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    Complications of PCNL: DR - Sanjay S Deshpande Sidheshwar Urological Society Solapur

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    Alat Masak
    This document discusses the complications that can occur during percutaneous nephrolithotomy (PCNL). It notes that PCNL has a steep learning curve and complications can lead to prolonged morbidity or death if not properly recognized and treated. General complications include those related to anesthesia, fluid and electrolyte imbalances, and sepsis. Specific complications involve issues with access, dilatation, hemorrhage, pleural injury, and bowel injury. The document provides details on preventing, diagnosing, and managing several of these potential complications.

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    Complications of PCNL: DR - Sanjay S Deshpande Sidheshwar Urological Society Solapur

    Uploaded by

    Alat Masak
    78 views20 pages
    This document discusses the complications that can occur during percutaneous nephrolithotomy (PCNL). It notes that PCNL has a steep learning curve and complications can lead to prolonged morbidity or death if not properly recognized and treated. General complications include those related to anesthesia, fluid and electrolyte imbalances, and sepsis. Specific complications involve issues with access, dilatation, hemorrhage, pleural injury, and bowel injury. The document provides details on preventing, diagnosing, and managing several of these potential complications.

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    Complications of Pcnl

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    Complications of Pcnl

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    This document discusses the complications that can occur during percutaneous nephrolithotomy (PCNL). It notes that PCNL has a steep learning curve and complications can lead to prolonged morbidity or death if not properly recognized and treated. General complications include those related to anesthesia, fluid and electrolyte imbalances, and sepsis. Specific complications involve issues with access, dilatation, hemorrhage, pleural injury, and bowel injury. The document provides details on preventing, diagnosing, and managing several of these potential complications.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    78 views20 pages

    Complications of PCNL: DR - Sanjay S Deshpande Sidheshwar Urological Society Solapur

    Uploaded by

    Alat Masak
    This document discusses the complications that can occur during percutaneous nephrolithotomy (PCNL). It notes that PCNL has a steep learning curve and complications can lead to prolonged morbidity or death if not properly recognized and treated. General complications include those related to anesthesia, fluid and electrolyte imbalances, and sepsis. Specific complications involve issues with access, dilatation, hemorrhage, pleural injury, and bowel injury. The document provides details on preventing, diagnosing, and managing several of these potential complications.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 20

    COMPLICATIONS OF PCNL

    Dr.Sanjay S Deshpande
    Sidheshwar Urological Society
    Solapur

    07/28/2020 Complications of PCNL 1


    Importance
    • Procedure has steep learning Curve
    • Complications can lead to prolonged
    morbidity and if not recognised and treated
    properly can lead to death
    • How they can be prevented?
    • If they happen how to deal with them?

    07/28/2020 Complications of PCNL 2


    General Complications
    • Cardiac or respiratory diseases leading to
    death
    • DM patient going to hypoglycaemia during
    surgery when under GA
    • Abdominal distension due to poor bowel
    preparation
    • Fluid and Electrolyte imbalance during
    prolonged surgery or fluid under pressure

    07/28/2020 Complications of PCNL 3


    General Complications
    • SEPSIS
    • Anaesthesia related problems
    • High spinal
    • GA in prone position Tube dislodgement
    • Injury to dependent parts like eyes, patella or
    ankle joint

    07/28/2020 Complications of PCNL 4


    Specific Complications
    • Related to Access
    • Related to dilatation
    • Haemorrhage
    • Pleural injury
    • Bowel injury

    07/28/2020 Complications of PCNL 5


    Access and Dilatation
    • Failure to obtain access coule be due to
    • Impacted stone, very little space between calyx
    and stone
    • Guide wire not passing beyond the stone
    • Dilatation either UNDER OR OVER DILATATION
    and difficult to assess under fluoroscopy
    • Loss of track, guide wire during dilatation
    • Buckling, Guide wire getting stuck in the needle

    07/28/2020 Complications of PCNL 6


    Haemorrhage
    • Anticogulants
    • Guidelines are
    • Asprin and Clopidrogel 10days prior to
    surgery
    • Warfarin 5 days
    • Heparin 6hrs
    • Low molecular weight heparin 24hrs

    07/28/2020 Complications of PCNL 7


    Haemorrhge
    Surgeon dependant factors
    Primary or Secondary
    • Single puncture blood in the urosac bag
    similar to that some time happens during
    renal biopsy
    • Dilatation between stone and cortex instead
    of up to the stone, wrong axis and depth
    • When the amplatz sheath is in the cortical
    tissue i.e. underdilatation

    07/28/2020 Complications of PCNL 8


    Specific : Haemorrhge Contd
    • Infundibular tear due to dilatation more than
    the size of the infundibulum
    • Overdilatation going to the opposite side
    leading to perforation
    • Inflamed PCS
    • Improper fitting Amplatz sheath, cut ends,
    bent tip etc

    07/28/2020 Complications of PCNL 9


    Haemorrhage
    • Venous : Placement of Amplatz sheath in the
    cortical tissue into the calyx
    • No overdilatation of the infundibulum which
    will tear it and cause bleeding
    • If more put a nephrostomy tube and come out
    keep it for 3-4 days and then do secondary
    PCNL
    • Kaye balloon dilator can be used

    07/28/2020 Complications of PCNL 10


    Haemorrhage
    • Arterial : Brisk bright red usually secondary
    • False aneurysm or A-V fistula
    • Needs embolisation
    • Rarely Nephrectomy

    07/28/2020 Complications of PCNL 11


    Thoracic Complications
    • Hydrothorax
    • Hydro-pneumothorax
    • Haemothorax
    • Lung injury
    • Nephro-pleural fistula
    • Can happen during PCNL or while removing
    the nephrostomy tube

    07/28/2020 Complications of PCNL 12


    Diagnosis
    • Clinical
    • Fluoroscopy
    • CXR
    • USG
    • Chest CT Scan

    07/28/2020 Complications of PCNL 13


    Pleural injury
    • Supracostal puncture Upper calyceal puncture
    • More medial puncture
    • In patients with kyphoscoliosis
    • COPD
    • Diagnosis: Breathlessness, Chest pain
    • CXR, USG, C-Arm screening on table
    • Chest drain, aspiration

    07/28/2020 Complications of PCNL 14


    Prevention
    • More lateral punctures
    • Along the upper border of the rib to prevent
    intercostal vessel bleed
    • Puncture in expiration
    • RENAL DISPLACEMENT technique
    • Nephropleural fistula : RGP & D-J stenting
    and rule out distal obstruction

    07/28/2020 Complications of PCNL 15


    Bowel and Visceral Injuries
    • Colon, Duodenum,
    • Retrorenal colon, Pts with previous
    laparotomy or renal surgery
    • More lateral punctures
    • Role of CT Scan or USG
    • USG guided puncture
    • How to recognise during surgery or post-op?
    • How to treat it?
    07/28/2020 Complications of PCNL 16
    Bowel injury Colonic
    • During puncture see whether kidney or bowel
    moves
    • Per-Op : Air and faecal matter through the
    nephrostomy
    • Diorrhea, abd pain, distension, leading to sepsis
    • If extraperitoneal : Conservative : Pigtail
    catheter to the kidney and drainage of the colon
    • If intraperitoneal: Laparotomy SOS Colostomy

    07/28/2020 Complications of PCNL 17


    Bowel injury Colonic
    • Extrperitoneal Conservative
    • Pigtail to colon D-J Stenting
    • After one week to do colostogram and RGP if
    no leak to remove the drain
    • Intraperitoneal injury: Laparotomy and
    Colostomy

    07/28/2020 Complications of PCNL 18


    Injury to renal pelvis and ureter
    • Happens due to aggressive tract dilatation or
    during the ICPL process
    • Antegrade D-J Stenting and nephrostomy is
    the treatment

    07/28/2020 Complications of PCNL 19


    SEPSIS
    • Operating on pyonephrosos
    • Operating on a Large staghorn calculus

    07/28/2020 Complications of PCNL 20

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