Preventive Measures and Mid-Term Outcomes After Percutaneous Nephrolithotomy: A Retrospective Cohort Study

Abstract

Introduction We aimed to evaluate the frequency of preventive recommendations provided to patients following PCNL and to assess their association with stone recurrence. Methods We conducted a retrospective cohort study of adult patients who underwent PCNL at Al-Zahra Hospital (Isfahan, Iran) between 2014 and 2016, with at least five years of follow-up. Data were extracted from medical records and patient interviews, including demographic characteristics, recurrence history, metabolic evaluation, preventive pharmacotherapy, and adherence to European Association of Urology (EAU) lifestyle recommendations. Preventive advice included adequate hydration, dietary modifications, and physical activity. Descriptive statistics summarized the frequency of recommendations, and associations with recurrence and reintervention were examined using Fisher’s exact test and Mann–Whitney U test. Results A total of 111 patients were included (mean age 49.7 years; 77.5 male). During follow-up, 67 patients (60.4) experienced at least one recurrence. Preventive lifestyle recommendations were commonly documented: advice on increased fluid intake was given to 80.2 of patients, limiting salt intake to 68.5, and restricting animal protein to 65.8. On the other hand, suggestions for regular exercise (22.5) and a balanced diet (24.9) were less common. Only 42.3 of patients received potassium citrate and 11.7 received thiazides as pharmacologic preventative measures. Lower recurrence rates were linked with limiting animal protein consumption (P-value=0.03) and diuresis (2-2.5 L/day) (P-value=0.02). Conclusion Even though some PCNL patients partially followed the recommended preventative measures, stone recurrence was nonetheless common. Recommendations for hydration and dietary salt/protein restriction were widespread, but there was a lack of emphasis on pharmacologic prophylaxis and thorough metabolic examination. Recurrence and long-term results might be greatly improved with stronger application of organized preventative approaches. Copyright © 2026 Urology Research Center (URC), Tehran University of Medical Sciences.