World J Urol (2015) 33:1069–1077 DOI 10.1007/s00345-014-1400-8

INVITED REVIEW

Complications in percutaneous nephrolithotomy Iason Kyriazis · Vasilios Panagopoulos · Panagiotis Kallidonis · Mehmet Özsoy · Marinos Vasilas · Evangelos Liatsikos 

Received: 2 July 2014 / Accepted: 2 September 2014 / Published online: 14 September 2014 © Springer-Verlag Berlin Heidelberg 2014

Abstract  Percutaneous nephrolithotomy (PCNL) is generally considered a safe technique offering the highest stone-free rates after the first treatment as compared to the other minimal invasive lithotripsy techniques. Still, serious complications although rare should be expected following this percutaneous procedure. In this work, the most common and important complications associated with PCNL are being reviewed focusing on the perioperative risk factors, current management, and preventing measures that need to be taken to reduce their incidence. In addition, complication reporting is being criticized given the absence of a universal consensus on PCNL complications description. Complications such as perioperative bleeding, urine leak from nephrocutaneous fistula, pelvicalyceal system injury, and pain are individually graded as complications by various authors and are responsible for a significant variation in the reported overall PCNL complication rate, rendering comparison of morbidity between studies almost impossible. Due to the latter, a universally accepted grading system specialized for the assessment of PCNL-related complications and standardized for each variation of PCNL technique is deemed necessary.

Introduction Early reports on percutaneous management of renal stone disease can be traced back to 1941 and 1955 when the first nephroscopy with renal calculus removal and the first series of percutaneous nephrostomies were reported [1, 2]. In 1981, the first series of percutaneous nephrolithotomies (PCNL) was reported by Wickham [3]. Since then, the technique and its instrumentation has evolved, and the procedure has been established as a common method of lithiasis treatment in the urological armamentarium. According to the European Association of Urology guidelines, PCNL is the recommended first-line treatment of large (>2 cm), multiple and inferior calyx renal stones [4]. PCNL is generally considered a safe technique offering the highest stone-free rates after the first treatment as compared to the other minimal invasive lithotripsy techniques [5]. Still, serious complications although rare should be expected following this percutaneous procedure. In the current study, complications associated with PCNL are being reviewed focusing on the perioperative risk factors, current management, and preventing measures that need to be taken to reduce their incidence.

Keywords  Percutaneous nephrolithotomy · Complications · Management Complications and grading

I. Kyriazis · V. Panagopoulos · P. Kallidonis · M. Özsoy · M. Vasilas · E. Liatsikos (*)  Department of Urology, University of Patras, Patras, Greece e-mail: [email protected] M. Özsoy  Department of Urology, Medical University of Vienna, Vienna, Austria

Currently, a specialized grading system for the assessment of PCNL-related complications is lacking, and the modified Clavien–Dindo classification of surgical complications is the most widely accepted reporting system. Based on the latter classification, the vast majority of PCNL complications are of low grade while major complications are very rare. De la Rosette et al. [6], in an analysis of Clinical Research Office of the Endourological Society (CROES)

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international prospective database including more than 5,800 cases, reported no complications in 79.5 % of cases and low-grade complications (grade 1 and grade 2) in 16.4 %. Medium-grade (IIIa and IIIb) complications were encountered in 3.6 % of cases while severe complications were only seen in 0.5 %. Nevertheless, it should be noted that the absence of a consensus on PCNL complications description and the lack of a standardized PCNL-specific grading system for complications result in a great variation between reported complication rates and render comparison of morbidity between different studies questionable. For example, a mild, clinically insignificant hematuria in the immediate postoperative period or a transient (

Complications in percutaneous nephrolithotomy.

Percutaneous nephrolithotomy (PCNL) is generally considered a safe technique offering the highest stone-free rates after the first treatment as compar...
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