Postoperative Outcomes and Complications of PCNL: A Comparative Study of Hydronephrotic and Non-hydronephrotic Calyceal Access

Abstract

Background: The selection of the optimal calyx for access is a critical step in percutaneous nephrolithotomy (PCNL). Whether the hydrostatic status of the accessed calyx influences outcomes remains unclear. Objectives: This study aimed to compare postoperative outcomes and complications in patients undergoing PCNL with access to hydronephrotic versus non-hydronephrotic calyces. Methods: We conducted a retrospective analytical study of 170 adult patients who underwent PCNL between January 2021 and December 2023. Patients were stratified into two groups based on calyceal status: Hydronephrotic (n = 85) and non-hydronephrotic (n = 85). Data on demographic, operative, and postoperative outcomes were collected and analyzed using appropriate descriptive and inferential statistics. Results: The two groups were comparable in baseline characteristics. Key perioperative outcomes showed no significant differences: Stone-free rate (SFR) (92.8% vs. 93.6%, P = 0.78), hemoglobin drop (2.1 ± 1.5 g/dL vs. 2.3 ± 1.7 g/dL, P = 0.35), blood transfusion rate (5.9% vs. 8.2%, P = 0.54), sepsis (9.4% vs. 12.0%, P = 0.45), and hospital stay (4.5 ± 2.1 days vs. 4.7 ± 2.3 days, P = 0.41). However, access through a hydronephrotic calyx was associated with a significantly higher incidence of chronic kidney disease (CKD) progression during (12-month) follow-up (22.4% vs. 5.9%, P < 0.001). Conclusions: Accessing a hydronephrotic calyx during PCNL is as safe and effective as accessing a non-hydronephrotic one in the immediate perioperative period. However, it is an independent and significant predictor of CKD progression, highlighting the importance of preoperative identification and long-term renal monitoring in these patients.