Complications of percutaneous nephrolithotomy

Kallidonis, Panagiotis; Panagopoulos, Vasilis; Kyriazis, Iason; Liatsikos, Evangelos

doi:10.1097/mou.0000000000000232

Cited by 56 publications

(21 citation statements)

References 42 publications

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“…This result is consistent with the fact that bleeding is generally common in PCNL, which may require transfusion. Actually, a systematic review has reported that the overall transfusion rate is about 7%, indicating the rare requirement of transfusion for PCNL [ 10 ]. If conservative measures fail, 0–1.5% cases require selective embolization [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Migration of stones or fragments is the main reason for failure in rigid URSL and further auxiliary procedures, such as flexible URSL and SWL, are often required in this case. PCNL is a more invasive technique, during which bleeding is generally common and 0–20% with an overall of 7% need transfusion [ 10 ]. Moreover, adjacent organ injury should not be ignored when referring to PCNL even though the incidence is only about 0.4% [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis

Wang

Guo

et al. 2017

PLoS ONE

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ObjectTo compare the safety and efficacy of rigid ureteroscopic lithotripsy (rigid URSL) and percutaneous nephrolithotomy (PCNL) in treating large proximal ureteral stones.MethodsA systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science databases was performed to find out relevant studies. After literature screening according to the predetermined inclusion and exclusion criteria, data of eligible studies was extracted and then a meta-analysis was conducted via RevMan 5.3 software.ResultsFive randomized controlled trials (RCTs), one prospective and four retrospective cohort studies involving 837 patients were included. Patients underwent rigid URSL were associated with shorter operation time (WMD, -23.66min; 95%CI, −45.00 to -2.32; p = 0.03), shorter hospital stay (WMD, -2.76d; 95%CI, −3.51 to −2.02; p< 0.00001), lower 3rd-day (RR, 0.73; 95%CI, 0.66 to 0.82; p < 0.00001) and 1st-month (RR, 0.82; 95%CI, 0.77 to 0.87; p < 0.00001) stone-free rate, higher risk of conversion to other surgical procedures (RR, 4.28; 95%CI, 1.93 to 9.46; p = 0.0003), higher incidence of migration (RR, 28.49; 95%CI, 9.12 to 89.00; p < 0.00001) and ureteral perforation (RR, 6.06; 95%CI, 1.80 to 20.44; p = 0.004), lower risk of fever (RR, 0.64; 95%CI, 0.42 to 0.97; p = 0.04), transfusion (RR, 0.19; 95%CI, 0.04 to 0.85; p = 0.03) and hematuria (RR, 0.38; 95%CI, 0.25 to 0.57; p < 0.0001). No significant difference was observed in terms of incidence of embolization, pain and ureterostenosis. When cohort studies or studies in which flexible ureteroscopy was used as an intraoperative auxiliary procedure were excluded, we both found that most of the results kept stable.ConclusionsBoth PCNL and rigid URSL are safe for patients with large proximal ureteral stones while PCNL is more effective in stone clearance.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis

Wang

Guo

et al. 2017

PLoS ONE

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“…Injury and perforation of the renal collecting system is a well-documented complication of percutaneous nephrolithotomy (PNL) [ 1 – 3 ]. Major injuries usually result in excessive bleeding or fluid extravasation and may necessitate cessation of the procedure and draining of the collecting system using nephrostomy tube, peri-renal drain, JJ stent or a combination of these procedures [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Embedded upper end of double J stent at the site of renal pelvis injury following percutaneous nephrolithotomy: a rare complication

Hammad

2020

BMC Urol

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Background: Injury of the renal collecting system is a well-known complication of percutaneous nephrolithotomy (PNL). Large injuries may cause excessive bleeding and fluid extravasation and require adequate drainage using several modalities such placement of JJ stents. Herein, we report on two cases in which the upper coil of the JJ stent got buried in the fibrous tissues which formed due to an injury of the collecting system during PNL. Case presentation: 40 years old male and 32 years old female underwent standard PNL for partial and total staghorn calculi, respectively. During the procedure in both cases, the renal pelvis was injured. In both cases, JJ stent was used to drain the collecting system. Trial to remove the JJ stent 6 weeks following the procedure failed because the upper coils of the stents were embedded in the fibrous tissues at the perforation site. Laser incision of the fibrous tissues and releasing the upper coil of the stents were performed using percutaneous approach in the first case and flexible ureterorenoscopy (fURS) in the second patient. The procedures were uneventful in both cases. Conclusion: This is the first report of embedded JJ stents which got buried by fibrous tissues at the site of collecting system injury that occurred during PNL. To prevent this complication in such cases, we suggest draining the collecting system using nephrostomy tube instead of JJ stent. Alternatively, the upper coil of the stent should be placed away from the injury site.

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“…It has less complication rate compared to the more invasive procedures such as percutaneous nephrolithotomy [1, 2]. Following percutaneous nephrolithotomy, the formation of intrarenal arteriovenous malformations (AVM) in the form of arteriovenous fistulae or pseudoaneurysms, although rare with an incidence of around 1.4%, is a well-known complication [3, 4]. However, this complication is extremely rare following FURS and holmium laser lithotripsy.…”

Section: Introductionmentioning

confidence: 99%

Intrarenal arteriovenous malformation following flexible ureterorenoscopy and holmium laser stone fragmentation: report of a case

Bashar

Hammad

2019

BMC Urol

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BackgroundFlexible ureterorenoscopy (FURS) and holmium laser lithotripsy is currently considered as one of the treatment options for large renal calculi. It has been shown to be safer than percutaneous nephrolithotomy. The latter can sometimes be complicated by the formation of intrarenal arteriovenous malformation (AVM). AVM is extremely rare following FURS and laser lithotripsy. Indeed only one case has been reported on reviewing the literature up to June 2018. We report on the second case illustrating the possibility of developing this major complication following this procedure.Case presentationA 79 years old diabetic and hypertensive male with stage-4 chronic kidney disease who previously had left extracorporeal shockwave lithotripsy and FURS with Holmium laser lithotripsy, presented with bilateral large renal calculi. He underwent simultaneous bilateral FURS and Holmium laser lithotripsy and was discharged home the following day with almost clear urine. Four days post-discharge, he presented with gross hematuria for which he required hospitalization and blood transfusion. CT scan demonstrated left subcapsular, perinephric and retroperitoneal hematoma. Angiography showed contrast extravasation from pseudoaneurysms in two small branches of left renal artery. Both were selectively embolized with micro-coils and this led to the cessation of the hematuria.ConclusionsDespite the relative safety of FURS and Holmium laser lithotripsy, it can be associated with major complications like intrarenal AVM. This can probably be prevented by careful and judicious use of laser energy in patients with large stone burden and premorbid conditions.

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Complications of percutaneous nephrolithotomy

Abstract: The knowledge of risk factors, complications, and their management is important for every endourologist. Establishing of a PCNL-specific classification system for reporting outcomes and complications could set the basis for further improvement of the PCNL technique and outcomes.

Cited by 56 publications

References 42 publications

Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis

Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis

Embedded upper end of double J stent at the site of renal pelvis injury following percutaneous nephrolithotomy: a rare complication

Intrarenal arteriovenous malformation following flexible ureterorenoscopy and holmium laser stone fragmentation: report of a case

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