Purpose: Percutaneous nephrolithotomy (PCNL) is a minimally-invasive procedure to remove stones from the renal pelvis by a small puncture wound through the skin. Some common complications include hemorrhage during the operation, and post operation infection were reported. Other uncommon complications such as hemothorax or hydrothothorax were also noticed. However, long-term follow up data were seldom reported. The association between PCNL and development of new hypertension has never been reported before. We aimed to determine whether the PCNL increased the development of hypertension with controls matched for age, gender, obesity, diabetes mellitus and hyperlipidemia by using the Taiwan National Health Insurance (NHI) database.
Materials and Methods: Data sourced from the “Longitudinal Health Insurance Database” (LHID200) of our country (Taiwan, Republic of China) compiled by the NHI from 1996 to 2010. The LHID200 include medical records for 1,000,000 individuals randomly sampled from all enrollers in NHI. Cases of renal stones were defined by the ICD-9 diagnostic codes as 592. Patients with newly onset of hypertension was defined as ICD-9 diagnostic codes 401 to 405 with hypertension medication. For the study group, we only include the renal stone patients underwent PCNL (procedure code 76016B), patients with diagnosis of renal stone who underwent either shock wave lithotripsy (SWL; procedure code: 50023B) or ureterorenoscopic lithotripsy (URSL; procedure code: 77026B, 77027B, 77028B) were precluded in our cohort. For control group, we included the patients with renal stones diagnosed but did not receive the SWL, PCNL and URSL. The Kaplan-Meier analysis was applied to estimate the effect of PCNL on hypertension free rates.
Results: We included 232 patients with PCNL and 1,160 patients with comparison. There were no difference in age, gender, urbanization, monthly income, and co-morbidities between the two groups. Patients underwent PCNL showed greater incidence with a hazard ration of 1.48 (95% CI: 1.13–1.95) for newly hypertension compared to the control group. The incidence rate of newly hypertension during the follow up period was 44.5 per 1,000 person-years.
Conclusion: On the basis of our results, PCNL may increase the risk of developing hypertension in Taiwan NHI database.