14% of all PCNLs performed in the UK were for staghorn stones. PCNL for staghorn stones was less likely to achieve complete stone clearance compared to other stone sizes (p < 0.01). Complications were higher in the staghorn stone group compared to PCNLs for smaller stone sizes and overall length of stay was longer._x000D_

Funding

None