Previous Open Renal Surgery Increased Vascular Complications in Percutaneous Nephrolithotomy (PCNL) Compared with Primary and Secondary PCNL and Extracorporeal Shock Wave Lithotripsy Patients: A Retrospective Study

Abstract

Objective: To evaluate the vascular complications of percutaneous nephrolithotomy (PCNL) patients who have undergone previous open surgery, PCNL and extracorporeal shock wave lithotripsy (ESWL). Patients and Methods: 360 patients who underwent a PCNL procedure were included into the study. The patients were divided into 4 groups: group 1: primary PCNL (n = 232); group 2: previous open nephrolithotomy (n = 42); group 3: previous PCNL (n = 33); group 4: previous ESWL (n = 63). The periods of operation and fluoroscopy use of the groups were compared in terms of residual stones, with haematuria, pre-operation and post-operation first-day haemoglobin values. Patients with persistent haematuria were assessed through ultrasonography (US), Doppler US, computed tomography and angiography. Results: Upon comparison of the patients' pre- and post-operative haemoglobin changes, haemoglobin was statistically higher in the previous open operation group than the others (p = 0.02). Permanent and intermittent haematuria were detected in 12 (3%) and 7 patients (1%), respectively. Angiography was done in 7 (1.94%) patients. This rate was 9.5% for group 2 and 3% for group 3. These rates were found to be statistically higher than compared to the other groups. Arteriovenous fistula (AVF) was detected in 4 of these patients and pseudoaneurysm in 1. While 1 of the patients with AVF improved spontaneously, embolisation was applied to 4 patients. Four of the patients had had a previous open operation, while 1 had had a PCNL treatment. Conclusions: Vascular complication is a rare complication of PCNL that can be successfully managed with angioembolisation. Our results indicate that previous open surgery significantly predicted the occurrence of these lesions.

Does previous open renal surgery or percutaneous nephrolithotomy affect the outcomes and complications of percutaneous nephrolithotomy

“…Also Yesil et al and Khoromi et al did not demonstrate any affect of previous renal surgery on hospitalization period after PNL [11,23]. In this study hospitalization period was longer in patients with history of open renal surgery but statistical analysis revealed no significant difference between groups (p 0.506).…”

“…Although, Yesil et al compared patients in four groups as PNL after open renal surgery, primary PNL, secondary PNL and PNL after shock wave lithotripsy, they evaluated only vascular complications [11]. Additionally, this study included the largest patient number who underwent PNL with previous open renal surgery (Table 4).…”

The effects of previous open renal stone surgery types on PNL outcomes

“…15 Sofikerim et al and Kurtulus et al did not report any unfavourable effect of previous ORSS on hospitalization time after PNL; however, their hospitalization times were much longer when compared with Yesil's study (4.4 vs. 4.2 days and 3.7 vs. 3.3 days, respectively). 12,14 In the current study, we have not found any statistically significant difference in hospitalization time between patients with previous open nephrolithotomy and previous open pyelolithotomy surgery (p=0.820).…”

Previous Open Stone Surgery: Is It a Risk Factor for Bleeding in Percutaneous Nephrolithotomy

“…Said et al (8), however, stated that previous open surgery can be an important determinant for hemorrhage and transfusion requirement in PNL. Yesil et al (9) reported that severe hemorrhages requiring angioembolization were frequent in their 42 patients who underwent open renal surgery. Sofikerim et al (10) determined that the incidence of bleeding requiring transfusion was nearly twice as high in the group with open surgery, suggesting that this was a predisposing factor for bleeding complication.…”