Complications associated with Percutaneous nephrolitholapaxy (PCNL): Our experience and literature review

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.

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“…Complication rates for PCNL range from 20 - 83% ( 14 ). There is a need for standardized reporting of complication after PCNL ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…No significant difference between group A 20% and group B 22%. Nikić P et al [ 21 ], Tzeng et al [ 25 ], and Wang et al [ 26 ] showed similar results.…”

Section: Discussionmentioning

confidence: 70%

“…Mousavi-Bahar SH et al [ 8 ] reported 6% incidence of intraoperative bleeding. Nikie P et al [ 21 ] also reported 7.9% of intraoperative bleeding. Both studies had higher incidence of bleeding than screwed sheath group.…”

Section: Discussionmentioning

confidence: 99%

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Comparative study between a new screwed Amplatz sheath and the ordinary one in percutaneous nephrolithotomy

et al. 2021

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Objective The objective of the article is to compare the results of using new screwed Amplatz sheath with results of the conventional Amplatz sheath regarding success and complications during percutaneous nephrolithotomy. Methods 100 patients aged more than 18 years with renal calculi more than 2 cm with guy's score 1 from December 2018 till July 2020 were randomly stratified by closed envelope in group A (50 patients) with using conventional sheath and group B (50 patients) with new screwed sheath. We exclude morbid obese patients and patients with contraindication for PNL. Results There were no significant differences between both groups regarding patients demographic and stone demographic. Operative time and fluoroscopy time were significantly lower in group B rather than group A. Tract stability was in favor of group B as no tract loss recorded while in group A, 5 cases were recorded. In overall complications there were no significant differences between both groups. Bleeding was higher in group A (14%) than in group B (4%), but it was not statistically significant. Success rates were 78% for group A and 88% for group B but it was not statistically significant. Conclusion The screwed Amplatz sheath had showed less operative and fluoroscopy time. Also it enables urologists to have stable PNL tract. So it may be a promising tool to make PNL easier with higher success rate and lower complications. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03806-2.

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“…The frequency of bacteremia after this intervention is 23%, of endotoxemia 34%, febrile reactions 25% and sepsis 0.3-2.5% [29]. One study showed that the overall complication rate after this procedure was 30% and that the most common complications observed were postoperative fever (9.52%) and bleeding [30]. A study involving 580 patients showed that three key factors correlated with the occurrence of sepsis.…”

Section: Interventions On the Urogenital Systemmentioning

confidence: 99%

Urosepsis in adults

Ladjević

Vuksanović

Durutović

et al. 2021

ARCH BIOL SCI BELGRA

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Urosepsis is defined as sepsis caused by urinary tract infection (UTI). Urosepsis represents a quarter of all cases of sepsis in adults. Complications of UTIs are the most common risk factor for urosepsis development. These infections, especially pyelonephritis, often occur in patients with structural or functional malformations that interfere with normal urine flow. The problem of a significant increase in UTIs with multiresistant bacteria should be emphasized, especially in patients with recurrent UTI and their frequent treatments. As the urogenital tract is one of the most common sources of infection in sepsis in general, a detailed assessment of the tract should be carried out in all septic patients. Even though urosepsis is associated with a relatively good prognosis and lower mortality than sepsis of another etiology, it occurs rapidly and progresses at a significant speed. Since urosepsis is mainly the result of obstruction of the urinary tract, the development of septic shock can most often be prevented by implementing early deobstruction. Knowledge of the most common causes of urosepsis and the category of high-risk patients will provide clinicians with the tools with which to prevent its occurrence.

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Complications associated with Percutaneous nephrolitholapaxy (PCNL): Our experience and literature review

Cited by 10 publications

References 19 publications

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

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

Comparative study between a new screwed Amplatz sheath and the ordinary one in percutaneous nephrolithotomy

Urosepsis in adults

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