Mortality from Percutaneous Nephrolithotomy: A Systematic Review from European Association of Urology Endourology

Background and objective: Percutaneous nephrolithotomy (PCNL) is a common urological procedure recommended as first-line treatment for large renal calculi. This systematic review aimed to determine the mortality associated with PCNL in managing kidney stone disease (KSD). Methods: In line with the Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines, a literature search was conducted across Medline, Embase, CINAHL, and the Cochrane Library. The inclusion criteria included English articles of adult and paediatric patients that reported on mortality from PCNL. The extracted data included patient demographics, comorbidities, number of mortalities, and cause of mortality. Key findings and limitations: Sixty-five articles were included, which reported on 634 844 patients over a time period spanning from 1983 to 2024. A total of 2777 mortalities were identified. The overall weighted proportion mortality rate for adult studies, excluding selected patient cohorts, was 0.24%. The overall weighted proportion paediatric mortality rate was 0.6%, and mortality rates for other specific patient subgroups varied. Where the cause of death was reported, the most common causes of death in patients were sepsis (35.6%), myocardial infarction (23.3%), haemorrhage (12.2%), and pulmonary embolism (11.1%). Conclusions and clinical implications: Mortality rates from PCNL have remained stable and low over the lifetime of the procedure, with a slight reduction in reported mortality rates over time, despite increasing prevalence of KSD and patient comorbidities. Reporting of mortalities from PCNL has increased in recent years, with the most common causes of mortality identified being sepsis, myocardial infarction, and haemorrhage. Careful patient selection, with the identification and mitigation of risk factors, is vital in reducing the risk of mortality from PCNL.