Efficacy and Economy of Two-Stage Percutaneous Nephrolithotomy for Complex Renal Calculi

ABSTRACT

Objectives: To evaluate the efficacy and cost effectiveness of two-stage percutaneous nephrolithotomy (PCNL) in complex renal calculus disease. The clinical data of 106 patients who underwent two-stage PCNL at the Second Affiliated Hospital of Kunming Medical University from January 2017 to May 2022 were analyzed. In order to select more accurate timing and strategies to reduce costs and surgery risk in two-stage PCNL patients, different parameters were measured—including the preoperative urinary tract infection, intraoperative bleeding, operative time, postoperative stone clearance and treatment costs. Patients were divided intogroup A and group B according to different timings of two-stage PCNL operation. Group A included patients who under wenttwo-stage PCNL during their period of hospitalization 5 to 9 days after the one-stage PCNL. Group B comprised patients whowere re-hospitalized for two-stage PCNL 29 to 35 days after the one-stage PCNL. Results: There were statistically significant differences in the influence of stone diameter and operation time in intraoperative blood loss of PCNL in 106 patients (p < 0.001). Compared with one-stage PCNL, the intraoperative hemoglobin loss and hematocrit loss means of patients with two-stage PCNL were decreased, the stone diameter mean of was smaller, and the mean operative time was diminished (p < 0.001). There were no significant differences in the hemoglobin loss, hematocrit loss and stone clearance rate means between group A and group B (p > 0.05). The urinary tract infection rate in group A was lower than the one in group B, and the average treatment cost was lower than the one in group B (p = 0.006, p < 0.001, respectively). (AU)