Comparative Evaluation of Outcomes After Standard versus “Modified Large PCNL”- Is Larger Better…?

Main Article Content

Deep Kumar Jain
Padmaraj Hegde
Arun Chawla


To comparatively evaluate the outcomes of standard percutaneous nephrolithotomy (PCNL) versus a 36 Fr PCNL in terms of operative time, complications, hospital stay, and stone free rates.

Patients and Methods
The data of 125 PCNL cases, out of the 168 PCNLs done from January 2014 to December 2015, was retrospectively analyzed within two subsets, namely group-A (standard PCNL with 22-32 Fr Amplatz) and group-B (modified large PCNL with 36 Fr Amplatz). The demographic profile, stone characteristics, operative and laboratory parameters, and stone clearance rate were analyzed to determine the safety and efficacy of the modified large PCNL as against standard PCNL.

Group-A comprised 88 patients with 100 renal units, while group-B comprised 37 patients with 45 renal units. The mean age of the patients in Group-A was 49.1 + 13.1 years, and in Group-B was 52.4 + 11.4 years (range 25-84 years) with a male to female ratio of 4:1. 54.5% and 75.7% unilaterally intervened, group-A and group-B patients respectively, required < 90 minutes for the procedure. Nine patients (10.2%) each of unilaterally and bilaterally intervened group-A cases had an operative time that exceeded 120 minutes compared to only two (5.4%) bilaterally intervened group-B cases. For patients with stone burden >1000 mm2, there was statistically significant (p = < 0.0001) higher complete stone clearance rates with the 36Fr PCNL compared to standard PCNL.

Our retrospective analysis revealed that 36 Fr PCNL is safe and efficacious in carefully selected patients with large stone burdens providing the advantage of better stone-free rates, less operative time, lesser need for additional punctures without increasing blood transfusion and complications rates. However, more extensive prospective randomized trials are needed to confirm this perceived benefit.


Download data is not yet available.

Article Details

How to Cite
Jain, D. K., Hegde, P., & Chawla, A. (2020). Comparative Evaluation of Outcomes After Standard versus “Modified Large PCNL”- Is Larger Better…?. Journal of Endoluminal Endourology, 4(1), e1-e12.
Original Article
Author Biographies

Deep Kumar Jain, Kasturba Medical College and Hospital, Manipal (Karnataka), India

Senior Resident, Department of Urology and Renal Transplantation, Kasturba Medical College and Hospital, Manipal (Karnataka), India

Padmaraj Hegde, Kasturba Medical College and Hospital, Manipal (Karnataka), India

Professor, Department of Urology and Renal Transplantation, Kasturba Medical College and Hospital, Manipal (Karnataka), India

Arun Chawla, Kasturba Medical College and Hospital, Manipal (Karnataka), India

Professor & Head, Department of Urology and Renal Transplantation, Kasturba Medical College and Hospital, Manipal (Karnataka), India


1. Pardalidis NP, Smith AD. Complications of percutaneous renal procedures. In: Controversies in Endourology. Philadelphia: WB Saunders; 1995.
2. Kessaris DN, Bellman GC, Pardalidis NP, et al. Management of hemorrhage after percutaneous renal surgery. J Urol 1995;153:604–08.
3. Stoller ML, Wolf JS, St Lezin MA. Estimated blood loss and transfusion rates associated with percutaneous nephrolithotomy. J Urol 1994;152:1977–81.
4. Netto R, Lemos GC, Palma PC, et al. Staghorn calculi: Percutaneous versus anatrophic nephrolithotomy. Eur Urol 1988;15:9–12.
5. Kahnoski RJ, Lingeman JE, Coury TA, et al. Combined percutaneous and extracorporeal shock wave lithotripsy for staghorn calculi: An alternative to anatrophic nephrolithotomy. J Urol 1986;135:679.
6. Snyder JA, Smith AD. Staghorn calculi: Percutaneous extraction versus anatrophic nephrolithotomy. J Urol 1986;136(2):351–54.
7. Schulze H, Hertle L, Kumpf HP, et al. Critical evaluation of treatment of staghorn calculi by percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy. J Urol 1989;141:822–24.
8. Assimos DG, Wrenn JJ, Harrison LH, et al. A comparison of anatrophic nephrolithotomy and percutaneous nephrolithotomy with and without extracorporeal shock wave lithotripsy for management of patients with staghorn calculi. J Urol 1991;145:710–14.
9. Lam HS, Lingeman JE, Baccon, M, et al. Staghorn calculi: Analysis of treatment results between initial percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy monotherapy with reference to surface area. J Urol 1992;147:1219–25.
10. Segura JW, Preminger GM, Assimos DG, et al. Nephrolithiasis Clinical Guidelines Panel Summary Report on the Management of Staghorn Calculi. J Urol 1994;151(6):1648–51.
11. Martin X, Tajra LC, Aboutaieb R, et al. Complete staghorn stones: Percutaneous approach using one or multiple percutaneous accesses. J Endourol 1999;13:367–70.
12. Giusti G, Piccinelli A, Taverna G. Miniperc? No, Thank You! Eur. Urology 2007;51(3),810–15.
13. Karaköse A, Aydogdu Ö, Atesci YZ. The use of the amplatz sheath in percutaneous nephrolithotomy: does Amplatz sheath size matter? Curr Urology 2014;7(3):127–31.
14. de la Rosette J, Dedan O, Francisco PJ, et al. Categorisation of complications and validation of the clavien score for percutaneous nephrolithotomy. Eur. Urol 2012;62(2);246–55.
15. Kukreja R, Desai M, Patel S, et al. Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol 2004;18(8):715–22.
16. Sharma L, Lavania S, Khetrapal A., et al Outcomes of PCNL-success & complications. IOSR 2016;15(8):121–25.
17. Gorbachinsky I, Wood K, Colaco M, et al. Evaluation of renal function after percutaneous nephrolithotomy does the number of percutaneous access tracts matter? J Urol 2016;196:131–36.
18. Shin TS, Cho HJ, Hong S-H, et al. Complications of percutaneous nephrolithotomy classified by the modified clavien grading system: a single center’s experience over 16 years. Korean J Urol 2011;52(11):769–75.