Percutaneous nephrolithotripsy in patients with diabetes mellitus

Purpose: To compare the surgical outcomes in a cohort of patients with diabetes who were undergoing percutaneous nephrolithotripsy (PCNL) for renal stone disease to a nondiabetic group of patients at a single center. Patients and Methods: Between July 1990 and December 2005, all patients scheduled for PCNL were prospectively included in a single-center database. Preoperative, intraoperative, and postoperative data were prospectively collected and analyzed. Primary outcomes evaluated were stone-free rates and complications, including the need for blood transfusion, while the secondary outcome was length of hospital stay. This report specifically reviews these outcomes in patients known to have diabetes at the time of surgery. Both outcomes were compared with those obtained in our nondiabetic patient population. Results: Analysis of the data from 183 (13.7%) patients with diabetes of the 1338 patients undergoing PCNL revealed that patient age (63.1 years), surgical time (90.8 minutes), and complications (major 2.2%), including need for transfusion (0.5%) and stone-free rate (94.5%), were not significantly different from those observed in our nondiabetic patients. The average length of hospital stay was significantly longer in the diabetic group (4.4 days vs 3.9 days, P = 0.022). Uric acid stone composition was found to be the most common stone composition among the patients with diabetes in this study (41%). Conclusions: PCNL can be performed with excellent stone-free rates and with an acceptable complication risk in the diabetic population. The incidence of uric acid stone disease appears to be significantly higher than previously reported and warrants heightened efforts directed toward stone prevention in this population.