Complications associated with Percutaneous nephrolitholapaxy (PCNL): Our experience and literature review

Abstract

Background: PCNL is safe procedure which is well tolerated, but as with any other surgical procedure, it is associated with a specific set of complications. There is a marked heterogeneity in reporting complication rates in literature, and this problem was highlighted in Ad Hoc EAU guidelines panel who recommended urgent creation of uniform and reproducible quality system. Modified Dindo-Clavien grading system today is the most utilized classification for complications in urology, and standard in reporting complications for PCNL. Aim(s): To analyze the complication rate for PCNL using the modified Dindo-Clavien grading system in our patients and literature review. Methods: In our institution, with few breaks, PCNL was performed since mid 2010. Complication rate in 63 patients was analyzed retrospectively. Modified Dindo-Clavien grading system that is validated for PCNL has been accepted for classification of complication for PCNL, and literature review was performed. We have summarized the most significant factors which may affect the complication rate during and after PCNL. Results : Overall complication rate was 30% in our study population. The most common complications observed were: postoperative fever Grade1-2 (9.52%) and bleeding Grade1 (7.9%), Grade2 (3.17%), Grade3a (4.76%) and Grade3b (1.58%). Nephrostomy tube leakage was not found in our sample, mostly due to specific postoperative utilizing of auxiliary procedures. Conclusion: Reporting of complication for PCNL should be uniform, and modified Dindo-Clavien grading system that is validated for PCNL should be accepted to be a standard in urology. Surgeons training and experience are the most important to ensure the efficacy of procedure, therefore we suggest that learning of percutaneous renal access should be mandatory in residents trainee program.