Outcomes of second-look percutaneous nephrolithotomy in renal calculi-a single centre experience

Özet

Objective: Percutaneous nephrolithotomy (PCNL) carries significant potential for morbidity. Scant dataexists on indications and outcomes of second-look PCNL after a failure to completely clear renal stones atthe first attempt. We present our experience with second-look PCNL.Material and methods: This was a retrospective record review of 922 patients who underwent unilateralPCNL at a tertiary care center in South India. Baseline patient, stone characteristics and outcomes werecompared between 844 patients undergoing primary PCNL and 78 patients requiring second-look PCNL.Results: Increased stone complexity in terms of Guy stone score (GSS), stone size, staghorn calculi andstones in multiple locations were significantly associated with primary treatment failure (p 75 min had a significant association with need for second-look PCNL and complications. InitialPCNL was discontinued due to bleeding (28; 35.9%), pelvicalyceal system perforation (3; 3.9%) and purulenturine leading to urosepsis and hemodynamic instability (2; 2.6%). Staged PCNL was done in 44 (56.3%)patients. During second-look PCNL, new access tracts were necessary in majority (42; 53.9%) of the patientsand multiple tracts in 20 (25.6%) patients. In second-look PCNL, complications were comparable to primaryPCNL (p=0.289).Conclusion: Second-look PCNL should be advocated in patients where the initial PCNL was discontinueddue to bleeding, perforation of collecting system, prolonged operative time (>75 min) and in patients withlarge stone burden.