Percutaneous nephrolithotomy
Updates to Article Attributes
Percutaneous nephrolithotomy (PCNL) is a surgical procedure for the extraction of large renal calculi. It is performed in the theatre environment either by a urologist or urologist-radiologist team. The kidney
Indication
PCNL is accessed via a percutaneous route, which is then used to destroy and remove renal calculi, typically over 2cm in size.
Procedure
PCNL is usually performed with the patient in prone position through a posterior calyx. Supine position can also be used, although, much less commonly perhaps due to lack of much experience and also risk of organ injury. Some of the potential advantages of supine position include: easier patient positioning, ability to perform simultaneous PCNL and ureteroscopic procedures and better control of the airways.
Complications:
PCNL can be regarded as acceptably low morbidity procedure. Some of the complications include:
- haemorrhage
- perforation of the collecting system followed by urine extravasation caused by a guide wire with straight and hard tip. It can be avoided to a large extent by using J-wire with soft and curved tip.
- sepsis
- colonic perforation, rare (0.5%)
- ureteral stone
- vascular injury
-<p><strong>Percutaneous nephrolithotomy (PCNL)</strong> is a surgical procedure for the extraction of large renal calculi. It is performed in the theatre environment either by a urologist or urologist-radiologist team. The kidney is accessed via a percutaneous route, which is then used to destroy and remove renal calculi, typically over 2cm in size.</p>- +<p><strong>Percutaneous nephrolithotomy (PCNL)</strong> is a surgical procedure for the extraction of large renal calculi. It is performed in the theatre environment either by a urologist or urologist-radiologist team. </p><h4>Indication</h4><p>PCNL is used to destroy and remove renal calculi, typically over 2cm in size.</p><h4>Procedure</h4><p>PCNL is usually performed with the patient in prone position through a posterior calyx. Supine position can also be used, although, much less commonly perhaps due to lack of much experience and also risk of organ injury. Some of the potential advantages of supine position include: easier patient positioning, ability to perform simultaneous PCNL and ureteroscopic procedures and better control of the airways. </p><h4>Complications: </h4><p>PCNL can be regarded as acceptably low morbidity procedure. Some of the complications include:</p><ul>
- +<li>haemorrhage </li>
- +<li>perforation of the collecting system followed by urine extravasation caused by a guide wire with straight and hard tip. It can be avoided to a large extent by using J-wire with soft and curved tip. </li>
- +<li>sepsis </li>
- +<li>colonic perforation, rare (0.5%)</li>
- +<li>ureteral stone</li>
- +<li>vascular injury</li>
- +</ul>
References changed:
- 1. Vicentini FC, Gomes CM, Danilovic A et-al. Percutaneous nephrolithotomy: Current concepts. Indian J Urol. 2009;25 (1): 4-10. <a href="http://dx.doi.org/10.4103/0970-1591.44281">doi:10.4103/0970-1591.44281</a> - <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684301">Free text at pubmed</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/19468422">Pubmed citation</a><span class="auto"></span>
- 2. Valdivia Uría JG, Valle Gerhold J, López López JA et-al. Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position. J. Urol. 1998;160 (6 Pt 1): 1975-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9817303">Pubmed citation</a><span class="auto"></span>
- 3. Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. Eur. Urol. 2007;51 (4): 899-906. <a href="http://dx.doi.org/10.1016/j.eururo.2006.10.020">doi:10.1016/j.eururo.2006.10.020</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/17095141">Pubmed citation</a><span class="auto"></span>
- 4. El-Nahas AR, Shokeir AA, El-Assmy AM et-al. Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. J. Urol. 2007;177 (2): 576-9. <a href="http://dx.doi.org/10.1016/j.juro.2006.09.048">doi:10.1016/j.juro.2006.09.048</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/17222636">Pubmed citation</a><span class="auto"></span>
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