Complications of Percutaneous Nephrolithotomy: Experience From a Tertiary Care Center

Introduction Renal stones are mineral concretions in the pelvicalyceal system. Their prevalence and recurrence are increasing globally. Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for the removal of kidney stones. It is a safer technique offering the highest stone-free rates. However, a few complications may still occur. We aimed to evaluate our experiences of PCNL and classify the complications as intraoperative, early postoperative, and late postoperative events. We also aimed to find the predictors of complications in PCNL. Methods A single-center prospective observational study was conducted from June 2021 to October 2022 where all patients who were >18 years old with radiopaque calculus in the kidney and underwent PCNL were included. Statistical analysis was performed using the IBM Statistical Package for Social Sciences (SPSS) software (IBM SPSS Statistics, Armonk, NY). A p-value of <0.05 was considered significant. Results Two hundred one patients including 137 males and 64 females participated in the study. The overall rate of complications was 21.9%. Most of the patients (16.4%) experienced minor complications of Clavien grades 1 and 2. A Clavien grade of >3 included major complications and was noted in 5.5% of patients. No mortality was seen in the postoperative period. Female patients (p = 0.028), a stone burden of >3 cm (p = 0.003), stones in multiple calyces (p = 0.001), hydronephrosis (p = 0.001), history of recently treated urinary tract infection (UTI) (p < 0.001), longer operative time (>91 minutes) (p < 0.001), Guy's stone scores (GSS) III and IV (p < 0.001), complex renal calculi (staghorn) (p = 0.002), and multiple punctures (p = 0.001) were associated with higher complication rates after PCNL. Conclusion Most PCNL-related complications are minor and resolve with conservative or minimally invasive management. However, there are certain complications that can limit the surgical outcome. The overall complication rate in the current study is similar to that reported in the literature. Bleeding was the most common intraoperative complication, whereas hematuria was the most common early postoperative complication. A stone burden of >3 cm, hydronephrosis, longer operative time, higher GSS, and multiple punctures can all affect the rate of complications.