Complications after prone PCNL in pediatric, adult and geriatric patients – a single center experience over 7 years

Abstract

Introduction CROES-Clavien system (CCS) for grading complications in percutaneous nephrolithotomy (PCNL) is a step towards standardization of outcomes. We categorized complications based on CCS and predicted risk factors across the entire cohort and individually for pediatric (P: ≤18 years), adult (A: 19-65 years) and geriatric (G: ≥65 years) subgroups to assess the risk factors in each subset. We assessed association of complications with length of hospitalization (LOH) and operation time (OT).Materials and Methods Retrospective record review of unilateral PCNL performed between January 2009-September 2015 at a tertiary care center in India, performing around 150 PCNL per year.Results Out of 922 (P=61; A=794; G=67) PCNL, 259 (28.09%) complications occurred with CCS I, II, III and IV constituting 152 (16.49%), 72 (7.81%), 31 (3.36%) and 4 (0.43%) respectively and its distribution was similar across the subsets and majority (224; 24.3%) were minor (CCS-1, 2). Placement of a nephrostomy (47.4%; 18/38) in Group P, supracostal access, ≥2 punctures, higher GSS, nephrostomy, staghorn stones, ≥2 stones, stone size in Group A and hydronephrosis and prolonged OT in Group G were significantly associated with complications. On logistic regression, need of nephrostomy (adj. OR - 4.549), OT (adj. OR - 1.364) and supracostal access (adj. OR - 1.471) significantly contributed to complications in the study population. LOH was found to be significantly associated with complications (p<0.001).Conclusions Contrary to the belief that extremes of ages are associated with complications of prone PCNL, we found age does not alter the incidence or grade of complications and LOH.

A Comparison of Complications and Success Rates after PCNL in Younger and Elderly Patients

“…They were managed by intercostal tube drainage under local anesthesia. 19 In the present study, only one patient in young age group required angiographic embolisation, impressively very low (0.017%). According to a study by Kisa et al, no notable difference was found among ASA 1, 2, 3 groups with regard to duration of procedure and mean inpatient hospital stay.…”

Efficacy of intercostal nerve block with 0.25% bupivacaine in percutaneous nephrolithotomy: A prospective randomized clinical trial

“…[21] in another study had reported postoperative fever as a common complication, with an overall incidence of 10.8%, which was concurred by Kumar et al . [22] in another similar study. It was graded as I in 8.46% of patients that could be managed without a change in antibiotics and as Grade II in 3.04% of patients requiring a change in antibiotics.…”

“…[21] in another study reported that blood transfusion was required in 0%–20% of patients with an overall incidence of 7%, whereas Kumar et al . [22] in their study had documented that bleeding was a complication accounted for in up to 9.76% of their patients and these authors had categorized the same as Grade I in 5.86% of patients where bleeding was controlled by single episode of nephrostomy clamping, skin compression, or pressure dressing and as Grade II in 3.91% of patients who required blood transfusion. They also demonstrated that nine of their patients had developed hydrothorax which was managed with ICD under LA.…”

The Functional State of the Renal Parenchyma After Various Video Endosurgical Methods of Treatment of Patients With Large and Complex Kidney Stones

“…Так, в своей работе S. Kumar с соавт. [100], провели анализ осложнений ПНЛ в положении на животе, в трех различных группах, включающих детей до 18 лет, взрослых с 19 до 65 лет и пожилых более 65 лет [101], оценивалась связь послеоперационных осложнений с длительностью операции и госпитализации. Из 922 случаев ПНЛ (Д=61; В=794; П=67) в 259 (28,09%) имелись осложнения по системе CROES-Clavien I, II, III и IV составляющих 152 (16,49%), 72 (7,81%), 31 (3,36%) и 4 (0,43%) соответственно, основное количество осложнений (224; 24,3%) относилось I и II степени по системе CROES-Clavien.…”