Mortality from Percutaneous Nephrolithotomy-temporal and global trends: A systematic review from EAU Endourology

Published Date: 05th September 2025

Publication Authors: Harrison. NL

ntroduction and Objective: Percutaneous nephrolithotomy (PCNL) is recommended first line for large renal calculi. This systematic review aimed to determine the mortality associated with PCNL in the management of kidney stone disease (KSD) and to identify relevant risk factors and highlight key learning points to reduce mortality from PCNL.
Method(s): A PRISMA compliant search was conducted across Medline, Embase, CINAHL and the Cochrane library. The study was registered with PROSPERO (registration number: CRD42024606297). The PICO statement: in patients with KSD, the intervention was PCNL, there was no comparator and the outcome was mortality. Inclusion criteria included English articles of adult and paediatric patients which reported on mortality from PCNL. Data extracted included patient demographics, comorbidities, number of mortalities and cause of mortality.
Result(s): After screening of abstracts and papers, 65 articles were eligible and reported on 634, 944 patients over a time period spanning from 1983-2024, from 20 countries, across all continents. A total of 2777 mortalities were reported following PCNL. Reported mortality rates were found to have remained stable for the past 40 years. The overall average mortality rate for adult studies, without selected patient cohorts, was 0.22%. The overall 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 (35.2%), myocardial infarction (MI) (23.1%), haemorrhage (12.1%) and pulmonary embolism (11%). The key insights affecting mortality were grouped into pre-operative, peri-operative and post-operative factors. Pre-operative factors included risk factors for sepsis, older age, co-morbidities, patient selection, and stone burden. Peri-operative factors focused on risk factors for haemorrhage, operative technique, procedure length and surgeon experience. Post-operative factors included risk factors for pulmonary embolism (PE).
Conclusion(s): Mortality rates from PCNL are low and have remained stable over past four decades, despite increasing prevalence of KSD and patient comorbidities. While rare, the most common causes of mortality were attributed to sepsis, myocardial infarction and haemorrhage. Higher mortality rates were seen in elderly patients, comorbid patients and those with spinal cord injury. Hence, efforts need to understand and possibly mitigate the pre-, peri-and post-operative risk factors and optimise patients undergoing PCNL procedure.

Dassanayake, S.N.; Harrison, N. et al. (2025). Mortality from Percutaneous Nephrolithotomy-temporal and global trends: A systematic review from EAU Endourology. Journal of Endourology. 39(Supp. 3), p.e147. [Online]. Available at: https://doi.org/10.1177/08927790251368714 [Accessed 5 November 2025].

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