Postoperative Outcomes and Complications of PCNL: A Comparative Study of Hydronephrotic and Non-Hydronephrotic Calyces

Background: Percutaneous nephrolithotomy (PCNL) is the preferred treatment for large or complex renal stones. Calyceal status (hydronephrotic versus non-hydronephrotic) at the time of PCNL access may influence postoperative outcomes and complications. Understanding these potential influences is crucial for surgical planning and patient counseling. Methods: A cross-sectional study was meticulously conducted on patients undergoing PCNL at a single academic medical center. Patients were rigorously divided into two distinct groups: hydronephrotic and non-hydronephrotic, based on objective assessments of their calyceal status at the point of surgical access. Key perioperative and postoperative parameters were systematically collected and analyzed. These parameters included: mean hemoglobin drop (reflecting potential blood loss), total hospitalization duration, stone clearance rates (assessed by postoperative imaging), incidence of sepsis, need for blood transfusion, degree of creatinine elevation (indicating renal function changes), and occurrence of fever. Statistical comparisons between the two groups were performed using appropriate tests such as Chi-square for categorical variables and t-tests for continuous variables, along with the calculation of Relative Risks (RR) and Odds Ratios (OR) with 95% Confidence Intervals (CI) where applicable. Results: A comprehensive comparative analysis revealed striking similarities in most postoperative outcomes across both groups. Specifically, there was no statistically significant difference observed in the mean hemoglobin drop, average hospital stay, overall stone clearance rates, or the incidence of fever and sepsis between the hydronephrotic and non-hydronephrotic cohorts. However, a notable finding was that the hydronephrotic group exhibited a numerically higher, though not statistically significant, risk of pre-existing underlying kidney disease. This suggests a potential association between hydronephrosis and baseline renal impairment. The overall similarity in outcomes underscores that modern surgical techniques, coupled with diligent perioperative management, have largely minimized the impact of anatomical variations on the majority of postoperative outcomes. Conclusions: The study concludes that the calyceal condition, specifically whether it is hydronephrotic or non-hydronephrotic, did not significantly alter the perioperative or major complication rates following PCNL. This implies that with current surgical standards, PCNL can be performed safely and effectively regardless of the initial calyceal dilatation. Nevertheless, it is important to acknowledge that patients presenting with hydronephrosis may be inherently more susceptible to chronic kidney disease, necessitating tailored and vigilant perioperative care. The findings also reinforce the critical role of advanced surgical techniques and stringent sterile practices in optimizing patient outcomes and mitigating potential risks associated with varying anatomical presentations.