Predictors of success and complications of monoplanar renal access for conventional prone percutaneous nephrolithotomy

Introduction: Our aim was to assess how monoplanar fluoroscopy-guided access affects the outcomes of percutaneous nephrolithotomy (PCNL). Methods: This retrospective study included all patients who had renal stones and underwent prone PCNL using monoplanar fluoroscopy-guided access in a single tertiary care center between January 2015 and January 2024. Preoperative and postoperative patient- and procedure-related variables, such as operative time, intraoperative blood loss, number of tracts, complications, stone-free rate (SFR), and hospital stay, were assessed. Multivariable analysis was performed to detect predictors of residual stones and complications. Results: A total of 662 patients with an average age of 47±12 years were included. Comorbidities were reported in 26.1%. American Society of Anesthesiologists (ASA) score was 1 in 64.8%. The mean stone diameter was 2.8±0.9 cm. Only 6% had positive preoperative urine culture. The mean stone HU was 1054±304 with a mean operative time of 94±31 minutes. Most cases (74.9%) required only one tract. Postoperative fever was reported in 22.4%. The median estimated blood loss (EBL) was 160 mL. The complications included urine leak (4.1%), blood transfusion (1.5%), sepsis (1.5%), renal pelvic perforation (0.8%), superselective angio-embolization (0.6%), pleural injury (0.6%), and colonic injury (0.2%). The median hospital stay was three days. Approximately 73% were stone-free. The only predictor of residual stone was higher stone diameter (odds ratio [OR] 1.536, p=0.001). Predictors of complications were three tracts (OR 4.501, p=0.033) and higher EBL (OR 1.003, p<0.001). Conclusions: The monoplanar fluoroscopy-guided approach has demonstrated a noteworthy success rate, rendering it a safe modality for prone conventional PCNL.