A Survey Regarding Preference in Management of Bilateral Stone Disease and Comparison of Clavien Complication Rate in Bilateral Versus Unilateral Percutaneous Nephrolithotomy

To discuss complications of simultaneous bilateral percutaneous nephrolithotomy (SB-PCNL) when compared to unilateral percutaneous nephrolithotomy (U-PCNL) and survey surgeon preference in bilateral stone disease management.

A database of all participating PCNL patients who received treatment at Indiana University Health Methodist Hospital within a 10-year period from 2006 to 2015 by a single surgeon (JL) was utilized. Perioperative data as well as complications, as defined according the Clavien grading system, were recorded. A survey of members of the Endourological Society was performed regarding surgical management in the setting of bilateral stone disease.

A total of 563 patients were identified over the study period with 129 undergoing SB-PCNL. Overall, SB-PCNL patients had a longer procedure (176.9 vs115.6 min, p<0.0001), were more likely to undergo a secondary procedure (73% vs 44 p<0.001), and had a longer hospital stay (3.2 vs 2.3 days, p<0.001). Notably, there were no differences in number or severity of complications between the two groups. A total of 153 endourologists completed the survey. Of these 58 (38%) perform bilateral PCNL under anesthesia. The top reasons for electing to not perform bilateral PCNLs included: duration of bilateral procedures (53%), bilateral renal injury (48%), rarely perform bilateral surgery (35%).

Although procedure length was longer in the SB-PCNL group there were similar rates of complications and severity between U-PCNL and SB-PCNL. A majority of endourologists surveyed do not perform bilateral PCNL but would perform bilateral URS with duration of the procedure and concern for bilateral renal injury representing the most common reasons.

Urology. 2017 Oct 09 [Epub ahead of print]

Marcelino E Rivera, Naeem Bhojani, Kevin Heinsimer, Marawan M El Tayeb, Jessica E Paonessa, Amy E Krambeck, James E Lingeman

Indiana University School of Medicine, Indianapolis, IN, USA., University of Montreal, Montreal, QC, Canada., Baylor Scott and White Health., SUNY Upstate Medical Center., Indiana University School of Medicine, Indianapolis, IN, USA. Electronic address: .