Renal Collecting System Injury During Percutaneous Nephrolithotomy, More Likely When Using Continuous Flow Sheaths?

Area of Science:

• Urology
• Minimally Invasive Surgery

Background:

• Percutaneous nephrolithotomy (PCNL) is a key procedure for managing large kidney stones.
• Renal collecting system injuries are infrequent but can lead to significant complications if not detected promptly.

Observation:

• A patient undergoing PCNL with continuous flow ureteral access and nephrostomy sheaths developed signs of irrigation fluid extravasation.
• Anesthesiologist's detection of abnormal pulmonary ventilation settings prompted a procedural halt and patient repositioning.
• Upon repositioning, a distended abdomen indicated significant fluid extravasation into the abdominal cavity.

Findings:

• The use of continuous flow sheaths in PCNL may be associated with a higher risk of collecting system injuries.
• Early recognition of intraoperative physiological changes is crucial for timely diagnosis and management of such injuries.
• This represents the second such incident within six months involving continuous flow sheaths.

Implications:

• Continuous flow sheaths require further investigation regarding their safety profile and potential for causing renal collecting system injuries.
• Prompt recognition and management of iatrogenic injuries during PCNL can prevent severe outcomes like abdominal compartment syndrome.
• Standardized monitoring for subtle physiological changes during PCNL may improve patient safety.