CORRELATION BETWEEN PREOPERATIVE VARIABLES OF T HE PATIENTS AND MANAGEMENT OUTCOME AFTER PCNL SURGERY- AN OBSERVATIONAL STUDY
Maj (Dr) Satyanarayan Panda MS, Maj (Dr) Vijay Singh DNB, *Lt Col (Dr) Shibu Sasidharan MD, DNB, MNAMS, Maj (Dr) Lalit Tomar DNB and Maj (Dr) Harpreet Dhillon, MD
Background: Urolithiasis is one of the most common diseases of trouble in our society and kidneys are the most common affected organ compared to ureter and bladder. It has various etiology such as imbalanced nutrition with excess oxalates, calcium in diet, inadequate urinary drainage, predisposed to heat exposure and urinary tract infection. Percutaneous nephrolithotomy (PCNL) is the treatment of choice for stones larger than 2 cm and lower pole stones larger than 1 cm and in patients. The true complications or successful outcome of PCNL surgery are difficult to determine and compare. Therefore, we have attempted to standardize the complications and outcome of PCNL by utilizing the modified Clavien complication grading system and correlated pre-op variables of the patients with the management outcome following PCNL surgery. Methodology: The study was conducted on 50 patients with urolithiasis posted for PCNL surgery and performed by senior Urologist with experience of >50 PCNL surgery at tertiary care service hospital, India.Various pre-op variables (Age, sex, BMI, comorbidity, positive urine culture, GSS and hydronephrosis) were correlated with management outcome based on modified Clavien complication grading system like complete/incomplete stone clearance, post-op fever, peri-op bleeding and other major complications following PCNL surgery. Result: PCNL surgery was performed by a senior urologist on 50 patients with renal calculi. The most common complications occurred to our patients after PCNL surgeries were incomplete stone clearance, post-op fever and peri-op bleeding. A total of 43 (86%) patients had complete clearance of stone while 7 (14%) patients had residual calculi. Post-op fever was developed in 13 (26%) patients, 10 patients (20%) developed peri-op bleeding and out of them, 5 patients required blood transfusion. Pre-op variables (comorbidity, Guy stone score) were significantly associated with stone clearance. While, only comorbidity of patients (a pre-op variable) was significantly associated with post-op fever > 38.5OC and with respect to peri-op bleeding, positive urine culture report, Guy stone score, hydronephrosis (pre-op variables) were statistically associated. None of the patients had major complications like loss of renal function, pneumothorax, visceral injury, urinoma, urosepsis or death. Conclusion: Stone clearance is significantly associated with comorbidity and increasing GSS. It is not statistically associated with age, sex, BMI, positive urine culture report and hydronephrosis. Post-op fever >38.5OC is significantly associated with comorbidity and not associated with other elaborated pre-op variables of the patient. Peri-op bleeding is significantly associated with preoperative urine culture, increasing GSS and hydronephrosis. Further studies with larger patient numbers and longer follow up would be needed to accurately study the profile and management outcomes of patients undergoing PCNL for the treatment of renal calculi.
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