Assessment of Necessity of Retrograde Filling during PCNL Tract Dilatation

Objective: To investigate the impact of retrograde filling on tract dilatation and associated outcomes among patients presenting at a tertiary care hospital, Pakistan. Methodology: A prospective cohort study was conducted at a tertiary care hospital's urology department from February 2022 to February 2023. A total of 126 patients undergoing elective PCNL were included, categorized into exposed (retrograde filling utilized) and unexposed (standard PCNL without retrograde filling) groups. Patient demographics, stone characteristics, and procedural details were recorded. Comparative analyses were performed to assess ease of tract dilation and infection rates using appropriate statistical tests. Results: The use of retrograde filling did not significantly influence the ease of tract dilation during PCNL. Moreover, the exposed group exhibited a significantly higher rate of post-procedure infections (55.4%) compared to the unexposed group (36.5%). Multivariate logistic regression analysis, controlling for potential confounding variables, confirmed that retrograde filling was associated with a substantial increase in the odds of post-operative infection (adjusted odds ratio of 2.48). Conclusion: Retrograde filling during PCNL is associated with risk of post-procedure infections and does not provide significant benefits in terms of ease of tract dilation. Moreover, the study emphasizes the economic and logistical implications of incorporating retrograde filling, including increased costs and the need for additional personnel. Therefore, urologists are advised to carefully consider the potential drawbacks and benefits before deciding on the adoption of retrograde filling in PCNL procedures.