Prevention and treatment of complications following percutaneous nephrolithotomy

Abstract

Purpose of review 

The aim of this article is to identify classification and grading systems of percutaneous nephrolithotomy-related complications and evidence for the prevention and treatment of these complications.

Recent findings 

A total complication rate of up to 83% following percutaneous nephrolithotomy was recognized. These complications were mostly clinically insignificant including minor bleeding or fever. The frequency of major complications was 0.9–4.7% for septicemia, 0.6–1.4% for renal hemorrhage requiring intervention, 2.3–3.1% for pleural injury and 0.2–0.8% for colonic injury. The significance of grading perioperative complications according to their severity, emphasizing the need for a unique and broadly accepted classification system, which could be helpful for monitoring and reporting outcomes emerged from the current review. The modified Clavien system has recently been used for this purpose. Proper patient selection, preoperative imaging for planning the operation, adequate antibiotic prophylaxis and therapy, manipulation of the collecting system only under fluoroscopic or endoscopic control, use of a continuous flow system, use of normal saline as irrigant fluid, judicious stone fragmentation and finally fluoroscopic monitoring of nephrostomy tube insertion and removal are necessary to prevent percutaneous nephrolithotomy complications. Appropriate treatment has been sufficiently described in the literature.

Summary 

Currently, a high index of suspicion and prompt recognition and institution of appropriate treatment of percutaneous nephrolithotomy-related complications is fundamental to limit morbidity.