Predictive factors of stone-free rate and complications in patients undergoing minimally invasive percutaneous nephrolit
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ORIGINAL ARTICLE
Predictive factors of stone‑free rate and complications in patients undergoing minimally invasive percutaneous nephrolithotomy under local infiltration anesthesia Ke Chen1 · Kai Xu2 · Bingkun Li2 · Shusheng Wang1 · Songtao Xiang1 · Hulin Li2 Received: 2 June 2019 / Accepted: 27 December 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To evaluate predictive factors affecting the stone-free rates (SFR) and complications of minimally invasive percutaneous nephrolithotomy (MPCNL) under local infiltration anesthesia (LIA) Methods A retrospective analysis was conducted on 976 consecutive patients who underwent MPCNL under LIA from January 2015 to June 2018. Postoperative complications were classified according to modified Clavien classification system. Univariate and multivariate logistic regression analyses were used to determine factors affecting SFR and complications. Results The pain was acceptable with postoperative visual analog scale (VAS) scores being 3.58, 2.99, 2.25, and 2.07 after 0, 6, 24, and 48 h, respectively. The SFR after primary MPCNL reached 85.7%. Postoperative complications were recorded in 77 patients (7.9%). In the univariate logistic analysis, larger stone size, staghorn stone, and multiple calyxes were significantly associated with lower SFR. The higher American Society of Anesthesiologists (ASA) score, staghorn stone, positive urine culture, multiple tracts, and longer operation time were associated with occurrence of complications. However, hydronephrosis was associated with lower complication rate. Multivariate analysis indicated that larger stone size (P 1.5 cm in diameter, (3) renal stones or upper ureteral calculi with lesser diameter and extracorporeal shock wave lithotripsy failure (ESWL), or (4) complex calculi coexisting with renal and upper ureteral calculi, and (5) no significant clinical evidence of infection, with or without (6) physical condition deemed unsuitable for epidural anesthesia or general anesthesia as assessed by anesthesiologists, including serious pulmonary dysfunction (FVC
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