Perioperative complications of percutaneous nephrolithotomy and combined percutaneous nephrolithotomy with uni‑ and bilateral ureterorenoscopic stone therapy: results of the GRAND study.

BACKGROUND: Percutaneous nephrolithotomy (PCNL) is a standard therapy for large renal stones. When combined with unilateral or bilateral ureterorenoscopy, stone-free rates may increase, but data on perioperative complications remain limited. METHODS: We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2005-2023). We assessed, through multiple patient-level analyses, perioperative morbidity, mortality, length of hospital stay, intensive care unit admissions, and the evolution of PCNL during the last years in Germany. RESULTS: A total of 110,276 patients underwent PCNL (n = 98,965; 90%) and 11,208 patients (10%) underwent PCNL + unilateral ureterorenoscopy, respectively. The number of patients undergoing PCNL + bilateral ureterorenoscopy was very low (n = 103; 0.1%). Overall mortality was low after PCNL (0.2%) and PCNL + unilateral ureterorenoscopy (0.2%). PCNL + unilateral ureterorenoscopy was associated with increased odds of transfusion (3.3% versus 2.4%, OR: 1.3, p < 0.001), sepsis (2% versus 1.3%, OR: 1.6, p < 0.001), and acute kidney disease (2.6% versus 1.5%, OR: 1.6, p < 0.001) compared to PCNL. ICU admission rates were 1.9% after PCNL and 2.3% after PCNL + unilateral ureterorenoscopy (OR: 1.2, p = 0.004). Median length of hospital stay was 6 and 7 days, respectively. CONCLUSIONS: PCNL in Germany over the past two decades was associated with low perioperative morbidity and mortality. While PCNL + unilateral ureterorenoscopy is increasingly performed and is generally safe, it carries a modestly elevated risk profile. PCNL + bilateral ureterorenoscopy, in contrast, remains rarely performed. Prospective collaborative studies are warranted to define the optimal stone management strategies.