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855: Is PCNL changing in the UK – analysis of 9500 cases from the BAUS PCNL Registry

Speaker
W. Finch, East Harling (GB)
Authors
Finch W. 1 , Armitage J. 2 , Withington J. 3 , Irving S. 1 , Fowler S. 4 , Burgess N. 1 , Wiseman O. 2 , British Association of Urological Surgeons on behalf of Section of Endourology5
Institutions
1Norfolk and Norwich University Hospitals, Dept. of Urology, Norwich, United Kingdom, 2Addenbrookes Hospital, Dept. of Urology, Cambridge, United Kingdom, 3Guy's Hospital, Dept. of Urology, London, United Kingdom, 4BAUS, Audit, London, United Kingdom, 5London, United Kingdom
Event
33rd Annual EAU Congress Copenhagen
Date – time - Location
19 March 2018, 12:15 - 13:45, Green Area, Room 1 (Level 0)
Session
Poster Session 63 - Straight access to the stone: Percutaneous nephrolithotomy
Topic
Stones: Open and percutaneous

Introduction & Objectives

PCNL indications, practices and techniques are evolving. BAUS developed an online data registry in January 2010 that now includes >9500 procedures. We evaluate outcomes and practices in PCNL and compare with previous analyses of the registry at 1000 and 5000 procedures to highlight significant changes in PCNL practice in the UK.

Materials & Methods

The BAUS PCNL registry was analysed between 2010 and 2017. We evaluated patient position, access and tract dilatation methods, grade of operator and fragmentation device used. Post-operative drainage, stone free rate at day 1 and complications were also analysed.

Results

9536 procedures were available for analysis and compared with previous analyses of 1028 cases in 2011 and 5191 cases in 2015. Submission of cases has stabilised at ~2,200 cases per year. Most PCNL is still prone, but supine continues to significantly increase from 5K analysis (22.4% vs. 16.2,p=0.0001). Access by interventional radiologist showed a small but significant decrease from 5K analysis (63.3% vs. 66.3%,p=0.0004), but not significantly different from 1K analysis. No significant changes in tract dilatation methods are seen, with balloon dilatation most popular (64.3%). Consultants increasingly perform PCNL themselves rather than their trainees (96.5% vs. 84.4%(5K) vs. 79.0%(1k), p=0.0001). Laser fragmentation usage has significantly increased (9.4% vs. 7.0%(5K) vs. 5.8%(1k), p=0.0001), with similar usage of ultrasound/ lithoclast/lift out. Sub-analysis of 4490 cases showed 25.8% of cases used multiple stone fragmentation modalities. Nephrostomy tube usage postoperatively is significantly reduced (72.6% vs. 75.6% (5k), p=0.0001). Intraoperatively 78.5% of patients were recorded as stone free, which was confirmed in 69.1% on postoperative imaging, similar to previous analyses. Complication rates are shown in Table 1.

Table 1 1k Analysis 5k Analysis 9k Analysis  
  N % N % N % Chi square test
Visceral Injury 4 0.3 17 0.3 22 0.2 Ns
Transfusion 24 2.5 117 2.4 199 2.2 Ns
Post op fever 155 16 551 12.1 916 10.7 p=0.02
Sepsis 25 2.4 128 2.8 215 2.5 Ns
Clavien 3-5 17 1.4 84 1.6 229 2.4 p=0.002

Conclusions

PCNL practices continue to evolve in the UK. Continued contribution of data and subsequent careful analysis of the registry allows us a better understanding of PCNL in the UK.