Evaluation of factors affecting success rate of open nephrolithotomy in adult patients

Abstract

Background
Indonesia has a high incidence of kidney stone disease. Endoscopic procedures are the preferred first-line treatment, but' nephrolithotomy remains an option for large or complex staghorn calculi, particularly in resource-limited settings. This study aimed to determine factors associated with the success rate of open nephrolithotomy at a single tertiary center. 

Methods
This retrospective study included 92 adults who underwent open nephrolithotomy at Wonogiri Regional General Hospital from January 2018 to December 2022. We analyzed demographic, laboratory, stone-related, and operative variables. Stone characteristics were assessed on preoperative non-contrast CT. Success was defined as complete stone clearance or residual fragments <4 mm on plain abdominal radiography (Blaas Nieren Overzicht, BNO) (KUB) on postoperative day 1. Associations were tested with simple binary logistic regression. Variables with p<0.25 were entered in a multiple logistic regression model. 

Results
Among the 92 patients, 59 were men and 33 were women, with a mean age of 53.25 ± 10.25 years. Surgery succeeded in 69 patients (75.0%), and complications occurred in 14 (15.2%). In simple logistic regression, female gender (OR 3.44, 95% CI 1.06–11.20; p=0.040) and multiple stones (OR 0.026, 95% CI 0.003–0.203; p=0.001) were associated with success. In multiple logistic regression, only stone number remained independently associated with success (aOR 0.029, 95% CI 0.004–0.230; p=0.001).

Conclusion
Stone number was the only independent factor associated with the success of open nephrolithotomy. Patients with multiple stones had lower odds of success. This should guide preoperative planning and counseling.