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[Complications of percutaneous litholapaxy]
M Ruoppolo1, C Bellorofonte, S Dell'Acqua
1Divisione di Urologia, Policlinico San Marco, Gruppo Ligresti Sanità, Zingonia.
Insights
Percutaneous nephrolithotomy (PCNL) is an effective treatment for kidney stones, with major complications in 3-6% of patients. Despite rare severe outcomes, PCNL is considered a safe procedure with minimal long-term effects.
Area of Science:
- Urology
- Nephrology
- Surgical Complications
Context:
- Renal calculi (kidney stones) management.
- Percutaneous nephrolithotomy (PCNL) as a primary treatment modality.
- Review of existing literature and institutional experience since 1985.
Purpose:
- To review and analyze the complications associated with the PCNL procedure.
- To assess the safety and efficacy of PCNL based on reported outcomes.
- To evaluate both early and late sequelae of PCNL.
Summary:
- Major complications (e.g., bleeding, fistulas, sepsis) occur in 3-6% of PCNL patients, with nephrectomy needed in <1%.
- Early complications arise during puncture, dilation, and lithotripsy; postoperative bleeding is reported in 0.5-1%.
- Late sequelae like strictures and renal damage are rare, supporting PCNL's safety and efficacy.
Impact:
- Provides a comprehensive overview of PCNL-related morbidity and mortality.
- Reinforces PCNL as a safe and effective intervention for renal calculi.
- Informs clinical decision-making regarding kidney stone treatment options.
Abstract:
Percutaneous nephrolithotomy has been proved an efficient management of renal calculi. We report, in present review, the complications of PCNL procedure referred by several authors and our casistic since 1985. Major complications occurred in 3-6% of treated patients: severe bleeding, arteriovenosal fistulas, haematoma perirenal, water syndrome, sepsis, DIC, etc.). Nephrectomy was necessary in less than 1% of reported cases. 5 patients died for complications related to PCNL. Early complications occurred during the percutaneous puncture, tract dilation and lithotripsy. Postoperatively bleeding at the time of nephrostomic tube removal was reported in 0.5-1% of cases. Late sequelae of PCNL: stricture, fistulas, renal damage, renal function loss, high lithiasis recurrence rate were reported rarely. We, herein, believe PCNL is a safe and effective procedure with minimal rate of complications and late effects, according to other important authors.