Percutaneous nephrolithotomy: analysis of 500 consecutive cases.

The first 500 patients who underwent percutaneous stone removal at our hospital and who have been evaluated for at least 8 months were reviewed. Comparison of the first 100 patients with the entire series showed a sharp improvement in the success rate as the radiologic and urologic team gained experience. The success rate for simple pelvicaliceal stones was 98% in the entire series (vs. 89% in the first 100 cases) and 87% for staghorn calculi. The most common complication was bleeding, with 12% of the patients requiring transfusion. Other complications include infection (0.6%), retained stone fragments (4%), and ureteropelvic junction stricture (1%). There was 1 death, an obese diabetic woman who suffered a myocardial infarction. Successful stone extraction requires a properly placed nephrostomy tract, and radiologic and urologic expertise. The advent of extracorporeal shock-wave lithotripsy will not abolish the need for nephrostolithotomy.