a Department of Urology, Pavlov First Saint Petersburg State Medical University, Russia b Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia c Department of Urology, Sechenov First Moscow State Medical University, Russia d Department of Urology, University of California, Oakland, CA, USA
Staghorn calculi comprise a unique subset of complex kidney stone disease. Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for staghorn stones. Despite continuous refinements to the technique and instrumentation of PCNL, these stones remain a troublesome challenge for endourologists and are associated with a higher rate of perioperative complications than that for non-staghorn stones. Common and notable intraoperative complications include bleeding, renal collecting system injury, injury of visceral organs, pulmonary complications, thromboembolic complications, extrarenal stone migration, and misplacement of the nephrostomy tube. Postoperative complications include infection and urosepsis, bleeding, persistent nephrocutaneous urine leakage, infundibular stenosis, and death. In this review, we report recommendations regarding troubleshooting measures that can be used to identify and characterize these complications. sAdditionally, we include information regarding management strategies for complications associated with PCNL for staghorn calculi.
Nariman Gadzhiev,Vigen Malkhasyan,Gagik Akopyan, et al. Percutaneous nephrolithotomy for staghorn calculi: Troubleshooting and managing complications[J]. Asian Journal of Urology,
2020, 7(2): 139-148.
Enhanced CT scan demonstrating massive urine leakage through renal collecting system defect. L, left; R, right. CT, computed tomography.
Axial CT scan demonstrating liver injury. The nephrostomy tube traverses the liver. CT, computed tomography.
Image demonstrating injury to the spleen. The nephrostomy tube traverses the spleen. Image obtained after open laparotomy. Image courtesy of Shaduri Vano.
Axial CT scan demonstrating colonic injury. The nephrostomy tube traverses the left colon. CT, computed tomography.
Axial CT scan demonstrating small bowel injury. The nephrostomy tube resides in the second part of the duodenum. CT, computed tomography.
Magnetic resonance imaging depicting ischemic region in thoracic cord.
Super selective embolization of a bleeding artery following percutaneous nephrolithotomy for staghorn stone.
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