Contemporary practice of percutaneous nephrolithotomy: review of practice in a single region of the UK.

INTRODUCTION: Most series of percutaneous nephrolithotomy (PCNL) from single specialised centres represent optimum results achievable and may not reflect outcomes of everyday practice. We analysed the practice in our region. PATIENTS AND METHODS: Medical records of 178 patients undergoing PCNL in 2002 in 12 participating hospital trusts were retrospectively analysed. RESULTS: Even outside the tertiary referral centres, there was a 6-fold difference between trusts in the frequency of PCNL. In 28% of cases, another stone-removing modality had been tried first. Failed renal puncture was a major cause of abandoning surgery (9%). An indication of the difficulty in obtaining complete stone clearance is that only 107 (60%) operation notes recorded complete clearance, while 75 (42%) patients required a subsequent procedure (13% a secondary PCNL). Use of supra 12th rib punctures was small (6%) as was the rate of 'tube-less' PCNL (4%). Some 22% had simultaneous ureteric stent insertion. Approximately 8% of cases required a blood transfusion. Thirty-eight patients (23%) had a proven infection (UTI) pre-operatively (> 10(4) organisms; > 10 white blood cells) with almost all patients receiving antibiotics at anaesthesia induction. Postoperative sepsis rates (temperature > 38.5 degrees C) were similar in those with and without a pre-operative UTI (18.4% versus 14.3%) and pre-operative antibiotics appeared to have little extra protective effect. Severe sepsis was rare with no patient requiring intensive care admission for this reason. Median length of stay postoperatively was 5 days. CONCLUSIONS: These results present important figures to quote when counselling patients pre-operatively, albeit that the degree of difficulty (and hence the likelihood of problems) is identifiable from stone and anatomical configurations. In addition, the present data are a more accurate reflection of urinary stone surgery in non-tertiary, general urological practice.

Convenience voids: an important new factor in urinary frequency volume chart analysis.

PURPOSE: We assessed the impact of convenience voids (CVs) on urinary frequency volume chart (FVC) analysis. MATERIALS AND METHODS: A total of 53 healthy volunteers completed a FVC for 1 week, highlighting as CVs samples when there was no sensation of bladder fullness, but rather a social reason to pass urine instead. RESULTS: Of the volunteers 72% had at least 1 CV during the week. Removing the CVs from analysis resulted in an increase of 17 ml in average mean individual voided volume from 308 to 325 ml (p <0.001). The average mean interval between voids increased by 11 minutes from 4 hours 34 minutes to 4 hours 45 minutes (p <0.001). CONCLUSIONS: Convenience voids have a small but significant effect on parameters analyzed on FVCs. They should be considered for inclusion in the FVCs used in research when changes in voided volume are being investigated.