Gadelkareem RA, Abodief HT, Azer SZ, Fawzy W, Desoky AA. Urological and nursing-related predictors of unplanned hospital readmission after percutaneous nephrolithotomy: A prospective cohort study. World J Nephrol 2025; 14(4): 112190 [DOI: 10.5527/wjn.v14.i4.112190]
Corresponding Author of This Article
Rabea A Gadelkareem, MD, Assistant Professor, Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Elgamaa Street, Assiut 71515, Egypt. rabeagad@aun.edu.eg
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Prospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Nephrol. Dec 25, 2025; 14(4): 112190 Published online Dec 25, 2025. doi: 10.5527/wjn.v14.i4.112190
Urological and nursing-related predictors of unplanned hospital readmission after percutaneous nephrolithotomy: A prospective cohort study
Rabea A Gadelkareem, Hazem T Abodief, Sahra Z Azer, Waheed Fawzy, Amna A Desoky
Rabea A Gadelkareem, Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
Hazem T Abodief, Sahra Z Azer, Amna A Desoky, Medical-Surgical Nursing, Faculty of Nursing, Assiut University, Assiut 71515, Egypt
Waheed Fawzy, Department of Urology, Faculty of Medicine, New Valley University, Kharga 72511, New Valley, Egypt
Author contributions: Gadelkareem RA and Abodief HT designed the research, collected the data, and wrote the paper; Desoky AA and Fawzy W contributed to statistical analysis, literature review, writing and revision; Abodief HT and Azer SZ contributed to literature review, revision and supervision of the work; all authors approved the paper.
Institutional review board statement: This study was approved by the local ethical committee (The Ethical Committee of Faculty of Nursing, Assiut University), and the Institutional Review Board approval number is 3750011, on 24 March, 2022.
Clinical trial registration statement: This study was registered in the ClinicalTrials registry (ID: NCT05852483).
Informed consent statement: Informed consent was obtained from all participants in the study.
Conflict-of-interest statement: The authors have no financial relationships to disclose.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Data sharing statement: The data supporting this study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rabea A Gadelkareem, MD, Assistant Professor, Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Elgamaa Street, Assiut 71515, Egypt. rabeagad@aun.edu.eg
Received: July 21, 2025 Revised: August 2, 2025 Accepted: September 18, 2025 Published online: December 25, 2025 Processing time: 156 Days and 8.9 Hours
Abstract
BACKGROUND
Percutaneous nephrolithotomy (PNL) is the standard treatment for medium-sized and large kidney stones. Many potential complications of PNL may warrant hospital readmission (HR) after discharge, threatening patient safety and increasing the costs.
AIM
To estimate the rate of unplanned HR after PNL and identify its urological and nursing-related predictors.
METHODS
One hundred sixty-one patients were prospectively studied for HR after PNL from April 2022 to December 2022. The relevant urological and nursing-related characteristics of patients with and without unplanned HR after PNL were studied for association with HR, using univariate and multivariate analyses. Variables such as the demographic characteristics, comorbidities, laboratory and imaging characteristics, dietary status, operative time, number of kidney punctures, blood loss, urinary tract infections, and the receipt of instructions for catheter care and activities of daily living were included. A risk score was created.
RESULTS
The mean age of patients with HR (44.4 ± 12.7 years) and without HR (43.9 ± 12.6 years) was similar (P = 0.847). The overall stone-free rate was 88.8%. The total complication rate was 32.3% (52 patients), and the highest grade was IIIa, according to the modified Clavein grading system, resulting in an HR rate of 22.4%. History of preoperative pyuria (P = 0.001), hydronephrosis (P = 0.001) and mean stone size (P = 0.012), multiple renal punctures (P < 0.001), double J stent (P = 0.033), total operative time (P = 0.001), intraoperative injury (P = 0.011), postoperative urinary tract infection (P < 0.001), and inadequate instructions for urethral catheter (P = 0.001) and activity daily living (P = 0.048) were significantly associated with HR after PNL. On multivariate analysis, only preoperative pyuria (P = 0.004), intraoperative injury (P = 0.001), and inadequate instructions on urethral catheter care (P = 0.035) were associated with HR. The risk score of the independent predictors was 0-17; 0-4 (low risk), 5-9 (moderate risk), and 10-17 (high risk).
CONCLUSION
The rate of unplanned HR after PNL was relatively high (22.4%). The presence of pus cells in the preoperative urine analysis, intraoperative injury, and receiving inadequate instructions on urethral catheter care were independent predictors of HR after PNL. Combined studying of the urological and nursing-related predictors may promote the implementation of enhanced recovery protocols after PNL.
Core Tip: Percutaneous nephrolithotomy (PNL) is the first line of treatment for large kidney stones. Although the complication rates are usually low, they may warrant hospital readmission (HR) in the convalescence course of patients undergoing PNL. The overall stone-free rate was 88.8%, and the total complication rate was 32.3%. The highest grade of complications was IIIa by the modified Clavein grading system, resulting in an HR rate of 22.4%. Several preoperative, operative, and postoperative variables may be associated with increased HR after PNL. However, only the preoperative pyuria, intraoperative injury, and inadequate instructions on urethral catheter care were independently associated with HR.
