Percutaneous nephrolithotomy outcomes remain the benchmark for evaluating the successful management of large and complex renal stones. Recently, a comprehensive retrospective study from Yemen analyzed results from 1,458 patients over a nine-year period. This research specifically highlights the feasibility of performing advanced endourological procedures in resource-limited environments. Consequently, the findings provide a roadmap for surgical centers facing similar infrastructure challenges globally.

The patient cohort included 763 males and 695 females, with a broad age range from childhood to late adulthood. Notably, staghorn calculi were present in 44.4% of cases, representing a significant surgical burden. Historically, many centers in such regions relied on open surgery for these complex stones. However, this study demonstrates that endoscopic techniques can deliver superior results. While prone lower-pole access was the initial standard, the team gradually incorporated mini-PCNL and supine techniques to enhance efficiency.

Improving Percutaneous Nephrolithotomy Outcomes with Adaptable Techniques

The primary stone-free rate (SFR) after a single operative session reached 76.0%. Furthermore, surgeons successfully increased the final SFR to 92.6% by utilizing auxiliary interventions. These procedures included repeat PCNL, ureteroscopy, and extracorporeal shock wave lithotripsy (ESWL). The team also managed small, clinically insignificant fragments conservatively. This multi-staged approach ensured that patients achieved high clearance rates despite the initial complexity of their stones.

Safety monitoring showed that major complications (Clavien-Dindo Grade III-V) occurred in only 1.44% of patients. Specifically, colonic perforation and conversion to open surgery were the most serious events, though they remained rare. In contrast, minor complications like transient fever and postoperative pain affected 17.4% of the group. Overall, the mortality rate was extremely low at 0.14%. These statistics confirm that specialized centers can maintain high safety standards in low-resource settings. Eventually, the adoption of miniaturized tools further minimized patient morbidity during the study period.

Frequently Asked Questions

What is the typical stone-free rate for PCNL in resource-limited settings?

In high-volume centers, the initial stone-free rate often reaches around 76%. With additional auxiliary procedures like ureteroscopy or repeat sessions, this final rate can improve to over 92%, even for complex staghorn stones.

How common are major complications during PCNL?

Major complications, classified as Clavien-Dindo Grade III to V, are rare. They typically occur in less than 1.5% of cases when performed by experienced surgical teams in specialized centers.

Why is the shift to mini-PCNL and supine positions significant?

The transition to miniaturized and supine techniques reflects institutional adaptability. These methods often reduce blood loss, shorten operative time, and improve anesthetic safety, making them ideal for modern urological practice.

Disclaimer: This content is for informational and educational purposes only... Refer to the latest local and national guidelines for clinical practice.

References

Ghaleb R et al. Outcomes of percutaneous nephrolithotomy in a resource-limited setting: a retrospective study. Arch Ital Urol Androl. 2026 Mar 31. doi: 10.4081/aiua.2026.14940. PMID: 41914233.

Deole S, et al. Outcome of Percutaneous Nephrolithotomy in a Tertiary Care Center in North Karnataka. World J Nephrol Urol. 2020;9(3):70-76.

Gadzhiev N, et al. Stone-free rate and complications of percutaneous nephrolithotomy in staghorn calculi. World J Urol. 2021;39(12):4413-4421.