{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T08:17:32Z","timestamp":1774945052810,"version":"3.50.1"},"reference-count":29,"publisher":"PAGEPress Publications","issue":"1","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Ital Urol Androl"],"abstract":"<jats:p>Background: Percutaneous nephrolithotomy (PCNL) is the gold standard for managing large renal calculi; however, data on its long-term efficacy in resource-limited settings such as Yemen are scarce. We evaluated the outcomes and complications of PCNL surgery in resource limited settings over a nine-year period in a high-volume centre in Ibb City, Yemen.Methods: We conducted a retrospective analysis of 1,458 patients who underwent PCNL between October 2016 and June 2025. Data included patient demographics, stone characteristics, surgical techniques (standard, mini-PCNL, and supine), and outcomes. The stone-free rate (SFR) was defined as the absence of fragments greater than 4 mm on follow-up imaging at three months. Complications were classified using the Clavien-Dindo system.Results: The cohort comprised 763 (52.3%) males and 695 (47.7%) females with a mean age of 43.8\u00b117.5 years (range: 2-87 years). Staghorn calculi were present in 647 cases (44.4%). Prone lower-pole access was the predominant approach (58.2%), with a progressive institutional shift toward mini-PCNL (5.7%), supine PCNL (3.1%), and ultrasound-guided access (1.4%) in later years. The primary stone-free rate after a single session was 76.0%, increasing to a final SFR of 92.6% following auxiliary interventions including repeat PCNL, ureteroscopy (2.8%), ESWL (1.5%), and conservative management of clinically insignificant residual fragments (6.0%). Major complications (Clavien-Dindo Grade III-V) occurred in 1.44% of cases, including colonic perforation (0.41%) and conversion to open surgery (0.62%). Mortality rate was 0.14% (n=2). Minor complications (Grade I-II) affected 17.4% of patients, predominantly postoperative pain (7.3%) and transient fever (5.3%).Conclusions: This large series demonstrates that PCNL can be performed with high stone-free rates and acceptable morbidity in resource-limited settings despite a high prevalence of complex staghorn calculi. The progressive adoption of miniaturized and supine techniques reflects institutional adaptability and confirms the feasibility of implementing contemporary endourological standards in low-resource environments.<\/jats:p>","DOI":"10.4081\/aiua.2026.14940","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T06:53:50Z","timestamp":1774940030000},"source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of percutaneous nephrolithotomy in a resource-limited setting: a retrospective study"],"prefix":"10.4081","volume":"98","author":[{"given":"Radman","family":"Ghaleb","sequence":"first","affiliation":[{"name":"Department of Urology, Faculty of Medicine, Taiz University, Ibb"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sultan","family":"Qaid","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, Ibb University, Ibb"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noaman","family":"Almashraki","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, Ibb University, Ibb"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nagm Aldean","family":"Haider","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, Ibb University, Ibb"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ebrahim","family":"Al-Shami","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, Ibb University, Ibb"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Basam Musleh","family":"Musleh","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, Ibb University, Ibb"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamil","family":"Muleky","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, Ibb University, Ibb"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faisal","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, Ibb University, Ibb"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2549","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"222159","doi-asserted-by":"crossref","unstructured":"1. 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Urological Science. 2025; 36:176-84.","DOI":"10.1097\/us9.0000000000000076"},{"key":"222172","doi-asserted-by":"crossref","unstructured":"14. Al-Naggar K, Aljuma\u2019ai N, Ahmed F, et al. Prevalence of urolithiasis in children from the EMRO region: A systematic review and meta-analysis. J Emerg Med Trauma Acute Care 2025; 2025:40.","DOI":"10.5339\/jemtac.2025.40"},{"key":"222173","doi-asserted-by":"crossref","unstructured":"15. Akpayak IC, Ikeh CD. Percutaneous nephrolithotomy in the management of renal stone: an audit of outcomes and complications. Ann Afr Med. 2025; 24:461-7.","DOI":"10.4103\/aam.aam_5_25"},{"key":"222174","doi-asserted-by":"crossref","unstructured":"16. Skolarikos A, Geraghty R, Somani B, et al. European Association of Urology guidelines on the diagnosis and treatment of urolithiasis. Eur Urol. 2025; 88:64-75.","DOI":"10.1016\/j.eururo.2025.03.011"},{"key":"222175","doi-asserted-by":"crossref","unstructured":"17. Ahmed EM. Management of nephrolithiasis in the Middle East over a recent decade: A systematic review. Urol Ann. 2024; 16:36-42.","DOI":"10.4103\/ua.ua_111_23"},{"key":"222176","doi-asserted-by":"crossref","unstructured":"18. AlAzab R, Ghammaz O, Ardah N, et al. Predicting the stone- free status of percutaneous nephrolithotomy with the machine learning system. Int J Nephrol Renovasc Dis. 2023; 16:197-206.","DOI":"10.2147\/IJNRD.S427404"},{"key":"222177","doi-asserted-by":"crossref","unstructured":"19. Jazzar A, Medlej A, Rahhal N, et al. Percutaneous nephrolithotomy safety, efficacy, and outcomes: a 10-year experience of a tertiary care center in South Lebanon. Cureus. 2025; 17:e84097.","DOI":"10.7759\/cureus.84097"},{"key":"222178","doi-asserted-by":"crossref","unstructured":"20. El-Nahas AR, Eraky I, Shokeir AA, et al. Percutaneous nephrolithotomy for treating staghorn stones: 10 years of experience of a tertiary-care centre. 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Sierra A, Alfambra H, L\u00f3pez JM, et al. Outcomes of percutaneous nephrolithotomy in kidney transplant recipients: results from a multicenter study by the Spanish Urology Association's Renal Transplant Group. World J Urol. 2025;43:564.","DOI":"10.1007\/s00345-025-05467-x"},{"key":"222183","doi-asserted-by":"crossref","unstructured":"25. El-Nahas AR, Shokeir AA, El-Assmy AM, et al. Colonic perforation during percutaneous nephrolithotomy: study of risk factors. Urology. 2006; 67:937-41.","DOI":"10.1016\/j.urology.2005.11.025"},{"key":"222184","unstructured":"26. \u00d6ztu\u0308rk H. Treatment of colonic injury during percutaneous nephrolithotomy. Rev Urol. 2015; 17:194-201."},{"key":"222185","doi-asserted-by":"crossref","unstructured":"27. Seitz C, Desai M, H\u00e4cker A, et al. Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy. Eur Urol. 2012; 61:146-58.","DOI":"10.1016\/j.eururo.2011.09.016"},{"key":"222186","doi-asserted-by":"crossref","unstructured":"28. Atassi N, Knoll T. Future of kidney stone management: surgical intervention miniaturization of PCNL: where is the limit? Curr Opin Urol. 2020; 30:107-12.","DOI":"10.1097\/MOU.0000000000000713"},{"key":"222187","doi-asserted-by":"crossref","unstructured":"29. Talyshinskii A, Tzelves L, Julieb\u00f8-Jones P, et al. The evolution of percutaneous nephrolithotripsy - An overview from European Association of Urology Endourology Section. J Endourol. 2025;39:985-97.","DOI":"10.1089\/end.2024.0910"}],"container-title":["Archivio Italiano di Urologia e Andrologia"],"original-title":[],"link":[{"URL":"https:\/\/www.pagepressjournals.org\/aiua\/article\/download\/14940\/13950","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.pagepressjournals.org\/aiua\/article\/download\/14940\/13950","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T06:54:04Z","timestamp":1774940044000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.pagepressjournals.org\/aiua\/article\/view\/14940"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,31]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,3,31]]}},"URL":"https:\/\/doi.org\/10.4081\/aiua.2026.14940","relation":{},"ISSN":["2282-4197","1124-3562"],"issn-type":[{"value":"2282-4197","type":"electronic"},{"value":"1124-3562","type":"print"}],"subject":[],"published":{"date-parts":[[2026,3,31]]}}}