Yesil S et al, 2013: Previous Open Renal Surgery Increased Vascular Complications in Percutaneous Nephrolithotomy (PCNL) Compared with Primary and Secondary PCNL and Extracorporeal Shock Wave Lithotripsy Patients: A Retrospective Study
Yesil S, Ozturk U, Goktug HN, Tuygun C, Nalbant I, Imamoglu MA
Department of Urology, Gazi University School of Medicine, Ankara, Turkey
OBJECTIVE: To evaluate the vascular complications of percutaneous nephrolithotomy (PCNL) patients who have undergone previous open surgery, PCNL and extracorporeal shock wave lithotripsy (ESWL).
PATIENTS AND METHODS: 360 patients who underwent a PCNL procedure were included into the study. The patients were divided into 4 groups: group 1: primary PCNL (n = 232); group 2: previous open nephrolithotomy (n = 42); group 3: previous PCNL (n = 33); group 4: previous ESWL (n = 63). The periods of operation and fluoroscopy use of the groups were compared in terms of residual stones, with haematuria, pre-operation and post-operation first-day haemoglobin values. Patients with persistent haematuria were assessed through ultrasonography (US), Doppler US, computed tomography and angiography.
RESULTS: Upon comparison of the patients' pre- and post-operative haemoglobin changes, haemoglobin was statistically higher in the previous open operation group than the others (p = 0.02). Permanent and intermittent haematuria were detected in 12 (3%) and 7 patients (1%), respectively. Angiography was done in 7 (1.94%) patients. This rate was 9.5% for group 2 and 3% for group 3. These rates were found to be statistically higher than compared to the other groups. Arteriovenous fistula (AVF) was detected in 4 of these patients and pseudoaneurysm in 1. While 1 of the patients with AVF improved spontaneously, embolisation was applied to 4 patients. Four of the patients had had a previous open operation, while 1 had had a PCNL treatment.
CONCLUSIONS: Vascular complication is a rare complication of PCNL that can be successfully managed with angioembolisation. Our results indicate that previous open surgery significantly predicted the occurrence of these lesions.
Urol Int. 2013;91(3):331-4. doi: 10.1159/000351968. Epub 2013 Jul 17
PMID:23867857[PubMed - in process]
As had to be expected a previous ESWL did not lead to increased complications during a secondary PNL.