KEY FACTORS INFLUENCING URINARY LEAK AFTER PERCUTANEOUS NEPHROLITHOTOMY: INSIGHTS AND IMPLICATIONS

Background: Percutaneous nephrolithotomy (PCNL) is the standard treatment for large or complex renal stones. Despite its high success rates, complications such as prolonged urinary leakage (PUL) are significant concerns, occurring in 5–15% of cases. This study investigates predictors of PUL following PCNL, focusing on anatomical and procedural factors.Methods: A retrospective cohort study of 225 PCNL patients was conducted.Data on demographic, anatomical (hydronephrosis grade, parenchymal thickness), stone characteristics (volume, location), and procedural factors (surgery time,number of punctures) were analyzed.Urinary leakage was categorized as leakage persisting >24 hours post-nephrostomy removal. Statistical analyses included t-tests, chi-square tests, and multivariate logistic regression. Results: Prolonged urinary leakage occurred in 23 patients (10%). Key predictors included higher hydronephrosis grade (mean: 2.39 vs. 0.98, p<0.001), thinner parenchymal thickness (mean: 15.97 mm vs. 20.11 mm, p<0.001),larger stone volume (mean:810.14 mm³ vs.684.56 mm³,p=0.04),and longer surgery time (mean:92.4 min vs. 81.0 min, p=0.01). Multiple punctures and lower calyceal access were also associated with increased risk. Skin-toparenchymal length showed no significant correlation with leakage. Conclusion: Higher grades of hydronephrosis, reduced parenchymal thickness,larger stones,prolonged surgery, and multiple punctures are significant predictors of urinary leakage after PCNL.Preoperative imaging and meticulous surgical planning can mitigate these risks.