Complications of Percutaneous Nephrolithotripsy (Literature Review)
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Abstract
Percutaneous nephrolithotripsy is a standard treatment option for upper urinary tract stones ≥1.5 cm in size, multiple and staghorn stones. The efficiency and reliability of this procedure have improved, because of advances in technology and increased experience. This operation is considered a safe technique, which have the highest level of stone-free rate in comparison with shock-wave lithotripsy and retrograde nephrolithotripsy. The percutaneous nephrolithotripsy does not rule out the risk of complications.
To analyze the complications of percutaneous nephrolithotripsy, their risk factors and treatment methods based on overview of scientific literature.
It was identified the following complications such as bleeding during surgery and postoperatively, perforation of the renal collecting system, chest injuries, spleen injuries, liver and gallbladder injuries, injuries of the small and large intestine, and also infectious complications.
The risk factors such as stone size and stone location, renal syntopia and skeletotopia, urinary system abnormalities, and overweight affect were established. Preoperative leukocytosis, positive urinary nitrite, and positive bacteriological culture of bladder urine are independent risk factors for infectious complications after percutaneous nephrolithotripsy, especially in patients with diabetes mellitus. Percutaneous nephrolithotripsy is the most difficult technique for treating urolithiasis. Therefore, the training of this operation is long and difficult. It is established that competence and perfection are achieved after 45 and 105 operations, respectively.
Adequate preoperative preparation, especially elimination of urinary tract infection before surgery, accurate puncture under the guidance of fluoroscopy and / or ultrasound, maintenance of low intrarenal pressure and reduction of surgery time are important technical requirements for safety and efficacy of percutaneous nephrolithotripsy.
According to the literature, percutaneous nephrolithotripsy is an effective and safe method of treating nephrolithiasis with a low level of complications. Knowledge of risk factors, treatment methods is important for every endourologist. Most complications, with timely diagnosis, can be eliminated conservatively, or with minimal invasive techniques, which has a positive effect on the treatment time and the psycho-emotional state of the surgeon.
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