Complications after PCNL: diagnosis and management

Gadzhiev, Nariman; Obidnyak, V M; Gorelov, Dmitry; Malkhasyan, V.A.; Akopyan, G.N.; Mazurenko, D.A.; Харчилава, Р Р; Петров, С. Б.; Martov, A G

doi:10.18565/urology.2020.5.139-148

Cited by 8 publications

(6 citation statements)

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“…Haotian et al [26] showed that the incidence of moderate-to-severe postoperative pain after PCNL was about 60%. Postoperative pain after PCNL has important negative effects on patients' postoperative rehabilitation, daily activities, quality of life, and social and economic conditions [27]. In the current study, (23.4%) patients in the group of standard PCNL, residual stones were found but none in the tubeless PCNL detected residual stones.…”

Section: Discussionmentioning

confidence: 43%

Comparison between Standard Percutaneous Nephrolithotomy versus Tubeless Percutaneous Nephrolithotomy

Hatroom

Saeed

2023

Int J Sci Healthcare Res

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Background: Percutaneous nephrolithotomy (PCNL) technique has become a routine treatment for upper urinary calculi. Objectives: To describe the socio-demographic characteristics of the patients and to compare the outcome of operated patients. Materials And Methods: This was a retrospective study, of patients underwent PCNL in our Urology Center, between January 2020 and December 2022. Data of age, side, location of stone, size of stone, operating time, hospital stay, post operation pain, residual stones, fever, fistula, blood transfusion, and postoperative infection were recorded and compared between the two groups. Data were analyzed by using the SPSS version 22. Independent t-tests were used to analyze continuous variables, while for categorical variables chi-square test was used to compare two groups and a p value of less than 0.05 was determined as statistically significant. Results: 51.1% of the patients were females and 48.9% were males, (P = 0.000). The mean age was 38.1 ± 11.1 years. The highest number of patients were in the age group 30 – 39 years (40.0%), (P = 0.000). The location of stones was in pelvic (48.9%), lower calyces (30.0%) and pelvic + lower calyces (21.1%), (P = 0.000). Pain was more common as moderate in both groups PCNL (42.2%). Residual stones were (23.4%) only in standard PCNL group, (P = 0.000). Fever was in (7.8%) standard PCNL and in tubeless PCNL was in (2.2%), (p = 0.045). Blood transfusion was provided to (5%) for the standard PCNL patients and (3.3%) for tubeless PCNL patients. Patients who had standard PCNL had postoperative infectious (2.2%) was found in standard PCNL patients. Mean operation-time and mean hospital stay of standard PCNL was predominant. Conclusion: Tubeless PCNL proved to be the safest and most effective. Keywords: Comparison, standard, tubeless percutaneous, nephrolithotomy.

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Section: Discussionmentioning

confidence: 43%

Comparison between Standard Percutaneous Nephrolithotomy versus Tubeless Percutaneous Nephrolithotomy

Hatroom

Saeed

2023

Int J Sci Healthcare Res

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“…Our study demonstrated that ASA classi cation, number of kidney stones, hydronephrosis, duration of surgery, and presence of residual stones after surgery are independent risk factors for the development of severe post-PCNL pain. Since the size of kidney stones was also reported to be an independent risk factor for the development of severe post-PCNL pain [11], we added this variable and developed a second clinical prediction model. Both models had good discriminatory power and were validated internally.…”

Section: Discussionmentioning

confidence: 99%

“…However, this may increase the risk of postoperative infectious complications due to the lack of effective urinary drainage [10]. Post-PCNL pain has a signi cant negative impact on postoperative recovery, quality of life and economic status of patients [11]. Severe postoperative pain causes nausea and vomiting in patients, prolongs the average length of hospital stay, and increases medical costs, which are not in accordance with the concept of comfort care.…”

Section: Discussionmentioning

confidence: 99%

Clinical Prediction Model for Severe Pain After Percutaneous Nephrolithotomy and Analysis of Associated Factors ：A Retrospective Study

Wei

et al. 2022

Preprint

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Objectives: This study aimed to develop severe pain prediction models for patients after percutaneous nephrolithotomy (PCNL), to identify and intervene the risk factors causing pain in a timely manner so as to improve patient satisfaction after surgery. Methods: The clinical data of 331 PCNL patients were retrospectively analyzed. Data of 265 patients (80%) were randomly selected as the training cohort and those of 66 (20%) patients were selected as the validation cohort. We choosed clinical data through the stepwise Akaike information criterion and best subset selection to build severe pain prediction models by the training data set. The validity of the model was verified and analyzed using the test data set. Results: The first clinical model was developed using the American Society of Anesthesiologists (ASA) classification, number of kidney stones, history of hydronephrosis, duration of surgery, and presence of stone remnants after surgery. This model had an area under the curve (AUC) of 0.8682 (95% confidence interval [CI], 0.8205–0.9160), threshold of 0.4771, sensitivity of 97.25%, specificity of 63.86%, and negative predictive value (NPV) of 91.38%. The second model was developed using the mentioned above six clinical features and size of kidney stones. This model showed a stronger discriminatory power (P=0.208), with an AUC of 0.8710 (95% CI, 0.8242–0.9187), threshold of 0.4813, sensitivity of 97.25%, specificity of 83.86%, and NPV of 91.38%. In the subsequent validation cohort (N = 66), the AUC (95% CI) was 0.9093 (0.8378–0.9808) for the first clinical model and 0.9098 (0.8373–0.9823) for the second clinical models. Conclusion: We developed two prediction models for postoperative pain severity in PCNL patients, which were validated internally. Trial registration: This is a retrospective study that does not include sensitive patient data, but only data provided by professionals from selected centres about their daily clinical practice. Therefore, our ethics Committee did not consider it necessary to register the study.

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“…Percutaneous nephrolithotomy(PCNL) is the primary treatment for renal and upper ureteral stones > 2 cm [1]. PCNL is associated with a high rate of stone clearance, but it is important to consider potential postoperative complications [2]. Urosepsis is the most common of these complications [3].…”

Section: Introductionmentioning

confidence: 99%

Prediction Model of Urosepsis in Patients after Percutaneous Nephrolithotomy and Pre- and Postoperative White Blood Cell Ratio to Predict Urosepsis Progresses to Septic Shock

Hao

Wang

Wei

et al. 2022

Preprint

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Background To study the predictors of urosepsis in patients after percutaneous nephrolithotomy and progression of urosepsis to septic shock, and establish the predictive models.Methods A total of 1046 patients were included in the study. Univariate and multivariate logistic regression analyses were used to screen independent risk factors for urosepsis after PCNL and urosepsis progresses to septic shock. The normogram prediction models was established according to the related independent risk factors. Areas under the receiver operating characteristic curves, calibration plots, and decision curve analysis (DCA) were used to estimate the discrimination, calibration and clinical usefulness of the prediction model, respectively.Results Urosepsis occurred in 86 patients, and 24 of these patients developed septic shock. Multivariate logistic regression analyses showed the independent risk factors for urosepsis after PCNL were diabetes, positive urine nitrite levels, staghorn calculi, HU of hydronephrosis>6.0, AGR<1.705, and hs-CRP/Alb>0.065. The pre- and postoperative WBC ratios were independent risk factors for the progression of urosepsis to septic shock. The AUC value for predicting urosepsis risk was 0.891 and that for predicting septic shock risk was 0.982. The P values of the calibration test in the urosepsis cohort and septic shock cohort were 0.946 and 0.714, respectively. DCA of the model in the urosepsis cohort and septic shock cohort showed threshold probabilities of 10–90%.ConclusionThe individualized nomogram prediction models can help improve the early identification of patients who are at higher risk of developing urosepsis after PCNL and progression of urosepsis to septic shock, to avoid further damage.

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Complications after PCNL: diagnosis and management

Cited by 8 publications

References 0 publications

Comparison between Standard Percutaneous Nephrolithotomy versus Tubeless Percutaneous Nephrolithotomy

Comparison between Standard Percutaneous Nephrolithotomy versus Tubeless Percutaneous Nephrolithotomy

Clinical Prediction Model for Severe Pain After Percutaneous Nephrolithotomy and Analysis of Associated Factors ：A Retrospective Study

Prediction Model of Urosepsis in Patients after Percutaneous Nephrolithotomy and Pre- and Postoperative White Blood Cell Ratio to Predict Urosepsis Progresses to Septic Shock

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