Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy

• Verfasst von: Seitz, Christian [VerfasserIn]
• Verfasst von: Häcker, Axel [VerfasserIn]
• Titel: Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy
• Verf.angabe: Christian Seitz, Mahesh Desai, Axel Häcker, Oliver W. Hakenberg, Evangelos Liatsikos, Udo Nagele, David Tolley
• Jahr: 2012
• Umfang: 13 S.
• Fussnoten: Published online ahead of print on September 28, 2011 ; Gesehen am 03.07.2018
• Titel Quelle: Enthalten in: European urology
• Ort Quelle: Amsterdam [u.a.] : Elsevier Science, 1976
• Jahr Quelle: 2012
• Band/Heft Quelle: 61(2012), 1, Seite 146-158
• ISSN Quelle: 1873-7560
• ISSN Quelle: 1421-993X
• DOI: doi:10.1016/j.eururo.2011.09.016
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Clavien
• Sach-SW: Complication
• Sach-SW: Incidence
• Sach-SW: Management
• Sach-SW: PCNL
• Sach-SW: Percutaneous nephrolitholapaxy
• Sach-SW: PNL
• Sach-SW: Prevention
• Sach-SW: Review
• Sach-SW: Urolithiasis
• K10plus-PPN: 1577238567

Abstract

Context: Incidence, prevention, and management of complications of percutaneous nephrolitholapaxy (PNL) still lack consensus. Objective: To review the pidemiology 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.