Skip to main content

Complications Related with PCNL and Their Management

  • Chapter
  • First Online:
Percutaneous Nephrolithotomy

Abstract

During the last 30 years, percutaneous nephrolithotomy (PCNL) has become the standard minimally invasive treatment for renal stones. Despite being a safe procedure, PCNL is still associated with specific complications, which can occur during percutaneous access, nephroscopy and lithotripsy or postoperative management. Detailed knowledge on PCNL complications and their management is mandatory in order to reduce procedure-related morbidity without compromising patient outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Türk C, Skolarikos A, Neisius A, Petřík A, Seitz C, Thomas K, et al.; Members of the European Association of Urology (EAU) Guidelines Office. Guidelines on urolithiasis. 2019. https://uroweb.org/guideline/urolithiasis/. Accessed 1 May 2019.

  2. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111:518–26.

    CAS  PubMed  Google Scholar 

  3. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    PubMed  PubMed Central  Google Scholar 

  4. de la Rosette JJ, Opondo D, Daels FP, Giusti G, Serrano A, Kandasami SV, et al.; CROES PCNL Study Group. Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy. Eur Urol. 2012;62(2):246–55.

    Google Scholar 

  5. Labate G, Modi P, Timoney A, Cormio L, Zhang X, Louie M, et al. The percutaneous nephrolithotomy global study: classification of complications. J Endourol. 2011;25(8):1275–80.

    PubMed  Google Scholar 

  6. Okeke Z, Smith AD, Labate G, D’Addessi A, Venkatesh R, Assimos D, et al.; CROES PCNL Study Group. Prospective comparison of outcomes of percutaneous nephrolithotomy in elderly patients versus younger patients. J Endourol. 2012;26(8):996–1001.

    Google Scholar 

  7. Unsal A, Resorlu B, Atmaca AF, Diri A, Goktug HN, Can CE, et al. Prediction of morbidity and mortality after percutaneous nephrolithotomy by using the Charlson Comorbidity Index. Urology. 2012;79(1):55–60.

    PubMed  Google Scholar 

  8. Wollin DA, Skolarikos A, Preminger GM. Obesity and metabolic stone disease. Curr Opin Urol. 2017;27(5):422–7.

    PubMed  Google Scholar 

  9. Apovian CM. Obesity: definition, comorbidities, causes, and burden. Am J Manag Care. 2016;22(7 Suppl):s176–85.

    PubMed  Google Scholar 

  10. Brodsky JB, Oldroyd M, Winfield HN, Kozlowski PM. Morbid obesity and the prone position: a case report. J Clin Anesth. 2001;13(2):138–40.

    CAS  PubMed  Google Scholar 

  11. Fuller A, Razvi H, Denstedt JD, Nott L, Pearle M, Cauda F, et al.; CROES PCNL Study Group. The CROES percutaneous nephrolithotomy global study: the influence of body mass index on outcome. J Urol. 2012;188(1):138–144.

    Google Scholar 

  12. El-Assmy AM, Shokeir AA, El-Nahas AR, Shoma AM, Eraky I, El-Kenawy MR, et al. Outcome of percutaneous nephrolithotomy: effect of body mass index. Eur Urol. 2007;52(1):199–204.

    PubMed  Google Scholar 

  13. Tomaszewski JJ, Smaldone MC, Schuster T, Jackman SV, Averch TD. Outcomes of percutaneous nephrolithotomy stratified by body mass index. J Endourol. 2010;24(4):547–50.

    PubMed  Google Scholar 

  14. Tikkinen KAO, Cartwright R, Gould R, Naspro R, Novara G, Sandset PM, et al.; Members of the European Association of Urology (EAU) Guidelines Office. EAU guidelines on thromboprophylaxis in urological surgery. 2019. https://uroweb.org/guideline/thromboprophylaxis/. Accessed 2 May 2019.

  15. Gross AJ, Bach T. Preoperative percutaneous stone surgery in patients receiving anticoagulant therapy. J Endourol. 2009;23(10):1563–5.

    PubMed  Google Scholar 

  16. Gutierrez J, Smith A, Geavlete P, Shah H, Kural AR, de Sio M, et al.; CROES PCNL Study Group. Urinary tract infections and post-operative fever in percutaneous nephrolithotomy. World J Urol. 2013;31(5):1135–40.

    Google Scholar 

  17. Rivera M, Viers B, Cockerill P, Agarwal D, Mehta R, Krambeck A. Pre- and postoperative predictors of infection-related complications in patients undergoing percutaneous nephrolithotomy. J Endourol. 2016;30(9):982–6.

    PubMed  Google Scholar 

  18. Lai WS, Assimos D. Factors associated with postoperative infection after percutaneous nephrolithotomy. Rev Urol. 2018;20(1):7–11.

    PubMed  PubMed Central  Google Scholar 

  19. Mariappan P, Smith G, Bariol SV, Moussa SA, Tolley DA. Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study. J Urol. 2005;173(5):1610–4.

    PubMed  Google Scholar 

  20. Mosavi-Bahar SH, Amirzargar MA, Rahnavardi M, Moghaddam SM, Babbolhavaeji H, Amirhasani S. Percutaneous nephrolithotomy in patients with kidney malformations. J Endourol. 2007;21(5):520–4.

    PubMed  Google Scholar 

  21. Ozden E, Bilen CY, Mercimek MN, Tan B, Sarikaya S, Sahin A. Horseshoe kidney: does it really have any negative impact on surgical outcomes of percutaneous nephrolithotomy? Urology. 2010;75(5):1049–52.

    PubMed  Google Scholar 

  22. Osther PJ, Razvi H, Liatsikos E, Averch T, Crisci A, Garcia JL, et al.; Croes PCNL Study Group. Percutaneous nephrolithotomy among patients with renal anomalies: patient characteristics and outcomes; a subgroup analysis of the clinical research office of the endourological society global percutaneous nephrolithotomy study. J Endourol. 2011;25(10):1627–1632.

    Google Scholar 

  23. Thomas K, Smith NC, Hegarty N, Glass JM. The Guy’s stone score—grading the complexity of percutaneous nephrolithotomy procedures. Urology. 2011;78:277–81.

    PubMed  Google Scholar 

  24. Smith A, Averch TD, Shahrour K, Opondo D, Daels FP, Labate G, et al. A nephrolithometric nomogram to predict treatment success of percutaneous nephrolithotomy. J Urol. 2013;190:149–56.

    PubMed  Google Scholar 

  25. Okhunov Z, Friedlander JI, George AK, Duty BD, Moreira DM, Srinivasan AK, et al. S.T.O.N.E. nephrolithometry: novel surgical classification system for kidney calculi. Urology. 2013;81:1154–9.

    PubMed  Google Scholar 

  26. Kumar S, Sreenivas J, Karthikeyan VS, Mallya A, Keshavamurthy R. Evaluation of CROES nephrolithometry nomogram as a preoperative predictive system for percutaneous nephrolithotomy outcomes. J Endourol. 2016;30(10):1079–83.

    PubMed  Google Scholar 

  27. Vicentini FC, Serzedello FR, Thomas K, Marchini GS, Torricelli FCM, Srougi M, et al. What is the quickest scoring system to predict percutaneous nephrolithotomy outcomes? A comparative study among S.T.O.N.E score, Guy’s stone score and CROES nomogram. Int Braz J Urol. 2017;43(6):1102–9.

    PubMed  PubMed Central  Google Scholar 

  28. Negrete-Pulido O, Molina-Torres M, Castaño-Tostado E, Loske AM, Gutiérrez-Aceves J. Percutaneous renal access: the learning curve of a simplified approach. J Endourol. 2010;24(3):457–60.

    PubMed  Google Scholar 

  29. Quirke K, Aydin A, Brunckhorst O, Bultitude M, Khan MS, Dasgupta P, et al. Learning curves in urolithiasis surgery: a systematic review. J Endourol. 2018;32(11):1008–20.

    PubMed  Google Scholar 

  30. Opondo D, Tefekli A, Esen T, Labate G, Sangam K, De Lisa A, et al. Impact of case volumes on the outcomes of percutaneous nephrolithotomy. Eur Urol. 2012;62(6):1181–7.

    PubMed  Google Scholar 

  31. Valdivia Uria JG, Valle Gerhold J, Lopez Lopez JA, Villarroya Rodriguez S, Ambroj Navarro C, Ramirez Fabián M, et al. Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position. J Urol. 1998;160(6):1975–8.

    CAS  PubMed  Google Scholar 

  32. Kerbl K, Clayman RV, Chandhoke PS, Urban DA, De Leo BC, Carbone JM. Percutaneous stone removal with the patient in a flank position. J Urol. 1994;151(3):686–8.

    CAS  PubMed  Google Scholar 

  33. Ibarluzea G, Scoffone CM, Cracco CM, Poggio M, Porpiglia F, Terrone C, et al. Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU Int. 2007;100(5):233–6.

    PubMed  Google Scholar 

  34. Bach C, Goyal A, Kumar P, Kachrilas S, Papatsoris AG, Buchholz N, Masood J. The Barts ‘flank-free’ modified supine position for percutaneous nephrolithotomy. Urol Int. 2012;89(3):365–8.

    CAS  PubMed  Google Scholar 

  35. Shoma AM, Eraky I, El-Kenawy MR, El-Kappany HA. Percutaneous nephrolithotomy in the supine position: technical aspects and functional outcome compared with the prone technique. Urology. 2002;60(3):388–92.

    PubMed  Google Scholar 

  36. DeSio M, Autorino R, Quarto G, Calabrò F, Damiano R, Giugliano F, et al. Modified supine versus prone position in percutaneous nephrolithotomy for renal stones treatable with a single percutaneous access: a prospective randomized trial. Eur Urol. 2008;54:196–203.

    Google Scholar 

  37. Yokoyama M, Ueda W, Hirakawa M, Yamamoto H. Hemodynamic effect of the prone position during anesthesia. Acta Anaesthesiol Scand. 1991;35:741–4.

    CAS  PubMed  Google Scholar 

  38. Poon KS, Wu KC, Chen CC, Fung ST, Lau AW, Huang CC, Wu RS. Hemodynamic changes during spinal surgery in the prone position. Acta Anaesthesiol Taiwanica. 2008;46(2):57–60.

    Google Scholar 

  39. Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, et al. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006;105:652–9.

    PubMed  Google Scholar 

  40. Ho VT, Newman NJ, Song S, Ksiazek S, Roth S. Ischemic optic neuropathy following spine surgery. J Neurosurg Anesthesiol. 2005;17:38–44.

    PubMed  PubMed Central  Google Scholar 

  41. Epstein NE. Perioperative visual loss following prone spinal surgery: a review. Surg Neurol Int. 2016;7(Suppl 13):S347–60.

    PubMed  PubMed Central  Google Scholar 

  42. Nasseh H, Pourreza F, Saberi A, Kazemnejad E, Kalantari BB, Falahatkar S. Focal neuropathies following percutaneous nephrolithotomy (PCNL)—preliminary study. Ger Med Sci. 2013;11:Doc07.

    PubMed  PubMed Central  Google Scholar 

  43. Agah M, Ghasemi M, Roodneshin F, Radpay B, Moradian S. Prone position in percutaneous nephrolithotomy and postoperative visual loss. Urol J. 2011;8(3):191–6.

    PubMed  Google Scholar 

  44. Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. Eur Urol. 2007;51:899–906.

    PubMed  Google Scholar 

  45. Gallucci M, Fortunato P, Schettini M, Vincenzoni A. Management of hemorrhage after percutaneous renal surgery. J Endourol. 1998;12:509–12.

    CAS  PubMed  Google Scholar 

  46. Kaye KW, Clayman RV. Tamponade nephrostomy catheter for percutaneous nephrostolithotomy. Urology. 1986;27:441–5.

    CAS  PubMed  Google Scholar 

  47. Srivastava A, Singh KJ, Suri A, Dubey D, Kumar A, Kapoor R, et al. Vascular complications after percutaneous nephrolithotomy: are there any predictive factors? Urology. 2005;66(1):38–40.

    PubMed  Google Scholar 

  48. Rastinehad AR, Andonian S, Smith AD, Siefel DN. Management of hemorrhagic complications associated with percutaneous nephrolithotomy. J Endourol. 2009;23(10):1763–7.

    PubMed  Google Scholar 

  49. Gupta R, Kumar A, Kapoor R, Srivastava A, Mandhani A. Prospective evaluation of safety and efficacy of the supracostal approach for percutaneous nephrolithotomy. BJU Int. 2002;90(9):809–13.

    CAS  PubMed  Google Scholar 

  50. Radecka E, Brehmer M, Holmgren K, Magnusson A. Complications associated with percutaneous nephrolithotripsy: supra- versus subcostal access. A retrospective study. Acta Radiol. 2003;44(4):447–51.

    CAS  PubMed  Google Scholar 

  51. Öztürk H. Gastrointestinal system complications in percutaneous nephrolithotomy: a systematic review. J Endourol. 2014;28(11):1256–67.

    PubMed  Google Scholar 

  52. Morse RM, Spirnak JP, Resnick MI. Iatrogenic colon and rectal injuries associated with urological intervention: report of 14 patients. J Urol. 1988;140(1):101–3.

    CAS  PubMed  Google Scholar 

  53. Neustein P, Barbaric ZL, Kaufman JJ. Nephrocolic fistula: a complication of percutaneous nephrostolithotomy. J Urol. 1986;135(3):571–3.

    CAS  PubMed  Google Scholar 

  54. Vallancien G, Capdeville R, Veillon B, Charton M, Brisset JM. Colonic perforation during percutaneous nephrolithotomy. J Urol. 1985;134:1185–7.

    CAS  PubMed  Google Scholar 

  55. Desai AC, Jain S, Benway BM, Grubb RL 3rd, Picus D, Figenshau RS. Splenic injury during percutaneous nephrolithotomy: a case report with novel management technique. J Endourol. 2010;24(4):541–5.

    PubMed  Google Scholar 

  56. Shah HN, Hegde SS, Mahajan AP, Sodha H, Shah R, Bansal M. Splenic injury: rare complication of percutaneous nephrolithotomy: report of two cases with review of literature. J Endourol. 2007;21:919–22.

    PubMed  Google Scholar 

  57. Seitz C, Desai M, Häcker A, Hakenberg OW, Liatsikos E, Nagele U, Tolley D. Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy. Eur Urol. 2012;61(1):146–58.

    PubMed  Google Scholar 

  58. Kyriazis I, Panagopoulos V, Kallidonis P, Özsoy M, Vasilas M, Liatsikos E. Complications in percutaneous nephrolithotomy. World J Urol. 2015;33(8):1069–77.

    PubMed  Google Scholar 

  59. Rao PN. Fluid absorption during urological endoscopy. Br J Urol. 1987;60(2):93–9.

    CAS  PubMed  Google Scholar 

  60. Hahn RG. Fluid absorption in endoscopic surgery. Br J Anaesth. 2006;96(1):8–20.

    CAS  PubMed  Google Scholar 

  61. Kukreja RA, Desai MR, Sabnis RB, Patel SH. Fluid absorption during percutaneous nephrolithotomy: does it matter? J Endourol. 2002;16(4):221–4.

    CAS  PubMed  Google Scholar 

  62. Guzelburc V, Balasar M, Colakogullari M, Guven S, Kandemir A, Ozturk A, et al. Comparison of absorbed irrigation fluid volumes during retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of kidney stones larger than 2 cm. Springerplus. 2016;5(1):1707.

    PubMed  PubMed Central  Google Scholar 

  63. Draga RO, Kok ET, Sorel MR, Bosch RJ, Lock TM. Percutaneous nephrolithotomy: factors associated with fever after the first postoperative day and systemic inflammatory response syndrome. J Endourol. 2009;23(6):921–7.

    PubMed  Google Scholar 

  64. O’Keeffe NK, Mortimer AJ, Sambrook PA, Rao PN. Severe sepsis following percutaneous or endoscopic procedures for urinary tract stones. Br J Urol. 1993;72:277–83.

    PubMed  Google Scholar 

  65. Negrete-Pulido O, Gutierrez-Aceves J. Management of infectious complications in percutaneous nephrolithotomy. J Endourol. 2009;23(10):1757–62.

    PubMed  Google Scholar 

  66. Korets R, Graversen JA, Kates M, Mues AC, Gupta M. Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol. 2011;186(5):1899–903.

    PubMed  Google Scholar 

  67. Stoller ML, Wolf JS Jr, St Lezin MA. Estimated blood loss and transfusion rates associated with percutaneous nephrolithotomy. J Urol. 1994;152(6 Pt 1):1977–81.

    CAS  PubMed  Google Scholar 

  68. Kukreja R, Desai M, Patel S, Bapat S, Desai M. Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol. 2004;18(8):715–22.

    PubMed  Google Scholar 

  69. Turna B, Nazli O, Demiryoguran S, Mammadov R, Cal C. Percutaneous nephrolithotomy: variables that influence hemorrhage. Urology. 2007;69(4):603–7.

    PubMed  Google Scholar 

  70. de la Rosette J, Assimos D, Desai M, Gutierrez J, Lingeman J, Scarpa R, et al.; CROES PCNL Study Group. The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients. J Endourol. 2011;25(1):11–7.

    Google Scholar 

  71. Yamaguchi A, Skolarikos A, Buchholz NP, Chomón GB, Grasso M, Saba P, et al.; CROES PCNL Study Group. Operating times and bleeding complications in percutaneous nephrolithotomy: a comparison of tract dilation methods in 5,537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study. J Endourol. 2011;25(6):933–9.

    Google Scholar 

  72. Srivastava A, Singh S, Dhayal IR, Rai P. A prospective randomized study comparing the four tract dilation methods of percutaneous nephrolithotomy. World J Urol. 2017;35(5):803–7.

    PubMed  Google Scholar 

  73. Gönen M, Istanbulluoglu OM, Cicek T, Ozturk B, Ozkardes H. Balloon dilatation versus Amplatz dilatation for nephrostomy tract dilatation. J Endourol. 2008;22:901–4.

    PubMed  Google Scholar 

  74. Amjadi M, Zolfaghari A, Elahian A, Tavoosi A. Percutaneous nephrolithotomy in patients with previous open nephrolithotomy: one-shot versus telescopic technique for tract dilatation. J Endourol. 2008;22:423–5.

    PubMed  Google Scholar 

  75. Whitehurst L, Jones P, Somani BK. Mortality from kidney stone disease (KSD) as reported in the literature over the last two decades: a systematic review. World J Urol. 2019;37(5):759–76.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Iliya Saltirov .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Saltirov, I., Petkova, K. (2020). Complications Related with PCNL and Their Management. In: Zeng, G., Sarica, K. (eds) Percutaneous Nephrolithotomy. Springer, Singapore. https://doi.org/10.1007/978-981-15-0575-1_12

Download citation

  • DOI: https://doi.org/10.1007/978-981-15-0575-1_12

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-0574-4

  • Online ISBN: 978-981-15-0575-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics