EFFICACY AND SAFETY OF PERCUTANEOUS

NEPHROLITHOTOMY DONE UNDER SPINAL ANESTHESIA

VERSUS GENERAL ANESTHESIA

By
Taimoor Ahmad Khan
For
MS (UROLOGY)
Under supervision of
Prof. Dr. Ghulam Mahboob Subhani
MS Urology, Dip. Med Edu, Fellow European Board of Urology (Brussels)

Head of Department
Department of Urology & Renal Transplantation
Allied Hospital, Faisalabad Medical University, Faisalabad
 Allied Hospital / FMU, Faisalabad

University of Health Sciences, Lahore

 UNIVERSITY OF HEALTH SCIENCES,
LAHORE
SYNOPSIS PROFORMA
Title of Research Project: “EFFICACY AND SAFETY OF PERCUTANEOUS
NEPHROLITHOTOMY DONE UNDER SPINAL ANESTHESIA VERSUS GENERAL
ANESTHESIA”
Synopsis submitted for: Discipline:

M.S Urology

Name of the Applicant: D.O.B:

DR. Taimoor Ahmad Khan 16-11-1991

Nationality: NIC #:

Pakistani 36602-0434740-1

Address: House# 101, Street No, 5, Ali Block, Muslim Town-1, Faisalabad

Phone #: 0300-8925046 Email : taimoorkhan5046@gmail.com

Qualifications (list all; with date of graduation):

Qualification Year of Institution

Graduation
MBBS 2015 Punjab Medical College, Faisalabad

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Practical Experience (list all; with dates of employment):

Medical officer at BHU 122/WB from 15-08-2016 to 15-01-2018

Post Graduate Resident at Allied Hospital, Faisalabad from 31-01-2018 to till date

Name of post-graduate institution, where applicant is currently studying:

Allied Hospital / FMU, Faisalabad. University Of health Sciences, Lahore

Name of parent institution (if on deputation): N/A

Name of Academic Supervisor Signature: Date:

Prof. Dr. Ghulam Mahboob Subhani

Name of Head of Department Signature: Date:

Prof. Dr. Ghulam Mahboob Subhani

Name of Principal/Dean Signature: Date:

Prof. Dr. Zafar Ali Chaudhary

Convener, Ethical Review Committee Signature: Date:

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Table of Contents

Sr. No Particular Page no

1. List of Abbreviations
2. Project Summary 1
3. Introduction 2
4. Literature Review 3
5. Hypothesis 5
6. Objectives 6
7. Operational Definitions 7
8. Material and Methods 9
9. Methodology 11
10. Statistical Analysis 13
11. Outcome and Utilization 14
12. Limitations of Proposed Study 15
13. Bibliography 16
14. Annexure-I Ethical Considerations 17
15. Annexure-II Informed Consent Proforma 18
16. Annexure-III Estimated Cost of Project 20
17. Annexure-IV Gantt Chart 21
18. Annexure-V Data Collection Proforma 22

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LIST OF ABBREVIATIONS
KUB: Kidney Ureter and Bladder
PCNL: Per Cutaneous Nephrolithotomy
VAS: Visual Analogue Score
SA: Spinal Anesthesia
GA: General Anesthesia

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PROJECT SUMMARY
Nephrolithiasis is a common urological problem. It can be treated by medical therapy for
stones <5mm, ESWL for stones <2cm or Percutaneous nephrolithotomy (PCNL) for stones >2cm.
PCNL is the treatment of choice for renal calculi of all types, but it is done mostly in large sized
calculi aggregate size of more than 2cm or >1cm in lower calyx stone and in patients with less than
2cm who failed treatment with extracorporeal shockwave lithotripsy. Percutaneous nephrolithotomy
can be done under general anesthesia (GA) as well as in spinal anesthesia (SA) but conventionally it
is done in general anesthesia. In this study, we will compare efficacy and safety of percutaneous
nephrolithotomy (PCNL) done under spinal anesthesia versus general anesthesia to test the
hypothesis that there is a difference in the efficacy and safety of PCNL done under spinal anesthesia
versus that in general anesthesia. The objective of this study is to compare the efficacy and safety of
PCNL done under spinal anesthesia versus that in general anesthesia in terms of duration of surgery,
per operative & post operative complications, stone clearance, hospital stay, surgeon’s satisfaction
and patient’s satisfaction. The rationale of study is that there is no local study available which
compare the efficacy and safety of PCNL under general versus spinal anesthesia. This study will be
conducted in Faisalabad Medical University, Faisalabad. Duration of study will be 6 months after
approval of synopsis. Study design will be Non randomized controlled trial. A total number of 40
patients submitted to PCNL will be divided into two groups: Group A (N = 20) will receive spinal
anesthesia and Group B (N = 20) will receive general anesthesia. In PCNL lithotomy position will be
made and ureteric catheter will be passed to produce artificial hydronephrosis. Patient will be placed
in flank free position for supine PCNL. Ultrasound or fluoroscope guided puncture of pelvicalyceal
system (PCS) will be done with LP Needle and tract will be dilated over guide wire. During
nephroscopy stone will be broken with pneumatic lithoclast and stone pieces will be removed using
three prong forceps. Demographic and operative data including age, BMI, stone size, duration of
surgery, per operative complications, post operative pain, amount of post operative analgesic usage,
stone clearance, length of hospital stay, surgeon satisfaction and patient satisfaction will be
compared between the two groups. Estimated result will be that Spinal anesthesia is an alternative
technique for PCNL which achieves more patient satisfaction and less early post operative pain with
the same efficacy and safety compared to general anesthesia. Limitation of study is that since this
study is being done at one center, the sample can’t be representative of Pakistan.
Keywords: Percutaneous nephrolithotomy, general anesthesia, spinal anesthesia.

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INTRODUCTION:

Kidney stone disease, also known as nephrolithiasis or urolithiasis, is one of the oldest
diseases known to medicine. It is estimated that 1-15% individuals suffer from kidney stone
formation at some point during their lifetime, and the prevalence and incidence of kidney stone is
reported to be increasing worldwide. (Wang et al., 2021) Nephrolithiasis is one of the most prevalent
urologic diseases in Asia. (Liu et al., 2018) There are several options for treatment of kidney stones,
these include medical therapy for less than 5mm stone, extracorporeal shock wave lithotripsy
(ESWL) for less than 2cm stone or percutaneous nephrolithotomy (PCNL) for greater then 2cm
stone. Percutaneous nephrolithotomy (PCNL) is the treatment of choice for renal calculi of all types,
but it is done mostly in large sized calculi aggregate size of more than 2cm and in patients with less
than 2cm who failed treatment with extracorporeal shockwave lithotripsy.

PCNL is a minimally invasive therapy for treatment of upper ureteral and renal stones.
(Mehrabi & Karimzadeh, 2010) Renal stones resistant to lithotripsy are treated with PCNL.
(Aravantinos et al., 2007) PCNL can be performed under general anesthesia (GA) as well as spinal
anesthesia (SA) but conventionally it is done in general anesthesia. There is controversy in data
regarding better technique of anesthesia for PCNL i.e., SA vs GA. Studies have been done to
evaluate risk factors leading to significant morbidity, operative time, stone clearance rate, visual pain
analog score, mean analgesic dose, patient satisfaction and factors affecting the stay in hospital.

Limited local data is available for our local population regarding the efficacy and safety of
PCNL done in GA in comparison with SA. The purpose of this study to compare the efficacy and
safety of PCNL under spinal anesthesia versus general anesthesia in terms of duration of surgery,
post operative complications, hospital stay, success rate of PCNL and patient’s satisfaction. The
technique with better success rate and minimum complications will be recommend to other surgeons.

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LITERATURE REVIEW:
PCNL is a minimally invasive therapy for treatment of renal stones. Renal stones resistant to
lithotripsy are treated with PCNL. The purpose of this study to assess the efficacy and safety of
PCNL under spinal anesthesia (SA) versus that in general anesthesia (GA). Administration of
anesthesia is a crucial part of surgery. The preferences of surgeon and patient, feasibility,
anesthesiologist skills, perioperative cost, and intra and post-operative costs determine the preferred
anesthetic technique to be employed. Owing to more patient comfort and better regulation of
breathing, GA is the preferred anesthetic technique during PCNL. However, GA is occasionally
accompanied with certain side-effects, such as drug allergy, postoperative vomiting/nausea, and
pulmonary complications. Other related concerns might include neurologic events and tracheal tube
displacement while shifting the patients to prone position. SA is a well-tolerated, safe, and feasible
method, particularly for elderly patients with cardiac and pulmonary co morbidities. The purpose of
doing PCNL under SA is to reduce the complications of GA. This becomes more significant in
elderly patients and in those with significant co morbidities. However, in the case of SA, if a suitable
level cannot be achieved, then the procedures have to be abandoned or converted to GA with
possible complications. Since the patients under SA can still follow verbal commands and manage
their breathing well, this technique helps in better prevention of neurologic events and pulmonary
complications during supracostal puncture and patient positioning.
In a study, collected data of 418 patients of PCNL done under SA and compared surgery
parameters and postoperative findings. The mean duration of surgery was 65.70±18.98 min and the
mean hospitalization period of 42.29±11.70 h. The overall success rate was 87.32%. After the
induction of anesthesia, 10.04% patients had hypotension and 4.8% patients required blood
transfusion, and 5.3% patients had dizziness, lower back pain, and headache that were managed with
bed rest and analgesics. 4.5% patients had fever. SA was concluded safe for PCNL with low
complication and high success rate. (Alaridy, 2020)
In a regional study, PCNL done in SA and GA were compared and it was reported that
postoperative mean pain score at 2 hours, 3 hours and 6 hours was showing highly significant
difference between GA and SA groups (P value <0.001). The need of analgesic like tramadol was
highly significant within 24 hours; it was lower in spinal group (79.0± 28.7mg) than of general
anesthesia group (125.0± 43.2 mg). There was statistically no significant difference in adverse
effects like hypotension, bradycardia in both groups except nausea. (Soni et al., 2017)

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 In a study author reported in a study on PCNL done under SA, age of the patients ranged
from 25 years to 60 years. The majority of patients were belonged to age 25-50 years mean was
41.37±3.3years. it was observed that male was predominant which 86.48 due to male predominance
of the disease. mean operating time was 69±14.2 min. 75.60% patient had Complete stone
Clearance, less then <4mm residual stone was 14.86% and >4mm residual stone was 5.04 %. Only
10.82% patients were suffering from grade I complications and mean hospital stay was 3.1±0.6 days.
(Hossain et al., 2020)
In a similar study, it was reported that the mean pain score at 1 hour was 6.88 in GA group
and 3.12 in SA group (p <0.001). At 4 hours, 5.07 in GA group and 3.42 in SA group (p =0.025).
Less morphine was required in the SA group as compared to GA group. Higher satisfaction was In a
similar study, it was reported found in the regional SA group (58.3% vs 15.4%). 23.07% patients in
GA and 4.19% in SA group had complications like postoperative nausea and vomiting, respectively
(p = 0.05). Pain score at (12 hours, 24 hours, 48 hours, 72 hours), length of hospital stay and adverse
effects were no different between the two groups. (Tangpaitoon et al., 2012)
In a study various feature of SA and GA was compared. VAS score was 5.29±0.62 in GA
group and 0.98±0.89 in SA group at 0 hour, 5.58±0.49 in GA group and 1.88±0.84 in SA group at 2
hours and 4.26±1.30 in GA group and 2.10±1.02 in SA group at 6 hours which was significantly
lower in SA group in comparison with GA group (P < 0.05). Mean analgesic requirement within 24
hours was lower in SA group (76±36.05) than GA group (140±28.57) and it was statistically highly
significant (p<0.001). Postoperative nausea and vomiting were more in GA group than SA group.
(Meena et al., 2017)

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NULL HYPOTHESIS (Ho):
There is no difference in the efficacy and safety of PCNL done under spinal anesthesia versus that in
general anesthesia.
ALTERNATE HYPOTHESIS (H1):
There is a difference in the efficacy and safety of PCNL done under spinal anesthesia versus that in
general anesthesia.

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OBJECTIVES
The objective of this study is to compare the efficacy and safety of PCNL done under spinal
anesthesia versus that in general anesthesia in terms of duration of surgery, per operative & post
operative complications, stone clearance, hospital stay, surgeon’s satisfaction and patient’s
satisfaction.

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OPERATIONAL DEFINITION:
PER OPERATIVE COMPLICATIONS
Patients will be observed for any per operative complications like bleeding, multiple pelvicalyceal
tract puncture, counter puncture and injury to adjacent organ.
PER OPERATIVE BLEEDING
Per operative blood loss will be assessed by comparing patient’s hemoglobin pre & post operatively.
Drop in Hb will be calculated by following formula
Drops in Hb = (pre-operative HB - post-operative HB at 24 Hour) + (No. of Units
transfused x 1g/dL Hb per Unit transfused)
It will be graded as: -
Mild: If Hb is decreased <1g/dl
Moderate: If Hb is decreased between 1-2g/dl
Severe: If Hb is decreased >2g/dl
POST_OPERATIVE COMPLICATIONS
Patients will be observed for any postoperative complications like fever, post op pain, hypotension,
bradycardia, back pain and postural headache. It will be reported by the patient himself.
POST- OPERATIVE PAIN:
Pain will be evaluated by Visual Analog Scale (VAS) (fig. 2) range 0-10, which is a subjective
measure of pain. It will be assessed for 24 hours at 3,6,12 & 24 hours. Any episode will be recorded
as YES or NO based-on VAS score. VAS score of 4 or less will be graded as absence of pain (NO)
and VAS of 5 or above will be graded as presence of pain (YES).

Fig.1

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POST OPERATIVE FEVER:
Patients with oral temperature of > 990F will be labeled as presence of fever.
STONE CLEARANCE:
Stone clearance will be seen on digital X-ray KUB and ultrasound KUB for radiolucent stones on
next day and success rate will be noted and patient will be divided into three groups,
1 stone free 2. Clinical insignificant residual fragment (<4mm) 3. Residual Stone.
STAY IN THE HOSPITAL:
Hospital stay will be measured from the surgery until discharge with discharge criteria: minimal or
no pain, minimal or no flank leakage, no urinary retention, minimal or no hematuria, and stable vital
signs.
PATIENT SATISFACTION:
Patients will be asked on discharge to score the satisfaction as:

Fig.2
SURGEON SATISFACTION:
Surgeon satisfactions will be recorded using Likert’s scale

Fig.3

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MATERIAL & METHODS:
Study Design: Non randomized controlled trial.
Setting: Department of Urology, Faisalabad Medical University, Faisalabad
Duration: 6 months after approval of synopsis.
Sample Size:
Calculated the WHO sample size calculator, taking the expected percentage of satisfied patients in
group A P1 = 15.4% and that in group B P2= 58%.
Sample size: Total 80 (40 in each group)
Power of the test = 90% and Level of significance = 5%

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Sampling Technique and Randomization:
Convenience Sampling.
Patient fulfilling the inclusion criteria will be included, and informed consent will be taken.
The patient’s will be divided into two groups by lottery method. Group A will undergo PCNL under
spinal anesthesia, whereas group B will undergo PCNL under general anesthesia.
Sample Selection
Inclusion criteria:
All patients of either gender having renal stone greater than 2cm or ESWL resistant stone admitted
for PCNL will be enrolled in the study.
Exclusion criteria:
1. All patients with any anatomical anomalies in kidney diagnosed on
radiography/ultrasonography
2. Body mass index of more than 35.
3. Patients with significant cardiac, respiratory, hepatic or renal dysfunction, with anticipated
difficult airway, with spinal deformity, local infection at injection site and with renal
anomalies.
4. Patient on antiplatelet therapy.
5. Pregnancy.
6. Untreated UTI.

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Methodology:
After approval of my synopsis, 40 patients fulfilling the inclusion criteria will be
enrolled in the study. Patients will be recruited from the outdoor Department of Urology and Renal
Transplant Allied Hospital, Faisalabad. Written and informed consent will be taken from each
patient. The demographic information like name, age, gender and address will be recorded on
Performa (Annexure V). A thorough history and urological examination will be carried out. Renal
Stone will be diagnosed based on history and investigations. The patient will be assessed by an
anesthesiologist and will be optimized for surgery. The patient will be assigned to either group A or
group B by lottery method. Patients in Group A will undergo PCNL under spinal anesthesia, whereas
patients in group B will undergo PCNL under general anesthesia. An experienced urologist will
execute all surgical procedures on the elective list. A single shot broad-spectrum antibiotic
(intravenously) will be given to all patients before induction of anesthesia.
In beginning of procedure cystoscopy and placement of a 6 Fr ureteral catheter in the
ipsilateral ureter in lithotomy position. Then, a Foley catheter will be inserted and ureteral catheter is
secured. The patient will be placed in the Flank free supine position. Renal access will be achieved
through the posterior axillary line. A subcostal puncture will be used in all patients. Saline will be
pushed through the ureteric catheter to create / enhance hydronephrosis. The desired calyx will be
punctured under ultrasound / fluoroscopic guidance and a 0.038″ J-tip guide wire will be inserted.
The tract will be sequentially dilated to 26 Fr using Alken’s metal dilators and the Amplatz sheath
will be positioned. Rigid nephroscope of 18 Fr and sheath of 24-28 Fr will be used for nephroscopy
and stone will be fragmented using pneumatic after localization. Three prong forceps will be used to
retrieve the stone fragments. Nephroscopy will be conducted at the end of procedure to locate any
stone fragments with help of fluoroscope. Double – J stent will be inserted as per indication and
wound will be closed using prolene. All the patients will be shifted to post-operative bay after the
operation. Per operative complications like bleeding, multiple pelvicalyceal tract puncture, counter
puncture and injury to adjacent organ will be recorded
The visual analog scale (VAS) will be explained to the patients. All patients in both the
groups will be monitored. Patients will be observed for 24 hours in post anesthesia care unit for pain
with VAS scoring which is a 10 cm horizontal line labeled as “No pain” at one end (0) and “Worst
pain” imaginable on the other end (10). Patients will be asked to mark on the line where the pain lies.
100 mg of tramadol will be administered intravenously when patients will have a VAS score more

11
than 4. Stone clearance will be seen on digital X-ray KUB and ultrasound KUB for radiolucent
stones on next day and success rate will be noted and patient will be divided into three groups, 1
stone free 2. Clinical insignificant residual fragment (<4mm) 3. Residual Stone.
Surgeon’s satisfaction will be recorded using Likert’s scale. Patients will be interviewed at
discharge and their satisfaction with treatment and their hospital stay will be recorded.
All the results will be collected and recorded on a Proforma(attached).

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Statistical Analysis
Data will be analyzed using SPSS version 23. Mean and standard deviation will be
calculated for quantitative variables like age, temperature, stone size, operating time, hospital
stay. Frequency and percentages will be calculated for qualitative variables like gender, side of
stone, presence of UTI, hematuria, dysuria, flank pain, frequency, urgency, fever and need of
analgesics. Chi-square test will be used to check the statistical difference between the two groups
by taking p-value <0.05 as significant.

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OUTCOME & UTILIZATION
This study is going to be conducted to evaluate the proportion of patients developing
postoperative complications, their morbidity after giving general anesthesia versus spinal
anesthesia. So that we may adopt the strategy to control the problem and treat patients with renal
stones with minimum adverse effects and better efficacy along with reduction in cost of the
treatment.
Urology department of Allied Hospital which is an apex urology referral center and this study
will add to local knowledge and will help us in defining guidelines more suited for our local
population.

14
LIMITATIONS OF PROPOSED STUDY
Since this study is being done at one center, the sample can’t be representative of Pakistan.

15
Bibliography
Alaridy, H.M., 2020. Efficacy and safety of percutaneous nephrolithotomy under spinal

anesthesia. Sys Rev Pharm, 11(1): 40-43.

Aravantinos, E., Karatzas, A., Gravas, S., Tzortzis, V., & Melekos, M., 2007. Feasibility of

percutaneous nephrolithotomy under assisted local anesthesia: a prospective study on selected

patients with upper urinary tract obstruction. European urology, 51(1): 224–228.

Hossain, M., Islam, S., Rahman, M., Hossain, F., Islam, M. and Hossain, S., 2020. Clearance of

Renal Stone in PCNL Under Spinal Anaesthesia. Bangladesh Journal of Urology, 23(2): 154-

157.

Liu, Y., Chen, Y., Liao, B., Luo, D., Wang, K., Li, H. and Zeng, G., 2018. Epidemiology of

urolithiasis in Asia. Asian Journal of Urology, 5(4): 205-214.

Meena, M., Mantan, K., Saxena, M., Dhawan, S., Sethia, S., Meena, A., 2017. General versus

spinal anesthesia in percutaneous nephrolithotomy: A comparative study. IAIM, 4(9): 59-66.

Mehrabi, S., & Karimzadeh Shirazi, K., 2010. Results and complications of spinal anesthesia in

percutaneous nephrolithotomy. Urology journal, 7(1): 22–25.

Soni, D.K., Jain, T., Maniyar, F., 2017. A randomized study comparing effectivity and safety of

spinal anesthesia versus general anesthesia in patients undergoing percutaneous nephrolithotomy

(PCNL). IJSR, 6(3): 56-61.

Tangpaitoon, T., Nisoog, C. and Lojanapiwat, B., 2012. Efficacy and safety of percutaneous

nephrolithotomy (PCNL): a prospective and randomized study comparing regional epidural

anesthesia with general anesthesia. International braz j urol, 38(4): 504-511.

Wang, Z., Zhang, Y., Zhang, J., Deng, Q. and Liang, H., 2021. Recent advances on the

mechanisms of kidney stone formation (Review). International Journal of Molecular Medicine,

48(2): 1-10.

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ANNEXURE-I ETHICAL CONSIDERATIONS
 Applied for ERC approval.
 Approval application from Medical Superintendent for Study funding sources.
 Appropriate treatment availability in institution for diseased.
 Appropriate investigations availability in institution for diseased.
 Maintain confidentiality of the data obtained.
 Obtain informed written consent from study participants.
 Give autonomy to study participants.
 Give some beneficial effects to study participants.
 No harms to study participants.
 Justice and fair play.
 Study results dissemination to study participants.
 Plagiarism check reports within appreciate limits less than 20%.
 Contribution of each author made in conducting the study his/her name mentioned with
proper designation and contact No/ E-mail etc.

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ANNEXURE-II INFORMED CONSENT PROFORMA (English)
ID NO: ______________________________________
I _________________________________________________________acknowledged that Dr.

Taimoor Ahmad Khan as informed me about his research titled: “EFFICACY AND SAFETY

OF PERCUTANEOUS NEPHROLITHOTOMY DONE UNDER SPINAL ANESTHESIA

VERSUS GENERAL ANESTHESIA” under supervision of Prof. Dr. Ghulam Mahboob

Subhani.

I am also informed regarding purpose, nature, aims & objectives of the study. All the information
in this study will be kept confidential & my name & other data will be utilized only for research
purpose. I have been informed that this research is not just in benefit of a single person but for
the humanity at larger. If after the briefing I refuse to participate, there will be no obligation on
my side; I shall be treated in routine. I may withdraw myself from study anytime & I shall not
force to continue.
I give full consent & willingness to participate in this study.

Signature of the Participant Signature of Doctor/Researcher

________________________ ______________________________
Date: Date:

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ANNEXURE-II INFORMED CONSENT PROFORMA (URDU)

‫تحقیق میں حصہ لینے کے لیے راضی نامہ‬

19
ANNEXURE-III ESTIMATED COST OF PROJECT

All the surgical interventions, medications and investigations are available free of cost for
admitted patients in Allied Hospital Faisalabad. So, no burden will be put on the patients.

Procedure under SA:

Drug related to
Procedure Surgical Items Investigations Irrigation Fluid Quantity Availability Total Cost
SA
PCNL LP needle Foley Catheter US KUB Normal Saline 0.9% = 1 each Available in None
Inj. Bupivacaine LP needle DIGITAL 10-12 bottles hospital
(Hyperbaric) Guide wire XRAY KUB pharmacy
Inj. Xylocaine Ureteric Catheter
DJ stent

Procedure under GA:

Procedur Drug related to Surgical Quantit Total

Investigations Irrigation Fluid Availability
e GA Items y Cost
PCNL Propofol ETT US KUB Normal Saline 0.9% 1 each Available in None
Suxamethonium Foley DIGITAL XRAY = 10-12 bottles hospital pharmacy
Atracurium Catheter KUB
Pyridostigmine LP needle
Nalbuphine Guide wire
Metoclopramide Ureteric
Catheter
DJ stent

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ANNEXURE-IV GANTT CHART
Phase I II III IV V

Synopsis writing

Synopsis approval

Experimental
work
Data collection

Thesis writing

Thesis submission

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ANNEXURE-V DATA COLLECTION PROFORMA
Sr. No.____________ Date: ________________ Contact No. ____________
Name: _______________________________ Father’s Name: ___________________
Age: ________ Gender: __________ Group: A/B
Address: ____________________________________________________
Weight: ____ Height: _________ BMI: _______ Obesity: yes / no
Time since diagnosis: __________ Side involved: L / R
Stone size: ____________cm Location of stone: _______________________
Total Operation time: _________hours
3 hours 06 hours 12hours 24 hours
Post op fever Yes / No Yes / No Yes / No Yes / No
Nausea Yes / No Yes / No Yes / No Yes / No
Vomiting Yes / No Yes / No Yes / No Yes / No
Hypotension Yes / No Yes / No Yes / No Yes / No
Bradycardia Yes / No Yes / No Yes / No Yes / No
Postop pain Yes / No Yes / No Yes / No Yes / No
Per operative bleeding: Mild Moderate Severe
Injury to adjacent organ Present Not Present
Multiple pelvicalyceal tract puncture Yes / No
Counter puncture Yes / No
VAS Score
Analgesia demand within 24 hours: <100mg / >100 mg
Stone clearance: Stone free / Clinical insignificant residual fragment / Residual stone
Surgeon satisfaction: 1 2 3 4 5
Patient Satisfaction at discharge: 1 2 3 4 5

Doctor’s Name: _________________ Signature: _____________

22