Introduction: How to quantify the impact of metabolic syndrome (MetS) on percutaneous nephrolithotomy (PCNL) is unclear. We aimed to evaluate the quantified effect of the number of MetS components on the outcome of PCNL. Materials and Methods: In this retrospective cohort study, consecutive 606 patients with idiopathic staghorn renal stones undergoing PCNL were included. The participants were divided into two groups: MetS(+) and MetS(-). The number of MetS components were calculated as 0 to 5. Primary outcomes were stone-free rate (SFR) and overall complication rate. Results: MetS, obesity, hypertension, increased triglycerides (TG), decreased high-density lipoprotein cholesterol (HDL), and diabetes mellitus were found in 24.1%, 38.1%, 70.0%, 29.9%, 34.5%, and 26.4% of the patients, respectively. SFR values were comparable between groups. MetS resulted in a higher rate of overall complication (p < 0.001, odds ratio [OR] = 2.4, 95% confidence interval [CI] 1.67-3.69), blood transfusion, urosepsis, larger hemoglobin deficiency, and length of hospital stay. Multivariable analysis confirmed that fasting plasma glucose (FPG) (p = 0.033, OR = 1.164, 95% CI 10.22-1.348) and number of MetS components (p = 0.001, OR = 1.496, 95% CI 1.184-1.890) were independent risk factors, whereas HDL (p = 0.014, OR = 0.428, 95% CI 0.217-0.837) played an independent protective role. Compared with 0, having 3, 4, and 5 MetS components was associated with stepwise increase in complication rate (19.5% vs 34.2%, 41.5%, 62.5%, p = 0.027, 0.006, <0.001; OR = 2.1, 2.9, 6.9). Subgroup analysis showed that MetS(+) patients without complications were associated with lower systolic blood pressure, TG, and FPG (p = 0.010, 0.031, 0.002, respectively). Conclusions: The number of MetS components is the central predictor in assessing both inner severity of MetS and outer risk for PCNL. The number of MetS components is recommended to be calculated on a scale of 0 to 5. Three, four, and five MetS components increase risk for PCNL in a stepwise manner regardless of the presence or absence of obesity. MetS components should be controlled preoperatively.

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