https://europeanurology.com/article/S0302-2838(06)01310-8/pdf/complications-in-percutaneous-nephrolithotomy

Complications in percutaneous nephrolithotomy.

Introduction Infections of the urinary tract (UTIs) pose a serious health problem for patients at high cost for society. UTIs are also the most frequent healthcare associated infections. E. coli is the predominating pathogen in uncomplicated UTIs while other Enterobacteriaceae and Enterococcus spp are isolated in higher frequency in patients with urological diseases. The present state of microbial resistance development is alarming and the rates of resistance are related to the amount of antibiotics used in the different countries. Particularly worrisome is the increasing resistance to broad spectrum antibiotics. It is thus essential to limit the use of antibiotics in general and fluoroquinolones and cephalosporins in particular, especially in uncomplicated infections and asymptomatic bacteriuria.

/pdf/guidelines-on-urological-infections-23ooqjk2xp.pdf

Guidelines on Urological Infections

Purpose: To assess the current indications, perioperative morbidity, and stone-free outcomes for percutaneous nephrolithotomy (PCNL) worldwide. Patients and Methods: The Clinical Research Office of the Endourological Society (CROES) collected prospective data for consecutive patients who were treated with PCNL at centers around the world for 1 year. PCNL was performed according to study protocol and local clinical practice guidelines. Stone load and location were recorded, and postoperative complications were graded according to the modified Clavien grading system. Results: Between November 2007 and December 2009, 5803 patients were treated at 96 centers in Europe, Asia, North America, South America, and Australia. Staghorn calculus was present in 1466 (27.5%) patients, and 940, 956, and 2603 patients had stones in the upper, interpolar, and lower pole calices, respectively. The majority of procedures (85.5%) were uneventful. Major procedure-related complications included significant bleeding (7....

The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients.

Classification of Percutaneous Nephrolithotomy Complications Using the Modified Clavien Grading System: Looking for a Standard

https://www.europeanurology.com/article/S0302-2838(11)01023-2/pdf/incidence-prevention-and-management-of-complications-following-percutaneous-nephrolitholapaxy

Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy.

OBJECTIVE To report our experience with over 300 patients treated with percutaneous nephrolithotomy (PNL), for although PNL was established as a treatment in the 1970s, its use diminished with the introduction of extracorporeal shockwave lithotripsy (ESWL); clinical experience with ESWL showed its limitations, and the role of PNL for treating urolithiasis was redefined, which with improvements in instruments and lithotripsy technology has expanded the capability of percutaneous stone disintegration. PATIENTS AND METHODS The study included 315 patients (156 males, 159 females, aged 13-85 years) treated with PNL in our department between 1987 and 2002. The mean (range) stone diameter was 27 (7-52) mm. The kidney was punctured under ultrasonography guidance via a lower-pole calyx whenever possible. The working channel was dilated using an Alken dilator under X-ray control. If necessary, a flexible renoscope was used. Ultrasonic, pneumatic and laser probes were used for lithotripsy. RESULTS Four weeks after treatment the total stone-free rate was 96.5%; 45.7% of all patients were primarily stone-free, 21.3% had clinically insignificant residual stones that passed spontaneously within 4 weeks after PNL, and 33% of the patients needed auxiliary measures (a second PNL, ESWL, ureterorenoscopy). Overall, the early complication rate was 50.8%, the most common complications being transient fever (27.6%), clinically insignificant bleeding (7.6%) or both (3.2%); 3.5% of the patients developed urinary tract infections (with no signs of urosepsis), 3.2% had renal colic and 2.9% upper urinary tract obstruction. One patient (0.3%) developed acute pancreatitis after PNL; one died from urosepsis and one needed selective angiographic embolization of the punctured kidney due to bleeding. No patient required transfusions and there were no injuries to neighbouring organs. CONCLUSIONS These results show that PNL causes no significant blood loss or major complications in almost all patients. Two aspects may especially reduce the potential complications: ultrasonography-guided renal puncture and using PNL in an experienced centre. PNL is a highly efficient procedure that provides fast and safe stone removal.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1464-410X.2005.05749.x

Katrin Heger

Papers

Percutaneous nephrolithotomy with ultrasonography‐guided renal access: experience from over 300 cases