In this massive study involving 96 centers in 26 countries, Jean de la Rosette and the Clinical Research Office of the Endourological Society in their first publication review the outcome of PCNL in nearly 6000 patients. What is clear is that PCNL works (76% stone free rate) regardless of stone size or location; retreatments are needed in 15%. Of note, in 90% of cases, the access was obtained by the treating urologist; in only 8% of cases were multiple tracts required despite 25% of the cases being done for a staghorn calculus. The procedure is associated with a reasonable rate of complications: hemorrhage and transfusion rates of 8% and 6% respectively; Clavien type III, IV, and V occur in: 3.4%, 0.5% and 0.03%.1
While this is not necessarily “earth-shattering” news, it is the means of the study that is most notable and the resulting data warehouse that is now rich for future mining. Within this data base there are nearly 1500 staghorn calculi awaiting further study; other questions that can now be explored are those regarding prone vs. supine positioning, anomalous kidney vs. eutopic kidney stone removal, and ultrasound vs. fluoroscopic access to name but a few.
This is but the initial result of a major collaborative effort on the part of Dr. de la Rosette and the executive committee of the Endourological Society to create a global approach to clinical urological studies. “No one of us is as smart as all of us.” (But together, all of us can make each of us much wiser, all to the benefit of the patients we treat.)
- Dindo, D., Demartines, N., and Clavien, P.: Classification of Surgical Complications. Ann. Surg. 240: 205-213, 2004.
((Grade III: Requiring surgical, endoscopic or radiological intervention:
Grade IIIa Intervention not under general anesthesia
Grade IIIb Intervention under general anesthesia
Grade IV: Life-threatening complication (including CNS complications)* requiring IC/ICU management
Grade IVa Single organ dysfunction (including dialysis)
Grade IVb Multiorgan dysfunction
Grade V: Death of a patient))
de la Rosette J, Assimos D, Desai M, Gutierrez J, Lingeman J, Scarpa R, Tefekli A
J Endourol. 2011 Jan;25(1):11-7.