An unusual presentation of colon perforation following percutaneous nephrolithotomy

Chubak, Barbara; Stern, Joshua M.

doi:10.5489/cuaj.2154

Cited by 8 publications

(9 citation statements)

References 29 publications

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“…PCNL has generally been considered to be a safe surgical method with overall low postoperative complication rates and the highest SFR compared with other surgical methods [ 24 25 ]. Although serious complications such as perioperative massive bleeding, urine leakage, bowel injury, hemothorax, and fistula are rare [ 26 ], increasing attention has been paid to the need for other minimally invasive surgical options to compensate for the shortcomings of PCNL.…”

Section: Current Role Of Flexible Ureteroscopymentioning

confidence: 99%

Current status of flexible ureteroscopy in urology

Cho

2015

Korean J Urol

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Retrograde intrarenal surgery (RIRS) is being performed for the surgical management of upper urinary tract pathology. With the development of surgical instruments with improved deflection mechanisms, visuality, and durability, the role of RIRS has expanded to the treatment of urinary calculi located in the upper urinary tract, which compensates for the shortcomings of shock wave lithotripsy and percutaneous nephrolithotomy. RIRS can be considered a conservative treatment of upper urinary tract urothelial cancer (UTUC) or for postoperative surveillance after radical treatment of UTUC under an intensive surveillance program. RIRS has a steep learning curve and various surgical techniques can be used. The choice of instruments during RIRS should be based on increased surgical efficiency, decreased complications, and improved cost-benefit ratio.

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Section: Current Role Of Flexible Ureteroscopymentioning

confidence: 99%

Current status of flexible ureteroscopy in urology

Cho

2015

Korean J Urol

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“…For large kidney stones (>2 cm), PCNL is currently the gold standard treatment method, with high stone free success after surgery 1 . The PCNL methods involves mostly minor complications with 1–3% rates for major complications like major hemorrhage, mediastinum-liver-spleen and colon injury 2 . Colon injuries are reported at 0.3–0.8% rates in broad series studies in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…With moderate level learning curve and promising high success rates, PCNL causes mainly minor but rarely abundant/major hemorrhage and neighboring organ injuries to lungs-intestines. One of these major complications is colon perforation, reported at rates of 0.3–0.8% in the literature 2 . Conservative treatment may be sufficient for retroperitoneal perforations without septic tableau and with early diagnosis; however, major surgeries like colostomy and/or colectomy may be required in patients with septic tableau, who are unstable or with intraperitoneal contamination.…”

Section: Introductionmentioning

confidence: 99%

Colon perforation after PCNL in reverse rotation anomalous kidney: A very rare case report and literature review

Güler

2020

Urology Case Reports

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PCNL is the gold standard method for large kidney stones currently. It offers high success and low complication rates. In recent times, miniaturized PCNL methods are used to further reduce the complication rates. Still major hemorrhage, mediastinum, spleen, liver and colon injuries are encountered at rates of 1–3%. Colon injuries occur in 0.3–0.8%. Thin patients, horseshoe kidney, retrorenal colon, previous intestinal surgeries, and access from posterior axillary line increase the risk of colon perforations. Treatment is mostly conservative approaches while sometimes major surgeries like colostomy and/or colon resection are required. The patient in our case report benefitted from conservative treatment.

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“…Therefore, surgical procedures such as retrograde intrarenal surgery (RIRS) or percutaneous nephrolithotomy (PCNL) are considered in these cases [ 2 , 3 ]. Although PCNL is usually the first line of treatment for renal calculi that are larger than 20 mm [ 1 ], some patients may experience severe complications such as hemorrhaging, urinary leakage, intestinal injury, pneumothorax, or hemothorax [ 4 ]. Thus, along with the recent development of a flexible endoscope, RIRS is more commonly being considered as the first line of surgical treatment for renal calculi because it does not require transcutaneous invasion and has similar success rates to that of PCNL.…”

Section: Introductionmentioning

confidence: 99%

“…With an increase in the use of radiological equipment, the risk of radiation exposure associated with these types of equipment is being realized. Many studies have demonstrated a dose-dependent effect between the radiation dose and its accompanying adverse effects [ 4 ]. Thus, in many medical fields, efforts are being made to minimize radiation exposure for both patients and radiation workers who are exposed to radiation [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Radiation exposure to the urology surgeon during retrograde intrarenal surgery

et al. 2021

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Retrograde intrarenal surgery is a common procedure that carries a risk of radiation exposure for urologists. This study aimed to measure the amount of radiation that urologists are exposed to during surgery, and to estimate how many procedures can be safely performed by one urologist per year. Variables that affect radiation exposure were also identified. Radiation exposure doses were measured for the eye, neck, chest, arms, and hands of a urologist who performed 226 retrograde intrarenal surgeries. To determine how many procedures could be safely performed per year, the Annual Permissible Occupational Exposure Radiation Dose Guidelines of the National Council on Radiation Protection and Measurements were consulted. Correlations between radiation exposure dose and the patient’s age, sex, body mass index, stone number/burden/laterality/location/Hounsfield unit, and their renal calculi were calculated. The mean surgery and fluoroscopy durations were 83.2 and 5.13 min; the mean tube voltage and current were 68.88 kV and 2.48 mA, respectively. Cumulative radiation doses for the eye, neck, chest, right upper arm, left hand, and right hand were 65.53, 69.95, 131.79, 124.43, 165.66, and 126.64 mSv, respectively. Radiation reduction rates for lead collars and aprons were 97% and 98%, respectively. If the urologists wear only radiation shields and lead apron but do not wear safety glasses during RIRS, the recommended by the ICRP publication 103 is taken into consideration, our results showed that 517 RIRS can be performed per year safely. However, if no protective measures are taken, this number decreases to only 85 RIRS per year. At all measurement sites, significant correlations were observed between the radiation exposure dose and stone numbers and Hounsfield unit values. In conclusion, it is imperative that urologists wear protective gear. Greater effort should be made to reduce radiation exposure when renal calculi have a large number of stones or large Hounsfield unit values.

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An unusual presentation of colon perforation following percutaneous nephrolithotomy

Cited by 8 publications

References 29 publications

Current status of flexible ureteroscopy in urology

Current status of flexible ureteroscopy in urology

Colon perforation after PCNL in reverse rotation anomalous kidney: A very rare case report and literature review

Radiation exposure to the urology surgeon during retrograde intrarenal surgery

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