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Purpose: To evaluate major and minor complications of percutaneous nephrolithotomy (PCNL) and their management in our consecutive cases.
Materials and Methods: We reviewed medical records of 671 patients who had undergone PCNL in our center from March 2000 to March 2006. The demographic data, stone parameters, PCNL complications, and stone-free rate were evaluated. Multiple parameters were evaluated for their association with PCNL complications using Chi-Square test.
Results: Complications occurred in 203 (30.3%) patients; renal parenchymal injury in 103 (15.4%), peri-operative bleeding in 42 (6.3%), late bleeding in 6 (0.9%), renal collecting ducts injury in 35 (5.2%), fever in 7 (1.0%), colon perforation in 2 (0.3%), major vessels injury in 3 (0.4%), pneumothorax in 3 (0.4%), and hemothorax in 2 (0.3%) subjects. Mortality occurred in 1 patient with colon perforation (0.15%).
Conclusion: Percutaneous nephrolithotomy has low complication rate in experienced hands.
Urol J. 2011;8:271-6.
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Keywords: complications, percutaneous nephrolithotomy, urogenital system, kidney calculi, hemorrhage
INTRODUCTION
Percutaneous nephrolithotomy (PCNL) was defined as a surgical treatment for removal of the renal stones in the 1970s.(1,2) Today, this procedure should be the first option for the treatment of single large or multiple renal stones and those in the inferior calyx.(3) Percutaneous stone removal was suggested as the first line treatment option for the management of staghorn calculi by the American Urological Association Nephrolithiasis Clinical Guidelines panel.(4) Furthermore, PCNL has been advised for the treatment of large, hard, or infected stones, obstructive stones, and extracorporeal shock wave lithotripsy (SWL) failure.(5)
Although percutaneous renal surgery is less invasive than an open procedure, complications may occur. Percutaneous nephrolithotomy is a successful, less invasive surgery (> 90%) at the cost of greater complications (> 10%).(6,7) There are some complications that may be predictable or unpredictable, such as hemorrhage, collecting system injuries, contiguous organ injuries, intra-operative technical complications, hypothermia, fluid overload, sepsis, stricture formation, nephrocutaneous fistula, renal loss, and death.(6,8) In this study, we evaluated the incidence and types of complications, with special attention to bleeding and adjacent organ injuries.
MATERIALS AND METHODS
In this study, the data from all the patients who had undergone PCNL in Ekbatan Hospital in Hamadan, Iran, between 2000 and 2006, were reviewed retrospectively. The ethics committee of Hamadan University of Medical Sciences approved the study.
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