Platinum Priority – Stone DiseaseEditorial by Jean de la Rosette on pp. 1194–1195 of this issuePercutaneous Nephrolithotomy in the United Kingdom: Results of a Prospective Data Registry
Introduction
The management of large upper renal tract stones is evolving. Open stone surgery is now almost never used, given the progress that has been made in extracorporeal shock wave lithotripsy (SWL), flexible ureterorenoscopy, and percutaneous nephrolithotomy (PCNL). Each has a role depending on factors such as stone features, renal anatomy, and patient characteristics and preferences. PCNL is often considered to be the most effective treatment but carries the highest risk of morbidity. It is recommended for the treatment of renal pelvic and upper calyceal stones >2 cm and lower pole stones >1.5 cm [1].
Since PCNL was first described in 1973 [2], many technological developments have made the procedure safer and more effective. For example, several imaging modalities are now available to guide percutaneous access, and three-dimensional computed tomography reconstruction can be used to plan the surgical approach [3]. The availability of flexible instruments and the practice of secondary nephroscopy may also improve stone-free rates [4]. A wide array of available energy sources for intracorporeal lithotripsy allows large, hard, and inaccessible stones to be effectively fragmented and removed from the kidney [5].
In recognition of the value of audit in the revalidation of surgeons, the British Association of Urological Surgeons (BAUS) has developed an online facility for the collection of data sets representing several benchmark urologic procedures. Following a retrospective national audit of PCNL in the United Kingdom [6], the BAUS Section of Endourology in January 2010 established a prospective data registry for this procedure. We present an evaluation of the data that have so far been submitted to the BAUS PCNL data registry that includes >1000 procedures.
Section snippets
Materials and methods
Through advertisement at national urologic meetings, all surgeons undertaking PCNL in the United Kingdom were invited to submit data to the registry using an online interface. An individual record that contained both a unique patient identifier and National Health Service (NHS) number was created for each PCNL procedure. Demographic and procedural data were collected for each case. Effectiveness was evaluated according to stone-free rates defined as “no visible stone on imaging.” Stone-free
Results
Between January 1, 2010, and September 16, 2011, 57 consultant urologic surgeons from 50 centres contributed 987 patients who had 1028 PCNL procedures. Because of incomplete data in some records, percentages were calculated from the total number for which these data were available. Mean age was 54 yr, and 526 of 980 patients (54%) were men (Table 1). A total of 577 of 1000 procedures (58%) were undertaken on the left side. Of 1009 procedures for which data on stone size were available, 295
Discussion
The BAUS PCNL data registry is a unique resource providing important information on current practice as well as essential outcome data for PCNL in the United Kingdom. It facilitates personal audit against national outcomes and may be used by surgeons when counselling patients about the treatment options for their renal stone. As the registry matures and surgeons become increasingly familiar with submitting data, it will be possible in the future to derive national standards for this benchmark
Conclusions
We envisage an increasing requirement for individual surgeons to maintain complete and accurate records of their procedures and outcome data in the future. We hope that the success of the BAUS PCNL data registry will encourage the development of prospective registries of other urologic procedures.
References (29)
- et al.
Complications in percutaneous nephrolithotomy
Eur Urol
(2007) - et al.
Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations
Eur Urol
(2012) - et al.
Residency training in percutaneous renal access: does it affect urological practice?
J Urol
(2004) - et al.
Renal access by urologist or radiologist for percutaneous nephrolithotomy—is it still an issue?
J Urol
(2007) - et al.
Influence of technique of percutaneous tract creation on incidence of renal hemorrhage
J Urol
(1997) - et al.
Comparative study of degree of renal trauma between Amplatz sequential fascial dilation and balloon dilation during percutaneous renal surgery in an animal model
Urology
(2007) - et al.
Treatment of complete staghorn stones: a prospective randomized comparison of open surgery versus percutaneous nephrolithotomy
J Urol
(2005) - Türk C, Knoll T, Petrik A, Sarica K, Straub M, Seitz C. Guidelines on urolithiasis. European Association of Urology Web...
- et al.
Percutaneous pyelolithotomy: a new extraction technique
Scand J Urol Nephrol
(1976) - et al.
Three-dimensional CT pyelography for planning of percutaneous nephrostolithotomy: accuracy of stone measurement, stone depiction and pelvicalyceal reconstruction
Eur Radiol
(2009)
Second-look nephroscopy after percutaneous nephrolithotomy
Ther Adv Urol
Ultrasonic, pneumatic and combination intracorporeal lithotripsy for percutaneous nephrolithotomy
J Endourol
An audit of percutaneous nephrolithotomy in the United Kingdom
Br J Med Surg Urol
Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey
Ann Surg
Cited by (113)
Definition, treatment and outcome of residual fragments in staghorn stones
2020, Asian Journal of Urology