Percutaneous Nephrolithotomy: Variables That Influence Hemorrhage

Turna, Burak; Nazlı, Oktay; Demiryoguran, Serkan; Mammadov, Rashad; Çal, Çağ

doi:10.1016/j.urology.2006.12.021

Cited by 175 publications

(119 citation statements)

References 15 publications

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“…Mini-PCNL is more difficult to perform at the early or middle stage in type III cases as there was no hydronephrosis and thereby little space. After a target was successfully punctured guided by X-ray or B ultrasound, the contrast agent could be injected using a needle to identify whether or not the agent is in the target renal calyx and the needle is in the renal calyx neck, thereby reducing the incidence of postoperative arteriovenous fistula [16,17]. The presence of multiple and complicated calculi in types IV and V cases results in a more difficult surgical treatment and relatively high surgical risk as well as incidence of complications.…”

Section: Discussionmentioning

confidence: 99%

Types of Renal Calculi and Management Regimen for Chinese Minimally Invasive Percutaneous Nephrolithotomy

Zeng²,

You

et al. 2014

Indian J Surg

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Strict selection of patients for minimally invasive percutaneous nephrolithotomy could effectively improve the success rate of surgery. This study aimed to understand the required skills and the efficacy of mini-PCNL in the treatment of five types of upper ureteral calculi. Data collected after X-ray analysis and B mode ultrasound from 633 patients with upper ureteral and renal pelvis calculi who underwent B ultrasound-guided lithotomy was reviewed, including the following: type I, upper ureteral or renal pelvis calculi with moderate hydronephrosis (154 cases); type II, upper ureteral or renal pelvis calculi with severe hydronephrosis (157 cases); type III, upper ureteral or renal pelvis calculi without hydronephrosis (61 cases); type IV, renal pelvis calculi, one or two renal calyx calculi (206 cases); and type V, renal staghorn calculi (55 cases). Operations on 611 cases were successful. The treatment method for five patients was converted to open surgery. Twelve cases were treated by indwelling double-J tube retrocatheterization and extracorporeal shock wave lithotripsy. Five patients gave up the treatment. The rate of calculus clearance was 82.3 %, and the rate of residual calculus was 17.6 %. Selective renal artery embolization was performed in nine cases. Hydropneumothorax occurred in nine cases. No intestinal fistula occurred, and no patient had to undergo nephrectomy. The difficulty and the curative effect of the operation were different because the types of calculi varied. Selection of the procedure based on the different types of calculi could effectively improve the success rate of the procedure, reduce complications, and shorten the learning curve.

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Section: Discussionmentioning

confidence: 99%

Types of Renal Calculi and Management Regimen for Chinese Minimally Invasive Percutaneous Nephrolithotomy

Zeng²,

You

et al. 2014

Indian J Surg

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“…The multiple tracts approach comes with increased blood loss and transfusion. 46,47 In Onal study, postoperative hematocrit had no significant effect on complication rate in children. 21 In our experience, postoperative hemoglobin and hemoglobin drop significantly affected MCC.…”

Section: Discussionmentioning

confidence: 83%

Factors affecting complications according to the modified Clavien classification in complete supine percutaneous nephrolithotomy

Falahatkar¹,

Moghaddam

Kazemnezhad³

et al. 2015

CUAJ

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Cite as: Can Urol Assoc J 2015;9(1-2):e83-92. http://dx.doi.org/10.5489/cuaj.2248 Published online February 9, 2015. AbstractIntroduction: An increase in percutaneous nephrolithotomy (PCNL) has been accompanied by an increase in complications. We identified the parameters affecting the severity of complications using the modified Clavien classification (MCC). Methods: From 2008 to 2013, 330 patients underwent complete supine PCNL using subcostal access, one-shot dilation, rigid nephroscopy, and pneumatic lithotripsy. We assessed the impact of the following factors on complication severity based on the MCC: age, gender, body mass index, hypertension, diabetes, previous stone surgery and extracorporeal shock wave lithotripsy, preoperative hemoglobin, renal dysfunction (creatinine >1.4 mg/dL), preoperative urinary tract infection, anatomic upper urinary tract abnormality (AUUTA), significant (moderate-severe) hydronephrosis, stonerelated parameters (opacity, number, burden, location, staghorn, complex stones), anesthesia type, kidney side, imaging and calyx for access, tract number, tubeless approach, operative time, postoperative hemoglobin, and hemoglobin drop and stone-free results. Results: The complication rate was 19.7% (MCC: 0=80.3%, I=6.4%, II=11.2%, ≥III=2.1%). On univariate analyses, only the following factors affected MCC: gender, preoperative hemoglobin, AUUTA, significant hydronephrosis, imaging for access, calyx for access, tract number, postoperative hemoglobin, hemoglobin drop and stone-free result. Renal dysfunction was accompanied by higher complications, yet the results were not statistically significant. Multivariate logistic regression analysis demonstrated renal dysfunction, absence of significant hydronephrosis, AUUTA, multiple tracts, lower postoperative hemoglobin, and higher postoperative hemoglobin drop as the significant parameters which affected MCC and predicted higher grades. The paper's limitations include a low number of cases in the higher Clavien grades and some subgroups of variables, and not applying some techniques due to surgeon preference. Interpretation: Many of the complete supine PCNL complications were in the lower Clavien grades and major complications were uncommon. Renal dysfunction, AUUTA, significant hydronephrosis, tract number, postoperative hemoglobin, and hemoglobin drop were the only factors affecting MCC. IntroductionPresently, percutaneous nephrolithotomy (PCNL) is preferred as a safe and effective way to remove large or multiple upper urinary tract calculi. [1][2][3][4][5][6][7] An increase in PCNL has been accompanied by variations in positions, techniques, and instruments, and these may have led to increased complications.1,2,4,5 Following PCNL, 79.5% of patients may experience an uncomplicated postoperative period, 5,8 although there are reports of an early complication rate of 50.8%. 4PCNL complications may occur during puncturing, access, or stone removal. 4 A standardized classification allow us to compare complications among different instruments, te...

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“…Literatürde böbrek yetmezliği, diabetes mellitus ve obezite varlığının hastalarda PNL operasyonun genel komplikasyon oranını arttırdığı gösterilmiştir [5]. Özellikle artmış kanama ile; operasyon süresi, dilatasyon sistemleri (amplatz,balon), renal parankimal kalınlık, staghorn taş, trakt boyutu, taş boyutu, multipl giriş ve soliter böbrek birer risk faktörü olarak tanımlanmıştır [9][10][11]. Kanama sıklıkla renal parankimden kaynaklandığı gibi çoğunluk-la da spontan olarak sınırlanır.…”

Section: Discussionunclassified

The Factors That Effects Hemorrhage in Percutaneous Nephrolitotomy

Duz¹

2015

Ann Clin Anal Med

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Anahtar KelimelerKomplikasyon; Perkütan Nefrolitotomi; Kanama; Litotripsi; Nefrostomi Abstract Aim: Today, PNL has become primary treatment alternative in multiple or large kidney stones where ESWL treatment has failed. In our study, we have analyzed the facts that affect hemorrhage in PNL surgeries. Material and Method: Between March 2008 and December 2009, 204 patient's histories who had undergone percutaneous nephrolithotomy surgery in Izmir Bozyaka Training & Research Hospital, Urology Department were analyzed retrospectively. The patients were assembled under four groups according to the effect of some factors related to stone (size and localization), operation (number and localization of the entrances) and the effects of PNL hemorrhage between these groups was investigated. Results: Of the 204 patients undergoing percutaneous nephrolithotomy, 76 were female, 128 were male, with an average age of 46. 9±14.2 (18-80). The preoperation and postoperation Hb differences of the 176 patients whose stone load was less than 1000 mm2 and 28 patients whose stone load was over 1000 m2 were compared, yielding no statistically significant difference (p=0.942). Also no statistically significant difference was observed with regard to stone type, number of entries and percutaneous entry location. Discussion: In our study, it has been observed the size and localization of the stone is not an independent factor that affects the hemorrage itself. And also it has been observed that number and localization of entrances are not an independent factor that affecting haemorrhage.

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Percutaneous Nephrolithotomy: Variables That Influence Hemorrhage

Cited by 175 publications

References 15 publications

Types of Renal Calculi and Management Regimen for Chinese Minimally Invasive Percutaneous Nephrolithotomy

Types of Renal Calculi and Management Regimen for Chinese Minimally Invasive Percutaneous Nephrolithotomy

Factors affecting complications according to the modified Clavien classification in complete supine percutaneous nephrolithotomy

The Factors That Effects Hemorrhage in Percutaneous Nephrolitotomy

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