BACKGROUND: Percutaneous nephrolithotomy(PCNL) has become the preferred treatment of choice for nephrolithiasis with overall complications ranging from 20-83%. Complications may range from transient fever to injury to adjacent organs and pleura. Chances of pleural injury increase when the access site is higher as noted in the supracostal approach. This study was undertaken to analyse complications of PCNL at our centre, with special reference to the supracostal approach.
MATERIALS & METHODS: This was a retrospective study of diagnosed patients with nephrolithiasis who underwent PCNL. Demographic data, size and location of calculi, site of puncture and postoperative complications were noted from hospitals case sheets. Parameters related to overall complications were evaluated by modified Clavien-Dindo classification and a separate analysis of supracostal approach-related complications was done.
RESULTS: A total of 87 patients, with mean age 40.48 SD13.33 years and M: F 2.34:1 underwent PCNL, with a mean size of 25 SD8.45 mm. Overall complications of 19.54%,2.29%,4.59% in grade I, II, IIIa respectively with no evidence of grade IIIb, IVa, IVb, V complications in our study. Supracostal approach had 17.39% pleural injury, as compared to none in infracostal approach. But with help of a simple test called a bubble test, done at our centre all pleural injuries were identified on the table and managed promptly and effectively.
CONCLUSION: PCNL is a safe procedure and most complications can be managed conservatively, though a minority of complications may require surgical interventions. PCNL in our centre had an overall complications rate of 26.43%, at par with existing literature. Pulmonary complications are most likely to be associated with the supracostal approach but can be early diagnosed and managed on the table using a bubble test.
Key words: Percutaneous nephrolithotomy, nephrolithiasis, supracostal approach, pleural injury, pulmonary complications
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