Percutaneous Nephrolithotomy and Retrorenal Colon: Its Incidence and Complications

Abstract

OBJECTIVE:The aim of this study was to investigate retrorenal colon incidence in percutaneous nephrolithotomy (PCNL) and to discuss the necessity of routine preoperative CT and perform a cost analysis of this procedure. MATERIALS AND METHODS: Clinical data of 608 PCNL patients over a 5 year period (2008)(2009)(2010)(2011)(2012)(2013), was surveyed. The patient files were reviewed retrospectively, and only those who had abdominal computed tomography (CT) images before PCNL intervention were included in the study. In the CT images, the position of both the ascending and descending colon in relation to the right and left kidneys were evaluated. We compared the total cost of CTs per incidence of retro colon versus the cost of restoring complications. RESULTS: According to our hospital reports, 262 patients with CT images were included in the present study. 4 patients (1.14%) had retrorenal colon, of which 2(0.76%) were on the left side, 1(0.38%) on the right side and 1(0.38%) had bilateral retrorenal colons. Colonic perforation complication was seen only in two patients who had no CT images and the colonic perforation rate was 0.57%. The cost of recognizing one retrorenal colon case using CT was cost-effective to avoid a serious complication. CONCLUSIONS: PCNL, in the process of becoming the standard treatment modality, is a safe and reliable technique for renal stone treatment. Colonic injury should be taken into consideration during PCNL interventions of the lower pole of the kidney. CT, which should be low-dose, if possible, should be performed routinely in all patients to prevent colon injuries. This technique appears to be cost-effective.

Open Pyelolithotomy in the Presence of a Retro-Renal Colon: A Safe Alternative in Resource-Limited Settings

“…Colonic perforation complicates 0.3% of PCNL procedures [13]. A series by Reddy and Shaik also demonstrated that although rare, only two cases of colonic perforations occurred in patients where preoperative CT scans were not done [14].…”

“…Colonic injury with percutaneous renal access can result in sepsis, peritonitis, abscess formation, or fistula formation [14]. Early detection and conservative or endoscopic management with a course of antibiotics has been reported to have good success rates.…”