Abstract
Objective: To determine social factors causing late presentation of complex renal calculi undergoing Percutaneous Nephrolithotomy.
Methodology: We conducted a one year prospective study of 80 patients, divided into 2 groups of 40 patients each, who presented with complex and non-complex renal calculi. Six variables (Social Factors), Economy (poverty), Illiteracy, Homeopathic drug usage, Ignorance about the disease, Lack of health care facilities, and Fear of surgery were evaluated. Patients were asked to record these social factors as numerical values (social factor scores) on a patient subjective scale of 0-4. The mean of each factor was then compared between the 2 groups to see which factor(s) showed a statistically significant difference between complex and non-complex calculi.
Results: Of 80 patients, 44 (55%) were men and 36 (45%) women, with mean age 38.9±16.3 years (range 3-80). 30% (24) had right sided renal stones, 36.25% (29) left sided, and 33.75% (27) had bilateral stones. Median household income was Pakistani Rupees 17,000 (range 7,000-80,000). Median duration of symptoms was 725 days (range 2-6205). Mean serum creatinine was 1.875±2.83 mg/dL (range 0.3-14.1 mg/dL). Economy (mean social factor score 2.5), Illiteracy (2.37) and Homeopathic drug usage (2.18) were the most common reasons for late presentation to hospital.
Lack of health care facilities (group A=1.85, group B=1.18, p=0.035) and Homeopathic drug usage (group A=2.5, group B=1.85, p=0.047) showed a statistically significant difference between the complex and non-complex stones.
Conclusions: Lack of financial resources (poverty), and illiteracy were the main factors for late presentation of renal stones. Lack of health care facilities and homeopathic drug usage were the main reasons for complex renal stones.

Key words: Social factors, Delayed presentation, Complex renal stones, Homeopathic drugs.