Abstract
Context
Incidence, prevention, and management of complications of percutaneous nephrolitholapaxy
(PNL) still lack consensus.
Objective
To review the epidemiology of complications and their prevention and management.
Evidence acquisition
A literature review was performed using the PubMed database between 2001 and May 1,
2011, restricted to human species, adults, and the English language. The Medline search
used a strategy including medical subject headings (MeSH) and free-text protocols
with the keywords percutaneous, nephrolithotomy, PCNL, PNL, urolithiasis, complications, and Clavien, and the MeSH terms nephrostomy, percutaneous/adverse effects, and intraoperative complications or postoperative complications.
Evidence synthesis
Assessing the epidemiology of complications is difficult because definitions of complications
and their management still lack consensus. For a reproducible quality assessment,
data should be obtained in a standardized manner, allowing for comparison. An approach
is the validated Dindo-modified Clavien system, which was originally reported by seven
studies. No deviation from the normal postoperative course (Clavien 0) was observed
in 76.7% of PNL procedures. Including deviations from the normal postoperative course
without the need for pharmacologic treatment or interventions (Clavien 1) would add
up to 88.1%. Clavien 2 complications including blood transfusion and parenteral nutrition
occurred in 7%; Clavien 3 complications requiring intervention in 4.1.%; Clavien 4,
life-threatening complications, in 0.6%; and Clavien 5, mortality, in 0.04%. High-quality
data on complication management of rare but potentially debilitating complications
are scarce and consist mainly of case reports.
Conclusions
Complications after PNL can be kept to a minimum in experienced hands with the development
of new techniques and improved technology. A modified procedure-specific Clavien classification
should be established that would need to be validated in prospective trials.
Keywords
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Article Info
Publication History
Published online: September 28, 2011
Accepted:
September 15,
2011
Identification
Copyright
© 2011 European Association of Urology. Published by Elsevier Inc. All rights reserved.
