Complications of percutaneous nephrostolithotomy.

Dunnick, N. Reed; Carson, C. C.; Braun, SD; Miller, G. A.; Cohan, Richard H.; Degesys, G E; Illescas, F F; Newman, Glenn E.; Weinerth, John L.

doi:10.1148/radiology.157.1.4034977

Cited by 27 publications

(14 citation statements)

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“…In the last 2 years there have also been reports about shock waves for the treatment of chil dren older than 3 years, which has proved to be an effec tive method [17,18]. There are however still certain problems in the treatment of large calculi over 2-3 cm, such as staghorn with shock waves: the necessity of per forming percutaneous nephrostomy for urinary drainage and several interventions with shock waves, ureter ob struction caused by multiple stone fragments (stone street), retained renal stone fragments, infection and bleeding, as well as uncertainty as to the duration of the treatment and the success rate [19,20]. Considering the many problems involved in the treatment of large calculi with shock waves, it may be advantageous to remove the calculi by operative procedures.…”

Section: Discussionmentioning

confidence: 99%

Childhood Urolithiasis in Iran with Special Reference to Staghorn Calculi

Kheradpir

Bodaghi²

1990

Urol Int

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Between 1972 and 1984 148 children with urolithiasis were studied and managed at the University Clinic Children’s Hospital of Teheran. In 125 children the calculi were in the upper and in 23 children in the lower urinary tract. The maximum incidence was between the ages of 5–8 and 12 years. 25 children had malformations and 16 had metabolic disorders. Cystinuria was observed in 6 and xanthinuria in 3 cases. The main constituents of calculi analyses in the upper urinary tract were calcium oxalate followed by ammonium acid urate. In the lower urinary tract ammonium acid urate and oxalate were seen with equal frequency, followed by uric acid. 16 children had staghorn calculi with an age profile of 5–13 years. Predominant symptoms were flank pain and gross hematuria. In 4 cases the calculi were bilateral. The calculi were removed successfully by pyelotomy and extensive pyelolithotomy. In 2 cases with more branched-out staghorn calculi and separate fragments, a longitudinal extensive nephrotomy was performed. In the absence of recurrent stones, renal growth and function were satisfactory postoperatively. In the majority of the cases the analyses of the staghorn calculi revealed phosphate.

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Section: Discussionmentioning

confidence: 99%

Childhood Urolithiasis in Iran with Special Reference to Staghorn Calculi

Kheradpir

Bodaghi²

1990

Urol Int

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“…1 With stone-free rates ranging from 75% to 95%, PCNL has proven to be an efficacious treatment for large calculi, staghorn, stones in kidneys with abnormal anatomy, and stones in more complicated patient groups. [2][3][4][5][6] Despite the advantages, incidence of complications is reported from 16% to 83%, with major complications representing 4.7% in tertiary referral centers.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Postoperative Complications after Percutaneous Nephrolithotomy

Basnet

Shrestha

et al. 2018

J Nepal Health Res Council

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Background:To identify the perioperative factors associated with complications after percutaneous nephrolithotomy by classification of complications according to the modified Clavien scoring system and evaluation of the minor and major complications related to the procedure. Methods:A prospective study of all the percutaneous nephrolithotomy performed by standard technique within 1.5 years at Bir Hospital was made. Possible demographic, preoperative and intraoperative variables were included in the study and patients were followed up postoperatively for any complications. All complications were classified according to modified Clavien scoring system and analyzed to identify the prognostic variables.Results: Two hundred and forty six percutaneous nephrolithotomy done within the study period were analyzed. Although 41.06 % of the study population developed complications, only 9.35 % had major complications. Age, body mass index, gender, clinical presentation, history of previous surgery and ASA score did not correlate with complications. Diabetes was the only comorbidity associated (p = 0.0482). Preoperatively estimated stone burden (p = 0.0023), number of calyces involved by the stones (p = 0.0002), and presence of staghorn calculi were significantly associated with development of postoperative complications. Multiple tracts were required (p = 0.0151) and operative time was longer (p < 0001) in the patients who developed complications. Conclusions:Percutaneous nephrolithotomy has lesser complications. Diabetic patients are more prone to develop complications. Larger stone burden, involvement of multiple calyces by stones and staghorn calculi are associated with need of multiple tracts and longer operative time, thus predisposing to higher incidence of complications.

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“…2 With stone-free rates ranging from 78% to 95%, PNL is an efficacious treatment for large calculi associated with a low but specific complication rate. 3 Complications can arise from the initial puncture(hemorrhage)andproximityofadjacentorgans(lungs, pleura, colon, spleen, and liver), while others are delayed (postoperative hemorrhage, infection, and fistulae). Major complications such as persistent urinary extravasation in 7.2%, [4][5][6][7] sepsis in 0.8% to 4.7%, [4][5][6][7] pleural injury in 2.3% to 3.1%, 1,4,7,8 colonic injury in 0.2% to 0.8%, 1,4,8,9 and death in 0.3% to 0.78% 4,6,7 are infrequently associated with PNL, whereas minor complications occur more frequently, including fever in 21% to 22.4% 4,5,10,11 and urinary tract infection in 11%.…”

Section: Introductionmentioning

confidence: 99%